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PubMed1975

The hemostatic mechanism after open-heart surgery. II. Frequency of abnormal platelet functions during and after extracorporeal circulation.

In a prospective study of 13 patients undergoing open-heart surgery with extracorporeal circulation, marked qualitative platelet function defects were observed in addition to the usually occurring drop of the thrombocyte count. At the end of bypass, the following test results were significantly abnormal: concentration of fibrinogen and of circulating fibrin degradation products, platelet count, platelet adhesiveness to glass beads, and platelet aggregation induced by low and high doses of ADP. One to 2 hours after neutralization of heparin with protamine sulfate all abnormal test results improved, but the template bleeding time was markedly prolonged in 10 patients. There was no correlation between length of bypass and platelet fall and between concentration of circulating fibrin degradation products and extent of platelet dysfunction. An apparent correlation was found between the length of the postoperative bleeding time and the number of units of blood transfued during surgery. The results of this study suggest that dilution of the patient's own platelets by nonviable platelets contained in 3-day-old transfused ACD blood and the production of a refractory state of the patient's circulating platelets to ADP induced aggregation played a significant role in the development of platelet function abnormalities during extracorporeal circulation.

Adenosine Diphosphate↗
PubMed1983

Vagal feedback with expiratory threshold load under extracorporeal circulation.

In 11 anesthetized dogs placed under extracorporeal circulation, the vagal feedback was tested by electrical stimulation of the vagus nerves with cold block of their caudal part and by passive lung hyperinflation. The apneic response to such vagal stimulation progressively disappeared during expiratory threshold load breathing but then returned to control values some minutes after the load was removed. This suppression of the inhibitory response to stimulation of the vagus nerves was usually observed when vagal afferents were intact or blocked by cold. However, it was not observed whether no evoked activity continued in expiratory muscles after the cold block, or after suppression of all proprioceptive muscular afferents after transection of the spinal cord at C6 level. These results strongly suggest that enhancement of proprioceptive inputs to the respiratory centers counteracts the vagally mediated inspiratory "off-switch" mechanisms.

Abdominal Muscles↗
PubMedDate not supplied

[Perioperative response of phosphorus and calcium metabolism and of bone remodeling markers during heart surgery under extracorporeal circulation].

HYPOTHESIS AND OBJECTIVES: Cardiovascular surgery with extracorporeal circulation (ECC) is highly stressful, inducing marked changes in calcium and magnesium homeostasis. Nevertheless, no studies have assessed osteoblastic/osteoclastic activity during and after heart surgery with ECC. Our objective was to analyze changes in serum levels of parameters reflecting phosphorus and calcium metabolism and markers of bone remodelling in this context. PATIENTS AND METHODS: Changes in serum levels of calcium, phosphorus, whole parathyroid hormone (PTH), magnesium, cortisol, interleukin-6, total alkaline phosphatase, osseous alkaline phosphatase (OAP), osteocalcin, propeptide of type 1 procollagen (PCP1), and carboxyl-terminal telopeptide of type 1 collagen (CTT1) during the 24 perioperative hours in 16 patients undergoing cardiac surgery with ECC. RESULTS: Total calcium decreased during ECC, triggering acute release of PTH. Osteocalcin decreased at 24 hours in a way that was not accounted for by hemodilution. OAP changes, on the other hand, were consistent with albumin levels and blood cell counts. PCP1 and CTT1 did not change, although correcting for dilution shows that these factors can in fact be considered to have increased. CONCLUSIONS: The parathyroid gland is activated during ECC. Markers of bone metabolism behave differently over time in response to heart surgery. The data suggest that heart surgery induces discordant responses in various bone cell functions.

Adult↗
PubMed2004

Analysis of cellular morphology, adhesion, and proliferation on uncoated and differently coated PVC tubes used in extracorporeal circulation (ECC).

The biggest challenge to improve extracorporeal circulation (ECC) circuits lays on avoiding platelet adhesion to their surfaces, because this contributes to thrombus formation, resulting in the activation of blood coagulation. One approach to minimize this effect is to improve the biocompatibility of ECC circuits by modifying their surfaces. This can be achieved by coating them with heparin or phospholipids. The present study investigated the adhesion and morphology characteristics of fibroblastic and blood cells cultured on uncoated poly (vinyl) chloride PVC tubes as well as on heparin, phosphatidylcholine (DMPC), and phosphatidylethanolamine (DMPE) -coated tubing. The results showed the importance of uniform coating regardless of the substance used, because the coatings cover the grooves on PVC surfaces, which favor cell adhesion. The comparison among the three different coatings showed the best biocompatibility results for the PVC tubes coated with heparin, followed by the coating with DMPE and with DMPC. For all coated tubes, cells did not spread on the PVC surfaces and, consequently, did not adhere to their surfaces, increasing the overall biocompatibility of PVC tubes. However, possible DMPE's alkylation, caused by sterilization, resulted in increased material hydrophobicity, which explains the decrease in fibroblastic adhesion. Furthermore, sterilization of DMPC-PVC improves its hydrophilic character, also decreasing adhesion. Based on these results, coating PVC with the phospholipids DMPC and DMPE seems to be a promising technique to improve the biocompatibility of PVC tubes, and is worthy of further investigation.

Animals↗
PubMed1980

[The influence of arterial partial pressure of co2 and of the arterial value of ph on endogenous catecholamines during extracorporal circulation in regard to oxygen consumption of the whole body (author's transl)].

Ten patients with coronary heart diseases were studied during total hypothermic extracorporal circulation relating changes of the endogenous catecholamines epinephrine and nor-epinephrine to arterial partial pressure of CO2 and to the arterial value of pH. Both of the catecholamines increased significantly during respiratory or metabolic acidosis whereas respiratory or metabolic alkalosis was accompanied by significantly lower catecholamine levels in blood. The changes in total peripheral resistance due to the endogenous blood levels of catecholamines depended proprotionally. Total peripheral resistance increased significantly due to increasing arterial level of both of the catecholamines. The results are discussed in consideration of oxygen consumption of the whole body during extracorporal circulation. It is known that the decrease of oxygen consumption of the whole body due to acidosis and due to an increased total peripheral resistance is accompanied by high catecholamine levels in blood. Increased hypothermic sympatho-adrenal activity during extracorporal circulation should not in any case cause in increase of oxygen consumption of the whole body.

Acidosis↗
PubMed1999

Is atrial fibrillation caused by extracorporeal circulation?

BACKGROUND: Atrial fibrillation is the most common rhythm disturbance encountered after open heart operations, with a reported incidence up to 40%. Despite its high incidence and clinical relevance its etiology remains obscure. It has been hypothesized that atrial fibrillation might be related to extracorporeal circulation. We performed a retrospective study (January 1, 1997 to December 31, 1997) comparing the incidence of atrial fibrillation in 3 groups of patients revascularized with and without extracorporeal circulation. METHODS: The first group comprised patients with coronary artery disease operated on with standard revascularization technique with cardiopulmonary bypass (n = 685). The second group included patients who had minimally invasive coronary artery bypass grafting without the use of extracorporeal circulation (n = 19). Patients in the third group had off-pump transmyocardial laser revascularization (n = 19). RESULTS: There was no significant difference in the incidence of atrial fibrillation in the group that had conventional coronary artery bypass and the group that had minimally invasive coronary artery bypass without cardiopulmonary bypass. The incidence of atrial fibrillation was significantly lower in the transmyocardial laser group compared with the other two groups. CONCLUSIONS: The present study found that postoperative atrial fibrillation is not caused solely by extracorporeal circulation, but patients who had transmyocardial laser revascularization had a significantly lower incidence of atrial fibrillation.

Aged↗
PubMed1993

[Case report of MRSA sepsis required two valve replacement twice a year--trying case with hyperthermal extracorporeal circulation].

We report a case in conjunction with MRSA sepsis, who needed re-mitral valve replacement (re-MVR) and re-tricuspid valve imposition (re-TVI), and who was successfully treated with a number of antibiotics in conjunction with hyperthermal extracorporeal circulation. Initially, we performed MVR and tricuspid valve superimposition on a 62-year-old woman lationing under the MRSA sepsis condition to control against heart failure. However, she developed a fever following the first operation, and MRSA was detected from her blood cultivation. She thus underwent treatment employing many kinds of antibiotics. A thickened C.E. valve at the tricuspid valve cardiac echogram suggested PVE, we performed a second operation of re-MVR and re-TVI about a year after the first operation. We used a tangl of antibiotics during the operation, adding Vancomycin into the extracorporeal circulation, and utilized hyperthermal extracorporeal circulation. This patient's postoperative course was uneventful, with no recurrence arising at 23 months after the second operation.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Cardiac arrhythmias during coronary bypass surgery without extracorporeal circulation].

Ventricular arrhythmias are recorded in most patients at coronary bypass surgery without extracorporeal circulation. The stages, such as the pulling of the sternal edges apart, the opening of the pericardium, the revision and dislocation of the heart, and revascularization of coronary arteries, are most dangerous due to the fact that they may lead to the development of arrhythmias. The major proarrhythmogenic factors at coronary bypass surgery without extracorporeal circulation are mechanical irritation of reflexogenic areas and myocardial ischemia, the mechanical factors playing the leading role in the development of ventricular arrhythmias.

Arrhythmias, Cardiac↗
PubMed1993

Detection of free radicals in the blood of animals using extracorporeal circulation.

A method was designed to detect free radicals in circulating blood of animals using extracorporeal circulation and electron paramagnetic resonance (EPR). An arterial-venous shunt was inserted into male Wistar rats between the distal abdominal aorta and the inferior vena cava. The polyethylene tube of the shunt was flowed through a quartz EPR cell. The circulation was supported by manual pumping and maintained at a rate of 3 ml/min. No signal was detected in the blood of untreated rats. After a bolus injection of four spin labels, 2,2,6,6-tetramethyl-piperidine-1-oxyl, 4-hydroxy-2,2,6,6-tetramethyl-piperidine-1-oxyl, 3-carbamoyl-2,2,5,5-tetramethyl-pyrrolidine-1-oxyl, and 3-carbamoyl-2,2,5,5-tetramethyl-pyrroline-1-oxyl, signals from each were detected. The intensity of the signal decreased exponentially and the half time was 23.9, 21.6, 47.1, 42.4 sec, respectively. After administration of ascorbic acid, ascorbyl radical signals were detected. This was enhanced by ethylenediaminetetraacetic acid-Fe or diethylenetriaminepentaacetic acid-Fe but not desferrioxamine-Fe. This assay system is useful in detecting free radicals either administered or generated in vivo.

Animals↗
PubMed1997

[Role for preliminary and continuous hemodialysis during extracorporeal circulation in infants and children].

The efficacy of both preliminary and continuous hemodialysis during extracorporeal circulation (ECC) was evaluated in the pediatric population. Preliminary hemodialysis of the priming solution was initiated in eight children (HD-I group), while both preliminary and continuous hemodialysis during ECC was performed in another eight children (HD-II group). The control group which consisted of eight children did not undergo hemodialysis. Urine volume during ECC, perfusion pressure, and water balance were measured and compared among the three groups. In the HD-I and HD-II groups, the total urine volume during ECC was greater than in control group, but there was no significant difference. In the control group, the perfusion pressure temporally decreased after the pump was operating for five minutes, but the perfusion pressures remained stable in the HD-I and HD-II groups. Therefore, preliminary hemodialysis appears to prevent the "initial drop" seen in perfusion pressures. Water balance in the control group tended to be in positive balance, but both the HD-I and HD-II groups appeared to be in negative balance. Significant differences between HD-I and HD-II in contrast to the control group (p < 0.05) and p < 0.04, respectively) were observed. Preliminary hemodialysis is useful during ECC in infants and children because by maintaining perfusion pressure urine output remains adequate while a net negative water balance is achieved. Preliminary hemodialysis will increase the continuous hemodialysis in infants who are subjected to prolonged extracorporeal circulation.

Child↗
PubMedDate not supplied

Electronmicroscopic and histoenzymologic study regarding morphophysiopathologic visceral modifications during open heart operations under extracorporeal circulation.

Morphophysiopathologic modifications occurred in myocardium, liver and lung during open heart operations under extracorporeal circulation had been studied using histologic, histoenzymologic, ultrastructural and biochemical investigations. Preexisting myocardic and hepatic lesions subsequent to chronic stasis and hypoxia are accentuated due to the "controlled shock" state induced by extracorporeal circulation. Mitochondrial marker enzymes like SDH, LDH and ATP-ase in the membrane are decreasing their levels and hydrolytic enzymes like acid phosphatase, nonspecific esterase (ANAE) and peroxidase are increasing their activity. These disseminated lesions can become irreversible under the conditions of a severe cardial insufficiency and of a prolonged operation. In the lung, the increase in the hydrolytic enzyme activity suggests the processes of phagocytosis and metabolization of red cells by macrophages.

Adenosine Triphosphatases↗
PubMed1980

Defibrinogenation as an alternative to heparinization in prolonged extracorporeal circulation.

Complications arising from difficulty controlled bleeding and thrombus formation during procedures which require extracorporeal circulation with heparin as anticoagulant motivate the search for better hemostasis and anticoagulant technology. An enzyme (Defibrase), having a specific interaction with fibrinopeptide A such as to cause fibrin depletion in a soluble form, has been proposed as an alternative to heparin. Defibrase, in contrast to heparin, does not affect blood platelet function. Heparin and Defibrase as anticoagulants were compared in 8 h perfusion studies using arterio-venous extracorporeal blood circuits in dogs; the circuitry included pumps, membrane oxygenators and filters serially. Thrombus formation, in the filters and the oxygenators as well as pathology of the perfused animal were investigated. The results suggest that defibrase-like enzymes have potential for enhanced control of hemorrhagic and thrombotic phenomena. Although impeded by a latency of several hours before the full anticoagulant properties are developed in vivo, it appears that enzymatically mediated defibrinogenation of blood may be a valuable alternative to heparinization in extracorporeal circulation procedures.

Animals↗
PubMed1992

[The function of red blood cells under open-heart surgery with extracorporeal circulation without donor blood].

In 18 patients scheduled for open-heart surgery with extracorporeal circulation without donor blood, P50, 2, 3-DPG, intracellular sodium and potassium in red blood cells, and erythrocyte deformability were measured for the purpose of investigating the influence of severe hemodilution on oxygen transport and function of red cells. P50 and 2, 3-DPG in red cells showed no significant changes until the end of cardiopulmonary bypass (CPB). At the end of operation, 2, 3-DPG content decreased significantly without a significant change of P50. This is probably due to the rightward shift of oxyhemoglobin dissociation curve as compensation for the hemodilution without donor blood. On the first postoperative day, P50 value and 2,3-DPG content decreased significantly but returned to previous values on the second day. As the result of changes of red cell sodium contents and deformability, erythrocyte morphology recovered soon after the end of CPB, but the membrane function of red cells was restored a few days later. In conclusion, oxygen transport in red cells may be disturbed after open-heart surgery with extracorporeal circulation without donor blood.

Adolescent↗
PubMed2000

The effects of heparin and extracorporeal circulation on platelet counts and platelet microaggregation during cardiopulmonary bypass.

BACKGROUND: Cardiopulmonary bypass is associated with platelet activation and reduced platelet counts. Platelet activation may artifactually lower platelet counts by causing aggregation. In vivo platelet activation may increase existent platelet microaggregation ex vivo. We studied platelet counts and existent platelet microaggregation at different stages of cardiopulmonary bypass. METHODS: Twenty-one patients were studied before and after heparinization (300 U. kg(-1)) and at the end of cardiopulmonary bypass. Unaggregated (or single) platelets were counted in hirudin-anticoagulated blood, and total platelets were counted in ethylenediaminetetraacetic acid-anticoagulated blood. RESULTS: The total platelet count, 198 +/- 61 x 10(9). L(-1), was unaffected by heparin and stayed at 197 +/- 60 x 10(9). L(-1) (P =.7) but fell during extracorporeal circulation; the hemodilution-corrected count was 163 +/- 52 x 10(9). L(-1) (P =.0004). Heparinization reduced the unaggregated platelet count from (mean +/- 1 SD) 178 +/- 62 x 10(9). L(-1) to 155 +/- 60 x 10(9). L(-1) (P =.0001). Extracorporeal circulation had little additional effect. The hemodilution-corrected count was 142 +/- 48 x 10(9). L(-1) (P =.6). CONCLUSIONS: Heparinization caused platelet activation and increased existent platelet microaggregation ex vivo. During extracorporeal circulation, there was a reduction in total platelets that was greater than could be explained by hemodilution alone, but the unaggregated platelet count did not change significantly when corrected for hemodilution. Furthermore, the increased platelet microaggregation observed after heparinization was no longer evident after this loss. These findings suggest that during extracorporeal circulation, the platelets that formed into microaggregates after heparinization were lost from the circulation in preference to single platelets.

Adult↗
PubMed2003

PRECiSe (priming reduced extracorporeal circulation setup): results of a safety study.

BACKGROUND: Different low-priming systems limited to coronary artery bypass grafting (CABG) have been introduced. We describe the priming reduce d extracorporeal circulation setup (PRECiSe), a new low-priming system that supplies all of the features of cardiopulmonary bypass. METHODS: PRECiSe incorporates the DeltaStream diagonal pump, which pumps blood from the right atrium to the aorta via a membrane oxygenator and a filter. The system is placed beneath the patient's head, resulting in extremely short tubing lengths. A reservoir allows the use of suckers and vents. Autologous blood priming further reduces hemodilution. RESULTS: In the safety study, the system was used for extracorporeal circulation in 11 patients undergoing CABG without the occurrence of any adverse events. By using the PRECiSe system, we reduced the mean priming volume to 268.5 mL, resulting in minimal hemodilution and transfusion requirements. CONCLUSION: The use of PRECiSe for extracorporeal circulation in CABG is safe and reduces priming volume as well as transfusion requirements. Further studies are necessary to investigate the clinical benefit for patients as well a s the use of the system in open heart procedures.

Aged↗
PubMed2000

Use of A heparin-coated circuit for extracorporeal circulation with selective cerebral perfusion.

The use of selective cerebral perfusion with a heparin-coated extracorporeal circuit has not been reported. We developed a unique extracorporeal circulation system that can be used for selective cerebral perfusion based on an existing heparin-coated circuit with a centrifugal pump for general open-heart surgery and a heparin-coated oxygenator without venous drainage by gravity. Between July 1994 and December 1999, this system was used for 12 patients undergoing surgery for true aortic arch aneurysm. The dose of heparin used was reduced to maintain minimum activated clotting time above 300 sec during extracorporeal circulation. One patient suffered a stroke, and one patient had transient postoperative neurologic deficit. One patient died suddenly of ventricular arrhythmia on the 11th postoperative day. The circuit remained thrombus-free. Selective cerebral perfusion with a heparin-coated bypass circuit was safe and very easy to perform after a simple modification of a standard circuit for open-heart surgery.

Aged↗
PubMed1993

[Extirpation of intra-atrial tumor thrombus of renal cell carcinoma by means of extracorporeal circulation--report of a case].

We report a case of renal cell carcinoma with a tumor thrombus extending into the right atrium, which was successfully removed with the use of extracorporeal circulation. A 68-year-old male presented with a one month history of abdominal distension. CT-scanning, selective renal angiography, vena cavography and echocardiography revealed a left renal tumor with a tumor thrombus extending into the right atrium through the inferior vena cava. Left nephrectomy and removal of the intra-atrial tumor thrombus were performed using extracorporeal circulation. Preoperative laboratory results showed elevation of the total bilirubin (17.0 mg/dl) due to congestion of the liver which was caused by obstruction of hepatic vein with the tumor thrombus. Postoperatively, the total bilirubin gradually decreased to 11.9 mg/dl on the third day, but increased to 22.2 mg/dl on the 9th day. So plasma exchange was performed on the 10th, 11th and 12th days, and the total bilirubin decreased to the normal range. The patient was discharged on the 50th day. For renal cell carcinoma with a tumor thrombus extending into the right atrium, effectiveness of operation using extracorporeal circulation and subsequent prognosis are discussed.

Aged↗