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At least 307 records · Page 17Linked to original sources
PubMed2000

Nitric oxide increases leukocyte granule release during simulated extracorporeal circulation.

BACKGROUND: Nitric Oxide (NO) is reported to possess anti-inflammatory properties. The aim of this study was to investigate if nitric oxide affects leukocyte response during simulated extracorporeal circulation (SECC). METHODS: Human blood was circulated for 23 hours through SECC circuit. Control group C (n = 5) was ventilated with an oxygen/air mixture, and NO was added in the study group (n = 5). Leukocyte response was determined by release of myeloperoxidase (MPO) and human neutrophil lipocalin (HNL) and by oxygen free radical production, estimated using chemiluminescence. RESULTS: Addition of NO significantly increased MPO at 30 minutes and 120 minutes of SECC and HNL at 120 minutes of SECC. Oxygen free radical production in whole blood was generally not affected by NO. Similarly, no significant differences were observed between the groups with regard to the chemiluminescence in isolated granulocytes. CONCLUSIONS: Nitric oxide increased release of leukocyte granule derived proteins; MPO and HNL at an early stage of simulated extracorporeal circulation. At the same time, nitric oxide did not affect the whole blood and leukocyte capacity to produce oxygen free radicals.

Acute-Phase Proteins↗
PubMed2004

Acute renal failure after coronary artery bypass surgery with extracorporeal circulation -- incidence, risk factors, and mortality.

OBJECTIVE: To identify the incidence, risk factors, and mortality of acute renal failure (ARF) in patients undergoing myocardial coronary artery bypass surgery with extracorporeal circulation. METHODS: All patients undergoing myocardial coronary artery bypass surgery were prospectively studied, and their clinical and laboratory variables were assessed using uni- and multivariate analysis (logistic regression). RESULTS: Acute renal failure occurred in 16.1% of the 223 patients studied; 4.9% of patients required dialysis. Risk factors associated with ARF in the univariate analysis were age > 63 years, OR 3.6 (95% CI=1.6 to 8.3); preoperative serum creatinine > 1.2 mg/dL, OR 5.9 (95% CI=2.4 to 14.6); duration of extracorporeal circulation > 90 min, OR 2.1 (95% CI=1.0 to 4.4); use of intraaortic balloon, OR 2.6 (95% CI=1.2 to 5.5); need for inotropic drugs, OR 4.4 (95% CI=1.9 to 10.2). In the multivariate analysis, independent factors associated with ARF were: age > 63 years, OR 3.0 (95% CI=1.3 to 7.2); preoperative serum creatinine > 1.2 mg/dL, OR 4.3 (95% CI=1.6 to 11.4); need for inotropic drugs, OR 3.2 (95% CI=1.3 to 8.0). Mortality in the patients with ARF was 25.0% compared with 1.1% in those without ARF and 63.6% in those who required dialysis. CONCLUSION: Acute renal failure after myocardial coronary artery bypass surgery is a frequent complication associated with a high mortality rate. The independent risk factors are age, previous renal failure, and the need for inotropic drugs.

Acute Kidney Injury↗
PubMed1992

[Operation of acute dissecting aortic aneurysm in the 25th week of pregnancy using hypothermic extracorporeal circulation].

We report on a 24 + 2 weeks pregnant woman with Marfan's syndrome, who acutely developed a dissecting aortic aneurysm with aortic valve insufficiency. Emergency surgery was performed by using hypothermic extracorporeal circulation, whilst the aortic valve and ascending aorta were replaced by a synthetic graft. Foetal heart rates, continuously monitored by using Doppler ultrasound, were shown to be closely correlated with perfusion pressures. By applying perfusion pressures of 90-100 mmHg, we were able to maintain foetal heart rates of approximately 100/min. During the first postoperative day, the CTG was normal for gestational age and no contractions were noted. During the second postoperative night, the patient prematurely delivered a dead 820 g infant (Apgar score 0/0/0/0). In view of this case report, opportunities and problems associated with an application of extracorporeal circulation during pregnancy are discussed.

Adult↗
PubMed1993

Brain resuscitation by extracorporeal circulation after prolonged cardiac arrest in cats.

OBJECTIVE: Brain reanimation after prolonged ischemia is limited by post-ischemic reperfusion deficits (no-reflow phenomenon). The present study was undertaken to establish whether after 30 min cardiac arrest extracorporeal circulation is able to restore brain reperfusion and to promote functional and metabolic recovery. DESIGN: Adult normothermic cats were submitted to 30 min cardiac arrest by KCl-induced cardioplegia. Resuscitation was carried out by extracorporeal circulation (ECC) until spontaneous heart function returned. The quality of brain recovery was assessed 3 h later by electrophysiological recording and by imaging of the regional distribution of brain energy metabolites. RESULTS: In 6 of 10 cats cardiac sinus rhythm returned after 32 +/- 15 min. In the other 4 cats cardiac function did not return or only intermittently returned during the 3 h observation period. Cerebral blood flow measured by laser Doppler flowmetry returned to 102% +/- 40% of control immediately after the beginning of resuscitation but then gradually declined to 43% +/- 32% after 3 h despite normotensive perfusion. In all cats pupils started to constrict within less than 5 min of recirculation but in 2 animals they secondarily dilated 1.5 and 2 h later, respectively. Spontaneous EEG activity reappeared in 4 of the 6 successfully resuscitated cats after 111 +/- 40 min but failed to recover in the others. Bioluminescent imaging of ATP after 3 h recirculation revealed near-complete depletion throughout the brain in all 4 cats without cardiac recovery. Of the 6 successfully resuscitated cats 5 exhibited patchy areas of low ATP, glucose and pH in 22%-92% of the cross sectional area of brain; in one cat recovery of energy metabolism and acid-base homoeostasis was homogeneous without any focal deficits. The cross sectional area of ATP recovery correlated directly with CBF and hematocrit and inversely with the plasma lactate level. CONCLUSIONS: This study demonstrates for the first time that ECC is able to restore electrophysiological and metabolic brain function after cardiac arrest of as long as 30 min, but recovery is heavily restricted by delayed post-ischemic disturbances of recirculation. Progress in cardiac resuscitation by ECC requires substantial improvement in the efficiency of cerebrovascular reperfusion.

Acid-Base Equilibrium↗
PubMed2003

Activated neutrophils and platelet microaggregates impede blood filterability through microchannels during simulated extracorporeal circulation.

BACKGROUND: Neutrophil sequestration and platelet microaggregates in organ capillaries have been implicated in the inflammatory response associated with cardiopulmonary bypass. We examined the filterability of neutrophils and platelet microaggregates through silicon microchannels during simulated extracorporeal circulation. We hypothesize that blood contact with artificial surfaces over time decreases the ability of neutrophils, platelets, and their aggregates to pass through microchannels. METHODS: Fresh human blood from donors (n = 9) was recirculated for 120 minutes in a simulated extracorporeal circuit. Blood samples were obtained from a donor at 0, 30, 60, and 120 minutes of recirculation. The microchannel transit time and the flow behavior of blood cells were evaluated by a silicon microchannel array flow analyzer. CD11b, L-selectin, and F-actin of neutrophils were measured by flow cytometry. Neutrophil and platelet counts and platelet aggregation to adenosine diphosphate were measured. RESULTS: The microchannel transit time was prolonged during recirculation, reaching 185.9% +/- 25.6% of baseline at 120 minutes. The video microscope showed that neutrophils and platelet microaggregates plugged the microchannels. CD11b, L-selectin, and F-actin levels changed significantly by 120 minutes. Platelet counts decreased and platelet aggregability was attenuated. CONCLUSIONS: Simulated extracorporeal circulation caused a progressive loss in the ability of neutrophils, platelets, and their aggregates to pass through the microchannels independent of neutrophil adhesion molecule expression.

Actins↗
PubMed1982

Intermittent vascular access for extracorporeal circulation in conscious rats: a new technique.

A new technique is described for repeated intermittent access to the systemic circulation in fully conscious rats for infusion or extracorporeal circulation. The femoral artery and vein of each rat were cannulated. The cannulas were then passed subcutaneously and exteriorized through the skin of the tail 2 cm from its base. The exposed cannulas were protected by a special plastic device. This new approach did not immobilize the rat except during access to the circulation; even then, only the distal portion of the tail was immobilized, thus allowing the animal to move freely. This way repeated access to the systemic circulation was easily achieved in the fully conscious rat.

Animals↗
PubMedDate not supplied

Renal cell carcinoma with thrombus in the inferior vena cava: extracorporeal circulation and deep hypothermia without open-chest surgery.

INTRODUCTION: Renal cell carcinoma with thrombus in the inferior vena cava and no apparent metastasis requires immediate surgical treatment. Over the last few years, extracorporeal circulation with deep hypothermia and total circulatory arrest have played an increasingly important role in the treatment of diseases not associated with primary cardiovascular disorders, such as cavoatrial tumor thrombus in uterine tumors, adrenal tumors, Wilms' tumor, as well as renal cell carcinoma. CASE REPORT: A 78-year-old patient with renal cell carcinoma and tumoral thrombus in the inferior vena cava and above the supra-hepatic veins underwent right radical nephrectomy and removal of the thrombus from the vena cava with extracorporeal circulation and deep hypothermia with total circulatory arrest without opening the chest. The patient presented good post-operative evolution.

Aged↗
PubMed1987

A technique for apex cannulation without extracorporeal circulation.

A simple, fast, and highly reliable technique for apex cannulation without extracorporeal circulation is presented as a result of more than 30 left ventricle assist device implants performed in calves in the last 4 years at the Cleveland Clinic Foundation. Minimal bleeding and reduced risk of ventricular fibrillation, air emboli, muscle flap, and trauma to the heart have made this technique very unique and highly applicable to any investigative laboratory, as no special tools or expensive apparatus are required. The practicality of the technique is immediately applicable to the clinical level to avoid potential complications with cannula insertion.

Animals↗
PubMed2002

How much myocardial revascularization can we do without extracorporeal circulation?

OBJECTIVE: The main goal of this study is to present a technical alternative that allows myocardial revascularization to be performed on the marginal branches of the circumflex coronary artery without the use of extracorporeal circulation (ECC). METHODS: The technique for exposing the coronary vessels is performed by placing a stitch in the posterior pericardium. The surgeon lifts the heart using his or her left hand with the aim of exposing the posterior pericardium. A single polypropylene "O" stitch on a #4 needle is threaded into a cardiac ribbon folded back on itself and run twice through the region between the inferior pulmonary vein and the inferior vena cava. The suture thread is run along a tourniquet-type rubber tube and the latter is then directed down to the pericardium, bringing the cardiac ribbon with it. Handling the thread by means of such a tourniquet and the two parts of the ribbon makes it possible to maneuver the heart into different positions in order to expose the coronary arteries: anterior interventricular, diagonal, circumflex, and right coronary. In the present study, the position exposing the coronary arteries was adopted. The circumflex artery was exposed by separating the two legs of the ribbon and pulling one of them +/- 90 degrees to the right and the other +/- 90 degrees to the left of the patient's main axis, with the polypropylene thread being pulled in the direction of the patient's main axis and fixed in the inferior angle of the surgical wound. RESULTS: From August 1981 to June 1999, 609 patients had their arteries revascularized without the use of ECC. Among this group, 147 patients (24.14%) had the circumflex artery revascularized. Of the 609 patients, 48 (7.88%) presented serious complications and 21 (3.44%) died. CONCLUSIONS: It was possible to modify the anatomical position of the heart by exposing the circumflex artery with its marginal obtuse branches and performing anastomosis in a simple manner with no loss of quality or hemodynamic involvement, permitting a complete revascularization without the aid of extracorporeal circulation.

Anastomosis, Surgical↗
PubMedDate not supplied

Application of intraoperative thermography in coronary artery bypass grafting without extracorporeal circulation - clinical report.

BACKGROUND: The development of low-invasive cardiosurgical techniques has contributed to an increase of the number of revascularization procedures performed on beating heart. The report presents the changes observed intraoperatively in thermographic images of the heart obtained during surgical revascularization performed without extracorporeal circulation. MATERIAL AND METHODS: In two patients with coronary heart disease, subjected to coronary artery bypass grafting performed without extracorporeal circulation, the images acquired over the operation area were recorded intraoperatively using a thermovision camera (Agema Thermovision SW/TE 900 system). RESULTS: On the basis of thermographic images, the area of lowered temperature corresponding to the region of myocardium with impaired blood flow supplied by the descending anterior coronary artery branch was determined. A rapid temperature increase to the baseline values was observed soon after removing the ligatures from the descending anterior coronary artery and left internal mammary artery used as a bypass. CONCLUSIONS: Recording thermographic heart images allows to observe restricted areas of perfusion disturbances, which take place during procedures performed on beating heart.

Aged↗
PubMed2001

Are standard human coagulation tests suitable in pigs and calves during extracorporeal circulation?

The thrombogenicity of membrane oxygenators as well as clotting parameters profiles, using standard human clotting tests, was analyzed in calves and pigs during 6 h perfusion. Three calves and 3 pigs were connected to extracorporeal circulation with standard heparinization. Blood samples were taken for coagulation variables throughout perfusion, and oxygenators were examined for clot deposits at the end of the experiment. Two out of 3 oxygenators of the calf group presented clot deposits while none in the pig group did. Baseline coagulation variables of pigs showed values similar to those of humans while neither extrinsic nor intrinsic pathways could be activated in calves with standard human coagulation tests. The calf model, in conclusion, was confirmed to be a difficult model for the testing of extracorporeal circulation device resistance to thrombus formation, which is, however, not reflected by standard human coagulation tests. The pig model is a better model in which both coagulation pathways could be activated with standard human coagulation tests.

Adult↗
PubMedDate not supplied

[Coronary revascularization with extracorporeal circulation, aortic clamping or OPCAB: does the method's choice influence the results?].

BACKGROUND AND OBJECTIVES: Off pump CABG-OPCAB is the most recent development in coronary surgery and is aimed to avoid the complications of extracorporeal circulation and to compete with interventional cardiology. The objective of this study is to compare 3 methods for cardiac support for CABG. METHODS: Between February 2001 and December 2002 ninety consecutive patients were operated by the same surgeon and the same team with the following techniques: extracorporeal circulation (CEC) and ischaemic arrest, CEC and beating heart, and OPCAB. RESULTS: There were no difference in mortality and morbidity for the 3 groups of patients. The OPCAB group showed less ventilation time, less blood transfusion needs and shorter hospital stays than the other 2 groups of patients that showed no differences between each other. CONCLUSION: OPCAB is safe and showed slight advantage over CEC supported groups but the number of grafts per patient was smaller.

Cardiopulmonary Bypass↗
PubMed1994

[Gastric juice secretion increases during extracorporeal circulation employed in cardiac surgery].

We evaluated gastric juice secretion during extracorporeal circulation (ECC) in cardiac surgery. The effect of pirenzepine, a muscarine receptor blocker, was also tested to clarify the mechanism involved. Gastric juice secretion increased significantly from pre ECC value of 3.8 +/- 1.3 ml.h-1 to 12.4 +/- 4.0 ml.h-1 during ECC. It decreased to 5.0 +/- 1.4 ml.h-1 (mean +/- SE) after ECC. Pirenzepine premedication reduced serum gastrin level. However, it did not suppress the increase of gastric juice secretion. There is no significant correlation between serum gastrin level and gastric juice secretion. ECC is a major stress and increases gastric juice secretion. This phenomenon is probably activated via sympathetic and hypophysis-adrenal gland system.

Cardiac Surgical Procedures↗
PubMed1983

[Treatment of auricular fibrillation after correction of rheumatic heart disease under extracorporeal circulation].

Of 372 patients operated on for rheumatic valvular defects under extracorporeal circulation, 221 patients had chronic atrial fibrillation. In 41 patients, the duration of arrhythmia ranged from a few months to 2 years. Sinus rhythm was recovered in 22 patients, using quinidine and electric-impulse treatment, and 19 patients have maintained it continuously for many years. Factors contributing to stable and lasting sinus rhythm are an adequate correction of the defect, inactive rheumatic process, and the duration of atrial fibrillation not exceeding 1-2 years. The optimum time for sinus rhythm recovery is 2-6 months after surgery. Sinus rhythm recovery prior to surgical correction of the defect is not recommended.

Adolescent↗
PubMed1992

[Surgical treatment under extracorporeal circulation for renal cell carcinoma with tumor thrombus in inferior vena cava].

Three cases of renal cell carcinoma with tumor thrombus extending into the inferior vena cava are reported. Radical nephrectomy and thrombectomy were performed under extracorporeal circulation in all the cases. The level of tumor thrombus was preoperatively determined by computed tomography, magnetic resonance imaging or venacavography. The tumor thrombus extended into the right atrium in one, and above the hepatic vein in two cases. One patient whose thrombus reached the right atrium died of multiple metastasis of renal cell carcinoma 5 months after operation. Another patient with lung metastasis was given interferon-alpha and is alive 5 months after operation. The other patient is clinically free of disease and in good health 7 years after operation. We believe that extracorporeal circulation allows an opportunity to resect the tumor thrombus in a controlled situation, and makes the operation safer.

Aged↗
PubMedDate not supplied

Effect of blood flow rate on thrombogenesis in a rabbit extracorporeal circulation model.

Blood flow is believed to affect the thrombogenicity of extracorporeal circulation (ECC). The purpose of this study was to look at the relationship between blood flow and thrombogenicity in a rabbit model of ECC. Rabbits were anesthetized and systematically heparinized. Bilateral jugular cannulation was performed, and the animals were placed on venovenous ECC. The circuits were composed of 1 m of 1/4 inch size surgical grade polyvinylchloride (PVC) tubing. ECC was maintained for 4 hours. Three experimental groups were studied: a high flow group (n=7; flow rate: 30 ml/min/Kg), low flow group (n=7; flow rate: 10 ml/mg/Kg), and no ECC group (n=7). Platelet count, fibrinogen concentration, PaO2/FiO2, and postmortem findings were evaluated. Platelet consumption was higher with high flow, and fibrinogen consumption was higher with low flow.

Animals↗
PubMed2002

[Extracorporeal circulation: an extraordinary tool that is not just for cardiac surgeons].

Extracorporeal circulation (ECC) is not only used for open heart surgery. There are also other surgical and medical applications. ECC can be used for encephalic arteries surgery to induce hypothermia and maximally protect the brain. Femoro-femoral ECC may be needful for urgent traumatologic surgery of the supra-aortic trunci. Intracranial aneurysm repair can occasionally necessitate deep hypothermia and circulatory arrest with ECC. Renal cell carcinomas may metastasize to the right atrium and surgery with ECC is mandatory for complete excision. Some reports in the literature mention use of ECC for hepatic surgery of intra-hepatic aneurysms. With acute peripheral ischemia, metabolites in the affected limb can be washed out with good results. Medical indications for ECC are numerous with pulmonary assistance as one of the foremost when mechanical ventilation failed. Homogeneous and rapid rewarming of hypothermic patients can be achieved with ECC. Finally, some groups have reported the use of ECC to administer chemotherapy in limb melanoma.

Cardiac Surgical Procedures↗