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Results for “Extracorporeal Circulation”

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At least 325 records · Page 18Linked to original sources

PubMed2003

[Cardioprotective effects of diltiazem infusion in the perioperative period in patients undergoing coronary artery bypass grafting with extracorporeal circulation].

OBJECTIVE: To evaluate the cardioprotective effects of intravenous diltiazem infusion perioperatively in patients undergoing coronary artery bypass grafting (CABG) under extracorporeal circulation. METHODS: Forty patients undergoing CABG were divided into 2 groups of 20 patients according to the operation date: experimental group in which infusion of diltiazem (0.1 mg/kg/h) was given starting from the onset of extracorporeal circulation until 24 h after the aortic cross-clamping, and blank control group. The relative hemodynamic parameters were recorded for 48 hours. RESULTS: (1) 4 approximately 24 hours after the aortic cross-clamping the heart rates of the experimental group was 98 +/- 18 approximately 96 +/- 13 times/min, significantly lower than those of the control group (111 +/- 16 approximately 105 +/- 14 times/min, P<0.05); the values of rate-pressure product (RPP) of the experimental group were 13.0 +/- 3.7 approximately 11.7 +/- 3.0 mm Hg/min/10(3), significantly lower than those of the control group (14.1 +/- 1.9 approximately 5.8 +/- 3.6 approximately mm Hg/min/10(3), P<0.05) (2) The postoperative peak value of creatine kinase (CK) was not significantly different between these 2 groups. The postoperative peak value of creatine kinase-MB (CK-MB) in the experimental group was 83 +/- 33 IU/L, significantly lower than that in the control group (105 +/- 20 IU/L, P<0.05) and postoperative peak value of cardiac troponin-T (cTNT) was 0.38 +/- 0.21 IU/L, significantly lower than that in the control group (0.83 +/- 0.20 IU/L, P<0.05). The values of CK, CK-MB, and cardiac troponin TC (cTNT) of the patients with coronary vasospasm in the experimental group were all significantly lower than those of the patients with coronary vasospasm in the control group. (3) The average number of arrhythmic events per hour was lower in diltiazem group, and the average number of ventricular premature contraction per hour was significantly lower during the period of ST segment depression in particular. CONCLUSION: Perioperative intravenous diltiazem infusion provides significant cardioprotective effect in patients undergoing CABG.

Arrhythmias, Cardiac↗

PubMedDate not supplied

Evaluation of materials for use in extracorporeal circulation. In vitro serum-material interaction.

Polymeric membranes used in extracorporeal circulation procedures of varying hydroxyl (-OH) percent were evaluated with normal human serum to detect differences between chemical composition and serum-material interactions. The materials were evaluated as hollow fibers built into modules, including polypropylene (PP; 0%), polyvinyl alcohol (PVA; 23.7%), ethylene vinyl alcohol (EVAL; 29.7%), Cuprophan (CP; 31.5%), and Hemophan (HP; 30.9%). Data from serum perfusions expressed as percent changes to sham (circuit minus module) showed that solute % decreases were from 0% to 10% in all materials except for PVA (10-22%). Complement activation product % increases were higher with PVA (606-4309%) and CP (48-567%), and mononuclear cell transformation functions (MNCTFs) were more suppressed with PVA (100 to 98%) and CP (10-18%). Despite EVAL and HP having an -OH %, complement activation products were relatively low with EVAL (less than 212%), HP (less than 13%), and PP (less than 131%). MNCTFs were stimulatory with the co-polymer of vinyl alcohol and ethylene (EVAL), and very suppressed by serums from PVA contact. Ethylene vinyl alcohol and modified cellulose (HP) had reduced complement activation despite higher or comparable bulk -OH. Bulk -OH content alone cannot explain the differences observed.

Biocompatible Materials↗

PubMedDate not supplied

[Perioperative management of the diabetic patient in cardiac surgery with extracorporeal circulation].

The hyperglycemia usually observed in patients undergoing heart surgery with extracorporeal circulation (EC) represents a difficult therapeutic problem. We studied the effects of several regimens of insulin therapy on serum glucose (SG) in 24 noninsulin dependent diabetic patients (NIDDs). The patients were randomly divided in five groups; group A received on IV bolus of 10.0-50.0 U/h according to glycosuria; groups B, C, D and E were given a continuous iv insulin infusion of 2.5, 5.0, 7.5 and 10.0 U/h respectively. In 10 non-diabetic patients (NDP) SG levels were also measured, but insulin was not given. A mean of 5.0 l/m2 of body surface of fluids containing 300 g of glucose were administered to all patients during surgery. At the operations SG levels rose progressively soon after the anesthesia was started, reached the highest values during the period of EC, and decreased slowly in blood samples taken after the EC phase and by 24h. This patterns was shown by all groups studied statistically significant lower SG levels, however, were observed in patients of group C, whose values were similar to those seen in the NDP group. Groups D and E had slightly higher SG levels than those of group C. An additional NIDDM patient with advanced chronic renal failure (CRF), had a tendency to hypoglycemia even during the EC period in response to relatively low doses of insulin (2.5 U/h), given by a continuous iv infusion and, although the insulin administration was stopped, his SG levels remained well below the mean values of the other patients for the rest of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Hemostasis in patients undergoing extracorporeal circulation: the effect of aprotinin (Trasylol).

The administration of aprotinin during extracorporeal circulation (ECC) reduces blood loss. To explore the mechanism of this effect, a placebo-controlled double-blind study was performed in 20 patients (10 were administered with a high dose of aprotinin, 10 with placebo) undergoing a primary, elective operation of coronary artery bypass grafting (CABG) with ECC. Biological tests were performed at 4 different time points during the operation. A marked reduction in the placebo group of ristocetin-induced platelet agglutination (binding of von Willebrand factor [vWF] to platelet glycoprotein [GP] Ib) was shown during ECC and at the end of surgery, but not in the aprotinin group. This abnormality is not related to the hydrolysis of vWF or GP Ib, since washed platelets were resuspended in pooled normal plasma which provided a constant amount of vWF in this test and since the plasma concentration of the fragment of GP Ib (glycocalicin) did not correlate with this abnormality. Despite a high concentration of heparin (5-7 IU/ml) in patient's plasma during bypass, activation of blood coagulation in both groups was evidenced by an increase in ATm (thrombin-modified antithrombin III) level. The level of ATm in the placebo group reached a maximum at the end of ECC during rewarming, while in the aprotinin group, ATm level at this time point was significantly lower than in the control group. In comparison to the placebo group, the generation of the fibrin degradation products (DDE complexes) was inhibited by aprotinin during ECC, but the level of DDE complexes in the aprotinin group was slightly elevated after ECC, although much less than in the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Antithrombin III↗

PubMed2006

Deairing of the venous drainage in standard extracorporeal circulation results in a profound reduction of arterial micro bubbles.

OBJECTIVE: Standard extracorporeal circulation (ECC) remains the staple procedure for cardiac surgeons. Despite modern membrane oxygenators and arterial filters micro bubbles are regularly detected in the arterial line. We investigated whether initial deairing of the venous drainage during connection can reduce the quantity and size of micro bubbles on the arterial side. METHODS: 12 patients underwent isolated coronary artery revascularization with conventional ECC using a two-stage venous catheter and an open, passive venous return into a reservoir. In 6 patients (Control) the venous catheter was routinely connected to the venous line, thereby accepting moderate incorporation of air. In another 6 patients (deaired) the catheter was connected avoiding any visible air entrapment. A bubble counter was used to detect the number and size of any micro bubbles in the arterial line of the ECC. The total number of bubbles as well as the number of bubbles of different sizes was assessed directly after initiation of ECC and during the first 60 sec. RESULTS: All patients had an uneventful surgery with a normal postoperative course. In the Control group a considerable number of bubbles of all sizes occurred initially and after 60 sec. In contrast, very few bubbles were detected in the deaired group. CONCLUSION: Incorporated venous air inevitably reaches the arterial side of the ECC. As deairing of the venous line is a simple and effective manoeuvre to significantly reduce the amount of micro bubbles on the arterial side, we recommend and perform routine deairing in all our patients.

Cardiac Surgical Procedures↗

PubMed2004

Deleterious effects of oxygen during extracorporeal circulation for the microcirculation in vivo.

OBJECTIVE: Clinical complications arising from extracorporeal circulation (ECC) have been linked to disturbances in the microcirculation. Hyperoxia, a mainstay of supportive treatment, is clinically used for a variety of pathological states. In previous in vivo animal experiments we found increased leukocyte/endothelial (L/E) cell interaction following ECC due to oxygen derived free radicals. This study was carried out to investigate the link between arterial pO2 during ECC and the potential damage to the microcirculation, supposedly caused by oxygen derived radicals. METHODS: Intravital fluorescence microscopy was used on the dorsal skinfold chamber preparation in syrian golden hamsters. ECC was introduced via a micro-rollerpump (0.7 ml/min) and a 60 cm silicon tube (1 mm inner diameter) shunted between the carotid artery and the jugular vein after application of 300 IE Heparin/kg/bw. Experiments were performed in chronically instrumented, awake animals (age: 10-14 weeks, weight: 65-75 g). Control inspired room air, experimental group 1 inspired 100% oxygen, group 2 received 100% oxygen and 2000 IE of Heparin i.v. (n=7/group), that releases endothelial bound superoxide dismutase, a natural scavenger of oxygen derived free radicals in the hamster. RESULTS: Normobaric inhalation of 100% oxygen increased arterial pO2 from 64+/-8.1 mmHg to 512+/-124 mmHg (P<0.05 vs. baseline). ECC under 100% oxygen reduced functional capillary density (FCD) to 70% of baseline values 8 h after ECC (P<0.05). Adherent leukocytes in postcapillary venules and arterioles increased significantly (P<0.05). 2000 IE Heparin prevented the reduction in FCD and decreased the number of adherent leukocytes. CONCLUSIONS: Reduction in FCD, increased leukocyte adherence to the microvascular endothelium of postcapillary venules and arterioles under hyperoxia compared to ECC under room air conditions, demonstrates harmful effects of oxygen during ECC in vivo. A high dose of Heparin enhances functional capillary density, thus attenuating the microvascular dysfunction/damage in the period after ECC.

Animals↗

PubMed1989

Lysosomal enzyme activity influenced by various types of respiration during extracorporeal circulation.

The hypoxic damage of the lung as seen after extracorporeal circulation (ECC) is in correlation to lysosomal hydrolase and protease activation. In the recent study the effect of various types of respiration during ECC on lysosomal enzyme release were studied. 53 patients undergoing open heart surgery were divided into 4 groups: Apnoea, low frequency, continuous positive airway pressure, combination of low frequency and continuous positive airway pressure. Paired blood samples were withdrawn from the superior vena cava (SVC) and the left atrium (LA) throughout the cardiopulmonary bypass. A continuous increase of N-azetyl-beta-D-Glucosaminidase (NAG) in venous plasma and significant differences (SVC-LA) with higher activities in the LA in the apnoea group were detectable (p less than or equal to 0.05-p less than or equal to 0.01). In the other groups a time dependent course could also be evaluated, but the changes of the activities were not significant. The different types of respiration during ECC influenced the clinical course and outcome of the patients in correlation to the release of lysosomal enzymes from the lung. It is concluded that concentration gradients of lysosomal enzymes are an index for pulmonary damage due to the extracorporeal perfusion in open heart surgery. The activation of lysosomal enzymes in the lung circulation are positively influenced by "ventilation" during ECC.

Acetylglucosaminidase↗

PubMed1984

[Antithrombin III substitution for optimization of the heparin effect during extracorporeal circulation in heart surgery].

In a prospective randomised study 20 patients undergoing coronary bypass surgery were assigned to two groups. Patients in group I (n = 10) received initially 250 IU heparin X kg-1 before the start of extracorporeal circulation. Patients in group II (n = 10) were given the same amount of heparin and in addition 1 000 units of purified human antithrombin III (AT III) concentrate. A highly significant lower heparin coefficient [2.69 +/- 0.57 IU X kg-1 X min-1, which is a parameter of heparin consumption (units of heparin X kg-1 given per minute during the time of heparinisation)], was found in group II compared to group I (3.73 +/- 0.56 IU X kg-1 min-1). Heparin sensitivity, measured as an increase in the ratio of activated coagulation time (ACT) X IU heparin-1 X kg-1 as a response to initial heparin dose, was found to be significantly higher (1.22 +/- 0.30 sec X IU heparin-1 X kg-1) in patients receiving AT III as measured in the control group (0.95 +/- 0.23 s X IU heparin-1 X kg-1). Mean values of ACT during the period of heparinisation were comparable (group I: 533 +/- 81 s, group II: 512 +/- 62 s) in the two groups. The substitution of AT III led to an increase of plasma AT III activity of 1.4% per substituted unit AT III X kg-1. AT III plasma activity, corrected to initial haematocrit levels to avoid dilution dependency, decreased as a consequence of extracorporeal circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Antithrombin III↗

PubMed1997

[Subtotal pericardectomy with the use of extracorporeal circulation].

The results of surgical treatment of 91 patients with constrictive pericarditis are analysed. There were 2 groups of patients: In 71 patients (1st group) the "closed" pericardectomy was used, 20 patients (2d group) were operated with the use of extracorporeal circulation. Both groups were comparable in terms of their preoperative status. The rate of hospital mortality was 7.6% (7 patients). In the 1st group the rate of mortality was 8.4%, while in the 2d group no patients died. The trauma of myocardium and coronary arteries, as well as acute arrythmias were the main factors of mortality. To achieve a positive result the ventricles should be completely released of the constricting capsule. The use of extracorporeal circulation provides favorable conditions for such a release and decreases the rate of mortality.

Adolescent↗

PubMedDate not supplied

Measurement of indocyanine green dye concentration in the extracorporeal circulation.

Indocyanine green (ICG) is a dye used to measure plasma volume and cardiac output and to assess hepatic function by monitoring the ICG plasma disappearance rate. A method for continuous and noninvasive measurement of ICG plasma concentration (c) in the extracorporeal circulation is presented using technology originally developed for on-line measurement of hematocrit. As expected from the ICG absorption maximum at 805 nm, the presence of ICG in blood leads to a pronounced increase in hematocrit (Hct) measured by optical means. This apparent change in hematocrit (Hct(rel) = Hct/ Hct(b) - 1) relative to the baseline hematocrit (Hct(b), where c = 0) showed a strong linear relationship (Hct(rel) = k.c) with respect to ICG concentration. The dependence of k on baseline hematocrit was best described by an exponential relationship (k = a*e(b*Hctb)). The constants a and b were determined in in vitro experiments using bovine blood. With the information on a and b, and when baseline hematocrit is known and can be assumed to remain constant throughout the observation phase, plasma ICG concentration can be noninvasively and continuously measured in the extracorporeal circulation by using available optical techniques without taking blood samples. This approach greatly simplifies the diagnostic use of ICG, which may be of importance in patients treated with extracorporeal blood purification techniques.

Animals↗

PubMed1992

Metabolic aspects of acute cerebral hypoxia during extracorporeal circulation and their modification induced by acetyl-carnitine treatment.

Following their previous research experiences in human tissue hypoxia, in the present study the authors. investigated the metabolic effects of acute brain hypoxia in a group of patients in course of extracorporeal circulation for aorto-pulmonary bypass. One hundred subjects were treated, half with a placebo and half with acetyl-carnitine to evaluate the effects of oxidative stress in some brain plasmatic metabolites and to verify the effect of acetyl-carnitine on the tissue energy capacity. The levels of lactate, pyruvate, succinate and fumarate showed a significant imbalance due to hypoxia, while the acetyl-carnitine treatment confined the metabolic gradients within physiological limits. This means that during the course of extracorporeal circulation brain hypoxia plays a pathological role assuming the typical picture of cellular oxidative damage and the acetyl-carnitine antagonizes these deleterious effects of hypoxia by a protective mechanism on the energy processes and then on the cellular enzymic activities. In this regard, the d-tyrosine levels, considered as a proteolytic index, confirm the action of acetyl-carnitine on the cell morpho-functional integrity.

Acetylcarnitine↗

PubMed2006

[Acute popliteal arterial occlusion during extracorporeal circulation].

A 79-year-old man underwent aortic arch replacement for thoracic aortic aneurysm. He had a history of smoking, coronary stenting for ischemic heart disease and replacement with artificial blood vessel for abdominal aortic aneurysm. Anesthesia was induced and maintained with midazolam, fentanyl, sevoflurane, and vecuronium. A 20 gage catheter was placed in the right radial artery and a 22 gage catheter in the left posterior tibial artery. Total circulatory arrest under profound hypothermia and retrograde cerebral perfusion were performed using extracorporeal circulation. After finishing anastomosis with artificial blood vessel, he was weaned from extracorporeal circulation. The pressure in the left posterior tibial artery was maintained at 15 mmHg, although the blood pressure in the right radial artery increased gradually. Then, the pressure in the left femoral artery in the operative field was the same as the pressure in the right radial artery. Therefore, we suspected the arterial line occlusion of the left posterior tibial artery. After the operation, we found the left leg and foot pale and cold with no pulsation on the left popliteal, dorsal pedis, and posterior tibial arteries. Further, acute left popliteal arterial occlusion was assessed by means of Doppler and left lower extremity angiography. We immediately performed the balloon-catheter embolectomy. However, as he developed compartment syndrome on the left lower limb due to reperfusion injury postoperatively, fascitomy was performed. On the 58th postoperative day, he was discharged from our hospital. Measurement by Doppler is useful for the early diagnosis of the lower leg arterial occlusion.

Aged↗

PubMed2006

[Thrombectomy of subacute pulmonary thromboembolism under extracorporeal circulation: report of a case].

A 63-year-old man was admitted to a hospital for sudden loss of consciousness. Chest computed tomography (CT) revealed massive pulmonary thromboembolism. Heparin sodium and urokinase were administered, but were not effective. He was then referred to our hospital. His oxygen saturation was 88% in room air. Due to presence of severe hypoxemia and ineffectiveness of the antithrombotic therapy, thrombectomy was done under extracorporeal circulation. Postoperative course was uneventful, and he was discharged on the 24 th postoperative day. Oxygen saturation on discharge was 98% in room air. In conclusion, thrombectomy of subacute pulmonary thromboembolism was performed successfully under extracorporeal circulation.

Extracorporeal Circulation↗

PubMed1998

Cardiac surgery with extracorporeal circulation in 23 infants weighing 2500 g or less: short and intermediate term outcome.

OBJECTIVE AND METHODS: From September 1990 to February 1997, 23 consecutive critically ill infants (12 males, 11 females) weighing 2500 g or less underwent cardiac surgery necessitating extracorporeal circulation (ECC). A retrospective study was carried out to evaluate short- and intermediate-term outcome. Mean weight at operation was 2265 g (range 1750-2500 g). Mean age at operation was 24 days. The indications for surgery were transposition of the great arteries (TGA; 7), ventricular septal defect (VSD; 4), aortic stenosis (AS; 3), univentricular heart (UVH; 2), tetralogy of Fallot (TOF; 2), interrupted aortic arch (IAA; 2), atrial septal defect (ASD; 1), atrioventicular septal defect (AVSD; 1) and total abnormal pulmonary venous return (TAPVR; 1). All patients were in NYHA class IV; 17 patients (74%) were intubated pre-operatively. RESULTS: The mean aortic cross-clamping time was 40 min. Twelve patients required deep hypothermia (<20 degrees C) with total circulatory arrest (mean duration 19 min). All patients were successfully weaned from extracorporeal circulation (ECC). Five patients left the operating room with an open sternum (mean duration before closure: 3.5 days). Mean duration of artificial ventilation was 10.6 days; of inotropic support 6.7 days and of intensive care stay 17.8 days. Severe complications were observed in 19 patients (83%): cardiac failure requiring high inotropic support (13), sepsis (7), and acute renal insufficiency (5). One patient needed a ventricular assist device. Five patients (22%) died in the intensive care unit (ICU): 2 AS with fibroelastosis, 2 IAA with VSD. and 1 UVH with pulmonary atresia. At discharge from the ICU, 7 patients were receiving no treatment. Mean duration of follow-up was 32 months (range 2-80 months). We had 2 reoperations: 1 for right ventricular outflow tract obstruction 1 year after a switch operation and 1 for mitral valve replacement 1 year after total abnormal pulmonary venous return repair (death 30 days post mitral valve replacement). Survival at I year was 73%. At the last clinical examination 16 patients were in NYHA class I. CONCLUSION: Despite the severity of pre-operative cardiac disease, early surgical repair with ECC in infants weighing 2500 g or less is feasible with tolerable mortality yet with significant early morbidity.

Body Weight↗

PubMed1991

Anesthesiologist-manned helicopters and regionalized extracorporeal circulation facilities: a unique chance in deep hypothermia.

Norway has nine light ambulance helicopters, four heavy sea rescue helicopters and seven ambulance air planes in 24-hours duty spread all over the country. Most are manned with anesthesiologists. Five regional hospitals in all parts of the country, offer facilities for extracorporeal circulation. A case in which a 33 year old woman was found hypothermic at 21 degrees C is presented. She developed ventricular fibrillation at the time of her rescue. She was intubated and received chest compression for 70 minutes until she was rewarmed by extracorporeal circulation. She was discharged without signs of cerebral damage. The decision to bypass less advanced hospitals en route to the regional hospital proved correct in this case, and is suggested as standard procedure in deep hypothermic patients.

Adult↗

PubMed2001

[Gastric perforation as an early complication of surgical myocardial revascularization using extracorporeal circulation].

The authors describe the case of a man with ischaemic heart disease after revascularization of the myocardium by an aortocoronary bypass using extracorporeal circulation. The early postoperative course was complicated by perforation of a gastric ulcer. The condition was successfully resolved by an urgent operation, suture of the perforated stomach with toilet of the abdominal cavity. In the discussion the authors analyze the causes of the possible development of gastrointestinal complications after cardiac surgery, in particular the influence of extracorporeal circulation and other specific effects during cardiac surgery and during the immediate postoperative period.

Cardiopulmonary Bypass↗

PubMed1996

Effect of factor Xa inhibitors on thrombin formation and complement and neutrophil activation during in vitro extracorporeal circulation.

BACKGROUND: Even when large doses of heparin are administered during cardiopulmonary bypass, thrombin is produced. Thrombin is a powerful protease that is associated with the thrombotic and bleeding complications of open heart surgery and is produced by cleavage of prothrombin by factor Xa. This study assessed the ability of a specific inhibitor of factor Xa, recombinant tick anticoagulant peptide (rTAP), alone or in combination with standard heparin and a low-molecular-weight heparin, enoxaparin, to suppress thrombin formation and activity during in vitro extracorporeal circulation. METHODS AND RESULTS: Fresh, anticoagulated human blood was recirculated for 2 hours in an extracorporeal membrane oxygenator perfusion circuit at 37 degrees C. Four anticoagulant protocols were evaluated; porcine heparin (3.75 U/mL); enoxaparin (17.5 U/mL); rTAP (4 mumol/L); and porcine heparin plus rTAP (2 mumol/L). Blood samples were obtained for analysis from the donor, after anticoagulation, and after 5, 30, 60, and 120 minutes of recirculation. There were no significant differences between groups in platelet count, response to adenosine diphosphate, or prothrombin fragment (F1.2) production. rTAP plus heparin reduced beta-thromboglobulin release; fibrinopeptide A concentrations were significantly higher with rTAP alone. Enoxaparin strongly and significantly inhibited complement C5b9 production and neutrophil elastase release and was associated with significantly increased concentrations of C1-C1 inhibitor and kallikrein-C1 inhibitor complexes. CONCLUSIONS: rTAP does not reduce thrombin formation or activity during in vitro extracorporeal circulation. Enoxaparin markedly inhibits formation of the complement membrane attack complex and neutrophil elastase release, possibly by accelerating C1 inhibitor activity.

Adenosine Diphosphate↗

PubMed1983

[A compact whole-body hyperthermia system utilizing extracorporeal circulation for anticancer treatment].

A compact whole-body hyperthermia system utilizing extracorporeal circulation for anticancer treatment has been devised and its clinical applicability is discussed. Our system has the following advantages; 1. Our small heat-exchanger made of polyvinyl-chloride hollow fibers exhibited sufficient heat-exchanging capability. 2. Our system is so compact as not to require priming with blood components. 3. Temporary blood access, created by direct puncture of the femoral vessels, eliminates vascular surgery and cardiac overload to the patients.

Body Temperature↗