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At least 127 records · Page 7Linked to original sources
PubMed1998

[Role of academic B.V. Petrovskiĭ in the development of extracorporeal circulation].

The paper shows the role of Academician B.V. Petrovsky and his scientific school in the development of extracorporeal circulation, as well as his ties with S.S. Bryukhonenko (1890-1960), the founder of extracorporeal circulation in Russia. Heart-lung apparatuses were designed with the participation of collaborators of the Surgery Research Center (SRC), Russian Academy of Medical Sciences. A short account is given of the principal aspects of extracorporeal circulation, which have been studied at the SRC, such as protective blood flow distribution, centralization of circulation, the optimal perfusion rate, criteria for adequate extracorporeal circulation, control of blood coagulation and acid-base state, blood concentration, extracorporeal circulation with autooxygenation, hyperbaric perfusion, normothermal perfusion with continuous warm blood cardioplegia).

Extracorporeal Circulation↗
PubMed1992

[Clinical and experimental study of the production of renal hemodynamic effects of IABP-assisted pulsatile flow extracorporeal circulation].

Renal hemodynamics during IABP-assisted pulsatile flow extracorporeal circulation was assessed in terms of measurement values for intraoperative renal blood flow obtained by the local thermodilution method in human clinical patients. In addition, the effect of IABP on renal hemodynamics was investigated in an animal model of renal denervation in a study undertaken to elucidate the action mechanism of IABP. Eighteen patients with acquired heart disease were involved in the study and measured for the renal blood flow (RBF), cardiac output (CO), renal-systemic partition coefficient for blood flow (RBF/CO), renal vascular resistance (RVR) and perfusion pressure. In the pulsatile flow group, the RBF/CO increased as the number of pump runs increased, whole the RVR was conversely reduced with increasing pump runs. The experimental study without extracorporeal circulation was conducted on 19 mongrel dogs. During IABP runs RBF/CO increased, while the RVR decreased. After renal denervation, no noticeable influence of IABP upon renal hemodynamics was observed. Following a loading dose of noradrenaline (Norad), the RVR increased in a Norad concentration-dependent fashion, independently of IABP and renal denervation. These results indicate that IABP reduces the RVR and thereby exerts a favorable action on renal hemodynamics during pump times. The study thus warrants us to surmise that a mechanism involving the renal sympathetic nerves might play an important role in the production of favorable renal hemodynamic effects of IABP-assisted pulsatile flow extracorporeal circulation.

Animals↗
PubMed1997

Coronary artery revascularisation without extracorporeal circulation. Indications and results.

OBJECTIVE: Coronary artery revascularisation without extracorporeal circulation is a technique which can be performed in selected patients in need of a coronary artery bypass graft. METHODS: Consecutive patients (210) underwent coronary artery bypass graft without extracorporeal circulation. Indications were high risk patients, or single coronary artery lesion. To predict perioperative mortality, preoperative risk factors were reviewed, and Parsonnet score was calculated. RESULTS: There were seven deaths (3.3%), and univariate analysis revealed greater age, NYHA, and poor ejection fraction to be the only predictors of early mortality. Perioperative myocardial infarction included 15 patients (7.1%), most of them seen in the multiple bypass group (10/39, 26%). Patients were divided into low risk (Parsonnet score < 15) 155 patients with two deaths (1.2%), and high risk (Parsonnet score > 15) 55 patients with five deaths (9%). Complete revascularisation was performed in the low risk group, while in the high risk only the symptomatic vessel was bypassed and other angiographic lesions treated with postoperative angioplasty (10 patients). A total of 12 patients developed early postoperative angina (5.7%), 9 presented an anastomosis dysfunction which was treated by angioplasty (5) and surgery (4), and 188 patients (85.7%) did not receive transfusions while 190 patients (90.4%) did not need postoperative inotropes. Length of stay, operating room time, and medical costs were all significantly reduced. CONCLUSIONS: Myocardial revascularisation without extracorporeal circulation can be performed with a low operative mortality, and minimal morbidity only in patients undergoing single bypass revascularisation. It can also be performed as part of a multiple revascularisation strategy in association with angioplasty in high risks patients.

Aged↗
PubMedDate not supplied

[Inflammatory response mediators in newborns and infants with congenital heart diseases during surgical treatment under extracorporeal circulation].

Surgical treatment of complex congenital heart disease under extracorporeal circulation is accompanied by a systemic inflammatory reaction occurring in neonatal infants and babies. There were drastic increases in the concentration of tumor necrosis factor, interleukin-8, neutrophilic elastase and a predominance of a proinflammatory response over an inflammatory one at the warming stages and after administration of protamine sulfate. The rate of an inflammatory response depended on the duration of extracorporeal circulation. Modified ultrafiltration could remove cytokines; however, their concentration in the body remains high. A relationship was found between the course of a postoperative period and the rate of a developing reaction to extracorporeal circulation in the surgical treatment of congenital heart diseases.

Cardiac Surgical Procedures↗
PubMed1990

[Energy metabolism of the brain, detected with 31-P magnetic resonance spectroscopy during extracorporeal circulation in the rabbit].

The question of a possible brain damage during open heart surgery using extracorporeal circulation is still a problem, especially in infants with circulatory arrest under deep hypothermia. During the last years Magnetic Resonance Spectroscopy was developed, and with this method we have now a possibility to study brain energy metabolism non-invasively and continuously. Our aim was to develop an animal model (rabbit) for studying brain energy metabolism by 31-P Magnetic Resonance Spectroscopy during extracorporeal circulation. In a first step we have shown that the influence of hypothermia on energy metabolism in the brain can be measured in the intact animal by MR-Spectroscopy. In a second step a non-magnetic heart-lung machine for rabbits was constructed and is described here. We get a completely normal brain spectrum in the beginning and after two hours of extracorporeal circulation. The spectrum is also normal on extracorporeal circulation at 35 degrees C and during cooling down to 18 degrees C. With this animal model it will be possible to study different variables of extracorporeal circulation such as duration of circulatory arrest under deep hypothermia or changes of the priming including pharmacological changes.

Adenosine Triphosphate↗
PubMed2003

[Axillary artery cannulation for extracorporeal circulation].

BACKGROUND: When the ascending aorta and the femoral artery cannot be used for extracorporeal circulation, an emerging alternative is the use of axillary artery. AIM: To report the experience using the axillary artery for extracorporeal circulation. PATIENTS AND METHODS: Between November 1998 and May 2002, 22 patients (14 male) were operated with extracorporeal circulation, cannulating the axillary artery. Briefly, an incision is made below the middle third of the clavicle and a cut is made on major pectoris muscle. Minor pectoris muscle is retracted and axillary artery is exposed. It is cannulated directly or with the aid of a prosthesis. RESULTS: Right axillary artery was used in 21 patients and in 20 it was cannulated with the aid of a prosthesis. Mean flow was 4.5 +/- 0.6 l/min. The most common indications were aortic dissection or aneurysms. The most common procedures done, were ascending aorta replacement in 8 cases and replacement of ascending aorta and aortic arch in 5. Thirty five percent of operations were emergencies and 32% were reoperations. In 15 patients (68%), a circulatory arrest was done. Of these, retrograde brain perfusion was used in 9, antegrade brain perfusion through the same axillary artery was used in 2 and mixed perfusion was used in 2. One patient had a complication related to the axillary cannulation. None had cerebrovascular accidents or thromboembolic complications. Two patients died in the postoperative period. Patients were followed up to 42 months after the procedure and no secondary complications of the cannulation were detected. CONCLUSIONS: When the ascending aorta and the femoral artery cannot be used, axillary artery is a good alternative for extracorporeal circulation.

Adult↗
PubMedDate not supplied

[Neurologic complications after extracorporeal circulation in the light of experimental studies].

On the basis of experimental investigations the authors describe the causes of certain complications after extracorporeal circulation. The experiments were carried out in 11 sheep. The duration of extracorporeal circulation was from 1 to 2 hours. It was found that the intracranial pressure, which is an indicator of intracranial expansion, increased with increasing time of cannule introduction into the heart and veins, with the volume of perfusing fluid given during the procedure, with falling value of the arterial blood pressure and impairment of venous return. The intracranial pressure increased also with the duration of extracorporeal circulation. Falls of the arterial blood pressure and venous return occurred simultaneously with impairment of the cerebral blood flow causing cerebral hypoxia. The results of histological examinations of brain tissue were consistent with central nervous system hypoxia, and showed also that these changes developed within the first hour of extracorporeal circulation. The complications arising after extracorporeal circulation may be due to brain oedema. Thus it would be recommendable to pay attention during preoperative management of the patients to the possibility of brain oedema as a complication of the procedure.

Animals↗
PubMedDate not supplied

Extracorporeal circulation as a new experimental pathway for myoblast implantation in mdx mice.

The deficiency of dystrophin, a sarcolemmal associated protein, is responsible for Duchenne muscular dystrophy (DMD). Gene replacement is attractive as a potential therapy. In this article, we describe a new method for myoblast transplantation and expression of dystrophin in skeletal muscle tissue of dystrophin-deficient mdx mouse through iliac vessels extracorporeal circulation. We evaluated the extracorporeal circulation as an alternative route of delivering myoblasts to the target tissue. Two series of experiments were performed with the extracorporeal circulation. In a first series, L6 rat myoblasts, transfected with LacZ reporter gene, were perfused in limbs of 15 rats. In the second series, the muscle limbs of three 6-8-week-old mdx were perfused with myoblasts of donor C57BL10J mice. Before these perfusions, the right tibialis anterior (TA) muscle of the rats and mdx was injected three times at several sites with bupivacaine (BPVC) and hyaluronidase. The ability of injected cells to migrate in the host tissue was assessed in rats by technetium-99m cell labeling. No radioactivity was detected in the lungs, bowels, and liver of animals treated with extracorporeal circulation. The tissue integration and viability of the myoblasts were ultimately confirmed by genetic and histochemical analysis of LacZ reporter gene. Following a single extracorporeal perfusion of myoblasts from donor C57BL10J, sarcolemmal expression of dystrophin was observed in clusters of myofibers in tibialis anterior muscles previously treated with BPVC and hyaluronidase. Furthermore, large clusters of dystrophin-positive fibers were observed in muscles up to 21 days after repeated treatments. These clusters represented an average of 4.2% of the total muscle fibers. These results demonstrate that the extracorporeal circulation allows selective myoblast-mediated gene transfer to muscles, opening new perspectives in muscular dystrophy gene therapy.

Animals↗
PubMed1980

Tracheal tube cuff volume changes during extracorporeal circulation.

Changes in the volume of tracheal tube cuffs were examined during extracorporeal circulation to determine the influence of the composition of the inspired gases and of the gas within the cuff. The study was carried out on 90 patients who underwent coronary artery bypass grafting. When the cuff contains nitrous oxide at the start of extracorporeal circulation, the cuff volume decreases during bypass regardless of the composition of the inspired gases. When the cuff is filled with air or 100 per cent oxygen at the start of extracorporeal circulation and the inspired gas mixture consists of nitrous oxide and oxygen the cuff volume increases. When the cuff is deflated and then refilled with either room air or oxygen at the beginning of the extracorporeal circulation and the lungs are inflated with oxygen, the cuff volume change is minimal during bypass. This combination of gas prevents any undesirable change in the cuff volume. It appears desirable to monitor the tracheal tube cuff volume or pressure and to maintain a constant pressure and volume during bypass to prevent deflation and silent aspiration associated with cuff deflation, as well as to avoid mucosal damage due to excessive pressure in the cuff.

Anesthesia↗
PubMed1989

[Changes in circulating blood volume in patients with ischemic heart disease during and after surgery with extracorporeal circulation].

Twelve men scheduled for elective coronary bypass graft surgery were investigated. Blood volume was measured using as a tracer iodine contained in Uropolin and endogenous iron. Concentration of this markers was measured by proton induced x-ray emission PIXE) method. Arterial blood was sampled before operation, every ten minutes during extracorporeal circulation and every hour during the day of operation. Simultaneously all of the outcome and income fluids were noted so it was possible to calculate changes in blood volume related to water moving from intravascular into extravascular space or inversely. It was found that patients suffered from coronary disease had lower circulating blood volume than the normal population. During extracorporeal circulation and the first hours after operation changes in blood volume ranges +/- 20% and this was caused by continuous water exchange between intravascular and extravascular spaces. The degree and direction of the changes were not related to time and type of infused fluids used in the pump prime as well. Most of the patients had the blood volume higher after operation than before, but that did not influence blood pressure and central venous pressure significantly.

Adult↗
PubMed1983

[Renal function after non-blood priming extracorporeal circulation].

Non-blood priming extracorporeal circulation (ECC) in open heart surgery was studied to evaluate its effect on kidney, and was compared with blood-priming ECC. Non-blood priming ECC was performed in 49 cases, and blood-priming ECC was performed in 25 cases. Serum creatinine creatinine clearance, BUN, UUN/BUN and urinary Na/K ratio were measured. Perfusion flow, total peripheral vascular resistance (TPR) and cardiac index after ECC were measured to know if there is a significant difference between the two groups. The following results were obtained: There were no significant differences between the two groups as to the perfusion flow, TPR during ECC and cardiac index after ECC. Using non-blood priming ECC was found to be the safer method from the point of preserving the renal function. When compared with blood priming ECC, the non-blood priming ECC was found to be more beneficial for the renal function. Renal failure was observed in 3 pediatric cases using blood priming ECC and 1 adult case using non-blood priming ECC. Low cardiac output syndrome or heart failure were thought to be causes of the renal failure in these 4 patients.

Adolescent↗
PubMed1997

Short-term and long-term neuropsychological consequences of cardiac surgery with extracorporeal circulation.

OBJECTIVE: Cognitive dysfunction after extracorporeal circulation is a major continuing problem in modern cardiac surgery. We designed this prospective study to update the incidence of postoperative neuropsychological changes after routine cardiopulmonary bypass (CPB) and to identify perioperative variables associated with these complications. METHODS: We assessed the patients with a comprehensive neuropsychological test battery 1 day before, 7 days after (n = 109) and 6 months after (n = 91) cardiopulmonary bypass. We used patients undergoing major vascular or thoracic surgery as a surgical control group (n = 20). RESULTS: Repeated measures multivariate analysis of variance (using surgical group as a between-subjects factor) on the group data revealed significant changes early after surgery compared with the preoperative performance (P = 0.001). The early changes are characterized by a significant decrease of visual attention and verbal memory performance (univariate F-tests, always P < 0.05). Cardiac patients showing cognitive impairment after cardiac surgery had lower preoperative ejection fractions (P = 0.014) and a more complicated medical history (P = 0.046). At 6-month follow-up, the patients performed significantly better than before surgery (P < 0.001). CPB patients showing persistent cognitive impairment at follow-up were significantly older at the time of surgery (P = 0.005). Individual comparisons revealed that 45% of the patients undergoing CPB showed evidence of cognitive impairment soon after surgery. In 12% of the patients, the cognitive sequelae persisted at follow-up. Both group data and individual incidence rates revealed neither significant pre-post differences between the surgical groups nor a time-by-group interaction effect. Variables directly associated with CPB were not significantly associated with the occurrence of cognitive impairment after surgery. CONCLUSIONS: We conclude that an important proportion of the cognitive impairment after cardiac surgery is likely to be due to nonspecific effects of surgery.

Adult↗
PubMed1986

Changes in platelet beta-thromboglobulin, fibrinogen, albumin, 5-hydroxytryptamine, ATP, and ADP during and after surgery with extracorporeal circulation in man.

Surgery with extracorporeal circulation (ECC) is associated with transient alterations of platelet function whose pathogenic mechanisms are not completely understood. To define further the platelet abnormalities, we determined the changes in platelet content of several granule-associated substances during and after ECC in patients subjected to aortocoronary bypass surgery. Platelet beta-thromboglobulin (beta-TG) decreased to 79.8% of the preoperative level at the end of ECC (p less than 0.01) and, as expected, did not recover 1 hr after the end of surgery. Platelet fibrinogen and albumin decreased to 67.9% (p less than 0.01) and to 29.8% (p less than 0.01) of baseline, respectively. However, 1 hr after surgery, platelet fibrinogen rose to 92% and albumin to 55.5% of baseline, denoting that during the recovery from ECC, platelets incorporate some plasma proteins. During ECC, platelet 5-hydroxytryptamine (5-HT) and total ATP and ADP decreased to 50.8% (p less than 0.01), 63.2% (p less than 0.01), and 69.9% (p less than 0.01) of their respective preoperative values, indicating dense body release. One hour after surgery, ATP recovered to 83.8%, suggesting that previous depletion compromised also the metabolic pool of adenine nucleotides. In summary, Our results confirm and extend previous observations demonstrating alpha-granule release during ECC. Platelets undergoing ECC can incorporate plasma proteins as evidenced by the rapid increase of platelet fibrinogen and albumin after bypass. Although the mechanisms of this increase and site of storage of the exogenous substances are unknown, this observation justifies further studies to determine if internalization of plasma proteins, especially fibrinogen, may take place in physiological conditions. Dense body depletion with transient storage pool deficiency appears to be a component of the reduced platelet function during ECC. Consumption of metabolic ATP with alteration of platelet energy metabolism may further impair platelet function, contributing to the bleeding episodes observed during surgery with ECC.

Adenosine Diphosphate↗
PubMedDate not supplied

Hemoglobin based oxygen carrying solution stability in extracorporeal circulation: an in vitro evaluation and implications for clinical use.

This study evaluated the stability of a hemoglobin based oxygen carrying (HBOC) solution during extracorporeal circulation. HBOC solution was diluted 1:1 with normal saline, 2 L of the resulting solution was oxygenated in either a bubble oxygenator (n=5) or membrane oxygenator (n=5), and it was placed in extracorporeal circulation at a rate of 2 L/min for 5 hr at 37 degrees C. To assess the effect of added human blood, 500 ml of fresh human whole blood was added to 1.5 L of diluted HBOC solution, and circulated as described. Methemoglobin level, hemoglobin integrity (percent of HBOC solution tetramer), and oxygen affinity (PO2 at 50% hemoglobin saturation) were measured. Extracorporeal circulation using the bubble oxygenator slightly altered (<1%) hemoglobin integrity compared with controls. Oxygen affinity decreased during extracorporeal circulation with both the membrane and bubble oxygenators; there was no significant difference between the oxygenators. Methemoglobin formation in controls and in extracorporeal circulation with either oxygenator was significant, with a slight advantage of the membrane compared with the bubble oxygenator; however, the presence of blood significantly decreased the rate of methemoglobin formation. In the presence of blood, HBOC solution remains structurally stable and efficacious for oxygen delivery during extracorporeal circulation.

Blood↗
PubMed1976

Specific removal of bovine serum albumin (BSA) antibodies in vivo by extracorporeal circulation over BSA immobilized on nylon microcapsules.

Studies were undertaken to determine whether BSA, once immobilized on activated nylon microspheres, would be capable of specifically removing circulating BSA antibody in vitro and in vivo in an extracorporeal circulation system in dogs. Nylon microspheres were prepared and, after gentle hydrolysis and glutaraldehyde treatment, demonstrated a retention of up to 34.5 mg of BSA. In vitro studies showed that BSA immobilized on microspheres removed a significant percentage of BSA-binding activity. For in vivo studies, an extracorporeal circulation system was established and mongrel dogs were then injected with anti-BSA and anti-HSA antibodies. After an equilibration period, BSA microspheres were introduced into the extracorporeal circulation system. After the insertion of BSA microcapsules, serum exhibited a sharp reduction in BSA binding over the next 15 min, with a more gradual diminution over the ensuing 60 to 90 min. There was no significant reduction in anti-HSA binding over the same time frame. This effect could not be attributed to release of BSA from the microspheres since no 125I-BSA was detected in the serum or organs of the dogs at the conclusion of the experiments. After extracorporeal circulation over nylon microspheres, there were only minimal changes in the host's hematocrit or leukocyte counts and no significant thrombotic material or cellular debris was recoverable on the capsules. These data suggest that antigen immobilized on nylon microspheres may specifically withdraw circulating antibodies in vivo with minimal release of its antigenic material and little alteration in the host's hematologic status.

Animals↗
PubMed2004

Phosphorylcholine or heparin coating for pediatric extracorporeal circulation causes similar biologic effects in neonates and infants.

OBJECTIVE: Cardiac surgery for complex congenital malformations with use of extracorporeal circulation predisposes to an excessive systemic inflammatory response and a consecutive capillary leak syndrome. In a prospective randomized study the influence of 2 oxygenators especially designed for pediatric use on inflammatory markers and clinical outcome was investigated. METHODS: Forty neonates and infants (body surface area, <0.36 m(2)) undergoing cardiac surgery with extracorporeal circulation were randomized into one of 3 groups: in the first group (n = 14) the Medtronic Minimax Oxygenator and in the second group (n = 12) the Dideco Lilliput 1 Oxygenator, both with a 750-mL priming volume, were used. In the third group the Dideco Lilliput 1 Oxygenator was filled with a reduced priming volume of 450 mL. Parameters of interest for evaluation of a systemic inflammatory response after extracorporeal circulation were interleukin 6, tumor necrosis factor alpha, neutrophil elastase, complement C3, and free hemoglobin. In addition, erythrocyte, leukocyte, and thrombocyte counts and hemoglobin and C-reactive protein values were determined at different measurement points before, during, and after the operation. RESULTS: In all 3 groups peak values for tumor necrosis factor alpha were observed during the operation, whereas interleukin 6, elastase, and free hemoglobin values peaked in the first 4 hours. The highest values for leukocytes and C-reactive protein were obtained between 24 and 72 hours after the operation. Erythrocyte and thrombocyte counts, as well as hemoglobin values, were lowest at extracorporeal circulation onset, normalizing under substitution in the first 4 hours after the operation. By using the Lilliput/750 oxygenator, higher interleukin 6 values 1 and 4 hours after the operation and higher tumor necrosis factor alpha values during and 1 hour after the operation could be observed compared with results with the Minimax and Lilliput/450 oxygenators. In spite of our randomization protocol, patients in the Lilliput/750 group were significantly smaller and younger than those in the Minimax group. However, the statistical analysis showed no correlation between age and interleukin 6 or tumor necrosis factor alpha values, but it did show a correlation between younger age and the occurrence of capillary leak syndrome. Accordingly, the number of children with clinically complicated course (capillary leak, longer duration of catecholamine therapy, and ventilation) was higher in the Lilliput/750 group than in the Minimax group. CONCLUSION: By using an adequate priming volume, the systemic inflammatory response is similar after use of the Dideco Lilliput 1 Oxygenator and the Medtronic Minimax Oxygenator. Tip-to-tip surface coating of the extracorporeal circulation with either heparin or phosphorylcholine seems to have similar biologic effects in neonates and infants undergoing cardiac surgery.

C-Reactive Protein↗