Cardiopulmonary Bypass ; Coronary Artery Bypass ; methods ; Humans

Background: Cardiac surgery with cardiopulmonary bypass (CPB) can cause haemostatic abnormalities that increase the risk of postoperative hemorrhage. Objectives: (1) To study changes of coagulation in cardiac patients undergoing surgery with CPB. (2) To research the relationship between duration of cardiopulmonary bypass, coagulation tests and postoperative hemorrhage complications. Subjects and methods: A cross sectional descriptive study was carried out on 252 patients (105 women, 147 men) undergoing cardiac surgery with CPB due to congenital heart disease and acquired heart disease at Viet Duc Hospital from December 2005 to August 2006. Results: After surgery, 54 patients had to transfuse the blood products, accounting for 21.4% rate. 21 cases had abnormal bleeding (8.3%). 12 patients assigned to re-operate due to bleeding (4.8%). There was an inverse correlation between platelet counts after surgery with duration of CPB and duration of aortic clamping. Relationship between rate of prothrombin, APTT, fibrinogen after surgery and duration of CPB and duration of aortic clamping was not seen. Duration of CPB prolonging over 120 minutes related to postoperative hemorrhage complication (OR=2.69 (p<0.5)). Reduced platelet count increased the risk of postoperative hemorrhage but not statistically significant (OR=1.36; p>0.05). Prothrombin ratio of less than 50% associated with the risk of postoperative hemorrhage (OR=4.83; p<0.01). Conclusion: The routine coagulation tests can help monitor clotting in patients after cardiac surgery
Hemorrhage/ blood ; therapy ; Cardiopulmonary Bypass/ methods

OBJECTIVETo summarize the experiences of cardiopulmonary bypass (CPB) techniques in 15 patients of orthotopic heart transplantation.

METHODSAll patients received mild hypothermia and high flow rate perfusion. Effective strategies were taken to protect myocardium, lung, kidney, and blood conservation. The donor hearts were arrested with aorto perfusion using 1 000 ml St. Thomas solution at 4 degrees C, perfused with 1 000 ml University of Wiscosin (UW) solution or Histidin-Tryptophan-Ketoglutarat (HTK) solution at 4 degrees C, and then preserved in ice saline. Ice mud was covered on the donor heart during anastomosis. Low potassium cardioplegia solution was perfused before the unclamping of aorta.

RESULTSThe CPB time was (165.2 +/- 22. 8) min, the warm ischemia time was ( 7. 7 +/- 1. 7) min, and the cold ischemia time was ( 142. 4 +/- 11. 5) min. Heart beats was automatically recovered in 10 patients, and was recovered upon defibrillation in 5 patients. Left ventricular ejection fractions were (64. 1 +/- 4. 6) % after one month. All patients survived.

CONCLUSIONProper CPB management and effective donor heart protection are essential to guarantee the success of heart transplantation.

Cardiopulmonary Bypass ; Heart Transplantation ; methods ; Humans

Cardiopulmonary Bypass ; adverse effects ; methods ; Child ; Hemofiltration ; adverse effects ; methods ; Humans

BACKGROUNDStudies on selected patients undergoing off-pump versus on-pump coronary artery bypass surgery have produced inconsistent results, especially in patients with multiple coronary artery disease. This study compared the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease.

METHODSA total of 300 consecutive isolated, multiple coronary artery bypass grafting (CABG) patients were assigned to the off-pump coronary artery bypass (OPCAB, n = 150) or CABG with cardiopulmonary bypass (CCABG, n = 150) groups. There were no significant differences regarding degree of angina, history of myocardial infarction or diabetes, and presence of left main coronary artery disease between the two groups. Ejection fraction in the OPCAB group before surgery was lower than in the CCABG group (P < 0.01). In addition, more patients had a history of stroke and abnormal renal function preoperatively in the OPCAB group (P < 0.01). In OPCAB patients, single deep pericardial stay suture with a sling snared down was used to expose the target vessels, along with a stabilizer and a coronary shunt. A Medi-Stim Butterfly Flowmeter was used to measure blood flow through grafts in both groups.

RESULTSNo OPCAB patient was converted to the CCABG group. The average numbers of distal anastomoses and the indexes of completeness of revascularization (ICR) were similar in both groups. Postoperative respiratory support time and the volumes of chest tube drainage and of blood transfusions were less in the OPCAB group than in the CCABG group (both P < 0.01). The postoperative incidences of pulmonary dysfunction and renal insufficiency were lower in the OPCAB group than in the CCABG group (both P < 0.05). There were no significant differences between the two groups in mortality and other causes of morbidity (perioperative myocardial infarction, stroke, atrial fibrillation).

CONCLUSIONSOPCAB can be applied to patients with triple-vessel coronary artery disease and can achieve similar completeness of revascularization and similar early surgical results, with shorter respiratory support, reduced transfusion requirement, and fewer cases of pulmonary dysfunction and abnormal renal function.

Aged ; Blood Flow Velocity ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; methods ; Female ; Humans ; Male ; Postoperative Complications ; Stroke Volume

Severe tracheal stenosis can not only cause critical medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on the physicians, particularly the anesthesiologist. Life-threatening airway obstruction can make the patient's gas exchange extremely difficult.Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis. Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists. In these cases, airway management is the top issue for the anesthesiologist, and the level of difficulty varies with stenosis location, severity of stenosis, and surgical technique. Extracorporeal membrane oxygenation (ECMO), or cardiopulmonary bypass (CPB), is rarely utilized for the surgery, but for those impossible airways due to nearly complete tracheal obstruction, ECMO or CPB could be the final choice for anesthesiologists. Here we report a case of successful urgent airway management for tracheal resection and reconstruction assisted by temporary CPB.
Cardiopulmonary Bypass ; Emergencies ; Female ; Humans ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Trachea ; surgery

OBJECTIVETo establish a good recoverable rat model of cardiopulmonary bypass (CPB) to lay the foundation for studying the pathophysiology of CPB.

METHODSTwenty adult male Sprague-Dawley rats weighing 480 g+/-20 g were randomly divided into CPB group (n equal to 10) and Sham group (n equal to 10). All rats were anaesthetized, intubated and ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular vein and further transferred by a miniaturized roller pump to a hollow fiber oxgenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 6 ml of colloid. The surface of the hollow fiber oxgenator was 0.075 m(2). Rats were catheterized and brought in bypass for 120 min at a flow rate of 100-120 ml/kg/min. Oxygen flow/perfusion flow was 0.8 to 1.0, the mean arterial pressure (MAP) kept in 60-80 mmHg. Blood gas analysis, lactate dehydrogenase (LDH), and survival rate were examined subsequently.

RESULTSAll CPB rats recovered from the operative process without incident and remained uneventful within one week. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. MAP remained stable. The results of blood gas analysis at different time points were within a normal range. No significant haemolysis could be detected in the given time frame under bypass condition by using LDH.

CONCLUSIONSThe rat model of CPB can principally simulate the clinical setting of human CPB. The non-transthoracic model is easy to establish and is associated with excellent recovery. This well reproducible model may open the field for various studies on pathophysiological process of CPB and also of systemic ischemia-reperfusion injury in vivo.

Animals ; Cardiopulmonary Bypass ; methods ; Male ; Models, Biological ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Resuscitation

OBJECTIVETo explore the effects of different oxygen flow rates during cardiopulmonary bypass (CPB) on myocardial ischemia-reperfusion (IR) injury in rabbits.

METHODSThirty rabbits were randomized equally into groups A, B and C to receive controlled oxygen reperfusion at low, normal and high flow rates (25, 50, and 80 ml.kg(-1).min(-1), respectively). Serum concentration of CK-MB and cTnT were tested by ELISA before the operation (T0) and after 30 min (T1), 2 h (T2), 12 h (T3) and 24 h (T4) of reperfusion. W/D, SOD and MDA of the myocardium were determined before and at 60 min after reperfusion. The ultrastructural alterations of the myocardium were observed.

RESULTSSerum concentration of CK-MB and cTnT in the 3 groups increased significantly after the operation, and their levels were the lowest in group A (P<0.05). W/D and MDA in the myocardium was also the lowest, while SOD the highest in group A (P<0.05). Ultrastructural pathologies were found in all the 3 groups, but relatively mild in group A.

CONCLUSIONLow oxygen flow rate during controlled reperfusion may protect the myocardium from IR injury in rabbits.

Animals ; Cardiopulmonary Bypass ; Myocardial Reperfusion Injury ; prevention & control ; Oxygen ; administration & dosage ; Rabbits ; Reperfusion ; methods

BACKGROUNDCardiopulmonary bypass (CPB) has been shown to be associated with systemic inflammatory response leading to postoperative organ dysfunction. Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model. The purpose of this study was to establish a novel, minimally invasive rat model of normothermic CPB model without blood priming.

METHODSTwenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into CPB group (n = 10) and control group (n = 10). All rats were anaesthetized and mechanically ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular and further transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery. The volume of the priming solution, composed of 6% HES 130/0.4 and 125 IU heparin, was less than 12 ml. The surface of the hollow fiber oxygenator was 0.075 m(2). CPB was conducted for 60 minutes at a flow rat of 100-120 ml × kg (-1)× min(-1) in CPB group. Oxygen flow/perfusion flow was 0.8 to 1.0, and the mean arterial pressure remained 60-80 mmHg.

RESULTSAll CPB processes were successfully achieved. Blood gas analysis and hemodynamic parameters of each time point were in accordance with normal ranges. The vital signs of all rats were stable.

CONCLUSIONSThe establishment of CPB without blood priming in rats can be achieved successfully. The nontransthoracic model should facilitate the investigation of pathophysiological processes concerning CPB-related multiple organ dysfunction and possible protective interventions. This novel, recovery, and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.

Animals ; Cardiopulmonary Bypass ; methods ; Lung Injury ; surgery ; Male ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo evaluate the possibility of radial artery pressure and waveform as a convenient definition of pulsatile flow and the the effect of pulsatile perfusion during cardiopulmonary bypass (CPB) procedures.

METHODSFrom March 2008 to December, Eighty patients underwent open heart surgery were randomly divided into a pulsatile group (P, n=45) and a nonpulsatile group (NP, n=35). Monitored by radial artery pressure and waveform, the pulsatile low was applied from the point of the aortic cross-clamp until its release in P group. A P group of patients whose radial artery pressure and waveform revealed "double peak" or "single peak" (>30 mm Hg, 1 mm Hg=0.133 kPa) were compared with NP group. Parameters examined were lactate, urine volume, high sensitivity C reactive protein, blood urea nitrogen, creatinine, blood uric acid, lactate dehydrogenase, glutamic oxalacetic transaminase, ratio of urine for occult blood test, prothrombin time and tracheal intubation time.

RESULTSThe waveform with "double peak" or "single peak" (>30 mm Hg) presented in 35 (77.78%) in P group. The urine volume during CPB was significantly higher in P group. The lactate (P<0.01) during CPB, high sensitivity C reactive protein (P<0.05), increasing extend of lactic acid dehydrogenase (P<0.05) and the prothrombin time (P<0.01) after CPB were significantly lower in P group. The blood uric acid after CPB was increased in P group and decreased in NP group.

CONCLUSIONSEffective pulsatile flow can be generated by optimization of equipment and adjustment of pulsatile parameter. The radial artery pressure and waveform is a convenient definition of pulsatile flow. The pulsatile flow is predominant monitored by radial artery pressure and waveform.

Adult ; Blood Pressure ; physiology ; Cardiopulmonary Bypass ; Humans ; Middle Aged ; Monitoring, Physiologic ; methods ; Pulsatile Flow ; Radial Artery