Protective effect of soluble Klotho in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass support—A pilot study

2021 ◽  
Author(s):  
Naomi Pode Shakked ◽  
Orgad Rosenblat ◽  
Doron Sagiv ◽  
Jeremy Molad ◽  
Hagai Weinberg ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pilot Study ◽  
Protective Effect ◽  
Pediatric Patients

Clinical application of a new ternary polymer, SEC-1 coat™, for pediatric cardiopulmonary bypass circuits: a prospective randomized pilot study

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 826-832
Author(s):  
Tomomi Hasegawa ◽  
Yoshihiro Oshima ◽  
Shinji Yokoyama ◽  
Asuka Akimoto ◽  
Yusuke Misaka ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pilot Study ◽  
Interleukin 6 ◽  
Patient Characteristics ◽  
Serum Levels ◽  
Pediatric Cardiac Surgery ◽  
Interleukin 8 ◽  
Control Group ◽  
Platelet Counts

Objective: The use of biocompatible materials to reduce the systemic activation of inflammation and coagulation pathways is expanding rapidly. However, there have been few clinical studies of biocompatible circuits for pediatric cardiopulmonary bypass. This pilot study aimed to preliminarily evaluate the biocompatibility of SEC-1 coat™ (SEC) for cardiopulmonary bypass circuits in pediatric cardiac surgery. Methods: Twenty infants undergoing cardiac surgery for isolated ventricular septal defects at Kobe Children’s Hospital were assigned randomly to an SEC-coated (SEC group, n = 10) or heparin-coated (control group, n = 10) circuit. Perioperative data and the following markers were prospectively analyzed: platelet counts and interleukin-6, interleukin-8, C3a, β-thromboglobulin, and thrombin–antithrombin complex levels. Results: Neither patient characteristics nor postoperative clinical outcomes differed significantly between the SEC and control groups. Platelet counts markedly decreased during cardiopulmonary bypass in both groups, but were significantly better preserved in the SEC group. Fewer patients needed postoperative platelet transfusions in the SEC group. After cardiopulmonary bypass termination, serum levels of β-thromboglobulin and thrombin–antithrombin complex were significantly lower in the SEC than in the control group. Although the differences were not statistically significant, serum levels of interleukin-6, interleukin-8, and C3a had a tendency toward being lower in the SEC group, with good preservation of leukocyte counts, fibrinogen, and antithrombin III. Conclusion: SEC-1 coat™ for cardiopulmonary bypass circuits have good biocompatibility with regard to platelet preservation and in terms of attenuating inflammatory reaction or coagulation activation during pediatric cardiac surgery. It can be beneficial in pediatric as well as adult cardiac surgery.

scholarly journals 83 The predictive role of neutrophil-to-lymphocyte ratio in post-operative cardiopulmonary bypass surgery

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Valentina Bucciarelli ◽  
Francesco Bianco ◽  
Annaclara Blasi ◽  
Martina Primavera ◽  
Baldinelli Alessandra ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pediatric Patients ◽  
Septal Defect ◽  
Left Ventricular ◽  
Conduction System ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Predictive Role

Abstract Aims Postoperative arrhythmias (POA) are a common complication after cardiac surgical repairs for congenital heart disease (CHD), representing a substantial source of morbidity, mortality, and prolonged total in-hospital stay, with an incidence of 7.5–48% in postoperative pediatric cardiac patients. The etiology is multifactorial, and it has been related to the direct surgical manipulation of the cardiac conduction system, to the local tissue inflammation in the myocardium adjacent to the conduction system and to the arrhythmogenic effects of cardiopulmonary bypass (CPB), inotropes, and electrolyte disturbances. Recently, the prognostic role of neutrophil-to-lymphocyte ratio (NLR), a novel inflammation marker, has been evaluated in pediatric patients after CPB surgery. To evaluate the predictive role of NLR in POA in a population of pediatric CHD patients after CPB. Methods and results We retrospectively collected perioperative clinical and laboratory data of 146 patients (age 8.27 ± 10.79 years; male gender: 60.8%) consecutively admitted to the cardiac surgery intensive care unit (ICU) of our institute after elective cardiac surgery with CPB in 2018. We grouped and analyzed our population over NLR tertiles evaluated at 24 h from CPB and types of POA: supraventricular (SVT) and junctional (JET). The prognostic value of NLR and its association with POA was analyzed. Diagnoses of 146 patients included atrial septal defect (n = 36), ventricular septal defect (n = 20), pulmonary atresia/stenosis (n = 10), tetralogy of Fallot (n = 20), endocardial cushion defect (n = 8), left ventricular outflow tract obstruction (n = 14), anomalous origin of coronary artery (n = 6), complex CHD (n = 13), interrupted/hypoplastic aortic arch (n = 12), anomalous pulmonary venous return (n = 3). The mean CPB time was 121.6 ± 84.6 min. The median ICU hospitalization was 48 h [Q1, Q3: 24, 96]. Twelve patients experienced POA: 6 SVT and 6 JET. The frequency of POA incremented over NLR-tertiles (P-Trend 0.017), while SVT onset was associated with higher values of NLR and C-reactive protein (P = 0.034 and P = 0.011, respectively). Patients in the second and third tertiles of NLR had a prolonged hospitalization (log-rank, P = 0.029), especially when associated with POA (log-rank, P = 0.012). At the multivariable analysis, higher age and NLR values were independently associated with SVT [OR per year 1.22; 95% CI (1.02, 1.25), P = 0.043 and OR per point 1.91; 95% CI (1.29, 2.82), P = 0.012, respectively], but not with JET. Conclusions 24-h post-CPB NLR can predict postoperative SVT in a population of pediatric CHD patients. Our data suggest that the NLR could be a useful, easy-to-obtain marker for postoperative outcome in pediatric patients who had undergone elective CPB.

Abstract 521: A Pilot Study Comparing Anti-Inflammatory Effects of Tranexamic Acid and Epsilon Aminocaproic Acid in Pediatric Congenital Heart Surgery

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Nirbhay Parashar ◽  
Tarek Nafee ◽  
Cheryl Lefaiver ◽  
Christine Steffensen ◽  
Vince Rizzo ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Pilot Study ◽  
Tranexamic Acid ◽  
Heart Surgery ◽  
Pediatric Patients ◽  
Aminocaproic Acid ◽  
Antifibrinolytic Agents ◽  
Gm Csf ◽  
Anti Inflammatory ◽  
Epsilon Aminocaproic Acid

Background: Antifibrinolytic agents are frequently used during pediatric heart surgery with cardiopulmonary bypass (CPB) to reduce transfusions. There are no studies comparing anti-inflammatory effects of antifibrinolytic agents, tranexamic acid (TXA) and Epsilon Aminocaproic acid (EACA). We compared the two agents in pediatric patients undergoing redo sternotomy with CPB. Aim: To compare anti-inflammatory effects of tranexamic acid versus aminocaproic acid in pediatric patients undergoing redo sternotomy and cardiopulmonary bypass. Methods: We conducted a randomized, double blind pilot study, comparing 10 subjects in each group receiving EACA and TXA. A cytokine panel was used to measure 13 inflammatory markers in pre, immediate post and 24 hours post-CPB period. Between group comparisons were tested with Mann-Whitney U tests and within group comparisons with Friedman tests. Results: Sample characteristics were comparable in both groups. Post CPB, plasma levels of 7 markers increased significantly (p<0.05) in both groups, including MCP-1; 3 increased significantly (p<0.03) in the EACA group alone, including GM-CSF; and 3 did not change over time (Table 1). No difference was found between groups for markers except for IL-10, which was significantly higher in EACA group post CPB. While absolute values of markers, chest tube output and volume of blood product needs were lower in TXA group, the differences were not statistically significant. Conclusion: There was no significant difference in anti-inflammatory profiles between EACA and TXA in this pilot study. GM-CSF and MCP-1 were increased in our study post CBP which has not been described in previous studies.

Pharmacokinetics of alfentanil before and after cardiopulmonary bypass in pediatric patients undergoing cardiac surgery: Part I

1992 ◽  
Vol 6 (3) ◽  
pp. 308-312 ◽  
Author(s):  
Jose M. den Hollander ◽  
Pim J. Hennis ◽  
Anton G.L. Burm ◽  
Arie A. Vletter ◽  
James G. Bovill
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pediatric Patients ◽  
Before And After

Platelet dysfunction after normothermic cardiopulmonary bypass in children: Effect of high-dose aprotinin

2007 ◽  
Vol 98 (08) ◽  
pp. 385-391 ◽  
Author(s):  
Claire Flaujac ◽  
Philippe Pouard ◽  
Pierre Boutouyrie ◽  
Joseph Emmerich ◽  
Christilla Bachelot-Loza ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Protective Effect ◽  
Platelet Activation ◽  
Platelet Function ◽  
Pediatric Patients ◽  
High Dose ◽  
Platelet Dysfunction ◽  
High Dose Aprotinin ◽  
Marker Expression ◽  
Heparin Neutralization

SummaryPlatelet dysfunction after cardiopulmonary bypass (CPB) can contribute to excessive post-operative bleeding. Most trials of the protective effect of aprotinin in this setting have involved hypothermic CPB, which is more deleterious for platelets than normothermic CPB.Here we investigated the effect of aprotinin on platelet function during normothermic CPB in pediatric patients. Twenty patients (9 newborns [<1 month old] and 11 infants [<36 month old]),weighting less than 15 kg and undergoing normothermic CPB (35–36°C) were randomly assigned to two equal groups,one of which received high-dose aprotinin.Platelet function was assessed by flow cytometry just before CPB and 5 minutes after heparin neutralization. F1+2 fragments were measured by ELISA before and 5 minutes after CPB. Platelet activation marker expression (CD62P and activated αIIbβ3) induced by ADP or TRAP was lower after CPB than before CPB, suggesting a deleterious effect of normothermic CPB on platelet function. Prothrombin fragment F1+2 levels increased after CPB. Aprotinin administration did not influence the level of prothrombin fragments or platelet marker expression measured in basal condition. However, after CPB, the capacity for platelet activation was higher in the aprotinin group, as shown by measuring CD62P expression afterTRAP activation (p=0.05).This study suggests that pediatric normothermic CPB causes platelet dysfunction, and that high-dose aprotinin has a protective effect.

scholarly journals Predictive Value of Plasma NGAL:Hepcidin-25 for Major Adverse Kidney Events After Cardiac Surgery with Cardiopulmonary Bypass: A Pilot Study

2021 ◽  
Vol 41 (4) ◽  
pp. 357-365
Author(s):  
Christian Albert ◽  
Michael Haase ◽  
Annemarie Albert ◽  
Martin Ernst ◽  
Siegfried Kropf ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pilot Study ◽  
Predictive Value ◽  
Major Adverse Kidney Events
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