scholarly journals Foley catheter and deep hypothermic circulatory arrest to control bleeding in redo cardiac surgery

2004 ◽  
Vol 51 (3) ◽  
pp. 117-119
Author(s):  
Dusko Nezic ◽  
S. Borovic ◽  
Milan Cirkovic ◽  
Ljiljana Lausevic-Vuk ◽  
A. Kenkovski ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Circulatory Arrest ◽  
Foley Catheter ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
The Right ◽  
Right Atria ◽  
Combined Technique ◽  
Uncontrolled Bleeding

Two cases with catastrophic hemorrhage in redo cardiac surgery are described. In the first one tearing of right ventricle with uncontrolled bleeding occurred during sternal reentry. In the second one, tearing of the right atria occurred while the patient was on cardiopulmonary bypass. In both cases we were able to control bleeding using Foley catheter, which enabled us to proceed to deep hypothermic circulatory arrest to repair heart chambers (due to dense adhesions it was impossible to m?nage it in any other way). We have found this combined technique to be extremely useful tool to control catastrophic hemorrhage during redo cardiac surgery.

scholarly journals Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest

2020 ◽  
Author(s):  
Ludmila Khailova ◽  
Justin Robison ◽  
James Jaggers ◽  
Richard Ing ◽  
Scott Lawson ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Phosphatase Activity ◽  
Alkaline Phosphatase Activity ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Swine Model ◽  
Intestinal Alkaline Phosphatase

Abstract Background: Infant cardiac surgery with cardiopulmonary bypass results in decreased circulating alkaline phosphatase that is associated with poor post-operative outcomes. Bovine intestinal alkaline phosphatase infusion represents a novel therapy for post-cardiac surgery organ injury. However, the effects of cardiopulmonary bypass and bovine-intestinal alkaline phosphatase infusion on tissue-level alkaline phosphatase activity/expression are unknown.Methods: Infant pigs (n=20) underwent cardiopulmonary bypass with deep hypothermic circulatory arrest followed by four hours of intensive care. Seven control animals underwent mechanical ventilation only. Cardiopulmonary bypass/deep hypothermic circulatory arrest animals were given escalating doses of bovine intestinal alkaline phosphatase infusion (0-25U/kg/hr; n=5/dose). Kidney, liver, ileum, jejunum, colon, heart and lung were collected for measurement of tissue alkaline phosphatase activity and mRNA.Results: Tissue alkaline phosphatase activity varied significantly across organs with the highest levels found in the kidney and small intestine. Cardiopulmonary bypass with deep hypothermic circulatory arrest resulted in decreased kidney alkaline phosphatase activity and increased lung alkaline phosphatase activity, with no significant changes in the other organs. Alkaline phosphatase mRNA expression was increased in both the lung and the ileum. The highest dose of bovine intestinal alkaline phosphatase resulted in increased kidney and liver tissue alkaline phosphatase activity.Conclusions: Changes in alkaline phosphatase activity after cardiopulmonary bypass with deep hypothermic circulatory arrest and bovine intestinal alkaline phosphatase delivery are tissue specific. Kidneys, lung, and ileal alkaline phosphatase appear most affected by cardiopulmonary bypass with deep hypothermic circulatory arrest and further research is warranted to determine the mechanism and biologic importance of these changes.

A novel augmented venous-drainage model of cardiopulmonary bypass for deep hypothermic circulatory arrest without blood priming

Perfusion ◽  
2017 ◽  
Vol 33 (4) ◽  
pp. 297-302 ◽  
Author(s):  
Xuan Jiang ◽  
Tianxiang Gu ◽  
Yu Liu ◽  
Chun Wang ◽  
Enyi Shi ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Femoral Artery ◽  
Jugular Vein ◽  
Circulatory Arrest ◽  
Venous Drainage ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Blood Gas ◽  
Left Femoral Artery ◽  
The Right

Objective: Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) are commonly used in cardiac surgery. However, the mortality and morbidity are still high in practice. Developing novel protective stategies and elucidating the underlying mechanisms for the pathophysiological consequences of DHCA have been hampered because of the absence of a satisfactory recovery animal model. The aim of this study was to establish a novel and safe DHCA model without blood priming in rats to study the pathophysiology of potential complications. Methods: Ten adult male Sprague-Dawley rats (age, 14-16 weeks; weight, 200-300g) were used. The entire CPB circuit consisted of a modified reservoir, a custom-designed small-volume membrane oxygenator, a roller pump and a home-made heat exchanger, all of which were connected via silicon tubing. The volume of the priming solution was less than 10 ml. The right jugular vein, right carotid artery and left femoral artery were cannulated. The blood was drained from the right atrium through the right jugular vein and fed back to the rat via the left femoral artery. CPB was commenced at a full flow rate. The animals were cooled to a pericranial temperature of 18°C and then subjected to 45 minutes of DHCA with global ischemia. Circulatory arrest was followed by rewarming and over 60 minutes of reperfusion. CPB was terminated carefully. Blood in the circuit was centrifuged and slowly transfused to achieve optimal hematocrit. Blood gas and hemodynamic parameters were recorded at each time point before CPB, during CPB and after CPB. Results: All CPB and DHCA processes were achieved successfully. No rat died in our research. Blood gas analyses at different times were normal. Cardiac function and blood pressure were stable after the operation. The vital signs of all the rats were stable. Conclusion: The novel augmented venous-drainage CPB and DHCA model in rats could be established successfully without blood priming.

scholarly journals Plasma prohepcidin as a negative acute phase reactant after large cardiac surgery with a deep hypothermic circulatory arrest

2009 ◽  
pp. 827-833
Author(s):  
P Maruna ◽  
J Lindner ◽  
J Kunštýř ◽  
K Kubzová ◽  
J Hubáček
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Acute Phase ◽  
Iron Metabolism ◽  
Circulatory Arrest ◽  
Acute Phase Reactant ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Pulmonary Endarterectomy ◽  
Phase Reactant

Hepcidin is a key regulator of iron metabolism and a mediator of anemia in inflammation. Recent in vitro studies recognized prohepcidin as a type II acute phase protein regulating via interleukin-6. The aim of the present study was to investigate the time course of plasma prohepcidin after a large cardiac surgery in relation to IL-6 and other inflammatory parameters. Patients with chronic thromboembolic hypertension (n=22, males/females 14/8, age 51.9±10.2 years) underwent pulmonary endarterectomy using cardiopulmonary bypass and deep hypothermic circulatory arrest were included into study. Arterial concentrations of prohepcidin, IL-1β, IL-6, IL-8, tumor necrosis factor-α, and C-reactive protein were measured before/after sternotomy, after circulatory arrest, after separation from bypass, and then 12, 18, 24, 36, 48 h and 72 h after the separation from bypass. Hemodynamic parameters, hematocrit and markers of iron metabolism were followed up. Pulmonary endarterectomy induced a 48 % fall in plasma prohepcidin; minimal concentrations were detected after separation from cardiopulmonary bypass. Prohepcidin decline correlated with an extracorporeal circulation time (p<0.01), while elevated IL-6 levels were inversely associated with duration of prohepcidin decline. Postoperative prohepcidin did not correlate with markers of iron metabolism or hemoglobin concentrations within a 72-h period after separation from CPB. Prohepcidin showed itself as a negative acute phase reactant during systemic inflammatory response syndrome associated with a cardiac surgery. Results indicate that the evolution of prohepcidin in postoperative period implies the antagonism of stimulatory effect of IL-6 and contraregulatory factors inhibiting prohepcidin synthesis or increasing prohepcidin clearance.

scholarly journals Alkaline Phosphatase Treatment of Acute Kidney Injury in an Infant Piglet Model of Cardiopulmonary Bypass with Deep Hypothermic Circulatory Arrest

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jesse A. Davidson ◽  
Ludmila Khailova ◽  
Amy Treece ◽  
Justin Robison ◽  
Danielle E. Soranno ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Circulatory Arrest ◽  
Kidney Injury ◽  
Renal Tissue ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
High Dose

Abstract Acute kidney injury (AKI) is associated with prolonged hospitalization and mortality following infant cardiac surgery, but therapeutic options are limited. Alkaline phosphatase (AP) infusion reduced AKI in phase 2 sepsis trials but has not been evaluated for cardiac surgery-induced AKI. We developed a porcine model of infant cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA) to investigate post-CPB/DHCA AKI, measure serum/renal tissue AP activity with escalating doses of AP infusion, and provide preliminary assessment of AP infusion for prevention of AKI. Infant pigs underwent CPB with DHCA followed by survival for 4 h. Groups were treated with escalating doses of bovine intestinal AP (1, 5, or 25U/kg/hr). Anesthesia controls were mechanically ventilated for 7 h without CPB. CPB/DHCA animals demonstrated histologic and biomarker evidence of AKI as well as decreased serum and renal tissue AP compared to anesthesia controls. Only high dose AP infusion significantly increased serum or renal tissue AP activity. Preliminary efficacy evaluation demonstrated a trend towards decreased AKI in the high dose AP group. The results of this dose-finding study indicate that AP infusion at the dose of 25U/kg/hr corrects serum and tissue AP deficiency and may prevent AKI in this piglet model of infant CPB/DHCA.

scholarly journals Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest

2020 ◽  
Author(s):  
Ludmila Khailova ◽  
Justin Robison ◽  
James Jaggers ◽  
Richard Ing ◽  
Scott Lawson ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Phosphatase Activity ◽  
Alkaline Phosphatase Activity ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Swine Model ◽  
Intestinal Alkaline Phosphatase

Abstract Background: Infant cardiac surgery with cardiopulmonary bypass results in decreased circulating alkaline phosphatase that is associated with poor postoperative outcomes. Bovine intestinal alkaline phosphatase infusion represents a novel therapy for post-cardiac surgery organ injury. However, the effects of cardiopulmonary bypass and bovine-intestinal alkaline phosphatase infusion on tissue-level alkaline phosphatase activity/expression are unknown.Methods: Infant pigs (n=20) underwent cardiopulmonary bypass with deep hypothermic circulatory arrest followed by four hours of intensive care. Seven control animals underwent mechanical ventilation only. Cardiopulmonary bypass/deep hypothermic circulatory arrest animals were given escalating doses of bovine intestinal alkaline phosphatase infusion (0-25U/kg/hr; n=5/dose). Kidney, liver, ileum, jejunum, colon, heart and lung were collected for measurement of tissue alkaline phosphatase activity and mRNA.Results: Tissue alkaline phosphatase activity varied significantly across organs with the highest levels found in the kidney and small intestine. Cardiopulmonary bypass with deep hypothermic circulatory arrest resulted in decreased kidney alkaline phosphatase activity and increased lung alkaline phosphatase activity, with no significant changes in the other organs. Alkaline phosphatase mRNA expression was increased in both the lung and the ileum. The highest dose of bovine intestinal alkaline phosphatase resulted in increased kidney and liver tissue alkaline phosphatase activity.Conclusions: Changes in alkaline phosphatase activity after cardiopulmonary bypass with deep hypothermic circulatory arrest and bovine intestinal alkaline phosphatase delivery are tissue specific. Kidneys, lung, and ileal alkaline phosphatase appear most affected by cardiopulmonary bypass with deep hypothermic circulatory arrest and further research is warranted to determine the mechanism and biologic importance of these changes.

Cardiopulmonary bypass and deep hypothermic circulatory arrest in a massively obese patient

Perfusion ◽  
2008 ◽  
Vol 23 (4) ◽  
pp. 243-245 ◽  
Author(s):  
J Molnar ◽  
S Colah ◽  
M Larobina ◽  
SR Large ◽  
JE Arrowsmith ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hospital Length ◽  
Hypothermic Circulatory Arrest ◽  
Hospital Length Of Stay ◽  
Morbidly Obese ◽  
Circuit Components ◽  
Selection Of

As a consequence of the rising global prevalence and magnitude of obesity, a greater proportion of patients presenting for cardiac surgery is morbidly obese. Being overweight (body mass index; BMI 25-29.9 kg/m2) or obese (BMI 30-35 kg/m2) appears to confer some survival benefit following cardiac surgery. By contrast, morbid obesity (BMI >40 kg/m2) is associated with an increased likelihood of postoperative complications and prolonged intensive care unit and hospital length of stay. The physical difficulties encountered when managing this group of patients is exemplified by those undergoing complex, multiple procedures requiring prolonged cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). We present the successful management of a massively obese 19-year-old male (BMI 45 kg/m2) with Marfan’s syndrome who required aortic root and arch replacement under DHCA. The selection of extracorporeal circuit components to accommodate a large circulating volume and permit high CPB flow rates (>9 l/min) is discussed.

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