scholarly journals Retrospective evaluation of ultrafiltration during cardiac surgery with cardiopulmonary bypass in adult patients with increased neutrophil to lymphocyte ratio

2020 ◽  
Vol 4 (12) ◽  
pp. 1209-1214
Author(s):  
Şahin ŞAHİNALP ◽  
Kadir ÇEVİKER ◽  
M.f.tolga SOYAL ◽  
Ali GÜR
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Adult Patients ◽  
Neutrophil To Lymphocyte Ratio ◽  
Retrospective Evaluation ◽  
Lymphocyte Ratio

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.

scholarly journals Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes

2017 ◽  
Vol Volume 8 ◽  
pp. 9-14 ◽  
Author(s):  
Konstantinos Giakoumidakis ◽  
Nikolaos Fotos ◽  
Athina Patelarou ◽  
Stavros Theologou ◽  
Mihalis Argiriou ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Patient Outcomes ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cardiac Surgery Patient ◽  
Lymphocyte Ratio ◽  
Surgery Patient

Propofol requirement titrated to bispectral index: a comparison between hypothermic and normothermic cardiopulmonary bypass

Perfusion ◽  
2009 ◽  
Vol 24 (1) ◽  
pp. 27-32 ◽  
Author(s):  
PJ Mathew ◽  
GD Puri ◽  
RS Dhaliwal
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bispectral Index ◽  
Adult Patients ◽  
Study Group ◽  
Factors Affecting ◽  
Inter Quartile Range ◽  
Elective Cardiac Surgery ◽  
Quartile Range ◽  
Hypothermic Group

Though propofol requirement is expected to decrease during cardiopulmonary bypass (CPB), a few studies have failed to demonstrate this. The factors affecting pharmacokinetics of propofol and, therefore, the requirement, are different during hypothermic and normothermic CPB. We evaluated and compared the requirement of propofol during hypothermic and normothermic CPB. Fifty adult patients scheduled for elective cardiac surgery on CPB were recruited and randomly allocated into hypothermic CPB (28–300 C) (Group H) and normothermic CPB (35–370 C) (Group N) groups. Patients were induced and maintained with propofol titrated to maintain a target bispectral index (BIS) of 50 ± 10. Propofol requirement (mean ± SD) was similar in normothermic and hypothermic groups, both before CPB (4.9 ± 1.5 mg.kg−1hr−1 in Group N, 4.6 ± 1.5 mg.kg−1hr−1 in Group H) and after cessation of bypass (p > 0.05) (4.6 ± 1.8 mg.kg−1hr−1 in Group N and 4.3 ± 1.7 mg.kg−1hr−1 in Group H). CPB significantly reduced (p < 0.001) propofol requirements in both arms of the study (Group N: 2.9 ± 1.4 mg.kg−1hr−1and Group H: 1.3 ± 0.7 mg.kg−1hr−1). This reduction was more pronounced in the hypothermic group (p < 0.001). The BIS (median ± inter quartile range) remained constant during normothermic CPB (50 ± 8.8), but declined significantly during hypothermic CPB (41 ± 5.6) despite decreased usage of propofol during hypothermia. No patient had recall of intra-operative events. CPB decreases the magnitude of propofol requirements and the effect of hypothermic CPB is significantly more than that of normothermic CPB.

A guideline nomogram to control intraoperative haemodilution in cardiac surgery

Perfusion ◽  
1994 ◽  
Vol 9 (1) ◽  
pp. 65-69 ◽  
Author(s):  
M. Ranucci ◽  
D. Conti
Keyword(s):  
Cardiac Surgery ◽  
Statistical Analysis ◽  
Cardiopulmonary Bypass ◽  
Autologous Blood ◽  
Adult Patients ◽  
Fluid Replacement ◽  
Blood Collection ◽  
Common Procedure ◽  
Theoretical Assumptions ◽  
Set Up

Intraoperative blood collection prior to cardiopulmonary bypass (CPB) is a common procedure in cardiac surgery. Its aims are to obtain fresh whole blood to be infused after CPB, to use autologous blood in the prime or to avoid too high levels of haematocrit (HCT) during CPB. Calculations to determine the amount of blood to be collected are generally based on theoretical assumptions. In this paper we have set up and controlled, on a clinical basis, a nomogram to be used in order to obtain a standard pre-CPB HCT equal to 38%, using a moderately hypervolaemic haemodilution based on blood collection simultaneous with fluid replacement. Thirty adult patients were evaluated in order to settle the nomogram; subsequently, the nomogram validity was checked on 100 adult patients. Statistical analysis revealed the good clinical usefulness of this instrument.

scholarly journals Del Nido Cardioplegia Versus Cold Blood Cardioplegia in Adult Cardiac Surgery: Protocol for a Randomized Controlled Trial

10.2196/17826 ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. e17826
Author(s):  
Jessica Garcia-Suarez ◽  
Javier Garcia Fernandez ◽  
Sergio Sanz ◽  
Daniel Martinez Lopez ◽  
Leticia Reques ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Myocardial Protection ◽  
Primary Outcome ◽  
Retrospective Studies ◽  
Adult Patients ◽  
Blood Cardioplegia ◽  
Cardioplegia Solution ◽  
Adult Cardiac Surgery

Background The use of cardioplegia solutions as a myocardial protection technique is essential during cardiac surgery with cardiopulmonary bypass. The del Nido cardioplegia solution (DNS) has been widely used as a myocardial preservation technique for pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Its unique pharmacological features have created growing interest for adult cardiac surgery, especially for elderly patients or those with ventricular dysfunction who are more prone to ischemia-reperfusion injury. Ever since its implementation, several retrospective studies have been published to validate the efficacy, safety, and efficiency of DNS in adult patients undergoing coronary revascularization, valve replacement, or combined procedures. Recently, a meta-analysis based on nine retrospective studies was published claiming the noninferiority of DNS compared to other conventional cardioplegia solutions. Few prospective randomized studies have been conducted whose primary outcome was the assessment of DNS clinical efficacy compared to other solutions commonly used in adult patients. Objective The aim of this randomized clinical trial is to assess the benefits of DNS compared to Cardi-Braun blood cardioplegia solution in clinical and biochemical terms regarding myocardial protection during adult cardiac surgery. Methods This is the protocol of a controlled, randomized, single-center clinical trial carried out at the Puerta de Hierro Majadahonda University Hospital in Spain. A total of 474 participants over the age of 18 years undergoing elective cardiac surgery with cardiopulmonary bypass will be assigned to groups by simple randomization to receive either DNS or Cardi-Braun blood cardioplegia solution. The primary outcome will be the differences between groups in myocardial protection in biochemical terms (ie, perioperative troponin levels) and clinical terms (ie, presence of the composite variable acute cardiovascular event). The clinical trial will be carried out under conditions of respect for the fundamental rights of the person and the ethical principles that affect biomedical research with human beings, as well as in accordance with international recommendations contained in the Declaration of Helsinki and its subsequent revisions. Results The inclusion process started in 2018. Data cleaning and analyses are expected to take place in the fall of 2020 and the results are expected in January 2021. Conclusions This study is particularly relevant as it will be one of the first to analyze the clinical effects of del Nido cardioplegia on the basis of direct myocardial protection parameters. In light of published studies, carrying out prospective studies based on primary clinical objectives with a larger sample, high-risk patients, and longer cardiopulmonary bypass times continues to be necessary. We believe that our study addresses an important gap in the knowledge of del Nido cardioplegia in adult patient cardiac surgery and will be able to clarify the possible benefits of this method in a large population of patients undergoing these procedures. Trial Registration European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) 2017-005144-14; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-005144-14+; ClinicalTrials.gov NCT04094168; https://clinicaltrials.gov/ct2/show/NCT04094168 International Registered Report Identifier (IRRID) DERR1-10.2196/17826

Relation between Prolonged Cardiopulmonary Bypass Time in Cardiac Surgery in Adult Patients and Post-Operative Acute Kidney Injury

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abd-El Khalek Mohamed Ali ◽  
Diaa Abd-El Khalek Akl ◽  
Mohamed Samir Mohamed Salama
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Adult Patients ◽  
Cardiopulmonary Bypass Time ◽  
Elective Cardiac Surgery ◽  
Short And Long Term ◽  
Long Term Prognosis

Abstract Background Cardiac-surgery associated acute kidney injury (CSA-AKI) remains an important and frequent complication in patients undergoing cardiac surgery and is associated with a poor short- and long-term prognosis. The incidence for CSA-AKI according to Acute Kidney Injury Network criteria (AKIN) varies between 3% and 50%. CSA-AKI requiring temporary renal replacement therapy (RRT) occurs in 5% to 20% of these patients and is associated with a high mortality rate. Objective To detect the relation between prolonged cardiopulmonary bypass time in cardiac surgery and the incidence of post-operative acute kidney injury. Patients and Methods This is an observational retrospective study conducted on (80) adult patients who underwent elective cardiac surgery at Aswan Heart Centre (Magdi Yacoub Foundation) after the approval of the Ethical Medical Committee of Aswan Heart Centre. Results Results of the statistical analysis of the present study showed that mean CPB duration was prolonged in the AKI group of patients (155 min) than the non-AKI group of patients (129 min). Conclusion Prolonged cardiopulmonary bypass duration may be an independent risk factor for acute kidney injury post cardiac surgery in adult patients.

Effect of Subzero-Balanced Ultrafiltration on Lung Gas Exchange Capacity after Cardiopulmonary Bypass in Adult Patients with Heart Valve Disease

2011 ◽  
Vol 14 (1) ◽  
pp. 22 ◽  
Author(s):  
Tao Zhang ◽  
Sheng-li Jiang ◽  
Chang-qing Gao ◽  
Jin Luo ◽  
Lan Ma ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Gas Exchange ◽  
Heart Valve ◽  
Exchange Capacity ◽  
Adult Patients ◽  
Heart Valve Disease ◽  
Arterial Oxygen ◽  
Control Group ◽  
Study Group

Objectives: This study was conducted to evaluate the effect of a new ultrafiltration techniquethe subzerobalanced ultrafiltration (SBUF)on lung gas exchange capacity after cardiopulmonary bypass (CPB) in adult patients with heart valve disease.Background: Attenuation of lung gas exchange capacity is one of the most common manifestations of an inflammatory response after CPB.Methods: Ninety-four patients who required CPB for cardiac surgery were randomized into 2 groups according to whether they received SBUF. Gas exchange capacity expressed as the oxygen index (OI), the respiratory index (RI), and the alveolar-arterial oxygen pressure difference (P(A-a)O2) were measured after intubation (T1), at the termination of CPB (T2), on admission to the intensive care unit (ICU) (T3), at postoperative hour 6 (T4), and at postoperative hour 12 (T5).Results: There were no significant differences in gas exchange capacity between the 2 groups at T1, T4, and T5. CPB produced significant changes in OI, RI, and P(A-a)O2 in the control group, whereas these changes were not significantly different in the study group. The OI in the study group was significantly higher at T2, and RI and P(A-a)O2 were significantly lower at T2 and T3. In the study group, the intubation time was shorter, and the transfusion volume within 24 hours postoperatively was less. The 2 groups were comparable with respect to the incidence of respiratory complications, length of stay in the ICU, duration of hospital stay, need for infusions of inotropic agents, and drainage volumes within 24 hours postoperatively.Conclusions: SBUF during CPB can produce an immediate improvement in lung gas exchange capacity, which may effectively minimize pulmonary dysfunction in adult patients undergoing cardiac surgery.

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