Priming fluids for cardiopulmonary bypass
Philip Kay, Christopher M Munsch in Techniques in Extracorporeal Circulation 4E, 2004
Priming the extracorporeal circuit with an appropriate volume of an appropriate fluid is a prerequisite for the initiation of cardiopulmonary bypass. During the early years of open-heart surgery, the whole extracorporeal circuit was primed with fresh heparinized homologous blood (Zuhdi et al., 1960). Shortly afterwards, the disadvantages and complications associated with blood priming demanded a search for alternative priming fluids (Gadboys et al., 1962). Nowadays, blood as priming fluid is rarely used for routine adult cardiopulmonary bypass, and instead a variety of artificial fluids are used to prime the extracorporeal circuit (Shah, 1992). This chapter reviews the classification and characteristics of priming fluids, the relationship between priming fluids and haemodilution, and the body’s reactions to the priming fluids, such as the allergic reactions and influences in blood coagulation and haemostasis. Some general principles for choosing the right priming fluid are discussed.
Cardiopulmonary bypass in children with congenital heart disease
Philip Kay, Christopher M Munsch in Techniques in Extracorporeal Circulation 4E, 2004
At present, the most common use of cardiopulmonary bypass is in the treatment of adults with acquired heart disease. The development of this technique, however, was originally driven by the need to perform intracardiac procedures for the correction of congenital heart defects in children. To allow access and visibility within the heart it was necessary to develop blood pumps and techniques for extracorporal oxygenation. After extensive laboratory research, 1953 saw the first successful use of a heart-lung bypass machine in humans by Gibbon (Gibbon, 1954) for the closure of an atrial septal defect (Warden et al., 1954). In 1955, Kirklin and colleagues (Kirklin et al., 1955) reported the first successful clinical series of intracardiac repairs. A further breakthrough came in the 1970s, when • There are important differences in the use of cardiopulmonary bypass in children with congenital cardiac abnormalities compared with its use in adults with normally connected hearts.
Endothelial and White Cell Activation in Bypass and Reperfusion Injury: Brain Injury
Richard A. Jonas, Jane W. Newburger, Joseph J. Volpe, John W. Kirklin in Brain Injury and Pediatric Cardiac Surgery, 2019
The role of endothelial and leukocyte adhesion molecules in the vascular damage and subsequent organ dysfunction related to cardiopulmonary bypass is an emerging area of interest that is based on the intense and continuing basic discoveries in the area of cellular adhesion research. Leukocyte and endothelial adhesion and subsequent activation underlie both the vascular injury resulting from extracorporeal circulation per se as well as that resulting from the ischemia and reperfusion that occur during bypass and circulatory arrest. Such injury may well underlie a substantial proportion of the brain injury resulting from pediatric cardiac surgery. Subsequent adherence to specific endothelial ligands plays a role in localization of leukocytes in specific vascular beds in poorly understood ways and also appears to result in secretory functions by the leukocyte. Deliberate, hypothermic ischemia with subsequent reperfusion is used routinely during clinical cardiopulmonary bypass in specific organ beds and, as total circulatory arrest, in the entire body including the brain.
Platelet function after cardiac surgery and its association with severe postoperative bleeding: the PLATFORM study
Published in Platelets, 2019
Marco Ranucci, Valeria Pistuddi, Umberto Di Dedda, Lorenzo Menicanti, Carlo De Vincentiis, Ekaterina Baryshnikova
Platelet dysfunction after cardiac surgery is a determinant of postoperative bleeding. The existing guidelines suggest the use of desmopressin and/or platelet concentrate transfusions in case of platelet dysfunction in bleeding patients, but no cut-off values for platelet activity exist in the literature. The Platelet Function in the Operating Room (PLATFORM) study aims to identify the relationship between platelet function after cardiopulmonary bypass and severe bleeding, finding adequate predictive values of platelet function for severe bleeding. The PLATFORM is a prospective cohort study on 490 adult patients receiving cardiac surgery with cardiopulmonary bypass. Patients received platelet function tests (multiple electrode aggregometry ADPtest and TRAPtest) before surgery and after cardiopulmonary bypass, and routine coagulation tests before surgery and at the arrival in the intensive care unit. The post-cardiopulmonary bypass ADPtest and TRAPtest were significantly (P = 0.001) associated with severe bleeding, as well as the post-cardiopulmonary bypass activated partial thromboplastin time, the international normalized ratio, and the fibrinogen concentration. At a multivariable analysis, the ADPtest (odds ratio 0.962, 95% confidence interval 0.936–0.989, P = 0.005) and the activated partial thromboplastin time (odds ratio 1.097, 95% confidence interval 1.016–1.185, P = 0.017) remained independently associated with severe bleeding. The post-cardiopulmonary bypass ADPtest had the best discrimination, with an area under the curve of 0.712. The best positive predictive value (42%) was found at a cut-off ≤8 U. In conclusion, platelet function tests after cardiopulmonary bypass are significantly associated with postoperative bleeding. However, postoperative bleeding has a multifactorial nature, and the measure of platelet function alone does not provide a high positive predictive value for severe bleeding.
Anterior ischemic optic neuropathy following off-pump cardiac bypass surgery
Published in Seminars in Ophthalmology, 2003
Susanne Tidow-Kebritchi, Walter Jay
Anterior ischemic optic neuropathy (AION) is a well-described cause of visual loss in patients who have undergone cardiac surgery with cardiopulmonary bypass. The etiology of AION following cardiac surgery with cardiopulmonary bypass is believed to be multifactorial. Microembolisation and pump-related platelet dysfunction have been considered risk factors for the development of AION following cardiac surgery with cardiopulmonary bypass. Currently, 10-15% of cardiac procedures are performed without cardiopulmonary bypass to reduce morbidity. To the best of our knowledge, this is the second report of a patient who underwent off-pump cardiac surgery and developed an AION postoperatively. The patient's potential risk factors were severe anemia, new onset of atrial fibrillation with rapid ventricular rate, hypotension postoperatively, a small optic disc, uncontrolled diabetes mellitus and a past medical history of hypertension and coronary artery disease.
Off-pump coronary artery bypass graft surgery: where should we stand?
Published in Expert Review of Cardiovascular Therapy, 2005
Coronary artery bypass grafting (CABG) performed with cardiopulmonary bypass has become a well-established treatment modality for patients with coronary artery disease. However, there is increasing evidence that cardiopulmonary bypass may be responsible for some of the morbidity associated with CABG surgery. Thus, it has been proposed that CABG surgery would be safer if cardiopulmonary bypass could be avoided. The development of cardiac stabilization devices has allowed for the creation of safe and reproducible coronary anastomoses on the beating heart. Several large, non-randomized, retrospective case series have demonstrated that CABG surgery can be performed safely without cardiopulmonary bypass (off-pump) and have in fact suggested benefits when compared with conventional CABG. However, the randomized controlled studies published to date have, as a whole, been unable to conclusively demonstrate the advantages of off-pump surgery. Taken together, the evidence to date suggests that a large-scale, prospective, randomized trial may be required to resolve the dilemma.