Objective. Activation of innate immunity cells is inseparably linked to cardiac surgical operation. The aim of this study was to assess the kinetics in the expression of receptor for Fc part of IgG, FcγRI (CD64), and scavenger receptor CD163 on peripheral blood cells of cardiac surgical patients and to examine the effect of cardiac bypass as a separable influence on the systemic acute inflammatory response. Methods. Forty patients, twenty in each group, were randomly assigned to CABG surgery performed either with “on-pump” or without “off-pump” cardiopulmonary bypass. Standardized quantitative flow cytometry method was used to determine the expression of surface markers. Results. The density of CD64 molecule on monocytes reached maximum on the 1st postoperative day (P<.001) whereas the peak for CD64 molecule expression on granulocytes was postponed to the 3rd postoperative day (P<.001). The expression of CD163 scavenger molecule on monocytes reached maximum on the 1st postoperative day (P<.001). The density of CD163 molecule on monocytes on the 1st postoperative day is significantly higher in “on-pump” patients in comparison with “off-pump” patients (P<.001). Conclusion. In cardiac surgical patients the expression of activation marker FcγR1 (CD64) on monocytes is increased earlier in comparison with granulocytes in both “on-pump” and “off-pump” patients. The expression of scavenger molecule CD163 on monocytes is significantly higher in “on-pump” patients.

Operations performed with the use of CPB are associated with a more pronounced release of PTX3 immediately after operation.

Our preliminary results show that CPB can modify the time course of cephuroxime plasma and tissue concentrations. A decrease in plasma drug concentrations occurred at the start of CPB and lasted until CPB ended. An increase in plasma concentrations corresponds to the second drug dose after CPB. The concentrations of cephuroxime in skeletal muscle (corrected by recovery) during CPB are higher than plasma concentrations. It is influenced by important changes during CPB; closely associated with hemodilution, a shift of intravascular volume, solutes and albumin to the extravascular space and inconstant protein binding of cephuroxime during operation.

Úvod: Kombinované srdeční operace s resekčními výkony na plicích jsou stále kontroverzním tématem. Tento přístup umožňuje léčbu dvou různých onemocnění v rámci jedné intervence, celkově kratší dobu hospitalizace, menší zátěž pro nemocného a nižší náklady spolu s uspokojivými výsledky. Diskutovanou otázkou zůstává nejasný vliv mimotělního oběhu na rozsev malignity, dostatečnost rozsahu plicní resekce z nestandardního chirurgického přístupu a větší riziko pooperačního krvácení. Metody: Od listopadu 2010 do dubna 2014 podstoupilo na naší klinice celkem deset nemocných (devět mužů, jedna žena) kombinovaný kardiochirurgický výkon spolu s resekcí plic (průměrný věk 69 ± 7 let). Patologický nález na plicích byl následující (čtyři primární karcinomy, čtyři benigní léze, jedna metastáza, jeden karcinoid). Pravá plíce byla operována v pěti případech, levá plíce také v pěti případech (pětkrát lobektomie, jednou extraanatomická resekce, třikrát enukleace). V jednom případě, v souvislosti s rozsahem malignity, byla provedena pouze explorace, pneumonektomie poté v druhé době z thorakotomie. Kardiochirurgické výkony byly následující: pětkrát aortokoronární bypass, třikrát náhrada aortální chlopně, jednou náhrada mitrální chlopně, jednou náhrada vzestupné aorty, třikrát ablace MAZE. Sternotomie byla metodou přístupu v osmi případech, ve dvou byla použita levostranná thorakotomie a revaskularizace myokardu byla provedena metodou MIDCAB (minimally invasive direct coronary artery bypass). Revaskularizace bez mimotělního oběhu byla použita čtyřikrát. Výsledky: V souboru byla zaznamenána nulová hospitalizační mortalita. Žádný z nemocných nebyl revidován pro pooperační krvácení, všechny kardiochirurgické výkony byly bez komplikací. V jednom případě byl léčen protrahovaný "air-leak". Všichni nemocní s benigním nálezem (čtyři) jsou naživu. Nemocný s rozsáhlou malignitou, operovaný dvoufázově, zemřel v terminální fázi onemocnění. Další nemocný s malignitou zemřel z důvodů nevztahujících se k operaci rok po výkonu. Ostatní jsou pravidelně sledováni v pneumo-onkologické ambulanci. Závěr: Kombinované srdeční operace s resekčními výkony na plicích mohou být prováděny bez zvýšené mortality a morbidity. Tento přístup eliminuje nutnost druhé intervence a má uspokojivé výsledky.

The aim of this study was to monitor the metabolism and blood flow in the interstitium of the skeletal muscle during cardiac surgery with cardiopulmonary bypass (CPB) and in the early postoperative period by means of microdialysis and to compare metabolic changes during CPB at normothermia (NT) and hypothermia (HT). Surgical revascularization using CPB was performed in 50 patients, 25 patients (group HT) were operated using hypothermic CPB, 25 (group NT) using normothermic CPB. Interstitial microdialysis was performed by two CMA 60 probes (CMA Microdialysis AB, Solna, Sweden) inserted into the patient's deltoid muscle. Constituents analysed in the obtained dialysates, collected at intervals, were glucose, urea, glycerol and lactate. Tissue blood flow was monitored by dynamic microdialysis with gentamicin as a marker. In both groups, NT versus HT, similar dynamics of concentrations were found. Low initial concentrations were followed by gradual increases during CPB and in the following phase of the operation. Concentrations were higher in the NT group. Immediately after the operation, the decrease in values continued, with a gradual increase in the succeeding postoperative period in both groups. Similar dynamic changes in the lactate concentration were found in both groups. The gentamicin concentrations were lower in the NT group (versus the HT group). The results showed dynamic changes in the interstitial concentrations of glucose, urea, glycerol and lactate, which depend on the phase of the surgery in the CPB and early postoperative phase in the both groups of patients. Higher tissue perfusion of the skeletal muscle was noted in those patients operated on in normothermia. The dynamics of the concentration changes of these substances in the interstitium of the skeletal muscle has been proven to be caused by both the metabolic activity of the tissue and by the blood flow through the interstitium of the muscle.

Cardiotomy suction is used for preservation of autologous blood during on-pump cardiac surgery at present. Controversially, the exclusion of cardiotomy suction in some types of operations (coronary artery bypass surgery) is not necessarily associated with an increased transfusion requirement. On the other hand, the use of cardiotomy suction causes an amplification of systemic inflammatory response and a resulting coagulopathy, as well as exacerbation of the microembolic load and hemolysis. This leads to a tendency towards increased blood loss, transfusion requirement and organ dysfunction. On the basis of these facts, it is appropriate to reconsider routine use of cardiotomy suction in on-pump coronary artery surgery.

Aim.To compare assessment of fibrinogen by thromboelastography with the standard von Clauss method. Methods. Observational prospective study. Results. Thromboelastography provides direct and complex evaluation of the entire coagulation cascade based upon changes in blood viscosity. It affects both platelets and plasma components. New application of this method measures fibrinogen contribution to coagulation as opposed to fibrinogen antigen levels measured by immunoassay. Paired samples from 117 patients before cardiopulmonary bypass were compared. A moderate correlation was found between fibrinogen and functional fibrinogen with a Spearman correlation coefficient of 0.476. Conclusion. The functional fibrinogen test is a valid point-of-care method for fibrinogen assay with a moderate correlation to the standard method.

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