Cardiopulmonary Bypass Emergencies and Intraoperative Issues

Gerstein, Neal S.; Panikkath, Pramod V.; Mirrakhimov, Aibek E.; Lewis, Alexander E.; Ram, Harish

doi:10.1053/j.jvca.2022.07.011

Cited by 2 publications

(2 citation statements)

References 102 publications

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“…Since the emergence and application of CPB in the 1950s, it has evolved into the cornerstone for supporting cardiac-related surgical management (27). However, CPB treatment is likely to cause different degrees of pulmonary complications, such as ALI, by causing inflammatory responses, I/R injuries, reactive oxygen species, and cell deaths (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

Zhang¹,

Li²,

An³

et al. 2023

Shock

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Introduction: Acute lung injury (ALI) is a devastating pulmonary illness with diffuse inflammatory responses. Hydromorphone (Hyd) is an opioid agonist used for relieving moderate-to-severe pain. The present work investigated the effect of Hyd on cardiopulmonary bypass (CPB)-induced ALI by regulating pyroptosis of alveolar macrophages (AMs). Methods: Rats were subjected to CPB, followed by Hyd treatment. The lung injury in rat lung tissues was appraised by the ratio of lung wet/dry weight (weight), histological staining, and the total protein concentrations in bronchoalveolar lavage fluid, and lung function was assessed by oxygenation index and respiratory index, and lung macrophage pyroptosis was observed by fluorescence staining. Alveolar macrophages were separated and pyroptosis was determined by western blot assay and enzyme-linked immunosorbent assay. The expression patterns of nuclear factor erythroid 2-related factor 2/heme oxygenase 1 (Nrf2/HO-1), nod-like receptor protein 3 (NLRP3), N-terminal gasdermin-D, and cleaved caspase-1 were examined by real-time quantitative polymerase chain reaction, western blot, and immunohistochemistry assays. The impact of NLRP3 or Nrf2 on pyroptosis of AMs and CPB-induced ALI was observed after treatment of nigericin (NLRP3 agonist) or ML385 (Nrf2 inhibitor). Results: Hyd attenuated CPB-induced lung injury as manifested by reductions in lung inflammation and edema, the scores of lung injury, the ratio of lung wet/dry weight, and the total protein concentrations in bronchoalveolar lavage fluid. Besides, Hyd repressed NLRP3 inflammasome-mediated pyroptosis of AMs after CPB treatment. Hyd upregulated Nrf2/HO-1 expression levels to repress NLRP3 inflammasome-mediated pyroptosis. Treatment of nigericin or ML385 counteracted the role of Hyd in ameliorating pyroptosis of AMs and CPB-induced ALI. Conclusions: Hyd alleviated NLRP3 inflammasome-mediated pyroptosis and CPB-induced ALI via upregulating the Nrf2/HO-1 pathway, which may be achieved by AMs.

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Section: Discussionmentioning

confidence: 99%

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

Zhang¹,

Li²,

An³

et al. 2023

Shock

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“…We observed similar finding in our cohort regarding the number of HITS and the type of procedure. Open heart cardiac surgery has a higher risk of incomplete deairing of the cardiac cavities, explaining the increased number of HITS as described in the literature [ 33 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Jarry,

Couture,

Beaubien-Souligny

et al. 2024

J Cardiothorac Surg

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Background During cardiac surgery, transcranial Doppler (TCD) represents a non-invasive modality that allows measurement of red blood cell flow velocities in the cerebral arteries. TCD can also be used to detect and monitor embolic material in the cerebral circulation. Detection of microemboli is reported as a high intensity transient signal (HITS). The importance of cerebral microemboli during cardiac surgery has been linked to the increased incidence of postoperative renal failure, right ventricular dysfunction, and hemodynamic instability. The objective of this study is to determine whether the embolic load is associated with hemodynamic instability during cardiopulmonary bypass (CPB) separation and postoperative complications. Methods A retrospective single-centre cohort study of 354 patients undergoing cardiac surgery between December 2015 and March 2020 was conducted. Patients were divided in tertiles, where 117 patients had a low quantity of embolic material (LEM), 119 patients have a medium quantity of microemboli (MEM) and 118 patients who have a high quantity of embolic material (HEM). The primary endpoint was a difficult CPB separation. Multivariate logistic regression was used to determine the potential association between a difficult CPB separation and the number of embolic materials. Results Patients who had a difficult CPB separation had more HITS compared to patients who had a successful CPB separation (p < 0.001). In the multivariate analysis, patients with MEM decreased their odds of having a difficult CPB weaning compared to patients in the HEM group (OR = 0.253, CI 0.111–0.593; p = 0.001). In the postoperative period patients in the HEM group have a higher Time of Persistent Organ Dysfunction (TPOD), a longer stay in the ICU, a longer duration under vasopressor drugs and a higher mortality rate compared to those in the MEM and LEM groups. Conclusion The result of this study suggests that a high quantity of cerebral embolic material increases the odds of having a difficult CPB separation. Also, it seems to be associated to more complex surgery, a longer CPB time, a higher TPOD and a longer stay in the ICU. Six out of eight patients who died in this cohort were in the HEM group.

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Cardiopulmonary Bypass Emergencies and Intraoperative Issues

Cited by 2 publications

References 102 publications

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

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