Cardiopulmonary bypass for pediatric cardiac surgery

Chakraborty

et al. 2020

Kidney Res Clin Pract

Cardiac surgery in the pediatric population is performed for a variety of reasons, including correction of congenital heart disease and acquired cardiac conditions. Pediatric cardiac surgery is not, however, without its risks, as post-operative complications have been seen in up to 43% of cases [1]. Among the risks is the development of acute kidney injury (AKI), a relatively common complication that can arise in the presence of multiple risk factors. Although AKI's exact mechanism, AKI's longterm outcomes, and treatment of AKI have yet to be fully illuminated, there have been advancements on these topics. Here, we describe the current understanding and practices as well as advances on the incidence, risk fac

Section: Intraoperativementioning

confidence: 99%

“…These factors include use of CPB, length of CPB, blood transfusions, and intraoperative hypotension. Although CPB provides for continued perfusion of body organs during heart surgery, CPB use poses an inherent risk for remote organ damage including kidney damage [19,20].…”

Section: Intraoperativementioning

confidence: 99%

Development of acute kidney injury following pediatric cardiac surgery

Chakraborty

et al. 2020

Kidney Res Clin Pract

“…However, hypothermia can also cause challenges in this population including negatively affecting cellular membrane stability and ATP production and utilization and increasing coagulopathy (96). Hypothermia can also interfere with oxygen and glucose uptake in the brain, as well as distort the pH of blood (97,98). As such, the ideal temperature for congenital cardiac surgery is controversial and dependent upon the surgeon and the surgical procedure being performed (96).…”

Section: Temperature Managementmentioning

confidence: 99%

“…Immature myocytes provide a different challenge than mature myocytes to achieve maximum protection. Immature myocardial tissue is more resistant to ischemia, but more susceptible to myocardial edema associated with frequent cardioplegia administration (98). An international survey performed in 2011 revealed that del Nido cardioplegia was the most commonly used solution in North America with 32% of centers using it (100).…”

Section: Myocardial Protectionmentioning

confidence: 99%

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Sturmer¹,

Beaty²,

Clingan³

et al. 2018

Transl Pediatr

Abstract:The development and refinement of cardiopulmonary bypass (CPB) has made the repair of complex congenital heart defects possible in neonates and infants. In the past, the primary goal for these procedures was patient survival. Now that substantial survival rates have been achieved for even the most complex of repairs in these patients, focus has been given to the reduction of morbidity. Although a necessity for these complex neonatal and infant heart defect repairs, CPB can also be an important source of perioperative complications. Recent innovations have been developed to mitigate these risks and is the topic of this review. Specifically, we will discuss improvements in minimizing blood transfusions, CPB circuit design, monitoring, perfusion techniques, temperature management, and myocardial protection, and then conclude with a brief discussion of how further systematic improvements can be made in these areas.

“…As modern medical technology develops, the number of patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) has increased (1). CPB enables cardiovascular surgery to be safer and more practical, but complications from surgery can lead to a systemic inflammatory response (2).…”

Section: Introductionmentioning

confidence: 99%

κ‑opioid receptor agonists may alleviate intestinal damage in cardiopulmonary bypass rats by inhibiting the NF‑κB/HIF‑1α pathway

et al. 2020

The aims of the present study were to investigate the protective effect of a κ-opioid receptor (KOR) agonist on intestinal barrier dysfunction in rats during cardiopulmonary bypass (CPB), as well as to examine the role of NF-κB and the transcription factor hypoxia-inducible factor-1α (HIF-1α) signaling pathway in the regulatory mechanism. A total of 50 rats were randomly divided into five groups, with 10 rats in each group: Sham surgery group (group Sham), CPB surgery group (group CPB), KOR agonist + CPB (group K), KOR agonist + specific KOR antagonist + CBP (group NK) and KOR agonist + NF-κB pathway specific inhibitor + CPB (group NF). Intestinal microcirculation was evaluated to determine intestinal barrier dysfunction in rats following CPB surgery. Hematoxylin and eosin (H&E) staining was used to observe intestinal tissue injury in the rats. ELISA was used to detect the inflammatory factors interleukin (IL)-1β, IL-6, IL10 and tumor necrosis factor-α, and the oxidative stress factors superoxidase dismutase, malondialdehyde and nitric oxide in serum. In addition, ELISA was used to investigate the serum levels of the intestinal damage markers D-lactic acid, diamine oxidase and intestinal fatty acid-binding protein. Western blotting was used to investigate the protein expression levels of tight junction proteins zonula occludens-1 and claudin-1. Furthermore, immunohistochemistry was used to examine intestinal injuries and western blotting was used to detect expression levels of NF-κB/HIF-1α signaling pathway-related proteins. H&E staining results suggested that the KOR agonist alleviated intestinal damage in the CPB model rats. This effect was reversed by the addition of a KOR antagonist. Further investigation of inflammatory and oxidative stress factors using ELISA revealed that the KOR agonist reduced the inflammatory and oxidative stress responses in the intestinal tissues of the CPB model rats. The ELISA results of intestinal damage markers and western blotting results of tight junction protein expression suggested that KOR agonist treatment may alleviate intestinal injury in CPB model rats. In addition, the western blotting and immunohistochemistry results suggested that KOR agonists may decrease the expression levels of NF-κB, p65 and HIF-1α in CPB. Collectively, the present results suggested that KOR agonists are able to ameliorate the intestinal barrier dysfunction in rats undergoing CPB by inhibiting the expression levels of NF-κB/HIF-1α signaling pathway-related proteins.