Cardiopulmonary bypass in man: role of the intestine in a self-limiting inflammatory response with demonstrable bacterial translocation

Rossi, Marco; Sganga, Gabriele; Mazzone, M; Valenza, Venanzio; Guarneri, Sergio; Portale, Grazia; Carbone, Luigi; Gatta, Lucia; Pioli, Claudio; Sanguinetti, Maurizio; Montalto, Massimo; Glieca, Franco; Fadda, Giovanni; Schiavello, R; Silveri, Nicolò Gentiloni

doi:10.1016/s0003-4975(03)01520-0

Cited by 62 publications

(35 citation statements)

References 23 publications

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“…It is well established that CPB is responsible for mesenteric endothelial dysfunction and microcirculation disturbances even under stable hemodynamic conditions. An increase in the contractile response to alpha1-adrenergic agonist and an early release of pro-inflammatory substances has been observed after CPB [140][141][142] . Nevertheless, the effect of pulseless extracorporeal circulation on bowel hypoperfusion is still under debate [143,144] , and off-pump coronary artery bypass does not prevent subsequent mesenteric ischemia [134,145,146] .…”

Section: Ami After Cpbmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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Section: Ami After Cpbmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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“…All of these inconveniences can be prevented only to a certain degree, even if utmost care is expended. Thus, the very trauma of surgery seems to be more relevant in starting on SIRS rather than cardiopulmonary bypass itself, the latter adding a CPB-specific fraction on top of other unfavorable events (12,14,15).…”

Section: Discussionmentioning

confidence: 99%

Expression of an Activated Form of Integrin β2 Chain CD18 in Cardiac Surgical Operations

Kudlová

Koláčková

Kuneš

et al. 2007

Acta Med. (Hradec Kralove, Czech Repub.)

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Summary: Background: Myeloid cells are extensively activated in patients undergoing cardiosurgical operations. It is supposed that this activation is more profound in patients operated with cardiopulmonary bypass (CPB) ("on-pump") in comparison with patients operated without CPB ("off-pump"). Aims: To evaluate changes in the expression of a novel activation marker expressed on myeloid cells recognized by MEM-148 antibody. Patients and Methods: The expression of MEM-148 positive myeloid cells was evaluated by flow cytometry in 40 patients who underwent coronary artery bypass surgery (CABG) randomly assigned to "on-pump" or "off-pump" technique. Results: The relative and absolute number of MEM-148 positive myeloid cells is significantly diminished during "on-pump" surgery. A significant increase in their number in postoperative period in both "on-pump" and "off-pump" patients was found. There were no significant differencies between "on-pump" and "off-pump" patients. Conclusions: The very trauma of surgery seems to be more relevant in starting on activation of myeloid cells them CPB itself.

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“…Несмотря на очевидные успехи в развитии реани матологии, летальность у больных, перенесших крити ческие состояния с развитием ПОН, остается высокой и колеблется по данным разных авторов от 35 до 70%, не имея серьезной тенденции к уменьшению [1]. В кардио хирургии развитие ПОН связывают преимущественно с системным воспалительным ответом (СВО), частота развития которого после операций в условиях искусст венного кровообращения (ИК) может достигать 90% [2,3]. Ряд авторов связывают увеличение ПОН с прогрес сом интенсивной терапии, позволяющим пережить кри зис декомпенсации основных функций [4].…”

Section: в п о м о щ ь п р а к т и ч е с к о м у в р а ч уunclassified

Multiple Organ Dysfunction After Cardiosurgical Interventions

Барбараш¹,

Grigoryev²,

Плотников³

et al. 2010

rmt

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Objective: to study the clinical efficiency of introducing an algorithm for organ protective intensive care. Materials and methods. 3278 case histories of patients admitted to the clinic in 2000-2009 for surgical treatment (under extracorpore al circulation) for coronary heart disease (CHD) and acquired heart defects (AHD) were retrospectively analyzed. Throughout the analyzed period, the patients operated on for CHD and AHD were 2068 (63.1%) and 1210 (36.9%), respectively; the postoperative incidence of multiple organ dysfunction (MOD) among all the patients was 11.8% (378 patients); mortality in MOD was 3.75% (n=123) of the operated patients (included into the study) or 32.5% of all the patients with MOD. Conclusion. The incidence of MOD is in proportion to the number of surgical interventions and depends on their specific features (recurrence, baseline severity, comorbidity, or multifocal atherosclerosis). Preventive intensive therapy for MOD reduced mortality and altered its syndromic pattern towards a preponderance of pyoseptic complications.

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Cardiopulmonary bypass in man: role of the intestine in a self-limiting inflammatory response with demonstrable bacterial translocation

Cited by 62 publications

References 23 publications

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Expression of an Activated Form of Integrin β2 Chain CD18 in Cardiac Surgical Operations

Multiple Organ Dysfunction After Cardiosurgical Interventions

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