Determinants of low systemic vascular resistance during cardiopulmonary bypass

Christakis, George T.; Fremes, Stephen E.; Koch, Jean-Paul; Harwood, Steven; Juhasz, Stephen; Sharpe, Eldon; Deemar, Kathy A.; Hamilton, Cody; Chen, Erluo; Rao, Vivek; Chang, Genevieve; Goldman, Bernard S.

doi:10.1016/0003-4975(94)90451-0

Cited by 34 publications

(11 citation statements)

References 28 publications

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“…Left ventricular ejection fraction and pump time have been shown to be potential risk factors for hypotension during CABG. 22 The finding of this study supports the association of hypotension and variables, including ejection fraction, history of myocardial infarction, pump time, and coronary grafting count during and after CABG. However, in this study, we could not identify any relationship between hypotension and other variables, such as gender, age, and diabetes mellitus, which have been previously reported in the literature.…”

Section: Discussionsupporting

confidence: 83%

The Effect of Angiotensin-Converting Enzyme Inhibitor on Hemodynamic Instability in Patients Undergoing Cardiopulmonary Bypass: Results of a Dose-Comparison Study

Shahzamani¹,

Yousefi²,

Frootaghe³

et al. 2009

J Cardiovasc Pharmacol Ther

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Section: Discussionsupporting

confidence: 83%

The Effect of Angiotensin-Converting Enzyme Inhibitor on Hemodynamic Instability in Patients Undergoing Cardiopulmonary Bypass: Results of a Dose-Comparison Study

Shahzamani¹,

Yousefi²,

Frootaghe³

et al. 2009

J Cardiovasc Pharmacol Ther

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“…Patients with vasopressor dependence required longer periods of ventilation; this may be as a result of their longer cardiopulmonary bypass times [18] and seems to be of clinical relevance [19,20]. These patients also needed significantly more transfusions of packed red blood cells, despite clinically comparable blood losses.…”

Section: Discussionmentioning

confidence: 99%

Association between vasopressor dependence and early outcome in patients after cardiac surgery

Weis¹,

Kilger²,

Beiras-Fernandez³

et al. 2006

Anaesthesia

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SummaryArterial hypotension with vasopressor dependence is a major problem after cardiac surgery. We evaluated the early postoperative course of 1558 consecutive patients scheduled for cardiac surgery, and compared the outcome of patients with and without vasopressor dependence (defined as the need for > 0.1 lg.kg )1 .h )1 noradrenaline for > 3 h in the face of normovolaemia).Vasopressor dependence was diagnosed in 424 patients (27%) and was associated with a higher incidence of postoperative renal failure (67 (15.7%) vs 7 (0.6%), respectively; p < 0. .

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“…This is supported by several studies showing the interference with both systemic (Fox & Henderson 1993) and pulmonary circulation (Michalot et al 1979, Dauber et al 1993, Fessatidis et al 1994. The marked blood pressure fall and loss of fluid into the interstitial space routinely seen after the starting of the heart-lung machine during open heart surgery clearly illustrate the existence of such an interference (Christakis et al 1994, Smith et al 1987, Dauber et al 1993. Extracorporeal circulation also seems to influence the blood cells, causing aggregation and accumulation of platelets and neutrophiles Correspondence : Dr John Jahr, Department of Physiology and Neuroscience, University of Lund, So$ lvegatan 19, S-223 62 Lund, Sweden.…”

mentioning

confidence: 84%

Peripheral circulatory effects of pump perfusion on cat skeletal muscle with and without prostacyclin

Jahr

Grände

1997

Acta Physiologica Scandinavica

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The present study analyses the peripheral circulatory effects of pump perfusion on a sympathectomized cat skeletal muscle in terms of effects on segmental vascular resistances (large-bore arterial vessels, arterioles and veins), hydrostatic capillary pressure, capillary filtration coefficient, transcapillary filtration and autoregulation of blood flow. The effect of prostacyclin during pump perfusion was analysed to evaluate whether it interferes with the pump-induced vascular alterations, especially if it reduces transcapillary filtration through its capillary permeability decreasing effect. Pump perfusion initiates a marked vasodilation (from 17.3 to 10.1 PRU), an increase in hydrostatic capillary pressure, and a marked inhibition of myogenic reactivity and of autoregulation of blood flow. There was a slow restoration of vascular tone reaching a steady-state level somewhat below the autoperfusion value within 2 h. Pump perfusion did not change the capillary filtration coefficient, indicating that the capillary permeability was not increased. This implies that short-term pump-induced capillary leakage is more an effect of increase in hydrostatic capillary pressure, perhaps in combination with increased number of open capillaries, than of an increase in capillary permeability. Prostacyclin decreased capillary permeability by at least 22% but simultaneously increased hydrostatic capillary pressure, resulting in an unchanged filtration compared with the situation just after the starting of the pump. The results obtained show that experiments using pump perfusion should be interpreted with care due to the interference with normal peripheral vascular control. The results give reasonable explanations of the lowered blood pressure and transcapillary fluid loss during the clinical use of a heart-lung machine.

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Determinants of low systemic vascular resistance during cardiopulmonary bypass

Cited by 34 publications

References 28 publications

The Effect of Angiotensin-Converting Enzyme Inhibitor on Hemodynamic Instability in Patients Undergoing Cardiopulmonary Bypass: Results of a Dose-Comparison Study

The Effect of Angiotensin-Converting Enzyme Inhibitor on Hemodynamic Instability in Patients Undergoing Cardiopulmonary Bypass: Results of a Dose-Comparison Study

Association between vasopressor dependence and early outcome in patients after cardiac surgery

Peripheral circulatory effects of pump perfusion on cat skeletal muscle with and without prostacyclin

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