Effect of Two Different Bypass Techniques on the Serum Troponin-T Levels in Newborns and Children

Nagy, Z; Collins, Mike; Sharpe, T.C.; Mirsadraee, Saeed; Guerrero, Rafael R.; Gibbs, J. Simon R.; Watterson, Kevin G.

doi:10.1161/01.cir.0000081779.88132.74

Cited by 30 publications

(5 citation statements)

References 29 publications

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“…The metric we derived performs as well or better as a predictor of clinical outcome when compared to the IS or other derivations of an inotrope score. Maximum VIS in the first 24 hours has biologic plausibility as a measure of illness severity and predictor of outcome as previously literature demonstrates a nadir in cardiac output after bypass [1], higher risk of cardiac arrest [11], and peaking serum markers of inflammation [12] and myocardial injury [13, 14] during this time period.…”

Section: Discussionmentioning

confidence: 93%

Vasoactive-Inotropic Score Is Associated With Outcome After Infant Cardiac Surgery

Gaies

Jeffries

Niebler

et al. 2014

Pediatric Critical Care Medicine

336

143

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Objective To empirically derive the optimal measure of pharmacologic cardiovascular support in infants undergoing cardiac surgery with bypass, and to assess the association between this score and clinical outcomes in a multi-institutional cohort. Design Prospective, multi-institutional cohort study. Setting Cardiac intensive care units (CICU) at 4 academic children’s hospitals participating in the Pediatric Cardiac Critical Care Consortium (PC4) during the study period. Patients Children <1 year of age at the time of surgery treated post-operatively in the CICU. Interventions None Measurements and Main Results Three hundred ninety-one infants undergoing surgery with bypass were enrolled consecutively from 11/2011–4/2012. Hourly doses of all vasoactive agents were recorded for the first 48 hours after CICU admission. Multiple derivations of an inotropic score were tested, and maximum vasoactive-inotropic score (VIS) in the first 24 hours was further analyzed for association with clinical outcomes. The primary composite “poor outcome” variable included at least one of mortality, mechanical circulatory support, cardiac arrest, renal replacement therapy, or neurologic injury. High VIS was empirically defined as ≥20. Multivariable logistic regression was performed controlling for center and patient characteristics. Patients with high VIS had significantly greater odds of a poor outcome [OR 6.5, 95% confidence interval (CI) 2.9–14.6], mortality (OR 13.2, 95% CI 3.7–47.6), time to first extubation, and CICU length of stay compared to patients with low VIS. Stratified analyses by age (neonate vs. infant) and surgical complexity (low vs. high) showed similar associations with increased morbidity and mortality for patients with high VIS. Conclusions Maximum VIS calculated in the first 24 hours after CICU admission was strongly and significantly associated with morbidity and mortality in this multi-institutional cohort of infants undergoing cardiac surgery. Maximum VIS≥20 predicts an increased likelihood of a poor composite clinical outcome. The findings were consistent in stratified analyses by age and surgical complexity.

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Section: Discussionmentioning

confidence: 93%

Vasoactive-Inotropic Score Is Associated With Outcome After Infant Cardiac Surgery

Gaies

Jeffries

Niebler

et al. 2014

Pediatric Critical Care Medicine

336

143

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“…Some clinical studies have suggested that, in infants, pH-stat provide some neuronal (7,8) and myocardial protection (9) compared to alpha-stat strategy. Other studies (10) have indicated that use of alpha-stat versus pH-stat acid-base management strategy during reparative infant cardiac operations with DHCA-CPB was not consistently related to either improved or impaired early neurodevelopmental outcomes.…”

Section: Introductionmentioning

confidence: 99%

Effect of deep hypothermic circulatory arrest followed by low-flow cardiopulmonary bypass on brain metabolism in newborn piglets: Comparison of pH-stat and α-stat management

Pirzadeh

Schears

Pastuszko

et al. 2011

Pediatric Critical Care Medicine

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Objective-To compare the effects of pH-stat and alpha-stat management prior to deep hypothermic circulatory arrest (DHCA) followed by a period of low flow (two rates) cardiopulmonary bypass (CPB) on cortical oxygenation and selected regulatory proteins: Bax, Bcl-2, Caspase-3 and phospho-Akt.Design-Piglets were placed on CPB, cooled with pH-stat or alpha-stat management to 18°C over 30 min, subjected to 30 min DHCA and 1h low flow at 20 (LF-20) or 50 ml/kg/min (LF-50), rewarmed to 37°C, separated from CPB, and recovered for 6 h.Subjects-Newborn piglets, 2-5 days old, randomly assigned to experimental groups.Measurements and main results-Cortical oxygen was measured by oxygen-dependent quenching of phosphorescence; proteins were measured by western blots. The means from 6 experiments ± standard error (SEM) are presented as % of alpha-stat. Significance was by t-test. For LF-20, cortical oxygenation was similar for alpha-stat and pH-stat, whereas for LF-50 it was significantly better using pH-stat. For LF-20, the measured proteins were not different except for Bax in the cortex (214±24%, p=0.006) and hippocampus (118% ± 6%, p=0.024) and Caspase 3 in striatum (126% ± 7%, p=0.019). For LF-50, in pH-stat group: In cortex, Bax and Caspase-3 were lower (72±8%, p=0.001 and 72±10%, p=0.004, respectively) and pAkt was higher (138±12%, p=0.049). In hippocampus, Bcl-2 and Bax were not different but pAkt was higher 212±37% (p=0.005) and Caspase 3 lower (84 ± 4%, p=0.018). In striatum, Bax and pAkt did not differ but Bcl-2 increased (146±11%, p=0.001) and Caspase-3 decreased (81±11%, p=0.042).Conclusions-In this DHCA-LF model, when flow was 20ml/kg/min there was little difference between alpha-stat and pH-stat management. However for LF-50, pH-stat management resulted in better cortical oxygenation during recovery and Bax, Bcl-2, pAkt and Caspase-3 changes consistent with lesser activation of pro-apoptotic signaling with pH-stat than with alpha-stat.

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“…A review recommended that the best management of acid–base therapy is dependent upon patient age, with the use of a pH-stat in pediatric patients and an alpha-stat in adult patients [ 180 ]. The results of a clinical trial also confirmed that the pH-stat is superior in the pediatric population [ 181 ].…”

Section: Preventionmentioning

confidence: 80%

Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention

Yang,

Zhu,

Pan

et al. 2024

Renal Failure

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Cardiopulmonary bypass (CPB) is a common technique in cardiac surgery but is associated with acute kidney injury (AKI), which carries considerable morbidity and mortality. In this review, we explore the range and definition of CPB-associated AKI and discuss the possible impact of different disease recognition methods on research outcomes. Furthermore, we introduce the specialized equipment and procedural intricacies associated with CPB surgeries. Based on recent research, we discuss the potential pathogenesis of AKI that may result from CPB, including compromised perfusion and oxygenation, inflammatory activation, oxidative stress, coagulopathy, hemolysis, and endothelial damage. Finally, we explore current interventions aimed at preventing and attenuating renal impairment related to CPB, and presenting these measures from three perspectives: (1) avoiding CPB to eliminate the fundamental impact on renal function; (2) optimizing CPB by adjusting equipment parameters, optimizing surgical procedures, or using improved materials to mitigate kidney damage; (3) employing pharmacological or interventional measures targeting pathogenic factors.

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Effect of Two Different Bypass Techniques on the Serum Troponin-T Levels in Newborns and Children

Abstract: Background-Cardiac troponin-T is a sensitive marker of myocardial damage. In a prospective study, the effect of 2 different pH strategies during cardiopulmonary bypass on ischemic myocardial injury and clinical outcome was measured in a pediatric population.

Cited by 30 publications

References 29 publications

Vasoactive-Inotropic Score Is Associated With Outcome After Infant Cardiac Surgery

Vasoactive-Inotropic Score Is Associated With Outcome After Infant Cardiac Surgery

Effect of deep hypothermic circulatory arrest followed by low-flow cardiopulmonary bypass on brain metabolism in newborn piglets: Comparison of pH-stat and α-stat management

Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention

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