Evidence for a significant myocardial contribution to total metabolic burden                 during hypothermic cardiopulmonary bypass: a study of continuously measured oxygen                 consumption and arterial lactate levels in pigs

Li, Jia; Stokoe, Jacqueline; Konstantinov, Igor E.; Kharbanda, Rajesh K.; Redington, Andrew N.

doi:10.1191/0267659105pf823oa

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…Therefore, we assessed hemodynamic state and tissue perfusion based on gross hemodynamic data, inotropic, and vasopressor support details and metabolic status. Although all animals developed elevated lactic acid levels during CPB, this is a well‐recognized complication of hypothermic CPB in pigs and not necessarily indicative of inadequate myocardial or tissue perfusion . Importantly, there was no further increase in arterial lactate levels after weaning from CPB.…”

Section: Discussionmentioning

confidence: 86%

Normothermic Ex Vivo Perfusion Provides Superior Organ Preservation and Enables Viability Assessment of Hearts From DCD Donors

Iyer

Gao

Doyle

et al. 2015

American Journal of Transplantation

118

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The shortage of donors in cardiac transplantation may be alleviated by the use of allografts from donation after circulatory death (DCD) donors. We have previously shown that hearts exposed to 30 min warm ischemic time and then flushed with Celsior supplemented with agents that activate ischemic postconditioning pathways, show complete recovery on a blood-perfused ex vivo working heart apparatus. In this study, these findings were assessed in a porcine orthotopic heart transplant model. DCD hearts were preserved with either normothermic ex vivo perfusion (NEVP) using a clinically approved device, or with standard cold storage (CS) for 4 h. Orthotopic transplantation into recipient animals was subsequently undertaken. Five of six hearts preserved with NEVP demonstrated favorable lactate profiles during NEVP and all five could be weaned off cardiopulmonary bypass posttransplant, compared with 0 of 3 hearts preserved with CS (p < 0.05, Fisher's exact test). In conclusion, DCD hearts flushed with supplemented Celsior solution and preserved with NEVP display viability before and after transplantation. Viability studies of human DCD hearts using NEVP are warranted.

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Section: Discussionmentioning

confidence: 86%

Normothermic Ex Vivo Perfusion Provides Superior Organ Preservation and Enables Viability Assessment of Hearts From DCD Donors

Iyer

Gao

Doyle

et al. 2015

American Journal of Transplantation

118

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“…So, the blood lactate concentration is a more sensitive indicator of early oxygen deficiency than pH and BE. 11 The accumulation of acidic materials in the presence of severe peripheral poor perfusion and oxygen deficiency will exhaust the compensatory ability of the blood buffer system, and blood gas analysis will demonstrate an abnormal pH and BE. Surely, the blood lactate concentration in this circumstance will increase further.…”

Section: Discussionmentioning

confidence: 99%

Moderate Hypothermia With Low Flow Rate Cardiopulmonary Bypass Used in Surgeries for Congenital Heart Defects

2007

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Low flow rate perfusion has been recommended in profound hypothermic cardiopulmonary bypass (CPB) in recent years. However, most patients with congenital heart defects are still operated on under moderate hypothermic CPB, where high flow rate perfusion has been adopted by most perfusionists. Fifty patients with congenital heart defects, ranging from 1 to 11 yr of age and 6.5 to 25 kg of weight, were included in the trial. Once on CPB, a high flow rate of 2.37 +/- 0.39 L/min/m was used to cool the patient to 27.3 degrees C +/- 0.84 degrees C rectal temperature, followed by a low flow rate of 1.31 +/- 0.09 L/min/m until the main intracardiac repair was completed and rewarming started. High flow rate was still used in rewarming the patients to a rectal temperature of 35 degrees C-36 degrees C. The total CPB, cross-clamp, and low flow rate perfusion time were 86.4 +/- 26.6, 46.4 +/- 22.3, and 40.7 +/- 22.4 min, respectively. After 24-99 min low flow rate perfusion, venous oxygen saturation remained above 80% for all the patients, and lactate concentration did not increase. Only three patients showed slight metabolic acidosis during CPB and required an extra 6-12 mEq sodium bicarbonate. Average urine output was 199 +/- 155 (50-600) ml during CPB. All patients recovered well after operation. No surgical death or neurologic complications occurred. Low flow rate perfusion might be safely used in moderate hypothermic CPB as long as the oxygen saturation of returned venous blood was kept above 80%.

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Improved Cerebral Recovery From Hypothermic Circulatory Arrest After Remote Ischemic Preconditioning

Yannopoulos

Mäkelä

Niemelä

et al. 2010

The Annals of Thoracic Surgery

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Evidence for a significant myocardial contribution to total metabolic burden during hypothermic cardiopulmonary bypass: a study of continuously measured oxygen consumption and arterial lactate levels in pigs

Cited by 4 publications

References 23 publications

Normothermic Ex Vivo Perfusion Provides Superior Organ Preservation and Enables Viability Assessment of Hearts From DCD Donors

Normothermic Ex Vivo Perfusion Provides Superior Organ Preservation and Enables Viability Assessment of Hearts From DCD Donors

Moderate Hypothermia With Low Flow Rate Cardiopulmonary Bypass Used in Surgeries for Congenital Heart Defects

Improved Cerebral Recovery From Hypothermic Circulatory Arrest After Remote Ischemic Preconditioning

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