The effect of left heart bypass on pulmonary blood flow and arterial oxygenation during one-lung ventilation in patients undergoing descending thoracic aortic surgery

Yuki, Koichi; Sakuramoto, Chieko; Matsumoto, Chieko; Hoshino, Mariko; Niimi, Yoshinari

doi:10.1016/j.jclinane.2008.12.028

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…The authors' speculation is consistent with a previous study, 8 in which TEE demonstrated that the increase in the right pulmonary blood flow was associated with improved oxygenation during LHB initiation. In that study, Yuki et al noted that neither the right pulmonary blood flow nor oxygenation increased before LHB initiation, but both were observed to increase after LHB initiation.…”

Section: Discussionsupporting

confidence: 91%

“…In particular, the safety and efficacy of LHB remain controversial when it is used as extracorporeal circulatory support in patients with preoperative pulmonary risks. [6][7][8] Some studies have suggested the use of CPB or an oxygenator during LHB to achieve better oxygenation in patients with impaired pulmonary function, such as those with chronic obstructive pulmonary disease (COPD). 6,7 However, only 2 studies have reported that LHB improved arterial oxygenation during OLV.…”

mentioning

confidence: 99%

“…6,7 However, only 2 studies have reported that LHB improved arterial oxygenation during OLV. 8,9 Because the change in oxygenation during LHB and the mechanism of its improvement have not been elucidated fully, such questions should be evaluated in more detail to prevent unexpected hypoxia during LHB.…”

mentioning

confidence: 99%

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Impact of Left Heart Bypass on Arterial Oxygenation During One-Lung Ventilation for Thoracic Aortic Surgery

Suga

Kobayashi

Ochiai

2017

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

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Impact of Left Heart Bypass on Arterial Oxygenation During One-Lung Ventilation for Thoracic Aortic Surgery

Suga

Kobayashi

Ochiai

2017

Journal of Cardiothoracic and Vascular Anesthesia

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“…The advantages of LHB include augmentation of distal perfusion and reduction of left ventricular strain by decreasing preload and afterload ( 40 ). Moreover, the heparin dose is significantly reduced to 1.5 mg/kg with ACT > 250 s under LHB without an oxygenator, which may contribute to less surgical bleeding ( 40 ). LHB generally lacks an oxygenator, so maintenance of oxygenation is important during single-lung ventilation.…”

Section: Discussionmentioning

confidence: 99%

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

Huang

Chen

et al. 2022

Front. Cardiovasc. Med.

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Open thoracoabdominal aortic aneurysm (TAAA) repair is a complex and challenging operation with a high incidence of serious complications, and high perioperative mortality and morbidity. Left heart bypass (LHB) is a circulatory support system used to perfuse the distal aorta during TAAA operation, and the advantages of LHB include guaranteeing distal perfusion, reducing the use of heparin, and diminishing the risk of bleeding and postoperative neurological deficits. In China, the circuit for TAAA repair is deficient, and far from the perfusion requirements. We designed a modular multifunctional LHB circuit for TAAA repair. The modular circuit consisted of cannulation pipelines, functional consumables connection pipelines, and accessory pipelines. The accessory pipelines make up lines for selective visceral perfusion and kidney perfusion, suckers and rapid infusion. The circuit can be assembled according to surgical requirements. The ultrafilter and heat exchanger are integrated into the circuit to fulfill the basic demands of LHB. The LHB circuit also has pipelines for selective visceral perfusion to the celiac artery and superior mesenteric artery and renal perfusion pipelines. Meanwhile, the reserved pipelines facilitate the quick switch from LHB to conventional cardiopulmonary bypass (CPB). The reserved pipelines reduce the time of reassembling the CPB circuit. Moreover, the rapid infusion was integrated into the LHB circuit, which can rapid infusion when massive hemorrhage during the open procedures such as exposure and reconstruction of the aorta. The ultrafiltration can diminish the consequent hemodilution of hemorrhage and rapid infusion. A hemoperfusion cartridge also can be added to reduce the systemic inflammatory during operation. The circuit can meet the needs of LHB and quickly switch to conventional CPB. No oxygenator was required during LHB, which reduce the use of heparin and reduce the risk of bleeding. The heat exchanger contributes to temperature regulation; ultrafiltration, arterial filter, and rapid-infusion facilitated the blood volume management and are useful to maintain hemodynamic stability. This circuit made the assembly of the LHB circuit more easily, and more efficient, which may contribute to the TAAA repair operation performed in lower volume centers easily. 26 patients who received TAAA repair under the modular multifunctional LHB from January 2018-March 2022 were analyzed, and we achieved acceptable clinical outcomes. The in-hospital mortality and 30-day postoperative mortality were 15.4%, and the postoperative incidences of paraparesis (4%), stroke (4%), and AKI need hemodialysis (12%) were not particularly high, based on the limited patients sample size in short research period duration.

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“…The pathogenesis of IPF was hypothesized to be due to the excessive deposition of dysregulated extracellular matrix (ECM) proteins leading to fibroblast proliferation and abnormal re-epithelialization, following alveolar injury and progressive respiratory failure (Wynn and Ramalingam, 2012). Since varieties of chronic respiratory diseases may be accompanied with the remodeling of right ventricle (Fishman, 1976), abnormal lung function also can affect the heart functionality (Billingham, 1995; Yuki et al, 2009; Rozova and Mankovska, 2012). Therefore, pulmonary heart disease (PHD) is named for the consideration of heart and lung as one function-coupled unit (Forfia et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Ability to Suppress TGF-β-Activated Myofibroblast Differentiation Distinguishes the Anti-pulmonary Fibrosis Efficacy of Two Danshen-Containing Chinese Herbal Medicine Prescriptions

et al. 2019

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Background: Idiopathic pulmonary fibrosis (IPF) is a devastating lung disease with limited treatment options. It also leads to progressive respiratory failure, which subsequently affects the heart functionality, a pathological heart-lung interaction increasingly noticed and defined as pulmonary-heart disease (PHD). Traditional Chinese medicine (TCM) theory for treating “phlegm-stasis cementation syndrome” may suggest a possibility of treating PHD complication with Chinese medicine prescriptions previously used for cardiovascular diseases. Methods: Here, we evaluate the efficacies of two compound Chinese medicine prescriptions, Danlou prescription (DLP) and Danhong prescription (DHP), which share a common herbal component, Salvia miltiorrhiza (Danshen), on pulmonary fibrosis. Severity grades of Bleomycin (BLM)-induced pulmonary fibrosis were assessed by micro-Computerized Tomography (μCT) in accordance with the clinical evaluation standard. Lung pathological changes and collagen deposition were investigated by histopathology. Myofibroblast differentiation was assessed by immunohistochemistry of α-SMA and TGF-β receptor type II expression in situ . Network pharmacology analysis of the drug-target interaction in IPF progression for DLP or DHP was performed using Ingenuity ® Pathways Analysis (IPA) system. Results: We show that a non-invasive μCT effectively monitor and quantify BLM-induced pulmonary fibrosis and its treatment efficacy by Chinese medicine prescription in rodents. In addition, although both containing Salvia miltiorrhiza, DLP but not DHP mitigates BLM-induced lung fibrosis by inhibiting the TGF-β signaling-activated myofibroblast differentiation and α-SMA expression in a mouse model. Core analysis by IPA revealed that DLP ingredients regulated not only pulmonary fibrosis related inflammatory genes but also genes associated with myofibroblast activation and collagen deposition. Conclusion: This study suggests that a clinically efficacious cardiovascular Chinese herbal medicine (DLP) can be successfully repurposed to treat a lung disease in pulmonary fibrosis guided by TCM theory. Our comparative study between DLP and DHP demonstrated a critical requirement of suppressing both pro-inflammatory and pro-fibrotic pathways for the treatment of pulmonary fibrosis, supporting that a multi-component prescription capable of “removing both phlegm and blood stasis” will better achieve co-protection of heart and lung in PHD.

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The effect of left heart bypass on pulmonary blood flow and arterial oxygenation during one-lung ventilation in patients undergoing descending thoracic aortic surgery

Cited by 6 publications

References 14 publications

Impact of Left Heart Bypass on Arterial Oxygenation During One-Lung Ventilation for Thoracic Aortic Surgery

Impact of Left Heart Bypass on Arterial Oxygenation During One-Lung Ventilation for Thoracic Aortic Surgery

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

Ability to Suppress TGF-β-Activated Myofibroblast Differentiation Distinguishes the Anti-pulmonary Fibrosis Efficacy of Two Danshen-Containing Chinese Herbal Medicine Prescriptions

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