What's New in Cardiopulmonary Bypass

Hessel, Eugene A.

doi:10.1053/j.jvca.2019.01.039

Cited by 58 publications

(35 citation statements)

References 226 publications

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“…Patients undergoing cardiac surgery with CPB have their heart exposed to ischemiareperfusion damage after aortic declamping. In addition, the body also suffers from the oxidative stress generated by the procedure and from the systemic inflammatory response syndrome (SIRS) (29). Several studies have evaluated the effects of vitamin C supplementation in patients undergoing CPB.…”

Section: Cardiopulmonary Bypass and Cardiac Surgerymentioning

confidence: 99%

Vitamin C supplementation in cardiopulmonary bypass: a review

Hennemann¹,

Filho

2020

VITTALLE, ISSN 1413-3563, Rio Grande, Brasil

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Hypovitaminosis C is frequent in postoperative period of surgical patients and may last for several days after surgery. The reestablishment of normal plasma ascorbate (vitamin C) levels by supplementation requires intravenous administration, which is safe and well tolerated. This antioxidant mitigates the oxidative damage produced by the insults of surgery, cardiopulmonary bypass and ischemia-reperfusion event. Ascorbate supplementation after cardiac surgery improves patient oxidative state, shortens hospital stay, streamlines wound closure and reduces incidence of postoperative atrial fibrillation. However, we think this vitamin may offer yet other benefits, especially in cardiac surgery postoperative period. The aim of this review is to evaluate recent studies on vitamin C supplementation in surgical patients, focusing on cardiac surgery with cardiopulmonary bypass, and to discuss the next steps regarding the potential benefits that can be obtained from the implementation of this conduct in the hospital routine. Suplementação de vitamina C na circulação extracorpórea: uma revisão RESUMO A hipovitaminose C é frequente no pós-operatório de pacientes cirúrgicos e pode durar vários dias após a cirurgia. O restabelecimento dos níveis plasmáticos normais de ascorbato (vitamina C) por suplementação requer administração intravenosa, o que é seguro e bem tolerado. Esse antioxidante mitiga os danos oxidativos produzidos pelos insultos da cirurgia, da circulação extracorpórea e do evento de isquemia-reperfusão. A suplementação de vitamina C após cirurgia cardíaca melhora o estado oxidativo dos pacientes, reduz o tempo de internação hospitalar, auxilia o fechamento de feridas e diminui incidência de fibrilação atrial pós-operatória. No entanto, acreditamos que essa vitamina possa oferecer ainda outros benefícios. O objetivo desta revisão é avaliar estudos recentes sobre suplementação de vitamina C em pacientes cirúrgicos, com foco em cirurgia cardíaca com circulação extracorpórea, e discutir as próximas etapas sobre os possíveis benefícios que podem ser obtidos com a implementação dessa conduta na rotina hospitalar.

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Section: Cardiopulmonary Bypass and Cardiac Surgerymentioning

confidence: 99%

Vitamin C supplementation in cardiopulmonary bypass: a review

Hennemann¹,

Filho

2020

VITTALLE, ISSN 1413-3563, Rio Grande, Brasil

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“…Un porcentaje bajo de hemodilución puede tener efectos beneficiosos: reduce la viscosidad sanguínea (por lo que mejora en cierta medida la perfusión de los órganos con mayor presencia de territorio capilar y microcirculación) y disminuye los requerimientos intraoperatorios de transfusiones sanguíneas en comparación con un cebado convencional. Por el contrario, una excesiva hemodilución puede comprometer el transporte de oxígeno y generar hipoperfusión orgánica e hipotensión (13,45).…”

Section: Anemia Y Hemodilución: Hematocrito óPtimo En Cecunclassified

“…Medición del lactato La medición del lactato ha sido ampliamente utilizada en la valoración del enfermo crítico como un factor de pronóstico vital y se asocia directamente con la morbilidad y mortalidad (3,9,45).…”

Section: Parámetros Técnicos En Cecunclassified

“…La utilización de monitorización de parámetros de aporte y consumo metabólico en tiempo real permite detectar situaciones de inadecuada perfusión de manera temprana y detectar el inicio del metabolismo anaeróbico (45,49) . Además de adecuar la perfusión a las necesidades metabó-licas del paciente: Anemia, hipotermia, patologías con alto consumo (endocarditis bacterianas, insuficiencia cardíaca aguda).…”

Section: Monitorización Avanzadaunclassified

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Untitled

2019

Rev Esp Perfusion

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“…Perioperative bleeding induced by cardiopulmonary bypass (CPB) is a major complication of cardiac surgery [1] . Various factors contribute to CPB-induced coagulation dysfunction, and hyperactivation of brinolysis is one of the important causes [2] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the in-vivo Effect of Two Tranexamic Acid Doses on Fibrinolysis Parameters in Adults Undergoing Valvular Cardiac Surgery with Cardiopulmonary Bypass - A Pilot Investigation

Zhou

Zhai

et al. 2020

Preprint

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Background: The blood saving efficacy of TXA in cardiac surgery has been proved in several studies, but TXA dosing regimens were varied in those studies. Therefore, we performed this study to investigate if there is a dose dependent in-vivo effect of TXA on fibrinolysis parameters by measurement of fibrinolysis markers in adults undergoing cardiac surgery with CPB, which has not been systematically elucidated.Methods: A double-blind, randomized, controlled prospective trial was conducted from February 11, 2017 to May 05, 2017. Thirty patients undergoing cardiac valve surgery were identified and randomly divided into a placebo group, low-dose group and high-dose group by 1: 1: 1. Fibrinolysis parameters were measured by plasma levels of D-Dimers, plasminogen activator inhibitor-1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI), plasmin-antiplasmin complex (PAP), tissue plasminogen activator (tPA) and thrombomodulin (TM). Those proteins were measured at five different sample times: preoperatively before the TXA injection (T1), 5 min after the TXA bolus (T2), 5 min after the initiation of CPB (T3), 5 min before the end of CPB (T4) and 5 min after the protamine administration (T5). A Thrombelastography (TEG) and standard coagulation test were also performed.Results: Compared with the control group, the level of the D-Dimers decreased in the low-dose and high-dose groups when the patients arrived at the ICU and on the first postoperative morning. Over time, the concentrations of PAI-1, TAFI, and TM, but not PAP and tPA, showed significant differences between the three groups (p <0.05). Compared with the placebo group, the plasma concentrations of PAI-1 and TAFI decreased significantly at the T3 and T4 (p <0.05); TAFI concentrations also decreased at the T5 in low-dose group (p <0.05). Compared with the low-dose group, the concentration of TM increased significantly at the T4 in high-dose group. No significant differences were observed in the levels of the coagulation proteins at any points between the groups.Conclusions: The vivo effect of low dose TXA is equivalent to high dose TXA on fibrinolysis parameters in adults undergoing valvular cardiac surgery with cardiopulmonary bypass, and we recommend a low dose TXA regimen for those patients.Clinical trial number and registry URL: ChiCTR-IPR-17010303; http://www.chictr.org.cn, Principal investigator: Zhen-feng ZHOU, Date of registration: January 1, 2017.

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What's New in Cardiopulmonary Bypass

Cited by 58 publications

References 226 publications

Vitamin C supplementation in cardiopulmonary bypass: a review

Vitamin C supplementation in cardiopulmonary bypass: a review

Untitled

Comparison of the in-vivo Effect of Two Tranexamic Acid Doses on Fibrinolysis Parameters in Adults Undergoing Valvular Cardiac Surgery with Cardiopulmonary Bypass - A Pilot Investigation

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