Hemolysis during cardiac surgery is associated with increased intravascular nitric oxide consumption and perioperative kidney and intestinal tissue damage.

Introduction: Acute kidney injury (AKI) and intestinal injury negatively impact patient outcome after cardiac surgery. Enhanced nitric oxide (NO) consumption due to intraoperative intravascular hemolysis, may play an important role in this setting. This study investigated the impact of hemolysis on plasma NO consumption, AKI, and intestinal tissue damage, after cardiac surgery.

Blood transfusions increase circulating plasma free hemoglobin levels and plasma nitric oxide consumption: a prospective observational pilot study.

Introduction: The increasing number of reports on the relation between transfusion of stored red blood cells (RBCs) and adverse patient outcome has sparked an intense debate on the benefits and risks of blood transfusions. Meanwhile, the pathophysiological mechanisms underlying this postulated relation remain unclear. The development of hemolysis during storage might contribute to this mechanism by release of free hemoglobin (fHb), a potent nitric oxide (NO) scavenger, which may impair vasodilation and microcirculatory perfusion after transfusion.

The impact of selective visceral perfusion on intestinal macrohemodynamics and microhemodynamics in a porcine model of thoracic aortic cross-clamping.

Introduction: Despite its presumed effectiveness and clinical use, the physiology of selective visceral perfusion combined with distal aortic perfusion during open thoracoabdominal aortic surgery has not been characterized. Thus, the aim of this study was to establish a translatable model of thoracic aortic-clamping to assess the effect of selective visceral perfusion with added distal aortic perfusion on local intestinal macrohemodynamics and microhemodynamics, intestinal histopathology, and markers of inflammation and intestinal damage.

Methods: A thoracolaparotomy was performed in 15 pigs, and the aorta was exposed, including the origins of celiac trunk and superior mesenteric artery.

Hemolysis compromises nitric oxide-dependent vasodilatory responses in patients undergoing major cardiovascular surgery.

Background: The hemolytic products cell-free oxyhemoglobin (FHb) and arginase-1 reduce nitric oxide (NO) bioavailability by scavenging NO and by degrading the NO precursor arginine to ornithine, respectively. In this study we evaluated the relevance of hemolysis to NO-dependent blood flow in patients undergoing cardiovascular surgery.

Methods: Plasma FHb, arginase-1, and amino acid concentrations were measured perioperatively.

Circulating intestinal fatty acid-binding protein as an early marker of intestinal necrosis after aortic surgery: a prospective observational cohort study.

Objective: This study evaluated the usefulness of plasma intestinal fatty-acid binding protein (IFABP) levels in the early identification of intestinal necrosis (IN) in patients undergoing different types of aortic surgery.

Background: Intestinal compromise greatly contributes to postoperative adverse outcome. IN is the most detrimental form of intestinal compromise and is notoriously difficult to diagnose.

Hemolysis is associated with acute kidney injury during major aortic surgery.

Hemolysis is an inevitable side effect of cardiopulmonary bypass resulting in increased plasma free hemoglobin that may impair tissue perfusion by scavenging nitric oxide. Acute kidney injury after on-pump cardiovascular surgery arises from a number of causes and severely affects patient morbidity and mortality. Here, we studied the effect of acute hemolysis on renal injury in 35 patients undergoing on-pump surgical repair of thoracic and thoracoabdominal aortic aneurysms of whom 19 experienced acute kidney injury.

Visceral injury and systemic inflammation in patients undergoing extracorporeal circulation during aortic surgery.

Objectives: Visceral injury and inflammation are evaluated in patients undergoing extracorporeal circulation (ECC) either with distal aortic perfusion (DAP) during thoracic aortic aneurysm (TAA) repair or DAP and selective organ perfusion (DAP and SP) during thoracoabdominal aortic aneurysm (TAAA) repair.

Summary Background Data: Visceral hypoperfusion and subsequent visceral injury, mainly to the gut, have been implicated as central events in the development of systemic inflammatory response syndrome (SIRS) and organ dysfunction after major surgery. Patients undergoing DAP or DAP and SP are exposed to artificial visceral perfusion, potentially leading to the development of intestinal injury and systemic inflammation.