Is cardioplegia system pressure the optimal measure of coronary perfusion during antegrade cardioplegia delivery? A critical review of pressure measurements for optimal antegrade delivery.

Antegrade cardioplegia is routinely given during cardiac surgery. The delivery of antegrade cardioplegia from the cardiopulmonary bypass machine has many variables. Many perfusionists rely exclusively on cardioplegia system pressure to ensure safe antegrade delivery.

Cardioplegia at subnormothermia facilitates rapid functional resuscitation of hearts preserved in SOMAH for transplants.

Objectives: Hearts preserved ex vivo at 4 ° C undergo time-dependent irreversible injury due to extreme hypothermia. Studies using novel organ preservative solution SOMAH, suggest that hearts are optimally 'preserved' at subnormothermic temperature of 21 ° C. Present study evaluates relative efficacy of SOMAH 'cardioplegia' at 4 and 21 ° C in preservation of optimum heart function after in vitro storage at subnormothermia.

Sub-normothermic preservation of donor hearts for transplantation using a novel solution, Somah: a comparative pre-clinical study.

Background: Hearts preserved ex vivo at extreme hypothermia (4°C) undergo time-dependent irreversible injury. Our studies using a novel solution, Somah, suggest that hearts are viably preserved at 21°C. In this study we evaluate the relative efficacy of Somah for preservation of hearts at 21°C when compared with the clinically used Celsior and University of Wisconsin (UWS) solutions.

Thromboresistant surfaces with low-dose anticoagulation alleviate clopidogrel-related complications in patients undergoing coronary artery bypass grafting.

Objective: Numerous studies have shown that, when using conventional perfusion methodology, patients undergoing coronary artery bypass grafting within 7 days of receiving clopidogrel are at increased risk of bleeding, re-exploration, and blood transfusion. The purpose of this study was to evaluate the effect of clopidogrel administration before coronary artery bypass grafting on patients using thromboresistant surfaces with low-dose heparin during surgical intervention.

Methods: Patients who underwent isolated coronary artery bypass grafting between 2005 and 2009 were incorporated in this retrospective study.

Multifactorial comparison of modified and conventional perfusion strategies in a porcine model of cardiopulmonary bypass.

Background: Utilization of thromboresistant circuits in cardiopulmonary bypass (CPB) surgery has been controversial. However, due to the advantages associated with these types of circuits, we sought to evaluate the efficacy of use of low-dose heparin in conjunction with thromboresistant surfaces, closed perfusion system, elimination of blood-gas interface, maintenance of hematocrit to >25%, and systemic normothermia, with respect to the conventional strategy of non-thromboresistant open circuits with high-dose heparin, during 3 h of CPB in an animal model.

Methods: Using an open-chest swine model, animals were placed on CPB for 3 h with additional monitoring for 1 h post-CPB.

Microemboli are not associated with delirium after coronary artery bypass graft surgery.

Delirium is an acute change in cognition which occurs frequently after coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from plaque, air, or thrombus, have been hypothesized to contribute to delirium and cognitive decline after CABG. The purpose of this study was to determine if there was an association between cerebral microemboli and delirium after cardiac surgery.

Evaluation of blood components exposed to coated arterial filters in extracorporeal circuits.

Background: Biocompatible surfaces play an important role in the inflammatory response during cardiopulmonary bypass (CBP), with the arterial filter contributing a large surface area of the circuit. Different filter-coating materials designed to improve blood-filter biocompatibility are currently used in CPB circuits. This study evaluates eight biocompatible coatings used for arterial filters and their effects on blood components during circulation.

Development and evaluation of a novel solution, Somah, for the procurement and preservation of beating and nonbeating donor hearts for transplantation.

Background: Injury to myocytes, endocardium, and the coronary endothelium during harvesting and storage can compromise outcomes after heart transplantation. Safeguarding of structure and function of cardiomyocytes and endothelium in donor hearts may lead to improved patient survival after transplantation. Information gained from porcine hearts stored in standard transplant solution was used to design a superior preservation solution that would optimally protect and maintain organs from beating heart and/or nonbeating heart donors during long-term storage.

Intraoperative myocardial acidosis as a risk for hospital readmission after cardiac surgery.

Background: This study elucidates the relationship between intraoperative myocardial acidosis/ischemia and the risk of unplanned hospital readmissions within 30 days and 6 months after cardiac surgery.

Methods: Myocardial tissue pH (corrected to 37 degrees C: pH(37C)) was monitored in 221 patients during cardiac surgery. Regional myocardial acidosis was defined in terms of specific pH thresholds.

Cerebral hemodynamics during coronary artery bypass graft surgery: the effect of carotid stenosis.

Carotid stenosis is a frequent coexisting condition in patients undergoing coronary artery bypass graft (CABG) surgery. The impact of carotid stenosis on cerebral perfusion is not fully understood. The purpose of this study was to determine the impact of carotid stenosis on cerebral blood flow velocity in patients undergoing CABG.

Patients with diabetes mellitus undergoing cardiac surgery are at greater risk for developing intraoperative myocardial acidosis.

Objective: In patients undergoing cardiac surgery, intraoperative myocardial acidosis, which quantifies regional myocardial ischemia, has been shown to increase the risk of adverse postoperative outcomes. In this study, we sought to determine the course of intraoperative myocardial acidosis and its impact on postoperative survival in patients with diabetes mellitus undergoing cardiac surgery.

Methods: Intraoperative myocardial tissue pH(37C) was continuously measured in the anterior and posterior left ventricular walls in 264 patients undergoing cardiac surgery; 74 (28.

Use of a large bore syringe creates significantly fewer high intensity transient signals (HITS) into a cardiopulmonary bypass system than a small bore syringe.

Introduction: High intensity transient signals (HITS) have been reported to occur following perfusionist intervention during cardiac surgery. This study investigates the relationship of the syringe bore, injection rate, and HITS created.

Methods: Syringes (10 mL) with a male luer-lock connection (Large Bore) and Abboject 'jet syringes' with a 20 GA needle and male luer-lock connector (Small Bore) were filled with 10 mL of 0.

Intracoronary shunt-induced endothelial cell damage in porcine heart.

Background: Injury to and dysfunction of the endothelium can compromise the patency of coronary arteries and lead to impaired perfusion of the heart. Such injury can occur after the application of an intravascular shunt and/or a snare to a coronary artery during bypass surgery. In this study, multiphoton microscopy was used to assess the integrity of endothelium in porcine coronary arteries subjected to shunting and snaring during off-pump coronary artery bypass grafting (OPCAB).

Adverse 30-day outcomes after cardiac surgery: predictive role of intraoperative myocardial acidosis.

Background: Regional myocardial acidosis in patients undergoing cardiac surgery has been shown to be reflective of regional myocardial ischemia. This study elucidates the relationship between intraoperative regional myocardial acidosis and 30-day postoperative outcomes after cardiac surgery.

Methods: Intramyocardial tissue pH in the anterior and posterior left ventricular walls was measured in 397 adult patients undergoing valve replacement or coronary revascularization surgery between 1987 and 2001.

Atherosclerosis is associated with delirium after coronary artery bypass graft surgery.

Objectives: To investigate whether atherosclerosis of the ascending aorta, internal carotid arteries, and coronary arteries is predictive of postoperative delirium in subjects undergoing coronary artery bypass graft (CABG) surgery.

Design: Prospective cohort study.

Setting: Boston Veterans Affairs Healthcare System.

Intraoperative regional myocardial acidosis and reduction in long-term survival after cardiac surgery.

Background: Regional myocardial acidosis, as measured with tissue pH electrodes during cardiac surgery, has been shown to be reflective of regional myocardial ischemia. This study examined the relationship between intraoperative regional myocardial acidosis and long-term survival of patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods: A total of 496 adult patients who underwent valve replacement, coronary artery revascularization, or both with intraoperative myocardial pH monitoring in the anterior and posterior left ventricular walls were followed up for 3 to 17 years (average 10.

Cardiopulmonary bypass: it's not the size, it's how you use it! Review of a comprehensive blood-conservation strategy.

Several of the manufacturers of cardiopulmonary bypass equipment have recently introduced new miniature cardiopulmonary bypass systems. New advancements in cardiopulmonary bypass technology are almost always of interest to the perfusion community. However, the question arises, what advantages do these systems offer over our present technology? The manufacturers claim that these new systems will add to our perfusion armamentarium by offering us an opportunity to further reduce priming volume and the surface area to which the blood is exposed.

Intraoperative regional myocardial acidosis predicts the need for inotropic support in cardiac surgery.

Objective: To determine the impact of regional myocardial acidosis encountered during cardiac surgery on the need for inotropic and intra-aortic balloon (IAB) support.

Methods: Intramyocardial tissue pH(37C) was measured in 247 patients undergoing cardiopulmonary bypass (CPB). Inotropic support (INO) was defined as requiring one or more of norepinephrine/epinephrine/amrinone/dobutamine/>2.

Determinants of regional myocardial acidosis during cardiac surgery.

Background: Intraoperative regional myocardial acidosis (RMA) during cardiac surgery has been shown to be reflective of regional myocardial ischemia and an independent predictor of adverse postoperative outcomes. This study identifies the determinants of intraoperative RMA.

Methods: Intramyocardial tissue pH(37C) in the anterior and posterior LV walls was measured in 641 adult patients during cardiac surgery.

Acidosis-induced apoptosis in human and porcine heart.

Background: Acidosis-mediated injury to cardiac myocytes during surgery may lead to progressive heart failure. The nature of this injury, although not well defined, may be caused by induction of apoptosis in cardiac myocytes. We applied fluorescence imaging and biochemical techniques to assess apoptosis in cardiac myocytes excised from human patients and porcine subjects maintained on cardiopulmonary bypass to demonstrate the relationship between acidosis and apoptosis.

A combined approach for improving cardiopulmonary bypass in coronary artery surgery: a pilot study.

Background: This is a pilot study carried out to assess the feasibility and the clinical impact of a combined approach of cardiopulmonary bypass (CPB) with reduced anti-coagulation.

Methods: We used a retrospective, non-randomized analysis of 45 consecutive patients undergoing coronary artery bypass using standard CPB with full anticoagulation (activated clotting time, ACT, > 450 s) (Group 1; n = 23) or closed, heparin-coated CPB with low anticoagulation (ACT>250 s), precise heparin and protamine titration, controlled suction, and retrograde autologous prime (Group 2; n = 22).

Results: Patients were similar except for a higher incidence of three-vessel disease in Group 2 (77.

Heparin-bonded circuits without a cardiotomy: a description of a minimally invasive technique of cardiopulmonary bypass.

The deleterious effects of cardiotomy suction have been well recognized and well documented for some time. The use of cardiotomy suction results in the exposure of blood to the defoaming sock, aspiration of stagnant pericardial blood into the systemic circulation, and the entrainment of both fatty and gaseous microemboli. The purpose of this paper is to describe a technique using heparin-bonded cardiopulmonary circuits (HBCs) without the use of a cardiotomy reservoir or cardiotomy suction.