Hemolysis and inflammatory response to extracorporeal circulation during on-pump cabg: comparison between roller and centrifugal pump systems

Abstract Objective: To compare the perioperative incidence rates of hemolysis and inflammatory response in patients undergoing coronary artery bypass grafting with the two main types of cardiopulmonary bypass, centrifugal and roller pumps, and establish correlations among hemolytic and inflammatory changes. Methods: This was a prospective, randomized trial of 60 patients assigned to either roller pump (G1, n=30) or centrifugal pump (G2, n=30) bypass. Markers of hemolysis (serum haptoglobin, lactate dehydrogenase [LDH]) and inflammation (interleukin [IL]1ß, IL-6, and TNF-α) were measured and analyzed. Results: There was no significant between-group difference in the variables of interest. In G1, there was a positive association with IL-6 and TNF-α (P<0.01 and P<0.05, respectively). In G2, there was a positive association with LDH in the postoperative period (P<0.5). At 24h post-cardiopulmonary bypass, there were positive associations between LDH and IL-1ß (P<0.05), LDH and TNF-α (P<0.01), haptoglobin and TNF-α (P<0.05), and LDH and TNF-α (P<0.01) in G1, and between LDH and IL-6 (P<0.01), LDH and TNF-α (P<0.01), and LDH and IL-6 (P<0.01) in G2. Conclusion: There were no significant between-group differences in markers of hemolysis or inflammation. IL-6 and TNF-α were positively associated with duration of cardiopulmonary bypass in G1, while LDH was positively associated with duration of cardiopulmonary bypass in G2. The rate of significant associations between markers of hemolysis and inflammation was higher in the roller pump group (G1). Registration number: ReBEC (RBR-92b9dg).

Cardiopulmonary bypass: development of John Gibbon's heart-lung machine / Circulação extracorpórea: desenvolvimento da máquina de coração-pulmão de John Gibbon

Abstract Objective: To provide a brief review of the development of cardiopulmonary bypass. Methods: A review of the literature on the development of extracorporeal circulation techniques, their essential role in cardiovascular surgery, and the complications associated with their use, including hemolysis and inflammation. Results: The advancement of extracorporeal circulation techniques has played an essential role in minimizing the complications of cardiopulmonary bypass, which can range from various degrees of tissue injury to multiple organ dysfunction syndrome. Investigators have long researched the ways in which cardiopulmonary bypass may insult the human body. Potential solutions arose and laid the groundwork for development of safer postoperative care strategies. Conclusion: Steady progress has been made in cardiopulmonary bypass in the decades since it was first conceived of by Gibbon. Despite the constant evolution of cardiopulmonary bypass techniques and attempts to minimize their complications, it is still essential that clinicians respect the particularities of each patient's physiological function. .

Resumo Objetivo: Relatar de forma simples e resumida o desenvolvimento da circulação extracorpórea. Métodos: Realizada revisão de literatura sobre a evolução da circulação extracorpórea, seu papel fundamental para cirurgia cardiovascular e as complicações que podem surgir após o seu uso, dentre elas, a hemólise e a inflamação. Resultados: O processo de desenvolvimento da circulação extracorpórea foi fundamental, diminuindo as complicações desencadeadas por ela, que acabam por repercutir no paciente, variando de lesões de graus variados até falência de múltiplos órgãos. Os pesquisadores estudaram quais as agressões que a circulação extracorpórea poderia suscitar no organismo humano. Possíveis soluções surgiram e, consequentemente, meios mais adequados para uma condução mais segura do pós-operatório foram propostas. Conclusão: A circulação extracorpórea progrediu a passos firmes e seguros ao longo destas últimas décadas desde a sua concepção por Gibbon. Apesar da sua evolução e das condutas realizadas na tentativa de amenizar as complicações, o respeito aos detalhes das funções fisiológicas do paciente é fundamental. .

Uso de nifedipina e incidência de lesão renal aguda em pós-operatório de cirurgia de revascularização do miocárdio com CEC / Use of nefidipine and acute kidney injury incidence in postoperative of myocardial revascularization surgery with cardiopulmonary bypass

OBJETIVO: Avaliar durante o período perioperatório o uso da nifedipina na incidência de lesão renal aguda dos pacientes submetidos à revascularização do miocárdio com circulação extracorpórea. MÉTODOS: Foram estudados, de modo prospectivo e sequencial, 94 pacientes submetidos à revascularização do miocárdio com circulação extracorpórea. As dosagens da creatinina sérica foram realizadas durante pré-operatório e pós-operatório de 24, 48 horas e no 7º dia. Estabeleceu-se como definição para presença de lesão renal a elevação da creatinina sérica 30 por cento em relação ao seu valor basal nas primeiras 24 ou 48 horas de pós-operatório. Os pacientes foram divididos em quatro grupos: G1, que recebeu nifedipina no pré-operatório; G2, que recebeu nifedipina no pós-operatório; G3, que recebeu nifedipina no pré e pós-operatórios e, G4, que não recebeu nifedipina. RESULTADOS: O grupo G4 mostrou maior elevação do percentual de creatinina sérica e maior percentual de pacientes que apresentaram insuficiência renal aguda em relação aos demais grupos no pós-operatório. CONCLUSÃO: Os valores da creatinina sérica e a incidência de lesão renal aguda no pós-operatório sugerem possível efeito nefroprotetor da nifedipina em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea.

OBJECTIVE: The objective of this work was to evaluate the influence of the use of nifedipine on the outcome of renal function in patients undergoing myocardial revascularization with extracorporeal circulation. METHODS: The casuistics and variables related to extracorporeal circulation were studied. Serum creatinine levels were measured preoperatively, 24, 48 hours and on 7th day postoperatively. Renal failure was defined as an increase in 30 percent of serum creatinine levels at 24 or 48 hours postoperatively compared to those at baseline. Patients were assigned to four groups: G1 (patients who received nifedipine preoperatively); G2 (patients who received nifedipine postoperatively); G3 (patients who received nifedipine pre and postoperatively) and G4 (patients who did not receive nifedipine). RESULTS: The mean serum creatinine levels postoperatively presented greater rise in G4 (G4>G1=G2=G3), and G4 also presented a higher percentage of patients with acute renal failure (G4>G1 and G4>G3, P<0.05; G1=G3 and G2=G4, P>0.05). CONCLUSION: The evaluation of serum creatinine values and incidence of acute kidney injury postoperatively suggest a possible nefro-potective effect of nifedipine in patients undergoing myocardial revascularization with extracorporeal circulation.