ABSTRACT
BACKGROUND: Conventional cardiopulmonary bypass results in cerebral ischemic sequelae that may be reduced with hybrid pump technologies, such as the CardioVention system (CardioVention, Santa Clara, CA, USA). CardioVention differs from conventional bypass in that it has a novel air elimination module and reduced membrane surface area and priming volume. This preliminary study tested whether this pump confers neurological safety advantages over conventional bypass. METHODS: Ten patients were studied, with 6 assigned to on-pump coronary artery bypass grafting and 4 to the CardioVention system. No patients had any stroke history. Within 72 hours postsurgery, each underwent diffusion-weighted magnetic resonance imaging, a sensitive test for cerebral ischemic events. RESULTS: Two on-pump patients (33%) had postoperative findings on imaging, but none of the CardioVention patients demonstrated comparable changes ( P =.47). No patients had symptoms of acute stroke. CONCLUSION: Postoperative magnetic resonance imaging showed a trend toward a greater rate of ischemic events in patients undergoing traditional on-pump surgery. These preliminary findings suggest that hybrid pump technologies, such as the CardioVention system, may attenuate the risk of short-term neurological complications. Future studies are indicated to confirm these subclinical ischemic changes and to correlate them with long-term neurocognitive changes.
Subject(s)
Brain Ischemia/diagnosis , Brain Ischemia/etiology , Cardiopulmonary Bypass/adverse effects , Cardiopulmonary Bypass/instrumentation , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/instrumentation , Magnetic Resonance Imaging/methods , Aged , Coronary Artery Bypass/methods , Equipment Design , Equipment Failure Analysis , Humans , Middle Aged , Prognosis , Treatment OutcomeABSTRACT
BACKGROUND: Recent data indicated a potential role for extracellular ubiquitin in hematopoiesis and inflammation. The biological significance and therapeutic potential of these findings in vivo are unknown. Based on its in vitro abilities to inhibit endotoxin-stimulated tumor necrosis factor alpha (TNFalpha) production, we hypothesized that exogenous ubiquitin has salutary effects on sequelae caused by endotoxin in vivo. METHODS: Anesthetized and mechanically ventilated swine were infused with endotoxin for 3 hours. Ubiquitin was administered intravenously either 15 minutes before or 45 minutes after the endotoxin infusion was started. Albumin was administered to a control group. An additional control group received only ubiquitin. Ex vivo endotoxin evoked TNFalpha production was measured using a whole blood assay. Ubiquitin and TNFalpha concentrations were determined by enzyme-linked immunosorbent assay. RESULTS: Ubiquitin reduced mortality (P <.05), prevented development of pulmonary failure (P <.05), reduced fluid requirements (P <.05), and diminished erythema and edema formation. Ubiquitin pretreatment was more effective than treatment 45 minutes after an endotoxin infusion was started. In vivo ubiquitin administration alone inhibited ex vivo endotoxin-evoked TNFalpha secretion, but had no effect on TNFalpha serum levels after endotoxin infusion. CONCLUSION: In vivo ubiquitin administration has salutary actions during lethal endotoxemia and inhibits ex vivo whole blood TNFalpha production upon endotoxin stimulation. The clinical appearance after ubiquitin treatment in endotoxemia indicates the endothelium as another potential target cell population for interactions with ubiquitin. A novel therapeutic approach to a broad variety of diseases, in which endotoxin triggers immune activation, is suggested.
