ABSTRACT
Use of a majority of structural variables (age, sex, height) to estimate oxygen consumption in the calculation of cardiac output (CO) by the Fick principle does not account for changes in physiological conditions. To improve this limitation, oxygen consumption was estimated based on the left ventricular pressure-volume area. A pilot study with 10 patients undergoing right cardiac catheterization showed that this approach was successful to estimate CO (r=0,73, vs. thermodilution measured CO). Further essays changing end-diastolic-volume in the pressure-volume area formula by body weight or body surface area showed that this last yielded the best correlation with the thermodilution measured CO (slope=1, ordinate =0.01 and r=0.93). These preliminary results indicate that use of a formula originated from the pressure-volume-area concept is a good alternative to estimate oxygen consumption for CO calculation.
Subject(s)
Heart Ventricles/pathology , Oxygen Consumption , Body Surface Area , Cardiac Output , Diastole , Echocardiography/methods , Hot Temperature , Humans , Models, Biological , Models, Theoretical , Oxygen Consumption/physiology , Pilot Projects , Pressure , Temperature , Thermodilution/methods , Ventricular PressureABSTRACT
Although interleukins (IL) 8 and 10 predict lung viability in lung transplantation from heart beating donors (HBD) and IL-1beta is a marker of ex vivo performance from after cardiac death donors (ACDD), IL expression in the recipient remains unknown. This study assessed IL-1beta, IL-8 and IL-10 as indicators of functional performance in single-lung transplantation from ACDD pigs. Animals were divided into: (i) HBD: immediate lung excision; (ii) ACDD: fibrillation, 30 min warm ischemia and 3 h topical cooling. Left lungs of both groups were then flushed with Perfadex and stored at 3-4 degrees C for 3 h. IL in bronchoalveolar lavage fluid (BAL) and hemodynamic and graft function were measured in the donor and during the 2 h reperfusion period in the recipient. Myeloperoxidase, nuclear factor kappa beta, wet/dry weight ratio and a histologic injury score were assessed from biopsies in basal conditions in the donor and at the end of reperfusion. Despite similar pulmonary function and histologic markers of injury in both groups and higher IL-1beta in the donor of ACDD, IL-8 during reperfusion was significantly lower in ACDD (119 +/- 33% of basal) than in HBD (306 +/- 238%, P < 0.05) recipients. The paradoxical behavior of IL-8 makes it an unreliable predictor of ACDD early outcome in this transplantation model.
Subject(s)
Interleukin-8/metabolism , Lung Transplantation , Primary Graft Dysfunction/diagnosis , Animals , Bronchoalveolar Lavage Fluid/chemistry , Death , Hemodynamics , Interleukin-10/metabolism , Interleukin-1beta/metabolism , Lung/pathology , Male , Organ Preservation , Primary Graft Dysfunction/metabolism , Sus scrofa , Tissue Donors , Tissue and Organ HarvestingABSTRACT
BACKGROUND: Lung transplantation has evolved to become an effective treatment for a variety of end-stage lung diseases. However, severe reperfusion injury is still a major cause for postoperative morbidity and mortality. Although lung reperfusion injury is complex and has not been fully comprehended yet, neutrophil infiltration and cytokine activation have been postulated to play a main role. Recent studies showed that nitric oxide (NO) therapy has salutary effects on lung chronic and acute pathologies because it inhibits interleukin-8 (IL-8) release, but no data have been found on its effects during organ harvest. The aim of this study was to assess whether low doses of inhaled NO pre-treatment at the time of harvesting improves allograft function during early reperfusion in a porcine model. METHODS: Twenty-two Landrace pigs were randomly assigned to NO-treated and control groups. In NO-treated pigs, NO at 20 ppm was administered 30 min before harvest. During the early allograft reperfusion period IL-8 content, dynamic and static compliance and gas exchange (Pa/FiO2 and PaO2) were measured in both control and NO-treated lungs. RESULTS: Pre-treatment with NO at the time of harvesting showed improvement of allograft function in terms of dynamic (92 +/- 8% in NO vs 72 +/- 7% in the control group, p < .05) and static (83 +/- 8% in NO vs 63 +/- 7% in the control group, p < 0.05) compliance and gas exchange (PaO2: 96 +/- 4% in NO vs 74 +/- 4.5% in the control group, p < 0.01; Pa/FiO2: 97 +/- 5% in NO vs 74 +/- 5% in the control group, p < 0.01) by diminishing IL-8 (66.5 +/- 4.7 pg/ml in NO versus 208 +/- 43 pg/ml in the control group, p < 0.05) release in pigs. CONCLUSION: These results show for the first time that NO pre-treatment at the time of harvesting reduces allograft reperfusion injury in part due to its effects on IL-8 release.
Subject(s)
Endothelium-Dependent Relaxing Factors/administration & dosage , Interleukin-8/metabolism , Lung Transplantation/adverse effects , Nitric Oxide/administration & dosage , Premedication , Reperfusion Injury/prevention & control , Administration, Inhalation , Animals , Dose-Response Relationship, Drug , Drug Administration Schedule , Lung/metabolism , Lung/pathology , Models, Animal , Peroxidase/metabolism , Reperfusion Injury/etiology , Reperfusion Injury/metabolism , SwineABSTRACT
OBJECTIVE: To determine the value of intraoperative transesophageal echocardiography for the assessment of the pulmonary valve anatomy and the pulmonary autograft performance in patients undergoing the Ross procedure. DESIGN: Open, prospective, observational survey. SETTING: Favaloro Foundation, single institution. PARTICIPANTS: Consecutive patients undergoing elective Ross procedure (n = 87). INTERVENTIONS: Pulmonary valve function and anatomy were assessed by transesophageal echocardiography and the surgeon. Pulmonary autograft function was assessed after implantation. Regurgitation was considered mild (+/4), moderate (++/4), moderate-to-severe (+++/4), and severe (++++/4). Patients were restudied during midterm follow-up. MEASUREMENTS AND MAIN RESULTS: The Ross procedure was done in 74 patients (85%). Overall mortality was 3.4%. Mean follow-up was 24 +/- 13 months. The Ross procedure was not done in 13 patients (15%): 6 patients had a bicuspid pulmonary valve, 6 patients had >3 mm fenestrations, and 1 patient had regurgitation. The surgeon diagnosed anomalies in the pulmonary valve through direct observation. Transesophageal echocardiography was not sensitive enough to diagnose pulmonary valve defects in 12 of 13 patients with anomalies. Pulmonary valve regurgitation was identified by intraoperative transesophageal echocardiography in only 1 patient. Autograft regurgitation was 1.07 +/- 0.35 at postoperative evaluation. At 1, 6, and 12 months, it was 1.25 +/- 0.7 (p = 0.18), 1.27 +/- 0.9 (p = 0.185), and 1.29 +/- 0.8 (p = 0.17). The difference in values was not statistically significant. Four patients (5.4%) showed an increase in regurgitation during the first transthoracic autograft control. CONCLUSION: Intraoperative transesophageal echocardiography allows assessment of autograft performance after implantation. This method is not helpful, however, in detecting pulmonary valve anatomic anomalies.
Subject(s)
Aortic Valve/surgery , Echocardiography, Transesophageal , Intraoperative Care , Pulmonary Artery/transplantation , Pulmonary Valve Insufficiency/diagnostic imaging , Pulmonary Valve Insufficiency/surgery , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Severity of Illness Index , Treatment OutcomeABSTRACT
El propósito de este trabajo es doble: resumir el estado actual de los transplantes cardíacos y dar a conocer los resultados obtenidos por nuestro grupo sobre el tema. Para lo primero, se analizan con particular detalle las indicaciones y contraindicaciones actuales, el estudio y valoración pretransplante, la técnica del mismo, poniendo especial énfasis en la elección de las anestesias, su forma de administración y contralor, así como los cuidados posoperatorios y el seguimiento alejado. Para lo segundo se refieren los resultados obtenidos por los autores desde Mayo de 1980 hasta la actualidad en 116 transplantes cardíacos ortotópicos y uno heterotópico realizados en 26 mujeres (22,2 por ciento) y 91 hombres (77,7 por ciento) con una edad media de 44,7 ñ 15 años (valores extremos 4 y 74 años). La mortalidad a 30 días fue del 16 por ciento siendo la causa más frecuente la falla del injerto o el rechazo agudo. Al año del transplante la mortalidad total se elevó al 25 por ciento siendo la causa principal las infecciones. La supervivencia observada en esta serie fue del 58 por ciento a los 5 años y del 44 por ciento a los 10 años. Se concluye que: 1. El transplante cardíaco en la actualidad es una terapéutica lograda exitosa y de realización simple para los centros de suficiente complejidad y entrenamiento; 2. La anestesia resulta perfectamente reglada y ha alcanzado máxima seguridad en este tipo de pacientes. (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Heart Transplantation/methods , Heart Transplantation/mortality , Heart Transplantation , Tissue Donors , Propofol/administration & dosage , Anesthetics, Combined/administration & dosage , Follow-Up Studies , Survivorship , Quality of Life , Risk Factors , Monitoring, Physiologic , Hemostasis , Postoperative Period , Antibiotic Prophylaxis , Immunosuppression TherapyABSTRACT
El propósito de este trabajo es doble: resumir el estado actual de los transplantes cardíacos y dar a conocer los resultados obtenidos por nuestro grupo sobre el tema. Para lo primero, se analizan con particular detalle las indicaciones y contraindicaciones actuales, el estudio y valoración pretransplante, la técnica del mismo, poniendo especial énfasis en la elección de las anestesias, su forma de administración y contralor, así como los cuidados posoperatorios y el seguimiento alejado. Para lo segundo se refieren los resultados obtenidos por los autores desde Mayo de 1980 hasta la actualidad en 116 transplantes cardíacos ortotópicos y uno heterotópico realizados en 26 mujeres (22,2 por ciento) y 91 hombres (77,7 por ciento) con una edad media de 44,7 ñ 15 años (valores extremos 4 y 74 años). La mortalidad a 30 días fue del 16 por ciento siendo la causa más frecuente la falla del injerto o el rechazo agudo. Al año del transplante la mortalidad total se elevó al 25 por ciento siendo la causa principal las infecciones. La supervivencia observada en esta serie fue del 58 por ciento a los 5 años y del 44 por ciento a los 10 años. Se concluye que: 1. El transplante cardíaco en la actualidad es una terapéutica lograda exitosa y de realización simple para los centros de suficiente complejidad y entrenamiento; 2. La anestesia resulta perfectamente reglada y ha alcanzado máxima seguridad en este tipo de pacientes.