Objective To investigate the clinical effects and the brain protection effect of different cardiopulmonary bypass in treating descending aortic aneurysms. Methods From January 2001 to December 2008, 65 patients were diagnosed to have descending aortic aneurysm with magnetic resonance imaging (MRI) in our hospital. Among them, there were 56 males and 9 females whose age was between 15 and 71 years old with an average of 48.1 years. The disease process ranged from 6 days to 4 months (19.0±6.5 d ). Preoperative diagnosis showed that there were 41 cases of DeBakey type Ⅲinterlayer, 9 cases of Marfan syndrome with postoperative complications of type Ⅲ interlayer, 7 cases of pseudoaneurysm and 8 cases of true aneurysm. We adopted artificial blood vessel repair patch to repair the damaged point of the descending aorta in 2 cases, performed vascular aneurysm resection and artificial vessel replacement on 63 patients, and carried out descending aorta replacement and intercostal artery grafting in 18 cases. Results Among the 65 cases of cardiopulmonary bypass patients, there were 13 cases of left heart bypass, 12 cases of heart bypass, 30 cases of deep hypothermic circulatory arrest (DHCA) with total body retrograde perfusion (TBRP) and 10 cases of modified separate perfusion of upper and low body. Cardiopulmonary bypass time, DHCA time, retrograde perfusion time, upper body circulatory arrest time and low body circulatory arrest time were respectively 51-212 min, 18-75min, 18-73 min, 21-31 min, and 39-67 min. No death occurred during the operation, and there were no brain complications or complications of paralysis among all the patients. Two patients died after operation because of renal failure. Conclusion Good results can be achieved by selecting different method of cardiopulmonary bypass based on the anatomical location and range of the thoracic descending aortic aneurysms. The selection criteria should be favorable to the surgical operation and organ protection.
Objective To investigate the clinical effects and the management of combined using of zerobalanced ultrafiltration(ZBUF) and modified ultrafiltration(MUF) in severe infant open heart surgery with cardiopulmonary bypass(CPB) , in order to evaluate the feasibility and clinical significance of combination of ZBUF and MUF. Methods 20 pediatric patients diagnosed as complicated congenital heart disease had been involved, which included 12 males and 8 females with 12.6±7.5months of age and 8.5±3.3 kg of weight. Gambro FH22 hemofilter was selected in all patients. The typical MUF method was chosen. ZBUF was done during CPB and MUF was performed after CPB. The variety of hemodynamics, blood gas, concentration of electrolytes, inflammatory media and change of the plasma colloid osmotic pressure(COP) were measured at several time points. Filtrate was salvaged to detect the level of tumor necrosis factor alpha (TNF-α) and interleukine-8 (IL-8). Results Mean arterial pressure(MAP) was significantly higher(P=0.001) after MUF finished in all patients. Lactate acid (LAC), TNF-α and IL-8 had no significant difference before and after ZBUF. COP was significantly higher after MUF than that after ZBUF(P=0.002). Concentration of TNF-α in MUF filtrate was significantly higher than that in ZBUF(p=0.036). Conclusion Combined using of ZBUF and MUF has the effective ability of removing the inflammatory mediators and ameliorating system immunoreaction in pediatric CPB. MUF can improve the respiratory and heart function through decreasing the body water and increasing COP and hematocrit.
Abstract: Objective To summarize the clinical experience of plasma exchange （PE） during recardiopulmonary bypass (CPB) of patients with severe haemolysis in cardiac surgery. Methods Between January 2001 and December 2005, five patients required PE for severe haemolysis after cardiac surgery. There were periprosthetic leakage and infective endocarditis in 3 patients, congenital heart disease of pulmonary artery stenosis with unsatisfied right ventricular outflow tract patching in 1 patient and thrombosis during extracorporeal membrane oxygenation (ECMO) in 1 patient. They all need blood purification to avoid acute renal failure. Results Five patients were successfully treated with PE during CPB without major complications. The amount of plasma and blood transfused in the 5 patients were 2.2±0.8L and 0.6±0.3L respectively. The volume of plasma exchange and ultrafiltrate were 3.9±1.8L and 2.4±1.3L respectively.The electrolytes and bloodgas analysis in all patients were maintained at the normal levels. The hemodynamics was stable. After heart resuscitation CPB stopped smoothly. Disappearance of periprosthetic leakage and satisfaction of right ventricular outflow tract patching were observed by echocardiograms after peration.Extubation was performed 24h after the operation in 5 patients, and they were discharged 12 to 53 d after the operation with fully recovery. The urine was clear and the body temperature was normal. Before they left thehospital, the concentration of free hemoglobin was tested in 3 patients. The concentration of free hemoglobin was slightly higher in 1 patient (68mg/L), and normal in 2 patients (lt;40mg/L). Conclusion PE during CPB in severe haemolysis is a safe technique which can effectively prevent acute renal failure caused by severe mechanical haemolysis after cardiac surgery.
Objective To compare the graft patency rates of conventional on-pump coronary artery bypass grafting （CCABG） and off-pump coronary artery bypass grafting （OPCAB） at 2 weeks，3 months and 1 year after surgery. Methods Clinical data of 200 patients who underwent coronary artery bypass grafting （CABG） in the First Affiliated Hospital of Harbin Medical University from May 2010 to November 2011 were retrospectively analyzed. All the 200 patients were divided into two groups according to different surgical procedures they received：CCABG group，61 patients including 32 male patients and 29 female patients with their age of 59.8±4.7 years；and OPCAB group，139 patients including 72 male patients and 67 female patients with their age of 59.6±8.9 years. Graft patency of all the patients was evaluated by 256-slice multislice computed tomography angiography （256-MSCTA） at 2 weeks，3 months and 1 year after CABG and compared between two groups. Results At 2 weeks，3 months and 1 year after CABG，the graft patency rates of left internal mammary artery （LIMA） grafting were not statistically different between CCABG group and OPCAB group，as well as those of great saphenous vein （GSV） grafting （P＞0.05）. The 1 year graft patency rates of LIMA grafting of CCABG group and OPCAB group were 92.31% and 91.94% respectively，and 1 year graft patency rates of GSV grafting of CCABG group and OPCAB group were 91.35% and 90.00% respectively. To compare the graft patency rates of different distal anastomotic locations，grafting to the left anterior descending （LAD） coronary artery had significantly higher patency rate than grafting to the right coronary artery （RCA，P＜0.05）. The 1 year graft patency rates of LAD grafting and RCA grafting were 97.78% and 85.90% respectively. But there was no statistical difference in graft patency rates at different respective distal anastomotic locations between OPCAB group and CCABG group （P＞0.05）. To compare early clinical outcomes of two groups，postoperative mechanical ventilation time，length of ICU stay，24-hour mediastinal drainage，24-hour blood transfusion，length of hospital stay，and hospitalization cost of OPCAB group were significantly shorter or lower than those of CCABG group （P＜0.05）. Conclusion Short-term graft patency rates of CCABG and OPCAB are quite similar. Patency rate of grafting to LAD is higher than that of grafting to RCA. OPCAB can produce better perioperative clinical outcomes than CCABG.
Abstract: Cardiovascular involvement by advanced thoracic malignancies direct extension or metastasis is a group of fatal diseases with urgent conditions. Recently the technique of cardiopulmonary bypass(CPB) has been widely used in the management of advanced thoracic malignancies. The application of this technique not only extended operation indications of these diseases, but also decreased mortality, improved the quality of life and overall survival time. This paper reviewed the history, present status, indications of operation, methods of operation, postoperative complications, efficacy, evaluation and prospect of surgical management requiring CPB for advanced thoracic malignancies.
Coronary artery bypass grafting has made great progress in recent years. Off-pump coronary artery bypass grafting （off-pump） can escape from many complications resulting from cardiopulmonary bypass which powered the interest of more and more surgeons, but it is more technically demanding. Conventional coronary artery bypass grafting aided by cardiopulmonary bypass （on-pump） can provide with good condition for anastomosis, and is still applied widely. The comparation of the two surgical techniques were reviewed, including graft patency, mortality, inflammatory response, influence on coagulation and anticoagulation, injury to important organs, hospital length of stay and cost, technical convertion, et al.
The increased morbidity and mortality following cardiopulmonary bypass （CPB） may be due to the development of systemic inflammatory response syndrome （SIRS）. Leukocyte, especially neutrophil, plays a crucial role in SIRS during and after CPB, so the leukocyte removal by filtrations appears to be a logical anti-inflammatory strategy. Many articles reported that leukocyte depletion filter can decrease the potential adverse effects during CPB and reduce the morbidity and mortality following CPB. But the protective effects of the filter varied greatly from paper to paper. This may be due to the different design and biocompatibility of the filter at present, But, because the leukocyte plays a central role in SIRS, leukocyte depletion filter would be an important apparatus in therapy of noninfectious inflammation induced by CPB after it was improved.
Objective To evaluate the effect of cardiopulmonary bypass （CPB） on pulmonary function in infants with variable pulmonary arterial pressure resulting from congenital ventricular septal defect （VSD）. Methods Twenty infants with VSD underwent corrective surgery were divided into pulmonary hypertension group （n= 10） and non-pulmonary hypertension group （n= 10） according to with pulmonary hypertension or not. Pulmonary function was measured before CPB , 3h,6h,9h,12h,15h,18h,21h, and 24h after CPB and duration for mechanical ventilation and cardiac intensive care unit stay were recorded. Results Pulmonary function parameters before CPB in nonpulmonary hypertension group were superior to those in pulmonary hypertension group （P〈0.01）, and pulmonary function parameters after CPB deteriorated than those before CPB （P〈0.05）, especially 9h,12h and 15h after CPB （P〈0.01）. Compared to pulmonary function parameters before CPB, pulmonary function parameters of pulmonary hypertension group at 3h after CPB were improved （P〉0.05）, but they deteriorated at 9h,12h and 15h after CPB （P〈0. 05）. Pulmonary function parameters at 21h and 24h after CPB was recoverd to those before CPB in two groups. Conclusions Although exposure to CPB affects pulmonary function after VSD repair in infants, the benefits of the surgical correction to patients with pulmonary hypertension outweigh the negative effects of CPB on pulmonary function. Improvement of cardiac function can avoid the nadir of pulmonary function decreasing. The infants with pulmonary hypertension will be weaned off from mechanical ventilator as soon as possible, if hemodynamics is stable, without the responsive pulmonary hypertension or pulmonary hypertension crisis after operation.
Objective To analyze the current situation of civil cardiopulmonary bypass, then to give suggestion and prediction for the future of civil cardiopulmonary bypass (CPB). Methods Civil hospitals carrying out cardiac operations were inquired with questionnaires annually concerning the scope of cardiac operations being carried out, the ratio of onpump operations and offpump operations, the situation of extracorporeal membrane oxygenation(ECMO), the composition of CPB technicians, and oxygenators being utilized, et al. Results 76 319 cases of cardiac operations were performed in 2003, while 136 015 cases of cardiac operations were performed in 2007 (among them 113 465 cases were CPB, account for 83.42% of cardiac operations). 41 hospitals carried out 153 cases of extracorporeal membrane oxygenation(ECMO) in 2007. The rate of membrane oxygenator(import) utilization was 46.16%, and the rate of membrane oxygenator(made in China) utilization was 23.9% in 2007. There were 1 497 persons engaged in of CPB in 2007, and among them 55% were doctors. All the perfusionisters had not been trained normally so far. Conclusion Cardiac surgery and CPB technique make rapid progress in china, so persons engaged in CPB need to be trained normally and systematically. In recent years, more and more membrane oxygenators are utilized, and there is a trend that bubble oxygenators would be abandoned finally.
Objective To learn the predictive risk factors of acute conversion of off-pump coronary artery bypass grafting (off-pump CABG)to on-pump coronary artery bypass grafting (on-pump CABG), referring for making decision in operating. Methods During Jan. 2002 to May 2006, 546 patients underwent planned off-pump CABG were analyzed retrospectively, and cases of acute conversion of off-pump to on-pump CABG (converted group) were compared with unconverted to on-pump(off-pump group) by multivariate logistic regression. Results 24 patients of off-pump CABG were acutely converted to on-pump CABG because of ventricular fibrillation or unstable hemodynamics. The mortality in converted group was 16.7%(4/24), much higher than off-pump group ［27% (14/522) , P＜0.001］. By multivariable logistic regression, acute myocardial infarction (OR=3.142,P=0004), emergent CABG (OR=1.571,P=0.011) and right main coronary artery(RCA) stenosis less than 90% (OR=1922,P=0.024) were predictors of acute conversion of off-pump to on-pump. Conclusions The mortality in patients undergoing acute conversion of off-pump to on-pump coronary artery surgery is high. When applying off-pump CABG in patients with acute myocardial infarction, emergency CABG and right main RCA stenosis ≤90%, preventive set up of extracorporeal circulation is necessary.
