| 1. |
- Ingemansson, Richard, et al.
(författare)
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Effect of temperature in long-term preservation of vascular endothelial and smooth muscle function
- 1996
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 61:5, s. 1413-1417
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND. In clinical transplantation the donor organ is perfused with a cold preservation solution to obtain quick core cooling and a suitable environment for the tissue cells. Without good preservation of the vasculature, progressive deterioration of the blood flow during reperfusion may ultimately lead to the no-reflow phenomenon, even though the function of the other cells in the organ may be adequately preserved. The aim of this study was to find the optimal storage temperature for preservation of the vasculature. METHODS. The infrarenal aorta of 126 Sprague-Dawley rats were studied in organ baths: as fresh controls, after 36 hours of storage at 0.5 degrees C, 4 degrees C, 8.5 degrees C, and 22 degrees C in University of Wisconsin solution, and after 36-hour storage followed by transplantation and a lapse of 2 hours, 24 hours, and 7 days. The thromboxane analogue U-46619 was used to test contractility. Acetylcholine was used to elicit endothelium-dependent relaxation (EDR), and papaverine to elicit endothelium-independent relaxation. RESULTS. Storing the vessels at 0.5 degree C proved best regarding preservation of contractility, with a nonsignificant decrease, whereas storage at 4 degrees C and 8.5 degrees C resulted in a significant decrease after 36 hours. The contractility did not recover within 24 hours of in vivo reperfusion, but full recovery was seen after 7 days. Regardless of the preservation temperature used, a significant impairment in EDR was seen after 36 hours of storage. Two hours after transplantation, vessels stored at 4 degrees C and 8.5 degrees C showed no significant impairment in EDR, whereas those stored at 0.5 degrees C demonstrated a significant loss of EDR. After 24 hours and after 7 days, EDR was normal in all groups. CONCLUSIONS. Endothelium-dependent relaxing factor function is best preserved at 4 degrees C and 8.5 degrees C, whereas preservation of vascular smooth muscle function is best preserved at 0.5 degrees C.
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| 2. |
- Ingemansson, Richard, et al.
(författare)
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Long-term preservation of vascular endothelium and smooth muscle
- 1995
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 59:5, s. 1177-1181
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Tidskriftsartikel (refereegranskat)abstract
- This study was performed in organ baths on 400 ring segments of infrarenal aorta taken from 40 Sprague-Dawley rats that had been randomized into five groups. Contractility was tested with the thromboxane analogue U-46619. Acetylcholine was used to elicit endothelium-dependent relaxing factor (EDRF). The results obtained from vessels preserved at 4 degrees C for 6, 12, 24, and 36 hours were compared with those from autologous vessels studied immediately after harvesting. Vessels preserved in Euro-Collins solution showed a 46% (p < 0.01) decrease in contractility after 12 hours of storage; after 24 hours only weak contractions could be elicited, and after 36 hours they had lost their ability to contract. The EDRF function was slightly reduced after 12 hours and could not be investigated after 24 and 36 hours. With the University of Wisconsin solution (UW) and the low-potassium-dextran-glucose solution Perfadex no decrease in contractility was seen in the first 24 hours, but at 36 hours the vessels preserved in UW had lost 40% (p < 0.01) and those preserved in Perfadex 30% (p < 0.05) of their contractility. The EDRF function was significantly reduced by about 15% after 6, 12, and 24 hours in both the UW and the Perfadex groups. At 36 hours, vessels stored in Perfadex had lost 41% (p < 0.001) and those stored in UW 17% (p < 0.01) of their EDRF function.(ABSTRACT TRUNCATED AT 250 WORDS)
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| 3. |
- Lindberg, Lars, et al.
(författare)
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Inhalation of nitric oxide after lung transplantation
- 1996
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 61:3, s. 956-962
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pulmonary hypertension is a postoperative complication that may adversely affect the outcome of lung transplantation. The effect of nitric oxide (NO) inhalation on pulmonary hemodynamic indices after lung transplantation was studied and compared with findings in control pigs. METHODS: Varying concentrations of NO were inhaled by 5 pigs after left lung transplantation and right pneumonectomy and by 5 controls after right pneumonectomy at an inspired oxygen fraction of 0.21 and 0.5. Hemodynamic data were recorded continuously, and fast circulatory courses were analyzed. RESULTS: Inhalation of NO reduced pulmonary vascular resistance and mean pulmonary arterial pressure in all pigs, but the decrease was pronounced and dose dependent only at an inspired oxygen fraction of 0.21 in the pigs that had transplantation. These were the only pigs that became hypoxic. With the termination of NO, there was a dose-independent rebound pulmonary vasoconstriction in the controls, especially at an inspired oxygen fraction of 0.21, but not in the pigs that had transplantation. This response was transient and could be blunted with a higher inspired oxygen fraction. CONCLUSION: Inhalation of NO reduced pulmonary vascular resistance in the transplanted lung and may be useful in the treatment of pulmonary hypertension after lung transplantation. The rebound pulmonary vasoconstriction with the termination of NO inhalation stresses the need to be aware of this effect and to wean NO carefully in clinical situations. This study showed oxygen dependency, which has to be taken into consideration in dose-response studies involving NO inhalation.
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| 4. |
- Jönsson, Henrik, et al.
(författare)
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S100β after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome
- 1999
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 68:6, s. 2202-2208
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Tidskriftsartikel (refereegranskat)abstract
- Background. S100β has been suggested as a marker of brain damage after cardiac operation. The aim of this study was to characterize the early S100β release in detail and relate it to neuropsychological outcome.Methods. Three groups of patients were investigated. All patients underwent coronary artery bypass surgery (CABG) with extracorporeal circulation. In group A, 110 patients had sampling of S100β for the first 10 postoperative hours and also underwent neuropsychological testing. In group B, 14 patients were examined for the effect of autotransfusion on S100β levels. Eight patients in group C had their intraoperative bleeding processed with a cell-saving device.Results. Group A had a heterogeneous release pattern with several rapid elevations in S100β concentration. In group B, high concentrations of S100β were found in the autotransfusion blood (range 0.2 to 210 μg/L) with a concurrent elevation of serum S100β levels after transfusion of shed blood. In group C, high levels of S100β were found in the blood from the surgical field (12.0 ± 6.0 μg/L) and decreased (1.1 ± 0.64 μg/L) after wash. Group C had significantly lower S100β values at the end of cardiopulmonary bypass compared to group A (0.53 ± 0.35 μg/L versus 2.40 ± 1.5 μg/L). S100β values were corrected for extracerebral contamination with a kinetic model. With this correction, an association was found between adverse neuropsychological outcome and S100β release in group A (r = 0.39, p < 0.02).Conclusions. A significant amount of S100β is found both in the blood from the surgical field and in the shed mediastinal blood postoperatively. Infusion of this blood will result in infusion of S100β into the blood and interfere in the interpretation of early systemic S100β values.Previous article in issue
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| 5. |
- Moen, Oddvar, et al.
(författare)
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Centrifugal pump and heparin coating improves cardiopulmonary bypass biocompatibility
- 1996
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 62:4, s. 1134-1140
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Centrifugal pumps are being used increasingly for short-term extracorporeal circulation purposes such as during heart operations. Whether the centrifugal pump improves the cardiopulmonary bypass biocompatibility has not been fully documented. METHODS: A roller pump (n = 20) was compared in vivo with a centrifugal pump (n = 20) in groups of patients in which cardiopulmonary bypass circuits that were either totally heparin coated (Carmeda BioActive Surface; n = 20) or uncoated (n = 20) were used. We expected the heparin coating to attenuate blood activation, thus possibly making the comparison of the two pumps easier with respect to their different blood activation potentials. Samples of blood plasma, obtained during cardiopulmonary bypass from low-risk coronary artery bypass grafting patients, were analyzed for hemolysis (plasma haemoglobin), complement activation (C3bc and the terminal complement complex), a complement lytic inhibitor (vitronectin), coagulation activation (fibrinopeptide A), granulocyte activation (lactoferrin), and platelet activation (beta-thromboglobulin). RESULTS: The concentrations of terminal complement complex, lactoferrin, and beta-thromboglobulin were significantly lower in association with heparin-coated surfaces. The concentration of plasma hemoglobin was significantly lower in association with the centrifugal pump. In uncoated circuits, the beta-thromboglobulin level was significantly higher in association with the roller pump than with the centrifugal pump, but this significant reduction in the beta-thromboglobulin level did not hold true for the heparin-coated circuit group. CONCLUSIONS: A heparin-coated cardiopulmonary bypass surface reduces the blood activation potential during cardiopulmonary bypass, and the centrifugal pump causes less hemolysis than the roller pump.
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| 6. |
- Moen, Oddvar, et al.
(författare)
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Disparity in blood activation by two different heparin-coated cardiopulmonary bypass systems
- 1995
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Ingår i: Annals of Thoracic Surgery. - 0003-4975 .- 1552-6259. ; 60:5, s. 1317-1323
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Several studies have indicated reduced "blood activation" in heparin-coated cardiopulmonary bypass systems. The present study compares the effect of two different heparin coatings on different blood activation indices. METHODS: Low-risk patients (n = 40) were randomized to coronary artery bypass grafting using cardiopulmonary bypass with surfaces coated entirely by either the Duraflo II heparin coat or the Carmeda Biological Active Surface, or with identical uncoated equipment. In all cases, a standard systemic heparin dosage was used. Complement activation (C3 activation products C3bc and C3a and formation of fluid phase terminal SC5b-9 complement complex), neutrophil activation (lactoferrin and myeloperoxidase), and lytic inhibitors (vitronectin and clusterin) were quantified during cardiopulmonary bypass and 6 hours postoperatively. RESULTS: Heparin coating by either method reduced the formation of terminal SC5b-9 complement complex and the release of lactoferrin and myeloperoxidase compared with uncoated systems. Lactoferrin and myeloperoxidase levels increased significantly during cardiopulmonary bypass in the Duraflo II group, whereas no significant increase was observed in the Carmeda Biological Active Surface group. The least formation of terminal SC5b-9 complement complex and neutrophil activation was observed with the Maxima Carmeda Biological Active Surface-coated equipment. The vitronectin and clusterin concentrations were significantly less reduced in the Duraflo II compared with the control group. This study underlines the importance of terminal SC5b-9 complement complex as a suitable marker in the evaluation of complement activation during cardiopulmonary bypass. CONCLUSIONS: Both heparin coatings reduce blood activation, probably more so with Carmeda Biological Active Surface than with Duraflo II.
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| 7. |
- Nilsson, Leif, et al.
(författare)
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Eosinophil granule proteins is cardiopulmonary bypass with and without heparin coating
- 1995
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 59:3, s. 713-716
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Tidskriftsartikel (refereegranskat)abstract
- Extracorporeal circulation with exposure of blood to foreign surfaces causes activation of different defense systems, eg, white cells. Several potent mediators are released into plasma, capable of causing harmful effects to different organs, contributing to postoperative morbidity after operations using cardiopulmonary bypass. The eosinophil granulocyte has not previously been investigated in this respect. We studied two of its activation products, eosinophil cationic protein and eosinophil protein X in coronary bypass patients. In 17 control patients, plasma levels of eosinophil cationic protein and eosinophil protein X increased considerably during cardiopulmonary bypass. In 19 patients with heparin-coated cardiopulmonary bypass equipment the levels were significantly reduced, indicating improved biocompatibility of the cardiopulmonary bypass circuit. The heparin-coated surface causes less activation of eosinophils; also released eosinophil cationic protein is bound to the heparinized surface.
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| 8. |
- Olsson, Christian, et al.
(författare)
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Quality of life in survivors of thoracic aortic surgery
- 1999
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Ingår i: Annals of Thoracic Surgery. - 0003-4975 .- 1552-6259. ; 67:5, s. 1262-1267
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The results of surgical repair of thoracic aortic lesions are improving. Still, mortality and morbidity are considerable. Outcomes need to be studied in greater detail. We studied quality of life in survivors of thoracic aortic surgery, which has not been reported before. METHODS: During a 5-year period, 115 patients underwent thoracic aortic repair. All mid- to long-term survivors (n = 81; median follow-up time, 26 months) received the Short Form-36 (SF-36) health questionnaire plus specific questions related to surgery. Five patients were lost to follow-up. RESULTS: Scores for the eight dimensions of SF-36 (range, 0 to 100, 100 reflecting best function) were compared with a normal population. The mean deficits from the norm were bodily pain, 0.1 (95% confidence interval, -3.4 to 3.6) points below norm; mental health, 8.3 (5.7 to 10.9); vitality, 9.5 (6.7 to 12.3); social functioning, 10.1 (6.9 to 13.3); general health, 11.1 (8.5 to 13.7); physical functioning, 16.6 (13.4 to 19.8); role emotional, 20.6 (15.3 to 25.9); and role physical, 30.2 (24.7 to 35.7). Subgroup scores for acute versus elective cases, ascendens versus arch versus descendens procedures, and major complication versus no major complication were not significantly different. Sixty-six percent (50 of 76) stated a general health perception improvement. In 82% (62 of 76), the quality of life improved or was preserved. Ninety-one percent (69 of 76) considered the operation successful. CONCLUSIONS: Considering the seriousness of the conditions, quality-of-life scores after thoracic aortic surgery were acceptable, although lower than in a normal population, except for bodily pain. Postoperative quality of life justifies thoracic aortic surgical repair.
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| 9. |
- Vanhanen, Ingemar, et al.
(författare)
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Intravenous Aspartate Infusion After a Coronary Operation : Effects on Myocardial Metabolism and Hemodynamic State
- 1998
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Ingår i: Annals of Thoracic Surgery. - 0003-4975 .- 1552-6259. ; 65:5, s. 1296-1302
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Tidskriftsartikel (refereegranskat)abstract
- Background. In a previous study glutamate infusion after coronary artery bypass grafting was associated with beneficial effects on myocardial metabolism and myocardial performance. It has been claimed that aspartate is more important than glutamate for the recovery of myocardial metabolism after cardioplegic arrest. Therefore, the metabolic and hemodynamic effects of aspartate were studied after coronary artery bypass grafting.Methods. Fifty to 240 mL of a 0.1 mol/L aspartic acid solution was infused intravenously during 60 minutes in 10 patients early after coronary artery bypass grafting. Myocardial metabolism was studied using the coronary sinus catheter technique.Results. Aspartate infusion caused a significant increase in the arterial levels of both aspartate and glutamate. This was associated with a significant increase in myocardial uptake of aspartate and a decrease in myocardial uptake of glutamate. Myocardial exchange of other substrates remained unaffected. There were no changes in hemodynamic state except an increase of heart rate and pulmonary vascular resistance.Conclusions. Interactions with glutamate metabolism, compatible with competitive inhibition of myocardial glutamate uptake, which may have outweighed potential effects of aspartate, were observed. Recognition of these amino acid interactions is important as they are used together as additives in cardioplegic solutions.
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| 10. |
- Wulff, John, et al.
(författare)
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Flow characteristics of the Hemopump : an experimental in vitro study.
- 1997
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Ingår i: Annals of Thoracic Surgery. - 0003-4975 .- 1552-6259. ; 63:1, s. 162-166
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Hemopump (DLP/Medtronic) has been in clinical use for about 7 years. There is still no adequate way of determining actual output from the three available pump systems in the clinical situation. If the pump is completely stopped during weaning from the device, there is a possibility of back-leakage through the pump, endangering the patient from regurgitation into the left ventricle. It can also make it more difficult to judge the recovery of heart function because of a volume load of the left ventricle. The aim of this study was to evaluate in a standardized, experimental in vitro model the output from three different-sized Hemopump catheters at various pressure levels and to quantify the back-flow through the pumps.METHODS: The Hemopump models were tested in an in vitro study regarding total outflow at various speeds at three pressure levels. The back-flow through the pumps was also measured with the pumps at a complete stop.RESULTS: The outflow from the Hemopumps ranged from 0.4 to 4.5 L/min, depending on which pump and speed were used. Variations in total output, depending on speed and various pressure settings, could be up to 0.4 L/min. Back-flow through the pump into the left ventricle may be as great as 1.6 L/min.CONCLUSIONS: The flow outputs from the different Hemopump models were reproducible over time and were closely related to the resistance of the model. The Hemopump, if not running, can induce substantial regurgitation through the pump into the left ventricle.
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