Basics of cardiopulmonary bypass

Sarkar, Manjula; Prabhu, Vishal

doi:10.4103/ija.ija_379_17

Cited by 122 publications

(93 citation statements)

References 38 publications

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“…Problems encountered during arterial cannulation include bleeding, cannula malposition, disruption of atherosclerotic plaque, and arterial dissection which may require repair under deep hypothermic circulatory arrest. 20 Similarly, venous cannulation can lead to bleeding and malposition. An incorrectly placed venous cannula can lead to an air-lock, preventing adequate venous drainage resulting in congestion in the cerebral and splanchnic vasculature.…”

Section: Mechanical Complications Of Cardiopulmonary Bypassmentioning

confidence: 99%

Complications of Coronary Artery Bypass Grafting

Hussain

Harky

2019

Int J Med Rev

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Introduction Coronary artery bypass grafting (CABG) is one of the most commonly performed operations with approximately 200 000 procedures performed annually in the United States of America and an incidence of 62 per 200 000 inhabitants in Western Europe. 1 It has evolved over the past century from a high-risk procedure to a relatively safe one with a current mortality rate of 1%-2% in elective patients. 2 Nonetheless, it is still a highly complex surgery and has been associated with a number of complications. The complications from this major surgery can be classified in various ways; some are catastrophic, such as death and stroke, while others can be self-limiting without any long-term residual effects, such as atelectasis, lower respiratory infection, or transient acute kidney injury. 2,3 CABG can be considered as a large operation incorporating many smaller operations. There may be variations in these smaller operations that can have both advantages and disadvantages. However, the end goal is to bypass a blocked or narrow coronary artery by anastomosis of a vessel conduit. 3 This may be done with or without cardio-pulmonary bypass, with arterial or venous grafts, and with open or endoscopic harvesting of conduits. The overall risk of this operation is determined by the Euroscore, which is a statistical determination of risk using logistic regression. 4,5 It is determined by patient-related factors (age, gender, renal impairment, peripheral vascular disease, mobility, previous cardiac surgery, chronic lung disease, active endocarditis, critical pre-operative state, insulin dependent diabetes), cardiac-related factors (NYHA dyspnea classification, CCS angina classification, left ventricular function, recent myocardial infarction, and pulmonary hypertension) and operation factors (urgency, weight of intervention, and involvement of thoracic aorta). 5 For the purposes of valid patient consent, it is considered mandatory to discuss the risk of death, peri-operative myocardial infarction, stroke, and sternal wound infection. 6 The general complications of CABG surgery are briefly discussed below followed by a discussion of the specific complications associated with cardiopulmonary bypass and graft patency. Extent of Complications Complications can be broadly divided into catastrophic events, such as death and stroke, or less serious complications, such as pulmonary, renal, or sternal wound complications. Death Mortality following CABG is reported to be between 1%-2% for elective procedures; however, it can be confounded by many factors including the urgency of the case, previous acute myocardial events, the presence of multiple comorbidities such as diabetes or chronic renal failure, or poor coronary vessels that are not amenable for grafting. 4-6 Stroke Post-operative stroke has an incidence of 1.4% to 3.8%. 2 The risk factors for this complication include increased age,

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Section: Mechanical Complications Of Cardiopulmonary Bypassmentioning

confidence: 99%

Complications of Coronary Artery Bypass Grafting

Hussain

Harky

2019

Int J Med Rev

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“…Heparin also binds to co-factor II, that inactivates thrombin independently of AT III 29 . Insufficient heparin anticoagulation could lead to life-threating clotting in the CPB circuit 30 . It may also result in bleeding diathesis due to consumption of coagulations factors 31 .…”

Section: The Ringers Chase Technique (Rc)mentioning

confidence: 99%

“…Protamine can cause various reactions such as hypotension, anaphylaxis and pulmonary hypertensive crisis 30 . The reactions can be managed with disruption of protamine administration, fluids, vasoconstrictors or in worst case scenario return to bypass.…”

Section: The Ringers Chase Technique (Rc)mentioning

confidence: 99%

Hemostatic function and inflammatory activation after weaning from cardio pulmonary bypass

Olsson¹

2018

Linköping University Medical Dissertations

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“…Cardioplegia (using potassium) is maintained via either retrograde coronary sinus or antegrade aortic root catheterization. Cross‐clamping of the aorta is involved and heparin is used to achieve anticoagulation …”

Section: Introductionmentioning

confidence: 99%

Pharmacological and non‐surgical renal protective strategies for cardiac surgery patients undergoing cardiopulmonary bypass: a systematic review

Tan

Brewster

Horrigan

et al. 2018

ANZ Journal of Surgery

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Background: Post-operative acute kidney injury after cardiopulmonary bypass (AKI-CPB) for cardiac surgery is a frequent complication. It may require renal replacement therapy (RRT), which is associated with an increased morbidity and mortality. This review explores the efficacy of proposed pharmacological and non-surgical renal protective strategies. Methods: A comprehensive literature search was done using Ovid MEDLINE, Embase and Scopus databases. Keywords included were cardiopulmonary bypass, cardiac surgery, coronary artery bypass, renal protection and renal preservation. Eligible articles consisted of all studies on patients who had undergone cardiac surgery via CPB with an outcome of AKI and/or RRT reported. All studies underwent a quality check via the risk of bias tool. The three most researched interventions (based on number of randomized controlled trials and total patients analysed) and their renal outcomes were then analysed with Review Manager Software. Results: Eighty-eight articles were extracted. A total of 26 management strategies for renal protection following CPB were identified. N-acetylcysteine (NAC), remote ischaemic preconditioning (RIPC) and the use of volatile anaesthetic agents (VAAs) were further analysed. NAC, RIPC and VAA had no statistically significant benefit in reducing either AKI-CPB or the need for RRT following CPB. Conclusion: NAC, RIPC and VAA were found to have no statistical significant benefit in reducing either AKI-CPB or the need for RRT following CPB. There remains clinical uncertainty with all currently proposed pharmacological and non-surgical renal protective strategies for CPB. Future research in this area should analyse the effects of combined interventions or specifically focus on 'at-risk' patients.

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Basics of cardiopulmonary bypass

Cited by 122 publications

References 38 publications

Complications of Coronary Artery Bypass Grafting

Complications of Coronary Artery Bypass Grafting

Hemostatic function and inflammatory activation after weaning from cardio pulmonary bypass

Pharmacological and non‐surgical renal protective strategies for cardiac surgery patients undergoing cardiopulmonary bypass: a systematic review

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