Better preservation of endothelial function and decreased activation of the fetal renin-angiotensin pathway with the use of pulsatile flow during experimental fetal bypass

Vedrinne, C.; Tronc, François; Martinot, Stéphane; Robin, Jacques; Allevard, A. M.; Vincent, Madeleine; Lehot, J.J.; Franck, M.; Champsaur, G

doi:10.1067/mtc.2000.108902

Cited by 47 publications

(38 citation statements)

References 29 publications

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“…Pulsatil akımın kullanıldığı diğer deneysel çalışmalarda; fetal pulsatil akım ile periferik vasküler dirençte azalma ve uteroplasental üniteden nitrik oksit gibi vazodilatör faktör-lerin salınımına bağlı olarak maternal kalp debisinde artış sağlanmış (5) . Endotel fonksiyonlarının daha iyi korunduğu, fetal renin-anjiotensin aktivasyonunda azalma olduğu ve laktat seviyelerinin nonpulsatil akı-ma göre daha stabil olduğu da gösterilmiştir (6) . KPB sırasında; maternal sirkülasyon, asid-baz dengesi ve perfüzyon basıncı stabil olsa bile anestezik ilaçlara özellikle opioidlere bağlı fetal kalp hızı değişiklikleri görülebilir.…”

Section: Discussionunclassified

Pregnancy and Cardiopulmonary Bypass with Pulsatile Flow

Sarkılar¹,

Narin²,

Kartal³

et al. 2013

GKDA Derg

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Section: Discussionunclassified

Pregnancy and Cardiopulmonary Bypass with Pulsatile Flow

Sarkılar¹,

Narin²,

Kartal³

et al. 2013

GKDA Derg

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“…In previous CPB ovine fetal models, the placenta served as the sole oxygenator, resulting in unstable oxygenation and severe placental damage occurring (24,25). It was observed that inhibiting stress and protecting vascular endothelial function of the placenta following CPB prevented an increase in the vascular resistance of the placenta that would otherwise lead to impairment of placental function, irreversible acidosis and subsequent fetal death (24).…”

Section: Discussionmentioning

confidence: 99%

“…It was observed that inhibiting stress and protecting vascular endothelial function of the placenta following CPB prevented an increase in the vascular resistance of the placenta that would otherwise lead to impairment of placental function, irreversible acidosis and subsequent fetal death (24). During CPB, the following typically influence the extent of placental damage: i) Re-distribution of fetal blood flow, ii) placental vascular endothelial dysfunction, iii) humoral factors, iv) perfusion patterns, v) pre-perfusion solution, and vi) low temperatures (25). Synergistic effects of these factors may cause progressive hypoxia, hypercapnia, acidosis and mortality of the fetuses (20,26).…”

Section: Discussionmentioning

confidence: 99%

Assessing the impact of total extracorporeal circulation on hemodynamics in an ovine fetal model

Xiao

Zhuang

Zhou

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study aimed to evaluate the impact of total extracorporeal circulation on hemodynamics and placental function in an ovine fetal model. Mid-term ovine fetuses (n=6) underwent extracorporeal circulation (30 min), cardioplegic arrest (20 min) and monitoring (120 min). The ascending aorta and umbilical cords of the fetuses were occluded during the bypass and an extracorporeal membrane oxygenator was used as the oxygen source. Biventricular intracardiac pressures, echocardiographic data, blood gas levels and placental function variables were recorded, and statistical analysis was performed using the repeated-measure analysis of variance test. The data indicated that fetal heart rate and blood pressure at 30, 60, 90 and 120 min following the bypass were stable relative to pre-arrest baseline (pre-bypass) values (P>0.05). However, end diastolic pressures in the ovine right ventricles post-bypass were significantly increased at 30, 60, 90 and 120 min relative to pre-bypass pressures (P<0.05). The pulsatility index also increased at 30 min post-bypass relative to the pre-bypass score (0.91±0.06 vs. 0.61±0.14; P=0.007). The mean resistivity index at all time points post-bypass was consistent with the pre-bypass score (P>0.05), while the mean Tei index values for the left and right ventricles post-bypass were significantly higher at all time points relative to pre-bypass values (P<0.05). The pre-bypass fetal blood pH, SaO 2 , base excess and lactate values were maintained during arrest (P>0.05). Fetal hemodynamics and placental function additionally remained stable for up to 2 h upon reperfusion following total extracorporeal circulation and cardioplegic arrest. Collectively these data suggest that the reproducible ovine fetal model may be useful in the evaluation of fetal cardiac surgery.

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“…Cerebral blood flow and microvascular blood flow both decrease, while the expression of inflammatory mediators in blood and vascular cells increases when pulsatile flow is replaced with nonpulsatile flow. [22][23][24] To circumvent this, some groups have added aortic counterpulsation attempting to reproduce pulsatile flow in the operating room, albeit with limited success. [22][23][24] (5) Alveolar blood flow is compromised.…”

Section: Physiologic Consequences Of Cardiopulmonary Bypassmentioning

confidence: 99%

“…[22][23][24] To circumvent this, some groups have added aortic counterpulsation attempting to reproduce pulsatile flow in the operating room, albeit with limited success. [22][23][24] (5) Alveolar blood flow is compromised. A common perception is that the alveoli are supplied by bronchial arterial blood, the flow of which is not interrupted by cardiopulmonary bypass.…”

Section: Physiologic Consequences Of Cardiopulmonary Bypassmentioning

confidence: 99%

Limiting brain and lung damage after coronary artery bypass grafting: An alternative to conventional coronary artery bypass graft

Runge

2004

Clinical Cardiology

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Summary:The development of coronary artery bypass graft (CABG) for the treatment of coronary heart disease has resulted in reduced morbidity and mortality compared with medical therapy. Even with the rapid development of improved percutaneous interventions, CABG remains an important approach for treating patients with advanced coronary heart disease. However, recent studies and commentary reporting an alarmingly high incidence of subtle, cognitive decline following CABG have generated questions about whether these adverse outcomes could be lessened. Even after considerable study, there is no consensus as to the cause of brain and lung injury after CABG and cardiopulmonary bypass, nor an agreed upon, mechanistic approach to study its prevention. The potential causes of these adverse outcomes and a simple approach are described, involving the use of the cannulae, biventricular pulsatile flow pump, and a blood substitute to optimize the perfusion of brain and alveolar cells, minimize systemic microembolization, and limit post-CABG cognitive decline.

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Better preservation of endothelial function and decreased activation of the fetal renin-angiotensin pathway with the use of pulsatile flow during experimental fetal bypass

Abstract: Improved placental and peripheral perfusion during fetal pulsatile-flow bypass may be mediated by preservation of fetal/maternal endothelial nitric oxide biosynthetic mechanisms and/or decreased activation of the fetal renin-angiotensin pathway.

Cited by 47 publications

References 29 publications

Pregnancy and Cardiopulmonary Bypass with Pulsatile Flow

Pregnancy and Cardiopulmonary Bypass with Pulsatile Flow

Assessing the impact of total extracorporeal circulation on hemodynamics in an ovine fetal model

Limiting brain and lung damage after coronary artery bypass grafting: An alternative to conventional coronary artery bypass graft

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