Cardiopulmonary bypass and internal thoracic artery: Can roller or centrifugal pumps change vascular reactivity of the graft? The IPITA study: A randomized controlled clinical trial

Abstract

Background Cardiopulmonary bypass (CPB) induces a systemic inflammatory response (SIRS) and affects the organ vascular bed. Experimentally, the lack of pulsatility alters myogenic tone of resistance arteries and increases the parietal inflammatory response. The purpose of this study was to compare the vascular reactivity of the internal thoracic arteries (ITAs) due to the inflammatory response between patients undergoing coronary artery bypass grafting (CABG) under CPB with a roller pump or with a centrifugal pump. Methods Eighty elective male patients undergoing CABG were selected using one or two internal thoracic arteries under CPB with a roller pump (RP group) or centrifugal pump (CFP group). ITA samples were collected before starting CPB (Time 1) and before the last coronary anastomosis during aortic cross clamping (Time 2). The primary endpoint was the endotheliumdependent relaxation of ITAs investigated using wire-myography. The secondary endpoint was the parietal inflammatory response of arteries defined by the measurements of superoxide levels, leukocytes and lymphocytes rate and gene expression of inflammatory proteins using. Terminal complement complex activation (SC5b-9) and neutrophil activation (elastase) analysis were performed on arterial blood at the same times. Results Exposure time of ITAs to the pump flow was respectively 43.3 minutes in the RP group and 45.7 minutes in the CFP group. Acetylcholine-dependent relaxation was conserved in the

The use of a vascular occlusion test combined with near-infrared spectroscopy in perioperative care: a systematic review

“…With regard to the maintenance of anesthesia, most studies found similar VOTderived NIRS values when comparing different anesthetics. In general, the RA decreased during both non-cardiac and cardiac surgery, indicating an impairment of vascular reactivity, which might be caused by a surgically induced inflammatory response [44][45][46]. During CPB, a decrease in the RA was consistently reported, reflecting an impairment in vascular reactivity possibly caused by an altered myogenic tone due to lack of pulsatile flow and increased inflammatory response [44].…”

“…In general, the RA decreased during both non-cardiac and cardiac surgery, indicating an impairment of vascular reactivity, which might be caused by a surgically induced inflammatory response [44][45][46]. During CPB, a decrease in the RA was consistently reported, reflecting an impairment in vascular reactivity possibly caused by an altered myogenic tone due to lack of pulsatile flow and increased inflammatory response [44]. Consistently, after weaning from CPB and restoration of pulsatile blood flow, the RA values generally increased towards pre-CPB values.…”

“…Surprisingly, fluid challenges did not affect the RA during cardiac surgery when measured at the thenar eminence, and continuous infusion of different types of fluids (HES or crystalloids) caused a decrease in the RA in this population. These findings might be explained by a pre-existing deficit in the vascular reactivity in patients with known cardiac disease [47], combined with the insult arising from the inflammatory response caused by cardiac surgery [44].…”