Effects of centrifugal and roller pumps on survival of autologous red cells                 in cardiopulmonary bypass surgery

Valeri, C. R.; Macgregor, H.; Ragno, Gina; Healey, Nancy A.; Fonger, James D.; Khuri, Shukri F.

doi:10.1177/0267659106073976

Cited by 41 publications

(45 citation statements)

References 14 publications

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“…Some studies have indicated Unpaired 't' test was done for test of significance; NS =not significant, S= significant n = number of patients sublethal damage by CPB instead of complete destruction, where RBC exposed to certain uniform shear stresses for prolonged time show significant changes in their deformability without lysis 10 . One study showed that 15% of the RBC subjected to CPB were irreversibly damaged and removed during the 24 hour post-infusion period 11 . Therefore, beside hemodilution anemia, the observed lower TC of RBC and Hb% in patients following CPB-aided cardiac surgery may be, at least partly, due to excessive hemolysis because of mechanical trauma from CPB procedure.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Bypass Induced Hematological Changes in Patients Undergoing Cardiac Surgery

et al. 2016

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:Cardiopulmonary bypass (CPB) assisted open heart surgery have become a frequent surgical procedures in almost all major heart surgeries. However,growing evidence indicates that anemia, coagulation derangements, platelet dysfunction and inflammatory responses are common in patients undergoing CPB aided cardiac surgery. The aim of the present study was to characterize CPB induced hematologic changes in patients undergoing cardiac surgery. A total of sixty three patients undergoing elective cardiac surgery in the department of Cardiac Surgery, BSMMU, Dhaka, Bangladesh, were prospectively randomized into the present study: 33 of which underwent CPB aided cardiac surgery (CPB-aided) and the rest 30 patients underwent cardiac surgery without CPB (CPB non-aided). Complete blood count together with Hb%, prothrombin time (PT) and International normalized ratio (INR) was determined preoperatively and on 1 st , 3 rd and 7 th postoperative days (POD). The TC of WBC was significantly higher in CPB aided patients than that of CPB non-aided patients on 1 st POD. When comparison was done, total count of RBC, platelets & Hb% were significantly lower in CPB aided patients compared to patients underwent cardiac surgery without CPB on the 7 th POD. Additionally, PT and INR were higher in CPB aided cardiac patients compared to that of CPB non-aided patients on the 7th POD. The lower levels of Hb% and TC of RBC following CPB-aided cardiac surgery may be due to excessive hemolysis because of mechanical force during extra-corporal circulation. The observed significant leucocytosis in the present CPB aided cardiac surgery patients on 1 st POD may support the notion that CPB induces a systemic inflammatory response following cardiac surgery. Further studies are required to evaluate the mechanisms of CPB-induced hematological changes following major cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Bypass Induced Hematological Changes in Patients Undergoing Cardiac Surgery

et al. 2016

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“…[6][7][8] Cardiac surgery results in a postoperative systemic inflammatory response syndrome due to a variety of factors including surgical trauma, exposure of blood to the artificial surface of the bypass circuit, tissue hypoperfusion, hemolysis, hemodilution, blood transfusion, and hypothermia. [9][10][11][12] Inflammation is believed to play a key role in the pathophysiology of AKI after cardiac surgery with CPB. A number of proinflammatory pathways are activated during CPB and can lead to leukocyte extravasation, lipid peroxidation, renal medullary congestion, and tubular cell injury.…”

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confidence: 99%

“…During CPB, blood is exposed to nonphysiologic surfaces and shear forces, leading to cell lysis and release of free hemoglobin into the circulation. 11,12,20 Free hemoglobin is removed from the circulation through binding to CD163, 21 a scavenger receptor on the cell surface of monocytes and macrophages that is upregulated by glucocorticoids in multiple cell lines. [22][23][24] Hence, enhanced removal of free hemoglobin through upregulated CD163 represents a biologically plausible pathway through which glucocorticoids may decrease the incidence of CPB-associated AKI.…”

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confidence: 99%

Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

Jacob

Leaf

Dieleman³

et al. 2015

Journal of the American Society of Nephrology

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Administration of prophylactic glucocorticoids has been suggested as a strategy to reduce postoperative AKI and other adverse events after cardiac surgery requiring cardiopulmonary bypass. In this post hoc analysis of a large placebo-controlled randomized trial of dexamethasone in 4465 adult patients undergoing cardiac surgery, we examined severe AKI, defined as use of RRT, as a primary outcome. Secondary outcomes were doubling of serum creatinine level or AKI-RRT, as well as AKI-RRT or in-hospital mortality (RRT/death). The primary outcome occurred in ten patients (0.4%) in the dexamethasone group and in 23 patients (1.0%) in the placebo group (relative risk, 0.44; 95% confidence interval, 0.19 to 0.96). In stratified analyses, the strongest signal for potential benefit of dexamethasone was in patients with an eGFR,15 ml/min per 1.73 m 2 . In conclusion, compared with placebo, intraoperative dexamethasone appeared to reduce the incidence of severe AKI after cardiac surgery in those with advanced CKD. 26: 294726: -295126: , 201526: . doi: 10.1681 Acute kidney injury is one of the most ominous complications after cardiac surgery with cardiopulmonary bypass (CPB). Approximately 1% of patients undergoing cardiac surgery require RRT for severe postoperative AKI, and experience strikingly high in-hospital mortality rates exceeding 40%. 1-3 Less severe AKI is far more common and identifies patients still at increased risk of shortand long-term mortality, prolonged length of hospital stay, and higher hospital costs. 4,5 The pathogenesis of AKI after cardiac surgery is complex and includes patient-related factors such as age and comorbidities (e.g., CKD and diabetes mellitus) as well as surgical factors such as type of procedure and duration of CPB. [6][7][8] Cardiac surgery results in a postoperative systemic inflammatory response syndrome due to a variety of factors including surgical trauma, exposure of blood to the artificial surface of the bypass circuit, tissue hypoperfusion, hemolysis, hemodilution, blood transfusion, and hypothermia. 9-12 Inflammation is believed to play a key role in the pathophysiology of AKI after cardiac surgery with CPB. A number of proinflammatory pathways are activated during CPB and can lead to leukocyte extravasation, lipid peroxidation, renal medullary congestion, and tubular cell injury. 1,9 Multiple strategies have been proposed to attenuate the inflammatory response after cardiac surgery with CPB, including the use of glucocorticoids. To date, the effect of glucocorticoids on AKI after cardiac surgery has been evaluated as a primary outcome in 14 randomized controlled trials, the largest of which included 216 patients. 3 A meta-analysis of these studies (which included a total of 888 patients) concluded that glucocorticoids have no protective effect on AKI after cardiac surgery. 3 However, these studies were underpowered, particularly to detect severe AKI. J Am Soc NephrolWe therefore conducted a post hoc analysis of severe AKI in the Dexamethasone for Cardiac Surgery (DE...

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“…Moreover, the highly reconfigurable model and the semiautomated simulation process extend the usefulness of the presented method to a wider range of applications. With recent independent studies failing to show any advantage in using centrifugal over roller pumps (3)(4)(5)(6) in shortterm assistance applications (less than 8 h), roller pumps are still commonly used in circulatory assist devices. Given the good consistency between the simulated results and the existing experimental data, the presented method displays promising potential to more effectively guide the development of improved roller pump systems which produce less mechanical damage to cells.…”

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confidence: 99%

A New Computational Fluid Dynamics Method for In‐Depth Investigation of Flow Dynamics in Roller Pump Systems

et al. 2014

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Roller pumps are commonly used in circulatory assist devices to deliver blood, but the inherent high mechanical stresses (especially wall shear stress) may cause considerable damage to cells. Conventional experimental approaches to evaluate and reduce device-induced cell damage require considerable effort and resources. In this work, we describe the use of a new computational fluid dynamics method to more effectively study roller pump systems. A generalized parametric model for the fluid field in a typical roller pump system is presented first, and analytical formulations of the moving boundary are then derived. Based on the model and formulations, the dynamic geometry and mesh of the fluid field can be updated automatically according to the time-dependent roller positions. The described method successfully simulated the pulsing flow generated by the pump, offering a convenient way to visualize the inherent flow pattern and to assess shear-induced cell damage. Moreover, the highly reconfigurable model and the semiautomated simulation process extend the usefulness of the presented method to a wider range of applications. Comparison studies were conducted, and valuable indications about the detailed effects of structural parameters and operational conditions on the produced wall shear stress were obtained. Given the good consistency between the simulated results and the existing experimental data, the presented method displays promising potential to more effectively guide the development of improved roller pump systems which produce less mechanical damage to cells.

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Effects of centrifugal and roller pumps on survival of autologous red cells in cardiopulmonary bypass surgery

Cited by 41 publications

References 14 publications

Cardiopulmonary Bypass Induced Hematological Changes in Patients Undergoing Cardiac Surgery

Cardiopulmonary Bypass Induced Hematological Changes in Patients Undergoing Cardiac Surgery

Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

A New Computational Fluid Dynamics Method for In‐Depth Investigation of Flow Dynamics in Roller Pump Systems

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