Frequency domain analysis and clinical outcomes of pulsatile and non-pulsatile blood flow energy during cardiopulmonary bypass

Jiang, Qingqing; Sun, Jie; Xu, Lingfeng; Chang, Xin; Sun, Lin; Zhen, Yue; Guo, Zhen

doi:10.1177/02676591211012216

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Similarly, the technical conduct of CPB also confers pulmonary ischemia by directing the pulmonary blood flow away from the lung vasculature. In addition, the most common non-pulsatile flow also reduces regional blood flow to systemic organs such as the kidney, liver, and gut and impacts cerebral circulation (25,26). Hemolysis and cell-free hemoglobin subsequently confer additional systemic vasoconstriction by scavenging endogenous endothelial-derived NO (27).…”

Section: Impact Of No On Ischemia/reperfusion Injury Systemic Inflamm...mentioning

confidence: 99%

Inhaled NO at a crossroads in cardiac surgery: current need to improve mechanistic understanding, clinical trial design and scientific evidence

Muenster,

Zarragoikoetxea,

Moscatelli

et al. 2024

Front. Cardiovasc. Med.

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Inhaled nitric oxide (NO) has been used in pediatric and adult perioperative cardiac intensive care for over three decades. NO is a cellular signaling molecule that induces smooth muscle relaxation in the mammalian vasculature. Inhaled NO has the unique ability to exert its vasodilatory effects in the pulmonary vasculature without any hypotensive side-effects in the systemic circulation. In patients undergoing cardiac surgery, NO has been reported in numerous studies to exert beneficial effects on acutely lowering pulmonary artery pressure and reversing right ventricular dysfunction and/or failure. Yet, various investigations failed to demonstrate significant differences in long-term clinical outcomes. The authors, serving as an advisory board of international experts in the field of inhaled NO within pediatric and adult cardiac surgery, will discuss how the existing scientific evidence can be further improved. We will summarize the basic mechanisms underlying the clinical applications of inhaled NO and how this translates into the mandate for inhaled NO in cardiac surgery. We will move on to the popular use of inhaled NO and will talk about the evidence base of the use of this selective pulmonary vasodilator. This review will elucidate what kind of clinical and biological barriers and gaps in knowledge need to be solved and how this has impacted in the development of clinical trials. The authors will elaborate on how the optimization of inhaled NO therapy, the development of biomarkers to identify the target population and the definition of response can improve the design of future large clinical trials. We will explain why it is mandatory to gain an international consensus for the state of the art of NO therapy far beyond this expert advisory board by including the different major players in the field, such as the different medical societies and the pharma industry to improve our understanding of the real-life effects of inhaled NO in large scale observational studies. The design for future innovative randomized controlled trials on inhaled NO therapy in cardiac surgery, adequately powered and based on enhanced biological phenotyping, will be crucial to eventually provide scientific evidence of its clinical efficacy beyond its beneficial hemodynamic properties.

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Section: Impact Of No On Ischemia/reperfusion Injury Systemic Inflamm...mentioning

confidence: 99%

Inhaled NO at a crossroads in cardiac surgery: current need to improve mechanistic understanding, clinical trial design and scientific evidence

Muenster,

Zarragoikoetxea,

Moscatelli

et al. 2024

Front. Cardiovasc. Med.

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“…Complications vary from sepsis and thrombosis to kidney damage which could lead to renal failure, gastrointestinal bleedings, pulmonary injury and neurological dysfunction added to longer hospitalization and need for multiple surgeries which contribute to increased costs (3)(4)(5). These complications are noted to probably be due to different flow types of CPB, pulsatile and non-pulsatile (6). Despite upgrades and improvements in technology in CPB, it is yet considered a non-physiological scenario (7).…”

Section: Introductionmentioning

confidence: 99%

The effect of pulsatile Versus nonpulsatile cardiopulmonary bypass on renal function in patients undergoing coronary artery bypass graft surgery, a randomized controlled trial

Khademi

Jahromi

Ghazinoor

et al. 2023

Preprint

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Introduction: Coronary artery bypass grafting is of the most major surgeries performed around the world. Even though advances are achieved in the surgical technique, a relatively high complication rate regarding circulation is still observed. These complications are believed to be related to cardiopulmonary bypass flow types, pulsatile and nonpulsatile. With renal complications being one of the most important ones, we aim to evaluate the effect of choice of these two flow types on patients' renal function in a randomized controlled trial. Method: The study is a double blind randomized clinical trial. Patients with left ventricular dysfunction who were candidates for CABG and were between the ages of 40 to 75 were included in this study. The patients then were randomly assigned into two groups of intraoperative pulsatile and nonpulsatile flow type. The patients renal function markers such as 24-hour urine output, blood urea nitrogen and serum creatinine levels and creatinine clearance were evaluated before and CABG and afterwards in the ICU ward. The results were then analyzed using SPSS 23 software. Results: of the initial 80 patients enrolled in this study, 16 patients were dropped due to unwillingness to continue follow-up and limitation of data gathering. Patients demographic data between two groups did not differ significantly. No statistically significant difference was observed between the 24 patients undergoing surgery with pulsatile flow and 40 with nonpulsatile flow regarding renal function. Both groups had a decrease in creatinine clearance during their ICU stay. Patients in the pulsatile flow group had less intubation time, less need for blood transfusion but more bleeding after the surgery. Conclusion: Our study indicated that there is no difference between the use of pulsatile versus nonpulsatile flow regarding patients' renal outcome. Our participants had a relatively broader age range than similar studies, including younger patients. This plus having an acceptable number of patients evaluated may illustrate that the differences in these two flow types may be dependent on other risk factors depending on the studied population. Further investigations with focal groups could lead us towards a better understanding how these two flow types differ.

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“…Dr. Jiang et al 1 investigated the impact of perfusion modes on the endothelial function, inflammatory response, and renal and cerebral injury in 60 adult valve disease patients ( n = 30 in pulsatile and n = 30 in the non-pulsatile groups) during cardiopulmonary bypass (CPB) procedures. More importantly, Dr. Jiang and colleagues precisely quantified the pressure-flow waveforms in terms of Energy Equivalent Pressure (EEP) and Surplus Hemodynamic Energy (SHE) in the CPB circuitry (after the arterial filter) and the patient’s radial artery.…”

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confidence: 99%