Its Possible Role in Cardiac Surgery

Bigelow, W. G.; Lindsay, William K.; Greenwood, W. F.

doi:10.1097/00000658-195011000-00001

Cited by 632 publications

(64 citation statements)

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“…I n 1950, Bigelow 1 identified the relation between temperature and metabolism and initiated the advent of modern cardiovascular surgery. Although deep hypothermic circulatory arrest (DHCA) had proven to be life-saving for thousands of children and adults, control of the adverse sequelae associated with this technique has remained a challenge over the last 50 years.…”

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confidence: 99%

Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Mangano¹,

Neville²,

Hsu³

et al. 2001

Circulation

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Background-The technique of deep hypothermic circulatory arrest (DHCA) for cardiothoracic surgery is associated with increased risk for perioperative blood loss and renal dysfunction. Although aprotinin, a serine protease inhibitor, reduces blood loss in patients undergoing cardiopulmonary bypass, its use has been limited in the setting of DHCA because of concerns regarding aprotinin-induced renal dysfunction. Therefore, we assessed the affect of aprotinin on both blood transfusion requirements and renal function in patients undergoing cardiovascular surgery and DHCA. Methods and Results-We reviewed the records of 853 patients who underwent aortic or thoracoabdominal surgery at Stanford University Medical Center between January 1992 and March 2000. Two hundred three of these patients were treated with DHCA, and 90% (183) survived for more than 24 hours. Preoperative patient characteristics and intraoperative and postoperative clinical and surgical variables were recorded, and creatinine clearance (CRCl) was calculated for the preoperative and postoperative periods; renal dysfunction was prospectively defined as a 25% reduction in CRCl. The association between perioperative variables, including aprotinin use, and renal dysfunction was assessed by ANOVA techniques. Total urine output was 1294Ϯ1024 mL and 3492Ϯ1613 mL during and after surgery, respectively. CRCl decreased significantly after DHCA from 86Ϯ8 mL/min (before surgery) to 67Ϯ4 mL/min (in the intensive care unit) (PϽ0.01). Thirty-eight percent of patients (70 of 183) had postoperative renal dysfunction. Multivariate regression analyses identified 5 factors independently associated with a Ͼ25% reduction in CRCl: requirement for Ն5 U of packed red blood cells (Pϭ0.0002; ORϭ2.1), Յ800 mL of urine collected in the operating room (Pϭ0.0011; ORϭ1.9), nonuse of dopamine (Pϭ0.0430; ORϭ1.6), hematocrit Յ21 mg% (Pϭ0.0343; ORϭ1.5), and Յ2100 mL of urine during the first 24 hours in the intensive care unit (Pϭ0.0039; ORϭ2.0). Aprotinin did not increase the likelihood of postoperative renal dysfunction (Pϭ0.951), nor did it significantly reduce packed red blood cell transfusion requirements in either primary (nϭ107) (Pϭ0.456) or reoperative cardiovascular (nϭ76) (Pϭ0.176) procedures. During the operative period, the aprotinin group received a greater number of units of platelets (10.0 versus 6.6 U, PϽ0.012), fresh frozen plasma (4.8 versus 3.1 U, PϽ0.03), and cryoprecipitate (9.9 versus 5.4 U, PϽ0.002) than patients not prescribed aprotinin. Similarly, patients given aprotinin received more cryoprecipitate in the intensive care unit (

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confidence: 99%

Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Mangano¹,

Neville²,

Hsu³

et al. 2001

Circulation

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“…Hipoterminin yararları ilk olarak Bigelov (3) tarafından ortaya konulmuştur. Bigelov yaptığı çalışmalarda 25-28°C arasındaki orta dereceli hipoterminin, kalbi belli oranlarda iskemik hasarlardan koruduğunu göstermiştir.…”

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The Effect of Hypotermia on Potassium Concentration in Blood Cardioplegia During Cardiopulmonary Bypass Surgery

Peker¹,

Karabayırlı²,

Özanbarci³

et al. 2014

GKDA Derg

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“…Hypothermia has been widely acknowledged to be the fundamental component of myocardial protection during cardiac operations (Bigelow et al, 1950a). Although hypothermia permits a long period of ischemic arrest by reduction of oxygen demand (Bigelow et al, 1950b;Reissman and van Citters, 1956) and metabolism (Lee, 1965), it is associated with a number of major disadvantages, which include its detrimental effects on enzyme Article, publication date, and citation information can be found at…”

Section: Introductionmentioning

confidence: 99%

Carrier-Mediated Norepinephrine Release and Reperfusion Arrhythmias Induced by Protracted Ischemia in Isolated Perfused Guinea Pig Hearts: Effect of Presynaptic Modulation by α₂-Adrenoceptor in Mild Hypothermic Ischemia

Oka

Imamura²,

Hatta³

et al. 2002

J Pharmacol Exp Ther

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Yohimbine, an ␣ 2 -adrenoceptor antagonist, has been reported to protect hypoxic myocardium and inhibit carrier-mediated norepinephrine (NE) release and reperfusion arrhythmias (ventricular fibrillation; VF) in normothermic ischemia. In heart surgery, mild hypothermic (tepid) cardioplegia has been reported to reduce metabolic demand and permit immediate recovery of cardiac function. Therefore, we determined the effect of yohimbine on NE release and reperfusion arrhythmias in isolated perfused guinea pig hearts of tepid temperature (32°C) ischemia model. Stepwise increase of global ischemia period (20, 40, and 60 min) induced a progressive increase of NE release and duration of VF. Neuronal uptake 1 inhibitor desipramine (100 nM) and Na ϩ -H ϩ exchanger inhibitor 5-N-ethyl-N-isopropyl-amiloride (10 M) decreased NE and VF in 60-min hypothermic ischemia. This indicated that NE release induced by protracted tepid ischemia was due to carrier-mediated release. Yohimbine (1 M) markedly reduced NE release and VF (p Ͻ 0.01 versus control) and 5-bromo-N-(4,5-dihydro-1H-imidazol-2-yl)-6-quinoxalinamine [UK 14,304 (UK); 10 M], an ␣ 2 -adrenoceptor agonist, increased NE release and VF (p Ͻ 0.01 versus control). Yohimbine (1 M) prevented the potentiated effect of UK (10 M) in hypothermia (p Ͻ 0.01 versus UK). Our findings indicate that presynaptic reduction of carrier-mediated NE release seems to be one of the most important factors controlling reperfusion arrhythmias, and ␣ 2 -adrenoceptor blockade by yohimbine (1 M) in tepid ischemia may contribute to effective myocardial protection in terms of NE release and reperfusion arrhythmia.Protracted myocardial ischemia induces much greater release of norepinephrine (NE) from sympathetic nerve endings than normal conditions. In this case, excessive NE release is carrier-mediated release rather than exocytosis (Schöming, 1990;Dart and Du, 1993). It is caused by reversal of the uptake 1 carrier that is responsible for reuptake of extracellular NE under normoxic condition (Schöming, 1990;Dart and Du, 1993;Kurz et al., 1995). Exaggerated NE release induced by ischemia increases oxygen demand by stimulating heart rate and contractility and decreases oxygen supply by constricting coronary vessels. This vicious cycle accelerates the progression of cell damage in ischemic myocardium and potentiates the arrhythmogenicity of NE (Braunwald and Sobel, 1988; Schöming et al., 1991;Kü bler and Strasser, 1994). Therefore, the modulation of excessive NE release would be expected to protect myocardium or improve functional recovery, or limit reperfusion arrhythmias.Antagonists of ␣ 2 -adrenoceptors, yohimbine (1 M), idazoxan (10 M), and rauwolscine (1 M), were reported to attenuate not only carrier-mediated NE release from sympathetic nerve terminals but also reperfusion arrhythmias in perfused guinea pig heart model in normothermic conditions (Imamura et al., 1996).In cardiac surgery, a surgeon cannot perform an operation without some form of cardioprotection. Hypothermia has been widely ac...

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Its Possible Role in Cardiac Surgery

Cited by 632 publications

References 5 publications

Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

The Effect of Hypotermia on Potassium Concentration in Blood Cardioplegia During Cardiopulmonary Bypass Surgery

Carrier-Mediated Norepinephrine Release and Reperfusion Arrhythmias Induced by Protracted Ischemia in Isolated Perfused Guinea Pig Hearts: Effect of Presynaptic Modulation by α₂-Adrenoceptor in Mild Hypothermic Ischemia

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Its Possible Role in Cardiac Surgery

Cited by 632 publications

References 5 publications

Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

The Effect of Hypotermia on Potassium Concentration in Blood Cardioplegia During Cardiopulmonary Bypass Surgery

Carrier-Mediated Norepinephrine Release and Reperfusion Arrhythmias Induced by Protracted Ischemia in Isolated Perfused Guinea Pig Hearts: Effect of Presynaptic Modulation by α2-Adrenoceptor in Mild Hypothermic Ischemia

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Carrier-Mediated Norepinephrine Release and Reperfusion Arrhythmias Induced by Protracted Ischemia in Isolated Perfused Guinea Pig Hearts: Effect of Presynaptic Modulation by α₂-Adrenoceptor in Mild Hypothermic Ischemia