Microcirculatory Alterations in Cardiac Surgery: Effects of Cardiopulmonary Bypass and Anesthesia

Backer, Daniel De; Dubois, Marc-Jacques; Schmartz, Denis; Koch, Marc; Ducart, Anne; Barvais, Luc; Vincent, Jean‐Louis

doi:10.1016/j.athoracsur.2009.07.002

Cited by 177 publications

(150 citation statements)

References 38 publications

Supporting

Mentioning

136

Contrasting

Order By: Relevance

“…Bauer et al [115] first reported that microcirculatory perfusion was transiently altered in humans after cardiopulmonary bypass. Similar findings were reported more recently by other groups [116,117]. More importantly, these alterations can also be observed in patients who undergo surgery without cardiopulmonary bypass [117]; of note, the sublingual microcirculation was still slightly abnormal up to 24 h after surgery in these patients [117].…”

Section: High-risk Surgerysupporting

confidence: 77%

“…Similar findings were reported more recently by other groups [116,117]. More importantly, these alterations can also be observed in patients who undergo surgery without cardiopulmonary bypass [117]; of note, the sublingual microcirculation was still slightly abnormal up to 24 h after surgery in these patients [117]. As in non-cardiac surgery, the severity of perioperative microvascular alterations correlated with peak lactate levels and severity of organ dysfunction after surgery [117].…”

Section: High-risk Surgerysupporting

confidence: 74%

See 1 more Smart Citation

Monitoring the microcirculation in the critically ill patient: current methods and future approaches

et al. 2010

Self Cite

View full text Add to dashboard Cite

show abstract

Section: High-risk Surgerysupporting

confidence: 77%

Section: High-risk Surgerysupporting

confidence: 74%

Monitoring the microcirculation in the critically ill patient: current methods and future approaches

et al. 2010

Self Cite

View full text Add to dashboard Cite

show abstract

“…There were some considerations about the different trends of hemodynamic and microcirculatory variables in these patients. Several authors demonstrated that macro-and micro-dynamic are not correlated either in septic patients or in patients undergoing cardiac surgery (21)(22)(23)(24). Also, it has been demonstrated that an increase in MAP with norepinephrine infusion may not change microcirculatory function (20).…”

Section: Discussionmentioning

confidence: 99%

Hyperthermic intrathoracic chemotherapy after extended pleurectomy and decortication for malignant pleura mesothelioma: an observational study on outcome and microcirculatory changes

Luzzi¹,

Franchi²,

Dapoto³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: In the treatment of malignant pleural mesothelioma the Hyperthermic Intra THOracic Chemotherapy (HITHOC) can improve the efficacy of pleurectomy and decortication with a local cytotoxic effect. However its biological impact in patient's hemodynamic and microcirculatory changes were rarely investigated. Aim of this study is to describe our experience with HITHOC after pleurectomy and decortication evaluating the role of sublingual video-microscopy in assessing the microcirculatory changes in the perioperative period. Methods: This is a prospective and observational study concerning 10 consecutive patients undergoing extended P/D followed by HITHOC. These patients underwent sublingual microcirculatory monitoring, which was adopted as a routine procedure since 2012. Haemodynamic parameters were collected at eight consecutive times: the day before surgery (T1), induction of anaesthesia (T2), surgical phase before HITHOC beginning (T3), 5 and 30 minutes after HITHOC start (T4 and T5, respectively), 5 minutes from HITHOC end (T6), after the admission in ICU (T7), at discharge from the ICU (T8). Cardiac output (CO) was calculated with MostCare. Systemic vascular resistance (SVR), oxygen delivery (DO 2 ), and oxygen extraction rate (O 2 ER) were calculated using standard formulas. Arterial blood pressure and central venous pressure (CVP) were obtained with standard arterial and venous catheters. At the same times we assessed the sublingual microcirculation with Sidestream Dark Field technique. Results: Hemodynamic and microcirculatory data were collected in 10 patients, 8 male and 2 females (mean age 68.6±9.0, and body surface area of 1.9±0.1 m 2 ). All patients had arterial hypertension, and one patient had diabetes. The mean arterial pressure significantly decreased at T2, with respect to T1 (P=0.05). CO, CVP, DO2 , O 2 ER, and ScvO 2 , did not change significantly over the time. All patients needed infusion of noradrenalin from T4 to T6. TVD significantly decreased from T1 to T3, T5, and T8. Similarly, PVD significantly decreased from T1 to T3 and T8, and MFI from T1 to T6 and T8. PPV and HI did not change over the study period. No correlation was found between hemodynamic parameters (MAP, CO, CVP, DO 2 , O 2 ER, ScvO 2 ) and microcirculatory data (TVD, PVD, PPV, MFI, HI), at any time of the study. Conclusions: In patients who receive HITHOC the fluid load can reduce the microvascular impairment restoring the normal tissue perfusion. This process takes days but is most evident in the first 72 h. The use of colloid and blood transfusion is much more effective in restoring microcirculation and reducing tissue damaging.

show abstract

“…Cardiopulmonary bypass likely causes vasoplegia through 3 interrelated mechanisms (61). First, patients may exhibit a hypersensitivity response causing a persistent proinflammatory state: in these patients, the resultant hypotension may be addressed partially by use of vasoconstrictors.…”

Section: Miscellaneousmentioning

confidence: 99%

“…In another study, the deleterious effects of bypass on tissue perfusion were examined at the microvascular level by quantifying sublingual capillary blood flow in patients during on-and off-pump cardiac surgery, and the results were compared with those of patients undergoing general anesthesia for noncardiac surgery (61). In all 3 patient groups, microvascular dysfunction resulted in marked heterogeneity of perfusion after induction, which was significantly worse in patients undergoing cardiac surgery compared with major noncardiac surgery, persisted for more than 24 h after surgery, and was only slighted exacerbated by cardiopulmonary bypass compared with off-pump cardiac surgery.…”

Section: Miscellaneousmentioning

confidence: 99%

The Year in Cardiovascular Surgery

Adams

Chikwe

Filsoufi

et al. 2011

Journal of the American College of Cardiology

View full text Add to dashboard Cite

The 2009 literature in cardiovascular surgery was characterized by several pivotal reports that will affect patient care and future trial design for years to come. The purpose of our annual review is to highlight key contributions in the field that focus on strategies and outcomes in cardiovascular surgery that practicing cardiovascular specialists will find both informative and useful in their daily practice. Particular emphasis this year was placed on articles that compare surgical with nonsurgical alternative treatment strategies or those that emphasize potential advances in specific surgical strategies. Our goal as always is to provide readers of the Journal with a succinct summary of specific studies organized around general categories, with pointed comments to highlight special significance or methodological limitations that cardiologists should consider in their pursuit of stateof-the-art care for their patients. Surgery for Valvular Heart DiseaseSurgery for asymptomatic severe mitral valve regurgitation. Long-term results in 161 patients who underwent early surgery were compared with 286 patients who received conventional medical follow-up for asymptomatic severe mitral valve regurgitation in the setting of preserved left ventricular function (1). The actuarial 7-year cardiac mortality was 0% in the surgery group and 5 Ϯ 2% in the conventional treatment group (p ϭ 0.0008), and actuarial 7-year event-free survival in 127 propensity score-matched patients was 99 Ϯ 1% in the surgery group and 84 Ϯ 4% in the conventional treatment group (p ϭ 0.007) (Fig.

show abstract

Microcirculatory Alterations in Cardiac Surgery: Effects of Cardiopulmonary Bypass and Anesthesia

Cited by 177 publications

References 38 publications

Monitoring the microcirculation in the critically ill patient: current methods and future approaches

Monitoring the microcirculation in the critically ill patient: current methods and future approaches

Hyperthermic intrathoracic chemotherapy after extended pleurectomy and decortication for malignant pleura mesothelioma: an observational study on outcome and microcirculatory changes

The Year in Cardiovascular Surgery

Contact Info

Product

Resources

About