Pulmonary and Systemic Vascular Resistances After Cardiopulmonary Bypass: Role of Hemolysis

Rezoagli, Emanuele; Ichinose, Fumito; Strelow, Sabrina; Roy, Nathalie; Shelton, Kenneth; Matsumine, Rui; Chen, Liu; Bittner, Edward A.; Bloch, Donald B.; Zapol, Warren M.

doi:10.1053/j.jvca.2016.06.009

Cited by 31 publications

(30 citation statements)

References 47 publications

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“…Transfusion of PRBCs stored for 42 days decreased acetylcholine-dependent forearm blood flows to a greater extent than transfusion of PRBCs stored for 5 days. Similarly, Rezoagli and co-authors reported a transient increase in both pulmonary and systemic vascular resistances in patients developing hemolysis after cardio-pulmonary bypass [29]. These results indicate systemic vasoconstriction with significant impairment of endothelial function after transfusion of PRBCs stored for prolonged periods or prolonged periods of cardio-pulmonary bypass.…”

Section: Discussionmentioning

confidence: 83%

Transfusion of standard-issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgery—A randomized, double-blinded, clinical trial

et al. 2019

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BackgroundExperimental and volunteer studies have reported pulmonary vasoconstriction during transfusion of packed red blood cells (PRBCs) stored for prolonged periods. The primary aim of this study was to evaluate whether transfusion of PRBCs stored over 21 days (standard-issue, siPRBCs) increases pulmonary artery pressure (PAP) to a greater extent than transfusion of PRBCs stored for less then 14 days (fresh, fPRBCs) in critically ill patients following cardiac surgery. The key secondary aim was to assess whether the pulmonary vascular resistance index (PVRI) increases after transfusion of siPRBCs to a greater extent than after transfusion of fPRBCs.MethodsThe study was performed as a single-center, double-blinded, parallel-group, randomized clinical trial. Leukoreduced PRBCs were transfused while continuously measuring hemodynamic parameters. Systemic concentrations of syndecan-1 were measured to assess glycocalyx injury. After randomizing 19 patients between January 2014 and June 2016, the study was stopped due to protracted patient recruitment.ResultsOf 19 randomized patients, 11 patients were transfused and included in statistical analyses. Eight patients were excluded prior to transfusion, 6 patients received fPRBCs (10±3 storage days), whereas 5 patients received siPRBCs (33±4 storage days). The increase in PAP (7±3 vs. 2±2 mmHg, P = 0.012) was greater during transfusion of siPRBCs than during transfusion of fPRBCs. In addition, the change in PVRI (150±89 vs. -4±37 dyn·s·cm-5·m2, P = 0.018) was greater after transfusion of siPRBCs than after transfusion of fPRBCs. The increase in PAP correlated with the change of systemic syndecan-1 concentrations at the end of transfusion (R = 0.64,P = 0.034).ConclusionAlthough this study is underpowered and results require verification in larger clinical trials, our findings suggest that transfusion of siPRBCs increases PAP and PVRI to a greater extent than transfusion of fPRBCs in critically ill patients following cardiac surgery. Glycocalyx injury might contribute to pulmonary vasoconstriction associated with transfusion of stored blood.

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Section: Discussionmentioning

confidence: 83%

Transfusion of standard-issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgery—A randomized, double-blinded, clinical trial

et al. 2019

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“…We speculate that an early decrease in endothelial function after SAVR may have been related to the use of the CPB. Decreased nitric oxide bioavailability as indicated by decreases in the expression of endothelial nitric oxide synthase following CPB may reduce endothelial reactivity [24]; indeed, various studies have demonstrated an association between CPB or the duration thereof and nitric oxide consumption [24]; the latter association may correspond not only to hemolysis due to the surgical procedure and CPB, but also due to the use of cell saver devices, the transfusion of stored blood, and other factors [24]. Several studies have demonstrated the deregulation of vascular resistance after CPB.…”

Section: Discussionmentioning

confidence: 99%

The effect of surgical versus transcatheter aortic valve replacement on endothelial function. An observational study

Moscarelli

Devito²,

Fattouch

et al. 2019

International Journal of Surgery

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Background: The effects of surgical aortic valve replacement versus transcatheter aortic valve replacement on endothelial function are unknown. We investigated the effects of surgical and transcatheter aortic valve replacement on early and 90-day endothelial function measured by brachial flow mediated dilation and apoptotic rate in the human umbilical vein endothelial cells in patients with significant aortic stenosis, intermediate risk of surgery, and no coronary artery disease. Methods: We conducted a prospective observational case control single-blind study at a single tertiary center. Endothelial function was measured at baseline, early post-procedure (4 days), and follow-up (90 days). A blood pressure cuff was used to elicit reactive hyperemia for measuring brachial wall shear stress and flow mediated dilation. The apoptosis rate was observed in the human umbilical vein endothelial cells after 48-h incubation with 20% serum from patients. The rate of apoptosis was assessed by determining the number of annexin V and propidium iodide positive cells by flow cytometry. Results: Early post-procedure flow dilation was significant lower in the surgical group (p < 0.003). At followup, both groups showed incremental increases in flow mediated dilation. Surgical group apoptotic rate did not significantly change, while transcatheter apoptotic rate steadily decreased, suggesting a trend toward improved endothelial function. Conclusions: The data suggest that conventional surgical aortic valve replacement may be associated with an early and transient decrease in endothelial function, likely due to the use of cardio-pulmonary bypass.

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“…Erhöhte Konzentrationen freien Hämoglobins persistieren für mehrere Stunden nach HLM im Patientenplasma. Sie sind mit einer signifikanten Reduktion der plasmatischen Konzentrationen von Haptoglobin sowie einer verstärkten Depletion von endothelialem NO assoziiert [62,63]. Der erhöhte "Verbrauch" des endothelialen NO durch Plasma-Hämoglobin korreliert mit dem erhöhten systemischen und pulmonalarteriellen Widerstand, der in den ersten Stunden nach einer längeren HLM-Phase beobachtet wird [62].…”

Section: Kardiopulmonaler Bypassunclassified

“…Sie sind mit einer signifikanten Reduktion der plasmatischen Konzentrationen von Haptoglobin sowie einer verstärkten Depletion von endothelialem NO assoziiert [62,63]. Der erhöhte "Verbrauch" des endothelialen NO durch Plasma-Hämoglobin korreliert mit dem erhöhten systemischen und pulmonalarteriellen Widerstand, der in den ersten Stunden nach einer längeren HLM-Phase beobachtet wird [62]. Weiterhin scheinen erhöhte Plasmakonzentrationen freien Hämoglobins für die Entwick-lung eines postoperativen Nierenversagens und einer Schädigung der Darmmukosa nach herzchirurgischen Eingriffen mitverantwortlich zu sein [56,64].…”

Section: Kardiopulmonaler Bypassunclassified

Die Bedeutung der Hämolyse in Anästhesie und Intensivmedizin

Graw¹,

Baron²,

Francis³

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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Hemolysis leads to an increase of circulating intravascular cell-free hemoglobin. Increased plasma concentrations of cell-free hemoglobin are relevant in critically ill patients because cell-free hemoglobin causes vasoconstriction by depletion of endothelial nitric oxide, oxidative stress, and inflammation. Furthermore, cell-free hemoglobin contributes to tissue injuries such as renal failure and intestinal mucosa damage after cardiac surgery. High concentrations of cell-free hemoglobin are associated with an increased mortality in patients with sepsis. Currently, it is unclear if hemolysis associated with transfusion of packed red blood cells that have been stored for prolonged periods of time is relevant for the clinical outcome. However, humans possess plasma proteins haptoglobin and hemopexin which bind to plasma hemoglobin and cell-free heme, respectively. The haptoglobin-hemoglobin and hemopexin-heme complexes are then eliminated from the plasma by hepatic or splenic uptake.

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Pulmonary and Systemic Vascular Resistances After Cardiopulmonary Bypass: Role of Hemolysis

Cited by 31 publications

References 47 publications

Transfusion of standard-issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgery—A randomized, double-blinded, clinical trial

Transfusion of standard-issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgery—A randomized, double-blinded, clinical trial

The effect of surgical versus transcatheter aortic valve replacement on endothelial function. An observational study

Die Bedeutung der Hämolyse in Anästhesie und Intensivmedizin

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