The Effects of Cardiopulmonary Bypass Following Pediatric Cardiac Surgery

Manrique, Ana; Vargas, Diana; Palmer, D. M.; Kelly, Kent; Litchenstein, Steven E.

doi:10.1007/978-3-030-21870-6_10

Cited by 5 publications

(4 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although some anesthetic agents may pose anti‐inflammatory effects, the surgery itself, especially cardiac surgery, and CPB causes an inflammatory response and acute lung injury 16,17 . The median airway pressure and FiO 2 of intubated patients were 10 cm H 2 O (IQR, 9.50‐10.50) and 0.64 (IQR, 0.60‐0.64), respectively, which are lower than the values reported in the study by Grasselli et al 3 Also, the severity of ARDS was lower in our patients.…”

Section: Discussioncontrasting

confidence: 71%

Early respiratory outcomes following cardiac surgery in patients with COVID‐19

et al. 2020

View full text Add to dashboard Cite

Background Both coronavirus disease (COVID‐19) and cardiac surgery have a negative impact on pulmonary function. This study aimed to determine the postoperative respiratory outcomes of patients with COVID‐19 who underwent cardiac surgery. Methods In this retrospective study, we reviewed and analyzed the patient characteristics and clinical data of 25 asymptomatic patients with COVID‐19 who underwent urgent or emergency cardiac surgery at Tehran Heart Center Hospital, Iran, between 29 February and 10 April 2020. Results The mean age, EuroSCORE, and body mass index were 57.3 ± 15.1 years, 6.65 ± 1.29, and 25.7 ± 3.7 kg/m2, respectively. Four patients underwent off‐pump cardiac surgery and 21 underwent on‐pump cardiac surgery with a median cardiopulmonary bypass time of 85 minutes (interquartile range (IQR, 50‐147). The overall mortality rate and the length of stay in the intensive care unit (ICU) were higher compared to those of a propensity‐matched group of patients who underwent cardiac surgery in the pre‐COVID era. The median intubation time was 13 hours (IQR, 9.5‐18), which was comparable to that of pre‐COVID cardiac surgery patients. The readmission rate to the ICU was 16%. In this ICU readmitted group, the mean oxygen index, FiO2, and mortality rate were higher and the PaO2/FiO2 ratio was lower than those of the nonreadmitted patients. Conclusions Although early respiratory outcomes of asymptomatic COVID‐19 patients who underwent early cardiac surgery appeared to be satisfactory, compared to the propensity‐scored matched non‐COVID group, the postoperative outcomes were worse, especially in the ICU readmitted patients. We suggest postponing cardiac operations unless the patient requires emergency surgery.

show abstract

Section: Discussioncontrasting

confidence: 71%

Early respiratory outcomes following cardiac surgery in patients with COVID‐19

et al. 2020

View full text Add to dashboard Cite

show abstract

“…All COVID patients were stable and asymptomatic before the surgery. However, the lung damage and inflammation caused by CPB and the open‐heart surgery 27,28 could have been amplified by the underlying pathologies caused by the COVID infection. Underlying COVID pathologies accounting for the evident increase in intraoperative and postoperative complications can include inflammatory response, cardiovascular and respiratory dysregulations, and coagulation abnormalities 29–31 .…”

Section: Discussionmentioning

confidence: 99%

Surgical coronary revascularization in patients with COVID‐19; complications and outcomes: A retrospective cohort study

Ayati

Hosseini

Hadizadeh

et al. 2022

Health Science Reports

View full text Add to dashboard Cite

Background and Aims Coronary artery disease is high‐risk comorbidity of COVID‐19 infection. Nonelective coronary artery revascularization in COVID‐19 patients carries substantial risk. Therefore, it is essential to understand the risk factors and outcomes fully. This study aims to evaluate the prognosis of coronary artery bypass grafting (CABG) surgery in patients with COVID‐19. Methods This retrospective cohort study assesses 171 patients who underwent urgent and emergent CABG in Tehran Heart Center from March 2020 to September 2021. The patients were allocated to cases and controls based on COVID‐19 infection status. Demographic and clinical features, alongside the complications and outcomes, were compared between the two groups. Results According to diagnostic criteria, 62 patients were diagnosed with COVID‐19 (Case) and 109 patients had no COVID diagnosis (Control). Regarding the demographics and risk factors, hypertension was more prevalent among patients with COVID‐19 (64.5% compared to 43.1% p = 0.007). Length of hospital stay, ventilation time, and intensive care unit (ICU) stay time were significantly higher in patients infected with COVID‐19. Postoperative complications, including stroke, atrial fibrillation, pleural effusion, blood transfusion, and Inotrope use, were significantly higher in the case group. Mortality rates were also higher in COVID‐19 patients with an odds ratio of 1.53; however, this difference is not statistically significant ( p : 0.44, 95% CI = 0.50–4.01). Conclusion COVID‐19 is associated with a significantly higher hospital stay, ventilation time, and ICU stay. Mortality rates are also higher, albeit insignificantly. Various postoperative complications are also higher with COVID‐19.

show abstract

“…Inflammatory response due to cardiopulmonary bypass (CBP) activates different pathways, resulting in cytokine production, cellular edema, endothelial injury, and organ ischemia [1] that affect multiple organs like lung, heart, brain, and kidneys [2][3][4][5]. This inflammatory response is exaggerated in pediatrics because of multiple factors such as; Major hemodilution due to small body surface area compared to the circuit area, which exposes them to more blood transfusion and abrupt temperature changes; need for higher perfusion rates due to higher metabolic demand increasing shear stress; and the immaturity of organs which increases the risk and severity of injury [6]. Several methods have been employed to decrease this inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

The effect of dexmedetomidine on the inflammatory response in children undergoing repair of congenital heart disease: a randomized controlled clinical trial

Abdelrahman

Hassan

Mohammed

et al. 2020

Egyptian Journal of Anaesthesia

View full text Add to dashboard Cite

Background: The inflammatory response due to cardiopulmonary bypass (CBP) activates different inflammatory pathways that affect multiple organs. Dexmedetomidine is proved to affect inflammatory marker production. Objectives: Evaluation of the effect of Dexmedetomidine on the inflammatory response associated with pediatric open-heart surgery using interleukin-6 (IL-6) and interferon-gamma (INF-ɤ) levels. Methods: 61children aged between one to 8 years undergoing elective repair of non-cyanotic congenital heart disease with CPB were randomly assigned into two groups. The control group (31 patients) received normal saline, whereas the Dex group (30 patients) received an initial bolus of Dexmedetomidine 0.5 µg/kg followed immediately by infusion of 0.5 µg/kg/hr continued till the end of CPB. The level of IL-6 and INF-ɤ was measured. Hemodynamic, ICU, and hospital data were recorded. Results: IL-6 and INF-ɤ levels were increased significantly with time in control group, with no increase in their levels in the Dex group. They were significantly lower in the Dex group compared to the control group in samples taken during bypass, 6 h and 24 h after the operation (the end of surgical procedure). There was a significant difference between the groups regarding inotropic score and mechanical ventilation. There was no significant difference between the groups regarding complications, duration of ICU or hospital stay. Conclusion: The use of Dexmedetomidine in pediatric cardiac surgery for non-cyanotic heart disease had significantly attenuated the inflammatory response. It was useful in decreasing the level of inflammatory mediators, inotropic support, and duration of mechanical ventilation, but not the ICU or hospital stay. Trial registration: https://clinicaltrials.gov. (Identifier: NCT03163238).

show abstract

The Effects of Cardiopulmonary Bypass Following Pediatric Cardiac Surgery

Cited by 5 publications

References 47 publications

Early respiratory outcomes following cardiac surgery in patients with COVID‐19

Early respiratory outcomes following cardiac surgery in patients with COVID‐19

Surgical coronary revascularization in patients with COVID‐19; complications and outcomes: A retrospective cohort study

The effect of dexmedetomidine on the inflammatory response in children undergoing repair of congenital heart disease: a randomized controlled clinical trial

Contact Info

Product

Resources

About