Surgical results of low-dose systemic heparinization (1 mg/kg, 100 IU/kg) in thoracic aortic operation combined with a heparin-coated cardiopulmonary bypass circuit: Is low-dose heparinization safe during deep hypothermic circulatory arrest?

2002 ◽  
Vol 5 (1) ◽  
pp. 0050-0053
Author(s):  
H. Kajiwara ◽  
T. Hamada ◽  
M. Ishii ◽  
K. Yamamoto ◽  
T. Kosuge ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Low Dose ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Surgical Results ◽  
Aortic Operation ◽  
Systemic Heparinization

scholarly journals Effects of Deep Hypothermic Circulatory Arrest on the Blood Brain Barrier in a Cardiopulmonary Bypass Model – A Pilot Study

2014 ◽  
Vol 23 (10) ◽  
pp. 981-984 ◽  
Author(s):  
Karsten Bartels ◽  
Qing Ma ◽  
Talaignair N. Venkatraman ◽  
Christopher R. Campos ◽  
Lindsay Smith ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Pilot Study ◽  
Blood Brain Barrier ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Brain Barrier ◽  
Blood Brain

scholarly journals Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest

2020 ◽  
Author(s):  
Ludmila Khailova ◽  
Justin Robison ◽  
James Jaggers ◽  
Richard Ing ◽  
Scott Lawson ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Phosphatase Activity ◽  
Alkaline Phosphatase Activity ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Swine Model ◽  
Intestinal Alkaline Phosphatase

Abstract Background: Infant cardiac surgery with cardiopulmonary bypass results in decreased circulating alkaline phosphatase that is associated with poor post-operative outcomes. Bovine intestinal alkaline phosphatase infusion represents a novel therapy for post-cardiac surgery organ injury. However, the effects of cardiopulmonary bypass and bovine-intestinal alkaline phosphatase infusion on tissue-level alkaline phosphatase activity/expression are unknown.Methods: Infant pigs (n=20) underwent cardiopulmonary bypass with deep hypothermic circulatory arrest followed by four hours of intensive care. Seven control animals underwent mechanical ventilation only. Cardiopulmonary bypass/deep hypothermic circulatory arrest animals were given escalating doses of bovine intestinal alkaline phosphatase infusion (0-25U/kg/hr; n=5/dose). Kidney, liver, ileum, jejunum, colon, heart and lung were collected for measurement of tissue alkaline phosphatase activity and mRNA.Results: Tissue alkaline phosphatase activity varied significantly across organs with the highest levels found in the kidney and small intestine. Cardiopulmonary bypass with deep hypothermic circulatory arrest resulted in decreased kidney alkaline phosphatase activity and increased lung alkaline phosphatase activity, with no significant changes in the other organs. Alkaline phosphatase mRNA expression was increased in both the lung and the ileum. The highest dose of bovine intestinal alkaline phosphatase resulted in increased kidney and liver tissue alkaline phosphatase activity.Conclusions: Changes in alkaline phosphatase activity after cardiopulmonary bypass with deep hypothermic circulatory arrest and bovine intestinal alkaline phosphatase delivery are tissue specific. Kidneys, lung, and ileal alkaline phosphatase appear most affected by cardiopulmonary bypass with deep hypothermic circulatory arrest and further research is warranted to determine the mechanism and biologic importance of these changes.

Anticoagulation management during pulmonary endarterectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest

Perfusion ◽  
2020 ◽  
Vol 36 (1) ◽  
pp. 87-96
Author(s):  
Dennis Veerhoek ◽  
Laurentius JM van Barneveld ◽  
Renard G Haumann ◽  
Suzanne K Kamminga ◽  
Alexander BA Vonk ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Confidence Interval ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Clotting Time ◽  
Pulmonary Endarterectomy ◽  
Anticoagulation Management ◽  
Activated Clotting Time ◽  
Protamine Administration

Introduction: Pulmonary endarterectomy requires cardiopulmonary bypass and deep hypothermic circulatory arrest, which may prolong the activated clotting time. We investigated whether activated clotting time–guided anticoagulation under these circumstances suppresses hemostatic activation. Methods: Individual heparin sensitivity was determined by the heparin dose–response test, and anticoagulation was monitored by the activated clotting time and heparin concentration. Perioperative hemostasis was evaluated by thromboelastometry, platelet aggregation, and several plasma coagulation markers. Results: Eighteen patients were included in this study. During cooling, tube-based activated clotting time increased from 719 (95% confidence interval = 566-872 seconds) to 1,273 (95% confidence interval = 1,136-1,410 seconds; p < 0.01) and the cartridge-based activated clotting time increased from 693 (95% confidence interval = 590-796 seconds) to 883 (95% confidence interval = 806-960 seconds; p < 0.01), while thrombin–antithrombin showed an eightfold increase. The heparin concentration showed a slightly declining trend during cardiopulmonary bypass. After protamine administration (protamine-to-heparin bolus ratio of 0.82 (0.71-0.90)), more than half of the patients showed an intrinsically activated coagulation test and intrinsically activated coagulation test without heparin effect clotting time >240 seconds. Platelet aggregation through activation of the P2Y12 (adenosine diphosphate test) and thrombin receptor (thrombin receptor activating peptide-6 test) decreased (both −33%) and PF4 levels almost doubled (from 48 (95% confidence interval = 42-53 ng/mL) to 77 (95% confidence interval = 71-82 ng/mL); p < 0.01) between weaning from cardiopulmonary bypass and 3 minutes after protamine administration. Conclusion: This study shows a wide variation in individual heparin sensitivity in patients undergoing pulmonary endarterectomy with deep hypothermic circulatory arrest. Although activated clotting time–guided anticoagulation management may underestimate the level of anticoagulation and consequently result in a less profound inhibition of hemostatic activation, this study lacked power to detect adverse outcomes.

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