Cardiopulmonary bypass, myocardial management, and support techniques Changes in autonomic response of the cerebral circulation after normothermic extracorporeal.

Slides:



Advertisements
Similar presentations
Influence of normothermic systemic perfusion during coronary artery bypass operations: A randomized prospective study  Inderpaul Birdi, FRCS, Idris Regragui,
Advertisements

Propionyl-L-carnitine dilates human subcutaneous arteries through an endothelium- dependent mechanism  Marilyn J. Cipolla, PhD, Alexander Nicoloff, MD,
Intraaortic Counterpulsation During Cardiopulmonary Bypass Impairs Distal Organ Perfusion  Steinar Lundemoen, MD, Venny Lise Kvalheim, MD, PhD, Øyvind.
Myocardial protection with oxygenated esmolol cardioplegia during prolonged normothermic ischemia in the rat  Ryuzo Bessho, MD, PhD, David J. Chambers,
Endothelial nitric oxide synthase enhancer for protection of endothelial function from asymmetric dimethylarginine–induced injury in human internal thoracic.
Ezetimibe reduces intimal hyperplasia in rabbit jugular vein graft
Altered coronary microvascular serotonin receptor expression after coronary artery bypass grafting with cardiopulmonary bypass  Michael P. Robich, MD,
Volume 116, Issue 2, Pages (February 1999)
Labetalol, nebivolol, and propranolol relax human radial artery used as coronary bypass graft  Ozge Korkmaz, MD, Bülent Saraç, MD, Sabahattin Göksel,
Esmolol and percutaneous cardiopulmonary bypass enhance myocardial salvage during ischemia in a dog model  Glenn W. Laub, MD, S. Muralidharan, MD, Jerome.
Iodinated contrast induced renal vasoconstriction is due in part to the downregulation of renal cortical and medullary nitric oxide synthesis  Stuart.
Marilyn J. Cipolla, MS, Christian T. Harker, PhD, John M. Porter, MD 
Guo-Wei He, MD, PhD, Cheng-Qin Yang, MD 
Oz M. Shapira, MDa, Aiming Xu, PhDb, Joseph A. Vita, MDb, Gabriel S
Harry L. Bush, M. D. , Joseph A. Jakubowski, Ph. D. , G
Comparative Effects of Continuous Warm Blood and Intermittent Cold Blood Cardioplegia on Coronary Reactivity  Motohisa Tofukuji, MD, PhD, Alon Stamler,
Blood cardioplegia enhanced with nitric oxide donor SPM-5185 counteracts postischemic endothelial and ventricular dysfunction  Katsuhiko Nakanishi, MD,
Endothelium-dependent vasorelaxations in response to aggregating platelets are impaired in reversed vein grafts  Kimihiro Komori, MD, Peter Gloviczki,
Steven R. Gundry, MD, Matthew A. Romano, MD, O
Protecting the brain and spinal cord
Determination of optimum retrograde cerebral perfusion conditions
The use of methylene blue as an extravascular surgical marker impairs vascular responses of human saphenous veins  Dustan A. Barber, PhDa, Joseph W. Rubin,
Continuous warm versus intermittent cold cardioplegic infusion: A comparison of energy metabolism, sodium-potassium adenosine triphosphatase activity,
Piet Borgdorff, PhD, Rogier H. van den Berg, MsC, Martijn A
Effects of cardioplegia on vascular function and the “no-reflow" phenomenon after ischemia and reperfusion: Studies in the isolated blood-perfused rat.
Intermittent aortic crossclamping prevents cumulative adenosine triphosphate depletion, ventricular fibrillation, and dysfunction (stunning): Is it preconditioning? 
Moderate hypothermia during cardiopulmonary bypass increases intramyocardial synthesis of heat shock protein 72  Ma Qing, MD, Jaime F. Vazquez-Jimenez,
Expression of vascular endothelial growth factor and its receptors is increased, but microvascular relaxation is impaired in patients after acute myocardial.
Differential effects on the mesenteric microcirculatory response to vasopressin and phenylephrine after cardiopulmonary bypass  Tanveer A. Khan, MD, Cesario.
Luminal surface concentration of lipoprotein (LDL) and its effect on the wall uptake of cholesterol by canine carotid arteries  Xiaoyan Deng, PhD, Yves.
Hendrik T. Tevaearai, MD, G. Brant Walton, BS, Andrea D
Propionyl-L-carnitine dilates human subcutaneous arteries through an endothelium- dependent mechanism  Marilyn J. Cipolla, PhD, Alexander Nicoloff, MD,
Effects of perfusion mode on regional and global organ blood flow in a neonatal piglet model  Akif Ündar, PhD, Takafumi Masai, MD, Shuang-Qiang Yang,
Inhaled but not intravenous milrinone prevents pulmonary endothelial dysfunction after cardiopulmonary bypass  Y. Lamarche, MD, O. Malo, MSc, E. Thorin,
Cardioplegia and vascular injury
Effect of cerebral embolization on regional autoregulation during cardiopulmonary bypass in dogs  Hulya Sungurtekin, MD, Umar S Boston, MD, Thomas A Orszulak,
Munir Boodhwani, MD, William E
Tissue concentrations of endothelins and functional effects of endothelin-receptor activation in human arteries and veins  Peter Holm, MD, Anders Franco-Cereceda,
Changes in Cerebral Vascular Reactivity Occur Early During Cardiopulmonary Bypass in the Rat  Thomas Modine, MD, Richard Azzaoui, MD, Thavarak Ouk, PhD,
Endothelium-dependent contraction of canine coronary artery is enhanced by crystalloid cardioplegic solution  Pyng Jing Lin, MD, Chau-Hsiung Chang, MD,
A novel protocol of retrograde cerebral perfusion with intermittent pressure augmentation for brain protection  Kazuo Kitahori, MD, Shinichi Takamoto,
In vitro protection of vascular function from oxidative stress and inflammation by pulsatility in resistance arteries  Frédéric Pinaud, MD, Laurent Loufrani,
Perfusion and repair technique in acute aortic dissection with cerebral malperfusion and damage of the innominate artery  Paul P. Urbanski, MD, PhD, Matthias.
Kai Ihnken, MD  The Journal of Thoracic and Cardiovascular Surgery 
John F. Eidt, MD, Mark B. Kahn, MD, Gary W. Barone, MD, James M
Impaired vasodilation of peripheral arteries in response to acetylcholine in human beings with abdominal aortic aneurysm  Kimihiro Komori, MD, PhD, Kyoutaro.
Ischemic preconditioning does not acutely improve load-insensitive parameters of contractility in in vivo stunned porcine myocardium  M.Salik Jahania,
Sialyl LewisX oligosaccharide preserves cardiopulmonary and endothelial function after hypothermic circulatory arrest in lambs  Marc L. Schermerhorn,
Cardiac cannulation, sodium and water balance, and ANF plasma levels
Nitric oxide mediates fluid accumulation during cardiopulmonary bypass
Mesenteric dysfunction after cardiopulmonary bypass: role of complement C5a  Motohisa Tofukuji, MD, PhD, Gregory L Stahl, PhD, Caroline Metais, MD, Mikio.
Paulo R. B. Evora, MD, PhD, Paul J
Role of Nitric Oxide Pathway in Placental Dysfunction Following Fetal Bypass  Christopher Lam, BS, R. Scott Baker, BS, Jerri McNamara, CCP, Robert Ferguson,
The limits of detectable cerebral perfusion by transcranial doppler sonography in neonates undergoing deep hypothermic low-flow cardiopulmonary bypass 
Increased endothelin-1 production in diabetic patients after cardioplegic arrest and reperfusion impairs coronary vascular reactivity: Reversal by means.
Iodinated contrast induced renal vasoconstriction is due in part to the downregulation of renal cortical and medullary nitric oxide synthesis  Stuart.
Regional cerebral tissue blood flow measured by the colored microsphere method during retrograde cerebral perfusion  Keiji Oohara, MDa, Akihiko Usui,
Postbypass effects of delayed rewarming on cerebral blood flow velocities in infants after total circulatory arrest  Rosendo A. Rodriguez, MD, PhDa (by.
Effect of sialyl Lewisx oligosaccharide on myocardial and cerebral injury in the pig  Motohisa Tofukuji, MD, PhD, Caroline Metais, MD, Charles D Collard,
Suprarenal aortic clamping and reperfusion decreases medullary and cortical blood flow by decreased endogenous renal nitric oxide and PGE2 synthesis 
Novel cerebral physiologic monitoring to guide low-flow cerebral perfusion during neonatal aortic arch reconstruction  Dean B. Andropoulos, MDa, Stephen.
Hypercholesterolemia impairs endothelium-dependent relaxations to aggregating platelets in porcine iliac arteries  Kimihiro Komori, MD, Hiroaki Shimokawa,
Effects of FK506 in rat and human resistance arteries
Nitroglycerin as a nitric oxide donor accelerates lipid peroxidation but preserves ventricular function in a canine model of orthotopic heart transplantation 
The Brain Uses Mostly Dissolved Oxygen During Profoundly Hypothermic Cardiopulmonary Bypass  Franklin Dexter, MD, PhD, Frank H Kern, MD, Bradley J Hindman,
Modulation of myocardial perfusion and vascular reactivity by pericardial basic fibroblast growth factor: Insight into ischemia-induced reduction in endothelium-dependent.
Arterial balloon catheter: a new atraumatic device for dilating arterial grafts  Hugues Jeanmart, MD, Louis P Perrault, MD, PhD, Nathalie Desjardins, BS,
William L. Holman, MDa, Russell D. Spruell, BSEEa, Edward R
Y.John Gu, MD, PhD, Piet W. Boonstra, MD, PhD, Willem van Oeveren, PhD 
A prospective randomized study of neurocognitive function and S-100 protein after antegrade or retrograde brain perfusion with hypothermic arrest for.
Presentation transcript:

Cardiopulmonary bypass, myocardial management, and support techniques Changes in autonomic response of the cerebral circulation after normothermic extracorporeal circulation  Frank W. Sellke, MD, Steven Y. Wang, MD, PhD, Alon Stamler, MD, Robert G. Johnson, MD, William E. Cohn, MD, Ronald M. Weintraub, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 112, Issue 2, Pages 450-461 (August 1996) DOI: 10.1016/S0022-5223(96)70273-8 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Schematic of method to measure blood flow responses to internal carotid artery infusion of vasoactive substances (in vivo). A silicone elastomer catheter (A) was placed into the common carotid artery and advanced into the proximal internal carotid artery (B) for drug infusion. A perivascular Doppler flow probe (C) was used to measure internal carotid blood flow under baseline conditions and during the administration of vasoactive substances. Additional catheters (D, E) were placed in the internal carotid artery and high in the internal jugular vein (F) for pressure monitoring. The external carotid artery was ligated at its origin. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Schematic of in vitro microvessel apparatus. Cerebral microvessels were cannulated and pressurized in a no-flow state. With an inverted microscope connected to a video camera, the vessel image was projected onto a television monitor. An electronic dimension analyzer was used to measure internal lumen diameter, which was recorded on an oscillographic strip chart recorder. A, Brain; B, organ chamber; C, imaging apparatus. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Plot of mean aortic blood pressure as a function of time. Time of onset of CPB is designated as 0 minutes. Values are mean ± SEM. Asterisks represent p < 0.05 versus initial prebypass value. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Plot of internal carotid artery blood flow (unilateral) as a function of time. Time of onset of CPB is designated as 0 minutes. Values are mean ± SEM. Asterisks represent p < 0.05 versus initial prebypass value. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Plot of cerebral vascular resistance (unilateral) as a function of time. Time of onset of CPB is designated as 0 minutes. Values are mean ± SEM. Asterisks represent p < 0.05 versus initial prebypass value. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Change in internal carotid artery blood flow (percentage change from baseline) in response to the intraluminal administration of acetylcholine before CPB and after 2 hours of total CPB and 15 minutes of post-CPB perfusion (CPB-15min). Data are mean ± SEM. Asterisk represents p < 0.05 versus before CPB. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 7 Change in internal carotid artery blood flow (percentage change from baseline) in response to the intraluminal administration of isoproterenol, before and after 2 hours of total CPB and 15 minutes of post-CPB perfusion (CPB-15min). Data are mean ± SEM. Asterisk represents p < 0.05 versus before CPB. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 8 Change in internal carotid artery blood flow (percentage change from baseline) in response to the intraluminal administration of sodium nitroprusside, before and after 2 hours of total CPB and 15 minutes of post-CPB perfusion (CPB-15min). Data are mean ± SEM. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 9 Plot of in vitro responses of precontracted porcine cerebral microvessels to the cholinergic agonist acetylcholine from uninstrumented animals in the absence (n = 6) or presence of NG-nitro-l-arginine (100 μmol/L, n = 6) or atropine (1 μmol/L, n = 6), or in microvessels denuded of endothelium (n = 6). Vessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. Daggers represent p < 0.01 versus microvessels with intact endothelium in the absence of any antagonist (control). The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 10 Plot of in vitro responses of precontracted porcine cerebral microvessels to the cholinergic agonist acetylcholine from control animals (n = 6), animals after 2 hours of CPB and 15 minutes of perfusion after CPB (CPB-15min, n = 7), and animals after separation from CPB and 1 hour of cerebral perfusion after separation from CPB (CPB-60min, n = 6). Microvessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. Daggers represent p < 0.01 versus control. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 11 Plot of in vitro responses of precontracted porcine cerebral microvessels to the β-adrenoceptor agonist isoproterenol from control animals (n = 6), animals after 2 hours of CPB and 15 minutes of perfusion after separation from CPB (CPB-15min, n = 7), and animals after CPB and 1 hour of cerebral perfusion after separation from CPB (CPB-60min, n = 6). In addition, the response of control vessels to isoproterenol in the presence of propranolol (1 μmol/L, PROP, n = 6) was examined. Microvessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. Asterisk represents p < 0.05 vs control at 0.1 μmol/L concentration; daggers represent p < 0.01 versus CPB-60min. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 12 Plot of in vitro responses of precontracted porcine cerebral microvessels to the guanylate cyclase activator sodium nitroprusside from control animals (n = 6), animals after 2 hours of CPB and 15 minutes of perfusion after separation from CPB (CPB-15min, n = 7), and animals after CPB and 1 hour of cerebral perfusion after separation from CPB (CPB-60min, n = 6). Microvessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 13 Plot of in vitro responses of precontracted porcine cerebral microvessels to the adenylate cyclase activator forskolin from control animals (n = 6), animals after 2 hours of CPB and 15 minutes of perfusion after separation from CPB (CPB-15min, n = 7), and animals after CPB and 1 hour of cerebral perfusion after separation from CPB (CPB-60min, n = 6). Microvessels were pressurized to 40 mm Hg in a no-flow state. Drugs were applied extraluminally. Responses are expressed as percentage relaxation of the U46619-induced vascular contraction. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 450-461DOI: (10.1016/S0022-5223(96)70273-8) Copyright © 1996 Mosby, Inc. Terms and Conditions