Navegando por Palavras-chave "cardiopulmonary bypass"
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- ItemSomente MetadadadosConventional and conventional plus modified ultrafiltration during cardiac surgery in high-risk congenital heart disease(Edizioni Minerva Medica, 2001-08-01) Maluf, Miguel Angel [UNIFESP]; Mangia, Cristina Malzoni Ferreira [UNIFESP]; Silva, C.; Carvalho, Werther Brunow de [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background. This prospective nonrandomized study is the critical assessment of conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) techniques and their efficiency in congenital heart disease surgeries. Use of cardiopulmonary bypass (C PB) in children is associated with body water retention as a consequence of prime volume and systemic inflammatory reaction. The CUF during CPB has reduced body water excess and the MUF after CPB, removes inflammatory mediators, improves hemodynamic performance, and decreases transfusion requirements.Methods. Forty-one patients, aged 9 to 36 months, submitted to surgical correction for cardiac defects, Using CPB, were divided into 2 similar groups: CUF (21 patients) operated between 1996-1997 were ultrafiltered during CPB, and CUF+MUF, (20 patients) operated between 1997-1998 and ultrafiltered during and after CPB. Postoperative duration of ventilator support, pediatric intensive care unit stay (PICU), hospital stay of the groups with and without preoperative pulmonary hypertension (PH), as well as transfusion requirement, hematocrit and platelet counts were compared.Results. There were no technical complications and a significant ultrafiltrate in the CUF+MUF group was observed as compared to the CUF group. No significant differences were observed between the CUF and CUF+MUF groups regarding ventilatory support, PICU stay and hospital stay. Requirements for red cell transfusion, Ht and platelet counts were not statistically different.Conclusions. CUF and CUF+MUF were safe and efficient methods for patient stabilization independent of diagnosis and complexity of surgery. Future clinical evaluation should address a larger population of patients to research the different variables.
- ItemSomente MetadadadosCoronary artery bypass grafting without cardiopulmonary bypass through sternotomy and minimally invasive procedure(Elsevier B.V., 1997-12-01) Buffolo, E.; Gerola, L. R.; Universidade Federal de São Paulo (UNIFESP)Coronary artery bypass grafting without cardiopulmonary bypass (CPB) is now an accepted technique of myocardial revascularization in a special subset of patients, This paper presents our total experience in 1761 cases operated on since September 1981 until April 1997 out of a total of 9164 patients revascularized with the conventional technique during this period of time. Among the 1761 patients, 53 (3%) were operated on by minimally invasive surgery. the overall applicability was 19.2% and the most common grafted arteries were left anterior descending artery (LAD), right coronary artery (RCA), and diagonal. Results indicate that the operation can be performed with an acceptable mortality (2.3%) and that all types of arterial conduits can be used. the incidence of major postoperative complications were significantly lower in this group of patients when compared with our patients receiving conventional myocardial revascularization. Most importantly there was decrease cost when the procedure was used because no extracorporeal circulation cardioplegia sets or other canulas were used. We conclude based on in this fifteen years experience that the technique of myocardial revascularization in a beating heart is justified, safe and can offer to selected patients the best option of coronary insufficiency surgical treatment. (C) 1997 Elsevier Science ireland Ltd.
- ItemSomente MetadadadosCytokines and pediatric open heart surgery with cardiopulmonary bypass(Greenwich Medical Media Ltd, 2001-01-01) Carvalho, Marcus Vinicius Henriques de [UNIFESP]; Maluf, Miguel Angel [UNIFESP]; Catani, Roberto [UNIFESP]; La Rotta, CAA; Gomes, Walter José [UNIFESP]; Salomão, Reinaldo [UNIFESP]; Silva, Celia Maria Carneiro; Carvalho, Antonio Carlos de [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)It is well known that, subsequent to cardiopulmonary bypass, and particularly in children, an inflammatory response within the body can often result in a characteristic syndrome. Recently, it has been suggested that this phenomenon is due to a systemic inflammatory response, with significant involvement of cytokines. With this in mind, we investigated the behavior of tumour necrosis factor-alpha and interleukin-6 during the operative and in the immediate postoperative period in a group of children submitted to Open heart surgery. We investigated any possible relation between the levels of these cytokines in the serum and the length of cardiopulmonary bypass, with the serum levels of lactate, and with the extent of use of inotropic drugs in postoperative period. The cytokines were measured in samples withdrawn after induction of anesthesia, after 10 minutes of cardiopulmonary bypass, after re-establishment of circulation, and then 2 and 24 hours after the end of cardiopulmonary bypass. The levels of tumour necrosis factor-a and interleukin-6 increased between the beginning and at two hours of the end of cardiopulmonary bypass. There was no correlation between the levels of these cytokines in the serum and the length of cardiopulmonary bypass, although there was a positive relation between levels of interleukin-6 and lactate in samples withdrawn at two hours of the end of bypass, and the measured levels of the cytokines correlated with the extent of inotropic drugs employed in the postoperative period.
- ItemAcesso aberto (Open Access)Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?(Academia Brasileira de Neurologia - ABNEURO, 2001-03-01) Malheiros, Suzana Maria Fleury [UNIFESP]; Massaro, Ayrton Roberto; Gabbai, Alberto Alain [UNIFESP]; Pessa, Clodualdo J. N. [UNIFESP]; Gerola, Luís Roberto [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Lira Filho, Edgar Bezerra; Christofalo, Dejaldo Marcos de Jesus; Federico, Darwin; Carvalho, Antonio Carlos [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Coronary artery bypass surgery (CABG) without cardiopulmonary bypass (CPB) may potentially reduce the number of microembolic signals (MES) associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue.
- ItemSomente MetadadadosA Novel Anti-Pollution Filter for Volatile Agents During Cardiopulmonary Bypass: Preliminary Tests(W B Saunders Co-Elsevier Inc, 2017) Nigro Neto, Caetano; Landoni, Giovanni; Tardelli, Maria Angela [UNIFESP]Objective: Concerns regarding pollution of the operating room by volatile anesthetics and effects on atmospheric ozone depletion exist. Volatile agents commonly are used during cardiopulmonary bypass to provide anesthesia independent of any supposed myocardial protective effects. The authors' aim was to create and to assess the performance of a prototype filter for volatile agents to be connected to the cardiopulmonary bypass circuit to avoid the emission of volatile agents to the operating room, and also to the environment without causing damage to the membrane oxygenator. Design: Observational trial. Setting: University hospital. Participants: Prototype filter for volatile agents. Interventions: The prototype filter was tested in a single ex vivo experiment. The main data measured during the test were pressure drop to detect interference with the performance of the oxygenator, back pressure to detect overpressure to the outlet gas jacket of the oxygenator, analysis of exhaled sevoflurane after the membrane oxygenator, and after the filter to detect any presence of sevoflurane. Measurements and Main Results: The prototype filter adsorbed the sevoflurane eliminated through the outlet portion of the oxygenator. During the entire test, the back pressure remained constant (4 mmHg) and pressure drop varied from 243 mmHg to 247 mmHg. Conclusion: The prototype filter was considered suitable to absorb the sevoflurane, and it did not cause an overpressure to the membrane oxygenator during the test. (C) 2017 Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)Off-pump coronary artery bypass surgery in selected patients is superior to the conventional approach for patients with severely depressed left ventricular function(Faculdade de Medicina / USP, 2011-01-01) Caputti, Guido Marco [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Gaia, Diego Felipe [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: Patients with coronary artery disease and left ventricular dysfunction have high mortality when kept in clinical treatment. Coronary artery bypass grafting can improve survival and the quality of life. Recently, revascularization without cardiopulmonary bypass has been presented as a viable alternative. The aim of this study is to compare patients with left ventricular ejection fractions of less than 20% who underwent coronary artery bypass graft with or without cardiopulmonary bypass. METHODS: From January 2001 to December 2005, 217 nonrandomized, consecutive, and nonselected patients with an ejection fraction less than or equal to 20% underwent coronary artery bypass graft surgery with (112) or without (off-pump) (105) the use of cardiopulmonary bypass. We studied demographic, operative, and postoperative data. RESULTS: There were no demographic differences between groups. The outcome variables showed similar graft numbers in both groups. Mortality was 12.5% in the cardiopulmonary bypass group and 3.8% in the off-pump group. Postoperative complications were statistically different (cardiopulmonary bypass versus off-pump): total length of hospital stay (days)-11.3 vs. 7.2, length of ICU stay (days)-3.7 vs. 2.1, pulmonary complications-10.7% vs. 2.8%, intubation time (hours)-22 vs. 10, postoperative bleeding (mL)-654 vs. 440, acute renal failure-8.9% vs. 1.9% and left-ventricle ejection fraction before discharge-22% vs. 29%. CONCLUSION: Coronary artery bypass grafting without cardiopulmonary bypass in selected patients with severe left ventricular dysfunction is valid and safe and promotes less mortality and morbidity compared with conventional operations.
- ItemSomente MetadadadosProcalcitonin and C-reactive protein kinetics in postoperative pediatric cardiac surgical patients(W B Saunders Co, 2004-04-01) Arkader, R.; Troster, E. J.; Abellan, D. M.; Lopes, M. R.; Raiz, R.; Carcillo, J. A.; Okay, T. S.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Univ PittsburghObjective: To determine the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) concentration after pediatric cardiac surgery with cardiopulmonary bypass.Design: Prospective, clinical cohort study.Setting: A fifteen-bed tertiary-care pediatric intensive care unit.Patients: Fourteen pediatric patients admitted for cardiac surgery.Measurements and Main Results: Serum PCT and CRP were measured before cardiopulmonary bypass (CPB); after CPB; and on the first, second, and third days after surgery by means of immunoluminometry and nephelometry, respectively. Reference values for systemic inflammatory response syndrome are 0.5 to 2.0 ng/mL for PCT and <5 mg/L for CRP. Baseline serum PCT and CRP concentrations were 0.24 +/- 0.13 ng/mL and 4.06 +/- 3.60 mg/L (median 25th percentile-75th percentile), respectively. PCT concentrations increased progressively from the end of CPB (0.62 +/- 0.30 ng/mL), peaked at 24 hours postoperatively (POD1) (0.77 +/- 0.49 ng/mL), and began to decrease at 48 hours or POD2 (0.35 +/- 0.21 ng/mL). CRP increased just after CPB (58.82 +/- 42.23 mg/L) and decreased after 72 hours (7.09 +/- 9.81 mg/L).Conclusion: An increment of both PCT and CRP was observed just after CPB. However, PCT values remained within reference values, whereas CRP concentrations increased significantly after CPB until the third day. These preliminary results suggest that PCT was more effective than CRP to monitor patients with SIRS and a favorable outcome. (C) 2004 Elsevier Inc. All rights reserved.
- ItemSomente MetadadadosRandomized Trial on the Effect of Sevoflurane on Polypropylene Membrane Oxygenator Performance(Elsevier B.V., 2013-10-01) Neto, Caetano Nigro; Arnoni, Renato; Rida, Bilal Smaili; Landoni, Giovanni; Tardelli, Maria Angela [UNIFESP]; Dante Pazzanese Inst Cardiol; Ist Sci San Raffaele; Maieut Fdn; Universidade Federal de São Paulo (UNIFESP)Objectives: Volatile anesthetics have cardioprotective properties that improve clinically relevant outcomes in cardiac surgery, and can be used during cardiopulmonary bypass (CPB) through adapted calibrated vaporizers together with air and oxygen (O-2). the effect of volatile agents on the membrane oxygenator is unknown. the aim of this study was to evaluate, for the first time, the performance of semiporous polypropylene membrane oxygenators after the use of sevoflurane vaporized during CPB in cardiac surgery.Design: A prospective, randomized, controlled trial.Setting: Teaching hospital.Participants: Thirty-two consecutive patients scheduled to undergo coronary artery bypass graft with CPB.Interventions: Patients were allocated randomly to receive either a volatile anesthetic (sevoflurane 1%-3%, 16 patients) or an intravenous hypnotic (midazolam, 16 patients) during CPB. After surgery, the membrane oxygenators used during CPB were tested with regard to O-2 transfer, carbon dioxide transfer, and pressure drop.Measurements and Main Results: the authors observed no protocol deviation or crossover. the performance of the membrane oxygenator was similar between the 2 groups, as documented by O-2 transfer (55 +/- 6.4 mL/min/L in the sevoflurane group versus 57 +/- 4.7 mL/min/L in the midazolam group, p = 0.4), carbon dioxide transfer, and pressure drop.Conclusions: the use of sevoflurane during CPB in cardiac surgery does not affect membrane oxygenator performance. (C) 2013 Elsevier Inc. All rights reserved.
- ItemSomente MetadadadosSurgical retrieval of undeployed intracoronary stent without cardiopulmonary bypass(Elsevier B.V., 1997-10-01) Gomes, Walter José [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Intracoronary stenting has now become a widely stablished method for treatment of complications of coronary angioplasty. the risk of stent embolism exists and if not retrieved, it may lead to thrombosis and coronary occlusion with myocardial infarction. We report a case of embolism of an undeployed intracoronary stent where there was failure of percutaneous attempts to pull back the stent, requiring surgical retrieval and simultaneous coronary artery bypass grafting, both without cardiopulmonary bypass. (C) 1997 Elsevier Science B.V.
- ItemSomente MetadadadosVasoplegic syndrome after open heart surgery(Edizioni Minerva Medica, 1998-10-01) Gomes, Walter José [UNIFESP]; Carvalho, A. C. [UNIFESP]; Palma, J. H. [UNIFESP]; Teles, Carlos Alberto [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Silas, Marcelo Grandini [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background. A new form of postperfusion manifestation is detailed, a vasoplegic syndrome presenting in the postoperative period after cardiopulmonary bypass (CPB) heart surgery.Methods. This retrospective study included sixteen patients who underwent cardiovascular surgery using CPB acid exhibited clinical and hemodynamic features compatible with vasoplegic syndrome. The technique of CPB was hypothermic (28 degrees C) in 15 and normothermic in 1 patient, and hypothermic blood cardioplegia was employed in all patients, except 1, The mean CPB time was 121 minutes, ranging from 80 to 210 minutes.Results. The patients presented a severe feature comprising hypotension, tachycardia, normal or elevated cardiac output, low systemic vascular resistance and decreased filling pressures. Fluid administration alone was not capable of restoring hemodynamic parameters. Physical examination revealed normal capillary filling at the extremities although oliguria and hypotension were observed. These patients needed a high dosage of vasoconstrictor drugs (norepinephrine) for blood pressure control but even high dose norepinephrine did clot produce the classical situation of cool extremities and weak peripheral pulses, with increased morbidity and mortality. Severe systemic complications could develop if the vasoplegic syndrome persisted 36-48 hours after its onset. All patients, except 3, presented associated postoperative complications and 4 patients died. The characteristics of vasoplegic syndrome are similar to those observed in septic shock, where the alterations are mediated by cytokines and tumor necrosis factor-alpha.Conclusions. The appearance of vasoplegic syndrome augmented operative morbidity with a consequent increased risk to the patient in the early postoperative period.