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1. Abstract

Author

Nivez F. Rasic, Robert M. Friesen, Bruce Anderson, Shirley A. Hoban, Nancy Olson, Jacob Kress, Simon Lévesque, Martin R. Lessard, Pierre Nicole, Stéphan Langevin, Jacques Langevin, François LeBlanc, Jacques Brochu, Alexis Turgeon, Pierre C. Nicole, Claude A. Trépanier, Sylvie Marcoux, Vynka C. Lash, Keith Anderson, J. Francisco Asenjo, Francesco Carli, Dale A. Engen, Gordon H. Morewood, Nancy Ghazar, Ted Ashbury, Elizabeth G. VanDenKerkhof, Louie Wang, Katherine R. Blight, C. David Mazer, Gregory M. T. Hare, Zhilan Wang, Carla Coackley, Rong Qu, Malcolm Robb, Duncan J. Stewart, Thomas Schricker, Sarkis Meterissian, Ralph Lattermann, Franco Carli, Jean-Yves Dupuis, Feng Wang, Howard Nathan, Kathryn Williams, James A. Robblee, Howard J. Nathan, Raynauld Ko, Marelise Kruger, Karen McRae, Gail Darling, Thomas Waddell, David Morrice, Desmond McGlade, Ken Cheung, Joel Katz, Peter Slinger, Andrew J. Baker, Kathryn M. Hum, Steve Y. Kim, Aiala Barr, Zeev Friedman, David T. Wong, Frances Chung, David H. Goldstein, William C. Blaine, Michael J. Rimmer, Jacelyn M. Kolman, Orlando R. Hung, Ian G. Beauprie, Robert Vandorpe, Chandran J. Baker, William Rennie, Robert Brown, Susan Kenny, Damon Kamming, Brid McGrath, Bruna Curti, Shirley King, Brenda W. Lau, Craig R. Ries, Josie Schmid, Richard N. Kraima, Toshimi Arai, Masao Yamashita, William Splinter, Uma R. Parekh, Teresa Valois-Gomez, John G. Muir, Andrew G. Usher, Ramona A. Kearney, Ban C. H. Tsui, D. Shende, V. Darlong, N. Asit, Justin Richards, John Van Aerde, Alese Wagner, Dominic Cave, Ramona Kearney, Leeanne Philips, Kathy Reid, Khalid Chowdary, Peter Brooks, Ron Ree, Mark Ansermino, David Rosen, Pirjo H. Manninen, Ghazali Ghazaime, Soad Louissi, Bisi Odukoya, Rosendo A. Rodriguez, Luciana Parlea, Fraser D. Rubens, Paul Hendry, Il-Ok Lee, In Ho Lee, Paul Audu, Peter H. K. Mak, Pirijo H. Manninen, Shanti Sundar, Stephan K. W. Schwarz, Ernest Puil, Steven E. Hybarger, Tod B. Sloan, Richard Brull, Colin J. L. McCartney, Regan Rawson, Sherif Abbas, Vincent W. S. Chan, D. Ong, D. Ha, H. Ha, W. P. S. McKay, Myung-Hoon Kong, Mi-Kyung Lee, Sang-Ho Lim, Young-Seok Choi, Nan-Sook Kim, P. H. Lennox, H. S. Umedaly, C. F. Keogh, D. Setton, R. P. Grant, B. G. Fitzmaurice, K. Evans, S. A. White, Judy Watt-Watson, Michael McGillion, M. Denise Daley, Peter H. Normanaf], Sarah Hogervorst, Alicia Kowalski, James Arens, Debra Kennamer, Steven Curley, Jean Vauthey, Brendan Finucaneaf], W. Scott Beattie, Peter Choi, Phillip E. Donais, William P. S. McKay, Robert Banner, Renee Kennedy, George Konok, Darryl R. Guglielmin, Francis G. King, Kyungil Hwang, Hoondo Kim, Sangho Lee, Valérie Cardinal, René Martin, Jean-Pierre Tétreault, Marie-José Colas, Linda Gagnon, Yves Claprood, Linda Wykes, Tao Luo, Zhengyuan Xia, David M. Ansley, Jingping Ouyang, Zhong-Yuan Xia, Paul Brousseau, Greg Dobson, Heather Lummis, Ramiro Arellano, David Steinberg, Leo Trigazis, Isabella Devito, Kristi Downey, Sean Minogue, James Ralph, Martin Lampa, Andrew J. Roscoe, Corey W. Sawchuk, Ashraf Fayad, Jeff Healey, Eugene Crystal, Kevin Teoh, Eva Lonn, Sandra Carroll, Stephan Hohnloser, Stuart Connolly, Gilbert Lavallee, Fraser Rubens, Carlos D. Rodriguez, Arnaud Robitaille, André Y. Denault, Pierre Couture, Sylvain Bélisle, Annik Fortier, Marie-Claude Guertin, Michel Carrier, Raymond Martineau, Sukhjeewan Basran, Robert Frumento, Catherine O’Malley, Linda Mongero, James Beck, Elliott Bennett-Guerrero, Thomas M. Hemmerling, Jen-Luc Choinière, Fadi Basile, Ignatio Prieto, Joanne D. Fortier, Charles MacAdams, Lawrence Fan, Douglas Seal, Karen Maier, Richard Kowalewski, Tim Tang, John Haigh, Karen Tofflemire, James Q. Norris, Steven Howells, Joseph Browne, Andrew Beney, Todd Pynn, Steven Taylor, Kam Mong, George Djaiani, Ludwik Fedorko, Jo Carroll, Mohamed Ali, Davy Cheng, Andrew Klein, Harry Rakowski, Anna Woo, Lee Heinrich, David Mikulis, Jacek Karski, Alex Sia, Sebastian Chua, Xi Hong, Branka Gvozdic, Pamela J. Morgan, Jordan Tarshis, Alison J. Macarthur, Rollin Brant, Jeffrey Pollard, Linda Cook, Hea Jo Yoon, Youn Woo Lee, Jeong-Yeon Hong, Soo Mie Kim, Sherry Parkhurst, Diane Biehl, Bill Ong, Jacques Brochuaf], Dary Croft, Anthony M. -H. Ho, Tak Wai Lee, Manoj K. Karmakar, Wynnie M. Lam, David C. Chung, Luc Massicotte, Peter R. H. Wilkes, Stephan Legault, Sanjiv Gupta, Alan D. Baxter, J. E. Allan, Stephan Malherbe, J. Allan, J. Bedard, S. Malone-Tucker, S. Slivar, M. Langil, M. Perrault, O. Janseo, George Carvalho, Anne Moore, Kevin Lachapelle, Baqir Quizilbash, Reda Salem, Andrew A. Klein, Charles Shayan, Dmitri Chamchad, Karkouti Keyvan, Sally J. Bird, Liane S. Feldman, Maurice Anidjar, Donna Stanbridge, Keyvan Karkouti, Esam Abdelnaem, Duminda Wijeysundera, Scott Beattie, Terry Yau, David Sutton, Bharathi Varadarajan, Geraldine Jose, Karen Kakizawa, Stuart A. McCluskey, Mohammed Ghannam, Robert Smith, Adam Goldman, Janet Hsu, Geoff Duviner, David Grant, Gary Levy, Alvin Chang, Michael Borger, Doreen Cleave-Hogg, Susan DeSousa, Omar Radwan, Gerald Fried, Steven Backman, Nicolas Christou, Dale Engen, Russell Brown, Stuart Iglesias, Monica Kohlhammer, Rob C. Tanzola, Brian Milne, D. John Doyle, Hwan Joo, Cassandra Frazer, Anthony Iacolucci, Andrew Bagrin, Orville Small, Warren Lewin, Anne L. Chowet, Jaime R. Lopez, John Brock-Utne, Richard A. Jaffe, Andrew D. Milne, J. Michael Lee, Michael J. M. English, O. R. Hung, and Brendan Finucane

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
2003
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2. Circuits with surface modifying additive alter the haemodynamic response to cardiopulmonary bypass1

Author

Denise Wozny, Marc Ruel, Gilbert Lavallee, Maura I Watson, Jim Robblee, Fraser D. Rubens, and Howard J. Nathan

Subjects
Pulmonary and Respiratory Medicine, Inotrope, Mean arterial pressure, medicine.medical_specialty, Haemodynamic response, business.industry, Hemodynamics, General Medicine, law.invention, Cardiac surgery, symbols.namesake, Blood pressure, law, Anesthesia, symbols, Cardiopulmonary bypass, medicine, Surgery, Cardiology and Cardiovascular Medicine, business, Fisher's exact test
Abstract

Objective: Blood contact with synthetic surfaces during cardiopulmonary bypass (CPB), inevitably results in the activation of a variety of interrelated pathways of inflammation and coagulation that may contribute to postoperative complications in cardiac surgery patients. The objective of this trial was to evaluate clinical events and complement activation related to the use of a novel biomaterial, into which a surface modifying additive had been incorporated into the polymer used to prepare the bypass circuit. Methods: A prospective, doubleblind trial was carried out with 34 patients randomized to surgery, with either a standard circuit or a circuit treated (‘tip to tip’) with the surface modifying additive. Variables recorded included perioperative haemodynamics, volume replacement, a-agonist and inotrope use. Terminal complement complex (SC5b-9) was measured using an ELISA. Results: Upon initiation of bypass, there was a decrease in mean arterial pressure (MAP) in the control group, not seen in the test group ( P = 0.0005, ANOVA). There was a decrease in the total volume of replacement fluid given intraoperatively in the test group as compared with the control group (total plus prime; control 5.3 ∠ 1.2 L, test 4.4 ∠ 1.9 L, P = 0.03, Mann‐Whitney test). There was a trend to decreased need for inotrope infusion in the test group after CPB (test 1/17, control 6/17, Fisher exact test; P = 0.085). No difference was seen in the generation of terminal complement complex between the groups either during or after CPB. Conclusions: The decrease in blood pressure in the control group, upon the initiation of CPB, did not occur in patients undergoing CPB with the circuit prepared with the surface modifying additive. The decrease in blood pressure was likely associated with the increase in total administered fluids intraoperatively (approximately 1 l/patient) and perhaps the trend towards higher use of inotropes in the control patients as opposed to the test patients. These haemodynamic changes did not appear to be related to complement activation early in CPB. © 1999 Elsevier Science B.V. All rights reserved.

Published
1999
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3. The management of temperature during hypothermic cardiopulmonary bypass: I — Canadian survey

Author

Howard J. Nathan and Gilbert Lavallee

Subjects
Adult, Hyperthermia, Canada, medicine.medical_specialty, Tympanic Membrane, Fever, Urinary Bladder, TEMPERATURE ELEVATION, Oxygenators, Brain cooling, Body Temperature, Brain Ischemia, law.invention, Hypothermia, Induced, law, Coronary Circulation, Nasopharynx, medicine, Cardiopulmonary bypass, Humans, Cardiac Surgical Procedures, Rewarming, Brain Diseases, Medical Audit, Cardiopulmonary Bypass, Local practice, business.industry, General Medicine, Blood flow, medicine.disease, Cardiac surgery, Blood, Anesthesiology and Pain Medicine, Anesthesia, Nasopharyngeal temperature, business, Body Temperature Regulation
Abstract

During hypothermic cardiopulmonary bypass (CPB) patients are cooled, usually to between 30-32 degrees C, and, after myocardial blood flow is restored, they are rewarmed with blood heated in the pump-oxygenator. We audited our local practice by recording tympanic and nasopharyngeal temperatures in 11 patients undergoing hypothermic CPB. We found that, during rewarming, nasopharyngeal and tympanic temperatures commonly exceeded 38 degrees C although temperature measured in the bladder was37 degrees C. A survey of cardiac surgery centres in Canada suggested that most centres induce hyperthermia in highly perfused tissues during rewarming, sometimes inadvertently. This may be of some importance because it has become widely appreciated by neuroscientists that mild degrees of brain cooling (2-5 degrees C) are capable of conferring dramatic protection from ischaemic brain injury and, conversely, mild temperature elevation may be markedly deleterious. If control of brain temperature is considered desirable then we would suggest that nasopharyngeal temperature be monitored during rewarming on CPB.

Published
1995
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4. Intercontinental LVAS patient transport

Author

Gilbert Lavallee, John P. Veinot, Akihiko Kawai, Tofy Mussivand, Paul J. Hendry, Michel Haddad, and Roy G. Masters

Subjects
Pulmonary and Respiratory Medicine, Thorax, Adult, Male, Patient Transfer, Cardiac output, medicine.medical_specialty, Bypass grafting, medicine.medical_treatment, Cardiac Output, Low, Myocardial Infarction, Ventricular Dysfunction, Left, Extracorporeal Membrane Oxygenation, Postoperative Complications, Japan, Patient Transport, Renal Dialysis, Medicine, Humans, Myocardial infarction, Coronary Artery Bypass, Heart transplantation, Ontario, Patient Care Team, Thrombocytosis, Intra-Aortic Balloon Pumping, business.industry, Coronary Thrombosis, Acute Kidney Injury, medicine.disease, Surgery, medicine.anatomical_structure, Transportation of Patients, Circulatory system, Aerospace Medicine, Heart Transplantation, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, Artery
Abstract

Mechanical circulatory support is currently indicated for patients with cardiac insufficiency as a bridge to transplantation or as a bridge to recovery. These systems continue to evolve and improve, and many patients (after they are stabilized) are now able to be discharged from the hospital. This article reports our experience with the intercontinental transportation of a patient while being supported with a Novacor left ventricular assist system (WorldHeart Corp, Ottawa, Canada). While in Japan, the Canadian patient suffered a myocardial infarction and despite coronary artery bypass grafting, the patient remained in a low cardiac output state. After implantation of the left ventricular assist system in Japan, the patient was stabilized and transported by a commercial airline to Canada where he underwent successful heart transplantation.

Published
2003

5. Hematologic evaluation of cardiopulmonary bypass circuits prepared with a novel block copolymer

Author

James A. Robblee, Rosalind S. Labow, Marc E Voorhees, Howard J. Nathan, Maura I Watson, Fraser D. Rubens, and Gilbert Lavallee

Subjects
Pulmonary and Respiratory Medicine, Male, Polymers, medicine.medical_treatment, Polyesters, Antithrombin III, Silicones, Biocompatible Materials, Tissue plasminogen activator, law.invention, Platelet preservation, law, Fibrinolysis, medicine, Cardiopulmonary bypass, Humans, Platelet, Derivation, Dimethylpolysiloxanes, Coronary Artery Bypass, Blood Coagulation, Cardiopulmonary Bypass, business.industry, Platelet Count, Thrombin, Middle Aged, Platelet Activation, beta-Thromboglobulin, P-Selectin, medicine.anatomical_structure, Anesthesia, Hemostasis, Tissue Plasminogen Activator, Microscopy, Electron, Scanning, Surgery, Female, Cardiology and Cardiovascular Medicine, business, Filtration, medicine.drug, Artery, Peptide Hydrolases
Abstract

To decrease the complications associated with cardiopulmonary bypass, novel biomaterials have been introduced that may be less thrombogenic than standard synthetic surfaces.Thirty-four patients undergoing coronary artery bypass grafting were randomized to bypass using either a control circuit or a circuit prepared "tip-to-tip" with a triblock-copolymer (polycaprolactone-polydimethylsiloxane-polycaprolactone).There was a progressive increase in thrombin generation in the control group during bypass, which was not seen in the test group. The test surface decreased the release of tissue plasminogen activator and plasmin-alpha2-antiplasmin complex formation (p0.005). There was also an increased platelet count and a decreased platelet activation in the test group, as detected by GMP-140 expression and beta-thromboglobulin release (p = 0.017). There was also significantly more debris that accumulated on the arterial filter in the control group, as confirmed by scanning electron microscopy.This clinical trial has demonstrated a significant difference in the hematologic effects of the test circuits, with evidence of platelet preservation, decreased fibrinolysis, and decreased thrombin generation. A larger trial would be necessary to establish the clinical relevance of these differences.

Published
1999

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