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Effects of pulsatile minimal invasive extracorporeal circulation on fibrinolysis and organ protection in adult cardiac surgery-a prospective randomized trial
- Source :
- Journal of thoracic disease. 11(Suppl 10)
- Publication Year :
- 2019
-
Abstract
- Background: Minimal invasive extracorporeal circulation (MiECC) reduces the impact of cardiopulmonary bypass during cardiac surgery on inflammation and hemostasis. Pulsatile perfusion may enhance organ perfusion and help to prevent renal and neuronal damage. The present study investigated the impact of pulsatile MiECC in low-risk coronary artery bypass grafting (CABG) patients. Methods: CABG patients were prospectively randomized for non-pulsatile (np: n=19) and pulsatile (p: n=21) MiECC. Blood and urine samples were collected at several time points until 72 h post-operative and analyzed for biochemical markers of fibrinolytic capacity, renal damage, and neuronal damage. Results: Although intraoperative tissue plasminogen activator (tPA) levels tended to be higher in the p group, none of the fibrinolysis markers including plasminogen activator inhibitor (PAI-1) and the PAI-1/tPA ratio were significantly affected by pulsation. Hemolysis and markers of renal and neuronal damage were comparable between groups. Intraoperative urinary excretion [np: 400 mL (355 to 680) vs . p: 530 mL (360 to 900)] and cumulative 24 h volume intake [np: 7,090 mL (5,492 to 7,544) vs . p: 7,155 mL (6,682 to 8,710)] were increased by pulsation whereas blood losses up to 12 h post-operative [np: 365 mL (270 to 515) vs . p: 310 mL (225 to 470)] and up to 24 h post-operative [np: 760 mL (555 to 870) vs . p: 520 mL (460 to 670)] were attenuated. Conclusions: The present study did not find evidence for a beneficial effect of pulsation on markers of fibrinolysis, renal damage, and neuronal damage. However, pulsatile perfusion increased intraoperative urinary secretion and reduced post-operative blood losses.
- Subjects :
- Pulmonary and Respiratory Medicine
medicine.medical_specialty
business.industry
medicine.medical_treatment
Extracorporeal circulation
Pulsatile flow
Acute kidney injury
030208 emergency & critical care medicine
030204 cardiovascular system & hematology
medicine.disease
law.invention
03 medical and health sciences
0302 clinical medicine
law
Internal medicine
Hemostasis
Fibrinolysis
medicine
Cardiopulmonary bypass
Cardiology
Original Article
business
Plasminogen activator
Perfusion
Subjects
Details
- ISSN :
- 20721439
- Volume :
- 11
- Issue :
- Suppl 10
- Database :
- OpenAIRE
- Journal :
- Journal of thoracic disease
- Accession number :
- edsair.doi.dedup.....574f486aec4dafdfd3d409423f366094