Skip to main content

Beating Heart Surgery and Pulmonary Ischemia and Reperfusion Injury

  • Chapter
  • First Online:
Principles of Pulmonary Protection in Heart Surgery

Abstract

Much progress has occurred over the past two decades in cardiac surgery. Innovations abound in the clinical arena, with trends toward less-invasive approaches to ischemic and valvular heart disease and further evolution in techniques of heart transplantation. Despite improvements in techniques, early morbidity and mortality remain high in several procedures, mostly related to cardiopulmonary bypass and cardioplegic arrest.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Nolan SP, Zacour R, Dammann JF. Reflections on the evolution of cardiopulmonary bypass. Ann Thorac Surg. 1997;64:1540-1543.

    Article  PubMed  CAS  Google Scholar 

  2. Murphy GJ, Angelini GD. Side effects of cardiopulmonary bypass: what’s the reality? J Card Surg. 2004;19:481-488.

    Article  PubMed  CAS  Google Scholar 

  3. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002;21:232-244.

    Article  PubMed  CAS  Google Scholar 

  4. Chenoweth DE, Cooper SW, Hugli TE, et al. Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylotoxins. N Engl J Med. 1981;304:497-503.

    Article  PubMed  CAS  Google Scholar 

  5. Fischer WH, Jagels MA, Hugli TE. Regulation of IL-6 synthesis in human peripheral blood mononuclear cells by C3a and C3a (desArg). J Immunol. 1999;162:453-459.

    PubMed  CAS  Google Scholar 

  6. Andersen LW, Landow L, Baek L, et al. Association between gastric intramucosal pH and splanchnic endotoxin, antibody to endotoxin, and TNF-α concentration in patients undergoing cardiopulmonary bypass. Crit Care Med. 1993;21:210-217.

    Article  PubMed  CAS  Google Scholar 

  7. Christman JW, Lancaster LH, Blackwell TS. Nuclear factor κ B: a pivotal role in the systemic inflammatory response syndrome and new target for therapy. Intensive Care Med. 1998;24:1131-1138.

    Article  PubMed  CAS  Google Scholar 

  8. Edmunds LH Jr. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 1998;66:S12-S16.

    Article  PubMed  Google Scholar 

  9. Ilton MK, Langton PE, Taylor ML, et al. Differential expression of neutrophil adhesion molecule during coronary artery surgery with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1999;118:930-937.

    Article  PubMed  CAS  Google Scholar 

  10. Jordan JE, Zhao ZQ, Vinten-Johansen J. The role of neutrophils in myocardial ischemia-reperfusion injury. Cardiovasc Res. 1999;43:860-878.

    Article  PubMed  CAS  Google Scholar 

  11. Zahler S, Massoudy P, Hartl H, et al. Acute cardiac inflammatory response to postischemic reperfusion during cardiopulmonary bypass. Cardiovasc Res. 1999;41:722-730.

    Article  PubMed  CAS  Google Scholar 

  12. Wan S, DeSmet JM, Barvais L, et al. Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1996;112:806-811.

    Article  PubMed  CAS  Google Scholar 

  13. Ng CS, Wan S, Yim AP, Arifi AA. Pulmonary dysfunction after cardiac surgery. Chest. 2002;121:1269-1277.

    Article  PubMed  Google Scholar 

  14. Schlensak C, Doenst T, Preusser S, et al. Bronchial artery perfusion during cardiopulmonary bypass does not prevent ischemia of the lung in piglets: assessment of bronchial artery blood flow with fluorescent microspheres. Eur J Cardiothorac Surg. 2001;19:326-331.

    Article  PubMed  CAS  Google Scholar 

  15. Massoudy P, Zahler S, Becker BF, et al. Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest. 2001;119:31-36.

    Article  PubMed  CAS  Google Scholar 

  16. Siepe M, Goebel U, Mecklenburg A, et al. Pulsatile pulmonary perfusion during cardiopulmonary bypass reduces the pulmonary inflammatory response. Ann Thorac Surg. 2008;86:115-122.

    Article  PubMed  Google Scholar 

  17. Magnusson L, Zemgulis V, Tehling A, et al. Use of a vital capacity maneuver to prevent atelectasis after cardiopulmonary bypass. Anesthesiology. 1998;88:134-142.

    Article  PubMed  CAS  Google Scholar 

  18. Friedman M, Sellke FW, Wang SY, et al. Parameters of pulmonary injury after total or partial cardiopulmonary bypass. Circulation. 1994;90:262-268.

    Google Scholar 

  19. Naik SK, Knight A, Elliot M. A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation. 1991;84:III422-III431.

    PubMed  CAS  Google Scholar 

  20. Adams DC, Heyer EJ, Simon AE, et al. Incidence of atrial fibrillation after mild or moderate hypothermic cardiopulmonary bypass. Crit Care Med. 2000;28:309-311.

    Article  PubMed  CAS  Google Scholar 

  21. Le Deist F, Menaché P, Kucharsky C, et al. Hypothermia during cardiopulmonary bypass delays but does not prevent neutrophil-endothelial cell adhesion. A clinical study. Circulation. 1995;92:II354-III358.

    PubMed  Google Scholar 

  22. Mezzetti A, Calafiore AM, Salerno TA, et al. Intermittent antegrade warm cardioplegia reduces oxidative stress and improves metabolism of the ischemic-reperfused human myocardium. J Thorac Cardiovasc Surg. 1995;109:787-795.

    Article  PubMed  CAS  Google Scholar 

  23. Wang J, Liu H, Salerno TA, et al. Does normothermic normokalemic simultaneous antegrade/retrograde perfusion improve myocardial oxygenation and energy metabolism for hypertrophied hearts? Ann Thorac Surg. 2007;83(5):1751-1758.

    Article  PubMed  Google Scholar 

  24. Conroy BP, Lin CY, Jenkins LW, et al. Hypothermic modulation of cerebral ischemic injury during cardiopulmonary bypass in pigs. Anesthesiology. 1998;88:390-402.

    Article  PubMed  CAS  Google Scholar 

  25. Salerno TA, Panos AL, Tian G, et al. Surgery for cardiac valve and aortic root without cardioplegic arrest (“beating heart”): experience with a new method of myocardial perfusion. J Card Surg. 2007;22:459-464.

    Article  PubMed  Google Scholar 

  26. Matsumoto Y, Watanabe G, Endo M, et al. Efficacy and safety of on-pump beating heart surgery for valvular disease. Ann Thorac Surg. 2002;74:678-683.

    Article  PubMed  Google Scholar 

  27. Katircioglu SF, Cicekcioglu F, Tutun U, et al. On-pump beating heart mitral valve surgery without cross-clamping the aorta. J Card Surg. 2008;23:307-311.

    Article  PubMed  Google Scholar 

  28. Ihnken K, Morita K, Buckberg GD, Salerno TA, et al. The safety of simultaneous arterial and coronary sinus perfusion: experimental background and initial clinical results. J Cardiac Surg. 1994;9:15-25.

    Article  CAS  Google Scholar 

  29. Ihnken K, Morita K, Buckberg GD, Salerno TA, et al. Simultaneous arterial and coronary sinus cardioplegic perfusion: an experimental and clinical study. Thorac Cardiovasc Surg. 1994;42(3):141-147.

    Article  PubMed  CAS  Google Scholar 

  30. Wang J, Liu H, Salerno TA, et al. Keeping heart empty and beating improves preservation of hypertrophied hearts for valve surgery. J Thorac Cardiovasc Surg. 2006;132:1314-1320.

    Article  PubMed  CAS  Google Scholar 

  31. Mehlhorn U, Allen SJ, Adams DL, et al. Normothermic continuous antegrade blood cardioplegia does not prevent myocardial edema and cardiac dysfunction. Circulation. 1995;92:1940-1946.

    Article  PubMed  CAS  Google Scholar 

  32. Wan IY, Arifi AA, Wan S, et al. Beating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study. J Thorac Cardiovasc Surg. 2004;127:1624-1631.

    Article  PubMed  Google Scholar 

  33. Dreyer WJ, Philips SC, Lindsey ML, et al. Interleukin-6 induction in the canine myocardium after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2000;120:256-263.

    Article  PubMed  CAS  Google Scholar 

  34. Ivey CL, Williams FM, Collins PD, et al. Neutrophil chemoattractants generated in two phases during reperfusion of ischemic myocardium in the rabbit: evidence for a role for C5a and interleukin-8. J Clin Invest. 1995;95:2720-2728.

    Article  PubMed  CAS  Google Scholar 

  35. Angelini GD, Taylor FC, Barnaby CR, et al. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomized controlled trials. Lancet. 2002;359:1194-1199.

    Article  PubMed  Google Scholar 

  36. Karadeniz U, Erdemli O, Yamak B, et al. On-pump beating heart versus hypothermic arrested heart valve replacement surgery. J Card Surg. 2008;23:107-113.

    Article  PubMed  Google Scholar 

  37. Ricci M, Macedo FI, Suarez MR, et al. Multiple valve surgery with beating heart technique. Ann. Thorac. Surg 2009; 87: 527-31.

    Article  PubMed  Google Scholar 

  38. Macedo FI, Carvalho EM, Hassan M, et al. Beating heart valve surgery in patients with low left ventricular ejection fraction. J. Card. Surg. 2010; 25(3):267–271.

    Article  PubMed  Google Scholar 

  39. Macedo FI, Carvalho EM, Gologorsky E, Salerno T. Lung ventilation/perfusion may reduce pulmonary injury during cardiopulmonary bypass. J. Thorac Cardiovasc Surg. 2010; 139(1): 234-6.

    Article  PubMed  Google Scholar 

  40. Macedo FI, Carvalho EM, Gologorsky E, et al. Gas Exchange during lung perfusion/ventilation during cardiopulmonary bypass: preliminary results of a pilot study. Open Journal of Cardiovascular Surgery 2010; 3:1-7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer London

About this chapter

Cite this chapter

Salerno, T.A., Macedo, F.I.B., Suarez, M.R., Ricci, M., Gologorsky, E. (2010). Beating Heart Surgery and Pulmonary Ischemia and Reperfusion Injury. In: Gabriel, E., Salerno, T. (eds) Principles of Pulmonary Protection in Heart Surgery. Springer, London. https://doi.org/10.1007/978-1-84996-308-4_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-84996-308-4_15

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84996-307-7

  • Online ISBN: 978-1-84996-308-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics