Skip to main content
SpringerLink
Log in

Pathophysiology of Cardiopulmonary Bypass

  • Chapter
Minimally Invasive Cardiac Surgery

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

From the earliest clinical experiences with cardiopulmonary bypass (CPB) for cardiac operations, it was apparent that significant morbidity and even mortality were associated with the CPB procedure itself (1). Often, only the contact of blood to the foreign material of the extracorporeal circuit was held responsible. However, cardiopulmonary bypass implies more than just connecting the circulation of the patient to an extracorporeal circuit, resulting in the material-dependent activation of blood. With cardiopulmonary bypass, a number of other nonphysiological events are introduced, including hemodilution, hypothermia, nonpulsatile blood flow, retransfusion of shed blood, and exclusion of the metabolic function of the lung resulting in material-independent activation. Together, these events cause the massive and systemic activation of the patient’ s defense mechanisms, with repercussions on nearly every end-organ system. Signs of this “whole-body inflammatory reaction” can be observed in every postoperative patient. In a number of patients, especially neonates, the elderly, and those undergoing large procedures or those with severe comorbidities, this phenomenon can escalate into the so-called postperfusion syndrome, which is characterized by elevated cardiac output with decreased vascular resistance, capillary leak, and renal function impairment, a constellation of factors that is associated with increased mortality (2).

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
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

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Kirklin JW. Open-heart surgery at the Mayo Clinic: the 25th anniversary. Mayo Clin Proc 1980; 55: 339–341.

    PubMed  CAS  Google Scholar 

  2. Westaby S. Organ dysfunction after cardiopulmonary bypass. A systemic inflammatory reaction initiated by the extracorporeal circuit. Intensive Care Med 1987; 13: 89–95.

    Article  PubMed  CAS  Google Scholar 

  3. Edmunds LH Jr. Blood-surface interactions during cardiopulmonary bypass. J Card Surg 1993; 8: 404–410.

    Article  PubMed  Google Scholar 

  4. Wachtfogel YT, Harpel PC, Edmunds LH Jr, Colman RW. Formation of C 1 s-C1-inhibitor, kallikreinC 1-inhibitor and plasmin-alpha 2-plasmin-inhibitor complexes during cardiopulmonary bypass. Blood 1989; 73: 468–471.

    PubMed  CAS  Google Scholar 

  5. Burman JF, Chung HI, Lane DA, Philippou H, Adami A, Lincoln JC. Role of factor XII in thrombin generation and fibrinolysis during cardiopulmonary bypass. Lancet 1994; 344: 1192–1193.

    Article  PubMed  CAS  Google Scholar 

  6. Moorman RM, Reynolds DS, Communale ME. Management of cardiopulmonary bypass in a patient with congenital factor XII deficiency. J Cardiothorac Vasc Anesth 1993; 7: 452–454.

    Article  PubMed  CAS  Google Scholar 

  7. to Velthuis H, Baufreton C, Jansen PG, et al. Heparin coating of extracorporeal circuits inhibits contact activation during cardiac operations. J Thorac Cardiovasc Surg 1997; 114: 117–122.

    Article  Google Scholar 

  8. Boisclair MD, Lane DA, Philippou H, et al. Mechanisms of thrombin generation during cardiopulmonary bypass. Blood 1993; 82: 3350–3357.

    PubMed  CAS  Google Scholar 

  9. Philippou H, Adami A, Boisclair MD, Lane DA. An ELISA for factor X activation peptide: application to the investigation of thrombogenesis in cardiopulmonary bypass. Br J Haematol 1995; 90: 432–437.

    Article  PubMed  CAS  Google Scholar 

  10. Kazatchkine MD, Nydegger UE. The human alternative pathway. Biology and immunopathology of activation and regulation. Prog Allergy 1982; 30: 193–234.

    PubMed  CAS  Google Scholar 

  11. Müller-Eberhard HJ. Complement: Chemistry and pathways. In Gallin JI, Goldstein IM, Snyderman R. Inflammation: Basic Principles and Clinical Correlates. New York: Raven Press, 1988: 21–54.

    Google Scholar 

  12. Chenoweth DE, Cooper SW, Hugli TE, Stewart RW, Blackstone EH, Kirklin JW. Complement activation during cardiopulmonary bypass. N Engl J Med 1981; 304: 497–503.

    Article  PubMed  CAS  Google Scholar 

  13. Parker DJ, Cantrell JW, Karp RB, Stroud RM, Digerness SB. Changes in serum complement and immunoglobins following cardiopulmonary bypass. Surgery 1972; 71: 824–827.

    PubMed  CAS  Google Scholar 

  14. Videm V, Fosse E, Mollnes TE, Garred P, Svennevig JL. Complement activation with bubble and membrane oxygenators in aortocoronary bypass grafting. Ann Thorac Surg 1990; 50: 387–391.

    Article  PubMed  CAS  Google Scholar 

  15. Videm V, Mollnes TE. Human complement activation by polygeline and dextran 70. Scand J Immunol 1994; 39: 314–320.

    Article  PubMed  CAS  Google Scholar 

  16. Cooper NR. The classical complement pathway: activation and regulation of the first complement component. Adv Immunol 1985; 37: 151–216.

    Article  PubMed  CAS  Google Scholar 

  17. Loos M, Wellek B, Thesen R, Opferkuch W. Antibody-independent interaction of the first component of complement with gram-negative bacteria. Infect Immun 1978; 22: 5–9.

    PubMed  CAS  Google Scholar 

  18. Fehr J, Rohr H. In vivo complement activation by polyanion-polycation complexes: Evidence that C5a is generated intravascularly during heparin-protamine interaction. Clin Immunol 1983; 29: 7–14.

    CAS  Google Scholar 

  19. Kirklin JK, Chenoweth DE, Naftel DC, et al. Effects of protamine administration after cardiopulmonary bypass on complement, blood elements, and the hemodynamic state. Ann Thorac Surg 1986; 41: 193–199.

    Article  PubMed  CAS  Google Scholar 

  20. Salama A, Hugo F, Heinrich D, et al. Deposition of terminal C5b-9 complement complexes on erythrocytes and leukocytes during cardiopulmonary bypass. N Engl J Med 1988; 318: 408–414.

    Article  PubMed  CAS  Google Scholar 

  21. Schreurs HH, Wijers MJ, Gu YJ, et al. Heparin coated bypass circuits: effects on inflammatory response in paediatric cardiac surgery. Ann Thorac Surg 1998; 66: 166–171.

    Article  PubMed  CAS  Google Scholar 

  22. Hugli TE, Müller-Eberhard HJ. Anaphylatoxins C3a and C5a: Adv Immunol 1978; 26: 1–53.

    Article  PubMed  CAS  Google Scholar 

  23. Charo IF, Yuen C, Perez HD, Goldstein IM. Chemotactic peptides modulate adherence of human polymorphonuclear leukocytes to monolayers to monolayers of cultured endothelial cells. J Immunol 1986; 136: 3412–3419.

    PubMed  CAS  Google Scholar 

  24. Tonnesen MG, Smedly LA, Henson PM. Neutrophil-endothelial cell interactions. J Clin Invest 1984; 74: 1581–1592.

    Article  PubMed  CAS  Google Scholar 

  25. Bender JG, van Epps DE. Stimulus interactions in release of superoxide anion (02) from human neutrophils. Inflammation 1985; 9: 67–86.

    Article  PubMed  CAS  Google Scholar 

  26. Bender JG, Mc Phail LC, van Epps DE. Exposure of human neutrophils to chemotactic factors potentiates activation of the respiratory burst enzyme. J Immunol 1983; 130: 2316–2323.

    PubMed  CAS  Google Scholar 

  27. Henson PM, Zanolari B, Schwartzman NA, Hong SR. Intracellular control of human neutrophil secretion. I. C5a-induced stimulus-specific desensitisation and the effects of cytochalasin B. J Immunol 1978; 121: 851–855.

    PubMed  CAS  Google Scholar 

  28. Clancy RM, Dahinden CA, Hugli TE. Arachidonate metabolism by human polymorphonuclear leukocytes stimulated by N-formyl-Met-Leu-Phe or complement component C5a is independent of phospholipase activation. Proc Natl Acad Sci USA 1983; 80: 7200–7204.

    Article  PubMed  CAS  Google Scholar 

  29. Palmer RMJ, Salmon JA. Release of leukotriene B4 from human neutrophils and its relationship to degranulation induced by n-formyl-methionyl-leucyl-phenylalanine, serum-treated zymosan and the ionophore A23187. Immunology 1983; 50: 65–73.

    PubMed  CAS  Google Scholar 

  30. Cochrane CG, Spragg RG, Revak SD. Studies on the pathogenesis of the adult respiratory distress syndrome: evidence of oxidants in the broncheoalveolar lavage fluid. J Clin Invest 1983; 71: 754–761.

    Article  PubMed  CAS  Google Scholar 

  31. Royston D, Minty BD, Higenbottam TW, Wallwork J, Jones GJ. The effect of surgery with cardiopulmonary bypass on alveolar-capillary barrier function in human beings. Ann Thorac Surg 1985; 40: 139–143.

    Article  PubMed  CAS  Google Scholar 

  32. Rinaldo JE, Rogers RM. Adult respiratory distress syndrome. Changing concepts of lung injury and repair. N Engl J Med 1982; 306: 900–909.

    Article  PubMed  CAS  Google Scholar 

  33. Dinarello CA. Interleukin-1. Rev Infect Dis 1984; 6: 51–95.

    Article  PubMed  CAS  Google Scholar 

  34. Smith RJ, Speziale SC, Bowman BJ. Properties of interleukin-1 as a complete secretagogue for human neutrophils. Biochem Biophys Res Commun 1982; 130: 1233–1240.

    Article  Google Scholar 

  35. Mizel SB. Interleukin 1 and T cell activation. Immunol Rev 1982; 63: 51–72.

    Article  PubMed  CAS  Google Scholar 

  36. Falkoff RJM, Muraguchi A, Hong JX, Buttler JL, Dinarello CA, Fanci AS. The effects of interleukin 1 on human B cell activation and proliferation. J Immunol 1983; 131: 801–805.

    PubMed  CAS  Google Scholar 

  37. Old LJ. Tumor necrosis factor (TNF). Science 1985; 230: 630–632.

    Article  PubMed  CAS  Google Scholar 

  38. Dinarello CA, Cannon JG, Wolff SM, et al. Tumor necrosis factor (cachectin) is an endogenous pyrogen and induces production of interleukin 1. J Exp Med 1986; 163: 1433–1450.

    Article  PubMed  CAS  Google Scholar 

  39. Nawroth PP, Stern D. Modulation of endothelial cell hemostatic properties by tumor necrosis factor. J Exp Med 1986; 164: 740–745.

    Article  Google Scholar 

  40. Nawroth PP, Bank I, Handley D, Cassimeris J, Chess L, Stern D. Tumor necrosis factor/cachectin interacts with endothelial cell receptors to induce release of interleukin 1. J Exp Med 1986; 163: 1363–1375.

    Article  PubMed  CAS  Google Scholar 

  41. Jansen NJ, van Oeveren W, van de Broek L, et al. Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass. J Thorac Cardiovasc Surg 1991; 102: 515–525.

    PubMed  CAS  Google Scholar 

  42. Jansen NJ, van Oeveren W, Gu YJ, van Vliet MH, Eijsman L, Wildevuur CR. Endotoxin release and tumor necrosis factor formation during cardiopulmonary bypass. Ann Thorac Surg 1992; 54: 744–748.

    Article  PubMed  CAS  Google Scholar 

  43. Fransen E, Maessen J, Dentener M, Senden N, Geskes G, Buurman W. Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest 1998; 113: 1290–1295.

    Article  PubMed  CAS  Google Scholar 

  44. Schulze C, Conrad N, Schutz A, et al. Reduced expression of systemic proinflammatory cytokines after off-pump versus conventional coronary artery bypass grafting. Thorac Cardiovasc Surg 2000; 48: 364–369.

    Article  PubMed  CAS  Google Scholar 

  45. Wan S, Marchant A, DeSmet JM, et al. Human cytokine responses to cardiac transplantation and coronary artery bypass grafting. J Thorac Cardiovasc Surg 1996; 111: 469–477.

    Article  PubMed  CAS  Google Scholar 

  46. Butler J, Chong GL, Baigrie RJ, Pillai R, Westaby S, Rocker GM. Cytokine responses to cardiopulmonary bypass with membrane and bubble oxygenation. Ann Thorac Surg 1992; 53: 833–838.

    Article  PubMed  CAS  Google Scholar 

  47. Kukielka GL, Smith CW, Manning AM, Youker KA, Michael LH, Entman ML. Induction of interleukin-6 synthesis in the myocardium. Potential role in postreperfusion inflammatory injury. Circulation 1995; 92: 1866–1875.

    Article  PubMed  CAS  Google Scholar 

  48. Jorens PG, de Jongh R, de Backer W, et al. Interleukin-8 production in patients undergoing cardiopulmonary bypass. The influence of pre-treatment with methylprednisolone. Am Rev Respir Dis 1993; 148: 890–895.

    Article  PubMed  CAS  Google Scholar 

  49. Ivey CL, Williams FW, Collins PD, Jose PJ, Williams TJ. 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 

  50. Gearing AJH, Newman W. Circulating adhesion molecules in disease. Immunol Today 1993; 14: 506–512.

    Article  PubMed  CAS  Google Scholar 

  51. Gu YJ, van Oeveren W, Boonstra PW, de Haan J, Wildevuur CR. Leukocyte activation with increased membrane expression of CR3 receptors induced by cardiopulmonary bypass. Ann Thorac Surg 1992; 53: 839–844.

    Article  PubMed  CAS  Google Scholar 

  52. Gillinov AM, Bator JM, Zehr KJ, et al. Neutrophil adhesion molecule expression during cardiopulmonary bypass with bubble and membrane oxygenators. Ann Thorac Surg 1993; 56: 847–853.

    Article  PubMed  CAS  Google Scholar 

  53. Arnaout MA, Hakim RM, Todd RF III, Dana N, Colten HR. Increased expression of an adhesion-promoting surface glycoprotein in the granulocytopenia of hemodialysis. N Engl J Med 1985; 312: 457–462.

    Article  PubMed  CAS  Google Scholar 

  54. Etzioni A. Adhesion molecules-their role in health and disease. Pediatr Res 1996; 39: 191–198.

    Article  PubMed  CAS  Google Scholar 

  55. Dreyer WJ, Michael LH, Millman EE, Berens KL. Neutrophil activation and adhesion molecule expression in a canine model of open heart surgery with cardiopulmonary bypass. Cardiovasc Res 1995; 29: 775–781.

    PubMed  CAS  Google Scholar 

  56. van Oeveren W, Eijsman L, Roozendaal KJ, Wildevuur CR. Platelet preservation by aprotinin during cardiopulmonary bypass. Lancet 1988; 19: 644.

    Article  Google Scholar 

  57. Moncada S, Higgs A. The L-arginine-nitric oxide pathway. N Engl J Med 1993; 329: 2002–2012.

    Article  PubMed  CAS  Google Scholar 

  58. Speziale G, Ruvolo G, Marino B. A role for nitric oxide in the vasoplegic syndrome. J Card Surg (Torino) 1996; 37: 301–303.

    CAS  Google Scholar 

  59. Finkel MS, Oddis CV, Jacob TD, et al. Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science 1992; 257: 387–389.

    Article  PubMed  CAS  Google Scholar 

  60. Alican I, Kubes P. A critical role for nitric oxide in intestinal barrier function and dysfunction. Am J Physiol 1996; 270: G225 - G237.

    PubMed  CAS  Google Scholar 

  61. Yanagisawa M, Kurihara H, Kimura S, et al. A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Nature 1988; 332: 411–415.

    Article  PubMed  CAS  Google Scholar 

  62. Yoshizawa T, Osamu S, Giaid A, et al. Endothelin, a novel peptide in the posterior pituitary system. Science 1989; 247: 462–464.

    Article  Google Scholar 

  63. to Velthuis H, Jansen PG, Oudemans-van Straaten HM, et al. Circulating endothelin in cardiac operations: influence of blood pressure and endotoxin. Ann Thorac Surg 1996; 61: 904–908.

    Article  Google Scholar 

  64. Dorman BH, Bond BR, Clair MJ, et al. Temporal synthesis and release of endothelin within the systemic and myocardial circulation during and after cardiopulmonary bypass: relation to postoperative recovery. J Cardiothorac Vasc Anesth 2000; 14: 540–545.

    Article  PubMed  CAS  Google Scholar 

  65. Kirshbom PM, Tsui SS, Di Bernardo LR, et al. Blockade of endothelin-converting enzyme reduces pulmonary hypertension after cardiopulmonary bypass and circulatory arrest. Surgery 1995; 118: 440–444.

    Article  PubMed  CAS  Google Scholar 

  66. Matheis G, Haak T, Beyersdorf F, Baretti R, Polywka C, Winkelmann BR. Circulating endothelin in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg 1995; 9: 269–274.

    Article  PubMed  CAS  Google Scholar 

  67. Nakamura H, Kim DK, Philbin DM, et al. Heparin-enhanced plasma phospholipase A2 activity and prostacyclin synthesis in patients undergoing cardiac surgery. J Clin Invest 1995; 95: 1062–1070.

    Article  PubMed  CAS  Google Scholar 

  68. Tabuchi N, Gallandat Huet RC, Sturk A, Eijsman L, Wildevuur CR. Aprotinin effects on aspirin treated platelets and hemostasis during cardiopulmonary bypass. Ann Thorac Surg 1994; 58: 1036–1039.

    Article  PubMed  CAS  Google Scholar 

  69. Suhara H, Sawa Y, Nishimura M, Oshiyama H, Yokoyama K, Saito N, Matsuda H. Efficacy of a new coating material, PMEA, for cardiopulmonary bypass circuits in a porcine model. Ann Thorac Surg 2001; 71: 1603–1608.

    Article  PubMed  CAS  Google Scholar 

  70. Wimmer-Greinecker G, Matheis G, Martens S, Oremek G, Abdel-Rahman U, Moritz A. Synthetic protein treated versus heparin coated cardiopulmonary bypass surfaces: similar clinical results and minor biochemical differences. Eur J Cardiothorac Surg 1999; 16: 211–217.

    Article  PubMed  CAS  Google Scholar 

  71. De Somer F, Francois K, van Oeveren W, et al. Phosphorylcholine coating of extracorporeal circuits provides natural protection against blood activation by the material surface. Eur J Cardiothorac Surg 200; 18: 602–606.

    Google Scholar 

  72. Videm V, Svennevig JL, Fosse E, Semb G, Osterud A, Mollnes TE. Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations. J Thorac Cardiovasc Surg 1992; 103: 806–813.

    PubMed  CAS  Google Scholar 

  73. Ovrum E, Mollnes TE, Fosse E, et al. Complement and granulocyte activation in two different types of heparinized extracorporeal circuits. J Thorac Cardiovasc Surg 1995; 110: 1623–1632.

    Article  PubMed  CAS  Google Scholar 

  74. Lundblad R, Moen O, Fosse E. Endothelin-1 and neutrophil activation during heparin-coated cardiopulmonary bypass. Ann Thorac Surg 1997; 63: 1361–1367.

    Article  PubMed  CAS  Google Scholar 

  75. Moen O, Fosse E, Brockmeier V, et al. Disparity in blood activation by two different heparin-coated cardiopulmonary bypass systems. Ann Thorac Surg 1995; 60: 1317–1323.

    Article  PubMed  CAS  Google Scholar 

  76. Steinberg BM, Grossi EA, Schwartz DS, et al. Heparin bonding of bypass circuits reduces cytokine release during cardiopulmonary bypass. Ann Thorac Surg 1995; 60: 525–529.

    Article  PubMed  CAS  Google Scholar 

  77. Weerwind PW, Maessen JG, van Tits LJ, et al. Influence of Duraflo II heparin-treated extracorporeal circuits on the systemic inflammatory response in patients having coronary bypass. J Thorac Cardiovas Surg 1995; 110: 1633–1641.

    Article  CAS  Google Scholar 

  78. Bozdayi M, Borowiec J, Nilsson L, Venge P, Thelin S, Hansson HE. Effects of heparin-coating of cardiopulmonary bypass circuits on in vitro oxygen free radical production during coronary bypass surgery. Artif Organs 1996; 20: 1008–1016.

    Article  PubMed  CAS  Google Scholar 

  79. Moen O, Hogasen K, Fosse E, et al. Attenuation of changes in leukocyte surface markers and complement activation with heparin-coated cardiopulmonary bypass. Ann Thorac Surg 1997; 63: 105–111.

    Article  PubMed  CAS  Google Scholar 

  80. Fukutomi M, Kobayashi S, Niwaya K, Hamada Y, Kitamura S. Changes in platelet, granulocyte and complement activation during cardiopulmonary bypass using heparin-coated equipment. Artif Organs 1996; 20: 767–776.

    Article  PubMed  CAS  Google Scholar 

  81. Gu YJ, van Oeveren W, Akkerman C, Boonstra PW, Huyzen RJ, Wildevuur CR. Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993; 55: 917–922.

    Article  PubMed  CAS  Google Scholar 

  82. to Velthuis H, Jansen PGM, Hack CE, Eijsman L, Wildevuur CR. Specific complement inhibition by heparin-coated extracorporeal circuits. Ann Thorac Surg 1996; 61: 1153–1157.

    Article  Google Scholar 

  83. van der Kamp KW, van Oeveren W. Contact, coagulation and platelet interaction with heparin treated equipment during heart surgery. Int J Artif Organs 1993; 16: 836–842.

    PubMed  Google Scholar 

  84. Gorman RC, Ziats N, Rao AK, et al. Surface-bound heparin fails to reduce thrombin formation during clinical cardiopulmonary bypass. J Thorac Cardiovasc Surg 1996; 111: 1–12.

    Article  PubMed  CAS  Google Scholar 

  85. Ovrum E, Brosstad F, Am Holen E, Tangen G, Abdelnoor M. Effects on coagulation and fibrinolysis with reduced versus full heparinization and heparin coated cardiopulmonary bypass. Circulation 1995; 92: 2579–2584.

    Article  PubMed  CAS  Google Scholar 

  86. von Segesser LK, Weiss BM, Garcia E, von Felten A, Turina MI. Reduction and elimination of systemic heparinization during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1992; 103: 790–799.

    Google Scholar 

  87. Ovrum E, Holen EA, Tangen G, et al. Completely heparinized cardiopulmonary bypass and reduced systemic heparin: clinical and hemostatic effects. Ann Thorac Surg 1995; 60: 365–371.

    Article  PubMed  CAS  Google Scholar 

  88. Edmunds LH Jr. Surface-bound heparin; panacea or peril? Ann Thorac Surg 1994; 85: 285–286.

    Article  Google Scholar 

  89. Ranucci M, Cirri S, Conti D, et al. Beneficial effects of Duraflo II heparin-coated circuits on post-perfusion lung dysfunction. Ann Thorac Surg 1996 61: 76–81.

    Article  PubMed  CAS  Google Scholar 

  90. Jansen PG, to Velthuis H, Huybrechts RA, et al. Reduced complement activation and improved postoperative performance after cardiopulmonary bypass with heparin-coated circuits. J Thorac Cardiovasc Surg 1995; 110: 829–834.

    Article  PubMed  CAS  Google Scholar 

  91. Jansen PG, Baufreton C, Le Besnerais P, Loisance DY, Wildevuur ChRH. Heparin-coated circuits and aprotinin prime for coronary artery bypass grafting. Ann Thorac Surg 1996; 61: 1363–1366.

    Article  PubMed  CAS  Google Scholar 

  92. Baufreton C, Le Besnerais P, Jansen P, et al. Clinical outcome after coronary surgery with heparin-coated extracorporeal circuits for cardiopulmonary bypass. Perfusion 1996; 11: 437–443.

    Article  PubMed  CAS  Google Scholar 

  93. Wildevuur CR, Jansen PG, Bezemer PD, et al. Clinical evaluation of Duraflo II treated extracorporeal circuits (2nd version). The European Working Group on heparin coated extracorporeal circulation circuits. Eur J Cardiothorac Surg 1997; 11: 616–623.

    Article  PubMed  CAS  Google Scholar 

  94. Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs 1985; 29: 236–261.

    Article  PubMed  CAS  Google Scholar 

  95. van Oeveren W, Jansen NJ, Bidstrup BP, et al. Effects of aprotinin on hemostatic mechanisms during cardiopulmonary bypass. Ann Thorac Surg 1987; 44: 640–645.

    Article  PubMed  Google Scholar 

  96. Wildevuur CR, Eijsman L, Roozendaal KJ, Harder MP, Chang MP, van Oeveren W. Platelet preservation during cardiopulmonary bypass with aprotinin. Eur J Cardiothor Surg 1989; 3: 533–538.

    Article  CAS  Google Scholar 

  97. van Oeveren W, Harder MP, Roozendaal KJ, Eijsman L, Wildevuur CR. Aprotinin protects platelets against the initial effect of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1990; 99: 788–797.

    PubMed  Google Scholar 

  98. Speekenbrink RG, Wildevuur CR, Sturk A, Eijsman L. Low-dose and high-dose aprotinin improve hemostasis in coronary surgery. J Thorac Cardiovasc Surg 1996; 112: 523–530.

    Article  PubMed  CAS  Google Scholar 

  99. Tatar H, Cicek S, Demirkilic U, et al. Topical use of aprotinin in open heart operations. Ann Thorac Surg 1993; 55: 659–661.

    Article  PubMed  CAS  Google Scholar 

  100. Speekenbrink RG, Vonk AB, Wildevuur CR, Eijsman L. Hemostatic efficacy of dipyridamole, tranexamic acid and aprotinin in coronary bypass grafting. Ann Thorac Surg 1995; 59: 438–442.

    Article  PubMed  CAS  Google Scholar 

  101. Maquelin KN, Nieuwland R, Lentjes EG, et al. Aprotinin administration in the pericardial cavity does not prevent platelet activation. J Thorac Cardiovasc Surg 2000: 120: 552–557.

    Article  PubMed  CAS  Google Scholar 

  102. Horrow JC, Hlavacek J, Strong MD, et al. Prophylactic tranexamic acid decreases bleeding after cardiac operations. J Thorac Cardiovasc Surg 1990; 99: 70–74.

    PubMed  CAS  Google Scholar 

  103. John LC, Rees GM, Kovacs IB. Reduction of heparin binding to and inhibition of platelets by aprotinin. Ann Thorac Surg 1993; 55: 1175–1179.

    Article  PubMed  CAS  Google Scholar 

  104. Wachtfogel YT, Kucich U, Hack CE, et al. Aprotinin inhibits the contact, neutrophil, and platelet activation systems during simulated extracorporeal perfusion. J Thorac Cardiovasc Surg 1993; 106: 1–10.

    PubMed  CAS  Google Scholar 

  105. Asimakopoulos G, Lidington EA, Mason J, Haskard DO, Taylor KM, Landis RC. Effect of aprotinin on endothelial cell activation. J Thorac Cardiovasc Surg 2001; 122: 123–128.

    Article  PubMed  CAS  Google Scholar 

  106. Asimakopoulos G, Taylor K1VI, Haskard DO, Landis RC. Inhibition of neutrophil L-selectin shedding: a potential anti-inflammatory effect of aprotinin. Perfusion 2000; 15: 495–499.

    Article  PubMed  CAS  Google Scholar 

  107. Asimakopoulos G, Thompson R, Nourshargh S, et al. An anti-inflammatory property of aprotinin detected at the level of leukocyte extravasation. J Thorac Cardiovasc Surg 2000; 120: 361–369.

    Article  PubMed  CAS  Google Scholar 

  108. Hill GE, Taylor JA, Robbins RA. Differing effects of aprotinin and e-aminocaproic acid on cytokine-induced inducible nitric oxide synthase expression. Ann Thorac Surg 1997; 63: 74–77.

    Article  PubMed  CAS  Google Scholar 

  109. Hill GE, Springal DR, Robbins RA. Aprotinin is associated with a decrease in nitric oxide production during cardiopulmonary bypass. Surgery 1997; 121: 449–455.

    Article  PubMed  CAS  Google Scholar 

  110. Hill GE, Alonso A, Spurzem JR, Stammers AH, Robbins RA. Aprotinin and methylprednisolone equally blunt cardiopulmonary bypass-induced inflammation in humans. J Thorac Cardiovasc Surg 1995; 110: 1658–1662.

    Article  PubMed  CAS  Google Scholar 

  111. Asimakopoulos G, Kohn A, Stefanou DC, Haskard DO, Landis RC, Taylor KM. Leukocyte integrin expression in patients undergoing cardiopulmonary bypass. Ann Thorac Surg 2000; 69: 1192–1197.

    Article  PubMed  CAS  Google Scholar 

  112. Alonso A, Whitten CW, Hill GE. Pump prime only aprotinin inhibits cardiopulmonary bypass-induced neutrophil CD11b up-regulation. Ann Thorac Surg 1999; 67: 392–395.

    Article  PubMed  CAS  Google Scholar 

  113. Isbir CS, Dogan R, Demircin M, Yaylim I, Pasaoglu I. Aprotinin reduces the IL-8 after coronary artery bypass grafting. Cardiovasc Surg 2001; 9: 403–406.

    Article  PubMed  CAS  Google Scholar 

  114. Tassani P, Augustin N, Barankay A, Braun SL, Zaccaria F, Richter JA. High-dose aprotinin modulates the balance between proinflammatory and anti-inflammatory responses during coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2000; 14: 682–686.

    Article  PubMed  CAS  Google Scholar 

  115. Hill GE, Pohorecki R, Alonso A, Rennard SI, Robbins RA. Aprotinin reduces interleukin-8 production and neutrophil accumulation after cardiopulmonary bypass. Anesth Analg 1996; 83: 696–700.

    PubMed  CAS  Google Scholar 

  116. Rahman A, Ustunda B, Burma O, Ozercan IH, Cekirdekci A, Bayar MK. Does aprotinin reduce lung reperfusion damage after cardiopulmonary bypass? Eur J Cardiothorac Surg 2000; 18: 583–588.

    Article  PubMed  CAS  Google Scholar 

  117. Rich JB. The efficacy and safety of aprotinin use in cardiac surgery. Ann Thorac Surg 199; 66: S6 - S11.

    Google Scholar 

  118. van Oeveren W, van Oeveren B, Wildevuur CR. Anticoagulation policy during use of aprotinin in cardiopulmonary bypass. J Thorac Cardiovasc Surg 1992; 104: 210–211.

    PubMed  Google Scholar 

  119. Feindt P, Seyfert U, Volkmar I, Huwer H, Kalweit G, Gams E. Is there a phase of hypercoagulability when aprotinin is used in cardiac surgery? Eur J Cardiothor Surg 1994; 8: 308–314.

    Article  CAS  Google Scholar 

  120. Bidstrup BP, Underwood SR, Sapsford RN. Effect of aprotinin (Trasylol) on aorta-coronary bypass graft patency. J Thorac Cardiovasc Surg 1993; 105: 147–153.

    PubMed  CAS  Google Scholar 

  121. Westaby S. Aprotinin in perspective. Ann Thorac Surg 1993; 55: 1033–1041.

    Article  PubMed  CAS  Google Scholar 

  122. Speekenbrink RG, Bertina RM, Espana F, Wildevuur CR, Eijsman L. Activation of the protein C anticoagulant system during cardiopulmonary bypass and the influence of aprotinin. Ann Thorac Surg 1998; 66: 1998–2002.

    Article  PubMed  CAS  Google Scholar 

  123. Weiler JM, Packard B. Methylprednisolone inhibits the alternative and amplification pathways of complement. Infect Immun 1982; 38: 122–126.

    PubMed  CAS  Google Scholar 

  124. Boscoe MJ, Yewdall VM, Thompson MA, Cameron JS. Complement activation during cardiopulmonary bypass: quantitative study of effects of methylprednisolone and pulsatile flow. Br Med J (Clin Res Ed) 1983; 287: 1747–1750.

    Article  CAS  Google Scholar 

  125. Jansen NJ, van Oeveren W, van Vliet M, Stoutenbeek CP, Eijsman L, Wildevuur CR. The role of different types of corticosteroids on the inflammatory mediators in cardiopulmonary bypass. Eur J Cardiothorac Surg 1991; 5: 211–217.

    Article  PubMed  CAS  Google Scholar 

  126. Hill GE, Snider S, Galbraith TA, Forst S, Robbins RA. Glucocorticoid reduction of bronchial epithelial inflammation during cardiopulmonary bypass. Am J Respir Crit Care Med 1995; 152: 1791–1795.

    PubMed  CAS  Google Scholar 

  127. Kawamura T, Inada K, Okada H, Okada K, Wakusawa R. Methylprednisolone inhibits increase of interleukin 8 and 6 during open heart surgery. Can J Anaesth 1995; 42: 399–403.

    Article  PubMed  CAS  Google Scholar 

  128. Teoh KH, Bradley CA, Gauldie J, Burrows H. Steroid inhibition of cytokine-mediated vasodilation after warm heart surgery. Circulation 1995; 92: 347–353.

    Article  Google Scholar 

  129. Tabardel Y, Duchateau J, Schmartz D, et al. Corticosteroids increase blood interleukin-10 levels during cardiopulmonary bypass in men. Surgery 1996; 119: 76–80.

    Article  PubMed  CAS  Google Scholar 

  130. Tassani P, Richter JA, Barankay A, et al. Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures? J Cardiothorac Vasc Anesth 1999; 13: 165–172.

    Article  PubMed  CAS  Google Scholar 

  131. Hill GE, Alonso A, Thiele GM, Robbins RA. Glucocorticoids blunt neutrophil CD11b surface glycoprotein upregulation during cardiopulmonary bypass in humans. Anesth Analg 1994; 79: 23–27.

    Article  PubMed  CAS  Google Scholar 

  132. Cronstein BN, Kimmel SC, Levin RI, Martiniuk F, Weissman G. A mechanism for the anti-inflammatory effects of corticosteroids: the glucocorticoid receptor regulates leukocyte adhesion to endothelial cells and expression of endothelial-leukocyte adhesion molecule 1 and intercellular adhesion molecule 1. Proc Natl Acad Sci USA 1992; 89: 9991–9995.

    Article  PubMed  CAS  Google Scholar 

  133. Busuttil RW, George WJ, Hewitt RL. Protective effect of methylprednisolone on the heart during ischemic arrest. J Thorac Cardiovasc Surg 1975; 70: 955–965.

    PubMed  CAS  Google Scholar 

  134. Hill DG, Aguilar MJ, Kosek JC, Hill JD. Corticosteroids and prevention of pulmonary damage following cardiopulmonary bypass in puppies. Ann Thorac Surg 1976; 22: 36

    Article  PubMed  CAS  Google Scholar 

  135. Tabuchi N, de Haan J, Boonstra PW, van Oeveren W. Activation of fibrinolytis in the pericardial cavity during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993; 106: 828–833.

    PubMed  CAS  Google Scholar 

  136. Nieuwland R, Berckmans RJ, Rotteveel-Eijkman RC, et al. Cell-derived microparticles generated in patients during cardiopulmonary bypass are highly procoagulant. Circulation 1997; 96: 3534–3541.

    Article  PubMed  CAS  Google Scholar 

  137. Philippou H, Adami A, Davidson SJ, Pepper JR, Burman JF, Lane DA. Tissue factor is rapidly elevated in plasma collected from the pericardial cavity during cardiopulmonary bypass. Thromb Haemost 2000; 84: 124–128.

    PubMed  CAS  Google Scholar 

  138. Chung JH, Gikakis N, Rao AK, Drake TA, Colman RW, Edmunds LH Jr. Pericardial blood activates the extrinsic coagulation pathway during clinical cardiopulmonary bypass. Circulation 1996; 93: 2014–2018.

    Article  PubMed  CAS  Google Scholar 

  139. van Hinsbergh VW, Kooistra T, Scheffer MA, van Bockel JH, van Muijen GN. Characterization and fibrinolytic properties of human omental tissue mesothelial cells. Comparison with endothelial cells. Blood 1990; 75: 1490–1497.

    Google Scholar 

  140. Adelman B, Michelson AD, Loscalzo J, Greenberg J, Handin RI. Plasmin effect on platelet glycoprotein Ib-von Willebrand’s factor interaction. Blood 1985; 65: 32–40.

    PubMed  CAS  Google Scholar 

  141. Coller BS. Platelet and thrombolytic therapy. N Engl J Med 1990; 99: 518–527.

    Google Scholar 

  142. de Haan J, Boonstra PW, Monnink SH, Ebels T, van Oeveren W. Retransfusion of suctioned blood during cardiopulmonary bypass impairs hemostasis. Ann Thorac Surg 1995; 59: 901–907.

    Article  PubMed  Google Scholar 

  143. Schönberger JP, van Oeveren W, Bredee JJ, Everts PA, de Haan J, Wildevuur CR. Systemic blood activation during and after autotransfusion Ann Thorac Surg 1994; 57: 1256–1262.

    Article  Google Scholar 

  144. Schönberger JP, Bredee JJ, Speekenbrink RG, Everts PA, Wildevuur CR. Autotransfusion of shed blood contributes additionally to blood saving in patients receiving aprotinin (2 million KIU). Eur J Cardiothorac Surg 1993; 7: 474–477.

    Article  PubMed  Google Scholar 

  145. Boonstra PW, van Imhoff GW, Eijsman L, et al. Reduced platelet activation and improved hemostasis after controlled cardiotomy suction during clinical membrane oxygenator perfusions. J Thorac Cardiovasc Surg 1985; 89: 900–906.

    PubMed  CAS  Google Scholar 

  146. Menasché P, Piwnica A. Free radicals and myocardial protection: a surgical viewpoint. Ann Thorac Surg 1989; 47: 939–945.

    Article  PubMed  Google Scholar 

  147. Royston D, Fleming JS, Desar JB, Westaby S, Taylor KM. Increased production of peroxidation products associated with cardiac operations. J Thorac Cardiovasc Surg 1986; 91: 759–766.

    PubMed  CAS  Google Scholar 

  148. Lefer AM. Role of selectins in myocardial ischemia-reperfusion injury. Ann Thorac Surg 1995; 60: 773–777.

    Article  PubMed  CAS  Google Scholar 

  149. Seccombe JF, Schaff HV. Coronary artery endothelial function after myocardial ischemia and reperfusion. Ann Thorac Surg 1995; 60: 778–788.

    Article  PubMed  CAS  Google Scholar 

  150. Menasché P, Grousset C, Gauduel Y, Piwnica A. A comparative study of free radical scavengers in cardioplegic solutions. Improved protection with peroxidase. J Thorac Cardiovasc Surg 1986; 92: 264–271.

    PubMed  Google Scholar 

  151. Kaneda T, Ku K, Inoue T, Onoe M, Oku H. Postischemic reperfusion injury can be attenuated by oxygen tension control. Jpn Circ J 2001; 65: 213–218.

    Article  PubMed  CAS  Google Scholar 

  152. Bochenek A, Religa Z, Spyt TJ, Mistarz K, Bochenek Ad, Zembala M, Grzybek H. Protective influence of pretreatment with allopurinol on myocardial function in patients undergoing coronary artery surgery. Eur J Cardiothorac Surg 1990; 4: 538–542.

    Article  PubMed  CAS  Google Scholar 

  153. Lichtenstein SV, Kassam AA, El Dalati H, Cusimano RJ, Panos A, Slutsky AS. Warm heart surgery. J Thorac Cardiovasc Surg 1991; 101: 269–274.

    PubMed  CAS  Google Scholar 

  154. Taggart DP, El-Fiky MM, Carter R, Bowman A, Wheatley DJ. Respiratory dysfunction after uncomplicated cardiopulmonary bypass. Ann Thorac Surg 1993; 56: 1123–1128.

    Article  PubMed  CAS  Google Scholar 

  155. Ratcliff NB, Young WG Jr, Hackel DB, et al. Pulmonary injury secondary to extracorporeal circulation: an ultrastructural study. J Thorac Cardiovasc Surg 1973; 65: 425–432.

    Google Scholar 

  156. Schlensak C, Doenst T, Preusser S, Wunderlich M, Kleinschmidt M, Beyersdorf F. 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 

  157. Hillman ND, Cheifetz IM, Craig DM, Smith PK, Ungerleider RM, Meliones JN. Inhaled nitric oxide, right ventricular efficiency, and pulmonary vascular mechanics: selective vasodilation of small pulmonary vessels during hypoxic pulmonary vasoconstriction. J Thorac Cardiovasc Surg 1997; 113: 1006–1013.

    Article  PubMed  CAS  Google Scholar 

  158. King RC, Binns OA, Kanithanon RC, et al. Low-dose sodium nitroprusside reduces pulmonary reperfusion injury. Ann Thorac Surg 1997; 63: 1398–1404.

    Article  PubMed  CAS  Google Scholar 

  159. Pearl JM, Wellmann SA, McNamara JL, et al. Bosentan prevents hypoxia-reoxygenation-induced pulmonary hypertension and improves pulmonary function. Ann Thorac Surg 1999; 68: 1714–1721.

    Article  PubMed  CAS  Google Scholar 

  160. MacNee W, Selby C. Neutrophil kinetics in the lungs. Clin Sci 1990; 79: 97–107.

    PubMed  CAS  Google Scholar 

  161. Tönz M, Mihaljevic T, von Segesser LK, Fehr J, Schmid ER, Turina MI. Acute lung injury during cardiopulmonary bypass: are the neutrophils responsible? Chest 1995; 108: 1551–1556.

    Article  PubMed  Google Scholar 

  162. Bando K, Pillai R, Cameron DE, et al. Leukocyte depletion ameliorates free radical-mediated lung injury after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1990; 99: 873–877.

    PubMed  CAS  Google Scholar 

  163. Johnson D, Thomson D, Mycyk T, Burbridge B, Mayers I. Depletion of leucocytes transiently improves postoperative cardiorespiratory status. Chest 1995; 107: 1253–1259.

    Article  PubMed  CAS  Google Scholar 

  164. Gu YJ, Vries AJ de, Boonstra PW, van Oeveren W. Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac surgery. J Thorac Cardiovasc Surg 1996; 112; 494–500.

    Article  PubMed  CAS  Google Scholar 

  165. Boldt J, Zickmann B, Dapper F, Hempelmann G. Does the technique of cardiopulmonary bypass affect lung water content? Eur J Cardiothorac Surg 1991; 5: 22–26.

    Article  PubMed  CAS  Google Scholar 

  166. Matheis G, Haak T, Beyersdorf F, Baretti R, Polywka C, Winkelmann BR. Circulating endothelin in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg 1995; 9: 269–274.

    Article  PubMed  CAS  Google Scholar 

  167. Dobell AR, Bailey JS. Charles Drew and the origins of deep hypothermic circulatory arrest. Ann Thorac Surg 1997; 63: 1193–1199.

    Article  PubMed  CAS  Google Scholar 

  168. Bochenek A, Religa Z, Kokot F, et al. Biocompatibility of extracorporeal circulation with auto-oxygenation. Eur J Cardiothorac Surg 1992; 6: 397–402.

    Article  PubMed  CAS  Google Scholar 

  169. DeFoe GR, Ross CS, Olmstead EM, et al. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Ann Thorac Surg 2001; 71: 769–776.

    Article  PubMed  CAS  Google Scholar 

  170. Beattie HW, Evans G, Garnett ES, Webber CE. Sustained hypovolemia and extracellular fluid volume expansion following cardiopulmonary bypass. Surgery 1972; 71: 891–897.

    PubMed  CAS  Google Scholar 

  171. Utley JR, Wachtel C, Cain RB, Spaw AE, Collins JC, Stephens DB. Effects of hypothermia, hemodilution, and pump oxygenation on organ water content, blood flow, and oxygen delivery, and renal function. Ann Thorac Surg 1981; 31: 121–133.

    Article  PubMed  CAS  Google Scholar 

  172. Jansen PG, to Velthuis H, Bulder ER, et al. Reduction in prime volume attenuates the hyperdynamic response after cardiopulmonary bypass. Ann Thorac Surg 1995; 60: 544–550.

    Article  PubMed  CAS  Google Scholar 

  173. Jansen PG, to Velthuis H, Wildevuur WR, et al. Cardiopulmonary bypass with modified fluid gelatin and heparin-coated circuits. Br J Anaesth 1996; 6: 13–19.

    Article  Google Scholar 

  174. Schönberger JP, Bredee JJ, Tjian D, Everts PA, Wildevuur CR. Intraoperative predonation contributes to blood saving. Ann Thorac Surg 1993; 56: 893–898.

    Article  PubMed  Google Scholar 

  175. Schönberger JP, Woolley S, Tavilla G, et al. Efficacy and safety of a blood conservation program including low-dose aprotinin in routine myocardial revascularization. J Cardiovasc Surg (Torino) 1996; 37: 35–44.

    Google Scholar 

  176. Menasché P, Haydar S, Peynet J, et al. A potential mechanism of vasodilation after warm heart surgery. J Thorac Cardiovasc Surg 1994; 107: 293–299.

    PubMed  Google Scholar 

  177. Menasché P, Peynet J, Lariviere J, et al. Does normothermia during cardiopulmonary bypass increase neutrophil-endothelium interactions? Circulation 1994;90:I1275–1I279.

    Google Scholar 

  178. Haddix TL, Pohlman TH, Noel RF, Sato TT, Boyle EM Jr, Verrier ED. Hypothermia inhibits human E-selectin transcription. J Surg Res 1996; 64: 176–183.

    Article  PubMed  CAS  Google Scholar 

  179. Menasché P, Peynet J, Haeffner-Cavaillon N, et al. Influence of temperature on neutrophil trafficking during clinical cardiopulmonary bypass. Circulation I995;92(suppl):11334–11340.

    Google Scholar 

  180. Frering B, Philip I, Dehoux M, Rolland C, Langlois JM, Desmonts JM. Circulating cytokines in patients undergoing normothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 1994; 108: 636–641.

    PubMed  CAS  Google Scholar 

  181. Birdi I, Regragui I, Izzat MB, Bryan AJ, Angelini GD. Influence of normothermic systemic perfusion during coronary artery bypass operations: a randomized prospective study. J Thorac Cardiovasc Surg 1997; 114: 475–481.

    Article  PubMed  CAS  Google Scholar 

  182. Tonz M, Mihaljevic T, von SegesserLK, Shaw S, LuscherTF, TurinaM. Postoperative hemodynamics depend on cardiopulmonary bypass temperature: the potential role of endothelia-1. Eur J Cardiothorac Surg 1997; 11: 157–161.

    Article  PubMed  CAS  Google Scholar 

  183. Ohata T, Sawa Y, Kadoba K, Kagisaki K, Suzuki K, Matsuda H. Role of nitric oxide in a temperature dependent regulation of systemic vascular resistance in cardiopulmonary bypass. Eur J Cardiothorac Surg 2000; 18: 342–347.

    Article  PubMed  CAS  Google Scholar 

  184. Ranucci M, Soro G, Frigiola A, et al. Normothermic perfusion and lung function after cardiopulmonary bypass: effects in pulmonary risk patients. Perfusion 1997; 12: 309–315.

    Article  PubMed  CAS  Google Scholar 

  185. Ohata T, Sawa Y, Kadoba K, Masai T, Ichikawa H, Matsuda H. Effect of cardiopulmonary bypass under tepid temperature on inflammatory reactions. Ann Thorac Surg 1997; 64: 124–128.

    Article  PubMed  CAS  Google Scholar 

  186. Adams DC, Heyer EJ, Simon AE, et al. Incidence of atrial fibrillation after mild or moderate hypothermic cardiopulmonary bypass. Crit Care Med 2000; 28: 574–545.

    Article  Google Scholar 

  187. Vingerhoets G, Van Nooten G, Vermassen F, De Soete G, Jannes C. Short-term and long-term neuropsychological consequences of cardiac surgery with extracorporeal circulation. EurJ Cardiothorac Surg 1997; 11: 424–431.

    Article  CAS  Google Scholar 

  188. Sotaniemi KA. Long-term neurologic outcome after cardiac operation. Ann Thorac Surg 1995; 59: 1336–1339.

    Article  PubMed  CAS  Google Scholar 

  189. Blauth CI. Macroemboli and microemboli during cardiopulmonary bypass. Ann Thorac Surg 1995; 59: 1300–1303.

    Article  PubMed  CAS  Google Scholar 

  190. Liu JF, Su ZK, Ding WX. Quantitation of particulate microemboli during cardiopulmonary bypass: experimental and clinical studies. Ann Thorac Surg 1992; 54: 1196–1202.

    Article  PubMed  CAS  Google Scholar 

  191. Moody DM, Brown WR, Challa VR, Stump DA, Reboussin DM, Legault C. Brain microemboli associated with cardiopulmonary bypass: a histologic and magnetic resonance imaging study. Ann Thorac Surg 1995; 59: 1304–1307.

    Article  PubMed  CAS  Google Scholar 

  192. Kincaid EH, Jones TJ, Stump DA, et al. Processing scavenged blood with a cell saver reduces cerebral lipid microembolization. Ann Thorac Surg 2000; 70: 1296–1300.

    Article  PubMed  CAS  Google Scholar 

  193. Plourde G, Leduc AS, Morin JE, et al. Temperature during cardiopulmonary bypass for coronary artery operations does not influence postoperative cognitive function: a prospective, randomized trial. J Thorac Cardiovasc Surg 1997; 114: 123–128.

    Article  PubMed  CAS  Google Scholar 

  194. Engelman RM, Pleet AB, Rousou JA, et al. What is the best perfusion temperature for coronary revascularization? J Thorac Cardiovasc Surg 1996; 112: 1622–1632.

    Article  PubMed  CAS  Google Scholar 

  195. Regragui I, Birdi I, Izzat MB, et al. The effects of cardiopulmonary bypass temperature on neuropsychologic outcome after coronary artery operations: a prospective randomized trial. J Thorac Cardiovasc Surg 1996; 112: 1036–1045.

    Article  PubMed  CAS  Google Scholar 

  196. Mora CT, Henson MB, Weintraub WS, et al. The effect of temperature management during cardiopulmonary bypass on neurologic and neuropsychologic outcomes in patients undergoing coronary revascularization. J Thorac Cardiovasc Surg 1996; 112: 514–522.

    Article  PubMed  CAS  Google Scholar 

  197. McLean RF, Wong BI, Naylor CD, et al. Cardiopulmonary bypass, temperature, and central nervous system dysfunction. Circulation 1994;90:1I250–1I255.

    Google Scholar 

  198. Martin TD, Craver JM, Gott JP, et al. Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurological threat. Ann Thorac Surg 1994; 57: 298–304.

    Article  PubMed  CAS  Google Scholar 

  199. Engelman RM, Pleet AB, Rousou JA, et al. Influence of cardiopulmonary bypass perfusion temperature on neurologic and hematologic function after coronary artery bypass grafting. Ann Thorac Surg 1999; 67: 1547–1555.

    Article  PubMed  CAS  Google Scholar 

  200. Grimm M, Czerny M, Baumer H, et al. Normothermic cardiopulmonary bypass is beneficial for cognitive brain function after coronary artery bypass grafting-a prospective randomized trial. Eur J Cardiothorac Surg 2000; 18: 270–275.

    Article  PubMed  CAS  Google Scholar 

  201. Rees K, Beranek-Stanley M, Burke M, Ebrahim S. Hypothermia to reduce neurological damage following coronary artery bypass surgery (Cochrane Review). Cochrane Database Syst Rev 2001;1:CD002138.

    Google Scholar 

  202. Johnsson P, Lundqvist C, Lindgren A, Ferencz I, Ailing C, Stahl E. Cerebral complications after cardiac surgery assessed by S-100 and NSE levels in blood. J Cardiothorac Vasc Anesth 1995; 9: 694–699.

    Article  PubMed  CAS  Google Scholar 

  203. Ali MS, Harmer M, Vaughan R. Serum S 100 protein as a marker of cerebral damage during cardiac surgery. Br J Anaesth 2000; 85: 287–298.

    Article  PubMed  CAS  Google Scholar 

  204. Westaby S, Johnsson P, Parry A, et al. Serum S l 00 protein: a potential marker for cerebral events during cardiopulmonary bypass. Ann Thorac Surg 1996; 61: 88–92.

    Article  PubMed  CAS  Google Scholar 

  205. Taggart DP, Mazel JW, Bhattacharya K, et al. Comparison of serum 5–100ß levels during CABG and intracardiac operations. Ann Thorac Surg 1997; 63: 492–496.

    Article  PubMed  CAS  Google Scholar 

  206. Taggart DP, Bhattacharya K, Meston N, et al. Serum S-100 protein concentration after cardiac surgery: a randomized trial of arterial line filtration. Eur J Cardiothorac Surg, 1997;1 I: 645–649.

    Google Scholar 

  207. Anderson RE, Hansson LO, Vaage J. Release of S100B during coronary artery bypass grafting is reduced by off-pump surgery. Ann Thorac Surg 1999; 67: 1721–1725.

    Article  PubMed  CAS  Google Scholar 

  208. Khuri SF, Valeri CR, Loscalzo J. Heparin causes platelet dysfunction and induces fibrinolysis before cardiopulmonary bypass. Ann Thorac Surg 1995; 60: 1008–1014.

    Article  PubMed  CAS  Google Scholar 

  209. Upchurch GR, Valeri CR, Khuri SF, et al. Effect of heparin on fibrinolytic activity and platelet function in vivo. Am J Physiol 1996; 271: 528–534.

    Google Scholar 

  210. John LCH, Rees GM, Kovacs IB. Inhibition of platelet function by heparin. J Thorac Cardiovasc Surg 1993; 105: 816–822.

    PubMed  CAS  Google Scholar 

  211. Wahba A, Black G, Koksch M, et al. Cardiopulmonary bypass leads to a preferential loss of activated platelets. A flow cytometric assay of platelet surface antigens. EurJ Cardiothorac Surg 1996; 10: 768–773.

    Article  CAS  Google Scholar 

  212. Videm V. Heparin in clinical doses “primes” granulocytes to subsequent activation as measured by myeloperoxidase release. Scand J Immunol 1996; 43: 385–390.

    Article  PubMed  CAS  Google Scholar 

  213. Shastri KA, Logue GL, Stern MP, Rehman S, Raza S. Complement activation by heparin-protamine complexes during cardiopulmonary bypass: effect of C4a null allele. J Thorac Cardiovasc Surg 1997; 114: 482–488.

    Article  PubMed  CAS  Google Scholar 

  214. Levy JH, Cormack JG, Morales A. Heparin neutralization by recombinant platelet factor 4 and protamine. Anesth Analg 1995; 81: 35–37.

    PubMed  CAS  Google Scholar 

  215. Dehmer GJ, Fisher M, Tate DA, Teo S, Bonnem EM. Reversal of heparin anticoagulation by recombinant platelet factor 4 in humans. Circulation 1995; 91: 2188–2194.

    Article  PubMed  CAS  Google Scholar 

  216. Riess FC, Potsch B, Behr I, et al. Recombinant hirudin as an anticoagulant during cardiac operations: experiments in a pig model. Eur J Cardiothorac Surg 1997; 11: 739–745.

    Article  PubMed  CAS  Google Scholar 

  217. Bernabei A, Rao AK, Niewiarowski S, Colman RW, Sun L, Edmunds LH Jr. Recombinant desulphatohirudin as a substitute for heparin during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1994; 108: 381–382.

    PubMed  CAS  Google Scholar 

  218. Edmunds LH Jr. HIT, HITT and desulphatohirudin: look before you leap. J Thorac Cardiovasc Surg 1995; 110: 1–3.

    Article  PubMed  Google Scholar 

  219. Jegger D, Tevaearai HT, Horisberger J, et al. Augmented venous return for minimally invasive open heart surgery with selective caval cannulation. Eur J Cardiothorac Surg 1999; 16: 312–316.

    Article  PubMed  CAS  Google Scholar 

  220. Nakanishi K, Shichijo T, Shinkawa Y, et al. Usefulness of vacuum-assisted cardiopulmonary bypass circuit for pediatric open-heart surgery in reducing homologous blood transfusion. Eur J Cardiothorac Surg 2001; 20: 233–238.

    Article  PubMed  CAS  Google Scholar 

  221. Rosengart TK, DeBois W, O’Hara M, et al.Retrograde autologous priming for cardiopulmonary bypass: a safe and effective means of decreasing hemodilution and transfusion requirements. J Thorac Cardiovasc Surg 1998; 115: 426–438.

    Article  PubMed  CAS  Google Scholar 

  222. Groner W, Winkelman JW, Harris AG, et al. Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med 1999: 10; 1209–1213.

    Google Scholar 

Download references

Authors
  1. Ron G. H. Speekenbrink MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wim van Oeveren PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles R. H. Wildevuur MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. León Eijsman MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Newark Beth Israel Medical Center, Newark, NJ, USA

    Daniel J. Goldstein MD

  2. New York Presbyterian Hospital, New York, NY, USA

    Mehmet C. Oz MD

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer Science+Business Media New York

About this chapter

Cite this chapter

Speekenbrink, R.G.H., van Oeveren, W., Wildevuur, C.R.H., Eijsman, L. (2004). Pathophysiology of Cardiopulmonary Bypass. In: Goldstein, D.J., Oz, M.C. (eds) Minimally Invasive Cardiac Surgery. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-416-0_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-416-0_1

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-400-5

  • Online ISBN: 978-1-59259-416-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation