Pulsatile Cardiopulmonary Bypass With Intra-Aortic Balloon Pump Improves Organ Function and Reduces Endothelial Activation

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著者

    • MARSICO Roberto
    • Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, University of Magna Graecia
    • MUSOLINO Giuseppe
    • Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, University of Magna Graecia
    • VENTURA Valeria
    • Department of Clinical and Experimental Medicine, Clinical Pathology Unit, University of Magna Graecia
    • GULLETTA Elio
    • Department of Clinical and Experimental Medicine, Clinical Pathology Unit, University of Magna Graecia
    • SANTE Pasquale
    • Department of Cardiothoracic and Respiratory Sciences, AON Monaldi Second University of Naples
    • RENZULLI Attilio
    • Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, University of Magna Graecia

抄録

<b><i>Background:</i></b> We aimed to evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves organ function and reduces endothelial activation in patients undergoing coronary artery bypass graft (CABG). <b><i>Methods and Results:</i></b> Five-hundred and one CABG patients were randomized into 2 groups: (Group A n=270) linear cardiopulmonary bypass (CPB); and (Group B n=231) automatic 80beats/min IABP-induced pulsatile CPB. We evaluated hemodynamic response, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate, renal function (estimated glomerular filtration rate [eGFR], creatinine and any possibility of renal insufficiency or failure), respiratory function and endothelial markers (vascular endothelial growth factor [VEGF] and monocyte chemotactic protein-1 [MCP-1]). IABP, which induced surplus hemodynamic energy, was 21,387±4,262ergs/cm<sup>3</sup>. Group B showed lower chest drainage, transfusions, international normalized ratio, and antithrombin III, together with higher platelets, activated partial thromboplastin time, fibrinogen and D-dimer. Transaminases, bilirubin, amylase, lactate were lower in Group B; there were better results for eGFR in Group B from ICU-arrival to 48h, resulting in lower creatinine from ICU-arrival to 48h. The necessity for renal replacement therapy was lower in Group B Stage-3. Group B P<sub>a</sub>O<sub>2</sub>/F<sub>i</sub>O<sub>2</sub> and lung compliance improved with aortic de-clamping on the first day with shorter intubation time. Group B showed lower VEGF and MCP-1. <b><i>Conclusions:</i></b> Pulsatile flow by IABP improves whole-body perfusion and reduces endothelial activation during CPB. (<i>Circ J</i> 2012; <b>76:</b> 1121-1129)<br>

収録刊行物

  • Circulation journal : official journal of the Japanese Circulation Society

    Circulation journal : official journal of the Japanese Circulation Society 76(5), 1121-1129, 2012-04-25

    一般社団法人 日本循環器学会

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各種コード

  • NII論文ID(NAID)
    10030132378
  • NII書誌ID(NCID)
    AA11591968
  • 本文言語コード
    ENG
  • 資料種別
    ART
  • ISSN
    13469843
  • データ提供元
    CJP書誌  J-STAGE 
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