Recovery of Cardiac Function during Weaning from Cardiopulmonary Bypass_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIONGJi-yue , LINJing ,  DULei

Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

DULei, Email: dulei@scu.edu.cn

Keywords：

Cardiac resuscitation; Ischemia/reperfusion injury; Myocardial protection

DOI：

10.7507/1007-4848.20150022

Video：

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From aortic declamping to weaning from cardiopulmonary bypass (CPB), myocardium needs recovery not only from surgical and ischemia/reperfusion injury, but also of its full performance of pumping function as quickly as possible. In the early period of resuming myocardial perfusion, coronary blood flow should be increased, but ventricular volume overload, large dosage of adrenaline and isoprenaline, and high-energy defibrillation should be avoided. Thenappropriate management according to cardiac function and ECG changes is needed for successful weaning from CPB.

Citation： XIONGJi-yue, LINJing, DULei. Recovery of Cardiac Function during Weaning from Cardiopulmonary Bypass. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 80-83. doi: 10.7507/1007-4848.20150022 Copy

1.	肖乾慧, 熊际月, 秦臻. 心肌缺血病理生理与保护. 中国胸心血管外科临床杂志, 2014, 5(21):681-685.
2.	Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med, 2007, 357(11):1121-1135.
3.	Kleinbongard P, Böse D, Baars T, et al. Vasoconstrictor potential of coronary aspirate from patients undergoing stenting of saphenous vein aortocoronary bypass grafts and its pharmacological attenuation. Circ Res, 2011,108(3):344-352.
4.	Joy BF, Elliott E, Hardy C, et al. Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit. Pediatr Crit Care, 2011, 12(3):304-308.
5.	Salerno TA, Panos AL, Tian G, et al. Surgery for cardiac valves and aortic root without cardioplegic arrest ("beating heart"):experience with a new method of myocardial perfusion. J Card Surg, 2007, 22(6):459-464.
6.	Allen BS, Veluz JS, Buckberg GD, et al. Deep hypothermic circulatory arrest and global reperfusion injury:avoidance by making a pump prime reperfusate——a new concept. J Thorac Cardiovasc Surg, 2003, 125(3):625-632.
7.	Martin B, Shaw AD, Gal J, et al. The comparison and validity of troponin I assay systems in diagnosing myocardial ischemic injury after surgical coronary revascularization. J Cardiothorac Vasc Anesth, 2005, 19(3):288-293.
8.	Krejca M, Skiba J, Szmagala P, et al. Cardiac troponin T release during surgery using intermittent cross-clamp with fibrillation, onpump and off-pump beating heart. Eur J Cardiothorac Surg, 1999, 16(3):337-341.
9.	Stein EJ, Glick DB, Minhaj MM, et al. Relationship between anesthetic depth and venous oxygen saturation during cardiopulmonary bypass. Anesthesiology, 2010, 113(1):35-40.
10.	Wang E, Nie Y, Zhao Q. Circulating miRNAs reflect early myocardial injury and recovery after heart transplantation. J Cardiothorac Surg, 2013, 8:165.
11.	Hausmann H, Meyer R, Siniawski H, et al. Factors excercising an influence on recovery of hibernating myocardium after coronary artery bypass grafting. Eur J Cardiothorac Surg, 2004, 26(1):89-95.
12.	Bogaert J, Kalantzi M, Rademakers FE, et al. Determinants and impact of microvascular obstruction in successfully reperfused STsegment elevation myocardial infarction. Assessment by magnetic resonance imaging. Eur Radiol, 2007, 17(10):2572-2580.
13.	Frank A, Bonney M, Bonney S, et al. Myocardial ischemia reperfusion injury:from basic science to clinical bedside. Semin Cardiothorac Vasc Anesth, 2012, 16(3):123-132.
14.	Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models:part 1-coronary artery bypass grafting surgery. Ann Thorac Surg, 2009, 8(1):S2-S22.
15.	Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol, 2003, 42(9):1547-1554.
16.	Senter S, Francis GS. A new, precise definition of acute myocardial infarction. Cleve Clin J Med, 2009, 76(3):159-166.
17.	Velden J, Merkus D, Klarenbeek BR, et al. Alterations in myofilament function contribute to left ventricular dysfunction in pigs early after myocardial infarction. Circ Res, 2004, 95(11):85-95.
18.	Razzaque MA, Gupta M, Osinska H, et al. An endogenously produced fragment of cardiac myosin-binding protein C is pathogenic and can lead to heart failure. Circ Res, 2013, 113(5):553-561.
19.	Di Eusanio M, Savini C, Folesani G, et al. Improved brain and myocardial protection during complex aortic reinterventions. Ann Thorac Surg, 2013, 95(1):358-359.
20.	Luciani N, De Geest R, Anselmi A, et al. Results of reoperation on the aortic root and the ascending aorta. Ann Thorac Surg, 2011, 92(3):898-903.
21.	Karck M, Cremer J, Wawersik J, et al. Reoperation for aneurysmal disease of the ascending aorta in patients with concomitant aortic valve incompetence. J Thorac Cardiovasc Surg, 1996, 112(2):1392-1393.
22.	Kraemer JL, Gobbato PL, Andrade-Souza YM. Third ventriculostomy through the lamina terminalis for intracranial pressure monitoring after aneurysm surgery:technical note. Arq Neuropsiquiatr, 2002, 60(4):932-934.
23.	Wahlberg E, Dimuzio PJ, Stoney RJ, et al. Aortic clamping during elective operations for infrarenal disease:The influence of clamping time on renal function. J Vasc Surg, 2002, 36(1):13-18.
24.	Guller B, Yipintsoi T, Orvis AL, et al. Myocardial sodium extraction at varied coronary flows in the dog. Estimation of capillary permeability of residue and outflow detection. Circ Res, 1975, 37(3):359-378.
25.	Turkoz R, Ozker E, Turkoz A. Secondary cross-clamping and blood cardioplegia for refractory ventricular fibrillate. Ann Thorac Surg, 2011, 92(1):403.
26.	Baumgart D, Haude M, Gorge G, et al. Augmented alphaadrenergic constriction of atherosclerotic human coronary arteries. Circulation, 1999, 99(16):2090-2097.
27.	Chilian WM. Functional distribution of alpha 1- and alpha 2-adrenergic receptors in the coronary microcirculation. Circulation, 1991, 84(5):2108-2122.
28.	Noora J, Puskas JD. Off-pump coronary artery bypass grafting through sternotomy:for whom? Curr Opin Cardiol, 2006, 21(6):573-577.
29.	Tashiro T, Wada H, Nishimi M, et al. Off-pump coronary artery bypass:techniques, pitfalls, and results. Gen Thorac Cardiovasc Surg, 2013, 61(8):429-434.
30.	Frässdorf J, De Hert S, Schlack W. Anaesthesia and myocardial ischaemia/reperfusion injury. Br J Anaesth, 2009, 103(1):89-98.
31.	Jie S, Yu C, Xiaohu L, et al. The effect of amiodarone on cardiac rhythm after cardiopulmonary bypass in patients with atrial fibrillation. J Heart Valve Dis, 2010, 19(6):786-788.
32.	Lange M, Smul TM, Blomeyer CA, et al. Role of the beta1-adrenergic pathway in anesthetic and ischemic preconditioning against myocardial infarction in the rabbit heart in vivo. Anesthesiology, 2006, 105(2):503-510.
33.	Octavia Y, Assman NL, Moens AL. Tackling reperfusion injury after cardiopulmonary bypass with tetrahydrobiopterin:new therapeutic potentials for this phenylketonuria drug? Eur J Cardiothorac Surg, 2012, 41(1):233-234.
34.	Stalioraityte E, Bluzas J, Mackiewicz Z,et al. Out-of-hospital coronary heart disease death:acute pathological lesions. Acta Cardiol, 2008, 63(4):423-429.
35.	Alqahtani AA. Atrial fibrillation post cardiac surgery trends toward management. Heart Views, 2010, 11(2):57-63.
36.	Kozlowski D, Budrejko S, Lip GY, et al. Lone atrial fibrillation:what do we know? Heart, 2010, 96(7):498.
37.	European Heart Rhythm Association (EHRA), European Cardiac Arrhythmia Scoiety (ECAS), American College of Cardiology (ACC), et al. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation:recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 2007, 4(6):816.
38.	Tsai CF, Tai CT, Hsieh MH, et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava:electrophysiological characteristics and results of radiofrequency ablation. Circulation, 2000, 102(1):67.
39.	Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, 2012, 126(3):1784.
40.	Birnie D, Williams K, Guo A, et al. Reasons for escalating pacemaker implants. Am J Cardiol, 2006, 98(1):93.

1. 肖乾慧, 熊际月, 秦臻. 心肌缺血病理生理与保护. 中国胸心血管外科临床杂志, 2014, 5(21):681-685.
2. Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med, 2007, 357(11):1121-1135.
3. Kleinbongard P, Böse D, Baars T, et al. Vasoconstrictor potential of coronary aspirate from patients undergoing stenting of saphenous vein aortocoronary bypass grafts and its pharmacological attenuation. Circ Res, 2011,108(3):344-352.
4. Joy BF, Elliott E, Hardy C, et al. Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit. Pediatr Crit Care, 2011, 12(3):304-308.
5. Salerno TA, Panos AL, Tian G, et al. Surgery for cardiac valves and aortic root without cardioplegic arrest ("beating heart"):experience with a new method of myocardial perfusion. J Card Surg, 2007, 22(6):459-464.
6. Allen BS, Veluz JS, Buckberg GD, et al. Deep hypothermic circulatory arrest and global reperfusion injury:avoidance by making a pump prime reperfusate——a new concept. J Thorac Cardiovasc Surg, 2003, 125(3):625-632.
7. Martin B, Shaw AD, Gal J, et al. The comparison and validity of troponin I assay systems in diagnosing myocardial ischemic injury after surgical coronary revascularization. J Cardiothorac Vasc Anesth, 2005, 19(3):288-293.
8. Krejca M, Skiba J, Szmagala P, et al. Cardiac troponin T release during surgery using intermittent cross-clamp with fibrillation, onpump and off-pump beating heart. Eur J Cardiothorac Surg, 1999, 16(3):337-341.
9. Stein EJ, Glick DB, Minhaj MM, et al. Relationship between anesthetic depth and venous oxygen saturation during cardiopulmonary bypass. Anesthesiology, 2010, 113(1):35-40.
10. Wang E, Nie Y, Zhao Q. Circulating miRNAs reflect early myocardial injury and recovery after heart transplantation. J Cardiothorac Surg, 2013, 8:165.
11. Hausmann H, Meyer R, Siniawski H, et al. Factors excercising an influence on recovery of hibernating myocardium after coronary artery bypass grafting. Eur J Cardiothorac Surg, 2004, 26(1):89-95.
12. Bogaert J, Kalantzi M, Rademakers FE, et al. Determinants and impact of microvascular obstruction in successfully reperfused STsegment elevation myocardial infarction. Assessment by magnetic resonance imaging. Eur Radiol, 2007, 17(10):2572-2580.
13. Frank A, Bonney M, Bonney S, et al. Myocardial ischemia reperfusion injury:from basic science to clinical bedside. Semin Cardiothorac Vasc Anesth, 2012, 16(3):123-132.
14. Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models:part 1-coronary artery bypass grafting surgery. Ann Thorac Surg, 2009, 8(1):S2-S22.
15. Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol, 2003, 42(9):1547-1554.
16. Senter S, Francis GS. A new, precise definition of acute myocardial infarction. Cleve Clin J Med, 2009, 76(3):159-166.
17. Velden J, Merkus D, Klarenbeek BR, et al. Alterations in myofilament function contribute to left ventricular dysfunction in pigs early after myocardial infarction. Circ Res, 2004, 95(11):85-95.
18. Razzaque MA, Gupta M, Osinska H, et al. An endogenously produced fragment of cardiac myosin-binding protein C is pathogenic and can lead to heart failure. Circ Res, 2013, 113(5):553-561.
19. Di Eusanio M, Savini C, Folesani G, et al. Improved brain and myocardial protection during complex aortic reinterventions. Ann Thorac Surg, 2013, 95(1):358-359.
20. Luciani N, De Geest R, Anselmi A, et al. Results of reoperation on the aortic root and the ascending aorta. Ann Thorac Surg, 2011, 92(3):898-903.
21. Karck M, Cremer J, Wawersik J, et al. Reoperation for aneurysmal disease of the ascending aorta in patients with concomitant aortic valve incompetence. J Thorac Cardiovasc Surg, 1996, 112(2):1392-1393.
22. Kraemer JL, Gobbato PL, Andrade-Souza YM. Third ventriculostomy through the lamina terminalis for intracranial pressure monitoring after aneurysm surgery:technical note. Arq Neuropsiquiatr, 2002, 60(4):932-934.
23. Wahlberg E, Dimuzio PJ, Stoney RJ, et al. Aortic clamping during elective operations for infrarenal disease:The influence of clamping time on renal function. J Vasc Surg, 2002, 36(1):13-18.
24. Guller B, Yipintsoi T, Orvis AL, et al. Myocardial sodium extraction at varied coronary flows in the dog. Estimation of capillary permeability of residue and outflow detection. Circ Res, 1975, 37(3):359-378.
25. Turkoz R, Ozker E, Turkoz A. Secondary cross-clamping and blood cardioplegia for refractory ventricular fibrillate. Ann Thorac Surg, 2011, 92(1):403.
26. Baumgart D, Haude M, Gorge G, et al. Augmented alphaadrenergic constriction of atherosclerotic human coronary arteries. Circulation, 1999, 99(16):2090-2097.
27. Chilian WM. Functional distribution of alpha 1- and alpha 2-adrenergic receptors in the coronary microcirculation. Circulation, 1991, 84(5):2108-2122.
28. Noora J, Puskas JD. Off-pump coronary artery bypass grafting through sternotomy:for whom? Curr Opin Cardiol, 2006, 21(6):573-577.
29. Tashiro T, Wada H, Nishimi M, et al. Off-pump coronary artery bypass:techniques, pitfalls, and results. Gen Thorac Cardiovasc Surg, 2013, 61(8):429-434.
30. Frässdorf J, De Hert S, Schlack W. Anaesthesia and myocardial ischaemia/reperfusion injury. Br J Anaesth, 2009, 103(1):89-98.
31. Jie S, Yu C, Xiaohu L, et al. The effect of amiodarone on cardiac rhythm after cardiopulmonary bypass in patients with atrial fibrillation. J Heart Valve Dis, 2010, 19(6):786-788.
32. Lange M, Smul TM, Blomeyer CA, et al. Role of the beta1-adrenergic pathway in anesthetic and ischemic preconditioning against myocardial infarction in the rabbit heart in vivo. Anesthesiology, 2006, 105(2):503-510.
33. Octavia Y, Assman NL, Moens AL. Tackling reperfusion injury after cardiopulmonary bypass with tetrahydrobiopterin:new therapeutic potentials for this phenylketonuria drug? Eur J Cardiothorac Surg, 2012, 41(1):233-234.
34. Stalioraityte E, Bluzas J, Mackiewicz Z,et al. Out-of-hospital coronary heart disease death:acute pathological lesions. Acta Cardiol, 2008, 63(4):423-429.
35. Alqahtani AA. Atrial fibrillation post cardiac surgery trends toward management. Heart Views, 2010, 11(2):57-63.
36. Kozlowski D, Budrejko S, Lip GY, et al. Lone atrial fibrillation:what do we know? Heart, 2010, 96(7):498.
37. European Heart Rhythm Association (EHRA), European Cardiac Arrhythmia Scoiety (ECAS), American College of Cardiology (ACC), et al. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation:recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 2007, 4(6):816.
38. Tsai CF, Tai CT, Hsieh MH, et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava:electrophysiological characteristics and results of radiofrequency ablation. Circulation, 2000, 102(1):67.
39. Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, 2012, 126(3):1784.
40. Birnie D, Williams K, Guo A, et al. Reasons for escalating pacemaker implants. Am J Cardiol, 2006, 98(1):93.

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Recovery of Cardiac Function during Weaning from Cardiopulmonary Bypass

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