Rapid Communication - Current Trends in Cardiology (2023) Volume 7, Issue 9
Cardiopulmonary bypass reduces oxidative stress in the myocardium of new-borns
Alessandro Bellis *
Cardiac Catheterization Laboratory, Chonnam National University Medical School, Mercogliano, Italy.
- *Corresponding Author:
- Alessandro Bellis
Cardiac Catheterization Laboratory
Chonnam National University Medical School
Received:26-Aug-2023, Manuscript No. AACC-23-111991; Editor assigned: 29-Aug-2023,PreQC No. AACC-23-111991 (PQ); Reviewed:12-Sep-2023,QC No. AACC-23-111991; Revised: 18-Sep-2023, Manuscript No. AACC-23-111991(R); Published:25-Sep-2023,DOI:10.35841/aacc-7.9.203
Citation: Bellis A. Cardiopulmonary bypass reduces oxidative stress in the myocardium of new-borns. J Cell Biol Metab. 2023;7(9):203
Cardiopulmonary bypass (CPB) is a life-saving technique that has revolutionized pediatric cardiac surgery. Children born with congenital heart defects often require surgical intervention to correct or palliate their conditions, and CPB plays a pivotal role in enabling these complex procedures. This article delves into the intricacies of cardiopulmonary bypass in children, shedding light on its process, challenges, and advancements. Cardiopulmonary bypass involves temporarily taking over the functions of the heart and lungs, allowing surgeons to perform intricate cardiac procedures while maintaining vital oxygenation and circulation. The process involves diverting blood away from the heart and lungs, circulating it through a heart-lung machine, and then returning it to the body. This enables the surgical team to work on a still heart, which is crucial for precise repairs. Components of cardiopulmonary bypass Heart-Lung Machine: The cornerstone of CPB is the heart-lung machine, also known as the perfusion circuit. This complex system consists of various components, including a pump, oxygenator, and filters. The pump ensures the continuous flow of oxygenated blood throughout the body, while the oxygenator removes carbon dioxide and adds oxygen to the blood. The process begins with the insertion of cannulas into the major blood vessels, typically the aorta and the right atrium. These cannulas facilitate the redirection of blood to and from the heart-lung machine. [1,2].
Anticoagulation: To prevent clotting within the heart-lung machine, the child is administered anticoagulants. This delicate balance between preventing clotting and avoiding excessive bleeding is a critical aspect of the procedure. Hypothermia: Children undergoing CPB are often cooled down to lower their metabolic rate. This helps protect their organs and tissues during the period of reduced blood flow. However, maintaining the optimal temperatureand preventing adverse effects requires careful monitoring .
While cardiopulmonary bypass has undoubtedly saved countless lives, it also presents a range of challenges specific to the pediatric population: The use of the heart-lung machine can cause hemodilution, a decrease in the concentration of red blood cells and other blood components. This can lead to complications such as coagulation disorders and the need for blood transfusions. CPB can trigger an inflammatory response, particularly in children. The interaction between blood components and the foreign surfaces of the heart-lung machine can lead to systemic inflammation, potentially affecting various organs .
Organ Protection: During CPB, blood flow to certain organs can be compromised. Surgeons must carefully manage and monitor perfusion to prevent damage to vital organs, particularly the brain and kidneys. Once blood flow is restored to the heart after surgery, there is a risk of reperfusion injury, which occurs when the sudden reintroduction of oxygen-rich blood leads to oxidative stress and tissue damage. Advancements in pediatric cardiopulmonary bypass Medical science and technology have made significant strides in improving the safety and efficacy of cardiopulmonary bypass in children. Advancements in technology have led to the development of smaller and more specialized heart-lung machines designed specifically for pediatric patients. These machines provide better control over blood flow and oxygenation while minimizing potential complications. Biocompatible Surfaces: The surfaces of the heart-lung machine have been modified to be more biocompatible, reducing the inflammatory response and minimizing the risk of clot formation. Innovative cooling techniques, such as "selective cerebral perfusion," allow surgeons to cool specific areas of the body, such as the brain, while maintaining normal body temperature in other areas. This approach helps protect vital organs and reduces the risk of cognitive deficits post-surgery. Advanced monitoring techniques, including near-infrared spectroscopy (NIRS), allow real-time assessment of tissue oxygenation during CPB. Imaging technologies, such as transesophageal echocardiography (TEE), provide detailed visualization of cardiac structures, aiding surgeons in making informed decisions .
Cardiopulmonary bypass in children is an intricate and life-saving procedure that demands a delicate balance between maintaining vital functions and safeguarding against potential complications. Over the years, advancements in technology, surgical techniques, and perioperative care have significantly improved the outcomes of pediatric cardiac surgeries. As medical knowledge continues to evolve, the quest for further enhancing the safety and efficacy of cardiopulmonary bypass in children remains a driving force behind ongoing research and innovation.
- Nguyen B. Sulforaphane pretreatment prevents systemic inflammation and renal injury in response to cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2014;148:690–97.
- Kumar AB. Association between postoperative acute kidney injury and duration of cardiopulmonary bypass: a meta-analysis. J Cardiothorac Vasc Anesth .2012; 26:64–69.
- Qu X, N-acetylcysteine attenuates cardiopulmonary bypass-induced lung injury in dogs. J Cardiothorac Surg. 2013; 8:107.
- Sleeman P. High fat feeding promotes obesity and renal inflammation and protects against post cardiopulmonary bypass acute kidney injury in swine. Crit Care.2013;17:R262.
- Goebel U. Inhaled carbon monoxide prevents acute kidney injury in pigs after cardiopulmonary bypass by inducing a heat shock response. Anesth Analg. 2010; 111:29–37.