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Microcirculatory changes during cardiac surgery with cardiopulmonary bypass
I Prestes1, J Riva1, J P Bouchacourt1
1Departamento de Anestesiología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
Insights
Cardiac surgery with cardiopulmonary bypass in high-risk patients can alter microcirculation, increasing the microcirculatory flow index (MFI) and blood lactate. These changes may indicate functional shunts, warranting further research.
Area of Science:
- Cardiovascular Surgery
- Intensive Care Medicine
- Microcirculation Research
Background:
- Intermediate and high mortality risk patients undergoing cardiac surgery (CS) with cardiopulmonary bypass (CPB) represent a vulnerable population.
- Assessing microcirculatory function is crucial for understanding tissue perfusion and predicting outcomes in these patients.
Purpose of the Study:
- To evaluate microcirculation in patients at intermediate and high risk for mortality undergoing CS with CPB.
- To identify potential alterations in microcirculatory parameters and their correlation with clinical outcomes.
Main Methods:
- A prospective study involving 22 patients with Euroscore >3.
- Utilized Videomicroscopy Side Stream Dark Field (SSD-BF) to assess capillary density, perfused capillaries, microcirculatory flow index (MFI), and heterogeneity flow index.
- Microcirculation was evaluated at four time points: post-anesthesia, start of CPB, end of CPB, and post-surgery.
Main Results:
- Mean arterial pressure decreased and blood lactate increased significantly from initial to final measurements.
- The microcirculatory flow index (MFI) showed a significant increase at the end of CPB and post-surgery.
- Postoperative complications were associated with significant differences in Euroscore, left ventricular ejection fraction, and MFI at the end of CPB.
Conclusions:
- Cardiac surgery with cardiopulmonary bypass in high-risk patients can lead to increased MFI and blood lactate.
- These microcirculatory changes suggest potential functional shunts at the tissue perfusion level.
- Further investigation is required to elucidate the underlying mechanisms of these observed alterations.
Objective:
To evaluate microcirculation in intermediate and high mortality risk patients undergoing cardiac surgery (CS) with cardiopulmonary bypass (CPB).
Patients And Methods:
The study included 22 patients with a Euroscore >3. Using the Videomicroscopy Side Stream Dark Field system, and evaluation was made of, capillary density, proportion of perfused capillaries, density of perfused capillaries, microcirculatory flow index (MFI), and heterogeneity flow index. Three to five video sequences were recorded: after induction of anaesthesia (T1), at the beginning of the CPB (T2), before finalising CPB (T3), at the end of the surgery, and before the patient was transferred to Intensive Care Unit (T4). Mean arterial pressure decreased, while the blood lactate increased significantly, when comparing the initial and final values (P<.05). MFI increased significantly in T3 and T4 (P<.05) with regards to the initial values. When the patients with and without postoperative complications were compared, significant differences were found in, Euroscore, left ventricular ejection fraction, and MFI in T3.
Conclusions:
in patients with intermediate/high preoperative risk, CS and CBP can involve an increase in MFI and blood lactate at the end of the study. These alterations suggest the possibility of a functional microcirculatory shunt at tissue perfusion level, secondary to the surgical injury and the CPB. Further investigation is needed to have a better understanding of the mechanisms involved.
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