Kardiyopulmoner Bypass
Özet
Kardiyopulmoner baypas (KPB); Kalp ve büyük damarlarda oluşan hasarların cerrahi müdahalesine olanak sağlamak amacıyla kalbin durdurulduğunda kalp-akciğer makinesi eşliğinde, yeterli kan debisi ve oksijenasyon sağlanarak gerçekleştirilen vücut dışı perfüzyon sisteminin adıdır. Bu teknik kalbin ve akciğerlerin görevini üstlenir. Bu sistemin çalışmasını sağlayan makinaya kalp-akciğer makinesi ya da kalp-akciğer pompası adı verilir. KPB sistemi perfüzyonistler tarafından hazırlanır ve yönetilir. KPB uygulaması ekstrakorporeal yani vücut dışı dolaşım sistemi olması nedeniyle önemli morbidite ve mortalite potansiyelini içinde barındırmaktadır. Gelişen biyomedikal teknolojiler ve personel nitelikliliği hem güvenliği arttırılmış cihazlar hem de geliştirilmiş hedefe yönelik perfüzyon stratejilerinin ortaya çıkmasına olanak sağlamıştır. Bu sayede komplikasyonların, mortalite ve morbitide etkilerinin her geçen gün azaldığı görülmektedir. Bunların yanında halen daha kardiyopulmoner baypas ve vücut dışı dolaşım teknikleri başta kalp ve damar cerrahisi olmak üzere göğüs cerrahisi, çeşitli izole organ perfüzyonları ve yoğun bakım ünitelerinde olmazsa olmazı temsil etmeye devam etmektedir.
Cardiopulmonary bypass (CPB); It is the name of the extracorporeal perfusion system, which is performed by providing adequate blood flow and oxygenation, accompanied by a heart-lung machine, when the heart is stopped in order to allow surgical intervention for damage to the heart and large vessels. This technique takes over the function of the heart and lungs. The machine that enables this system to work is called the heart-lung machine or heart-lung pump. The CPB system is prepared and managed by perfusionists. CPB application carries the potential for significant morbidity and mortality due to the extracorporeal circulatory system. Developing biomedical technologies and personnel qualifications have enabled the emergence of both safety-increased devices and improved targeted perfusion strategies. In this way, it is seen that the effects of complications, mortality and morbidity are decreasing day by day. In addition, cardiopulmonary bypass and extracorporeal circulation techniques continue to be indispensable in cardiovascular surgery, thoracic surgery, various isolated organ perfusions and intensive care units.
Referanslar
Anastasiadis K, Antonitsis P, Argiriadou H, et al. Modular minimally invasive extracorporeal circulation systems; can they become the standard practice for performing cardiac surgery? Perfusion. 2015;30(3): p. 195-200. doi: 10.1177/0267659114567555.
King J, Lowery DR. Physiology, Cardiac Output. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
Grigore AM, Grocott HP, Mathew JP, et al. The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery. Anesth Analg. 2002;94:4–10. doi: 10.1097/00000539-200201000-00002.
Edmunds LH. (2007). Blood‐Surface Interactions During Cardiopulmonary Bypass. Journal of Cardiac Surgery. 8(3):404 – 410. Doi: 10.1111/j.1540-8191.1993.tb00384.x.
Choudhary SK, Reddy PR. Cannulation strategies in aortic surgery: techniques and decision making. Indian J Thorac Cardiovasc Surg. 2022 Apr;38(Suppl 1):132-145. doi: 10.1007/s12055-021-01191-4.
Wang S, Palanzo D, Kunselman AR, et al. In vitro hemodynamic evaluation of five 6 Fr and 8 Fr arterial cannulae in simulated neonatal cardiopulmonary bypass circuits. Artif Organs. 2016;40(1):56–64. doi: 10.1111/aor.12579.
Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017 Sep;61(9):760-767. doi: 10.4103/ija.IJA_379_17.
Aydin S, Yerli I, Kirali K, et al. The effect of vacuum-assisted venous drainage on hemolysis during cardiopulmonary bypass. Am J Cardiovasc Dis. 2020 Oct 15;10(4):473-478.
Schulz-Stübner S, Schorer C, Ennker J, et al. 72 hours standby time of wet-primed cardiopulmonary bypass circuits: a microbiological quality assurance study. Thorac Cardiovasc Surg. 2014 Oct;62(7):575-7. doi: 10.1055/s-0034-1371698.
Ranucci M, Carboni G, Cotza M, et al. Surgical and Clinical Outcome Research (SCORE) Group. Hemodilution on cardiopulmonary bypass as a determinant of early postoperative hyperlactatemia. PLoS One. 2015 May 18;10(5):e0126939. doi: 10.1371/journal.pone.0126939.
Ranucci M, Johnson I, Willcox T, et al. Goal-directed perfusion to reduce acute kidney injury: A randomized trial. J Thorac Cardiovasc Surg. 2018 Nov;156(5):1918-1927. doi: 10.1016/j.jtcvs.2018.04.045.
McCullough JN, Zhang N, Reich DL, et al. Cerebral Metabolic Suppression during Hypothermic Circulatory Arrest in Humans. Ann. Thorac. Surg. 1999;67:1895–1899; discussion 1919–1921. doi: 10.1016/s0003-4975(99)00441-5.
Hori D, Nomura Y, Ono M, et al. Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring. J Thorac Cardiovasc Surg. 2017 Nov;154(5):1590-1598. doi: 10.1016/j.jtcvs.2017.04.091
Srey R, Rance G, Shapeton AD, et al. A Quick Reference Tool for Goal-Directed Perfusion in Cardiac Surgery. J Extra Corpor Technol. 2019 Sep;51(3):172-174.
Brash JL, Horbett TA, Latour RA, et al. The blood compatibility challenge. Part 2: Protein adsorption phenomena governing blood reactivity. Acta Biomater. 2019 Aug;94:11-24. doi: 10.1016/j.actbio.2019.06.022.
Robich M, Ryzhov S, Kacer D, et al. Prolonged Cardiopulmonary Bypass is Associated With Endothelial Glycocalyx Degradation. J Surg Res. 2020 Jul;251:287-295. doi: 10.1016/j.jss.2020.02.011.
Jaffer U, Wade RG, Gourlay T. Cytokines in the systemic inflammatory response syndrome: a review. HSR Proc Intensive Care Cardiovasc Anesth. 2010;2(3):161-75. PMID: 23441054; PMCID: PMC3484588.
Referanslar
Anastasiadis K, Antonitsis P, Argiriadou H, et al. Modular minimally invasive extracorporeal circulation systems; can they become the standard practice for performing cardiac surgery? Perfusion. 2015;30(3): p. 195-200. doi: 10.1177/0267659114567555.
King J, Lowery DR. Physiology, Cardiac Output. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
Grigore AM, Grocott HP, Mathew JP, et al. The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery. Anesth Analg. 2002;94:4–10. doi: 10.1097/00000539-200201000-00002.
Edmunds LH. (2007). Blood‐Surface Interactions During Cardiopulmonary Bypass. Journal of Cardiac Surgery. 8(3):404 – 410. Doi: 10.1111/j.1540-8191.1993.tb00384.x.
Choudhary SK, Reddy PR. Cannulation strategies in aortic surgery: techniques and decision making. Indian J Thorac Cardiovasc Surg. 2022 Apr;38(Suppl 1):132-145. doi: 10.1007/s12055-021-01191-4.
Wang S, Palanzo D, Kunselman AR, et al. In vitro hemodynamic evaluation of five 6 Fr and 8 Fr arterial cannulae in simulated neonatal cardiopulmonary bypass circuits. Artif Organs. 2016;40(1):56–64. doi: 10.1111/aor.12579.
Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017 Sep;61(9):760-767. doi: 10.4103/ija.IJA_379_17.
Aydin S, Yerli I, Kirali K, et al. The effect of vacuum-assisted venous drainage on hemolysis during cardiopulmonary bypass. Am J Cardiovasc Dis. 2020 Oct 15;10(4):473-478.
Schulz-Stübner S, Schorer C, Ennker J, et al. 72 hours standby time of wet-primed cardiopulmonary bypass circuits: a microbiological quality assurance study. Thorac Cardiovasc Surg. 2014 Oct;62(7):575-7. doi: 10.1055/s-0034-1371698.
Ranucci M, Carboni G, Cotza M, et al. Surgical and Clinical Outcome Research (SCORE) Group. Hemodilution on cardiopulmonary bypass as a determinant of early postoperative hyperlactatemia. PLoS One. 2015 May 18;10(5):e0126939. doi: 10.1371/journal.pone.0126939.
Ranucci M, Johnson I, Willcox T, et al. Goal-directed perfusion to reduce acute kidney injury: A randomized trial. J Thorac Cardiovasc Surg. 2018 Nov;156(5):1918-1927. doi: 10.1016/j.jtcvs.2018.04.045.
McCullough JN, Zhang N, Reich DL, et al. Cerebral Metabolic Suppression during Hypothermic Circulatory Arrest in Humans. Ann. Thorac. Surg. 1999;67:1895–1899; discussion 1919–1921. doi: 10.1016/s0003-4975(99)00441-5.
Hori D, Nomura Y, Ono M, et al. Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring. J Thorac Cardiovasc Surg. 2017 Nov;154(5):1590-1598. doi: 10.1016/j.jtcvs.2017.04.091
Srey R, Rance G, Shapeton AD, et al. A Quick Reference Tool for Goal-Directed Perfusion in Cardiac Surgery. J Extra Corpor Technol. 2019 Sep;51(3):172-174.
Brash JL, Horbett TA, Latour RA, et al. The blood compatibility challenge. Part 2: Protein adsorption phenomena governing blood reactivity. Acta Biomater. 2019 Aug;94:11-24. doi: 10.1016/j.actbio.2019.06.022.
Robich M, Ryzhov S, Kacer D, et al. Prolonged Cardiopulmonary Bypass is Associated With Endothelial Glycocalyx Degradation. J Surg Res. 2020 Jul;251:287-295. doi: 10.1016/j.jss.2020.02.011.
Jaffer U, Wade RG, Gourlay T. Cytokines in the systemic inflammatory response syndrome: a review. HSR Proc Intensive Care Cardiovasc Anesth. 2010;2(3):161-75. PMID: 23441054; PMCID: PMC3484588.
