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Open access

Nora Porīte, Eva Striķe, Mihails Bekers-Ančipolovskis, Larisa Semčenko, Inguna Krustiņa and Pēteris Stradiņš

Assessment of Tissue Perfusion During Cardiopulmonary Bypass

Cardiopulmonary bypass (CPB) remains essential for all valvular operations and the vast majority of coronary bypass surgeries. Inadequate CPB results in tissue underperfusion, activation of anaerobic metabolism and increased lactate production. The goal of the study was to determine the factors influencing oxygen delivery to and consumption in tissue. Fifty-six patients (41 male and 14 female patients of 27 to 84 years of age) scheduled to undergo cardiac surgery with CPB were enrolled in this prospective study. No operation-based selection was applied. The following data have been collected and analysed: demographics, preoperative cardiovascular profile. Arterial and venous blood gas tests, including blood glucose and lactate concentrations were obtained. We have assessed DO2 (mL/min/m2) and VO2 (mL/min/m2), venous oxygen content (CvO2) (mL/dL), arterial oxygen content (CaO2) (mL/dL) calculated according to standard equations based on haemoglobin concentration and saturation in arterial blood, cardiac output or pump flow. The main factors of organ dysoxia during CPB are the haemodilution degree and low peripheral oxygen delivery (DO2). Our study confirmed that hematocrit on pump and systemic flow rate determine the amount of oxygen delivery to the body, i.e. DO2 decrease is correlated with decrease of both hematocrit (Ht) and pump flow.

Open access

Roberts Leibuss, Mārtiēņš Kalējs, Andris Skride, Mihails Bekkers, Agnese Ozoliņa, Pēteris Stradiņš, Eva Strīķe and Romāns Lācis

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in 1 to 4% after acute pulmonary embolism. CTEPH can be cured by pulmonary endarterectomy (PEA), which is approved golden standard in chronic condition. There were performed three cases of PEA in Latvian Cardiology Centre during 2013-2014. General anaesthesia under cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrests was provided. The core issue is correct patient selection (in terms of central PA obstruction by thrombus) as well as pulmonary circulation recovery capacity. Neuroprotection was provided by deep hypothermia, topical cooling of the head, Trendelenburg position, mild hypocapnia, Hb 9-10 g/L and pharmacological agents. For screening postoperative cognitive function the mini mental state examination (MMSE) was used before and after the surgery. Postoperative pulmonary vascular resistance index decreased by 56.3% (right ventricular systolic pressure decreased from 93.3 ± 25.7 to 44.5 ± 11.2 mmHg). Before the surgery three patients had NYHA functional class III or IV, at the time of discharge - I or II. In one case moderate (MMSE 18) cognitive disorders was observed at discharge from the ICU. No one died neither in the hospital nor within 30 days of discharge. The surgery improved RV function and pulmonary perfusion with no considerable organ failure, except mild cognitive disorders.

Open access

Roberts Leibuss, Martins Kalejs, Agnese Ozolina, Andris Skride, Peteris Stradins, Eva Strike and Romans Lacis

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in a minority of patients after acute embolism and belongs to Orphan diseases. There is no specific medical treatment currently approved. Pulmonary thromboendarterectomy (PTEAE) remains as the main and curative treatment for the CTEPH. Case presentation in a patient with acquired CTEPH is a rare condition that can be treated successfully with PTEAE under cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrests.

Open access

Ainārs Rudzītis, Kristaps Šablinskis, Baiba Luriņa, Irina Cgojeva-Sproģe, Aļona Grāve, Andis Dombrovskis, Pēteris Stradiņš and Andrejs Ērglis

Abstract

Percutaneous transcatheter device closure of secundum atrial septal defects (ASD) has now largely replaced surgical closure in most centres. The aim of this study was to compare results of transcatheter and surgical ASD closure in adults in Latvia during the years 2002–2014 and to analyse long-term outcomes of transcatheter closure. We analysed data from 334 patients with secundum ASD who underwent ASD closure in Pauls Stradiņš Clinical University Hospital. Patients were included into device or surgical closure groups. In the device group, three follow-ups were made 1, 6, and 12 months after the procedure. No follow-up data were available for surgical arm patients beyond their hospitalisation period. The mean age of patients was 45.3 ± 19.9 years for the device group and 40.0 ± 16.9 years for the surgical group (p = 0.023). The mean secundum ASD size in the device and surgical groups was 14.2 ± 5.6 mm and 28.7 ± 10.0 mm, respectively (p < 0.001). No differences were observed regarding procedure success rates: 99.2% in the device group and 100% in the surgical group (p = 0.451). Periprocedural complications generally were more common in the surgical closure group. The study results show a successful introduction of the percutaneous ASD closure method in Latvia with good early and late outcomes and without significant differences in procedure success rate compared to surgical closure.