Pulmonary and Systemic Vascular Resistances After Cardiopulmonary Bypass: Role of Hemolysis

• Published in: Journal of cardiothoracic and vascular anesthesia 2017-04, Vol.31 (2), p.505-515
• Main Authors: Rezoagli, Emanuele, MD, Ichinose, Fumito, MD, PhD, Strelow, Sabrina, Roy, Nathalie, MD, Shelton, Kenneth, MD, Matsumine, Rui, MD, PhD, Chen, Liu, PhD, Bittner, Edward A., MD, PhD, Bloch, Donald B., MD, Zapol, Warren M., MD, Berra, Lorenzo, MD
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia & Perioperative Care; cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - trends; Cohort Studies; Critical Care; Female; hemolysis; Hemolysis - physiology; Humans; Male; Middle Aged; nitric oxide; plasma hemoglobin; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Prospective Studies; pulmonary vascular resistance; systemic vascular resistance; Vascular Resistance - physiology
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2016.06.009

Objectives Prolonged cardiopulmonary bypass (CPB) is associated with hemolysis, resulting in increased plasma oxyhemoglobin and vascular nitric oxide depletion. The authors hypothesized that hemolysis associated with CPB would reduce nitric oxide bioavailability, resulting in high pulmonary and systemic vascular resistances that after CPB would normalize gradually over time, due to clearance of plasma oxyhemoglobin. The authors also investigated whether prolonged CPB (≥140 min) produced increased levels of hemolysis and greater pulmonary and systemic vasoconstriction. Design Prospective cohort study. Setting Single-center university hospital. Patients The study comprised 50 patients undergoing elective cardiac surgery requiring CPB. Interventions Plasma hemoglobin and plasma nitric oxide consumption were measured before surgery and after CPB. Pulmonary and systemic hemodynamics were measured after CPB. The effects of short (