60 research outputs found
Hemodynamic Disorders Related To Beating Heart Surgery Using Cardiac Stabilizers: Experimental Study.
To study in swine the hemodynamic changes secondary to the use of stabilizers for off-pump coronary artery bypass graft surgeries by means of both a suction device Octopus and a compression device (Speroni). Ten swine underwent median sternotomy. Monitoring of ECG, continuous cardiac output, mean arterial pressure, mean pulmonary artery pressure, mean right and left atrial pressures, and right and left ventricular diastolic pressure were performed. Stroke volume and systemic vascular resistance were calculated. Both stabilizers were studied placed on three vessels: anterior interventricular branch, posterior interventricular branch, and marginal branch of the circumflex branch. Each animal was randomly designed to application regarding the type of stabilizer and the target artery. The measurements were carried out 5 minutes before and after the stabilizer application. In the anterior interventricular branch changes have occurred only with the compression device, thus reducing cardiac output, stroke volume, and mean arterial pressure, but increasing the systemic vascular resistance. In the posterior interventricular branch changes have occurred with the compression device (Speroni), reducing cardiac output and stroke volume, but increasing the heart rate. With the suction device (octopus) there was an increase of both heart rate and systemic vascular resistance, but a decrease in stroke volume. In the marginal branch of the circumflex branch there was a decrease of cardiac output, stroke volume, and mean arterial pressure with both stabilizers. Also, there was a decrease in the mean pulmonary artery pressure and an increase in the mean right atrial pressure with the compression device (Speroni). Both stabilizers have caused hemodynamic changes. The compression device (Speroni) is more associated with changes than the suction device (Octopus).22407-1
Identificação de um método estatístico como instrumento da qualidade: tempo da presença do doente na sala de operação
Association of Trimetazidine to different methods of cardioplegia : experimental study on swines
Orientador: Reinaldo Wilson VieiraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Introdução: A administração de diferentes agentes associados à cardioplegia tem sido realizada desde o surgimento da proteção miocárdica em Cirurgia Cardíaca. Qualquer medicamento que promova uma melhora na capacidade do coração operado resistir à isquemia, que se traduza em melhora hemodinâmica e de sobrevida, pode ter sua associação à cardioplegia justificada. O agente de manejo metabólico trimetazidine (TMZ), utilizado na prática clínica como agente anti-isquêmico, tem sido usado em pacientes cirúrgicos esporadicamente, não havendo comprovação de sua eficácia quando apenas associado à solução cardioplégica. Objetivo: Verificar em modelo experimental de coração isolado de suínos se a associação do trimetazidine à solução cardioplégica promove melhora no desempenho do coração Material e métodos: O modelo experimental utilizou suínos Large-White, com coração isolado perfundido por suporte de outro animal em modo de execução de trabalho ("working heart state"). Foram divididos em três grupos (n = 6), submetidos a isquemia regional seguido de isquemia global, que recebiam um dos três tratamentos: Solução St Thomas (ST), solução St Thomas acrescida de trimetazidine (TMZ) e grupo controle (Co). Durante período de reperfusão aos 30, 60 e 90 minutos foram medidos parâmetros hemodinâmicos de contratilidade e metabólicos, obtendo-se assim a elastância máxima (Emáx), o índice de trabalho sistólico pré-recrutável (PRSW), "dureza" do ventrículo (EDPRV), fluxo coronariano, consumo de oxigênio e dosagens de lactato e glicose. Os resultados foram analisados estatisticamente Resultados: Em relação aos parâmetros hemodinâmicos de contratilidade não houve diferença estatisticamente significante entre os três grupos. Houve produção crescente de lactato nos três grupos quanto maior o tempo de reperfusão de forma uniforme. O fluxo coronariano, o consumo de oxigênio e o consumo de glicose tiveram grande variação entre os diferentes tempos medidos mas sem diferença entre os três tratamentos. O peso final do ventrículo esquerdo foi significativamente menor no grupo trimetazidine (TMZ) que nos demais. Conclusão: A administração aguda do trimetazidine, associada simplesmente como adjuvante à solução cardioplégica não demonstrou benefício hemodinâmico ou metabólico em modelo experimental de coração isolado em porcos. Palavras-chave: Trimetazidine, coração isolado, solução cardioplégicaAbstract: Introduction: Many drugs have usually been associated to cardioplegia since beggining of myocardial protection in Cardiac Surgery in order to improve surgical outcome. Any medicine able to induce resistance to ischemia and better hemodinamic effects and survival may have its utilization justified. Trimetazidine is an agent currently available as anti-ischemic medicine for anginal symptoms acting by protective metabolic effects Its role to be used in heart surgical patients as an adjuvant to cardioplegia is yet not fully comprehended. Objective: Verify in an isolated working heart state animal model if the association of trimetazidine to cardioplegia improves heart performance. Materials and method: Swines were used in this working heart model. They were divided in three grups (n = 6) that underwent regional and global ischemia. Each group was selected to a different treatment. St Thomas Cardioplegia (ST), St Thomas associated to trimetazidine (TMZ) and control group (Co). Data was collected during reperfusion period at 30, 60 and 90 minutes and were measured: Hemodinamic parameters such as elastance contractility index (Emáx), preload recruitable stroke work relationship (PRSW) and heart "stiffness" (EDPRV). Other data included coronary flow, oxygen and glucose consumption and lactate. Results were statistically analysed. Results: All contractility data were not significantly different among three groups. Lactate became constantly higher according to time uniformly in all three groups Coronary flow, glucose consumption and oxygen consumption presented large variations during time periods but according to treatments showed no statistical differences in all three groups. Left ventricle final weight was significantly lower in trimetazidine group compared to both other groups. Conclusion: Acute administration of trimetazidine associated to cardioplegia as an adjuvant showed no hemodinamic or metabolic improvement in an isolated working heart experimental model in swines. Key-words: Trimetazidine; isolated working heart model; cardioplegiaMestradoCirurgiaMestre em Cirurgi
Lidocaine and Pinacidil Added to Blood versus Crystalloid Cardioplegic Solutions: Study in Isolated Hearts
Abstract Objective: The present study aimed the functional recovery evaluation after long term of cardiac arrest induced by Custodiol (crystalloid-based) versus del Nido (blood-based) solutions, both added lidocaine and pinacidil as cardioplegic agents. Experiments were performed in isolated rat heart perfusion models. Methods: Male rat heart perfusions, according to Langendorff technique, were induced to cause 3 hours of cardiac arrest with a single dose. The hearts were assigned to one of the following three groups: (I) control; (II) Custodiol-LP; and (III) del Nido-LP. They were evaluated after ischemia throughout 90 minutes of reperfusion. Left ventricular contractility function was reported as percentage of recovery, expressed by developed pressure, maximum dP/dt, minimum dP/dt, and rate pressure product variables. In addition, coronary resistance and myocardial injury marker by alpha-fodrin degradation were also evaluated. Results: At 90 minutes of reperfusion, both solutions had superior left ventricular contractile recovery function than the control group. Del Nido-LP was superior to Custodiol-LP in maximum dP/dt (46%±8 vs. 67%±7, P<0.05) and minimum dP/dt (31%±4 vs. 51%±9, P<0.05) variables. Coronary resistance was lower in del Nido-LP group than in Custodiol-LP (395%±50 vs. 307%±13, P<0.05), as well as alpha-fodrin degradation, with lower levels in del Nido-LP group (P<0.05). Conclusion: Del Nido-LP cardioplegia showed higher functional recovery after 3 hours of ischemia. The analysis of alpha-fodrin degradation showed del Nido-LP solution provided greater protection against myocardial ischemia and reperfusion (IR) in this experimental model
Trimetazidina como aditivo em solução cardioplégica sem pré-tratamento não traz proteção adicional ao miocárdio isquêmico: estudo em modelo suíno de coração isolado Trimetazidine as cardioplegia addictive without pre-treatment does not improve myocardial protection: study in a swine working heart model
OBJETIVO: Verificar, em modelo experimental de coração isolado de suínos, se a associação da trimetazidina à solução cardioplégica promove melhora no desempenho do coração. MÉTODOS: O modelo experimental utilizou suínos Large-White, com coração isolado perfundido por suporte de outro animal em modo de execução de trabalho ("working heart state"). Foram divididos em três grupos (n = 6), submetidos a isquemia regional seguida de isquemia global, que recebiam um dos três tratamentos: solução St Thomas (ST), solução St Thomas acrescida de trimetazidina (TMZ) e grupo controle (Co). Durante período de reperfusão, aos 30, 60 e 90 minutos, foram medidos parâmetros hemodinâmicos de contratilidade e metabólicos, obtendo-se assim a elastância máxima (Emáx), o índice de trabalho sistólico pré-recrutável (PRSW), "dureza" do ventrículo (EDPRV), fluxo coronariano, consumo de oxigênio e dosagens de lactato e glicose. Os resultados foram analisados estatisticamente. RESULTADOS: Em relação aos parâmetros hemodinâmicos de contratilidade, não houve diferença estatística significante entre os três grupos. Houve produção crescente de lactato nos três grupos de forma uniforme quanto maior o tempo de reperfusão. O fluxo coronariano, o consumo de oxigênio e o consumo de glicose tiveram grande variação entre os diferentes tempos medidos, mas sem diferença entre os três tratamentos. O peso final do ventrículo esquerdo foi significativamente menor no grupo trimetazidina (TMZ) do que nos demais. CONCLUSÃO: A administração da trimetazidina associada como adjuvante à solução cardioplégica, sem pré-tratamento, não demonstrou benefício hemodinâmico ou metabólico em modelo experimental "working heart" de coração isolado em porcos.OBJECTIVE: The aim of this study is to verify in an isolated working heart swine model if the acute administration of trimetazidine to cardioplegia, without pre=treatment improves heart performance. METHODS: Eighteen pairs of swines were used in this working heart model, divided into three groups (n = 6) that underwent regional and global ischemia. Each group was selected to a different treatment: St Thomas cardioplegia (ST), St Thomas enriched with trimetazidine (TMZ) and control group (Co). Data was collected during reperfusion period at 30, 60 and 90 minutes. Hemodinamic parameters such as elastance contractility index (Emax), preload recruitable stroke work relationship (PRSW) and heart "stiffness" (EDPVR) were measured. Other data included coronary flow, lactate, oxygen and glucose consumption. Results were statistically analyzed. RESULTS: All contractility data were not significantly different among three groups. Lactate became constantly higher according to time uniformly in all three groups. Coronary flow, glucose consumption and oxygen consumption presented large variations during time periods but according to treatments showed no statistical differences in all three groups. Left ventricle final weight was significantly lower in trimetazidine group compared to both other groups. CONCLUSION: Administration of trimetazidine enhanced cardioplegia, without pre-treatment, showed no hemodinamic or metabolic improvement in swine isolated working heart model
Trimetazidina como aditivo em solução cardioplégica sem pré-tratamento não traz proteção adicional ao miocárdio isquêmico: estudo em modelo suíno de coração isolado Trimetazidine as cardioplegia addictive without pre-treatment does not improve myocardial protection: study in a swine working heart model
OBJETIVO: Verificar, em modelo experimental de coração isolado de suínos, se a associação da trimetazidina à solução cardioplégica promove melhora no desempenho do coração. MÉTODOS: O modelo experimental utilizou suínos Large-White, com coração isolado perfundido por suporte de outro animal em modo de execução de trabalho ("working heart state"). Foram divididos em três grupos (n = 6), submetidos a isquemia regional seguida de isquemia global, que recebiam um dos três tratamentos: solução St Thomas (ST), solução St Thomas acrescida de trimetazidina (TMZ) e grupo controle (Co). Durante período de reperfusão, aos 30, 60 e 90 minutos, foram medidos parâmetros hemodinâmicos de contratilidade e metabólicos, obtendo-se assim a elastância máxima (Emáx), o índice de trabalho sistólico pré-recrutável (PRSW), "dureza" do ventrículo (EDPRV), fluxo coronariano, consumo de oxigênio e dosagens de lactato e glicose. Os resultados foram analisados estatisticamente. RESULTADOS: Em relação aos parâmetros hemodinâmicos de contratilidade, não houve diferença estatística significante entre os três grupos. Houve produção crescente de lactato nos três grupos de forma uniforme quanto maior o tempo de reperfusão. O fluxo coronariano, o consumo de oxigênio e o consumo de glicose tiveram grande variação entre os diferentes tempos medidos, mas sem diferença entre os três tratamentos. O peso final do ventrículo esquerdo foi significativamente menor no grupo trimetazidina (TMZ) do que nos demais. CONCLUSÃO: A administração da trimetazidina associada como adjuvante à solução cardioplégica, sem pré-tratamento, não demonstrou benefício hemodinâmico ou metabólico em modelo experimental "working heart" de coração isolado em porcos.<br>OBJECTIVE: The aim of this study is to verify in an isolated working heart swine model if the acute administration of trimetazidine to cardioplegia, without pre=treatment improves heart performance. METHODS: Eighteen pairs of swines were used in this working heart model, divided into three groups (n = 6) that underwent regional and global ischemia. Each group was selected to a different treatment: St Thomas cardioplegia (ST), St Thomas enriched with trimetazidine (TMZ) and control group (Co). Data was collected during reperfusion period at 30, 60 and 90 minutes. Hemodinamic parameters such as elastance contractility index (Emax), preload recruitable stroke work relationship (PRSW) and heart "stiffness" (EDPVR) were measured. Other data included coronary flow, lactate, oxygen and glucose consumption. Results were statistically analyzed. RESULTS: All contractility data were not significantly different among three groups. Lactate became constantly higher according to time uniformly in all three groups. Coronary flow, glucose consumption and oxygen consumption presented large variations during time periods but according to treatments showed no statistical differences in all three groups. Left ventricle final weight was significantly lower in trimetazidine group compared to both other groups. CONCLUSION: Administration of trimetazidine enhanced cardioplegia, without pre-treatment, showed no hemodinamic or metabolic improvement in swine isolated working heart model
Padronização de modelo de coração isolado "working heart" com circulação parabiótica Development of isolated swine "working heart model" with parabiotic circulation
OBJETIVO: Desenvolver modelo de coração isolado de suíno "working heart" sob suporte por circulação parabiótica e verificar se o mesmo é estável e se possibilitou de forma efetiva a mensuração dos dados propostos. MÉTODOS: O modelo foi padronizado durante preparação para estudo de associação de agente à solução cardioplégica. Foram realizados 18 experimentos com um animal suporte e um animal doador em cada. O coração do animal doador foi perfundido como coração isolado pelo animal suporte em modo de execução de trabalho ("coração ejetante"). O coração isolado foi submetido à isquemia regional por pinçamento da artéria interventricular anterior seguido de isquemia global. Durante reperfusão, com o coração ejetante (em modo "working heart"), aos 30, 60 e 90 minutos foram medidos parâmetros hemodinâmicos de contratilidade e metabólicos, obtendo-se assim a elastância máxima (Emáx), o trabalho sistólico pré-recrutável (PRSW), rigidez do ventrículo (EDPRV), fluxo coronariano, consumo de oxigênio e dosagens de lactato e glicose. RESULTADOS: Os animais suporte ficaram estáveis durante todo o experimento. O pH, a pressão parcial de oxigênio e o hematócrito foram mantidos estáveis e dentro da faixa fisiológica. O coração isolado foi perfundido de forma adequada durante todo o experimento. Os dados hemodinâmicos e metabólicos propostos puderam ser mensurados adequadamente e sempre com o coração ejetante, em modo de execução de trabalho ("working heart"). CONCLUSÃO: O modelo de coração isolado desenvolvido tipo "working heart" se manteve estável durante todo o experimento, sem a administração de drogas cardiotônicas e possibilitou a mensuração de todos os dados propostos de forma efetiva com o coração executando trabalho.<br>OBJECTIVE: To develop an isolated working heart model with parabiotic circulaton in swines and verify its stability and possibility to allow effective measurements of hemodinamic and metabolic data. METHODS: This model was developed during study of association of agents to cardiolegia. There were performed 18 experiments, each with a support animal and a donor animal. Donor animal heart was perfused as isolated working heart with parabiotic circulation from support animal. Isolated heart underwent regional ischemia by interventricular artery clamping, followed by global ischemia. During reperfusion in working heart state mode at 30, 60 and 90 minutes, contractility indices such as elastance, preload recruitable stroke work index and metabolic data were acquired. RESULTS: Support animals were kept stable throughout the procedures without use of blood transfusions or vasoactive drugs. pH, oxygen partial pressure and hematocrit were kept stable and within physiologic ranges. Isolated heart was perfused adequately throughout the experiment. All hemodinamic and metabolic data proposed were adequately measured in working heart state mode. CONCLUSION: This swine isolated "working heart" model was kept stable throughout the experiments with no administration of vasoactive drugs and it allowed adequate measurements of metabolic and hemodinamic data
Trimetazidine As Cardioplegia Addictive Without Pre-treatment Does Not Improve Myocardial Protection: Study In A Swine Working Heart Model.
The aim of this study is to verify in an isolated working heart swine model if the acute administration of trimetazidine to cardioplegia, without pre-treatment improves heart performance. Eighteen pairs of swine were used in this working heart model, divided into three groups (n = 6) that underwent regional and global ischemia. Each group was selected to a different treatment: St. Thomas cardioplegia (ST), St. Thomas enriched with trimetazidine (TMZ) and control group (Co). Data was collected during reperfusion period at 30, 60 and 90 minutes. Hemodynamic parameters such as elastance contractility index (Emax), preload recruitable stroke work relationship (PRSW) and heart stiffness (EDPVR) were measured. Other data included coronary flow, lactate, oxygen and glucose consumption. Results were statistically analyzed. All contractility data were not significantly different among three groups. Lactate became constantly higher according to time uniformly in all three groups. Coronary flow, glucose consumption and oxygen consumption presented large variations during time periods but according to treatments showed no statistical differences in all three groups. Left ventricle final weight was significantly lower in trimetazidine group compared to both other groups. Administration of trimetazidine enhanced cardioplegia, without pre-treatment, showed no hemodynamic or metabolic improvement in swine isolated working heart model.23224-3
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