Three-Dimensional and Biomimetic Technology in Cardiac Injury After Myocardial Infarction: Effect of Acellular Devices on Ventricular Function and Cardiac Remodelling

Dilated cardiomyopathy (DMC) of ischemic or non-ischemic aetiology remains a lethal condition nowadays. Despite early percutaneous or medical revascularization after an acute myocardial infarct (AMI), many patients still develop DMC and severe heart failure due to cardiac remodelling. Possibility of regenerating myocardium already damaged or at least inducing a more positive cardiac remodelling with use of biodegradable scaffolds has been attempted in many experimental studies, which can be cellular or acellular. In the cellular scaffolds, the cells are incorporated in the structure prior to implantation of the same into the injured tissue. Acellular scaffolds, in turn, are composites that use one or more biomaterials present in the extracellular matrix (ECM), such as proteoglycans non-proteoglycan polysaccharide, proteins and glycoproteins to stimulate the chemotaxis of cellular/molecular complexes as growth factors to initiate specific regeneration. For the development of scaffold, the choice of biomaterials to be used must meet specific biological, chemical and architectural requirements like ECM of the tissue of interest. In acute myocardial infarction, treating the root of the problem by repairing injured tissue is more beneficial to the patient. Inducing more constructive forms of endogenous repair. Thus, patches of acellular scaffolds capable of mimicking the epicardium and ECM should be able to attenuate both cardiac remodelling and adverse cardiac dysfunction

Does the roller pump adjustment in cardiopulmonary bypass settings influence hemolysis?

Roller pumps are widely used in procedures involving cardiopulmonary bypass (CPB) due to their ease of operation and maintenance, safety, and cost. Several studies in the literature have compared the use of roller pumps with centrifugal pumps, but the influence of the roller pump adjustment on hemolysis has been poorly explored. Measurements of hemolysis rates were carried out in 86 patients. The pump was adjusted by the dynamic calibration method, which was performed by an auxiliary device, and the patients were grouped according to the pump calibration: Group 1 (n = 20) 75 mmHg; Group 2 (n = 24) 150 mmHg; Group 3 (n = 22) 300 mmHg and Group 4 (n = 21) 450 mmHg. The hemolysis rates were measured at 4 different times during CPB (TO: before the surgical procedure; T1: 5 minutes after the start of CPB; T2: 30 minutes of CPB; and T3: 5 minutes after the CPB procedure). Hemolysis rates were calculated between the time intervals T0–T1, T1–T2, and T0–T3. No difference in hemolysis rates was observed between the groups (p>0.31). During the first 5 minutes of CPB, hemolysis represented 35.5% of the total hemolysis and no significant difference was found between groups (p>0.60). Calibration of roller pumps by the dynamic method did not influence the hemolysis rates. Additionally, the hemolysis during the first 5 minutes of CPB accounted for ∼1/3 of the total hemolysis40311812

Use Of Modified Ultrafiltration In Adults Undergoing Coronary Artery Bypass Grafting Is Associated With Inflammatory Modulation And Less Postoperative Blood Loss: A Randomized And Controlled Study.

Modified ultrafiltration (MUF) has been shown to decrease the postcardiac surgery inflammatory response and to improve respiratory function and cardiac performance in pediatric patients; however, this approach has not been well established in adults. The present study hypothesized that MUF could decrease the postsurgical inflammatory response, leading to improved respiratory and cardiac function in adults undergoing coronary artery bypass grafting. Sixty patients undergoing coronary artery bypass grafting were randomized to the MUF or control group (n = 30 each). MUF was performed for 15 minutes at the end of bypass. The following data were recorded at the beginning of anesthesia, end of bypass, end of experimental treatment, and 24 and 48 hours after surgery: alveolar-arterial oxygen gradient, red blood cell units transfused, chest tube drainage, hemodynamic parameters, and cytokine levels (interleukin-6, P-selectin, intercellular adhesion molecule, and soluble tumor necrosis factor receptor). The MUF group displayed less chest tube drainage than the control group after 48 hours (598 ± 123 mL vs 848.0 ± 455 mL; P = .04) and less red blood cell transfusions (0.6 ± 0.6 units/patient vs 1.6 ± 1.1 units/patient; P = .03). Hematocrit level was higher in the MUF group than in the control group at the end of bypass (37.8% ± 1.1% vs 34.1% ± 1.1%; P < .05), but the levels were comparable at 48 hours. Similar values for interleukin-6 and P-selectin were observed at all stages. Plasma levels of intercellular adhesion molecule were higher in the MUF group than in the control group, particularly in the first sampling after experimental treatment (P = .01). Plasma levels of soluble tumor necrosis factor receptor were higher in the MUF group than in the control group at 48 hours. Hemodynamic and oxygen transport parameters were similar in both groups throughout the observation period. There were no differences in other clinical outcomes. Use of MUF was associated with increased inflammatory response, reduced blood loss, and less blood transfusions in adults undergoing coronary artery bypass grafting.144663-7