Až do konce 19. století se na srdce nahlíželo jako na v jistém smyslu "nedotknutelný" orgán. V roce 1895 napsal známý chirurg Stephen Paget, že "výkony na srdci nejspíše dosáhly hranice nastavené přírodou, (protože) žádné nové metody a žádné nové objevy nedokážou překonat přirozené obtíže doprovázející poranění srdce". Nicméně chirurgové jako Axel Cappelen v Norsku v roce 1895 a Němec Ludwig Rehn se v roce 1896 odvážili vstoupit do této tabuizované oblasti a řešit bodná poranění srdce; tak začala éra kardiochirurgie. Později dvě světové války poskytly válečným veteránům, jakými byli George Gray Turner, Henry Souter, Dewitt E. Harken, Wilfred Gordon Bill Bigelow, Walton Lillehei, John Gibbon, Vasilii Kolesov, Nikolai Amosov, Christian Cabrol a mnoho dalších, četné příležitosti k hledání způsobů léčby poranění srdce. Na přelomu století nabyla revmatická horečka s endokarditidou téměř epidemických rozměrů; výsledkem bylo, že se postižení mitrální chlopně stalo běžnou komplikací. Intenzivní pátrání po chirurgickém řešení si vyžádalo dlouhou řadu experimentů, jež prováděli chirurgové Alexis Carrel a Tuffier v roce 1914, Elliot C. Cuttler v roce 1923 a sir Henry Souttar v roce 1925. Operace malého pacienta se syndromem modrého dítěte, kterou v roce 1944 provedli Blalock a Taussigová, prokázala, že výkony na srdci jsou možné. Za začátek moderní éry kardiochirurgie lze považovat rok 1953, kdy John Gibbon popsal metodu kardiopulmonálního bypassu (cardiopulmonary bypass, CPB). Dějiny inovací v kardiochirurgii v období před CPB tak představují fascinující součást dějin medicíny.

Until the late 19th century, the heart was thought as an organ that shouldn't be touched. Famous surgeon Stephen Paget in 1895 wrote: "Surgery of the heart has probably reached the limit set by the nature, no new methods, and no new discovery can overcome the natural difficulties that attend a wound of the heart." But surgeons like Axel Cappelen in Norway in 1895, and Ludwig Rehn in Germany in 1896 dared to enter into this taboo territory and repaired stab injuries of the heart. With these, the era of cardiac surgery began. Later, the two world wars opened the opportunities of exploring heart wounds for the war veterans like George Gray Turner, Henry Souter, Dewitt E. Harken, Wilfred Gordon Bill Bigelow, Walton Lillehei, John Gib- bon, Vasilii Kolesov, Nikolai Amosov, Christian Cabrol and many others. At the turn of the century, rheumatic fever with endocarditis was almost an epidemic disease. Consequently, mitral valvular pathologies were common complications. The intense search for a surgical solution led to the valuable experimental works of Alexis Carrel and Tuffier in 1914, Elliot C. Cuttler in 1923, and Sir Henry Souttar in 1925. In 1944, Blalock-Taussig shunt designed for blue baby demonstrated that heart surgery could be possible. Finally in 1953 John Gibbon developed the cardiopulmonary bypass (CPB) technique with the heart lung machine com- mencing the modern era of cardiac surgery. The history of Pre-CPB innovations of cardiac surgery remains a fascinating part of the history of medicine.

• MeSH
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• hrudní chirurgie dějiny   metody   MeSH
• kardiochirurgické výkony * dějiny   metody   MeSH
• kardiopulmonální bypass dějiny   metody   MeSH
• lidé MeSH
• srdce patofyziologie   MeSH
• Check Tag
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH

The aim of this study was to describe and quantify pharmacokinetics of ampicillin used prophylactically in cardiac surgery both with and without cardiopulmonary bypass (CPB) using population pharmacokinetic analysis in order to propose an optimal dosing strategy. Adult patients undergoing cardiac surgery and treated with prophylactic dose of 2 g ampicillin were enrolled to this prospective study. Blood samples were collected according to the study protocol and ampicillin plasma concentrations were measured using HPLC/UV system. A three-stage population pharmacokinetic model using nonlinear mixed-effects modelling approach was developed. Totally 273 blood samples obtained from 20 patients undergoing cardiac surgery with the use of the CPB and 20 patients without CPB use were analyzed. Two-comparmental model best fits ampicillin concentration-time data. Mean ± SD body weight-normalized ampicillin central and peripheral volume of distribution was 0.12 ± 0.02 L/kg and 0.15 ± 0.03 L/kg, respectively, while mean ± SD ampicillin clearance in typical patient with eGFR of 1.5 mL/s/1.73 m2 was 1.17 ± 0.05 L/h. The use of CPB did not significantly affect the pharmacokinetics of ampicillin. When administering 2 g of ampicillin before surgery, an additional dose should be administered to reach the PK/PD target of fT > MIC = 50% if the operation lasts longer than 430 min in patients with moderate to severe renal impairment, 320 min in patients with mild renal impairment, 220 min in patients with normal renal function status or 140 min in patients with an augmented renal clearance.

• MeSH
• ampicilin MeSH
• antibakteriální látky * terapeutické užití   MeSH
• dospělí MeSH
• kardiochirurgické výkony * MeSH
• kardiopulmonální bypass škodlivé účinky   metody   MeSH
• lidé MeSH
• prospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Cardiac surgery and cardiopulmonary bypass (CPB) have been shown to stimulate a systemic inflammatory response which has been associated with adverse postoperative outcomes. Adipose tissue, both epicardial (EAT) and subcutaneous (SAT), is a known source of inflammatory cytokines, but its role in the pathophysiology of surgery- and CPB-induced systemic inflammatory response has not been fully elucidated. Therefore, we conducted a study to establish levels of selected cytokines in EAT and SAT prior to and after surgery with CPB. METHODS: Adipose tissue samples were obtained from patients undergoing planned cardiac surgery on CPB. Samples from EAT and SAT were collected before and immediately after CPB. Levels of tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), adipocyte fatty acid-binding protein (AFABP), leptin and adiponectin were determined by ELISA, which were adjusted for a total concentration of proteins in the individual samples. RESULTS: Samples from 77 patients (mean age 67.68 ± 11.5 years) were obtained and analysed. Leptin, adiponectin, TNF-α and AFABP were shown to decrease their concentrations statistically significantly in the EAT after CPB while no statistically significant drop was observed in the SAT. On the contrary, IL-6 showed only a slight and statistically insignificant decrease in the EAT after CPB and it was in the SAT where a statistically significant drop was observed. DISCUSSION: One of the most relevant findings of this study was the marked decrease in EAT levels of TNF-α, AFABP, leptin and adiponectin after the CPB termination. Our results suggest that EAT might serve as a pool of cytokines which are released into the circulation in reaction to surgery with CPB. Should these novel findings be confirmed, new strategies to assess and possibly reduce EAT contribution on adverse outcomes of cardiac surgery may be developed.

• MeSH
• cytokiny metabolismus   MeSH
• kardiopulmonální bypass metody   MeSH
• lidé MeSH
• perikard metabolismus   MeSH
• podkožní tuk metabolismus   MeSH
• senioři MeSH
• tuková tkáň metabolismus   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

OBJECTIVE: Cardiac surgery is known to trigger a systemic inflammatory response. While the use of conventional cardiopulmonary bypass (CPB) results in profound inflammation, modified mini-CPB is considered less harmful. We evaluated the impact of cardiac surgery on the expression of CD162, CD166, CD195 molecules and their association with the type of CPB used. METHODS AND RESULTS: Twenty-four patients were enrolled in our study. Twelve of them were operated using conventional CPB while the other twelve patients underwent surgery with mini-CPB. Blood samples were analysed by flow cytometry. We observed a significant increase in median fluorescence intensity of CD162 and CD195 that peaked instantly after surgery and normalized to the baseline value on the 1st day post surgery, whereas CD166 was initially down-regulated and its median fluorescence intensity (MFI) value increased to the baseline in the next few days. CONCLUSION: We observed immediate changes in the expression of CD162, CD166, and CD195 molecules on the neutrophils after surgery in both study groups of patients. The intensity of the observed changes was significantly greater in the group of patients who underwent conventional CPB compared to patients who underwent mini-CPB cardiac surgery.

• MeSH
• CD antigeny analýza   imunologie   MeSH
• fetální proteiny analýza   imunologie   MeSH
• kardiopulmonální bypass škodlivé účinky   přístrojové vybavení   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• membránové glykoproteiny analýza   imunologie   MeSH
• miniinvazivní chirurgické výkony škodlivé účinky   přístrojové vybavení   metody   MeSH
• molekuly buněčné adheze neuronové analýza   imunologie   MeSH
• neutrofily imunologie   MeSH
• receptory CCR5 analýza   imunologie   MeSH
• senioři MeSH
• zánět etiologie   imunologie   prevence a kontrola   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

OBJECTIVES: The systemic inflammatory response syndrome (SIRS) after cardiac surgery with cardiopulmonary bypass (CPB) exacerbates organ dysfunction and increases postoperative mortality. The aim of this study was to reduce SIRS after CPB in a pig model by profoundly decreasing all blood defence factors (complement, coagulation and fibrinolytic and contact systems, leukocytes and thrombocytes) using pre‑operative aphaeresis. METHODS: Thirty-three pigs underwent 3 h of hypothermic CPB with 2 h of cardioplegic arrest, followed by 4 days of observation. One half of the sample underwent prebypass plasma-thrombo-leukocyte aphaeresis with the adjuvant leukofiltration. RESULTS: In the control group, there were classical signs of SIRS (tachycardia, tachypnea and leukocytosis) postoperatively. There was also myocardial ischaemia and the need for inotropic support in 90% of the control animals. Neutrophils showed an increase in superoxide anion production (P < 0.001), and surface neutral protease activity (P < 0.001) and blood endotoxin levels increased (P < 0.01) compared with preoperative levels. In contrast, in the aphaeretic group, there were no classical signs of SIRS; no myocardial ischaemia; minimum neutrophil production of the superoxide anion and protease activity were recorded (P < 0.001); and endotoxin levels were also decreased (P < 0.05) compared with the controls. In the control group, the haemodynamic problems associated with disconnecting from CPB correlated with the histologic findings in the myocardium (leukocyte endothelial adhesion and leukodiapedesis). CONCLUSIONS: Pre‑operative plasma‑thrombo-leukocyte aphaeresis significantly reduces the major symptoms of SIRS and organ dysfunction after 3 h of CPB without adverse effects, such as bleeding and infection, during the postoperative course.

• MeSH
• ischemická choroba srdeční etiologie   MeSH
• kardiopulmonální bypass metody   MeSH
• krevní plazma MeSH
• leukaferéza metody   MeSH
• leukocyty fyziologie   MeSH
• miniaturní prasata MeSH
• modely nemocí na zvířatech MeSH
• plazmaferéza metody   MeSH
• prasata MeSH
• předoperační období MeSH
• separace krevních složek metody   MeSH
• syndrom systémové zánětlivé reakce prevence a kontrola   MeSH
• terapeutická hypotermie metody   MeSH
• trombocyty MeSH
• vyvolaná zástava srdce metody   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: There is some controversy as to whether there is a benefit from the use of a centrifugal pump compared with a roller pump during cardiopulmonary bypass to facilitate cardiac surgery. We compared the two pumps, with the primary aim of determining any difference in the effects on inflammation after pulmonary endarterectomy surgery which required prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest. METHODS: Between September 2010 and July 2013, 58 elective patients undergoing pulmonary endarterectomy were included in this prospective, randomised, controlled study; 30 patients were randomly allocated to the control group, which used a roller pump, and 28 patients to the treatment group, which used a centrifugal pump. Interleukin-6, procalcitonin, C-reactive protein, thromboelastographic parameters, P-selectin, international normalised ratio, activated prothrombin time, free haemoglobin, haematocrit, red blood cell count, white blood cell count, platelet count and protein S100β were recorded during and after the procedure. We also recorded the length of intensive care unit stay, blood loss and transfusion, neurological outcomes and respiratory and renal failure. RESULTS: There was a significant difference in the primary outcome measure: Interleukin-6 was significantly higher in the roller pump group (587 ± 38 ng · l(-1) vs. 327 ± 37 ng · l(-1); p<0.001) 24 hours after surgery, which we interpreted as an increased inflammatory response. This was confirmed by a significant rise in the procalcitonin level in the roller pump group 48 hours following surgery (0.79 (0.08-25.25) ng · ml(-1) vs. 0.36 (0.02-5.83) ng · ml(-1); p<0.05). There were, however, no significant differences in clinical outcome data. CONCLUSIONS: We have shown that the use of a centrifugal pump during prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with a reduced inflammatory response compared to the standard roller pump. Larger multi-centre trials in this area of practice are required.

• MeSH
• dospělí MeSH
• kardiopulmonální bypass přístrojové vybavení   metody   MeSH
• krevní proteiny metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počet leukocytů MeSH
• podpůrné srdeční systémy * MeSH
• zánět krev   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

AIM: The aim of this study was to compare the impact of standard cardiopulmonary bypass (CPB) with mini CPB on peripheral tissue perfusion. METHODS: 24 patients with ischemic heart disease scheduled for CPB were randomised to two groups: Group A (12 patients, standard CPB) and Group B (12 patients, mini CPB). Oxygen tension was measured with an optical multiparametric sensor inserted into the patient's deltoid muscle. RESULTS: Lower priming in Group B (870 ± 221 mL) vs. Group A (1502 ± 48 mL) and significantly reduced hemodilution during mini CPB (Group B 25.3 ± 1.1% vs. Group A 30.1 ± 2.3%) were recorded. Higher and continuous blood flow during perfusion was analysed in Group A (4.58 ± 0.34 L.min(-1)) and lower than calculated blood flow was found in Group B (3.49 ± 0.51 L.min(-1) vs. 4.66 ± 0.38 L.min(-1)). There was a direct correlation between mean arterial pressure (MAP) and ptO2 in Group A during CPB and a direct correlation between pump blood flow and MAP during CPB in Group B. Higher levels of ptO2 during CPB and surgery after CPB in comparison with initial levels were found in Group B. Decreased ptO2 levels after surgery were found in both groups. CONCLUSION: Mini CPB enables perfusion with a relatively low flow. The results of this study suggest that a flow decrease in mini CPB is well tolerated by the organism.

• MeSH
• arteriální tlak MeSH
• elektivní chirurgické výkony metody   MeSH
• hodnocení rizik MeSH
• ischemická choroba srdeční krev   patofyziologie   chirurgie   MeSH
• kardiopulmonální bypass přístrojové vybavení   metody   MeSH
• kyslík krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrocirkulace * MeSH
• musculus deltoideus krevní zásobení   MeSH
• oxymetrie přístrojové vybavení   metody   MeSH
• pilotní projekty MeSH
• reprodukovatelnost výsledků MeSH
• rizikové faktory MeSH
• senioři MeSH
• spotřeba kyslíku MeSH
• vzorkové studie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Coronary artery bypass grafting (CABG) is performed with the use of cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) of the heart. The advantage of this technique, alternatively referred to as "on-pump" surgery, resides, for the surgeon, in relatively easy access to and manipulation with the non-beating, bloodless heart. However, the advantage that is, thereby, gained by the patient is paid off by an increased susceptibility to postoperative systemic inflammatory response syndrome (SIRS). Under unfavorable conditions, the inflammatory syndrome may develop into life-threatening forms of MODS (multiple organ dysfunction syndrome) or even MOFS (multiple organ failure syndrome). Deliberate avoidance of CPB, also known as "off-pump" surgery, attenuates early postoperative inflammation throughout its trajectory of SIRS→MODS→MOFS, but, in the long run, there appears to be no substantial difference in the overall mortality rates. In the last years, our knowledge of the pathophysiology of surgical inflammation has increased considerably. Recent findings, highlighting the as yet rather obscure role of pentraxin 3 (PTX3) in these processes, are discussed in this review article.

• MeSH
• antiflogistika imunologie   MeSH
• ateroskleróza imunologie   MeSH
• C-reaktivní protein genetika   imunologie   MeSH
• infarkt myokardu imunologie   MeSH
• interleukin-10 imunologie   MeSH
• kardiopulmonální bypass škodlivé účinky   metody   MeSH
• koronární bypass škodlivé účinky   metody   MeSH
• lidé MeSH
• sérový amyloidový protein genetika   imunologie   MeSH
• syndrom systémové zánětlivé reakce etiologie   genetika   imunologie   MeSH
• transkriptom MeSH
• vyvolaná zástava srdce škodlivé účinky   metody   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

Interleukin-10 (IL-10) is considered to be a cytokine with potent anti-inflammatory properties, which have been previously linked to increased incidence of sepsis. The level of IL-10 is elevated by cardiac surgery when cardiopulmonary bypass (CPB) and methylprednisolone are used. In our study, we compare the level of IL-10, IL-10 Receptor (IL-10R), and percentage of neutrophils between two groups of cardiac surgical patients undergoing Coronary Artery Bypass Grafting, both of which were not given methylprednisolone. The first group was operated with conventional CPB, while the second group was operated with minimally invasive CPB (mini-CPB). We detected enhanced level of IL-10 during surgery and at the end of surgery in both groups of patients. While no correlation between IL-10 and IL10R was found, IL-10 was positively correlated with increased percentage of neutrophils at the time points when the level of IL-10 peaked.

• MeSH
• aktivace neutrofilů MeSH
• cytokiny metabolismus   MeSH
• interleukin-10 metabolismus   MeSH
• kardiopulmonální bypass metody   MeSH
• koronární bypass metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• methylprednisolon farmakologie   MeSH
• miniinvazivní chirurgické výkony MeSH
• neutrofily cytologie   metabolismus   MeSH
• receptory interleukinu-1 biosyntéza   MeSH
• regulace genové exprese MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Aims: To follow the IFNγ receptor expression on monocytes and granulocytes of cardiac surgical patients with respect to the type of cardiopulmonary bypass (CPB). Methods: Expression of IFNγ receptor on monocytes and granulocytes of 26 cardiac surgical patients operated with the use of either "standard" or "miniaturised" CPB was determined by flow cytometry. Results: The significant increase in IFNγ receptor expression on monocytes on the 1(st) and on the 3(rd) postoperative days was revealed in both groups of patients (p<0.001) irrespective of the type of CPB used, being non-significantly different between groups. In contrast, the expression of IFNγ on granulocytes displayed significant differences in terms of the CPB used. Whereas, in "standard" CPB patients, granulocyte INFγ receptor expression reached its maximum immediately after surgery (p<0.01), in "miniivasive" CPB patients, the peak in INFγ receptor expression was postponed to the 1(st) postoperative day (p<0.05). Statistically significantly higher IFNγ receptor expression on granulocytes was found in "standard" CPB patients (p<0.05). Conclusion: Compared to "miniaturised" CPB patients, the significantly higher IFNγ receptor expression on granulocytes was found in "standard" CPB patients (p<0.05) on the 1(st) postoperative day.

• MeSH
• granulocyty metabolismus   MeSH
• kardiochirurgické výkony MeSH
• kardiopulmonální bypass klasifikace   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniaturizace MeSH
• monocyty metabolismus   MeSH
• pooperační období MeSH
• průtoková cytometrie MeSH
• receptory interferonů metabolismus   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH