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Cardiovascular surgery and organ damage: Time to reconsider the role of hemolysis
IC Vermeulen Windsant, SJ Hanssen... - ... and Cardiovascular ..., 2011 - AATS/WTSACardiovascular surgery with cardiopulmonary bypass is associated with postoperative organ injury, which severely affects patient morbidity and mortality. Multiple cardiopulmonary bypassrelated mechanisms have been linked to the development of tissue damage, ...
Introduction Cardiovascular surgery with cardiopulmonary bypass is associated with postoperative organ injury, which severely affects patient morbidity and mortality. Multiple cardiopulmonary bypass related mechanisms have been linked to the development of tissue damage, including hypoperfusion, ischemia reperfusion, and induction of a proinflammatory response. Hemolysis, resulting in increased plasma free hemoglobin concentrations, is generally considered an inevitable but relatively harmless side effect of cardiopulmonary bypass. Recently, however, evidence has been mounting that plasma free hemoglobin scavenges intravascular nitric oxide, thereby attenuating its bioavailability. Any significant reduction in nitric oxide, the most important endogenous vasodilator, impairs tissue perfusion and induces organ injury development. Moreover, urinary free hemoglobin contributes to renal damage, specifically by catalysis of reactive oxygen species formation. In this review, the effects of increased free hemoglobin levels on nitric oxide metabolism are discussed. In addition, we review the role of free hemoglobin in organ injury development, potential sources of free hemoglobin during cardiovascular surgery, and therapeutic options to attenuate the consequences of hemolysis. We propose that hemolysis is more than an innocent bystander effect of cardiopulmonary bypass assisted surgery. Therapeutic interventions to attenuate the effects of hemolysis seem crucial in the reduction of postoperative morbidity and mortality after cardiovascular surgery.
Cardiovascular surgery with extracorporeal circulation is associated with considerable postoperative morbidity and mortality, especially among patients undergoing complex procedures such as combined coronary artery bypass grafting (CABG) and valve surgery, Bentall procedures, and open repair of thoracic and thoracoabdominal aortic aneurysms. These patients are at high risk for development of such major complications as acute kidney injury,1-6 pulmonary dysfunction,7,8 sepsis, and multiple organ failure.9
The pathophysiologic mechanisms underlying these complications have been studied extensively in an attempt to develop specific prevention and treatment strategies. The cardiopulmonary bypass (CPB) circuit has been associated with the development of tissue damage as a result of insufficient oxygen . . . [Full Text of this Article]
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