[The post-perfusion syndrome after operations performed with extracorporeal circulation].
Postperfusion syndrome (PPS) is a dreaded complication of cardiac surgery operation in extracorporeal circulation (ECC). Four factors play a key role in its pathophysiology: 1. contact of blood with the material of ECC, 2. release of activated leucocytes from pulmonary bed after the release of aortic cross-clamp, 3. translocation of endotoxin due to gut ischemia and its consequent reperfusion, 4. activation of coagulation, fibrinolytic, kallikrein-kinin and complement systems. The occurrence of PPS can be limited by reducing the ECC time and/or cross-clamp time, by using membrane oxygenator in the system of ECC, by using polyester or polypropylene in the set of ECC, by using heparin-coated set or leucocyte filter in the system of ECC, by application of pharmacological dosis of corticosteroids prior to the ECC, by early enteral nutrition. In eligible patients it is possible to eliminate the risk of PPS completely by using the operation without ECC. The experience of the authors with above mentioned problems is given and confronted with literature.
Brtko
M
M
Kardiochirurgická klinika, Fakultní nemocnice v Hradci Králové. brtkova@fnhk.cz
Lonský
V
V
Kunes
P
P
Dominik
J
J
Kubícek
J
J
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D006801:Humans; D015427:Reperfusion Injury / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*