33,575 results on '"CARDIOPULMONARY BYPASS"'
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2. Inhibition of Caspase-1-dependent pyroptosis alleviates myocardial ischemia/reperfusion injury during cardiopulmonary bypass (CPB) in type 2 diabetic rats
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Wenjing Zhou, Yingya Yang, Zhouheng Feng, Yu Zhang, Yiman Chen, Tian Yu, and Haiying Wang
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Type 2 diabetes mellitus ,Cardiopulmonary bypass ,Myocardial ischemia/reperfusion injury ,Pyroptosis ,Caspase-1 ,Medicine ,Science - Abstract
Abstract Cardiovascular complications pose a significant burden in type 2 diabetes mellitus (T2DM), driven by the intricate interplay of chronic hyperglycemia, insulin resistance, and lipid metabolism disturbances. Myocardial ischemia/reperfusion (MI/R) injury during cardiopulmonary bypass (CPB) exacerbates cardiac vulnerability. This study aims to probe the role of Caspase-1-dependent pyroptosis in global ischemia/reperfusion injury among T2DM rats undergoing CPB, elucidating the mechanisms underlying heightened myocardial injury in T2DM. This study established a rat model of T2DM and compared Mean arterial pressure (MAP), heart rate (HR), and hematocrit (Hct) between T2DM and normal rats. Myocardial cell morphology, infarction area, mitochondrial ROS and caspase-1 levels, NLRP3, pro-caspase-1, caspase-1 p10, GSDMD expressions, plasma CK-MB, cTnI, IL-1β, and IL-18 levels were assessed after reperfusion in both T2DM and normal rats. The role of Caspase-1-dependent pyroptosis in myocardial ischemia/reperfusion injury during CPB in T2DM rats was examined using the caspase-1 inhibitor VX-765 and the ROS scavenger NAC. T2DM rats demonstrated impaired glucose tolerance but stable hemodynamics during CPB, while showing heightened vulnerability to MI/R injury. This was marked by substantial lipid deposition, disrupted myocardial fibers, and intensified cellular apoptosis. The activation of caspase-1-mediated pyroptosis and increased reactive oxygen species (ROS) production further contributed to tissue damage and the ensuing inflammatory response. Notably, myocardial injury was mitigated by inhibiting caspase-1 through VX-765, which also attenuated the inflammatory cascade. Likewise, NAC treatment reduced oxidative stress and partially suppressed ROS-mediated caspase-1 activation, resulting in diminished myocardial injury. This study proved that Caspase-1-dependent pyroptosis significantly contributes to the inflammation and injury stemming from global MI/R in T2DM rats under CPB, which correlate with the surplus ROS generated by oxidative stress during reperfusion.
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- 2024
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3. Designing an experimental method for assessing biocompatibility of circuit coatings using biomarkers for platelet activation during cardiopulmonary bypass
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Sancheti Meghal, Rentschler Mitchell, Bolch Charlotte, Li Weidang, Necco Katelyn, Rath Thomas, Esfandiarei Mitra, and Darban Nathaniel
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cardiopulmonary bypass ,platelets ,biomarkers ,platelet activation ,elisa ,circuit coating ,Medicine - Abstract
Introduction: Cardiopulmonary bypass is an essential component of cardiothoracic surgeries. However, significant complications such as systemic inflammatory response syndrome (SIRS) resulting from cardiopulmonary bypass (CPB) are a common occurrence due to contact between circulating blood and foreign surfaces that leads to platelet activation. It is suggested that different available CPB circuit coatings can potentially reduce platelet activation. However, there have been no published evidence-based reports confirming these claims. In addition, there is no well-established protocol for studying platelet activation biomarkers during CPB in vitro in a laboratory setting. Methods: CPB was simulated in the laboratory using bovine blood in two different types of coated CPB circuits: Trillium® Biosurface by Medtronic, and XcoatingTM Surface by Terumo. Fresh bovine blood samples were collected and circulated through the CPB circuit following the standard protocol used in the operation rooms. Blood samples were then collected at 5 min, 30 min, and 55 min during the circulation. Blood plasmas were separated and subjected to enzyme-linked immunosorbent assay to measure most established platelet activation markers P-selectin, Platelet Factor 4 (PF4), Glycoprotein IIb/IIIa (GPIIb/IIIa), and β-thromboglobulin (β-TG) at different time points. Results: The biomarker values at 30 min and 55 min were compared to the base values at 5 min for each type of CPB circuit. The results of the means from all measured biomarkers showed data measurements that indicated no significant variability within each coating. All collected data points fell within ±2 SD of the means, which was considered acceptable variations across technical replicates. Conclusion: In this study, we were able to establish an in vitro protocol in the laboratory setting that is precise and reliable with minimum intra-variability. This established protocol will allow for future studies in which different coated CPB circuits can be compared for their effectiveness in blocking platelet activation during the CPB.
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- 2024
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4. Probiotics relieve perioperative postoperative cognitive dysfunction induced by cardiopulmonary bypass through the kynurenine metabolic pathway
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Xiaodong Zhang, Yanzhang Yang, Xinyi Ma, Huijuan Cao, and Yingjie Sun
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Probiotics ,Postoperative cognitive dysfunction ,Cardiopulmonary bypass ,Kynurenine metabolic pathway ,Medicine ,Science - Abstract
Abstract Postoperative cognitive dysfunction (POCD) has become the popular critical post-operative consequences, especially cardiopulmonary bypass surgery, leading to an increased risk of mortality. However, no therapeutic effect about POCD. Probiotics are beneficial bacteria living in the gut and help to reduce the risk of POCD. However, the detailed mechanism is still not entirely known. Therefore, our research aims to uncover the effect and mechanism of probiotics in relieving POCD and to figure out the possible relationship between kynurenine metabolic pathway. 36 rats were grouped into three groups: sham operated group (S group, n = 12), Cardiopulmonary bypass group (CPB group, n = 12), and probiotics+CPB (P group, n = 12). After CPB model preparation, water maze test and Garcia score scale was performed to identify the neurological function. Immunofluorescence and Hematoxylin and eosin staining has been used for hippocampal neurons detection. Brain injury related proteins, oxidative stress factors, and inflammatory factors were detected using enzyme-linked immunosorbent assays (ELISA). Neuronal apoptosis was detected by TdT-mediated dUTP nick end-labeling (TUNEL) staining and western blot. High-performance liquid chromatography/mass spectrometry (HPLC/MS) was performed to detect the key factors of the kynurenine metabolic pathway. Our results demonstrated that probiotics improved neurological function of post-CPB rats. The administration of probiotics ameliorated memory and learning in spatial terms CPB rats (P
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- 2024
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5. Relative band power in assessing temporary neurological dysfunction post- type A aortic dissection surgery: a prospective study
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Ya-peng Wang, Li Li, Hua Jin, Yang Chen, Yi Jiang, Wen-xue Liu, Yun-xing Xue, Li Huang, and Dong-jin Wang
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Aortic Dissection ,Temporary neurological dysfunction ,Delirium ,Delayed recovery ,Relative band power ,Cardiopulmonary bypass ,Medicine ,Science - Abstract
Abstract Temporary neurological dysfunction (TND), a common complication following surgical repair of Type A Aortic Dissection (TAAD), is closely associated with increased mortality and long-term cognitive impairment. Currently, effective treatment options for TND remain elusive. Therefore, we sought to investigate the potential of postoperative relative band power (RBP) in predicting the occurrence of postoperative TND, with the aim of identifying high-risk patients prior to the onset of TND. We conducted a prospective observational study between February and December 2022, involving 165 patients who underwent surgical repair for TAAD at our institution. Bedside Quantitative electroencephalography (QEEG) was utilized to monitor the post-operative brain electrical activity of each participant, recording changes in RBP (RBP Delta, RBP Theta, RBP Beta and RBP Alpha), and analyzing their correlation with TND. Univariate and multivariate analyses were employed to identify independent risk factors for TND. Subsequently, line graphs were generated to estimate the incidence of TND. The primary outcome of interest was the development of TND, while secondary outcomes included intensive care unit (ICU) admission and length of hospital stay. A total of 165 patients were included in the study, among whom 68 (41.2%) experienced TND. To further investigate the independent risk factors for postoperative TND, we conducted both univariate and multivariate logistic regression analyses on all variables. In the univariate regression analysis, we identified age (Odds Ratio [OR], 1.025; 95% CI, 1.002–1.049), age ≥ 60 years (OR, 2.588; 95% CI, 1.250–5.475), hemopericardium (OR, 2.767; 95% CI, 1.150–7.009), cardiopulmonary bypass (CPB) (OR, 1.007; 95% CI, 1.001–1.014), RBP Delta (OR, 1.047; 95% CI, 1.020–1.077), RBP Alpha (OR, 0.853; 95% CI, 0.794–0.907), and Beta (OR, 0.755; 95% CI, 0.649–0.855) as independent risk factors for postoperative TND. Further multivariate regression analyses, we discovered that CPB time ≥ 180 min (OR, 1.021; 95% CI, 1.011–1.032), RBP Delta (OR, 1.168; 95% CI, 1.105–1.245), and RBP Theta (OR, 1.227; 95% CI, 1.135–1.342) emerged as independent risk factors. TND patients had significantly longer ICU stays (p
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- 2024
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6. Risk Factors for Early Post-Operative Arrhythmias in Children Undergoing Congenital Heart Surgeries
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Mujeeb ur Rehman, Muhammad Asif Khan, Raam Chand, Shahnawaz Sathio, Abdul Sattar Shaikh, Fatima Amin, and Najma Patel
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Arrhythmia ,cardiopulmonary bypass ,inotropic score ,left ventricular ejection fraction ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objective: To determine the risk factors for early post-operative arrhythmias in children undergoing congenital heart surgeries at a tertiary care hospital. Study Design: Prospective longitudinal study. Place and Duration of Study: National Institute of Cardiovascular Disease, Karachi Pakistan, from Jan to Jul 2020. Methodology: We included 143 patients of both genders undergoing open heart surgery for congenital heart diseases. We noted all patients' pre-operative, intra-operative, and post-operative clinical characteristics. Patients were monitored in the pediatric cardiac intensive care unit. We analyzed the development of postoperative arrhythmias and the factors associated with them. Results: In 143 patients, the mean age at the time of surgery was 7.52±6.0 years. There were 83(58.0%) male patients. Tetralogy of Fallot was the most common type of congenital heart disease noted in 57(39.0%) patients. The mean cardiopulmonary bypass time was 83.9±25.5 minutes, while the mean aortic cross-clamp time was 58.1±21.9 minutes. Post-operatively, arrhythmia was observed in 39(27.3%) children. Intra-operative arrhythmias (p
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- 2024
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7. Perfusion techniques for an 800 g premature neonate undergoing Arterial Switch Procedure for Transposition of the Great Arteries★
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Owens Richard, Loftin Madeline, Rosten Kellen, Fisher Douglas, Denison Blake, Gottlieb Erin, and Fraser Charles
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prematurity ,arterial switch operation ,low birth weight ,cardiopulmonary bypass ,Medicine - Abstract
Early cardiac surgery in neonates and infants with congenital heart disease has been performed since the middle to late years of the twentieth century. To date, there are very few reports of successful congenital heart surgery using cardiopulmonary bypass (CPB) in premature babies less than 1000 g with serious congenital heart disease. Limited information is available in the literature describing perfusion techniques for this extremely fragile patient population. Miniaturization of the CPB circuit contributes to multiple factors that affect this population significantly. These factors include the reduction of patient-to-circuit ratios, volume of distribution of pharmacological agents, management of pressure gradients within the CPB system, and increased tactile control by the attending perfusionist. Careful management of the physiological environment of the patient is of utmost importance and can mitigate risks during CPB, including volume shifts into the interstitial space, electrolyte, and acid-base imbalance, and intracranial hemorrhage. We report perfusion techniques successfully utilized during the surgical repair of transposition of the great arteries for an 800 g, 28-week-old neonate. CPB techniques for the smallest and youngest patients may be executed safely when proper physical, chemical, and perfusion process adjustments are made and managed meticulously.
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- 2024
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8. THE INFLUENCE OF BIOCOMPATIBILITY OF THE EXTRACORPOREAL OXYGENATOR CIRCUIT ON THE DEGREE OF HEMOLYSIS AND OPTIMIZATION OF OXYGEN STATUS IN MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING
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Volodymyr I. Cherniy, Lada O. Sobanska, Pavlo O. Topolov, and Arina V. Grygorieva
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cardiopulmonary bypass ,biocompatibility ,hemolysis ,coronary artery bypass grafting ,oxygen delivery ,oxygen consumption ,Medicine - Abstract
Introduction. A distinctive feature of cardiopulmonary bypass in minimally invasive coronary artery bypass grafting (CABG) is the significantly longer perfusion time, involving active blood drainage from the vein to the cardiotomy reservoir, which carries the risk of hemolysis development. In this context, mechanical hemolysis disrupts the gas transport function of the blood. The aim of the research. Reducing hemolysis and optimizing oxygen status of patients during minimally invasive coronary artery bypass grafting surgeries. Materials and methods. The study included 60 patients, who underwent minimally invasive coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) under moderate hypothermia. The patients were divided into two groups of 30 individuals each. To improve the biocompatibility of the oxygenator, the circuit in Group 1 (Gr1) was treated with an adaptive composition, while in Group 2 (Gr2), the oxygenator circuit remained untreated. The following parameters were examined: hemoglobin (Hb), hematocrit (Ht), red blood cell count (RBC), oxygen delivery index (DO2I), oxygen consumption index (VO2I), oxygen extraction ratio (O2ER%), oxygen extraction index (O2EI%), venous (SpvO2), and arterial (SpaO2) oxygen saturation, oxygen tension in arterial (PaO2) and venous blood (PvO2), acid-base status of the blood (pH, pCO2,HCO3ˉ, BE), and the degree of hemolysis. Results. Before initiation of cardiopulmonary bypass (CPB), an insignificant increase in O2IE% was observed in Gr1 (26.07±1.57) and Gr2 (27.11±0.81); p=0.875, indicating an increase in tissue oxygen consumption. At the hypothermic stage CPB, both Gr1 and Gr2 demonstrated a statistically significant decrease in Hb, Ht, and RBC levels (p
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- 2024
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9. Effects of nitric oxide on microviscosity and polarity of erythrocyte membranes in experiment
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T. Yu. Rebrova, Yu. K. Podoksenov, S. A. Afanasiev, N. O. Kamenshchikov, V. A. Korepanov, and M. L. Diakova
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nitric oxide ,cardiopulmonary bypass ,sheep ,Medicine - Abstract
Enhancement of methods for protecting target organs during coronary artery bypass surgery determined the development of a technology for delivering nitric oxide (NO) to the systemic blood flow using a cardiopulmonary bypass (CB) apparatus, which makes NO available to all organs and tissues.The aim of the study was to access the effect of perioperative NO conditioning on the coefficients of microviscosity and polarity of sheep etythrocyte membranes during experimental surgical intervention using CB.Material and methods. Study was carried out on 20 sheep weighing 30–34 kg. Two groups were formed. In the CB group, 10 sheep underwent the standard clinical protocol of artificial lung ventilation (ALV) and CB. In the CB + NO group, 10 sheep received NO at a dose of 80 ppm through the circuit of ALV apparatus immediately after tracheal intubation. At the start of CB, NO was delivered to the extracorporeal circulation circuit at a dose of 80 ppm for 90 min. After disconnection from CB, NO supply continued through the ALV apparatus at a dose of 80 ppm for 60 min. The coefficients of microviscosity and polarity of sheep erythrocyte membranes were determined by spectrofluorimetry using pyrene probe.Results and discussion. The implementation of CB was accompanied by a statistically significant decrease in the microviscosity coefficient in the zones of proteinlipid contact of sheep erythrocyte membranes. In the zone of total lipids, the microviscosity coefficient did not change after CB implementation. The membrane polarity coefficient at the final stage of the surgery increased significantly in the zone of annular lipids and did not change in the zone of total lipids. NO supply to the circuit of the extracorporeal circulation neutralizes the revealed increase in the microviscosity and polarity of the annular lipids.Conclusions. The introduction of NO into the extracorporeal circulation circuit at the concentration of 80 ppm prevents a decrease in the coefficients of microviscosity and polarity of annular lipids of erythrocyte membranes that occurs during cardiac surgery.
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- 2024
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10. Acute Normovolemic Hemodilution (ANH) impacts postoperative coagulation profile and bleeding in Adult Cardiac Surgery
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Shahbaz Ahmad Khilji and Muhammad Fahad Ghaffar
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Acute normovolemic hemodilution ,Cardiopulmonary Bypass ,Drain output ,Coagulation profile ,Cardiac surgery ,Medicine - Abstract
Introduction: The coagulation profile of cardiac surgery patients is impacted by pro-inflammatory effects caused by procedures involving cardiopulmonary bypass. In order to counteract these effects, pharmacological therapies and allogeneic blood transfusions are required. The strategy of Acute normovolemic hemodilution also known as “intraoperative autologous donation” is also a viable option to address these negative effects. The theoretical basis for ANH is that the removed blood of a patient’s own self is shielded from the inflammatory response of blood cells to the bypass circuit. ANH is an infrequently practiced strategy at various cardiac surgery institutes within Pakistan to enhance coagulation profile, decrease the need for blood transfusions despite being an established approach abroad. Aims and Objectives: The objective of our study is to compare the effect of ANH on patients undergoing adult cardiac surgery in a sample group versus a control group with the primary endpoint of postoperative drain output as a measure of effectiveness of blood coagulation profile. Blood coagulation profiles were also compared between the two groups as secondary variables. Place and Duration of study: The study was conducted at the Faisalabad Institute of Cardiology from December 21st, 2023 to February 13th, 2024. Material and Methods: A randomized controlled trial involving 60 patients over the age of 12 years who were to undergo adult cardiac surgery was conducted. An online research randomizer software randomly selected them into two equal groups, sample and control (n=30). The ANH volume retrieved from the patient's central vein in the sample group was used to fill the CPD blood transfusion bags after administering anesthesia. After the patients in both groups were weaned off CPB and protamine administered to neutralize heparin, ANH blood was infused back into the patients in the sample group whereas the control group received allogenic blood only. Chi square test was applied to all qualitative variables and Independent Samples t-test for all quantitative variables. The results were analyzed using SPSS version 25, and a p-value ? 0.05 was considered statistically significant. Results: Hemoglobin (12.9±0.90 g/dL in ANH and 11.8±1.00 g/dL in non-ANH) and aPTT levels (34.2±6.06 seconds in ANH and 54.2±10.95 seconds in non-ANH) were statistically significant (p-value
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- 2024
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11. Our initial experience of monitoring the autoregulation of cerebral blood flow during cardiopulmonary bypass
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Andersen Leon, Appelblad Micael, Wiklund Urban, Sundström Nina, and Svenmarker Staffan
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cardiopulmonary bypass ,monitoring ,cerebral blood flow ,autoregulation ,near-infrared spectroscopy ,Medicine - Abstract
Background: Cerebral blood flow (CBF) is believed to be relatively constant within an upper and lower blood pressure limit. Different methods are available to monitor CBF autoregulation during surgery. This study aims to critically analyze the application of the cerebral oxygenation index (COx), one of the commonly used techniques, using a reference to data from a series of clinical registrations. Method: CBF was monitored using near-infrared spectroscopy, while cerebral blood pressure was estimated by recordings obtained from either the radial or femoral artery in 10 patients undergoing cardiopulmonary bypass. The association between CBF and blood pressure was calculated as a moving continuous correlation coefficient. A COx index > 0.4 was regarded as a sign of abnormal cerebral autoregulation (CA). Recordings were examined to discuss reliability measures and clinical feasibility of the measurements, followed by interpretation of individual results, identification of possible pitfalls, and suggestions of alternative methods. Results and Conclusion: Monitoring of CA during cardiopulmonary bypass is intriguing and complex. A series of challenges and limitations should be considered before introducing this method into clinical practice.
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- 2023
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12. The Journal of ExtraCorporeal Technology
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cardiopulmonary bypass ,cardiovascular perfusion ,blood management ,cardiac surgery and anaesthesia ,extracorporeal membrane oxygenation ,mechanical circulatory support ,Medicine - Published
- 2024
13. Association between lactic acidosis and multiple organ dysfunction syndrome after cardiopulmonary bypass
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Dan Zheng, Guo-Liang Yu, Yi-Ping Zhou, Qiao-Min Zhang, Chun-Guo Wang, and Sheng Zhang
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Cardiopulmonary bypass ,Acidosis ,Lactic ,Hyperlactatemia ,Multiple organ dysfunction syndrome ,Medicine ,Biology (General) ,QH301-705.5 - Abstract
Background The relationship between hyperlactatemia and prognosis after cardiopulmonary bypass (CPB) is controversial, and some studies ignore the presence of lactic acidosis in patients with severe hyperlactacemia. This study explored the association between lactic acidosis (LA) and the occurrence of multiple organ dysfunction syndrome (MODS) after cardiopulmonary bypass. Methods This study was a post hoc analysis of patients who underwent cardiac surgery between February 2017 and August 2018 and participated in a prospective study at Taizhou Hospital. The data were collected at: ICU admission (H0), and 4, 8, 12, 24, and 48 h after admission. Blood lactate levels gradually increased after CPB, peaking at H8 and then gradually decreasing. The patients were grouped as LA, hyperlactatemia (HL), and normal control (NC) based on blood test results 8 h after ICU admission. Basic preoperative, perioperative, and postoperative conditions were compared between the three groups, as well as postoperative perfusion and oxygen metabolism indexes. Results There were 22 (19%), 73 (64%), and 19 (17%) patients in the LA, HL, and NC groups, respectively. APACHE II (24h) and SOFA (24h) scores were the highest in the LA group (P
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- 2024
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14. Protamine dose to neutralize heparin at the completion of cardiopulmonary bypass can be reduced significantly without affecting post-operative bleeding
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Lee Min-Ho, Beck Matthew, and Shann Kenneth
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protamine-to-heparin ratio ,protamine dose ,post-operative bleeding ,heparin protamine titration ,cardiopulmonary bypass ,Medicine - Abstract
Background: Systemic anticoagulation with heparin during cardiopulmonary bypass (CPB) should be neutralized by protamine administration to restore normal hemostasis. Our previous study showed the protamine-to-heparin ratio (P-to-H) of 1:1 (1 mg protamine:100 IU circulating heparin; 1.0 Ratio) is likely an overestimation. Thus, we reduced the P-to-H in the HMS Plus Hemostasis Management System to 0.9:1 (0.9 Ratio) for 5 months and then to 0.8:1 (0.8 Ratio). We monitored post-operative (post-op) bleeding in the setting of reduced protamine dose (PD). Methods: We performed a retrospective study of 632 patients (209 for the 1.0 Ratio, 211 for 0.9 Ratio, 212 for 0.8 Ratio group) who underwent cardiac surgery to measure the reduction of PD and how it affects 24-hour (24 h) post-op chest tube output. We also analyzed the entire data set to explore whether further reduction of P-to-H is warranted. Results: While there was no difference in the indexed heparin dose among the three groups, we achieved a significant reduction in the indexed actual protamine dose (APDi) by 24% (0.9 Ratio) and 31% (0.8 Ratio) reductions compared to the 1.0 Ratio group. On average, APDi was 88 ± 22, 67 ± 18, and 61 ± 15 mg/m2 in the 1.0, 0.9, and 0.8 Ratio groups, respectively. We found no significant difference in 24 h post-op bleeding among the three groups. Conclusion: 1.0 Ratio at the completion of CPB is likely an excessive administration of protamine. With the stepwise reduction of PD, we observed no increase in post-op bleeding, which may indicate that no meaningful increase in heparin rebound occurred. In addition, further analysis of the entire data set demonstrates that a 0.75 Ratio is likely sufficient to neutralize the heparin completely.
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- 2023
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15. Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury
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Dreher Molly, Min Jungwon, Mavroudis Constantine, Ryba Douglas, Ostapenko Svetlana, Melchior Richard, Rosenthal Tami, Nuri Muhammad, and Blinder Joshua
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acute kidney injury ,indexed oxygen delivery ,cardiopulmonary bypass ,pediatric ,cardiac surgery ,Medicine - Abstract
Background: Acute kidney injury after pediatric cardiac surgery is a common complication with few established modifiable risk factors. We sought to characterize whether indexed oxygen delivery during cardiopulmonary bypass was associated with postoperative acute kidney injury in a large pediatric cohort. Methods: This was a retrospective analysis of patients under 1 year old undergoing cardiac surgery with cardiopulmonary bypass between January 1, 2013, and January 1, 2020. Receiver operating characteristic curves across values ranging from 260 to 400 mL/min/m2 were used to identify the indexed oxygen delivery most significantly associated with acute kidney injury risk. Results: We included 980 patients with acute kidney injury occurring in 212 (21.2%). After adjusting for covariates associated with acute kidney injury, an indexed oxygen delivery threshold of 340 mL/min/m2 predicted acute kidney injury in STAT 4 and 5 neonates (area under the curve = 0.66, 95% CI = 0.60 – 0.72, sensitivity = 56.1%, specificity = 69.4%). An indexed oxygen delivery threshold of 400 mL/min/m2 predicted acute kidney injury in STAT 1-3 infants (area under the curve = 0.65, 95% CI = 0.58 – 0.72, sensitivity = 52.6%, specificity = 74.6%). Conclusion: Indexed oxygen delivery during cardiopulmonary bypass is a modifiable variable independently associated with postoperative acute kidney injury in specific pediatric populations. Strategies aimed at maintaining oxygen delivery greater than 340 mL/min/m2 in complex neonates and greater than 400 mL/min/m2 in infants may reduce the occurrence of postoperative acute kidney injury in the pediatric population.
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- 2023
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16. Novel inflammatory mediator profile observed during pediatric heart surgery with cardiopulmonary bypass and continuous ultrafiltration
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Joel Bierer, Roger Stanzel, Mark Henderson, Suvro Sett, John Sapp, Pantelis Andreou, Jean S. Marshall, and David Horne
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Pediatric cardiac surgery ,Congenital heart disease ,Cardiopulmonary bypass ,Complement ,Inflammation ,Ultrafiltration ,Medicine - Abstract
Abstract Background Cardiopulmonary bypass (CPB) is associated with systemic inflammation, featuring increased levels of circulating pro-inflammatory cytokines. Intra-operative ultrafiltration extracts fluid and inflammatory factors potentially dampening inflammation-related organ dysfunction and enhancing post-operative recovery. This study aimed to define the impact of continuous subzero-balance ultrafiltration (SBUF) on circulating levels of major inflammatory mediators. Methods Twenty pediatric patients undergoing cardiac surgery, CPB and SBUF were prospectively enrolled. Blood samples were collected prior to CPB initiation (Pre-CPB Plasma) and immediately before weaning off CPB (End-CPB Plasma). Ultrafiltrate effluent samples were also collected at the End-CPB time-point (End-CPB Effluent). The concentrations of thirty-nine inflammatory factors were assessed and sieving coefficients were calculated. Results A profound increase in inflammatory cytokines and activated complement products were noted in plasma following CBP. Twenty-two inflammatory mediators were detected in the ultrafiltrate effluent. Novel mediators removed by ultrafiltration included cytokines IL1-Ra, IL-2, IL-12, IL-17A, IL-33, TRAIL, GM-CSF, ET-1, and the chemokines CCL2, CCL3, CCL4, CXCL1, CXCL2 and CXCL10. Mediator extraction by SBUF was significantly associated with molecular mass
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- 2023
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17. Selenoprotein P-1 (SEPP1) as an Early Biomarker of Myocardial Injury in Patients Undergoing Cardiopulmonary Bypass
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Giuseppe Filiberto Serraino, Davide Bolignano, Federica Jiritano, Giuseppe Coppolino, Désirée Napolitano, Mariateresa Zicarelli, Patrizia Pizzini, Sebastiano Cutrupi, Alessandra Testa, Belinda Spoto, Michele Andreucci, Pasquale Mastroroberto, and Raffaele Serra
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cardiac surgery ,biomarker ,SEEP1 ,selenoprotein 1 ,cardiopulmonary bypass ,myocardial injury ,Medicine - Abstract
Background: Biomarkers development for prognostication or prediction of perioperative myocardial disease is critical for the evolution of treatment options in patients undergoing cardiac surgery. The aim of our prospective monocentric study was to investigate the role of selenoprotein 1 (SEEP 1) as a potential biomarker for assessing the risk of myocardial injury after cardiac surgery. Methods: Circulating SEPP1 was measured in the blood of 45 patients before surgery and at 4 h, 8 h and 12 h after CPB by enzyme-linked immunosorbent assay (ELISA); (3) Results: circulating SEPP-1 levels measured 4 h after surgery were strongly correlated with CK-MB levels measured at 48 h (R = 0.598, p < 0.0001) and at 72 h (R = 0.308, p = 0.05). Close correlations were also found between 4 h SEPP-1 and Hs-c troponin values measured at 24 h (R = 0.532, p < 0.0001), 48 h (R = 0.348, p = 0.01) and 72 h (R = 0.377, p = 0.02), as well as with cardiopulmonary bypass (CPB) (R = 0.389, p = 0.008) and cross-clamp time (R = 0.374, p = 0.001); (4) Conclusions: Early SEPP1 measurement after CPB may hold great potential for identifying cardiac surgery patients at risk of developing perioperative myocardial injury.
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- 2024
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18. Investigating Potential Correlations between Calcium Metabolism Biomarkers and Periprocedural Clinical Events in Major Cardiovascular Surgeries: An Exploratory Study
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Adrian Ștef, Constantin Bodolea, Ioana Corina Bocșan, Ștefan Cristian Vesa, Raluca Maria Pop, Simona Sorana Cainap, Alexandru Achim, Oana Antal, Nadina Tintiuc, and Anca Dana Buzoianu
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calcium ,ionized calcium ,vitamin D ,cardiopulmonary bypass ,cardiovascular surgery ,open-heart surgery ,Medicine - Abstract
Background: There is emerging but conflicting evidence regarding the association between calcium biomarkers, more specifically ionized calcium and the prognosis of intensive care unit (ICU) postoperative cardiac patients. Methods: Our study investigated the relationship between ionized calcium, vitamin D, and periprocedural clinical events such as cardiac, neurologic and renal complications, major bleeding, vasoactive–inotropic score (VIS), and length of ICU and hospitalization. Results: Our study included 83 consecutive subjects undergoing elective major cardiac surgery requiring cardiopulmonary bypass. The mean age of the participants was 64.9 ± 8.5 years. The majority of procedures comprised isolated CABG (N = 26, 31.3%), aortic valve procedures (N = 26, 31.3%), and mitral valve procedures (N = 12, 14.5%). A difference in calcium levels across all time points (p < 0.001) was observed, with preoperative calcium being directly associated with intraoperative VIS (r = 0.26, p = 0.016). On day 1, calcium levels were inversely associated with the duration of mechanical ventilation (r = −0.30, p = 0.007) and the length of hospital stay (r = −0.22, p = 0.049). At discharge, calcium was inversely associated with length of hospital stay (r = −0.22, p = 0.044). All calcium levels tended to be lower in those who died during the 1-year follow-up (p = 0.054). Preoperative vitamin D levels were significantly higher in those who experienced AKI during hospitalization (median 17.5, IQR 14.5–17.7, versus median 15.3, IQR 15.6–20.5, p = 0.048) Conclusion: Fluctuations in calcium levels and vitamin D may be associated with the clinical course of patients undergoing cardiac surgery. In our study, hypocalcemic patients exhibited a greater severity of illness, as evidenced by elevated VIS scores, and experienced prolonged mechanical ventilation time and hospital stays. Additional larger-scale studies are required to gain a deeper understanding of their impact on cardiac performance and the process of weaning from cardiopulmonary bypass, as well as to distinguish between causal and associative relationships.
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- 2024
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19. Management of priming fluids in cardiopulmonary bypass for adult cardiac surgery: network meta-analysis
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Chen-Yang Xian-Yu, Jian-Bo Xu, Yu-Tong Ma, Nian-Jia Deng, Yu-Ting Tao, Hui-Jun Li, Teng-Yu Gao, Jing-Ying Yang, and Chao Zhang
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PROSPERO CRD42023416194 ,Cardiopulmonary bypass ,priming fluid ,colloid ,crystalloid ,hydroxyethyl starch ,Medicine - Abstract
AbstractBackground Cardiopulmonary bypass (CPB) is frequently employed for cardiac surgery, and selecting a suitable priming fluid is a prerequisite for CPB. Currently, the commonly used priming fluids in clinics are classified as crystalloids and colloids, including balanced crystalloids, albumin, dextran, gelatin and hydroxyethyl starch (HES). This network meta-analysis compared the effects of eight fluids used during CPB in adults to determine optimal priming fluid during CPB surgery.Methods Randomised controlled trials assessing priming fluids for CPB in adult cardiac surgery published before 13 April 2023 were searched across Ovid MEDLINE(R) ALL, OVID EMbase, and Cochrane Central Register of Controlled Trials. Various priming fluids were classified into eight categories, including balanced crystalloids, 0.9% NaCl, iso-oncotic human albumin, hyperoncotic human albumin, HES with molecular weight 130k, HES with molecular weight 200k, gelatin and dextran.Results The NMA of platelet counts revealed no significant differences in any result. In direct comparison results, only the comparison of HES with molecular weight 130k vs. gelatin (standard mean difference = −0.40, 95% confidence interval [95%CI: −0.63, −0.16) revealed a significant difference. According to the SUCRA, balanced crystalloids had the highest platelet count, followed by gelatin, and HES with a molecular weight of 130k had the lowest platelet, followed by HES with a molecular weight of 200k.Conclusion Patients using dextran have a low mortality rate and a short mean CPB time, the use of balanced crystalloids is beneficial in terms of platelet count, and HES with molecular weight 130k is beneficial for postoperative urine volume at 24h. However, all priming fluids have pros and cons quite, and the optimal choice of priming fluids remains unsupported by current evidences. When performing CPB surgery, the type of priming fluid should be selected according to the actual situation in CPB for adult cardiac surgery.
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- 2023
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20. Surgical results of only antegrade del Nido cardioplegia infusion in conventional coronary artery bypass grafting: a retrospective study
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Sang-Uk Park, Yo Han Bae, Yun Seok Kim, Kyungsub Song, and Woo Sung Jang
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cardioplegic solution ,cardiopulmonary bypass ,coronary artery bypass ,Medicine - Abstract
Background Additional retrograde cardioplegia infusion in conventional coronary artery bypass grafting (CABG) was introduced to address the concern of inappropriate cardioplegia delivery through the stenotic coronary artery. However, this method is complex and requires repeated infusions. Therefore, we investigated the surgical outcomes of only antegrade cardioplegia infusion in conventional CABG. Methods We included 224 patients who underwent isolated CABG between 2017 and 2019. The patients were divided into two groups according to the cardioplegia infusion method: antegrade cardioplegia infusion with del Nido solution (n=111, group I) and antegrade+retrograde cardioplegia infusion with blood cardioplegia solution (n=113, group II). Results The sinus recovery time after release of the aorta cross-clamp was shorter in group I (3.8±7.1 minutes, n=98) than in group II (5.8±4.1 minutes, n=73) (p=0.033). The total cardioplegia infusion volume was lower in group I (1,998.6±668.6 mL) than in group II (7,321.0±2,865.3 mL) (p
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- 2023
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21. An alternate technique of performing total cavopulmonary connection without cardiopulmonary bypass
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Sachin Talwar, Anjali Tiwari, Sanjoy Sengupta, Arindam Choudhury, Amitabh Satsangi, and Shiv Kumar Choudhary
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cardiopulmonary bypass ,fontan ,surgical technique ,total cavopulmonary connection ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Total cavopulmonary connection (Fontan) without using cardiopulmonary bypass (CPB) may be superior to Fontan on CPB. In the experience of many, a Fontan operation without CPB may be associated with a reduced need for inotropic support, improved outcomes in the postoperative phase including faster time to termination of mechanical ventilatory support, reduced intensive care unit stay, lower volume of pleural and peritoneal effusions, and decreased hospital stay, thereby rendering it more cost-effective. However, the operation is technically more difficult to perform than Fontan on CPB and requires significant modifications of surgical technique and alteration in overall management strategy. In this article, an alternative technique of performing total cavopulmonary connection without CPB is described. Its advantages are briefly discussed.
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- 2023
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22. Successful surgical management of cardiac tamponade following direct intrahepatic portosystemic shunt in a child with Budd–Chiari syndrome: A potentially life-threatening situation
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Anand Kumar Mishra, Meenakshi Mandal, Irshad R Mohamed, Sadhna Lal, and Harish Bhujade
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cardiac tamponade ,cardiopulmonary bypass ,direct intrahepatic portosystemic shunts ,intervention complications ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Direct intrahepatic portosystemic shunt is a technique of portocaval shunting performed through the percutaneous route in patients with Budd–Chiari syndrome. Stent migration into right-sided heart chambers or perforations causing hemopericardium and cardiac tamponade is rare and underreported. In a child with a coexisting decompensated liver disease, surgical intervention and cardiopulmonary bypass can be challenging. However, surgical management in these life-threatening situations is better than redo interventions.
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- 2023
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23. A Comparison of the Clinical Outcomes of Minimum and Maximum Hematocrit Levels During Cardiopulmonary Bypass (CPB) in Low-risk Patients Undergoing Coronary Artery Bypass Graft Surgery (CABG): A Cross-sectional Study
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Fatemeh Shiravi, Mehran Shahzamani, Sayyed Alireza Hosseini, and Davood Shafie
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cardiopulmonary bypass ,coronary artery bypass ,hematocrit ,Medicine ,Biology (General) ,QH301-705.5 - Abstract
Background: This study investigated the clinical outcomes at the minimum and maximum levels of hematocrit (HCT) during cardiopulmonary bypass (CPB) in low-risk patients undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: In this cross-sectional study, 85 patients who underwent CABG with an ejection fraction of greater than 35% were selected. Based on the HCT range during CPB, patients were divided into two groups: minimum HCT: HCT = 16–18% and maximum HCT: HCT = 25–27%. Then the operation outcomes, amount of drainage, and transfusion were recorded and compared between these groups. Results: In the middle tube 8 h after surgery and left tube 24 h after surgery, the amount of drainage in the minimum HCT group with mean of 71.00 ± 130.9 and 60.65 ± 71.23, respectively, was significantly lower than the maximum HCT group with mean of 101.5 ± 246.50 and 123.76 ± 93.17, respectively (P value < 0.05). The incidence of cognitive disorders in the maximum HCT group was significantly higher than in the minimum HCT group (11.1% vs. 0%, P value = 0.041). Also, the mean transfusion of packed red blood cell (PRBC) and fresh frozen plasm (FFP) during CPB in the maximum HCT group, with mean of 346.7 ± 86.22 and 396.1 ± 21.05, respectively, were significantly higher than the minimum HCT group with mean of 178.8 ± 80.91 and 136.8 ± 46.77, respectively (P value < 0.05). After CPB, there was no significant difference in transfusion products (P value > 0.05). Conclusion: According to the results of this study, patients undergoing CABG surgery with maximum HCT level versus minimum HCT level during CPB, need more packed cells and fresh frozen plasma products transfusion, which will be associated with the complication of cognitive impairment.
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- 2024
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24. A Contemporary Review of the Use of Extracorporeal CytoSorb® Hemoadsorption Therapy in Patients with Infective Endocarditis
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Anan Gong, Yupei Li, Mei Yang, Shujing Wang, and Baihai Su
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hemoadsorption ,infective endocarditis ,CytoSorb® ,cardiopulmonary bypass ,cardiac surgery ,mortality ,Medicine - Abstract
Infective endocarditis (IE) is a rare but severe disease with high morbidity and mortality. Cardiac surgery plays a major role in the contemporary clinical management of IE patients. During cardiac surgery, cardiopulmonary bypass significantly contributes to an increased risk of organ dysfunction and mortality by inducing an acute inflammatory response, vascular endothelial cell injury, impairment of the coagulation cascade, and ischemia–reperfusion injury. During the past decade, the use of extracorporeal hemoadsorption therapy with the CytoSorb® hemoadsorber (CytoSorbents Europe GmbH, Berlin, Germany) has been proposed as an adjuvant therapy to mediate inflammatory responses in IE patients undergoing cardiac surgery with cardiopulmonary bypass. However, there is currently no systematic evaluation of the effect of CytoSorb® hemoadsorption on clinical outcomes such as hemodynamics, organ dysfunction, and mortality in patients with IE. Therefore, in this review, we exclusively discuss contemporary findings concerning the rationale, clinical evidence, and future perspectives for CytoSorb® hemoadsorption therapy in IE patients.
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- 2024
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25. Stem cells mobilization by cardiopulmonary bypass after coronary artery bypass grafting
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Adam R. Kowalówka, Wojciech Wojakowski, Ryszard Bachowski, and Marek Deja
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inflammation ,stem cells ,cardiopulmonary bypass ,coronary artery disease ,Medicine - Published
- 2022
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26. Peak Value of Central Venous Pressure and Acute Kidney Injury in Cardiac Patients After Cardiopulmonary Bypass Surgery
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ZHANG Hongmin, CHEN Xiukai, WANG Xiaoting, LIU Dawei, and CHAI Wenzhao
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central venous pressure ,cardiac surgery ,acute kidney injury ,cardiopulmonary bypass ,Medicine - Abstract
Objective To explore the relationship between the post-operative peak value of central venous pressure (CVPp) and the incidence of acute kidney injury (AKI) in patients who had undergone cardiopulmonary bypass surgery (CBS). Methods Clinical data were retrospectively collected from 1 May 2016 to 1 May 2018 from all patients undergoing CBS in the Department of Intensive Care Medicine, Peking Union Medical College Hospital. The CVP values immediately after transfer to ICU (CVP 0h) and at 6 h(CVP 6h), and CVPp within 48 h(CVPp 48h) of transfer to ICU, the incidence of AKI after 48 h of transfer to ICU and in-hospital mortality were recorded. The receiver operating characteristic (ROC) curve was used to evaluate the clinical value of CVP-related indicators in predicting AKI after CBS and determine the optimal threshold. The risk factors for AKI and in-hospital mortality after CBS were analysed using single factor and multifactorial Logistic regression. Results A total of 485 patients after CBS who met the inclusion and exclusion criteria were enrolled, with an incidence of AKI after 48 h of transfer to ICU of 25.2% (122/485) and an in-hospital mortality rate of 2.5% (12/485). The ROC curve analysis showed that the area under the curve (AUC) for CVPp 48h to predict AKI after CBS was 0.634 (95% CI: 0.577-0.692, P < 0.001), with an optimal threshold value of 14 mm Hg, sensitivity of 49.6% and specificity of 63.5%. Multifactorial logistic regression analysis showed that hypertension(OR=2.505, 95% CI: 1.581-3.969, P < 0.001), pulmonary hyperten-sion(OR=2.552, 95% CI: 1.573-4.412, P < 0.001), prolonged aortic block time(OR=1.009, 95% CI: 1.004-1.014, P=0.001), and CVPp 48h≥14 mm Hg(OR=1.613, 95% CI: 1.030-2.526, P=0.037) were independent risk factors for AKI after CBS; CVPp 48h≥14 mm Hg was an independent risk factor for in-hospital death(OR=8.044, 95% CI: 1.579-40.979, P=0.012). Conclusions CVPp 48h is associated with AKI in patients who have undergone CBS. The monitoring and management of CVP might be a way to improve the prognosis of these patients.
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- 2022
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27. Vasoplegic syndrome after cardiopulmonary bypass for paravalvular leak of mitral bioprosthesis
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Yu-Xuan Jiang, Po-Shun Hsu, Chien-Sung Tsai, and Chih-Yuan Lin
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vasoplegic syndrome ,cardiopulmonary bypass ,paravalvular leak ,Medicine ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Vasoplegic syndrome (VS) is characterized by low systemic vascular resistance paired with relatively preserved cardiac output that may result in increased morbidity and mortality rate after open-heart surgery utilizing cardiopulmonary bypass. We report a case of a 61-year-old male who underwent redo open-heart surgery due to a paravalvular leak of the previous implanted mitral bioprosthesis and severe tricuspid regurgitation. The patient experienced the VS in the intensive care unit after the operation. He was resuscitated by vasopressors and recovered uneventfully.
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- 2023
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28. Effect of intravenous lidocaine on postoperative atrial fibrillation, IL-6 and IL-10 in patients undergoing cardiac surgery
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Li Qiongzhen, Wu Dehua, Tan Gang, Wu Jingxiang, Xu Meiying
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lidocaine ,cardiac surgery ,cardiopulmonary bypass ,atrial fibrillation ,interleukin ,Medicine - Abstract
Objective To investigate the effect of intravenous lidocaine on postoperative atrial fibrillation, IL-6 and IL-10 levels in patients undergoing cardiac surgery. Methods Sixty patients scheduled for cardiac surgery requiring cardiopulmonary bypass, were randomly divided into two groups based on computer-generated randomized assignments: lidocaine group (Group L, n = 30) and control group (Group C, n = 30). Patients in Group L received three-phase intravenous lidocaine infusion regimen as follows: upon induction of general anesthesia, a bolus of intravenous lidocaine 1.5 mg/kg was given over a minimum of 5 min; subsequently, lidocaine 2.3 mg/(kg·h) was infused for the first 3 h; lidocaine was then reduced to 0.8 mg/(kg·h) and discontinued 24 h postoperatively. Patients in Group C received intravenous saline infusion. The bolus amounts and infusion rates were identical to those in Group L. Blood samples were collected before, at the end of surgery and 24 h after surgery for measurement of IL-6 and IL-10 levels. The episode of new onset of atrial fibrillation and the development of cardiovascular events after surgery were recorded. Results Compared with preoperative levels, serum IL-6 and IL-10 levels at the end of surgery and 24 h after surgery were significantly higher (all P < 0.01). Compared with Group C, serum IL-6 and IL-10 levels at the end of surgery and 24 h after surgery were significantly lower in Group L (P < 0.05 or P < 0.01). In Group C, postoperative extubation time was (15.9±3.6) h, significantly longer than (12.2±4.7) h in Group L (P < 0.01). Compared with Group C, the incidence of postoperative atrial fibrillation tended to decline in Group L(10% vs. 24%, P > 0.05). Conclusions Perioperative intravenous infusion of lidocaine could decrease postoperative serum IL-6 and IL-10 levels, shorten tracheal extubation time and lower the risk of postoperative atrial fibrillation.
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- 2022
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29. Risk factors in the development of postoperative complications after reconstructive surgery on the thoracic aorta
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Alisa Krdžalić, Mustafa Tabaković, Ivana Iveljić, Ema Tahto, and Goran Krdžalić
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aortic aneurysm ,cardiopulmonary bypass ,patient outcome assessment ,Medicine - Abstract
Aim To determine risk factors responsible for developing postoperative complications after the thoracic aorta reconstructive surgery. Methods Medical records of 100 patients, who had undergone elective or emergency thoracic aorta reconstructive surgery at the Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, were analysed. Intraoperative data as cross-clamp time (CCT), duration of cardiopulmonary bypass (CPBT) and hypothermic circulatory arrest time (HCAT) were evaluated. Univariate analysis was used to show risk factors for developing postoperative cardiac, respiratory, surgical and renal complications. Results Between May 2019 and April 2021, 48 Bentall procedures (BP), 23 ascending aortic replacements (AAR), 20 BP and coronary artery bypass grafting (CABG) and 9 aortic valve replacements (AVR) with AAR were performed. Incidence of postoperative complications in the elective and emergency groups was as follows: respiratory 20% vs 38% (p=0.049), cardiac 18% vs 70% (p=0.015), renal 16% vs 48% (p=0.027) and surgical 4% vs 6% (p>0.05). Intrahospital 30 days morbidity was 44% with mortality rate of 13%. The results showed that CPBT>180 minutes was a risk factor for respiratory (p=0.034), cardiac (p=0.020) and renal (p=0.027) postoperative complications after acute type A aortic dissection surgery. Conclusion CPBT > 180 min is a risk factor for postoperative development of respiratory, cardiac and renal complications. Postoperative cardiac and renal complications were associated with longer HCAT.
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- 2022
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30. The progression of traumatic Stanford type A acute aortic dissection
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Hironobu Nishiori, Hisanori Fujita, and Seiichi Yamaguchi
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aortic dissection ,blunt injury ,cardiopulmonary bypass ,Medicine ,Medicine (General) ,R5-920 - Abstract
Key Clinical Message Cardiopulmonary bypass for trauma patients carries the risk of bleeding from injured organs, while traumatic aortic dissection can progress rapidly. It is sometimes difficult to determine the optimal time for aortic repair in trauma patients. Abstract An 85‐year‐old woman was diagnosed with traumatic ascending aortic dissection, right clavicle and left first rib fracture, and abdominal contusions after a vehicle accident. After admission, the aortic dissection progressed, and emergent surgery was performed. Although the risk of hemorrhagic complications needs to be evaluated, prompt aortic repair is required.
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- 2023
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31. Off-pump versus on-pump coronary artery bypass grafting in patients with chronic obstructive pulmonary disease
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Karim Mohamed Mady, Amr Ahmed Abdou Ettish, Wael Mohamed Elfeky, and Mohamed Mostafa Abdelaal
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Cardiopulmonary bypass ,Atrial fibrillation ,Respiration ,Coronary artery ,Lung ,Chronic obstructive ,Medicine - Abstract
N/A
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- 2023
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32. Creatinine Reduction Ratio Is a Prognostic Factor for Acute Kidney Injury following Cardiac Surgery with Cardiopulmonary Bypass: A Single-Center Retrospective Cohort Study
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Akiko Anzai, Shunsuke Takaki, Nobuyuki Yokoyama, Shizuka Kashiwagi, Masashi Yokose, and Takahisa Goto
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reduction of creatinine ,acute kidney injury ,cardiopulmonary bypass ,Medicine - Abstract
Acute kidney injury (AKI) after cardiac surgery is a common complication that can lead to death. We previously reported that the creatinine reduction ratio (CRR) serves as a useful prognostic factor for AKI. The primary objective of this study was to determine the predictors of AKI after surgery. The secondary objective was to determine the reliability of the CRR for short- and long-term outcomes. We retrospectively collected information about cardiac surgery patients who underwent cardiopulmonary bypass. Patients were divided into AKI and non-AKI groups based on the AKIN and RIFLE criteria. We analyzed the two groups regarding the preoperative patient data and operative information. The CRR was calculated as follows: (preoperative creatinine—postoperative creatinine)/preoperative creatinine. The prognostic factors of AKI-CS were surgery time, CPB time, aorta clamp time, platelet transfusion, and CRR < 20%. In the multivariate logistical analysis, CRR was an independent predictor of AKI (adjusted odds ratio: 0.90 [0.87–0.93], p < 0.001). However, there were no significant differences in CRR in terms of the rate of new onset chronic kidney disease (CKD). After cardiac surgery with cardiopulmonary bypass, CRR has good diagnostic power for predicting perioperative AKI. However, we cannot use it as a prognostic factor over a long-term period.
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- 2023
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33. Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks
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Jakub Udzik, Jerzy Pacholewicz, Andrzej Biskupski, Paweł Walerowicz, Kornelia Januszkiewicz, and Ewa Kwiatkowska
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cardiac surgery ,clinical physiology ,cardiopulmonary bypass ,acute kidney injury ,Medicine - Abstract
Introduction: According to different authors, cardiac surgery-associated acute kidney injury (CSA-AKI) incidence can be as high as 20–50%. This complication increases postoperative morbidity and mortality and impairs long-term kidney function in some patients. This review aims to summarize current knowledge regarding alterations to renal physiology during cardiopulmonary bypass (CPB) and to discuss possible nephroprotective strategies for cardiac surgeries. Relevant sections: Systemic and renal circulation, Vasoactive drugs, Fluid balance and Osmotic regulation and Inflammatory response. Conclusions: Considering the available scientific evidence, it is concluded that adequate kidney perfusion and fluid balance are the most critical factors determining postoperative kidney function. By adequate perfusion, one should understand perfusion with proper oxygen delivery and sufficient perfusion pressure. Maintaining the fluid balance is imperative for a normal kidney filtration process, which is essential for preserving the intra- and postoperative kidney function. Future directions: The review of the available literature regarding kidney function during cardiac surgery revealed a need for a more holistic approach to this subject.
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- 2023
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34. Biochemical Changes in Cardiopulmonary Bypass in Cardiac Surgery: New Insights
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Luan Oliveira Ferreira, Victoria Winkler Vasconcelos, Janielle de Sousa Lima, Jaime Rodrigues Vieira Neto, Giovana Escribano da Costa, Jordana de Castro Esteves, Sallatiel Cabral de Sousa, Jonathan Almeida Moura, Felipe Ruda Silva Santos, João Monteiro Leitão Filho, Matheus Ramos Protásio, Pollyana Sousa Araújo, Cláudio José da Silva Lemos, Karina Dias Resende, and Dielly Catrina Favacho Lopes
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cardiopulmonary bypass ,inflammation ,lactate ,cytokines ,cardiac surgery ,Medicine - Abstract
Patients undergoing coronary revascularization with extracorporeal circulation or cardiopulmonary bypass (CPB) may develop several biochemical changes in the microcirculation that lead to a systemic inflammatory response. Surgical incision, post-CPB reperfusion injury and blood contact with non-endothelial membranes can activate inflammatory signaling pathways that lead to the production and activation of inflammatory cells, with cytokine production and oxidative stress. This inflammatory storm can cause damage to vital organs, especially the heart, and thus lead to complications in the postoperative period. In addition to the organic pathophysiology during and after the period of exposure to extracorporeal circulation, this review addresses new perspectives for intraoperative treatment and management that may lead to a reduction in this inflammatory storm and thereby improve the prognosis and possibly reduce the mortality of these patients.
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- 2023
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35. Management of Microvascular Bleeding after On-Pump Cardiac Surgery in a Patient with Perioperative Diagnosis of Impairment of Platelet Responses to Adenosine Diphosphate: A Case Report and a Literature Review
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Jacopo D’Andria Ursoleo, Margherita Licheri, Gaia Barucco, Sara Breggion, Francesco De Simone, and Fabrizio Monaco
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adenosine diphosphate ,blood platelets ,cardiac surgical procedures ,cardiopulmonary bypass ,deamino arginine vasopressin ,P2Y12 purinoceptor ,Medicine - Abstract
Background: Impairment of platelet responses to adenosine diphosphate (ADP) is typified by mild to severe bleeding diathesis, easy bruising, excessive mucosal and post-operative bleeding. Patients lack full platelet activation and aggregation in response to ADP. Following research of the literature in Scopus, PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, we report only 18 patients described to date with impaired platelet response to ADP, none of whom in the high bleeding-risk surgical setting or exploring potential therapeutic options. Data regarding population, putative genetic mutations, modes of inheritance, functional defects, and related clinical manifestations were retrieved from case series and case reports. Case presentation: A 40-year-old woman was scheduled for on-pump cardiac surgery. Her past medical history included episodes of spontaneous mucocutaneous hemorrhages of the mild entity since childhood. Multiple electrode aggregometry (MEA, Multiplate® Roche Diagnostics, Rotkreuz, Switzerland) was used to evaluate platelet response to thrombin-activated peptide-6 (TRAP), arachidonic acid (ASPI), and ADP. An inadequate platelet aggregation induced using a high concentration of ADP with normal TRAP and ASPI tests was detected preoperatively. Therefore, intravenous desmopressin (DVVAP) 0.3 μg/kg body weight was administered to manage microvascular bleeding developed after weaning from cardiopulmonary bypass (CPB). Conclusions: Proper management of impaired platelet response to ADP requires a systematic assessment. The Multiplate analyzer is a valuable tool to promptly detect the disorder when a high clinical suspect is present and obtain insights during high bleeding-risk surgical procedures. DVVAP can be beneficial as first-line therapy in bleeding patients to improve platelet function.
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- 2023
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36. Evaluation of the correlation between end-tidal arterial carbon dioxide pressure based on mainstream capnography technique and arterial carbon dioxide pressure based on arterial blood gas analysis before and after cardiopulmonary bypass pump in children with non-cyanotic congenital heart defects
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Ashkan Taghizadeh, Hooman Naghashian, Rojin Faroughi, and Behrang Nooralishahi
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carbon dioxide ,arterial blood gas ,cardiopulmonary bypass ,capnography ,Medicine - Abstract
Background. It is still a matter of debate whether the evaluation of end-tidal carbon dioxide (ETCO2) using a capnography device allows the evaluation of non-invasive monitoring of arterial carbon dioxide pressure (PaCO2). The aim of this study was to compare the value of ETCO2 by direct mainstream and PaCO2 based on arterial gas analysis (ABG) before and after cardiopulmonary bypass pump in children with congenital heart defects. Methods. Twenty nine children who were candidates for elective cardiac surgery and were admitted to the Children's Medical Center were enrolled. Before and after cardiopulmonary bypass pump, ETCO2 was evaluated based on mainstream technique and PaCO2 based on arterial gas analysis. Results. The mean difference between ETCO2 and PaCO2 values before cardiopulmonary bypass pump was 3.68±5.32 mm Hg, which considering that the difference of less than 5 mm Hg is clinically negligible, indicates an acceptable agreement between them. However, the mean difference between the two indices after cardiopulmonary bypass pump was 6.85 ±7.0 mm Hg that accordingly, the difference between the two measured values after cardiopulmonary bypass will be clinically significant. Conclusion. Preoperative ETCO2 evaluation can provide a close prediction of PaCO2 levels, but after pumping, direct arterial sampling should be taken to accurately measure PaCO2 levels in non-cyanotic patients undergoing heart surgery. Practical Implications. When confronting with a child with non-cyanotic heart defect undergoing surgery, we suggest relying on capnography as a mirror of arterial blood pressure of carbon dioxide. However, capnography may not be as reliable during early post-bypass period in this group of patients and repeated arterial blood samples may be necessary.
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- 2022
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37. Protocol for the electroencephalography guidance of anesthesia to alleviate geriatric syndromes (ENGAGES-Canada) study: A pragmatic, randomized clinical trial [version 2; peer review: 2 approved]
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Eva M. Schmitt, Rob Tanzola, Jordan Oberhaus, Sharon K. Inouye, Canadian Perioperative Anesthesia Clinical Trials Group, Angela Mickle, Arbi Ben Abdallah, Jo Carroll, Tarit Saha, Alain Deschamps, Eric Jacobsohn, Renée El-Gabalawy, Jennifer Palermo, Charles Overbeek, Andrea Alicia Dumont, Sophie Robichaud, Morvarid S. Kavosh, Michael S. Avidan, and George Djaiani
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EEG suppression ,geriatric outcomes ,postoperative delirium ,cardiac surgery ,anesthetic management ,cardiopulmonary bypass ,eng ,Medicine ,Science - Abstract
Background: There is some evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium after non-cardiac surgery. There is limited evidence in this regard for cardiac surgery. A suppressed electroencephalogram pattern, occurring with deep anesthesia, is associated with increased incidence of postoperative delirium (POD) and death. However, it is not yet clear whether this electroencephalographic pattern reflects an underlying vulnerability associated with increased incidence of delirium and mortality, or whether it is a modifiable risk factor for these adverse outcomes. Methods: The Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES-Canada) is an ongoing pragmatic 1200 patient trial at four Canadian sites. The study compares the effect of two anesthetic management approaches on the incidence of POD after cardiac surgery. One approach is based on current standard anesthetic practice and the other on electroencephalography guidance to reduce POD. In the guided arm, clinicians are encouraged to decrease anesthetic administration, primarily if there is electroencephalogram suppression and secondarily if the EEG index is lower than the manufacturers recommended value (bispectral index (BIS) or WAVcns below 40 or Patient State Index below 25). The aim in the guided group is to administer the minimum concentration of anesthetic considered safe for individual patients. The primary outcome of the study is the incidence of POD, detected using the confusion assessment method or the confusion assessment method for the intensive care unit; coupled with structured delirium chart review. Secondary outcomes include unexpected intraoperative movement, awareness, length of intensive care unit and hospital stay, delirium severity and duration, quality of life, falls, and predictors and outcomes of perioperative distress and dissociation. Discussion: The ENGAGES-Canada trial will help to clarify whether or not using the electroencephalogram to guide anesthetic administration during cardiac surgery decreases the incidence, severity, and duration of POD. Registration: ClinicalTrials.gov (NCT02692300) 26/02/2016
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- 2023
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38. Strategies to mitigate inflammation in management of complex congenital heart disease complicated by 'multisystem inflammatory syndrome in children'
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Anil Kumar, Reena K Joshi, Neeraj Aggarwal, Mily Ray, and Raja Joshi
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cardiopulmonary bypass ,congenital heart surgery ,cytosorb ,multisystem inflammatory syndrome in children ,shone's complex ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 6-month-old boy, a case of Shone's complex, presented in decompensated state was found to have severe mitral stenosis along with multisystem inflammatory syndrome in children (MISC) warranting urgent surgical intervention. Various modalities including cytokine-adsorbing hemofilter were used to target inflammation. Postoperatively, the child recovered from low cardiac output accompanied by decrease in the levels of inflammatory markers, inopressors, and ventilatory requirements. Open heart surgery in itself is a proinflammatory process and is best avoided during the active inflammatory phase of MISC. In the rare and unavoidable circumstance exemplified by this index case, multipronged strategy targeting inflammation as described can be successfully implemented.
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- 2022
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39. Short-term results of off-pump and on-pump aortic arch debranching during type I hybrid arch repair: A single-center experience
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Mohamed A El-Badawy, Mostafa M Abdalraouf, Ahmed S Emara, Hussein A Zaher, Mohamed A El-Hady, and Mahmoud F El-Safty
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aortic aneurysm ,aortic arch ,beating heart ,cardiopulmonary bypass ,debranching ,repair ,Medicine - Abstract
Background Compared with off-pump surgeries, cardiopulmonary bypass (CPB) is associated with a high systemic inflammatory response and with substantial myocardial injury, especially in high-risk subgroups. Every effort should be exerted to minimize the role of CPB without affecting the safety and outcome. Classically, aortic arch surgeries were done using CPB and deep circulatory arrest together with cerebral brain protection strategies. With the development of endovascular techniques, the role of CPB decreased. Management of aortic arch pathologies carries special needs, specifically rerouting of the great vessels and preparing a landing zone. Objectives To assess the effectiveness and safety of off-pump aortic arch debranching during type I hybrid aortic arch repair. Patients and methods We report our single-center experience of rerouting aortic arch branches (debranching) without using CPB, consisting of bypass grafting of the aortic arch branches off pump, preparing a landing zone for endovascular aortic repair. The preoperative, operative, and postoperative data were collected and analyzed retrospectively. Starting from 2015, 20 low-risk patients were subjected to type I aortic arch hybrid repair, whereas the Dacron tube graft was anastomosed to a normal ascending aorta, preparing a landing zone to the subsequent stenting of arch and descending aorta. CPB was used in 10 patients, and off-pump technique was used in the remaining group. Preoperative, operative, and postoperative data were collected and analyzed to compare the results. Results All surgeries went uneventful, with mean operative time of 141.5 ± 24.3 min for group I (on-pump group) and 137.5 ± 14.6 for group II (off-pump group). There were no conversions to CPB in off-pump group. There was no sternotomy for bleeding in off-pump group, compared with only one patient explored for postoperative bleeding in CPB group. All patients in both groups went without any neurological deficit of significance, with no mortality in the 30 days of follow-up. Conclusion Off-pump debranching of aortic arch followed by endovascular repair is a safe and reproducible technique, compared with the gold standard technique using CPB. However, further efforts using intraoperative cerebral perfusion monitoring techniques should be considered in the future.
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- 2022
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40. Inflammatory Biomarkers and Blood Physical Property Transformations Following On-Pump Coronary Artery Bypass Graft Surgery
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Po-Shun Hsu, Jia-Lin Chen, Shih-Ying Sung, Yi-Ting Tsai, Chih-Yuan Lin, Yi-Fan Wu, and Chien-Sung Tsai
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cardiopulmonary bypass ,on-pump coronary artery bypass graft ,inflammation ,hemorheology ,Medicine - Abstract
Objective: This study aimed to compare the hemorheological and inflammatory changes before and after coronary artery bypass graft (CABG) surgery, as factors such as hypothermia, hemodilution, transfusion, and other variables affect blood viscosity and inflammation during the procedure. Methods: A total of 25 patients who underwent CABG surgery were enrolled in this study. Whole blood was collected just before the CABG (D0), 2 days after surgery (D2), and 5 days after surgery (D5). The plasma viscosity (PV) and whole blood viscosity (WBV) were measured at shear rates ranging from 0.1 to 1000 s−1 using a rheometer, and the mean values were compared. Inflammatory markers were also assessed and analyzed in relation to the hemorheological changes. Results: Compared with the baseline values, the PV significantly increased after 5 days. WBV showed a significant increase on day 2 and after 5 days. The WBV and fibrinogen were significantly correlated on day 2 and day 5 but not before surgery. Inflammatory markers such as CRP, WBC, platelets, and fibrinogen also demonstrated notable changes in relation to the hemorheological alterations. Conclusions: This study highlights the crucial finding that hyperviscosity, characterized by elevated PV and WBV, persists for almost one week after on-pump CABG surgery. Understanding the interplay between inflammation and hemorheological properties during the postoperative period is crucial for optimizing patient care. Future research should focus on exploring the underlying mechanisms and potential therapeutic interventions to mitigate the impact of inflammation on blood viscosity and improve patient outcomes following CABG surgery.
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- 2023
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41. Analysis of P(v-a)CO2/C(a-v)O2 Ratio and Other Perfusion Markers in a Population of 98 Pediatric Patients Undergoing Cardiac Surgery
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Matteo Taiana, Irene Tomasella, Alessandro Russo, Annalisa Lerose, Marcello Ceola Graziadei, Luisa Corubolo, Jacopo Rama, Vittorio Schweiger, Alessandro Vignola, Enrico Polati, Giovanni Battista Luciani, Francesco Onorati, Katia Donadello, and Leonardo Gottin
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venoarterial carbon dioxide difference ,congenital heart disease ,cardiopulmonary bypass ,postoperative care ,physiologic monitoring ,infant ,Medicine - Abstract
Background: The so-called Low Cardiac Output Syndrome (LCOS) is one of the most common complications in pediatric patients with congenital heart disease undergoing corrective surgery. LCOS requires high concentrations of inotropes to support cardiac contractility and improve cardiac output, allowing for better systemic perfusion. To date, serum lactate concentrations and central venous oxygen saturation (ScVO2) are the most commonly used perfusion markers, but they are not completely reliable in identifying a state of global tissue hypoxia. The study aims to evaluate whether the venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio [P(v-a)CO2/C(a-v)O2] can be a good index to predict the development of LCOS in the aforementioned patients, so as to treat it promptly. Methods: This study followed a population of 98 children undergoing corrective cardiac surgery from June 2018 to October 2020 at the Department of Cardiac Surgery of University Hospital Integrated Trust and their subsequent admission at the Postoperative Cardiothoracic Surgery Intensive Care Unit. During the study, central arterial and venous blood gas analyses were carried out before and after cardiopulmonary bypass (CPB) (pre-CPB and post-CPB), at admission to the intensive care unit, before and after extubation, and at any time of instability or modification of the patient’s clinical and therapeutic conditions. Results: The data analysis shows that 46.9% of the children developed LCOS (in line with the current literature) but that there is no statistically significant association between the P(v-a)CO2/C(a-v)O2 ratio and LCOS onset. Despite the limits of statistical significance, however, a 31% increase in the ratio emerged from the pre-CPB phase to the post-CPB phase when LCOS is present. Conclusions: This study confirms a statistically significant association between the most used markers in adult patients (serum lactate concentration, ScVO2, and oxygen extraction ratio—ERO2) measured in the pre-CPB phase and the incidence of LCOS onset, especially in patients with hemodynamic instability before surgery.
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- 2023
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42. Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial
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Thomas S. Zajonz, Christian Kunzemann, Anna Lena Schreiner, Frauke Beckert, Emmanuel Schneck, Andreas Boening, Melanie Markmann, Michael Sander, and Christian Koch
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intensive care ,postoperative delirium ,cardiac surgery ,preoperative patient evaluation and improvement ,cardiopulmonary bypass ,postoperative care ,Medicine - Abstract
Cardiac surgery is regularly associated with postoperative delirium (POD), affected by neuro-inflammation and changes in cholinergic activity. Therefore, this prospective observational study aimed to evaluate whether pre- and perioperative changes in blood acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity were associated with POD development in patients undergoing isolated elective coronary artery bypass graft (CABG) surgery. It included 93 patients. Pre- and postoperative blood AChE and BChE activities were measured with photometric rapid-point-of-care-testing. The Intensive Care Delirium Screening Checklist and the Confusion Assessment Method for the Intensive Care Unit were used to screen patients for POD. POD developed in 20 patients (21.5%), who were older (p = 0.003), had higher EuroSCOREs (p ≤ 0.001), and had longer intensive care unit stays (p < 0.001). On postoperative day one, BChE activity decreased from preoperative values more in patients with (31.9%) than without (23.7%) POD (group difference p = 0.002). Applying a cutoff of ≥32.0% for BChE activity changes, receiver operating characteristic analysis demonstrated a moderate prediction capability for POD (area under the curve = 0.72, p = 0.002). The risk of developing POD was 4.31 times higher with a BChE activity change of ≥32.0% (p = 0.010). Monitoring the pre- to postoperative reduction in BChE activity might be a clinically practicable biomarker for detecting patients at risk of developing POD after CABG surgery.
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- 2023
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43. The effects of levosimendan on renal functions in open-heart surgery patients with a low ejection fraction
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Süleyman Yazıcı, Mehmet N. Karabulut, Ayşe Baysal, and Rahmi Zeybek
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levosimendan ,low ejection fraction ,cardiopulmonary bypass ,serum creatinine ,Medicine - Abstract
Purpose. This study investigated the effects of levosimendan on renal functions in patients with a preoperative low ejection fraction undergoing open-heart surgery and cardiopulmonary bypass (CPB). Materials and Methods. The study retrospectively evaluated 64 patients with a diagnosis of mitral valve insufficiency and left ventricular dysfunction undergoing open-heart surgery with CPB. Patients were divided depending on the preoperative blood creatinine level less (Group 1) or more than 1.2 mg/dL (Group 2). A bolus dose of levosimendan was administered through the aortic arch at the end of the CPB, preceding an infusion of levosimendan intravenously in all patients. Demographic data, preoperative and 48-hour postoperative echocardiographic studies were done. The blood urea and creatinine levels were collected preoperatively and on postoperative days 1, 3, and 10. The use of inotropic support, intra-aortic balloon pump, and complications were recorded. Results. The demographic data were similar between groups (p>0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p=0.01, p0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p0.05). Complications were similar between groups (p>0.05). Conclusions. In patients with low ejection fraction undergoing open-heart surgery, the use of levosimendan intraoperatively and 24 hours postoperatively prevents deterioration of renal functions in patients with or without preoperative disturbance in serum creatinine level.
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- 2021
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44. Acute kidney injury after coronary artery bypass graft surgery: a narrative review of causes, diagnosis, and prevention
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Mansour Jannati and Javad Kojuri
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coronary artery bypass ,acute kidney injury ,creatinine ,serum ,cardiopulmonary bypass ,Medicine - Abstract
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is a common cardiac event associated with short and long-term consequences and occurs in 30–51% of CABG patients. AKI may be associated with many other factors and is also responsible for many other pathologies. An increased level of serum creatinine (SCr) after surgery is one of the signs of AKI that may occur more often during cardiopulmonary bypass (CPB) in susceptible individuals. Preparing preoperative checklists is a good practice for the prevention of AKI. Defining new opportunities and strategies of perioperative care is a useful procedure for decreasing the risk of AKI after cardiac surgery. Collecting more data on preoperative risk factors and improving the intraoperative practices may decrease the incidence of AKI in the aggregate population. In this review study, we are going to review the literature on the pathophysiology of AKI and introduce the discussion about the features of patients who are more at the risk of AKI than others.
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- 2021
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45. Do continuous forms of intra-operative ultrafiltration enhance recovery after adult cardiac surgery with cardiopulmonary bypass? A protocol for systematic review and meta-analysis of randomized controlled trials
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Joel Bierer, David Horne, Roger Stanzel, Mark Henderson, Leah Boulos, and Jill Hayden
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Continuous ,Ultrafiltration ,Adult ,Cardiac surgery ,Cardiopulmonary bypass ,Medicine - Abstract
Abstract Background Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a systemic inflammatory syndrome that adversely impacts cardiopulmonary function and can contribute to prolonged postoperative recovery. Intra-operative ultrafiltration during CPB is a strategy developed by pediatric cardiac specialists, aiming to dampen the inflammatory syndrome by removing circulating cytokines and improving coagulation profiles during the cardiac operation. Although ultrafiltration is commonly used in the pediatric population, it is not routinely used in the adult population. This study aims to evaluate if randomized evidence supports the use of continuous intra-operative ultrafiltration to enhance recovery for adults undergoing cardiac surgery with CPB. Methods This systematic review and meta-analysis will include randomized controlled trials (RCT) that feature continuous forms of ultrafiltration during adult cardiac surgery with CPB, specifically assessing for benefit in mortality rates, invasive ventilation time and intensive care unit length of stay (ICU LOS). Relevant RCTs will be retrieved from databases, including MEDLINE, Embase, CENTRAL and Scopus, by a pre-defined search strategy. Search results will be screened for inclusion and exclusion criteria by two independent persons with consensus. Selected RCTs will have study demographics and outcome data extracted by two independent persons and transferred into RevMan. Risk of bias will be independently assessed by the Revised Cochrane Risk-of-Bias (RoB2) tool and studies rated as low-, some-, or high- risk of bias. Meta-analyses will compare the intervention of continuous ultrafiltration against comparators in terms of mortality, ventilation time, ICU LOS, and renal failure. Heterogeneity will be measured by the χ 2 test and described by the I 2 statistic. A sensitivity analysis will be completed by excluding included studies judged to have a high risk of bias. Summary of findings and certainty of the evidence, determined by the GRADE approach, will display the analysis findings. Discussion The findings of this systematic review and meta-analysis will summarize the evidence to date of continuous forms of ultrafiltration in adult cardiac surgery with CPB, to both inform adult cardiac specialists about this technique and identify critical questions for future research in this subject area. Systematic review registration This systematic review and meta-analysis is registered in PROSPERO CRD42020219309 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020219309 ).
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- 2021
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46. Effect of Modified Ultrafiltration (MUF) on Lactate Levels in Pediatric Patients Undergoing Cardiac Surgery
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Jahanzaib Azam, Muhammad Imran Asghar, Nasir Ali, Shoaib Umer, Naseem Azad, Hafsa Khalil, Fatima Azam, Arslan Muneer, Zainab Khatoon, and Wajahat Naeem
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Cardiopulmonary bypass ,Lactate levels ,Modified ultrafiltration ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objective: To determine the effect of MUF on pre and post MUF lactate levels. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Pediatric Operation Theater at Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi Pakistan from Oct 2021 to Dec 2021. Methodology: It was descriptive cross-sectional study and non-probability consecutive sampling technique was used. Data was collected during Oct 2021 to Dec 2021, from Tertiary Care Hospital, Rawalpindi Pakistan. Current study was conducted in pediatric OT at Armed Forces Institute of Cardiology/National Institute of Heart Disease. MUF technique was applied to 115 pediatric patients during congenital cardiac surgeries. Pre and post MUF lactate levels were noted. Inferential statistics were applied with the help of test of significance (Paired T-Test), p value ≤ 0.05 was considered statistically significant at 95% Confidence Interval (CI) with margin of error 5%. Collected data was analyzed by IBM SPSS version 25. Result: Significant decrease in post MUF lactate level (p
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- 2022
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47. Comparison of Amiodarone with Combined Doses of Magnesium Sulphate and Lidocaine for Prevention of Ventricular Fibrillation Following Coronary Clamp Release During Coronary Artery Bypass Graft Surgery
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Muhammad Adnan Akram, Mehwish Naseer, Fakher-e- Fayaz, Hana Khurshid, Nasir Ali, and Imtiaz Ahmed Chaudhry
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Amiodarone ,Arrhythmias ,Cardiopulmonary bypass ,Coronary artery bypass grafting (CABG) ,Lidocaine ,Magnesium sulphate ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objective: To compare the effects of amiodarone with effects of combined doses of magnesium sulphate and lidocaine for prevention of ventricular fibrillation following coronary clamp release during (coronary artery bypass grafting) CABG. Study Design: Comparative cross sectional study. Place and Duration of Study: Army Cardiac Centre, Lahore Pakistan, from Jun 2021 to Dec 2021. Methodology: One hundred patients who reported at Army Cardiac Centre Lahore, Pakistan for coronary artery bypass grafting surgery, were involved in comparative study. Patients satisfying the inclusion criteria were allocated into the LM(Lidocaine Magnesium) and A (Amiodarone) groups. Following aortic cross clamp release, the incidence of ventricular fibrillation (VF) and other arrhythmias was calculated in first 30 minutes and up to 24 hours later. The ionotropic agent used was epinephrine at a rate of 0.05 to 0.1 micrograms/kg/minute. Within 15 minutes of anesthetic induction and 15 minutes after the CPB pump was removed, hemodynamic parameters were assessed and recorded. Results: Arrhythmias within 30 minutes and up to 24 hours after aortic cross clamp ACC release in A and LM group were compared. The difference between two groups, having arrhythmias and no arrhythmias was statistically insignificant (p≥0.050) except VF up to 24 hours after ACC release. The highest voltage for defibrillation was used in Group-A n=20 (40.0%) and n=27 (54.0%) in L.M group, (p=0.004). The average electrical defibrillations in group-A was less than that of group L.M,(p=0.000). While, the use of ionotropic agent was almost equal in both the groups, (p=0.975). Conclusion: Overall, the amiodarone group had a decreased incidence of VF when the ACC was released, while the difference was not statistically significant.
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- 2022
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48. Evaluation of right ventricular performance in patients with postoperative congenital heart disease using Doppler tissue imaging and cardiopulmonary bypass indices: A prospective cohort study
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Vishal V. Bhende, Tanishq S. Sharma, Bhadra Y. Trivedi, Amit Kumar, Dushyant M. Parmar, Paresh Nerurkar, Prachi M. Shah, Naresh J. Fumakiya, Hardil P. Majmudar, and Sohilkhan R. Pathan
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cardiopulmonary bypass ,congenital heart disease ,Doppler tissue imaging ,intracardiac repair ,ventricular performance ,Medicine - Abstract
Abstract Background and Aims Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically. RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study. Methods This is a prospective single‐centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022. All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery, where pre‐ and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross‐clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored. Results The mean ± standard deviation for pre‐ and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre‐ and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with p value of
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- 2022
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49. Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report
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Young-Eun Jang, Jin-Tae Kim, and Ji-Hyun Lee
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Cardiopulmonary bypass ,Echocardiography ,Transesophageal echocardiography ,Hematoma ,Pediatric ,Ventricular septal defect ,Medicine - Abstract
Abstract Background Interventricular septal hematoma is an extremely rare complication following congenital heart surgery. During cardiac surgery, interventricular septal hematomas can be detected only by intraoperative transesophageal echocardiography. Here, we report an interesting case of interventricular septal hematoma that was accidentally found in an infant following ventricular septal defect (VSD) closure. Case presentation Transesophageal echocardiography images were acquired from a 1-month-old boy after surgical repair of a large (6.5 mm) perimembranous outlet VSD with interventricular septal flattening. Surgical correction was performed with auto-pericardium and 7–0 Prolene sutures. The patient was successfully weaned from cardiopulmonary bypass, and transesophageal echocardiography showed no VSD leakage and good ventricular function. However, approximately 30 min later, two anechoic masses were found within the interventricular septum, which were suspected to be interventricular septal hematomas; the larger mass measured 1.51 $$\times $$ × 1.48 cm. The swollen interventricular septum showed decreased contractility and compressed both the right and left ventricles. However, there was no change in the size of hematomas or a significant hemodynamic instability for 30 min of observation. Therefore, expecting spontaneous resolution of the hematomas, the interventricular septum was not explored, and the patient was removed from cardiopulmonary bypass. On postoperative day 4, follow-up transthoracic echocardiography revealed thrombi filling the hematomas. The patient was discharged on postoperative day 15 and followed up with regular echocardiographic evaluations. Conclusions We describe a unique case of interventricular septal hematoma after VSD closure. Surgical manipulation of perimembranous VSD and injury of the septal perforating artery may contribute to the development of an interventricular septal hematoma. Moreover, conservative treatment and serial echocardiographic evaluation generally show gradual hematoma resolution in hemodynamically stable patients. Pediatric cardiac anesthesiologists should be aware of this rare complication after VSD repair.
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- 2021
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50. Manejo quirúrgico y anestésico de fístula aortoesofágica secundaria a perforación por espina de pescado: un reporte de caso y revisión de la literatura
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Juan M. Mantilla, Carlos A. Laverde-Rodríguez, Edwar Santis, Héctor G. Olaya, William Díaz, Sergio A. Valdés, and Emiro J. Noguera
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Aortoesophageal fistula ,Fishbone mediastinitis ,Thoracic aortic replacement ,Cardiopulmonary bypass ,Medicine ,Surgery ,RD1-811 - Abstract
Resumen: La perforación aórtica secundaria a ingesta de espina de pescado es una rara y mortal afección; representa entre el 0,08 y el 0,1% de todos los casos de ingesta de cuerpos extraños. Su baja incidencia hace que su diagnóstico sea complicado, ya que no se piensa en esta insólita lesión. El diagnóstico y tratamiento temprano es definitivo en el pronóstico. Describimos detalladamente el manejo quirúrgico y anestésico con el cual se manejó el caso exitosamente, sin presentar daño neurológico ni medular. Este es un reporte de caso de un paciente con fístula aortoesofágica y mediastinitis secundaria a la deglución de un cuerpo extraño, y una revisión de la literatura actual, ya que es una afección mortal y de poca prevalencia. Abstract: Aortic perforation secondary to ingestion of a fish bone is a rare and fatal condition that occurs in between 0.08 and 0.1% of all cases of foreign body ingestion. Its low incidence makes its diagnosis complicated, since this unusual injury is often not considered. Early diagnosis and treatment are definitive in prognosis. The details are presented of the surgical and anaesthetic management of a case that was successfully managed without neurological or medullar damage. The case is presented of an aortoesophageal fistula and mediastinitis secondary to the swallowing of a foreign body, as well as a review of the current literature due to it being a low prevalence condition with a fatal outcome.
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- 2021
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