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Background Heater–cooler devices (HCD) have been implicated in a cardiosurgical contamination scenario causing prosthetic valve endocarditis. Aim We characterized contamination of new HCDs and assessed the risk of intraoperative microorganism transmission from the HCD to the operating field. Methods We initially acquired four new FlexTherm and then four new Maquet HCU40 HCDs and assessed occurrence and speed of microbial contamination (including mycobacteria) assessing swab and water samples from the device. In parallel, we collected repeated samples from different sites in the operating room either by swab sticks or by exposing different sample plates to room air. We also reviewed microbiological results from the hospital and compared them to cardiosurgical wound infections and endocarditis cases. Finally, we simulated cardiosurgical conditions and assessed the devices' ability to expel air to the operative field. Results All new HCDs were clean before first use. Despite authority-mandated decontamination procedures, microbial growth (Fusarium solani , Sphingomonas paucimobilis , Pseudomonas aeruginosa , Mycobacterium chelonae , and gordonae) was identified in all HCDs over time and could not be permanently eliminated. Four of these mircoorganisms were also found in tap water. However, none of the HCD-organisms were found inside the laminar airflow operating area. Importantly, except for P. aeruginosa , none of the HCD organisms were found in patients with surgical wound infections or endocarditis. HCD-expelled air did not rise more than 40 cm above ground. Conclusion HCDs cannot be expected to remain sterile despite extensive decontamination procedures. However, airborne transmission of microorganisms directly from the HCD to the operating field appears unlikely. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications.Methods: We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan-Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables.Results: The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups.Conclusions: The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable. [ABSTRACT FROM AUTHOR]

Colorado potato beetle (CPB, Leptinotarsa decemlineata) is a major pest of potato and other solanaceous vegetables in the Northern Hemisphere. The insect feeds on leaves and can completely defoliate crops. Because of the repeated use of single insecticide classes without rotating active ingredients, many chemicals are no longer effective in controlling CPB. Ledprona is a sprayable double-stranded RNA biopesticide with a new mode of action that triggers the RNA interference pathway. Laboratory assays with second instar larvae fed Ledprona showed a dose–response where 25×10−6g/L of dsPSMB5 caused 90% mortality after 6days of initial exposure. We also showed that exposure to Ledprona for 6h caused larval mortality and decreased target messenger RNA (mRNA) expression. Decrease in PSMB5 protein levels was observed after 48h of larval exposure to Ledprona. Both PSMB5 mRNA and protein levels did not recover over time. Ledprona efficacy was demonstrated in a whole plant greenhouse trial and performed similarly to spinosad. Ledprona, currently pending registration at EPA, represents a new biopesticide class integrated pest management and insecticide resistance management programs directed against CPB. [ABSTRACT FROM AUTHOR]

Background: Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery. Methods: Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively. Results: nRIFLE criteria were used to divide cohorts in "NO AKI" (12 patients) and "AKI" (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time. Conclusions: The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis. [ABSTRACT FROM AUTHOR]

The safety of transesophageal echocardiography (TEE) probes has been documented in pediatric patients (neonates, infants, and small children even < 2.5 kg). The overall safety profile of TEE probe is quite favorable with a reported incidence of complications of 1%–3%. However, insertion of the TEE probe can induce vagal and sympathetic reflexes such as hypertension or hypotension, nonsustained ventricular and supraventricular tachyarrhythmias, or bradyarrhythmias (third degree heart block), and even angina and myocardial infarction. We hereby document a repeated intraoperative ventricular fibrillation precipitated by TEE probe in a 2‐year‐old, 10 kg pediatric patient diagnosed with ostium secundum‐atrial septal defect, supravalvular pulmonary stenosis, and severe right ventricular dysfunction. The international review board approval or waiver and clinical trial registrations are not applicable for this case report publication. [ABSTRACT FROM AUTHOR]

Background: Vasoplegic syndrome (VPS) is defined as systemic hypotension due to profound vasodilatation and loss of systemic vascular resistance (SVR), despite normal or increased cardiac index, and characterized by inadequate response to standard doses of vasopressors, and increased morbidity and mortality. It occurs in 9%–44% of cardiac surgery patients after cardiopulmonary bypass (CPB). The underlying pathophysiology following CPB consists of resistance to vasopressors (inactivation of Ca2+ voltage gated channels) on the one hand and excessive activation of vasodilators (SIRS, iNOS, and low AVP) on the other. Use of angiotensin‐converting enzyme inhibitor (ACE‐I), calcium channel blockers, amiodarone, heparin, low cardiac reserve (EF < 35%), symptomatic congestive heart failure, and diabetes mellitus are the perioperative risk factors for VPS after cardiac surgery in adults. Till date, there is no consensus about the outcome‐oriented therapeutic management of VPS. Vasopressors such as norepinephrine (NE; 0.025–0.2 µg/kg/min) and vasopressin (0.06 U/min or 6 U/h median dose) are the first choice for the treatment. The adjuvant therapy (hydrocortisone, calcium, vitamin C, and thiamine) and rescue therapy (methylene blue [MB] and hydroxocobalamin) are also considered when perfusion goals (meanarterial pressure [MAP] > 60–70 mmHg) are not achieved with nor‐epinephrine and/or vasopressin. Aims: The aims of this systematic review are to collect all the clinically relevant data to describe the VPS, its potential risk factors, pathophysiology after CPB, and to assess the efficacy, safety, and outcome of the therapeutic management with catecholamine and non‐catecholamine vasopressors employed for refractory vasoplegia after cardiac surgery. Also, to elucidate the current and practical approach for management of VPS after cardiac surgery. Material and Methods: "PubMed," "Google," and "Medline" weresearched, and over 150 recent relevant articles including RCTs, clinical studies, meta‐analysis, reviews, case reports, case series and Cochrane data were analyzed for this systematic review. The filter was applied specificallyusing key words like VPS after cardiac surgery, perioperative VPS following CPB, morbidity, and mortality in VPS after cardiac surgery, vasopressors for VPS that improve outcomes, VPS after valve surgery, VPS after CABG surgery, VPS following complex congenital cardiac anomalies corrective surgery, rescue therapy for VPS, adjuvant therapy for VPS, definition of VPS, outcome in VPS after cardiac surgery, etiopathology of VPS following CPB. This review did not require any ethical approval or consent from the patients. Results: Despite the recent advances in therapy, the mortality remains as high as 30%–50%. NE has been recommended the most frequent used vasopressor for VPS. It restores and maintain the MAP and provides the outcome benefits. Vasopressin rescue therapy is an alternative approach, if catecholamines and fluid infusions fail to improve hemodynamics. It effectively increases vascular tone and lowers CO, and significantly decreases the 30 days mortality. Hence, suggested a first‐line vasopressor agent in postcardiac surgery VPS. Terlipressin (1.3μg/kg/h), a longer acting and more specific vasoconstrictor prevents the development of VPS after CPB in patients treated with ACE‐I. MB significantly reduces morbidity and mortality of VPS. The Preoperative MB (1%, 2mg/kg/30min, 1h before surgery) administration in high risk (on ACE‐I) patients for VPS undergoing CABG surgery, provides 100% protection against VPS, and early of MB significantly reduces operative mortality, and recommended as a rescue therapy for VPS. Hydroxocobalamin (5 g) has been recommended as a rescue agent in VPS refractory to multiple vasopressors. A combination of ascorbic acid (6 g), hydrocortisone (200 mg/day), and thiamine (400 mg/day) as an adjuvant therapy significantly reduces the vasopressors requirement, and provides mortality and morbidity benefits. Conclusion: Currently, the VPS is frequently encountered (9%–40%) in cardiac surgical patients with predisposing patient‐specific risk factors and combined with inflammatory response to CPB. Multidrug therapy (NE, MB, AVP, ATII, terlipressin, hydroxocobalamin) targeting multiple receptor systems is recommended in refractory VPS. A combination of high dosage of ascorbic acid, hydrocortisone and thiamine has been used successfully as adjunctive therapyto restore the MAP. We also advocate for the early use of multiagent vasopressors therapy and catecholamine sparing adjunctive agents to restore the systemic perfusion pressure with a goal of preventing the progressive refractory VPS. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of aging on postoperative neurocognitive decline (NCD) in cardiac surgery patients. Methods: Patients undergoing coronary artery bypass graft or open aortic valve replacement were administered the Repeatable Battery for the Assessment of Neuropsychological Status at preoperative, postoperative day (POD) 4, and 1 month. Blood samples were collected at preoperative, 6 hours postoperative, and POD 4. Plasma interleukin (IL)-6, tumor necrosis factor-α, and C-reactive protein (CRP) levels were quantified. Quality of life was measured with the 12-Item Short Form Health Survey. Data were analyzed using paired ratio and unpaired t tests with Welch's correction, and linear regression for cytokine levels. Results: NCD occurred in 15 patients (N = 33, 45.5%). Dichotomized at age extremes (

Concentrated polymer brushes (CPBs) are a class of thin polymer films that are composed of polymer chains densely grafted to substrate surfaces. Due to their excellent tribological performance derived from the highly stretched conformation of the polymer chains in suitable solvents, CPBs are expected to be applicable as tribological coatings in sliding components. However, a long swelling time is required to obtain fully swelled CPBs in solvents. To overcome this issue, we propose a simple method involving thermal treatment of CPBs in solvents. Our results showed that this method can dramatically reduce the swelling time of CPBs from more than 48 h to less than 3 min. Moreover, thermal-treatment-CPBs (TT-CPBs) can provide an extremely low friction coefficient (0.002) under the boundary lubrication regime at the TT-CPB/steel tribo-pair interface. All our results suggest that the thermal treatment method is a practical method that will allow the industrial application of CPBs.

Near-infrared spectroscopy (NIRS) has been widely used in cardiac surgery to monitor cerebral oxygen supply. The initiation and perioperative management of cardiopulmonary bypass (CPB) constitute critical events in modifying the normal physiology of adequate blood and oxygen supply to the brain. First, little is known about how frequent NIRS is really used. Second, there are varying practices on how to initiate CPB. We therefore conducted a survey in Germany to get an idea of NIRS usage in cardiac surgery for the duration of initiation of CPB protocols. A web-based e-mail survey using commercial SurveyMonkeyVR (SurveyMonkey, San Mateo, CA) software was conducted in August 2017 including all German cardiac surgery centers. About 75% of the perfusion departments do not use NIRS as a standard monitoring device. It is usually reserved for clinical scenarios where cerebral perfusion might be impaired such as aortic arch surgery or carotid artery stenosis. Only onethird of the departments use a standardized duration of initiation of CPB despite a common belief of potential harm with fast initiation. The usual applied time to initiate CPB ranges from 30 to 120 seconds. Our survey revealed that the NIRS technology is only used in specific types of cardiac surgery to this date. In addition, there is a clear need for scientific studies on how to initiate CPB in the best way for the patient. [ABSTRACT FROM AUTHOR]

ObjectiveThe objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD).MethodsSeventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject's preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought.ResultsSubjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P

ObjectiveWe sought to investigate the impact of 22q11.2 deletion on perioperative outcome in tetralogy of Fallot.MethodsWe conducted a retrospective review of patients with tetralogy of Fallot who underwent complete surgical reconstruction at The Children's Hospital of Philadelphia between 1995 and 2006. Inclusion criteria included diagnosis of tetralogy of Fallot and known genotype. Fisher exact and Mann-Whitney tests were used for categoric and continuous variables, respectively. Regression analysis was used to determine whether deletion status predicts outcome.ResultsWe studied 208 subjects with tetralogy of Fallot, 164 (79%) without and 44 (20%) with 22q11.2 deletion syndrome. There were no differences in sex, race, gestational age, age at diagnosis, admission weight, and duration of mechanical ventilation. Presenting anatomy, survival, complications and reoperations were also comparable between patients with and without 22q11.2 deletion syndrome. Those with 22q11.2 deletion syndrome had more aortopulmonary shunts preceding complete surgical repair (21% vs 7%, P = .02). This association was present after adjustment for presenting anatomy (stenosis, atresia, or absence of pulmonary valve and common atrioventricular canal) and surgical era. In addition, those with 22q11.2 deletion syndrome had longer cardiopulmonary bypass time (84 vs 72 minutes, P = .02) and duration of intensive care (6 vs 4 days, P = .007).ConclusionsGenotype affects early operative outcomes in tetralogy of Fallot resulting, in particular, in longer duration of intensive care. Future studies are required to determine factors contributing to such differences in this susceptible population.

Introduction Acute aortic dissection Type A (AADA) is still associated with a high mortality rate and frequent postoperative complications. This study was designed to evaluate the risk factors for mortality in AADA patients. Patients and Methods This retrospective analysis included 344 consecutive patients who underwent surgery for AADA in moderate hypothermic circulatory arrest (20–24°C nasopharyngeal) between 2001 and 2016. Results The 30-day mortality rate was 18%. Nonsurvivors were significantly older (65.7 ± 12.0 years vs. 62.0 ± 12.5 years; p = 0.034) with significantly higher Euro-score II [15.4% (6.6; 23.0) vs. 4.63% (2.78; 9.88); p < 0.001)]. Intraoperatively, survivors had statistically shorter cardiopulmonary bypass times [163 (134; 206) vs. 198 min (150; 245); p = 0.001]. However, the hypothermic circulatory arrest time was similar between both groups. Postoperatively, the incidence of acute kidney injury (AKI) (55.9 vs. 15.2%; p < 0.001), stroke (27.9 vs. 12.1%; p = 0.002) and sepsis (18.0 vs. 2.1%; p < 0.001) were significantly higher among nonsurvivors. The multi-variable logistic regression confirmed that older age, previous cardiac surgery, preoperative cardiopulmonary resuscitation (CPR), blood transfusion and postoperative acute kidney injury (AKI) were independent risk factors for mortality. Conclusion Our analysis suggested that the reason for mortality was multifactorial, especially age, previous cardiac surgery, CPR, transfusion, as well as postoperative AKI were considered risk factors for mortality. [ABSTRACT FROM AUTHOR]

Background Historically, female patients had worse outcome undergoing heart surgery. No recent data exist on gender-specific outcome after moderate hypothermic circulatory arrest (MHCA). The aim of this large retrospective analysis was to investigate gender disparity in patients undergoing elective surgery of ascending aorta in MHCA at 24°C. Methods We conducted a retrospective review of 905 (33.3% female) cases of elective heart surgery in MHCA for ascending aortic aneurysm (90.9%) or severely calcified aorta (12.5%) between 2001 and 2015. Furthermore, 299 female and 299 male patients matched by propensity score were compared. Patients with dissection of the aorta were excluded. Results Women were older (68.4 ± 9.9 vs. 65.8 ± 11.6 years; p = 0.002), had higher logistic EuroSCORE I (18.4 [11.7; 29.2] vs. 12.3% [7.4; 22.6]; p < 0.001), and significantly shorter cardiopulmonary bypass (CPB) time (132 [105; 175] vs. 150 [118; 192] minutes; p < 0.001), while mean MHCA time was longer (15 [13; 19] vs. 14 [12; 17] minutes; p = 0.003). Surgical procedures were less complex in women and they were treated more frequently by isolated supracoronary ascending aorta replacement (61 vs. 54%; p = 0.046). Postoperatively, men showed a higher incidence of neurologic complications (7.0 vs. 3.3%; p = 0.03). The 30-day mortality (women 4.9% vs. men 3.9%; p = 0.48) did not differ significantly, likewise after statistical matching (4.7 vs. 2.3%; p = 0.120). Age, CPB time, and blood transfusion, but not female gender, were risk factors for mortality in multivariable regression analysis. Conclusion This study supports the hypothesis that female gender is not associated with increased short-term mortality or perioperative adverse events in elective aortic surgery in MHCA. [ABSTRACT FROM AUTHOR]

Background: Stroke is a devastating complication of cardiovascular surgeries, and the risk is particularly high for those requiring cardiopulmonary bypass (CPB). Embolic particles generated during the unclamping of the aortic cross-clamp may enter the cerebral circulation, lodging in small vessels. External manual compression of the carotid arteries is a non-invasive technique that has been proposed for cerebral protection during CPB procedures but is not widely deployed. Methods: The aim of this study is to assess the potential for cerebral emboli reduction with carotid compression using an in vitro model. Experiments were performed with a glass aortic arch model in a mock cardiovascular circuit. Small fluorescent particles were released into the circulation with and without carotid compression, and the particles visualized in the aortic midplane. The number of particles in the aorta and arch branch vessels were counted from the images before, during and following the release of carotid compression for durations of 10, 15 and 20 s. A gamma variate function was fit to the data to describe the bolus dynamics. Results: Carotid compression for 10 s reduces the number of embolic articles entering the carotid arteries by over 75%. A compression duration of 15–20 s does not result in greater particle reduction than one of 10 s. Conclusion: Brief compression of the common carotid arteries during cardiovascular interventions has the potential to dramatically reduce the number of cerebral emboli and should be investigated further. [ABSTRACT FROM AUTHOR]

The highwall mining technique is widely used to extend the life of open-pit mines without disturbing the surface dwellings, while maintaining economy and productivity. In this paper, the theoretical analysis, numerical simulation and material testing methods were used to study the damage form of the false roof in Juhugeng No. 7 mine with highwall cemented paste backfill (CPB) mining of Qinghai Yanhu Group. The CPB strength effect on the false roof stability and its control are investigated in detail. The results show that the main failure mode of the false roof is breaking failure, which is mainly affected by the strength of the CPB. The simulation study found that when the strength of CPB is increased from 0.5 to 1.5 MPa, the stress of the false roof is reduced to about 1/3, and the vertical displacement is decreased from 6.8 to 4.4 mm. When the strength is changed to 3.0 MPa, the vertical displacement is further reduced to around 50%, and the vertical stress and the surrounding plastic zone are greatly dropped correspondently. It can be seen that the strength of the CPB is essential to ensure the stability of the false roof. Furthermore, the preliminary tests of the filling material show that the cement dosage, rock fineness and mass concentration have significant effect on improving the quality of CPB and guarantee the stability of false roof, it is conducive to the safe and efficient exploitation of the slicing mining with CPB. [ABSTRACT FROM AUTHOR]

Objective Pulmonary endarterectomy (PEA) is the only causative, but demanding treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). We analyzed our results with PEA to evaluate the learning curve. Methods Consecutive 499 patients who underwent PEA between 1995 and 2014 were divided into two groups according to the temporal order: early cohort (n = 200, December 1995–March 2006), and late cohort (n = 299, March 2006–December 2014). We assessed perioperative outcomes after PEA as compared between the early and the late cohort also in propensity-score–matched cohorts. Results Age at the surgery was older in the late cohort (p = 0.042). Preoperative mean pulmonary artery pressure (mPAP) was 46.8 ± 11.0 mm Hg in the early cohort and 43.5 ± 112.7 mm Hg in the late cohort (p = 0.0035). The in-hospital mortality in the early and late cohorts was 14.0% (28/200) and 4.7% (14/299), respectively (p = 0.00030). The duration of circulatory arrest (CA) became much shorter in the late cohort (42.0 ± 20.5 min in the early and 24.2 ± 11.6 min in the late cohort, respectively, p <.0001). In matched cohorts, the in-hospital mortality showed no significant difference (8.7% in the early cohort and 5.2% in the late cohort, < 0.0001). The CA duration, however, was still shorter in the late cohort (p <0.0001). Conclusions Over time, older patients have been accepted for surgery, more patients were operated for lesser severity of CTEPH. Duration of CA and mortality decreased even beyond the first 200 patients, indicating a long learning curve. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to analyze the results of pulmonary endarterectomy (PEA) performed simultaneously with additional cardiac procedures in a single tertiary-level center. Methods Data of patients who underwent PEA with additional cardiac procedures for chronic thromboembolic pulmonary hypertension (CTEPH) in our clinic were retrospectively reviewed using patient records. Results Between March 2011 and April 2019, 56 patients underwent PEA with additional cardiac surgery. The most common additional procedure was coronary artery bypass grafting (21 patients; 38%). The median intensive care unit and hospital stays were 4 (3–6) days and 10 (8–14) days. Mortality was recorded in six patients (11%). In multivariate analysis, only preoperative pulmonary vascular resistance (PVR) (p = 0.02; odds ratio [OR]: 1.003) and cardiopulmonary bypass duration (p = 0.02; OR: 1.028) were associated with mortality. When the cutoff value of 1000 dyn.s.cm−5 was taken in the receiver operating characteristic curve analysis, preoperative PVR predicted mortality with 83% sensitivity and 94% specificity (area under curve = 0.89; p < 0.01). Conclusion PEA for CTEPH may be performed safely with other cardiac operations. This type of surgery is a complex procedure that should be performed only in expert centers. Patients with high preoperative PVR are at increased risk of perioperative complications. [ABSTRACT FROM AUTHOR]

Objective: Extracorporeal membrane oxygenation (ECMO) has recently replaced cardiopulmonary bypass (CPB) as the preferred option for providing circulatory support during lung transplantation. This review aimed to summarize the previous data and to address the relative use of ECMO and CPB during lung transplantation. Methods: The database was searched in PubMed (Medline) using the following keywords: lung transplantation, extracorporeal membrane oxygenation, and cardiopulmonary bypass, for all relevant reports which were written in English and were published between 2000 and 2020. Review: Several reports have revealed that intraoperative use of ECMO is associated with lower blood product transfusion requirements, shorter ventilator support, and shorter length of hospital stay. During recent years, preoperative ECMO has also been used with favorable outcomes as a bridge to lung transplantation in critically ill patients. Conclusions: The use of ECMO during lung transplantation seems to reduce postoperative complications and improve short-term outcomes, relative to CPB. However, additional data should be collected through large multicenter randomized controlled trials. Furthermore, preoperative ECMO as a bridge to lung transplantation appears to provide favorable outcomes, although additional data are also needed from experienced transplant centers. [ABSTRACT FROM AUTHOR]

Latar belakang: Bedah jantung terbuka merupakan salah satu jenis operasi dengan trauma yang cukup besar, dalam pelaksanaannya menggunakan mesin Cardiopulmonary Bypass (CPB). Penggunaan mesin CPB menyebabkan respon inflamasi yang luas dan ditandai dengan peningkatan C-Reactive Protein (CRP). Salah satu cara untuk menekan produksi CRP ini dengan menggunakan deksametason. Dosis deksametason dengan teknik pemberian premedikasi yang sering digunakan yaitu 1 mg/kgbb dan 2 mg/kgbb. Tujuan: Membandingkan efek deksametason dengan dosis 1 mg/kgbb dan dosis 2 mg/kgbb sebagai premedikasi terhadap kadar CRP pasca CPB pada operasi jantung. Metode: Penelitian ini merupakan uji klinik acak yang mengikutsertakan 18 pasien bedah jantung dengan anestesi umum dan menggunakan mesin CPB. Sampel dibagi 2 kelompok, yaitu deksametason dosis 1 mg/kgbb dan dosis 2 mg/kgbb sebagai premedikasi. Membandingkan jumlah CRP pada masing-masing dosis deksametason saat praoperasi dan pascaoperasi. Hasil: Pada penelitian ini, tidak ditemukan peningkatan yang bermakna dari kadar CRP pada kedua kelompok (deksametason 1 mg/kg [p=0,813] dan deksametason 2 mg/kg [p=0,115]). Perbandingan kadar CRP pascaoperasi antara kelompok deksametason 1 mg/kg dengan kelompok deksametason 2 mg/kg didapatkan hasil yang tidak bermakna (p=0,596), Simpulan: Tidak didapatkan perbedaan antara pemberian premedikasi deksametason 1 mg/kg dengan deksametason 2 mg/kg dalam menurunkan respon inflamasi pada operasi jantung dengan CPB.

Abstract Background Optimal anticoagulation strategy for cardiopulmonary bypass (CPB) in end-stage heart failure patients with heparin-induced thrombocytopenia (HIT) requiring left ventricular assist device (LVAD) implantation remains uncertain. Presently, there are no large-scale randomized studies comparing outcomes of alternative anticoagulation strategies for CPB in this patient population. A novel antiplatelet agent – cangrelor, which is a potent P2Y12 inhibitor with robust antiplatelet efficacy, rapid reversibility, and measurable drug effect, has become available since 2015. Intraoperative anticoagulation for CPB using cangrelor with heparin has not been reported before. Case presentation We report the case of a 47-year-old male with ischemic cardiomyopathy and acute HIT, who underwent an urgent LVAD implantation using cangrelor with heparin for anticoagulation on CPB. This novel strategy resulted in satisfactory anticoagulation for CPB without perioperative thromboembolic events or major bleeding requiring reoperation. Conclusions Cangrelor with heparin was an effective anticoagulation strategy for CPB in this critically ill patient with acute HIT requiring an urgent LVAD implantation. Further studies are warranted to evaluate its efficacy and replicability in other patients with acute or subacute HIT who require urgent cardiac surgery.

This paper aims to address the coal seam floor behavior after mining with CPB method. Firstly, the numerical model by using Midas/GTS-Flac3d method is developed on the basis of 2353 working face, Daizhuang Coal Mine; then, the slip line field theory of plastic mechanics is applied to calculate the floor damage depth. Furthermore, field observation is carried out by using water injection method. The results show that the floor deformation is well controlled by using CPB; the tensile zone reduces greatly to one-sixth of the size with traditional caving mining method; the coal seam excavation with CPB mining method is equivalent to reducing the original mining thickness; and the depth of the fracture floor is around 2 ~ 4 m. The numerical simulation and analytical calculation in terms of floor damage depth coincide with the in situ measurement. The proposed analytic model provides insight into the floor behavior with backfilling mining method. [ABSTRACT FROM AUTHOR]

Introduction Mitochondrial DNA (mtDNA) is gaining increasing interest as a marker of cellular damage and could also act as an inflammatory mediator in cardiopulmonary bypass induced postoperative inflammatory response. Although minimally invasive heart valve surgery reportedly reduces inflammation, the mtDNA and cytokine profile in this context remains unclear. Materials and Methods Here, we report a prospective series of 40 elderly patients with aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR) through upper ministernotomy with either a sutureless (n = 20) or a conventional (n = 20) valve. Primary end points included serial plasma levels of mtDNA (T1: at baseline; T2: 4 hours after surgery; and T3: 24s hour after surgery), cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), and myocardial necrosis biomarkers (MNBs), whereas secondary end points included clinical and echocardiographic data. Results Significant increases in the postoperative plasma levels (T2) of mtDNA, cytokines, and MNBs were observed in all patients. The postoperative plasma levels of mtDNA, TNF-α, and MNBs showed no significant differences between the treatment groups, although there was a trend toward lower levels in the sutureless group. The decreases in aortic cross-clamp and cardiopulmonary bypass times seen in the sutureless group were associated with significant lower postoperative levels (T2 and T3) of IL-6. Conclusion AVR through upper ministernotomy was associated with a significant increase in postoperative plasma levels of mtDNA and cytokines. There was no difference in the mtDNA levels between the sutureless and conventional valve groups, suggesting a similar level of inflammation in both groups. However, the shorter operation time observed in the sutureless valve group was associated with significantly lower postoperative levels of IL-6, indicating potential clinical benefits. [ABSTRACT FROM AUTHOR]

Background Results of resection of lung cancer invading left atrium (T4atrium) without cardiopulmonary bypass (CPB) remain controversial. We reviewed our experience analyzing surgical results and postoperative outcomes. Methods Patients who underwent extended lung resection for T4atrium without CPB between 1998 and 2018 were retrospectively reviewed using a prospective database. Results The study included 44 patients (34 males and 10 females; median age: 63 years). Twenty-five patients underwent preoperative mediastinal staging and 27 received induction treatment (IT). Surgery included 40 (90.9%) pneumonectomies, 3 (6.8%) lobectomies, and 1 bilobectomy (2.3%). Pathological nodal status was N0 in 10 patients (22.7%), N1 in 18 (40.9%), and N2 in 16 (36.4%). Four patients receiving IT had a complete pathological response (9.1%). Eight (18.2%) patients had microscopic tumor evidence on atrial resected margins. Mortality was nil. The major complication rate was 11.4%, including one bronchopleural fistula, one cardiac herniation, and three hemothoraces, all requiring reintervention. The minor complication rate was 25.5%. After a median survival of 37 months (range: 1–144 months), 20 (45.4%) patients were alive. Five-year survival rate and disease-free interval were 39 and 45.8%, respectively. Patients with N0 and R0 disease had a best prognosis (log-rank test: p = 0.03 and p = 0.01, respectively). IT neither influenced survival nor postoperative complications. On multivariate analysis, pN0 (p = 0.04 [95% confidence interval [CI]: 0.65–9.66] and negative atrial margins (p = 0.02 [95% CI: 0.96–8.35]) were positive independent prognostic factors. Conclusions T4atrium is technically feasible without mortality and acceptable morbidity. Patients with N2 cancers should not be operated. T4atrium should not be systematically considered as a definitive contraindication to surgery. [ABSTRACT FROM AUTHOR]

Cardiopulmonary bypass (CPB) is a highly technical clinical discipline with a recognized variability in practice. Professional standards and guidelines documents help direct clinical practice and reduce variability, but these guidelines are necessarily vague and fall short of providing specific objective recommendations of clinical practice metrics. If clinical practice metrics were known, they would be informative when writing departmental policy manuals, structuring quality improvement initiatives, describing product R&D specifications, and designing educational assessment rubrics. Therefore, to address this gap, we conducted a national survey of clinical practice with the purpose of producing a benchmark of the typical variability of specific technical parameters that are commonly managed during adult CPB procedures. A pool of expert clinical perfusionists collaborated to compile a data set of normal ranges for 41 individual physiologic and technical parameters (pressures, flows, saturation, times, solutions, and temperatures) that are commonly managed during adult CPB procedures. Results were collected using an online survey application. Respondent demographics and measures of central tendency with descriptive quartile statistics and confidence intervals for each parameter are presented. Of the 335 people who participated in the survey, 315 met the inclusion criteria. The geographic demographics of the respondents were representative of the American Board of Cardiovascular Perfusion's distribution of certified clinical perfusionists. Of the 41 parameters investigated, there were 13 hemodynamic parameters, 13 normal flow rates and technical circuit parameters, 10 blood gasses and hematocrit parameters, and five parameters of patient temperatures. The data presented here are informative and provide a consensus-based objective assessment of the standard practice for adult CPB as reported by practicing clinical perfusionists. Based on these survey data, we have identified the typical clinical limits for the 41 parameters that are managed during adult CPB. This information may be incorporated into guiding documents to support the work of clinicians, researchers, and educators. [ABSTRACT FROM AUTHOR]

In this work, a simple and low‐cost method was developed for the simultaneous determination of the antioxidants tert‐butylhydroquinone (TBHQ) and butylated hydroxyanisole (BHA) in the presence of the cationic surfactant CPB by square wave voltammetry (SWV) technique using a carbon black paste electrode (CBPE). The performance of the method was investigated by varying parameters such as pH, electrolyte, and type and concentration of surfactant. Under the optimum conditions of 0.2 mol L−1 phosphate buffer (pH 7.0), 600.0 μmol L−1 of cetylpyridinium bromide surfactant and SWV operating parameters optimized through the Doehlert matrix, the method presented low limits of quantification for TBHQ and BHA (0.23 and 0.26 μmol L−1, respectively) and high precision in successive measurements. The proposed method was applied in mayonnaise, margarine and biodiesel and the accuracy of method was checked by the HPLC technique. [ABSTRACT FROM AUTHOR]

Background From the results of a previous study, it remained to be investigated if a perioperative rise of few tested coagulation and inflammation markers is caused by conventional cardiopulmonary bypass (CPB) itself or rather by direct recirculation of pericardial fluids. Methods Forty-eight patients operated on with conventional CPB for myocardial revascularization were randomized either for direct recirculation of pericardial suction fluids or for cell saving (CS). Results Thrombin–antithrombin complexes showed lower values intraoperatively in the CS group (p < 0.0001), and D-dimers tended to remain lower at intensive care unit arrival (p = 0.095). Tests of inflammation markers were less meaningful. Conclusion Direct recirculation of pericardial fluids rather than conventional CPB itself causes major intraoperative changes of some coagulation markers. Pericardial blood loss with direct recirculation should be kept to a minimum to avoid unnecessary activation of coagulation. Inflammation markers need further investigations. [ABSTRACT FROM AUTHOR]

The incidence of acquired von Willebrand syndrome (AvWS) in patients with heart disease is commonly perceived as rare. However, its occurrence is underestimated and underdiagnosed, potentially leading to inadequate treatment resulting in increased morbidity and mortality. In patients with cardiac disease, AvWS frequently occurs in patients with structural heart disease and in those undergoing mechanical circulatory support (MCS). The clinical manifestation of an AvWS is usually characterized by apparent or occult gastrointestinal (GI) or mucocutaneous hemorrhage frequently accompanied by signs of anemia and/or increased bleeding during surgical procedures. The primary change is loss of high-molecular weight von Willebrand factor multimers (HMWM). Whereas the loss of HMWM in patients with structural heart disease is caused by increased HMWM cleavage by von Willebrand factor (vWF)-cleaving protease, ADAMTS13, AvWS in MCS patients is predominantly a result of a high shear stress coupled with mechanical destruction of vWF itself. This manuscript provides a comprehensive review of the evidence regarding both diagnosis and contemporary management of AVWS in patients with heart disease. [ABSTRACT FROM AUTHOR]

Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. Here we describe the anesthetic management of an 18-year-old woman with a mature teratoma who presented with progressive exertional dyspnea that was aggravated in the supine position in the operating room. After tracheal intubation, the tidal volume decreased, airway pressure increased, and pet CO2 grew beyond 105 mmHg without oxygen desaturation, prompting a femoro-femoral cardio-pulmonary bypass. Cardio-pulmonary bypass (CPB) can facilitate tumor dissection by safely deflating the lungs and retracting the heart, enhancing exposure and reducing risks of hemodynamic or respiratory complications. However, systemic heparinization may increase complications, necessitating a preoperative risk assessment. Preoperative management of large mediastinal masses requires careful attention to tumor anatomical details and relationships with surrounding structures. Preoperative preparation includes multimodality imaging and multidisciplinary team discussions to assess MMS risk, requiring specialized center management. • Resection is necessary for compression, intrathoracic structures, and malignant tumors in the mediastinum, suitable for both symptomatic and non-clinical patients. • Cardio-pulmonary bypass (CPB) assists in tumor dissection by safely deflating the lungs and withdrawing the heart, which reduces difficulties. However, it necessitates preoperative risk assessment due to potential heightened hazards. • Cardiopulmonary bypass may be required when dealing with mediastinal tumors to offer respiratory assistance if the tumor is blocking the airways. [ABSTRACT FROM AUTHOR]

• Creative Self-Efficacy (CSE) and Creative Performance Behaviors (CPB) across males and females in terms of furthering their Open Government Data (OGD) adoption and usage are investigated (adapted Unified Theory of Acceptance and Use of Technology (UTAUT) model). • CSE and CPB differ across males and females as far as their behavioral intention to adopt and use OGD is concerned. • Clinches the gender differentials in OGD adoption and usage in terms of creativity dimensions thereby contributing to the creativity and OGD literature corpus. Open Government Data (OGD) has been considered as a potent instrument for value creation and innovation by a range of stakeholders. Given that individual ingenuity is a function of individual and environmental factors, it is important to understand how the OGD adoption and usage is a factor of creative performance behaviors (CPB), viz., Problem Identification (PI), Information Search (IS), Idea Generation (IG) and Idea Promotion (IP) as well as creative self-efficacy (CSE). Invoking the adapted Unified Theory of Acceptance and Use of Technology (UTAUT) constructs alongside the moderating effects of CPB and CSE constructs and also gender, the present study seeks to underline the behavioural intention towards OGD adoption and usage among 362 undergraduate and postgraduate university students in India. The guiding research question is: "Is there any difference among the males and females in terms of their OGD adoption and usage as far as their creative propensities are concerned?" Findings from the PLS-SEM (Partial Least Squares-Structural Equation Modeling) procedures show that there are gender differences across the CPB and CSE constructs. The study's contribution lies in furthering our understanding of OGD adoption and use with the additional determinants of creativity literature. [ABSTRACT FROM AUTHOR]

In a prospective observational pilot study on patients undergoing elective cardiac surgery with cardiopulmonary bypass, we evaluated label-free quantitative phase imaging (QPI) with digital holographic microscopy (DHM) to describe perioperative inflammation by changes in biophysical cell properties of lymphocytes and monocytes. Blood samples from 25 patients were investigated prior to cardiac surgery and postoperatively at day 1, 3 and 6. Biophysical and morphological cell parameters accessible with DHM, such as cell volume, refractive index, dry mass, and cell shape related form factor, were acquired and compared to common flow cytometric blood cell markers of inflammation and selected routine laboratory parameters. In all examined patients, cardiac surgery induced an acute inflammatory response as indicated by changes in routine laboratory parameters and flow cytometric cell markers. DHM results were associated with routine laboratory and flow cytometric data and correlated with complications in the postoperative course. In a subgroup analysis, patients were classified according to the inflammation related C-reactive protein (CRP) level, treatment with epinephrine and the occurrence of postoperative complications. Patients with regular courses, without epinephrine treatment and with low CRP values showed a postoperative lymphocyte volume increase. In contrast, the group of patients with increased CRP levels indicated an even further enlarged lymphocyte volume, while for the groups of epinephrine treated patients and patients with complicative courses, no postoperative lymphocyte volume changes were detected. In summary, the study demonstrates the capability of DHM to describe biophysical cell parameters of perioperative lymphocytes and monocytes changes in cardiac surgery patients. The pattern of correlations between biophysical DHM data and laboratory parameters, flow cytometric cell markers, and the postoperative course exemplify DHM as a promising diagnostic tool for a characterization of inflammatory processes and course of disease.

The combined mine backfill–geothermal (CMBG) system can be used to effectively extract geothermal energy by installing a heat exchange tube (HET) in the underground backfilled stopes of mines, which can be used as the heat supply for buildings in mines and the surrounding areas. The efficient performance of this system strongly depends on the thermal exchange process between the HET and its surrounding cemented paste backfill body (CPB). In this study, a validated simulation model is established to investigate the heat exchange performance of CPB, in which the nonuniformly distributed thermal properties in CPB are fully considered. The results indicate that the increase in the porosity has a negative effect on the heat exchange performance of CPB. With the increase in the porosity, the decreased rate of the conductive heat transfer in CPB could be up to approximately 18%. In conditions with seepage flow, the heat transfer capacity of CPB could be effectively improved. Generally, a higher hydraulic conductivity corresponds to a higher heat transfer performance of CPB. When the seepage velocity rose from 2 × 10−6 to 6 × 10−6 m/s, the thermal conductivity of CPB achieved a 114% increase from 1.843 to 3.957 W/(m·K). Furthermore, it was found that the thermal energy accumulates along the seepage flow direction, enhancing the thermal influencing radius of the HET in this direction. Thus, the arrangement of HETs should fully take into account the seepage flow effect. This proposed simulation model could provide a reference for parameter determination and optimization of CMBG systems.

Latar belakang: Bedah jantung terbuka merupakan salah satu jenis operasi dengan trauma yang cukup besar, dalam pelaksanaannya menggunakan mesin jantung paru. Penggunaan mesin jantung paru menyebabkan respon inflamasi yang besar dan ditandai dengan leukositosis (neutrophil). Salah satu cara untuk mengurangi produksi neutrophil ini dengan menggunakan dexamethason, ada beberapa teknik pemberian deksametason diantaranya cara premedikasi dan priming. Tujuan: Membandingkan dexamethason 1 mg/kgBB sebagai premedikasi dan dexamethason 1 mg/kgBB saat priming terhadap jumlah neutrofil post CPB pada operasi jantung. Metode: Penelitian ini merupakan percobaan klinik secara acak yang mengikut sertakan 18 pasien bedah jantung ganti katup dengan general anestesi dan menggunakan mesin jantung paru. Sampel dibagi 2, antara pemberian deksametason teknik premedikasi dan teknik priming. Kelompok premedikasi mendapatkan deksametason 1 mg/kgbb setelah induksi, kelompok priming mendapatkan deksametason 1 mg/kgbb pada mesin jantung paru. Dengan membandingkan jumlah neutrophil pada masing-masing teknik antara preoperasi dan postoperasi. Hasil: pada penelitian ini didapatkan penurunan produksi neutrophil batang untuk teknik premedikasi dengan (p = 0,048) dan terjadi peningkatan neutrophil batang pada teknik priming (p = 0,012). Namun pada pemeriksaan neutrophil segmen terjadi peningkatan yang tidak bermakna untuk teknik premedikasi (p = 0,086) dan peningkatan yang bermakna untuk neutrophil segmen untung teknik priming (p = 0,012). Simpulan: Pemberian dexamethasone 1 mg/kgbb dengan teknik premedikasi terbukti menurunkan jumlah neutrophil batang pada pemeriksaan paska operasi bila dibandingkan pemberian dengan teknik priming. Namun tidak terbukti pada jumlah neutrophil segmen.

Cocoa pod borer (CPB), Conopomorpha cramerella Snellen (Lepidoptera: Gracillariidae) is a major pest of cocoa. Detection of the pest infestation using sex pheromone traps in the early growth and development of cocoa pods is important for an early warning system programme. In order to prevent the pest infestation the young pods were wrapped with plastic bags. A research to study the CPB incidence was conducted at cocoa plantations in Banjarharjo and Banjaroya villages, District of Kalibawang; Hargotirto and Hargowilis villages, District of Kokap; and Pagerharjo village, District of Samigaluh, Yogyakarta. The experiments design used RCBD with four treatments (sex pheromone trap, combination of sex pheromone trap and pod wrapping, pod wrapping, and control) and five replications. As many as 6 units/ha pheromone traps were installed with a distance of 40 m in between. Results showed that one month prior to the trap installation in the experimental plots there were ripen cocoa pods as many as 9-13%, which were mostly infested by CPB. During the time period of introducting research on August to Desember 2016 there was not rambutan fruits as the CPB host, hence the CPB resource was from infested cocoa pods. The CPB moth trapped as many as 0−7 (1.13 ± 0.14) moths/6 traps/12 observations. The seed damage due to CPB larvae in the pheromone trap treatments (23.98%) was relatively similar with the control (20.25%). Seed damage rate in combination treatment of pheromone trap and pod wrapping (0.59%) was relatively the same with the pod wrapping (0.20%). The pheromone trap was more usefull for monitoring tool rather than for control, meanwhile pod wrapping was an effective control measure of CPB. Intisari Penggerek Buah Kakao (PBK), Conopomorpha cramerella Snellen (Lepidoptera: Gracillariidae) merupakan salah satu hama utama kakao. Deteksi serangan hama PBK dengan perangkap feromon seks pada awal pertumbuhan dan perkembangan buah kakao penting dilakukan sebagai sistem peringatan dini. Dalam upaya pencegahan serangan hama tersebut dilakukan pembrongsongan buah muda. Penelitian dilakukan di kebun kakao rakyat di Desa Banjarharjo dan Banjaroya, Kecamatan Kalibawang, Desa Hargotirto dan Hargowilis, Kecamatan Kokap, serta kebun PT Pagilaran di Desa Pagerharjo, Kecamatan Samigaluh, Yogyakarta. Percobaan dengan empat perlakuan (perangkap feromon, kombinasi perangkap feromon dan brongsong, brongsong, kontrol) dan lima ulangan menggunakan rancangan RCBD. Perangkap feromon sebanyak 6 unit/ha dipasang dengan jarak antar perangkap sekitar 40 m. Hasil percobaan menunjukkan bahwa satu bulan sebelum pemasangan perangkap terdapat buah tua sebanyak 9−13 % dan umumnya terserang PBK. Selama kajian berlangsung tidak terdapat buah rambutan sebagai inang PBK sehingga sumber PBK diduga hanya dari buah kakao yang terserang. Ngengat PBK yang tertangkap yaitu sebanyak 0−7 (1,13±0,14) ekor/6 perangkap/12 pengamatan. Intensitas kerusakan biji akibat ulat PBK pada perlakuan perangkap feromon (23,98%) relatif sama dengan kontrol (20,25%). Kerusakan biji kakao pada perlakuan kombinasi perangkap feromon dan pembrongsongan (0,59%) relatif sama dengan pembrongsongan saja (0,20%). Perangkap feromon lebih berfungsi sebagai alat monitoring daripada alat pengendalian PBK, sedangkan pembrongsongan buah merupakan teknologi pengendalian PBK yang efektif.

Priming the cardiopulmonary bypass (CPB) circuit without the addition of homologous blood constitutes the basis of blood-saving strategies in open-heart surgery. For low-weight patients, in particular neonates and infants, this implies avoidance of excessive hemodilution during extracorporeal circulation. The circuit has to be miniaturized and tubing must be cut as short as possible to reduce the priming volume to prevent unacceptable hemodilution with initiating CPB. During perfusion, measures should be taken to prevent blood loss from the primary circuit to avoid replacement by additional volume. Favorable factors such as mild hypothermia/normothermia and high heparin concentrations during extracorporeal circulation promote earlier hemostasis after coming off bypass. Lower mortality score, first chest entry, higher hemoglobin concentration before going on bypass, and shorter CPB duration support transfusion-free CPB procedure. Reduced postoperative morbidity and mortality were observed when CPB was performed without blood transfusion. In our experience, this can be achieved in at least 70% of CPBs, even in low-weight patients. Bloodless CPB circuit priming should become a widespread reality, even in neonates and young infants, in any open-heart procedure. [ABSTRACT FROM AUTHOR]

Cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO) cause hemostatic derangements that can predispose patients to both bleeding and thrombotic complications. Often, patients present for urgent surgery while taking medications including antiplatelet agents, vitamin K antagonists, and direct oral anticoagulants, which must be recognized, monitored, and managed. During extracorporeal circulation, appropriate anticoagulation, most commonly with heparin, is required to maintain blood flow and avoid thrombotic complications. However, anticoagulation and other effects of extracorporeal circuits can also have an undesired consequence of bleeding. Extracorporeal circulation leads to coagulopathy that may require therapy with blood products such as platelets, cryoprecipitate, and plasma in case a patient bleeds. Platelet dysfunction related to exposure to a foreign circuit is a primary concern, as is the development of acquired von Willebrand syndrome, which frequently remains undetected on routine testing. Hemorrhagic complications in ECMO, such as intracranial hemorrhage, pulmonary hemorrhage, and hemithorax, can occur. Hemostatic agents including antifibrinolytics, desmopressin, fibrinogen concentrates, and other factor concentrates may be needed to achieve hemostasis in these often-challenging patients. Managing bleeding on extracorporeal support requires careful monitoring and a thoughtful approach. [ABSTRACT FROM AUTHOR]

Background: Process related to systemic inflammatory response syndrome (SIRS) in congenital heart disease (CHD) surgery using cardiopulmonary bypass (CPB) machine often causes post-operative complications. This process begins with mitochon-drial dysfunction in SIRS, initiated by the release of inflammatory mediators such as tumor necrosis factor receptor-α (TNF-α) and soluble tumor necrosis factor receptor-1 (sTNFR-1). Neurological injury following pediatric congenital heart surgery remains common. Studies related to brain-derived protein (S100B) biomarker for cerebral hypoxia caused by microcirculation and mitochondrial dysfunction as a consequence of SIRS in CPB or pedi-atric CHD surgery have yet to be conducted. Observation to identify cerebral hypoxia is necessary due to the fact that early stages of cerebral hypoxia are often asymptomatic. Near-infrared spectros-copy (NIRS) is a tool used for observing oxygen delivery to the brain by measuring cerebral oxygen saturation (SctO2). In Indonesia, NIRS remains uncommon and no study has been conducted to date. Objectives: To evaluate the role of S100B, sTNFR-1, lactate, and superior vena cava and cerebral saturations as predictors of neurological injury in CHD patients undergoing corrective surgeries, as measured using NIRS during and after surgical procedure. Methods: This was a prospective cohort study. Inclusion criteria were pediatric patients with CHD aged 1 month to 6 years old undergoing corrective surgery. Exclusion criteria were patients with Down syndrome, single coronary artery, and not consented to participate in the study. For analysis, subjects were divided into 2 groups: (1) those with neurological deficits and (2) those without neurological deficits. All subjects were observed closely in intensive care unit (ICU) until they were discharged. Blood examinations were performed 3 times: before surgery, after CPB, and 4 hours after CPB. Results: Fifty-one patients were observed from March to October 2015. Significant differences were observed in the value of S100B, STNFR-1, lactate, and area under the curve (20% AUC) baseline for cerebral saturation between both groups, as measured using NIRS. Those parameters could be used as predictors of post-CPB neurological deficit incidence in children with CHD. Summary: In CHD patients undergoing corrective surgery, S100B value, sTNFR-1, lactate, and 20% AUC baseline for cerebral saturation could be used as predictors of neurological deficit following corrective surgery. [ABSTRACT FROM AUTHOR]

Minimally invasive extracorporeal circulation systems are developed to decrease the deleterious effects of cardiopulmonary bypass. For instance, prime volume and foreign surface area are decreased in these systems. However, because of the lack of a venous reservoir in minimized systems, air handling properties of these minimally invasive extracorporeal circulation systems may be decreased as compared to conventional cardiopulmonary bypass systems. The aim of this in vitro study is to compare the air handling properties of two complete minimized cardiopulmonary bypass systems of two manufacturers, of which one system is provided with the air purge control. In an in vitro study, two minimally invasive extracorporeal circulation systems, Inspire Min.I manufactured by Sorin Group Italia, Mirandola, Italy (LivaNova, London, United Kingdom) and minimized extracorporeal circulation manufactured by Maquet, Rastatt, Germany (Getinge, Germany), were challenged with two types of air challenges; a bolus air challenge and a gaseous microemboli challenge. The air removal characteristics of the venous bubble traps and of the complete minimally invasive extracorporeal circulation systems were assessed by measuring the gaseous microemboli volume and number downstream of the venous bubble traps in the arterial line with a bubble counter. No significant differences were observed in air reduction between the venous bubble traps of Getinge (venous bubble traps) and LivaNova (Inspire venous bubble traps 8 in conjunction with the air purge control). Similarly, no significant differences were observed in volume and number of gaseous microemboli in the arterial line of both complete minimally invasive extracorporeal circulation systems. However, the gaseous microemboli load of the Inspire Min.I system was marginally lower after both the bolus air and the gaseous microemboli challenges. Both minimally invasive extracorporeal circulation systems assessed in this study, the LivaNova Inspire Min.I and the Getinge minimized extracorporeal circulation, showed comparable air removal properties, after both bolus and gaseous microemboli air challenges. Besides, air purge control automatic air removal system provided with the LivaNova Inspire Min.I. system may enhance patient's safety with the use of a minimally invasive extracorporeal circulation system. We consider both systems equally safe for clinical use. [ABSTRACT FROM AUTHOR]

• Flow and later strength properties of CPBs are both great in the system. • Steel slag was proved to exhibit latent hydraulic behavior. • The main hydration products in the system are C-S-H gels and Friedel's salt. • Impure ions can be fixed by layered structure of Friedel's salt. The increasing depth and widening scale of potash mines are suggestive of the use of mortars with greater homogeneity and fluidity properties for mine backfills. Results of the experimental investigations discussed herein indicated that the flow property and the later strength of mortars can both be satisfied through the utilization of steel slag (SS) as a binder in potash mines. Paste samples were evaluated in terms of the hydration mechanism for the mixture of brine water (liquid waste from potash mines) and SS, and were found to achieve a compressive strength of 10 and 15 MPa after 28 and 60 curing days, respectively. An analysis carried out for the microstructure of the pastes revealed C–S–H gels and Friedel's salt being the main hydration products in the system, in which active interpenetration between the substances contributes to the enhancement of the paste's strength. Impure ions in the system can be fixed to improve the stability of the filler through the formation of Friedel's salt. Overall, the findings of the present study confirmed that SS exhibits a latent hydraulic behavior and can be used as a binder in mortars for long-distance transportation in potash mines. [ABSTRACT FROM AUTHOR]

Anticoagulation for cardiopulmonary bypass (CPB) is required to prevent acute disseminated intravascular coagulation and clot formation within the bypass circuit. Unfractionated heparin is the standard anticoagulant for CPB due to its many advantages and long history of successful use. However, heparin has the unique drawback of triggering Heparin-PF4 (PF4) antibodies potentially leading to heparin-induced thrombocytopenia (HIT). We have limited data regarding reformation of antibodies if a patient has had a prior (remote) antibody production or full HIT. Patients with antiphospholipid antibodies undergoing CPB with unfractionated heparin have a high complication rate, even in the absence of HIT. Antiphospholipid antibodies have a multifaceted, cumulatively inhibitory effect on the normal anticoagulation armamentarium in vivo. Even more concerning is the possibility that antiphospholipid syndrome and HIT may be synergistic. We report a patient with risk factors for both thromboembolic (remote history of HIT and antiphospholipid syndrome) and hemorrhagic complications who underwent an aortic valve replacement and coronary artery bypass grafting on CPB using bivalirudin. We discuss the complex decision making regarding anticoagulant for CPB, particularly with regard to American College of Chest Physicians guidelines. [ABSTRACT FROM AUTHOR]

A 44-year-old male with ongoing chest pain and left ventricular ejection fraction <20% was transferred from a peripheral hospital with intra-aortic balloon pump placement following a non-ST-elevation myocardial infarction (STEMI). The patient underwent emergent multi-vessel coronary artery bypass grafting requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) on post-operative day (POD)#9 secondary to cardiogenic shock with biventricular failure. Due to clot formation, an oxygenator change-out was necessary shortly after initiation. Following a positive heparin-induced thrombocytopenia (HIT) assay, a total circuit exchange was required to eliminate all heparin coating and argatroban was deemed the anticoagulant of choice due to acute kidney injury. On POD#24, the decision was made to implant a left ventricle assist device (LVAD) as a bridge to heart transplantation. There was difficulty achieving an activated clotting time (ACT) >400 s: multiple argatroban bolus doses were required, along with accelerated up-titration of infusion dosing. Despite maintaining an ACT >484 s, clot formation was observed in the cardiotomy reservoir prior to separation. Subsequently, the patient developed severe disseminated intravascular coagulopathy, with both intra-cardiac and intravascular thrombi, requiring massive transfusion and continuous cell saving due to severe hemorrhage post cardiopulmonary bypass (CPB). The patient received a total of 105 units of plasma, 74 units of packed red cells, 19 units of platelets, 13 bottles of 5% albumin, 6 units of cryoprecipitate and 2 doses of factor VIIa intraoperatively over the course of 24 hours. A total of 19.7 L of washed red blood cells were returned to the patient from the cell saver. With the LVAD in place, the patient developed transfusion-related acute lung injury and acute respiratory distress syndrome with right ventricular dysfunction requiring VA ECMO once again. On POD#30, ECMO was discontinued and the patient was discharged from the intensive care unit (ICU) on POD 66. After a very complex post-operative stay with numerous surgeries and extensive rehabilitation, the patient was discharged home with the LVAD on POD#112. [ABSTRACT FROM AUTHOR]

Purpose: Peptidylarginine deiminase (PAD) catalyzes citrullination, a post-translational modification that can alter structure, function and antigenicity of proteins. Citrullination in the lungs due to smoking is believed to initiate an anti-citrulline immune response in rheumatoid arthritis. Citrullination in other inflamed organs has also been demonstrated, but it is not known whether smoking or inflammatory processes in general result in release of relevant amounts of PAD into the circulation with potential to cause citrullination of proteins at various anatomical sites. Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) induces an acute systemic inflammation response. In the present study, we investigate whether smoking or acute systemic inflammation causes release of PAD into the circulation. Patients and methods: This study included 36 patients with coronary heart disease (16 smokers and 20 non-smokers) undergoing CABG surgery with CPB. Circulating levels of PAD2 and PAD4, PAD activity, the neutrophil activation markers MPO, MMP-9 and lipocalin-2, the cytokines IL-6 and IL-10, and the chemokine CXCL8 were measured 2 hrs preoperatively and 2 hrs postoperatively. Results: At baseline, serum PAD2 and PAD4 concentration did not differ between smokers and non-smokers. However, serum from non-smokers contained higher PAD activity than serum from smokers. Circulating PAD2 levels and PAD activity increased markedly in both groups after surgery, as did all neutrophil activation markers, cytokines and chemokine. PAD2 levels correlated with neutrophil activation markers, but not with cytokine and chemokine levels. Conclusion: Blood levels of PAD2 did not differ significantly between smokers and non-smokers, but smokers had decreased PAD activity in the circulation. PAD2 levels and PAD activity increased in blood during inflammation induced by CABG with CPB. This suggests that acute inflammation, ischemia or reperfusion, or a combination of these, leads to systemic spreading of enzymatically active PAD, which may affect protein function and induce generation of citrullinated self-antigens. [ABSTRACT FROM AUTHOR]

Introduction The recommended minimum activated clotting time (ACT) level for cardiopulmonary bypass (CPB) of 480 seconds originated from investigations with bubble oxygenators and uncoated extracorporeal circulation (ECC) systems. Modern minimal invasive ECC (MiECC) systems are completely closed circuits containing a membrane oxygenator and a tip-to-tip surface coating. We hypothesized that surface coating and the "closed-loop" design allow the MiECC to safely run with lower ACT levels and that an ACT level of 300 seconds can be safely applied without thromboembolic complications. The aim of this study was to investigate the potential risks during application of reduced heparin levels in patients undergoing coronary surgery. Methods In this study, 68 patients undergoing coronary artery bypass grafting with MiECC were randomized to either the study group with an ACT target of 300 seconds or the control group with an ACT of 450 seconds. All other factors of MiECC remained unchanged. Results The study group received significantly less heparin and protamine (heparin [international units] median [min–max], Red_AC: 32,800 [23,000–51,500] vs. Full_AC: 50,000 [35,000–65,000] p < 0.001; protamine [international units], Red_AC: 18,000 [10,000–35,000] vs. Full_AC: 30,000 [20,000–45,000] p < 0.001). The ACT in the study group was significantly lower at the start of MiECC (mean ± standard deviation: study group 400 ± 112 vs. control group 633 ± 177; p < 0.0001). Before termination of CPB the ACT levels were: study group 344 ± 60 versus control group 506 ± 80. In both groups, the values of the endogenous thrombin potential (ETP) decreased simultaneously. None of the study participants experienced thromboembolic complications. Conclusion Since no evidence of increased thrombin formation (ETP) was found from a laboratory standpoint, we concluded that the use of MiECC with a reduced anticoagulation strategy seems possible. This alternative anticoagulation strategy leads to significant reduction in dosages of both heparin and protamine. We can confidently move forward with investigating this anticoagulation concept. However, to establish clinical safety of ACT below 300 seconds, we need larger clinical studies. [ABSTRACT FROM AUTHOR]

[Display omitted] • Interactions of cationic surfactants (CTAB and CPB) with anionic azo dye tartrazine (TZ) was studied. • The cmc value decreases in the presence of TZ dye and rises with the rise in temperature. • Standard Gibb energy of micellization (Δ G m o < 0) and Gibb energy of adsorption ( Δ G ad o < 0) indicate that the micellization and adsorption of CTAB/CPB in aqueous TZ solution and at air– aqueous TZ solution interface is thermodynamically feasible. • The TZ dye absorbance values are relatively higher in CPB than CTAB. Different techniques such as conductometric, tensiometric and spectroscopic methods were deployed to investigate the interactions of tartrazine (TZ) dye with cetyltrimethylammonium bromide (CTAB) and cetylpyridinium bromide (CPB) in aqueous media at four temperatures. Results revealed a lower cmc values for CPB as compared to CTAB in presence/or absence of aqueous TZ solutions. A qualitative analysis, using UV–vis spectroscopy, was carried out to understand the interactions between the dye TZ and CTAB/CPB in the premicellar and post micellar phase. Interfacial properties such as surface excess concentration (Γ m a x ), area occupied per surfactant molecule (A min), surface pressure (π c m c ), standard Gibbs energy of adsorption ( Δ G a d o), packing parameter (P), etc., were evaluated at air–water/aqueous TZ solution of CTAB/CPB. The equilibrium model was used to determine the change in standard Gibbs energy (Δ G m 0) , enthalpy (Δ H m 0) , and entropy (Δ S m 0) of micellization. Due to the interruption of the structured water molecules encasing the hydrophobic groups of the surfactant, the critical micelle concentration (cmc) rose with temperature. For both the studied systems, the values of Δ G m 0 and Δ H m 0 were negative, implying that the process of micellization is thermodynamically spontaneous and exothermic. The - T Δ S m 0 values, which were found to be greater than Δ H m 0 values, suggest the gain in entropy primarily governs the process of micellization. [ABSTRACT FROM AUTHOR]

Background: The primary objective of the study was to evaluate the effect of nitoglycerine (NTG) and sodium nitroprusside (SNP) on serum lactate (S. lactate), mixed venous oxygen saturation (SvO2), and mixed venous arterial carbon dioxide difference (V-ACO2) during cardiopulmonary bypass (CPB). The secondary objectives included the effect on mortality, end organ dysfunction, requirement of vasopressors, duration of mechanical ventilation (MV), intensive care unit (ICU) stay and hospital stay. Materials and Methods: A prospective randomized single blinded study was conducted in 40 patients aged between 20 years and 70 years who underwent cardiac surgery on CPB. The patients were randomly divided into Group N (n = 20) receiving NTG (0.5–2 mic/kg/min) and group S (n = 20) receiving SNP (0.5–2 mic/kg/min) from the commencement of total CPB up to complete rewarming (nasopharyngeal temperature >36.5°C). Arterial blood gases and S. lactate were measured at baseline, after institution of total bypass, after completion of cooling and rewarming, at weaning off CPB and admission to ICU. Venous blood gas (VBG) was sampled from the venous reservoir immediately after institution of total bypass and completion of rewarming. Urine output, dose of rescue vasodilator, use of inotropes and vasopressor after CPB, end organ dysfunction, duration of MV, ICU, and hospital stay were noted. Results: Though the SvO2at the end of CPB decreased significantly from the baseline (P < 0.05), it was similar between the groups. There was no difference in V-ACO2too. The S. lactate markedly increased (P = 0.00) from the baseline; however, only the S. lactate at admission to ICU was significantly lower in Group S (P = 0.034). There was no difference in mortality, end organ dysfunction, requirement of vasopressors, duration of MV, ICU, and hospital stay. Conclusion: The authors showed that S. lactate increased with CPB and this increase did not correlate with SvO2and V-ACO2. NTG and SNP were comparable in their effect on indices of tissue perfusion.