International Perfusion Association

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IPA

Day: November 28, 2024

Bivalirudin ECMO

Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Pediatric ECMO

This pilot randomized controlled trial compared bivalirudin and unfractionated heparin for anticoagulation in 30 pediatric ECMO patients. No difference was found in time at goal anticoagulation, the primary endpoint. However, bivalirudin was associated with higher thrombotic complications (37.5% vs. 0%; p=0.02) but required fewer RBC transfusions (median 6.3 vs. 12.2 mL/kg/day; p=0.02). The study demonstrates feasibility for larger trials to evaluate the safety and efficacy of bivalirudin in pediatric ECMO.

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November 28, 2024
MICS Cardioplegia

Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries: A Comparative Analysis of Cardioplegia Solutions

This network meta-analysis compared four cardioplegia solutions—del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), blood cardioplegia (BC), and St. Thomas’ (STH)—in minimally invasive cardiac surgeries (MICS). Across 15 studies with 2282 patients, no significant differences in major clinical outcomes were found. DN reduced cardiopulmonary bypass times, while HTK shortened hospital stays. Both DN and HTK were deemed safe and effective for long-lasting myocardial protection in MICS.

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November 28, 2024
Aortic Rupture

Extracorporeal Off-Pump Antegrade Cerebral Perfusion in Reconstructive Surgery for Type A Aortic Dissection with Cerebral Malperfusion

This study evaluates a novel off-pump axillo-axillary shunt technique for antegrade cerebral perfusion (ACP) during total aortic arch replacement (BF-TAR) in patients with Type A aortic dissection (TAAD) complicated by cerebral malperfusion (CM). The method provides continuous bihemispheric perfusion, reducing risks linked to cardiopulmonary bypass. Among 18 patients, outcomes included low mortality (5.6%), no permanent neurological deficits, and improved perfusion times compared to traditional methods.

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November 28, 2024
Pediatic Cardioplegia

Hyperlactataemia Following Crystalloid Cardiopulmonary Bypass Priming in Paediatric Cardiac Surgery: Benign or Malignant?

This retrospective study examined paediatric patients undergoing cardiac surgery with crystalloid priming to evaluate outcomes related to postoperative hyperlactataemia. Among 186 patients, 53% experienced hyperlactataemia, which was associated with longer cardiopulmonary bypass and ICU stays but did not increase ventilation duration. Findings suggest transient hyperlactataemia may not indicate tissue hypoxaemia, but longer inotropic support and ICU stays necessitate careful management post-surgery.

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November 28, 2024

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