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Category: Cardiac Surgery

Del Nido vs Hyper

Outcomes of Del Nido and Hyperkalemic Blood Cardioplegia in Adult Cardiac Surgery with Prolonged Aortic Cross-Clamp Times

This study compares the effectiveness of Del Nido cardioplegia (DNC) and hyperkalemic blood cardioplegia (HKB) in adult cardiac surgery with prolonged aortic cross-clamp times. In a retrospective cohort of 388 patients, findings revealed no significant differences in clinical outcomes or myocardial protection, as assessed by troponin profiles. However, DNC required fewer doses, had longer ischemic intervals, and was associated with higher rates of spontaneous rhythm recovery, suggesting logistical and procedural benefits.

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December 21, 2024
Lungs Feature

The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation Among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

This systematic review analyzes prolonged mechanical ventilation (PMV) post-cardiac surgery, finding an incidence rate of 20%. PMV, defined as ventilation lasting ≥24 hours, is linked to in-hospital mortality (odds ratio: 14.13). Key risk factors include advanced age, female sex, ejection fraction <50%, and body mass index >28 kg/m². PMV also correlates with conditions like chronic renal failure and prolonged cardiopulmonary bypass time. These insights highlight the need for targeted prevention and management strategies.

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December 20, 2024
Superman Impella

The Role of Impella in the Pre-Procedural Management of Post-Infarct Ventricular Septal Defect: A Systematic Review

This systematic review explores the use of the Impella device in patients with post-infarct ventricular septal defect (VSD) prior to definitive treatment. Analyzing 68 patients across 20 studies, the Impella improved hemodynamic stability, reduced left ventricular strain, and delayed urgent intervention. Patients with surgically-placed Impella devices showed lower mortality and fewer complications compared to percutaneous alternatives. While effective, complications like bleeding and hemolysis must be carefully managed.

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December 17, 2024
Revascularization

Meta-Analysis Comparing Immediate Versus Staged Complete Revascularization for ST-Elevation Myocardial Infarction With Multivessel Disease

This meta-analysis compares immediate versus staged complete revascularization (CR) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease. Analyzing five randomized controlled trials (1,415 patients), no significant difference was observed in major adverse cardiovascular events (MACE), mortality, or myocardial infarction rates. However, staged CR showed a higher rate of unplanned ischemia-driven revascularization. Timing of staged intervention is crucial for optimized outcomes.

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December 17, 2024
Cytocaine CPB

Removal of Cytokines During Cardiac Surgery (RECCAS): A Randomised Controlled Trial

This randomized controlled trial evaluates the efficacy of intraoperative haemoadsorption (HA) using CytoSorb® during cardiac surgery with cardiopulmonary bypass (CPB). The primary focus was on reducing interleukin-6 (IL-6) levels post-surgery. Despite a significant reduction in cytokine levels within the HA device during surgery, there was no difference in IL-6 levels between the treatment and control groups upon ICU admission or during the ICU stay. Some haemodynamic benefits, such as reduced fluid and fibrinogen requirements and shorter need for renal replacement therapy, were observed, though these did not translate into improved clinical outcomes like ICU length of stay or mortality rates. The study underscores the need for further large-scale trials to refine patient selection and HA application strategies.

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December 14, 2024
ECMO Scale

Novel Risk Scoring Model to Predict the Implementation of Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocarditis

This study introduces the Korean Acute Myocarditis (KAM) score, a predictive model for assessing the likelihood of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use in acute myocarditis. Analyzing data from 841 patients across seven Korean hospitals, eight clinical parameters were identified as predictors, including cardiac arrest and left ventricular ejection fraction <40%. The KAM score demonstrated excellent discriminant ability, supporting its potential to guide timely interventions and improve patient outcomes.

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December 13, 2024
del Nido 2024

Early Postoperative Outcomes of Modified Del Nido Cardioplegia in Coronary Artery Bypass Surgery in Patients with Low Ejection Fraction

This study compares the effectiveness of modified del Nido cardioplegia (DNC) with classic blood cardioplegia (BC) in coronary artery bypass grafting (CABG) patients with low ejection fraction (≤35%). Results show that DNC offers comparable myocardial protection to BC while reducing postoperative atrial fibrillation and the need for inotropic agents. DNC also showed lower troponin levels postoperatively, indicating better myocardial recovery, though no significant differences in mortality or hospital stay were observed.

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December 13, 2024
TOF Repair

Comparison of Immediate Outcomes of Pulmonary Valve-Sparing and Transannular Patch Techniques for Correction of Tetralogy of Fallot

This retrospective cohort study compared pulmonary valve-sparing and transannular patch techniques for correcting Tetralogy of Fallot (ToF) in 102 pediatric patients. The study found that the valve-sparing approach led to shorter durations of mechanical ventilation, ICU stays, and hospitalization, with fewer complications like arrhythmias. However, transannular patch patients had higher rates of severe pulmonary regurgitation. Weight was identified as an independent predictor of ventilation duration.

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December 12, 2024
Cold Platelets

Delayed Cold-Stored vs. Room Temperature Stored Platelet Transfusions in Bleeding Adult Cardiac Surgery Patients—A Randomized Multicentre Pilot Study (PLTS-1)

This study investigates the feasibility of using delayed cold-stored platelets (DCSP) compared to standard room-temperature platelets (RTP) in bleeding cardiac surgery patients. DCSP, stored initially at 22°C and then refrigerated, may address platelet supply challenges by extending shelf life and enhancing hemostatic activity. The multicentre pilot aims to assess recruitment, adherence, and product availability to inform a future definitive trial. The trial could improve transfusion logistics and patient outcomes.

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December 10, 2024
Hypertrophic Cardiomyopathy

Anesthetic Precision in Severe Hypertrophic Cardiomyopathy: Navigating Perioperative Challenges

This case report details the anesthetic management of a 77-year-old female with hypertrophic obstructive cardiomyopathy (HOCM), undergoing surgery for ileal adenocarcinoma. It highlights challenges such as preventing left ventricular outflow tract obstruction and maintaining hemodynamic stability. A tailored approach, including vigilant monitoring, goal-directed fluid therapy, and careful use of vasopressors, ensured successful outcomes. The report underscores the importance of meticulous perioperative planning in HOCM cases.

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December 10, 2024
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