Advanced Monitoring During Ventilator Weaning After Cardiac Surgery

Weaning From Mechanical Ventilation in Cardiac Surgery Patients: Current Strategies, Monitoring Innovations, and Future Perspectives

March 16, 2026 No Comments

This review examines the complex process of liberating cardiac surgery patients from mechanical ventilation. It highlights how cardiopulmonary interactions, surgical factors, sedation, and respiratory muscle dysfunction influence weaning outcomes. The authors discuss predictors of failure, monitoring innovations such as diaphragm ultrasound and electrical impedance tomography, and strategies like spontaneous breathing trials and personalized protocols to improve extubation success and long-term recovery.

Viscoelastic Monitoring Guiding Hemostasis During Cardiac Surgery

A Prospective Analysis of Viscoelastic Assays, Platelet Aggregometry, and Standard Laboratory Tests in Predicting Perioperative Blood Loss in Cardiac Surgery

March 14, 2026 No Comments

This prospective observational study of 79 cardiac surgery patients evaluated whether viscoelastic testing (ROTEM), platelet aggregometry, or standard coagulation tests best predict perioperative bleeding. Clot firmness measured by FIBTEM A10 strongly correlated with blood loss using the Hb/kg Index, while platelet count, platelet aggregation, and conventional tests did not. A FIBTEM A10 cutoff of 12 mm accurately detected hypofibrinogenemia, supporting fibrinogen-focused transfusion strategies.

Heparin Anticoagulation Management During Cardiopulmonary Bypass

Contemporary Clinical Practices in Anticoagulation Management During Cardiopulmonary Bypass: A Europe-Wide Survey

March 10, 2026 No Comments

A Europe-wide survey of 114 cardiac surgery centers across 29 countries evaluated current anticoagulation practices during cardiopulmonary bypass. Most centers reported standardized heparin protocols and commonly used a 300 IU/kg initial dose with ACT targets of 400–480 seconds. However, substantial variability existed in protamine reversal strategies, post-reversal ACT targets, and transfusion decision-making, highlighting gaps between guidelines and real-world practice. These findings identify key opportunities for standardizing perioperative anticoagulation management in cardiac surgery.

$Stepwise Rescue Therapy for Refractory Vasoplegia$

Evaluating the Impact of a Standardized Protocol for Managing Refractory Vasoplegia After Cardiopulmonary Bypass

March 2, 2026 No Comments

This single-center pre-post study evaluated a standardized stepwise protocol for refractory vasoplegia after cardiopulmonary bypass (CPB). Compared to provider-directed therapy, the protocol—escalating from methylene blue to angiotensin II and hydroxocobalamin—accelerated norepinephrine-equivalent reduction and reduced vasopressor costs by 26% at 48 hours, without worsening hemodynamic or clinical outcomes.

Nanoscale Impact of Cardiopulmonary Bypass on Red Blood Cells

The Impact of Cardiopulmonary Bypass on the Structure and Mechanics of Red Blood Cells: Pilot Study

March 1, 2026 No Comments

This pilot study evaluated how cardiopulmonary bypass (CPB), with and without hypothermic circulatory arrest (HCA), affects red blood cell (RBC) morphology, membrane nanostructure, and mechanical properties using atomic force microscopy. In 14 cardiac surgery patients, CPB increased RBC stiffness, while CPB+HCA caused more severe morphological damage and membrane roughness. The findings suggest distinct cellular injury mechanisms depending on perfusion strategy.

Association Between Cardiopulmonary Bypass Weaning Time and Adverse Outcomes in Patients With Aortic Dissection Who Underwent Total Arch Replacement Combined With Stented Elephant Trunk Implantation

February 28, 2026 No Comments

This retrospective single-center study of 475 patients with acute type A aortic dissection undergoing total arch replacement with stented elephant trunk implantation found that prolonged cardiopulmonary bypass (CPB) weaning time was independently associated with increased in-hospital mortality and postoperative stroke. A cutoff of 90 minutes strongly predicted early mortality and reduced short-term survival, though mid-term survival was unaffected.

Seamless Transition: Single-Circuit ECMO to CPB in Pediatric Surgery

ECMO to CPB: A Single Circuit Approach

February 27, 2026 No Comments

This technique article describes a novel method for converting pediatric patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to cardiopulmonary bypass (CPB) using a single circuit with the addition of a cardiotomy reservoir. In seven patients (eight procedures), the approach preserved circulating blood volume, limited donor exposure, and maintained effective surgical support. All patients were successfully decannulated, demonstrating feasibility and safety in complex congenital heart surgery.

Outcomes of Heart Failure Hospitalizations at Urban Teaching vs. Non-Teaching Hospitals: A Nationwide Propensity Score Matched Analysis in the United States

February 26, 2026 No Comments

This nationwide propensity-matched study of 7.5 million U.S. heart failure hospitalizations (2016–2022) found that urban teaching hospitals had higher inpatient mortality, complication rates, length of stay, costs, and palliative care consultations compared with urban non-teaching hospitals. Despite worse in-hospital outcomes, 30- and 90-day readmission rates were similar. Findings likely reflect referral bias and greater illness severity at teaching centers rather than differences in care quality.

Comparing Myocardial Protection Strategies in Heart Transplantation

Long-Term Outcome of Myocardial Protection in Heart Transplantation: Comparison Among 3 Different Solutions

February 23, 2026 No Comments

This 20-year single-center study of 528 heart transplant recipients compared three preservation solutions: Celsior, HTK-Custodiol, and St Thomas. HTK-Custodiol was associated with a significantly higher rate of severe primary graft dysfunction (10.2% vs 4.5%), but long-term survival and rejection rates were similar across groups. Severe PGD, ischemic time, and donor/recipient age predicted late mortality. Authors advise caution with HTK-Custodiol.

Emergency Repair of a Rupturing Ascending Aorta

Circulatory Arrest Time Above 30 Minutes Has Significantly Detrimental Effects on the Outcomes of Type A Aortic Dissection Repair

February 20, 2026 No Comments

This retrospective study of 109 patients undergoing emergent type A aortic dissection repair found that deep hypothermic circulatory arrest (DHCA) times exceeding 30 minutes were associated with significantly higher 30-day mortality, 12-month mortality, and postoperative stroke rates. Cerebral perfusion strategy did not alter stroke risk. The findings suggest that limiting circulatory arrest to under 30 minutes may improve survival and neurological outcomes.