International Perfusion Association

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Category: Cardiac Surgery

Protamine 101

On-Pump FIBTEM-A5 Accurately Predicts the A5 Values After Protamine Administration

This study investigates whether on-pump FIBTEM-A5 values measured during cardiopulmonary bypass (CPB) accurately predict post-protamine administration values. Conducted at a single cardiac center, the retrospective analysis of 70 patients found a strong correlation (R² = 0.813) between the two measurements. Despite a statistically significant but clinically negligible difference, the findings support using on-pump FIBTEM-A5 to guide fibrinogen supplementation in cardiac surgery.

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February 18, 2025
Nitric Oxide

Neurodevelopmental Outcomes After Nitric Oxide During Cardiopulmonary Bypass for Open Heart Surgery: A Randomized Clinical Trial

This randomized clinical trial examined whether nitric oxide (NO) administered during cardiopulmonary bypass (CPB) improves neurodevelopmental and health-related quality of life (HRQOL) outcomes in infants undergoing open heart surgery. Conducted across six centers, the study followed 927 infants at 12 months post-surgery. Results showed no significant differences in neurodevelopment or HRQOL between the NO and standard CPB groups, suggesting NO does not enhance long-term neurological outcomes.

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February 8, 2025
Robot

Perioperative Mechanical Circulatory Support: Transitioning from Sequential to Parallel Recovery

This editorial explores the evolution of mechanical circulatory support (MCS) in perioperative cardiac care. It discusses advancements in venoarterial extracorporeal membrane oxygenation (VA-ECMO) and micro-axial flow pumps, highlighting the shift from sequential to parallel recovery. The article emphasizes early MCS intervention, left ventricular unloading, and minimizing adverse events. Insights from the DanGer Shock trial suggest improved survival with early MCS use, but further research is needed for perioperative applications.

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February 7, 2025
Surgical Outcomes Stratified by Type of Transportation and Presence of Coronary Reperfusion in Patients with Coronary Malperfusion Caused by Type A Aortic Dissection

Surgical Outcomes Stratified by Type of Transportation and Presence of Coronary Reperfusion in Patients with Coronary Malperfusion Caused by Type A Aortic Dissection

This study examines surgical outcomes in patients with Type A acute aortic dissection (AAAD) complicated by coronary malperfusion, focusing on transportation type and clinical management. Analyzing 70 cases, researchers found no significant mortality differences between direct transfers and referrals. However, preoperative extracorporeal membrane oxygenation (ECMO) was not a definitive solution. Diagnostic-only coronary angiography (CAG) without successful reperfusion posed a higher fatality risk, especially with left coronary artery involvement.

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February 7, 2025
The Mystery of Methylene Blue and Its Role in Managing Post-Cardiac Surgery Vasoplegic Shock

The Mystery of Methylene Blue and Its Role in Managing Post-Cardiac Surgery Vasoplegic Shock

This study examines the effectiveness of methylene blue (MB) in managing vasoplegic syndrome (VS) following cardiac surgery with cardiopulmonary bypass. A retrospective cohort of 2753 patients identified 200 with VS, of whom 84 received MB. Results showed MB shortened ICU stays, reduced norepinephrine requirements, and improved serum lactate levels, but did not significantly impact in-hospital mortality. The study suggests MB may aid recovery but calls for further research on its broader effectiveness.

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February 5, 2025
Development and Validation of a Nomogram for Predicting Perioperative Transfusion in Children Undergoing Cardiac Surgery with CPB

Development and Validation of a Nomogram for Predicting Perioperative Transfusion in Children Undergoing Cardiac Surgery with CPB

This study develops and validates a predictive model for perioperative red blood cell transfusion (PRT) risk in pediatric cardiac surgery with cardiopulmonary bypass (CPB). Using data from 19,155 children, eight key predictors—including age, weight, preoperative hemoglobin, CPB duration, and cyanotic congenital heart disease—were identified. The nomogram demonstrated high accuracy (AUC 0.886) and clinical utility, aiding personalized blood management strategies to optimize outcomes and reduce transfusion risks.

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February 3, 2025
Platelet Inhibitor Withdrawal and Outcomes After Coronary Artery Surgery: An Individual Patient Data Meta-Analysis

Platelet Inhibitor Withdrawal and Outcomes After Coronary Artery Surgery: An Individual Patient Data Meta-Analysis

This study analyzes the impact of preoperative withdrawal of P2Y12 receptor inhibitors on bleeding and ischemic outcomes in coronary artery bypass grafting (CABG). Using individual patient data from 4,837 patients across seven observational studies, the meta-analysis finds that guideline-conforming withdrawal reduces severe bleeding (BARC-4) risk by 50% without increasing mortality or postoperative ischemic events. These findings support adherence to standardized preoperative withdrawal guidelines.

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February 3, 2025
Clinical Outcomes of Cardiac Transplantation in Heart Failure Patients with Previous Mechanical Cardiocirculatory Support

Clinical Outcomes of Cardiac Transplantation in Heart Failure Patients with Previous Mechanical Cardiocirculatory Support

This study evaluates the long-term outcomes of heart failure patients undergoing cardiac transplantation with prior left ventricular assist device (LVAD) use as a bridge-to-transplant (BTT) compared to direct-to-transplant (DTT). The findings indicate similar survival rates at 1 and 7 years post-transplant in both groups. Although LVADs increase surgical complexity and incidence of cerebrovascular events, they do not negatively affect overall outcomes, supporting their viability in advanced heart failure care.

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January 18, 2025
Myxoma Leg

A Firing Cannon: Bilateral Lower Limb Ischemia as a Manifestation of Cardiac Myxoma

This article presents a rare case of a 33-year-old woman with a left atrial myxoma, a benign cardiac tumor, causing bilateral lower limb ischemia due to systemic embolization. The patient’s myxoma, identified as the source of emboli, was successfully excised through open-heart surgery. The case underscores the critical need for timely surgical intervention to prevent potentially fatal complications such as stroke. Postoperative outcomes were excellent, with the patient resuming normal activities.

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December 28, 2024
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
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