International Perfusion Association

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Category: Cardiac Surgery

The Role of Continuous Monitoring of Venous Drainage Flow and Integrated Oxygen Extraction (ERiO2) via Bilateral Near-Infrared Spectroscopy in Cerebral Perfusion During Aortic Arch Surgery

The Role of Continuous Monitoring of Venous Drainage Flow and Integrated Oxygen Extraction (ERiO2) via Bilateral Near-Infrared Spectroscopy in Cerebral Perfusion During Aortic Arch Surgery

This study evaluates the role of continuous monitoring of venous drainage flow and oxygen extraction (ERiO2) using near-infrared spectroscopy (NIRS) in cerebral perfusion during aortic arch surgery. A retrospective review of 10 patients undergoing selective antegrade cerebral perfusion (SACP) found a strong correlation (r = 0.91, p < 0.01) between ERiO2 and NIRS-derived regional oxygen saturation (rSO2). The study suggests that integrated monitoring improves perfusion management and neurological outcomes.

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March 6, 2025
Is Surgery for Congenital Heart Defects in Neonates, Infants, and Children More Challenging and Demanding Than Surgery for Acquired Heart Defects in Adults?

Is Surgery for Congenital Heart Defects in Neonates, Infants, and Children More Challenging and Demanding Than Surgery for Acquired Heart Defects in Adults?

Pediatric cardiac surgery presents unique challenges due to the complexity of congenital heart defects (CHD), requiring highly specialized techniques, individualized interventions, and long-term patient care. Unlike adult cardiac surgery, which addresses standardized conditions, CHD surgery demands precision, adaptability, and multidisciplinary expertise. Limited cardiovascular reserves in younger patients increase surgical risks. Addressing global disparities in pediatric cardiac care is crucial for improving outcomes.

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March 5, 2025
Lethal Myocardial Infarction in a Neonate During Extracorporeal Membrane Oxygenation

Lethal Myocardial Infarction in a Neonate During Extracorporeal Membrane Oxygenation

This case study explores a neonate with congenital diaphragmatic hernia (CDH) who experienced a lethal myocardial infarction (MI) while on extracorporeal membrane oxygenation (ECMO). The patient developed a large thrombus extending from the arterial cannula into the left main coronary artery, leading to severe cardiac dysfunction. Despite anticoagulation efforts, the clot progressed, resulting in a fatal outcome. The study highlights the challenges of managing neonatal ECMO and intracardiac thrombosis.

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March 4, 2025
Outcomes and Biochemical Parameters Following Cardiac Surgery: Effects of Transfusion of Residual Blood Using Centrifugation and Multiple-Pass Hemoconcentration

Outcomes and Biochemical Parameters Following Cardiac Surgery: Effects of Transfusion of Residual Blood Using Centrifugation and Multiple-Pass Hemoconcentration

This study compares centrifugation (CF) and multiple-pass hemoconcentration (MPH) for salvaging residual blood after cardiopulmonary bypass. A randomized trial with 61 patients found that MPH resulted in higher postoperative albumin, total protein, fibrinogen, and platelet levels compared to CF. While CF processed blood faster and cleared heparin more consistently, MPH was associated with lower allogeneic transfusion needs and reduced fluid retention. Overall, MPH demonstrated improved biochemical and clinical outcomes.

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March 4, 2025
Transfusion Use and Hemoglobin Levels by Blood Conservation Method After Cardiopulmonary Bypass

Transfusion Use and Hemoglobin Levels by Blood Conservation Method After Cardiopulmonary Bypass

This study evaluates three blood conservation techniques—online modified ultrafiltration (MUF), off-line MUF, and centrifugation—following cardiopulmonary bypass. A cohort of 99 patients was analyzed for transfusion rates, hemoglobin levels, and fluid balance. Results indicated no significant advantage of online MUF in reducing transfusions. Off-line MUF had the lowest transfusion rates, while online MUF showed greater hemoglobin improvement, likely due to fluid shifts.

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March 4, 2025
Pulmonary Artery Systolic Pressure Associated with Inflammatory Factors Among Pediatric Congenital Heart Disease with Pulmonary Arterial Hypertension After Cardiopulmonary Bypass

Pulmonary Artery Systolic Pressure Associated with Inflammatory Factors Among Pediatric Congenital Heart Disease with Pulmonary Arterial Hypertension After Cardiopulmonary Bypass

This study investigates the relationship between pulmonary artery systolic pressure (PASP) and inflammatory factors in pediatric congenital heart disease (CHD) patients with pulmonary arterial hypertension (PAH) after cardiopulmonary bypass (CPB). The study found that elevated preoperative PASP correlates with increased postoperative inflammatory cytokines, particularly IL-6 and IL-10. Higher PASP (>52 mmHg) predicted prolonged ventilation time (>21 hours), suggesting worsened postoperative outcomes.

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March 3, 2025

Vasoplegic Syndrome Following Bypass: A Comprehensive Review of Pathophysiology and Proposed Treatments

Vasoplegic syndrome (VS) is a severe circulatory condition occurring post-cardiopulmonary bypass (CPB), affecting up to 44% of high-risk patients with mortality rates reaching 50%. It is characterized by profound hypotension, vasopressor resistance, and vascular collapse. The review explores pathophysiology, risk factors, and treatments, including nitric oxide synthase inhibitors (methylene blue, hydroxocobalamin), vasopressors, and fluid management to mitigate complications and improve survival.

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March 1, 2025
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
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