International Perfusion Association

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IPA

Category: Cardiac Surgery

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
Transfusion Blood Cardiac Surgery

A Systematic Approach to Reduce Blood Transfusions in Acute Type A Aortic Dissection Surgery

This clinical study evaluates a systematic approach to reducing blood transfusions in patients undergoing acute type A aortic dissection (ATAAD) surgery. Techniques included Liu’s aortic root repair, moderate hypothermia circulatory arrest, and the use of a centrifugal pump in cardiopulmonary bypass. Among 326 patients, 53.37% avoided transfusions. Transfusion-free patients had lower mortality (1.72% vs. 9.21%) and complications. The findings support transfusion-free ATAAD surgeries for selected cases.

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December 7, 2024
TEG Results 2024

Temperature Effect on Coagulation Function in Mild Hypothermic Patients Undergoing Thoracic Surgeries: Thromboelastography (TEG) Versus Standard Tests

This study compared coagulation monitoring methods in mild hypothermic patients during thoracic surgery. Thromboelastography (TEG) detected significant coagulation impairments, including delayed clot formation and reduced clot strength, which standard tests failed to reveal. Temperature-adjusted TEG showed worse coagulation function at core hypothermic temperatures. Findings suggest TEG’s superiority for hemostatic monitoring and transfusion guidance in hypothermic surgical patients.

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December 4, 2024
Goal Direct Perfusion

Efficacy of Goal-Directed Versus Preemptive Tranexamic Acid Administration in Cardiovascular Surgery: The GDT Trial

The GDT trial compares goal-directed tranexamic acid (TXA) administration guided by rotational thromboelastometry (ROTEM) to preemptive TXA administration in cardiovascular surgery. This multi-center, double-blind, randomized trial aims to determine non-inferiority in reducing postoperative bleeding. Secondary outcomes include transfusion rates, thromboembolic complications, seizures, and hospital costs. The study hypothesizes that selective TXA administration will lower adverse events compared to preemptive dosing.

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December 4, 2024
Sodium CPB

Relation Between Serum Sodium Trajectory and Survival in Septic Patients with Cardiopulmonary Bypass Surgery

This study examined the impact of serum sodium trajectory on 30-day mortality in septic patients after cardiopulmonary bypass (CPB) surgery using the MIMIC-IV database. Among 1,038 patients, serum sodium trajectories were classified into three groups, with higher levels linked to increased mortality. Elevated fluctuations, even within normal sodium ranges, were associated with adverse outcomes. These findings highlight the need for close monitoring and sodium management in critically ill patients undergoing CPB.

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December 3, 2024
Five Pillars

Acute Right Ventricular Heart Failure, ECMO, RVAD, Hemodynamic Support, Five Pillars Framework

A conceptual representation of the “Five Pillars” framework for aRHF therapy. The image shows five pillars, each labeled with key aspects: Etiological Treatment, Hemodynamic Support, Ventilation, Fluid Optimization, and Mechanical Support. A heart is balanced on top of these pillars, symbolizing stability. The design is clean and professional, with subtle arrows indicating the interconnectedness of the pillars.

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December 3, 2024
IABP 2024

A Multivariate and Retrospective Analysis of the Impact of Intra-Aortic Balloon Counterpulsation in Open-Heart Surgery

This retrospective study examined 1,114 cardiac surgical patients who required intra-aortic balloon pump (IABP) support between 2009 and 2018. Patients were divided into pre-operative, intra-operative, and post-operative IABP insertion groups. The overall mortality rate was 10.9%, highest postoperatively (25.8%). Predictors of mortality included age, BMI, pulmonary hypertension, renal disease, and cardiogenic shock. Complications, particularly renal issues, were common in post-operative IABP use. Pre-operative IABP prophylaxis may reduce mortality in high-risk cases.

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December 1, 2024
Ped CV Volume

Center Volume and Survival in Inter-Hospital Transfers for Pediatric Cardiac Surgery: No Significant Association

This study analyzed 25,749 pediatric cardiac surgery cases requiring cardiopulmonary bypass (CPB) using the Kids’ Inpatient Database (2016 and 2019) to evaluate whether hospital case volume impacts inpatient mortality for transferred patients. Among 3,511 transferred patients, unadjusted mortality was higher than for direct admissions across low-, mid-, and high-volume centers. However, risk-adjusted inpatient mortality showed no significant differences based on hospital volume, even for high-complexity cases. The findings suggest that transfer decisions should not rely solely on annual case volume.

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December 1, 2024
Surgery vs. PCI

Comparing Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Non-ST-Segment Elevation Acute Coronary Syndromes: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for treating non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Analyzing data from 15 studies with 48,891 patients, results showed no significant mortality difference between PCI and CABG. However, CABG reduced the risk of myocardial infarction (RR = 0.56) and repeat revascularization (RR = 2.94), while PCI was associated with a lower risk of cerebrovascular accidents (RR = 0.58). These findings emphasize individualized treatment strategies based on patient-specific risk profiles.

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November 29, 2024
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