International Perfusion Association

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IPA

Category: Cardiac Surgery

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
Aortic Rupture

Extracorporeal Off-Pump Antegrade Cerebral Perfusion in Reconstructive Surgery for Type A Aortic Dissection with Cerebral Malperfusion

This study evaluates a novel off-pump axillo-axillary shunt technique for antegrade cerebral perfusion (ACP) during total aortic arch replacement (BF-TAR) in patients with Type A aortic dissection (TAAD) complicated by cerebral malperfusion (CM). The method provides continuous bihemispheric perfusion, reducing risks linked to cardiopulmonary bypass. Among 18 patients, outcomes included low mortality (5.6%), no permanent neurological deficits, and improved perfusion times compared to traditional methods.

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November 28, 2024
Pediatic Cardioplegia

Hyperlactataemia Following Crystalloid Cardiopulmonary Bypass Priming in Paediatric Cardiac Surgery: Benign or Malignant?

This retrospective study examined paediatric patients undergoing cardiac surgery with crystalloid priming to evaluate outcomes related to postoperative hyperlactataemia. Among 186 patients, 53% experienced hyperlactataemia, which was associated with longer cardiopulmonary bypass and ICU stays but did not increase ventilation duration. Findings suggest transient hyperlactataemia may not indicate tissue hypoxaemia, but longer inotropic support and ICU stays necessitate careful management post-surgery.

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November 28, 2024
Protamine Done

Protamine Dosing for Heparin Reversal After Cardiopulmonary Bypass: A Double-Blinded Prospective Randomized Control Trial Comparing Two StrategieS

This study compared two protamine dosing strategies for heparin reversal after cardiopulmonary bypass: a fixed 250-mg dose versus a 1:1 (1 mg:100 U heparin) ratio-based approach. The trial included 125 elective adult cardiac surgery patients. Both methods showed similar activated clotting times and postoperative bleeding, but the fixed-dose group used significantly less protamine. These results suggest fixed dosing may optimize drug conservation without compromising safety or efficacy.

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November 24, 2024
BSA CPB

Predictive Role of Cardiopulmonary Bypass Exposure Indexed to Body Surface Area on Postoperative Organ Dysfunction: A Retrospective Cohort Study

This study analyzed the relationship between cardiopulmonary bypass (CPB) exposure indexed to body surface area (bypass index) and postoperative outcomes in 2,413 cardiac surgery patients. A higher bypass index was predictive of increased hospital stay and organ dysfunction, particularly renal and cardiac rhythm issues, but not pulmonary dysfunction. These findings highlight the bypass index as a valuable metric for assessing risk and optimizing resource use during cardiac surgery.

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November 24, 2024
Robo MVR

A Historical Perspective and Update on Robotic Mitral Valve Surgery

This study reviews the evolution of minimally invasive mitral valve repair, emphasizing the use of robotic platforms from 2005 to 2023. Analyzing 1,412 robotic repairs, it highlights improvements in outcomes, including reduced cross-clamp and bypass times and high repair durability. Degenerative disease was the most common indication, with 98.1% repair success and a ten-year survival rate exceeding 91%. The findings support robotic surgery as a durable, teachable, and safe option for mitral valve repair.

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November 19, 2024
DHCA

Temperature Management in Acute Type A Aortic Dissection Treatment: Deep vs. Moderate Hypothermic Circulatory Arrest

This study compares the clinical outcomes of deep hypothermic circulatory arrest (DHCA, <20°C) and moderate hypothermic circulatory arrest (MHCA, 20-28°C) in 143 patients undergoing acute type A aortic dissection surgery. DHCA was associated with higher rates of acute kidney injury (25.2% vs. 7.5%), delirium (22.3% vs. 5%), longer ICU stays, and greater complication risks compared to MHCA. While survival rates after two years were similar, MHCA proved to be safer and more beneficial in minimizing postoperative complications when feasible.

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November 17, 2024
Cerebral 2024

Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Linked to Postoperative Delirium in Cardiac Surgery Patients

This study explores the association between cerebral overperfusion and postoperative delirium (POD) in cardiac surgery patients. Continuous monitoring of cerebral blood flow, oxygen levels, and brain activity revealed increased middle cerebral artery velocity (MCAV) in patients with POD, despite stable oxygen saturation and autoregulation. The findings suggest that impaired cortical metabolism may render the brain vulnerable to overperfusion during surgery, increasing POD risk.

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November 17, 2024
CABG A-FIB

Risk Factors of Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Grafting Surgery in the Recent 10 Years: Clinical Analysis of 6229 Patients

This retrospective study analyzed 6,229 patients who underwent isolated coronary artery bypass grafting (CABG) from 2015 to 2023 to determine the risk factors for postoperative atrial fibrillation (POAF). The incidence of POAF was 30.94%. Univariate analysis revealed factors such as age, hypertension, smoking, CPB time, and ejection fraction (EF) as significant. Multivariate analysis identified older age and low EF as independent risk factors for POAF.

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October 22, 2024
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