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

February 5, 2025 No Comments

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.

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

February 3, 2025 No Comments

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.

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

February 3, 2025 No Comments

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.

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

January 18, 2025 No Comments

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.

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

December 28, 2024 No Comments

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.

Outcomes of Del Nido and Hyperkalemic Blood Cardioplegia in Adult Cardiac Surgery with Prolonged Aortic Cross-Clamp Times

December 21, 2024 No Comments

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.

The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation Among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

December 20, 2024 No Comments

This systematic review analyzes prolonged mechanical ventilation (PMV) post-cardiac surgery, finding an incidence rate of 20%. PMV, defined as ventilation lasting ≥24 hours, is linked to in-hospital mortality (odds ratio: 14.13). Key risk factors include advanced age, female sex, ejection fraction <50%, and body mass index >28 kg/m². PMV also correlates with conditions like chronic renal failure and prolonged cardiopulmonary bypass time. These insights highlight the need for targeted prevention and management strategies.

The Role of Impella in the Pre-Procedural Management of Post-Infarct Ventricular Septal Defect: A Systematic Review

December 17, 2024 No Comments

This systematic review explores the use of the Impella device in patients with post-infarct ventricular septal defect (VSD) prior to definitive treatment. Analyzing 68 patients across 20 studies, the Impella improved hemodynamic stability, reduced left ventricular strain, and delayed urgent intervention. Patients with surgically-placed Impella devices showed lower mortality and fewer complications compared to percutaneous alternatives. While effective, complications like bleeding and hemolysis must be carefully managed.

Meta-Analysis Comparing Immediate Versus Staged Complete Revascularization for ST-Elevation Myocardial Infarction With Multivessel Disease

December 17, 2024 No Comments

This meta-analysis compares immediate versus staged complete revascularization (CR) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease. Analyzing five randomized controlled trials (1,415 patients), no significant difference was observed in major adverse cardiovascular events (MACE), mortality, or myocardial infarction rates. However, staged CR showed a higher rate of unplanned ischemia-driven revascularization. Timing of staged intervention is crucial for optimized outcomes.

Removal of Cytokines During Cardiac Surgery (RECCAS): A Randomised Controlled Trial

December 14, 2024 No Comments

This randomized controlled trial evaluates the efficacy of intraoperative haemoadsorption (HA) using CytoSorb® during cardiac surgery with cardiopulmonary bypass (CPB). The primary focus was on reducing interleukin-6 (IL-6) levels post-surgery. Despite a significant reduction in cytokine levels within the HA device during surgery, there was no difference in IL-6 levels between the treatment and control groups upon ICU admission or during the ICU stay. Some haemodynamic benefits, such as reduced fluid and fibrinogen requirements and shorter need for renal replacement therapy, were observed, though these did not translate into improved clinical outcomes like ICU length of stay or mortality rates. The study underscores the need for further large-scale trials to refine patient selection and HA application strategies.

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

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

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

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

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

Outcomes of Del Nido and Hyperkalemic Blood Cardioplegia in Adult Cardiac Surgery with Prolonged Aortic Cross-Clamp Times

The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation Among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

The Role of Impella in the Pre-Procedural Management of Post-Infarct Ventricular Septal Defect: A Systematic Review

Meta-Analysis Comparing Immediate Versus Staged Complete Revascularization for ST-Elevation Myocardial Infarction With Multivessel Disease

Removal of Cytokines During Cardiac Surgery (RECCAS): A Randomised Controlled Trial

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