International Perfusion Association

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IPA

Category: Cardiac Surgery

Hemaglobin 2024

Association Between Perioperative Hemoglobin Decrease and Outcomes of Transfusion in Patients Undergoing On-Pump Cardiac Surgery: An Observational Study From Two Chinese Heart Centers

This study analyzed 8186 adult patients undergoing cardiac surgery to examine the impact of perioperative hemoglobin decrease (ΔHb) on red blood cell transfusion outcomes. Patients with greater hemoglobin decreases (≥50%) were found to have higher risks of complications like mortality and organ failure. Transfusions helped in some cases but became harmful when exceeding four units. The findings underscore the importance of careful transfusion management in cardiac surgery.

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October 1, 2024
IABP Cardiogenic Shock

The Intra-Aortic Balloon Pump as a Rescue Device: Do We Need to Shift Our Strategy for Cardiogenic Shock Rescue After Cardiac Surgery?

This study evaluates the efficacy of the intra-aortic balloon pump (IABP) as a rescue strategy for patients experiencing complications following cardiac surgery. Data from 10,591 patients between 2012 and 2020 were analyzed, revealing that IABP use is associated with increased early and one-year mortality, especially when deployed for more than four days or after cardiac arrest. The findings suggest alternative mechanical circulatory support methods may be more appropriate for severe cardiogenic shock.

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September 28, 2024
Del Nido Cardioplegia

Comparison of Routine Del Nido Cardioplegia vs Two Types of Modified Del Nido Cardioplegias for Myocardial Protection in CABG: A Randomized Double-Blind Clinical Trial

This randomized, double-blind trial compared the effectiveness of routine del Nido cardioplegia with two modified versions (Ringer lactate-based and plain Ringer-based) in coronary artery bypass grafting (CABG) surgery. Among 120 adult patients, no significant differences were found in myocardial protection markers (CK-MB, Troponin T, Troponin I, lactate). However, Troponin T and lactate levels showed time-related effects. All cardioplegia solutions provided comparable protection, suggesting the need for further studies.

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September 27, 2024
WBC ECMO

Increased White Blood Cell Count is Associated with an Increased Demand for Unfractionated Heparin During Veno-Arterial Extracorporeal Oxygenation in Lung Transplantation

This retrospective study investigated whether increased white blood cell (WBC) counts correlate with higher unfractionated heparin (UFH) dosage needs during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) in lung transplantation. Among 27 patients, those with elevated WBC counts (above 10.2 × 10³/μL) required higher UFH doses to maintain targeted clotting times. The findings suggest WBC count could help determine optimal UFH dosing during surgery.

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September 26, 2024
Factor VII

Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency

This case report discusses the challenges of managing cardiopulmonary bypass (CPB) in an 8-month-old pediatric patient with factor XII deficiency, a rare coagulopathy that complicates anticoagulation monitoring. The use of the Hemochron Signature Elite with ACT+ cartridges provided reliable anticoagulation monitoring during surgery. The report reviews current strategies for managing CPB in patients with this condition, highlighting the importance of specialized tools for predictable results.

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September 21, 2024
Transfusion 2024

Acute Normovolemic Hemodilution in Cardiac Surgery: Rationale and Design of a Multicenter Randomized Trial

This study explores whether Acute Normovolemic Hemodilution (ANH) can reduce the need for Red Blood Cell (RBC) transfusions after cardiac surgery. The multicenter, randomized controlled trial involves patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Participants are assigned to receive either ANH or standard treatment. The primary outcome is the rate of RBC transfusion, with secondary outcomes including mortality and complications.

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August 9, 2024
Anesthesia MICS

Anesthesia for Minimally Invasive Cardiac Surgery: The Bonn Heart Center Protocol

This article outlines the anesthetic management protocol for minimally invasive cardiac surgery (MICS) at the Bonn Heart Center. It covers preoperative assessment, tailored anesthesia induction, and intraoperative techniques designed to maintain hemodynamic stability and ensure optimal ventilation. Advanced monitoring methods, including transesophageal echocardiography (TEE), processed EEG, and near-infrared spectroscopy (NIRS), are utilized to optimize patient safety. The article emphasizes the importance of peripheral cannulation techniques for cardiopulmonary bypass (CPB) and discusses the necessity of a multidisciplinary approach to perioperative care to enhance recovery and patient outcomes.

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July 17, 2024
Cardioplegia 2024

Comparative Analysis of Del Nido Cardioplegia Versus Blood Cardioplegia in Isolated Coronary Artery Bypass Grafting

This study examined the efficacy of del Nido cardioplegia compared to traditional blood cardioplegia in adult coronary artery bypass grafting. Among 119 patients, the del Nido group showed superior myocardial protection, indicated by lower Troponin I levels and fewer defibrillation attempts post-surgery. Additionally, this group experienced shorter surgery durations, including reduced aortic cross-clamping and total operative times. The findings suggest del Nido cardioplegia as a viable option for these procedures, necessitating a standardized protocol.

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July 17, 2024
Aortic Surgery

Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study

This single-center retrospective study evaluated the impact of different arterial cannulation strategies on surgical outcomes for patients with acute type A aortic dissection (AD) and intramural hematoma (IMH). By comparing 32 patients who underwent antegrade cannulation with 114 patients who underwent retrograde cannulation, the study found significant differences in total surgical time and intensive care unit stay duration. However, no significant differences were observed in 30-day mortality or postoperative cerebrovascular accident rates. The findings suggest that the choice of cannulation strategy should be tailored to individual patient needs.

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July 6, 2024
Patient Blood Management

Methodologic Quality and Pharmacotherapy Recommendations for Patient Blood Management Guidelines for Cardiac Surgery on Cardiopulmonary Bypass

This study evaluated the methodology and pharmacotherapy recommendations of Patient Blood Management (PBM) guidelines for cardiac surgery under cardiopulmonary bypass (CPB). It analyzed nine guidelines using the AGREE II tool, finding that “Stakeholder involvement” scored lowest. Drug therapy strategies include anemia therapy, antithrombotic and anticoagulation drugs, and hemostatic drugs, with distinct recommendations for pediatric and adult patients.

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June 29, 2024
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