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

December 4, 2024 No Comments

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.

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

December 3, 2024 No Comments

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.

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

December 3, 2024 No Comments

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.

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

December 1, 2024 No Comments

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.

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

December 1, 2024 No Comments

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.

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

November 29, 2024 No Comments

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.

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

November 28, 2024 No Comments

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.

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

November 28, 2024 No Comments

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.

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

November 24, 2024 No Comments

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.

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

November 24, 2024 No Comments

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

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

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

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

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

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

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

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

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

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

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