International Perfusion Association

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IPA

Category: Cardiac Surgery

CABG Hema

Antithrombotic Drug Removal with Hemoadsorption During Off-Pump Coronary Artery Bypass Grafting

This study evaluates the efficacy of using a hemoadsorption cartridge to remove antithrombotic drugs during off-pump coronary artery bypass grafting (OPCAB). Ten patients, predominantly male and with a mean age of 67.4 years, were treated with antithrombotics like ticagrelor and rivaroxaban. Hemoadsorption was integrated into the perioperative management using either a dialysis device or a standalone apheresis pump, showing a mean treatment time of 145 minutes. Results indicated low rates of bleeding, no deaths, or further interventions during a mean follow-up of 19.5 months, demonstrating that this method is feasible and safe.

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April 18, 2024
TA

The Efficacy of Tranexamic Acid in Reducing Perioperative Drainage in Cardiac Surgery with Cardiopulmonary Bypass

This study evaluates the effectiveness of tranexamic acid in reducing bleeding during and after cardiac surgery involving cardiopulmonary bypass. It compared 40 patients who received tranexamic acid to 40 who did not, finding significant differences in bleeding and transfusion rates, and improvements in hematological parameters for the treated group. These results suggest tranexamic acid effectively minimizes bleeding in such surgeries.

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April 17, 2024
Cerebral Protection

Cannula Placement for Cerebral Protection Without Circulatory Arrest in Patients Undergoing Hemiarch Aortic Aneurysm Repair

This retrospective study evaluates the efficacy and outcomes of left carotid antegrade cerebral perfusion (LCP) versus traditional right-sided perfusion with hypothermic circulatory arrest in hemiarch aortic aneurysm repairs. The study, encompassing 68 patients between 2015 and 2019, suggests that LCP via distal arch cannulation is a viable and safer alternative, showing comparable clinical outcomes but reduced cardiopulmonary bypass and cerebral perfusion times. The findings advocate for LCP as a method that potentially reduces the risks associated with circulatory arrest.

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April 16, 2024
ECMO Hero

Comparative Analysis of Therapeutic Strategies in Post-Cardiotomy Cardiogenic Shock: Insight into a High-Volume Cardiac Surgery Center

This study compares treatment outcomes for post-cardiotomy cardiogenic shock (PCCS) at a high-volume center. It retrospectively analyzes 220 patients (3% of 7028) from 2018 to 2022, assessing outcomes between conservative treatments and additional mechanical support with ECMO. Findings show ECMO patients had lower in-hospital mortality (60% vs. 85%) and better end-organ recovery, despite higher complications like dialysis and myocardial infarction, suggesting ECMO’s potential to improve critical patient outcomes.

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April 14, 2024
Arch Surgery

A New Minimal Invasive Technique with In-Situ Stent-Graft Fenestration for Type A Aortic Dissection

A new surgical method called the in-situ stent-graft fenestration (ISSF) technique is presented as an alternative for aortic arch reconstruction in type A aortic dissection. This technique offers shorter surgical durations and less intraoperative blood loss compared to the traditional Sun’s procedure. ISSF also results in lower in-hospital mortality rates and fewer postoperative complications. The six-month follow-up shows significant improvements in the dimensions of the aorta’s true and false lumens, suggesting promising short-term efficacy and safety.

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April 14, 2024
Valve Suction

Development of Endocavitary Suction Device for MiECC on Minimally Invasive Mitral Valve Surgery

This paper introduces a new endocavitary suction device designed to enhance minimally invasive extracorporeal circulation (MiECC) systems during mitral valve surgeries. By reducing blood contact with air and foreign surfaces, it aims to diminish the inflammatory response and improve biocompatibility. The device, coupled with the MiECC technique in minimally invasive mitral valve surgery (MIMVS), addresses limitations in endo-cavitary aspiration, aiming to eliminate gaseous micro-embolic activity and hemolysis while adjusting CO2 levels. This innovation could revolutionize cardiac chamber surgery by facilitating safer, less invasive procedures, ultimately improving patient outcomes and reducing healthcare costs.

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April 7, 2024
Heart HGB

Haemoglobin Thresholds for Transfusion: How Are We Doing in the Era of Choosing Wisely? A Retrospective Cohort Study

This retrospective cohort study examines red blood cell (RBC) transfusion practices at a Swiss university hospital from 2012 to 2019, in line with the Choosing Wisely initiative’s recommended haemoglobin thresholds. It reveals a trend towards more restrictive transfusion practices, with mean pretransfusion haemoglobin levels decreasing over the years. The study also found a significant reduction in potentially inadequate transfusions, indicating adherence to guidelines. Key risk factors for potentially inadequate transfusions include older age, surgical procedures, and chronic conditions. The increase in single RBC unit transfusions suggests a shift towards efficiency and caution in transfusion practices, aligning with the initiative’s goals to improve patient care and outcomes.

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April 7, 2024
Blood Purification

Preliminary Report of Extracorporeal Blood Purification Therapy in Patients Receiving LVAD: Cytosorb or Jafron HA330

This study investigates the effects of extracorporeal blood purification therapy using Cytosorb and Jafron HA330 in patients undergoing Left Ventricular Assist Device (LVAD) implantation, aimed at mitigating immune dysregulation and infectious complications by reducing proinflammatory cytokine levels. Data from 15 patients receiving HeartMate 3™ LVADs were analyzed, with groups assigned to Cytosorb therapy, Jafron HA330, or control (usual care without filters). Results indicated that despite LVAD implantation increasing levels of various inflammatory markers, neither Cytosorb nor Jafron therapies had a significant impact on these markers, in-hospital mortality, or overall survival. The study suggests the need for larger, prospective studies to explore the potential benefits of hemoadsorption therapies in improving outcomes for LVAD patients.

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April 4, 2024
Heart Blood

Consensus of the Brazilian Association of Hematology, Hemotherapy, and Cellular Therapy on Patient Blood Management: Antifibrinolytics

The article highlights the importance of antifibrinolytic drugs, such as epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA), in reducing blood loss and the need for transfusions in both cardiac and non-cardiac surgeries. These drugs are recognized for their effectiveness without causing significant adverse effects. EACA comes highly recommended for heart surgeries, with no substantial evidence of thrombotic potential, while TXA is noted for its safety and efficacy in reducing transfusion use, with precautions for dose adjustment in renal impairment and seizure risks at doses over 2 g per day.

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April 3, 2024
Childs Heart

Effectiveness of Dexmedetomidine as Myocardial Protector in Children With Classic Tetralogy of Fallot Having Corrective Surgery: A Randomized Controlled Trial

This randomized controlled trial investigated dexmedetomidine’s (DEX) efficacy as a cardioprotective agent in children with classic tetralogy of Fallot undergoing corrective surgery in Indonesia. Administering DEX in the cardiopulmonary bypass solution significantly reduced troponin I levels, interleukin-6, and lactate levels postoperatively, indicating reduced cardiac injury and inflammation. It also improved cardiac output and reduced the need for vasoactive drugs in intensive care, although it did not significantly impact ventilation duration, ICU stay, or mortality. These findings suggest DEX is an effective cardioprotective agent in pediatric cardiac surgery.

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April 1, 2024
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