International Perfusion Association

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IPA

Category: Cardiac Surgery

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
Easter Heart

Risk Factors for Higher Postoperative Myocardial Injury in Minimally Invasive Mitral Valve Surgery Patients: A Cohort Study

This cohort study analyzed 316 patients who underwent minimally invasive mitral valve surgery to identify risk factors for higher postoperative myocardial injury, as indicated by elevated levels of high-sensitivity cardiac troponin I (hs-cTnI). It found that prolonged aortic cross-clamp time and a higher preoperative New York Heart Association (NYHA) class were associated with an increased risk, while robotic-assisted surgery appeared to lower the risk. Patients with higher myocardial injury also had worse postoperative outcomes, including higher lactate levels, increased incidence of acute kidney injury, longer mechanical ventilation, and extended hospital stays, although mortality was not affected.

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March 31, 2024
Heart 2024-2

Intraoperative Acute Cardiac Tamponade as a Result of Intracardiac Perforation Requiring Emergency Continuous Pericardiocentesis and Open Sternotomy: A Case Report and Literature Review of a Rare but Fatal Complication

This report details a case of intraoperative acute cardiac tamponade caused by left atrial perforation during a percutaneous intervention for anomalous pulmonary venous return, a rare but life-threatening complication. Despite emergency measures including continuous pericardiocentesis and an open sternotomy for repair, the patient, an 86-year-old female with history of right-ventricular failure and atrial fibrillation, succumbed to her condition hours post-operation. The case emphasizes the critical need for swift, multidisciplinary intervention in managing such complications and outlines the potential risks associated with percutaneous cardiac procedures.

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March 30, 2024
Robotic Surgery

Transferring Surgical Expertise: Analyzing the Learning Curve of Robotic Cardiac Surgery Operative Time Reduction When Surgeon Moves from One Experienced Center to Another

This study examines how the learning curve for robotic cardiac surgery operative time evolves when a surgeon with prior experience moves to a new team. A retrospective analysis of 103 cases at Weill Cornell Medicine shows that total operative time decreased significantly after the first 30 cases, indicating a period of adaptation to the new surgical environment. This adaptation did not affect the complication rates or cross-clamp times, highlighting the importance of understanding these dynamics for planning and managing surgical transitions to ensure optimal patient care and surgical outcomes.

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March 30, 2024
Cerebral P

Cerebral Protection in Acute Type A Aortic Dissection Surgery: A Comprehensive Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to compare antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) methods for reducing cerebrovascular events during acute type A aortic dissection (ATAAD) surgeries. After assessing 26 studies involving 13,039 patients, findings suggest both ACP and RCP are safe and acceptable for emergency use. While no significant differences in permanent neurological dysfunction (PND) and mortality were observed between unilateral ACP (uACP) and bilateral ACP (bACP), uACP showed a preference in reducing transient neurologic deficits (TND). This study underscores the effectiveness of cerebral perfusion techniques in ATAAD surgery, highlighting uACP as a preferable method for minimizing TND.

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March 26, 2024
Cardioplegia 123

Myocardial Protection: Histological Effects of Single-Dose Cardioplegic Solutions in the CARDIOPLEGIA Trial

This study aims to compare the myocardial protection offered by single-dose cardioplegic solutions (Custodiol, del Nido, and modified del Nido) using histological analysis in a double-blind clinical trial. At least 90 patients undergoing cardiac surgery will be randomly assigned to one of the three solutions, with myocardial biopsies collected before and after cardiopulmonary bypass. The research seeks to determine the most effective solution for minimizing ischemic damage during cardiac surgery, which is critical for patient safety and outcome optimization. Results could influence clinical protocols and cardioplegic solution selection globally.

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March 22, 2024
Valve Knot

Efficacy of Automated Fasteners Versus Hand-Tied Knots in Cardiac Surgery: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis compares the efficacy of COR-KNOT® automated fasteners to hand-tied knots in cardiac valve surgery. Analyzing data from 1,411 participants across eight observational studies and two randomized controlled trials, the findings indicate that COR-KNOT significantly reduces aortic cross-clamp (AXT) and cardiopulmonary bypass (CPB) times, as well as the incidences of valvular regurgitation and need for prolonged ventilatory support, without negatively impacting mortality, atrial fibrillation, left ventricular ejection fraction, or renal failure rates. These results support the use of COR-KNOT devices in cardiac surgery to enhance surgical efficiency and patient outcomes.

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March 17, 2024
Microbubbles

The Number of Microbubbles Generated During Cardiopulmonary Bypass Can Be Estimated Using Machine Learning From Suction Flow Rate, Venous Reservoir Level, Perfusion Flow Rate, Hematocrit Level, and Blood Temperature

This study introduces a neural network-based model to estimate the count rate of microbubbles (MBs) in cardiopulmonary bypass (CPB) systems, using suction flow rate, venous reservoir level, perfusion flow rate, hematocrit level, and blood temperature. Through perfusion experiments and clinical applications, the model demonstrated high accuracy (R2 > 0.95) and a strong correlation in clinical settings (R2 = 0.8576). This innovation could significantly enhance patient safety and outcomes by enabling precise monitoring and potentially reducing the risk of MB-associated complications in cardiac surgery.

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March 17, 2024
Cardiogenic Shock

Identifying and Mitigating Risk of Post-Cardiotomy Cardiogenic Shock in Patients with Ischemic and Non-Ischemic Cardiomyopathy

This study aimed to identify preoperative predictors of post-cardiotomy cardiogenic shock in patients with ischemic and non-ischemic cardiomyopathy, focusing on 238 patients undergoing cardiac surgery. It found that pulmonary artery pulsatility index and pulmonary capillary wedge pressure were key predictors, with the predictors varying between ischemic and non-ischemic conditions. The study highlights the importance of preoperative right heart catheterization in identifying patients at higher risk of cardiogenic shock. Ejection fraction improvements were noted at 12 months post-surgery.

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March 14, 2024
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