International Perfusion Association

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IPA

Category: Cardiac Surgery

Aortic Arch

Meta-Analysis of Central and Peripheral Cannulation for Type A Aortic Dissection

This meta-analysis evaluates the safety and effectiveness of direct aortic cannulation (AoC) versus peripheral cannulation (PC) in patients undergoing surgery for acute type A aortic dissection. Analyzing 10 retrospective studies involving 2518 patients, it found no significant differences in short-term mortality, stroke, or acute kidney injury between the two methods. However, AoC was associated with shorter operation times, suggesting it could be a viable alternative to PC, offering comparable outcomes with potential operational advantages.

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March 13, 2024
Blood Mgmt

A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age

This study investigates the effectiveness of Patient Blood Management (PBM) programs in older adults undergoing cardiovascular surgery, focusing on those aged 60 and above, including a detailed look at individuals 75 and older. The findings reveal significant reductions in red blood cell transfusion rates and mortality, alongside lower risks of adverse events post-PBM implementation, without any negative outcomes. Notably, the advantages of PBM were consistent across all age groups studied, indicating that even the oldest patients can benefit from tailored blood management strategies in cardiovascular procedures.

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March 12, 2024
TP Perfusion

Beating Heart Transplant Procedures Using Organs From Donors With Circulatory Death

This study evaluates the safety and efficacy of the beating heart method for heart transplantation using donors deceased after circulatory death (DCD). Conducted on 10 male patients with end-stage heart failure, it found 100% survival without the need for postoperative extracorporeal membrane oxygenation (ECMO). This method, which potentially reduces ischemia reperfusion injury, suggests a promising approach to DCD heart transplantation that may lower the incidence of primary graft dysfunction. The findings are significant for institutions considering the use of DCD donors for heart transplants.

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March 12, 2024
Chest Tube Removal

Early Chest Tube Removal on the First Postoperative Day Protocol of an Enhanced Recovery After Cardiac Surgery Programme Is Safe

This study assessed the safety of an early chest tube removal (CTR) protocol on the first postoperative day in an enhanced recovery after surgery (ERAS) program, focusing on patients undergoing elective coronary revascularization and/or valve surgery from 2015 to 2021. A propensity score matching compared outcomes between patients following the ERAS programme with early CTR and a control group receiving conventional care. The results showed no significant difference in the primary endpoint, which included postoperative complications such as pneumothorax, pleural and pericardial effusion requiring intervention, and hospital mortality, between the groups. The ERAS group experienced lower incidences of bronchopneumonia, and higher incidences of reduced mechanical ventilation time, shorter intensive care, and hospital stays, demonstrating that CTR on POD1 can be safely incorporated into ERAS programmes.

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March 11, 2024
Cardiac BP

Hemodynamic Monitoring In The Cardiac Surgical Patient: Comparison of Three Arterial Catheters

This study evaluates three arterial catheter placement strategies (Radial Short, Radial Long, and Brachial Long) for hemodynamic monitoring in cardiac surgery. Conducted at a single academic university hospital, it involved adult patients undergoing non-emergent cardiac surgery with cardiopulmonary bypass. The findings indicate that both Radial Long and Brachial Long catheter placements offer superior systemic systolic arterial pressure (SAP) and mean arterial pressure (MAP) monitoring compared to the Radial Short strategy. Specifically, the Brachial Long placement showed superior results in MAP gradients post-CPB, and lesser need for femoral line placement and vasopressin administration, underscoring the effectiveness of longer catheters in critical care.

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March 11, 2024
ECMO Summary

A Comprehensive Review of Extracorporeal Membrane Oxygenation: The Lifeline in Critical Moments

Extracorporeal membrane oxygenation (ECMO) emerges as a crucial lifesaver in critical care for patients with severe respiratory or cardiac failure. This review delves into ECMO’s journey from its inception to the cutting-edge advancements and its profound impact in critical care. It highlights ECMO’s versatility in treating diverse conditions, the importance of patient selection, and managing complications. Technological progress, including miniaturization, innovative circuit designs, and remote monitoring, illustrates the evolving ECMO landscape. The article underscores ECMO’s significant role in enhancing survival rates, mobility, and leveraging remote expertise, portraying it as a beacon of hope and innovation in redefining life support boundaries.

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March 7, 2024
CPB Time

Difference Between Cardiopulmonary Bypass Time and Aortic Cross-Clamping Time as a Predictor of Complications After Coronary Artery Bypass Grafting

This study examines the impact of the time difference between cardiopulmonary bypass and aortic cross-clamping on complications after coronary artery bypass grafting. Analyzing data from 3,090 patients, it identifies a correlation between increased time differences and higher risks of reoperation, stroke, kidney failure, and in-hospital mortality. The findings suggest that the time difference serves as a significant predictive factor for postoperative complications, highlighting the importance of incorporating this metric in future research for better complication prediction.

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March 7, 2024
Valve AVR

Outcomes of Minimally Invasive Aortic Valve Replacement in Obese Patients: A Propensity-Matched Study

This study compared minimally invasive aortic valve replacement (MIAVR) to conventional approaches (CAVR) in 203 obese patients, using propensity-matched analysis to ensure comparability. Results indicated no significant difference in 30-day mortality rates, with MIAVR patients benefiting from faster extubation times, reduced need for continuous positive airway pressure therapy, and shorter ICU stays, though hospital stays were comparable. This suggests that MIAVR is a safe, effective option for obese patients, offering notable postoperative respiratory and recovery advantages.

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March 5, 2024
Cardiotomy Suction

Advancing Cardiotomy Suction Practices for Coronary Surgery via Multidisciplinary Collaborative Learning

This study evaluates a quality-improvement intervention aimed at standardizing cardiotomy suction practices during coronary artery bypass grafting (CABG), promoting cessation before protamine administration. Involving 32 Michigan centers and comparing with four non-Michigan centers, the intervention included surgeon and perfusionist feedback, lectures, and evaluating change barriers. Results showed an 80.7% adherence to the practice among Michigan patients, with significant improvements post-intervention without negative clinical outcomes. This underscores the effectiveness of multidisciplinary collaboration in enhancing cardiotomy suction practices and patient care during CABG.

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March 3, 2024
Heart Brain

Effects of Pulsatile and Non-Pulsatile Cardiopulmonary Bypass Techniques in Coronary Artery Bypass Grafting Surgeries on Cerebral Perfusion

This study investigates the impact of pulsatile and non-pulsatile cardiopulmonary bypass (CPB) techniques on cerebral perfusion in coronary artery bypass grafting surgeries. Using near-infrared spectroscopy for cerebral oximetry monitoring, S100β protein levels, and neurocognitive function tests, it was found that pulsatile perfusion may offer benefits for cerebral perfusion based on specific biomarker levels, despite no significant differences in neurocognitive outcomes between groups. The findings suggest further research is needed to fully understand the advantages of pulsatile flow for cerebral health post-surgery.

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March 1, 2024
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