Neurodevelopmental Outcomes After Nitric Oxide During Cardiopulmonary Bypass for Open Heart Surgery: A Randomized Clinical Trial

February 8, 2025 No Comments

This randomized clinical trial examined whether nitric oxide (NO) administered during cardiopulmonary bypass (CPB) improves neurodevelopmental and health-related quality of life (HRQOL) outcomes in infants undergoing open heart surgery. Conducted across six centers, the study followed 927 infants at 12 months post-surgery. Results showed no significant differences in neurodevelopment or HRQOL between the NO and standard CPB groups, suggesting NO does not enhance long-term neurological outcomes.

Platelet Inhibitor Withdrawal and Outcomes After Coronary Artery Surgery: An Individual Patient Data Meta-Analysis

February 3, 2025 No Comments

This study analyzes the impact of preoperative withdrawal of P2Y12 receptor inhibitors on bleeding and ischemic outcomes in coronary artery bypass grafting (CABG). Using individual patient data from 4,837 patients across seven observational studies, the meta-analysis finds that guideline-conforming withdrawal reduces severe bleeding (BARC-4) risk by 50% without increasing mortality or postoperative ischemic events. These findings support adherence to standardized preoperative withdrawal guidelines.

Trial of Oxygen Delivery on Cardiopulmonary Bypass and Major Clinical Outcomes

January 18, 2025 No Comments

This study investigates the impact of oxygen delivery (DO2) during cardiopulmonary bypass (CPB) on major clinical outcomes in cardiac surgery patients. Maintaining adequate DO2 during

Failure to Oxygenate During Cardiopulmonary Bypass: Treatment Options and Intervention Algorithm

December 23, 2024 No Comments

This study addresses the critical issue of oxygenator failure during cardiopulmonary bypass (CPB), a rare but high-risk event. It explores protocols and techniques for addressing oxygenator malfunction, including traditional oxygenator change-outs and alternative approaches like arterial and venous piggyback methods. The authors emphasize the need for institutional preparation, including written protocols and routine emergency drills, and propose a venous piggyback technique as a safer first-line response to improve patient outcomes.

Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Associated with Postoperative Delirium in Cardiac Surgery Patients: A Prospective Observational Study

December 21, 2024 No Comments

This study investigates the relationship between cerebral overperfusion and postoperative delirium (POD) in cardiac surgery patients. Despite reduced cortical metabolism, patients with POD exhibited increased cerebral blood flow, measured via transcranial Doppler. Low bispectral index (BIS) values indicated reduced metabolism, but no differences in autoregulation impairments were noted. The findings suggest a mismatch between cerebral blood flow and metabolism contributes to POD, independent of cerebral autoregulation.

Intraoperative Extracorporeal Support for Lung Transplant: A Systematic Review and Network Meta-Analysis

December 20, 2024 No Comments

This systematic review and network meta-analysis investigates the comparative effectiveness of veno-arterial extracorporeal membrane oxygenation (V-A ECMO), cardiopulmonary bypass (CPB), and OffPump strategies for lung transplantation (LT). Based on 27 observational studies with 6113 patients, the study finds that OffPump approaches outperform both ECMO and CPB in all major outcomes, including reduced ICU stay, mechanical ventilation duration, and mortality. Among extracorporeal supports, V-A ECMO showed better performance than CPB. Factors such as age, gender, and BMI significantly influenced postoperative outcomes.

Removal of Cytokines During Cardiac Surgery (RECCAS): A Randomised Controlled Trial

December 14, 2024 No Comments

This randomized controlled trial evaluates the efficacy of intraoperative haemoadsorption (HA) using CytoSorb® during cardiac surgery with cardiopulmonary bypass (CPB). The primary focus was on reducing interleukin-6 (IL-6) levels post-surgery. Despite a significant reduction in cytokine levels within the HA device during surgery, there was no difference in IL-6 levels between the treatment and control groups upon ICU admission or during the ICU stay. Some haemodynamic benefits, such as reduced fluid and fibrinogen requirements and shorter need for renal replacement therapy, were observed, though these did not translate into improved clinical outcomes like ICU length of stay or mortality rates. The study underscores the need for further large-scale trials to refine patient selection and HA application strategies.

Delayed Cold-Stored vs. Room Temperature Stored Platelet Transfusions in Bleeding Adult Cardiac Surgery Patients—A Randomized Multicentre Pilot Study (PLTS-1)

December 10, 2024 No Comments

This study investigates the feasibility of using delayed cold-stored platelets (DCSP) compared to standard room-temperature platelets (RTP) in bleeding cardiac surgery patients. DCSP, stored initially at 22°C and then refrigerated, may address platelet supply challenges by extending shelf life and enhancing hemostatic activity. The multicentre pilot aims to assess recruitment, adherence, and product availability to inform a future definitive trial. The trial could improve transfusion logistics and patient outcomes.

Differences in Plasma Extracellular Vesicles of Different Origin in On-Pump Versus Off-Pump Cardiac Surgery

December 8, 2024 No Comments

This study compares the immune responses of patients undergoing coronary artery bypass grafting (CABG) via on-pump and off-pump methods. On-pump CABG induced a more significant immune response, with notable increases in extracellular vesicles (EVs) derived from platelets, endothelial cells, and B-cells. Off-pump surgery was associated with milder changes in cytokine and EV profiles. Findings highlight EVs’ role in regulating postoperative inflammation and suggest a potential mechanism for immune modulation.

The Value of Off-Pump Coronary Artery Bypass Grafting in Surgery for Combined Valvular and Coronary Heart Disease

December 8, 2024 No Comments

This study explores the benefits of off-pump coronary artery bypass grafting (OPCABG) in surgeries combining valve and coronary interventions. Among 884 patients, the OPCABG group showed reduced incidences of postoperative atrial fibrillation (29.5% vs. 39.5%) and acute kidney injury (14.5% vs. 21.2%) compared to on-pump CABG. No differences in mortality or stroke rates were observed. The results suggest OPCABG is a safe and effective approach for improved short-term outcomes in complex cardiac surgeries.

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Platelet Inhibitor Withdrawal and Outcomes After Coronary Artery Surgery: An Individual Patient Data Meta-Analysis

Trial of Oxygen Delivery on Cardiopulmonary Bypass and Major Clinical Outcomes

Failure to Oxygenate During Cardiopulmonary Bypass: Treatment Options and Intervention Algorithm

Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Associated with Postoperative Delirium in Cardiac Surgery Patients: A Prospective Observational Study

Intraoperative Extracorporeal Support for Lung Transplant: A Systematic Review and Network Meta-Analysis

Removal of Cytokines During Cardiac Surgery (RECCAS): A Randomised Controlled Trial

Delayed Cold-Stored vs. Room Temperature Stored Platelet Transfusions in Bleeding Adult Cardiac Surgery Patients—A Randomized Multicentre Pilot Study (PLTS-1)

Differences in Plasma Extracellular Vesicles of Different Origin in On-Pump Versus Off-Pump Cardiac Surgery

The Value of Off-Pump Coronary Artery Bypass Grafting in Surgery for Combined Valvular and Coronary Heart Disease

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