International Perfusion Association

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IPA

Category: CPB

Vasopressin

Prospective Randomized Double-Blind Study to Evaluate the Superiority of Vasopressin Versus Norepinephrine in the Management of Patients at Renal Risk Undergoing Cardiac Surgery with Cardiopulmonary Bypass (NOVACC Trial)

The NOVACC trial, a multicentre, randomized, double-blind study, evaluates vasopressin against norepinephrine for patients at renal risk during cardiac surgery with cardiopulmonary bypass. Targeting the reduction of cardiac surgery-associated acute kidney injury (CS-AKI) and its associated morbidity and healthcare costs, the study is based on preliminary findings suggesting vasopressin’s potential to lower CS-AKI incidence and post-operative atrial fibrillation. With the primary endpoint being the occurrence of acute kidney injury and death, and secondary endpoints including a range of post-operative complications and medico-economic costs, the trial aims to demonstrate vasopressin’s effectiveness in reducing CS-AKI, mortality, and medical expenses.

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March 20, 2024
MAP Study

Mean Arterial Pressure (MAP) Trial: Study Protocol for a Multicentre, Randomized, Controlled Trial to Compare Three Different Strategies of Mean Arterial Pressure Management during Cardiopulmonary Bypass

The MAP Trial is a pioneering multicentre, randomized, controlled study comparing three strategies for managing mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) in heart surgery. It challenges the traditional “standard MAP” of 50-60 mmHg by introducing a “high MAP” (70-80 mmHg) and a “patient-tailored MAP” approach, aiming to optimize organ perfusion. The study’s primary goal is to identify the most effective MAP management technique by measuring serum lactate peaks as indicators of tissue hypoxia. Secondary outcomes include intraoperative oxygenation parameters and major postoperative complications, contributing to enhanced cardiac surgery results.

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March 20, 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
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
CPB TIME

The Effect of Surgery Started at Different Time Points During the Day on the Clinical Outcomes of Mitral Valve Surgery

This study investigates the impact of mitral valve surgery conducted at different times of the day (morning, afternoon, and evening) on short-term and long-term clinical outcomes. Across 947 patients from January 2018 to December 2020, divided into morning, afternoon, and evening groups based on surgery start time, results showed no significant differences in long-term mortality, stroke risk, reoperation rates, or in-hospital outcomes such as cardiopulmonary bypass time and ICU length of stay. The study concludes that mitral valve surgery is safe regardless of the time of day it is performed.

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March 8, 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
AKI Pressure

Higher Perfusion Pressure and Pump Flow During Cardiopulmonary Bypass Are Beneficial for Kidney Function-A Single-Centre Prospective Study

This study investigates the impact of higher mean arterial pressure (MAP) and pump flow during cardiopulmonary bypass (CPB) on kidney function. One hundred nine patients were divided into groups with standard and increased CPB pump flow to maintain MAP > 90 mmHg. Results showed that a higher MAP did not affect the incidence of acute kidney injury but improved intraoperative and postoperative diuresis and reduced renin release. Additionally, higher MAP did not increase cerebrovascular complications and may reduce postoperative delirium incidence, suggesting that maintaining MAP > 90 mmHg during CPB is beneficial for kidney function and potentially for the central nervous system.

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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
Blood Pressure

Blood Pressure Fragmentation as a New Measure of Blood Pressure Variability: Association with Predictors of Cardiac Surgery Outcomes

This study introduces a novel measure for assessing beat-to-beat blood pressure variability (BPV) called blood pressure fragmentation (BPF). It examines the association of increased preoperative BPF with older age, higher cardiac surgical risk, and longer ICU stay after cardiac surgery. A sample of 497 patients undergoing cardiac surgery was analyzed, showing that higher systolic BPF is linked to older age, increased surgical risk scores, and extended ICU stays. The study suggests BPF as a potential tool for preoperative health status and risk stratification, encouraging further research into its utility.

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February 29, 2024
TAVR Valve

Right Anterior versus Right Transaxillary Access for Minimally Invasive Aortic Valve Replacement: A Propensity Matched Competitive Analysis

This study compares the procedural and clinical outcomes of two minimally invasive techniques for aortic valve replacement: right anterior thoracotomy (RAT-AVR) and transaxillary access (MICLATS-AVR). With a cohort of 918 patients, after propensity score matching, both methods showed comparable major adverse cardio-cerebral events, cardiopulmonary bypass, and aortic cross-clamp times. However, MICLATS-AVR patients had a significantly shorter hospital stay and lower rates of postoperative wound issues, suggesting MICLATS-AVR as a safe, efficient, and feasible alternative for aortic valve replacement.

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February 28, 2024
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