International Perfusion Association

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Category: CPB

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
Keytone Blood

Levels of Circulating Ketone Bodies in Patients Undergoing Cardiac Surgery on Cardiopulmonary Bypass

This study explores the dynamics of circulating ketone bodies (KBs) in 192 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), examining pre- and post-operative blood samples. It finds that median levels of KBs significantly decrease perioperatively, inversely correlating with Troponin T levels, which indicate myocardial cell injury. The research underscores the distinct perioperative changes in KBs compared to Troponin T and suggests that patient characteristics might influence these biomarkers differently. The inverse relationship between KBs and myocardial injury opens avenues for further investigation into the metabolic impacts of cardiac surgery.

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February 26, 2024
Heparin

Contributing Factors to Heparin Resistance During Cardiopulmonary Bypass

This study delves into heparin resistance (HR) during cardiopulmonary bypass (CPB) surgeries, analyzing 371 patients to identify contributing factors. HR, defined as the inability to achieve an activated clotting time of >480 seconds with an initial unfractionated heparin dose, was observed in 9.7% of cases. Key findings include the significant association of preoperative use of unfractionated heparin, certain blood parameters (e.g., white blood cell counts, fibrinogen levels), and notably, albumin and fibrinogen as independent predictors for HR. The research highlights the need for precise preoperative assessments to mitigate HR risks in CPB.

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February 20, 2024
Heparin

Comparison of Blood Concentration and Weight-Based Heparin and Protamine Dosing Strategies for Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis

This article reviews randomized controlled trials and prospective studies comparing individualized heparin and protamine dosing based on real-time blood heparin concentration versus traditional total body weight methods during cardiopulmonary bypass (CPB). Meta-analysis shows that individualized dosing significantly reduces postoperative blood loss, improves protamine-to-heparin ratios, and increases early postoperative platelet counts. These findings suggest that precision in heparin and protamine dosing could decrease bleeding and transfusion needs, highlighting the potential of machine learning for future advancements in anticoagulation management for CPB.

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February 17, 2024
Doppler

Clinical Relevance of Transcranial Doppler in a Cardiac Surgery Setting: Embolic Load Predicts Difficult Separation from Cardiopulmonary Bypass

This study explores the use of transcranial Doppler (TCD) for detecting cerebral microemboli during cardiac surgery and its correlation with difficulties in separating from cardiopulmonary bypass (CPB) and postoperative complications. Analyzing 354 patients, it found that a higher quantity of cerebral embolic material significantly increases the odds of challenging CPB separation. The presence of microemboli was also linked to more complex surgeries, extended CPB durations, prolonged organ dysfunction, longer ICU stays, and increased mortality rates, particularly in the high embolic material (HEM) group.

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February 15, 2024
Surgery Prime

Effects of Albumin and Crystalloid Priming Strategies on Red Blood Cell Transfusions in On-pump Cardiac Surgery: A Network Meta-analysis

This network meta-analysis evaluates the impact of albumin and crystalloid priming strategies on red blood cell transfusion requirements in on-pump cardiac surgery. The study reviewed 830 studies and included 10 in the final analysis. The findings suggest that crystalloid priming may significantly decrease total perioperative red blood cell transfusions compared to albumin. However, the difference in postoperative transfusions was not statistically significant. Both direct comparisons and network meta-analysis indicate that albumin priming results in higher transfusion rates, suggesting a reconsideration of its use in cardiac surgery for optimal blood management.

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February 8, 2024
Lactic Acidosis

Association Between Lactic Acidosis and Multiple Organ Dysfunction Syndrome After Cardiopulmonary Bypass

The study investigates the link between lactic acidosis and multiple organ dysfunction syndrome (MODS) post-cardiopulmonary bypass (CPB). A post hoc analysis on cardiac surgery patients shows a correlation between lactic acidosis and higher incidences of MODS, with lactic acidosis patients experiencing the worst outcomes. The research suggests the need for intensive monitoring of lactic acidosis post-CPB to mitigate risks and improve patient care.

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February 6, 2024
Pump Head

Target Flow Deviations on the Cardiopulmonary Bypass Cause Postoperative Delirium in Cardiothoracic Surgery – A Retrospective Study Evaluating Temporal Fluctuations of Perfusion Data

This study investigates the role of cardiopulmonary bypass (CPB) in postoperative delirium following cardiac surgery, employing algorithm-based data analysis on patient records from 2014 to 2019. It identifies not only demographic and comorbidity predictors but also highlights the significance of CPB parameters in delirium risk. Specifically, total blood volume and minimal blood flow rates during CPB were linked to delirium outcomes. The findings suggest that meticulous management of CPB parameters, especially flow rates and acid-base balance, could mitigate the risk of postoperative delirium, emphasizing the potential of precise CPB data processing in improving post-surgical care.

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February 5, 2024
CPU RBC

Development and Validation of a Machine Learning Method to Predict Intraoperative Red Blood Cell Transfusions in Cardiothoracic Surgery

A novel machine learning (ML) method has been developed to predict red blood cell (RBC) transfusion requirements in cardiothoracic surgery, enhancing blood inventory management and preoperative hemorrhage risk assessment. Utilizing data from 2410 surgeries between May 2014 and June 2019, with an additional 437 cases for validation, this method employs a hybrid approach combining Gaussian Process regression and classification algorithms. The model accurately predicts both minor (0 to 3 units) and significant (4+ units) RBC transfusions, showing promise for integrating ML into surgical planning and patient care optimization.

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February 4, 2024
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