Is Ultrafiltration Volume a Predictor of Postoperative Acute Kidney Injury in Patients Undergoing Cardiopulmonary Bypass?

April 9, 2024 No Comments

This study investigates the relationship between intraoperative ultrafiltration (UF) volume during cardiopulmonary bypass (CPB) and the incidence of acute kidney injury (AKI) post-coronary artery bypass graft (CABG) surgery. Analyzing data from 641 patients, it found that higher UF volumes are significantly associated with an increased risk of AKI. Other identified predictors of AKI include patient age, the lowest mean arterial pressure during surgery, and red blood cell transfusions. These results underscore the importance of careful UF management during CPB to mitigate the risk of postoperative AKI.

Preliminary Report of Extracorporeal Blood Purification Therapy in Patients Receiving LVAD: Cytosorb or Jafron HA330

April 4, 2024 No Comments

This study investigates the effects of extracorporeal blood purification therapy using Cytosorb and Jafron HA330 in patients undergoing Left Ventricular Assist Device (LVAD) implantation, aimed at mitigating immune dysregulation and infectious complications by reducing proinflammatory cytokine levels. Data from 15 patients receiving HeartMate 3™ LVADs were analyzed, with groups assigned to Cytosorb therapy, Jafron HA330, or control (usual care without filters). Results indicated that despite LVAD implantation increasing levels of various inflammatory markers, neither Cytosorb nor Jafron therapies had a significant impact on these markers, in-hospital mortality, or overall survival. The study suggests the need for larger, prospective studies to explore the potential benefits of hemoadsorption therapies in improving outcomes for LVAD patients.

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

March 30, 2024 No Comments

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.

A Comparison of the Clinical Outcomes of Minimum and Maximum Hematocrit Levels During Cardiopulmonary Bypass (CPB) in Low-risk Patients Undergoing Coronary Artery Bypass Graft Surgery (CABG): A Cross-sectional Study

March 27, 2024 No Comments

This cross-sectional study explores the clinical outcomes of minimum and maximum hematocrit (HCT) levels during cardiopulmonary bypass (CPB) in low-risk coronary artery bypass graft (CABG) surgery patients. It found that lower HCT levels (16-18%) resulted in significantly less post-surgery drainage and lower incidence of cognitive disorders compared to higher HCT levels (25-27%), which required more transfusions of packed red blood cells and fresh frozen plasma, leading to an increased risk of cognitive impairments.

Plasma Hyperosmolality as a Risk Factor for Postoperative Acute Kidney Injury in Cardiopulmonary Bypass Patients

March 25, 2024 No Comments

This double-blind, randomized controlled trial from a tertiary teaching hospital in Sweden aimed to evaluate the impact of hyperosmolar priming solutions on cardiac surgery-associated acute kidney injury (CSA-AKI). Including patients aged ≥65 years undergoing routine cardiac surgery with cardiopulmonary bypass, the study compared the effects of a Ringer’s acetate based solution with Mannitol and sodium concentrate to a control group. Results indicated that while the hyperosmolar prime solution itself did not increase postoperative CSA-AKI incidence, high plasma osmolality was identified as an independent risk factor, increasing CSA-AKI risk by 30%. The findings underscore the need for further investigation into plasma hyperosmolality’s role in CSA-AKI risk.

Cerebral Perfusion and Metabolism with Mild Hypercapnia vs. Normocapnia in Porcine Models Post Cardiac Arrest: Impacts of Targeted Temperature Management

March 22, 2024 No Comments

This study evaluates the effects of mild hypercapnia compared to normocapnia on cerebral blood flow and metabolism in porcine models post-cardiac arrest, with and without targeted temperature management (TTM33). It involved resuscitating 39 pigs after 10 minutes of cardiac arrest and randomizing them to different conditions. Results indicate that hypercapnia increases cerebral flow in all groups, but raises intracranial pressure and lowers cerebral perfusion pressure in non-TTM animals. Hypercapnia with TTM33 showed reduced cerebral lactate, pyruvate, glycerol, and lactate/pyruvate ratios, highlighting the varying impacts of hypercapnia with TTM.

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)

March 20, 2024 No Comments

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.

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

March 20, 2024 No Comments

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.

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

March 17, 2024 No Comments

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.

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

March 11, 2024 No Comments

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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Is Ultrafiltration Volume a Predictor of Postoperative Acute Kidney Injury in Patients Undergoing Cardiopulmonary Bypass?

Preliminary Report of Extracorporeal Blood Purification Therapy in Patients Receiving LVAD: Cytosorb or Jafron HA330

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

A Comparison of the Clinical Outcomes of Minimum and Maximum Hematocrit Levels During Cardiopulmonary Bypass (CPB) in Low-risk Patients Undergoing Coronary Artery Bypass Graft Surgery (CABG): A Cross-sectional Study

Plasma Hyperosmolality as a Risk Factor for Postoperative Acute Kidney Injury in Cardiopulmonary Bypass Patients

Cerebral Perfusion and Metabolism with Mild Hypercapnia vs. Normocapnia in Porcine Models Post Cardiac Arrest: Impacts of Targeted Temperature Management

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)

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 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

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

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