International Perfusion Association

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Category: Transplantation

Clinical Outcomes of Cardiac Transplantation in Heart Failure Patients with Previous Mechanical Cardiocirculatory Support

Clinical Outcomes of Cardiac Transplantation in Heart Failure Patients with Previous Mechanical Cardiocirculatory Support

This study evaluates the long-term outcomes of heart failure patients undergoing cardiac transplantation with prior left ventricular assist device (LVAD) use as a bridge-to-transplant (BTT) compared to direct-to-transplant (DTT). The findings indicate similar survival rates at 1 and 7 years post-transplant in both groups. Although LVADs increase surgical complexity and incidence of cerebrovascular events, they do not negatively affect overall outcomes, supporting their viability in advanced heart failure care.

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January 18, 2025
Lung ECMO

Enhancing Lung Transplantation with ECMO: A Comprehensive Review of Mechanisms, Outcomes, and Future Considerations

Lung transplantation (LTx) is a transformative solution for patients with end-stage lung disease, but it comes with significant challenges, including limited donor availability and severe post-operative complications. This review focuses on the role of Extracorporeal Membrane Oxygenation (ECMO) in overcoming these hurdles and improving patient outcomes across all phases of the transplant process.

ECMO, initially developed for cardiac surgery, has become an essential tool in lung transplantation, particularly for its ability to provide cardiopulmonary support. Its applications span the preoperative, intraoperative, and postoperative stages, making it integral to modern LTx practices.

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December 22, 2024
Monitoring Oxygen Delivery

The Potential Benefits of Monitoring Oxygen Delivery in Relation to O2ERi and VCO2 During Normothermic Regional Perfusion in DCD Donors

This article discusses the significance of monitoring indexed oxygen delivery (DO2i), oxygen extraction ratio (O2ERi), and carbon dioxide production (VCO2) during normothermic regional perfusion (NRP) in Donation after Circulatory Death (DCD) donors. These metrics ensure optimal oxygenation, reduce ischemic injuries, and prevent organ dysfunction. Personalized perfusion strategies, informed by these parameters, improve organ viability and transplantation outcomes while lowering post-transplant complications like acute kidney injury.

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December 21, 2024
Lungs Feature

The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation Among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

This systematic review analyzes prolonged mechanical ventilation (PMV) post-cardiac surgery, finding an incidence rate of 20%. PMV, defined as ventilation lasting ≥24 hours, is linked to in-hospital mortality (odds ratio: 14.13). Key risk factors include advanced age, female sex, ejection fraction <50%, and body mass index >28 kg/m². PMV also correlates with conditions like chronic renal failure and prolonged cardiopulmonary bypass time. These insights highlight the need for targeted prevention and management strategies.

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December 20, 2024
ECMO Lung

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

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.

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December 20, 2024
Hypertrophic Cardiomyopathy

Anesthetic Precision in Severe Hypertrophic Cardiomyopathy: Navigating Perioperative Challenges

This case report details the anesthetic management of a 77-year-old female with hypertrophic obstructive cardiomyopathy (HOCM), undergoing surgery for ileal adenocarcinoma. It highlights challenges such as preventing left ventricular outflow tract obstruction and maintaining hemodynamic stability. A tailored approach, including vigilant monitoring, goal-directed fluid therapy, and careful use of vasopressors, ensured successful outcomes. The report underscores the importance of meticulous perioperative planning in HOCM cases.

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December 10, 2024
Liver Bypass

Venovenous Bypass in Liver Transplantation: Exploring the Benefits, Efficacy, and Safety

This article explores the utilization of venovenous bypass (VVB) in liver transplantation (LT), highlighting its benefits, efficacy, and safety. Although VVB helps maintain hemodynamic stability and improve patient outcomes, its global use has declined due to concerns about heparinization, major bleeding, and the need for specialized expertise. Recent advancements in percutaneous cannulation techniques and extracorporeal technology have enhanced the safety of VVB. Studies show that VVB reduces the incidence of acute kidney injury, operative time, and blood loss without increasing morbidity or mortality. Despite these benefits, alternative techniques are being increasingly adopted. The article emphasizes the role of VVB in complex clinical scenarios and calls for continued research to optimize its application in liver transplantation.

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June 19, 2024
N Regional Lung

Lung Transplantation in Controlled Donation After Circulatory-Determination-of-Death Using Normothermic Abdominal Perfusion

The shortage of suitable lung donors remains a significant challenge in lung transplantation. While brain-death donors (DBD) currently provide most lung allografts, only 20% are suitable for transplantation. This review discusses the potential of using donors after circulatory-determination-of-death (DCD) to increase the donor pool. Emphasizing controlled DCD (cDCD) donors, the article outlines the importance of ICU management and expertise in organ procurement, presenting a protocol for lung retrieval using normothermic abdominal perfusion.

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June 1, 2024
LVAD

Escalating Surgical Treatment for Left Ventricular Assist Device Infection and Expected Mortality: Clinical Risk Prediction Score

This study evaluates the mortality risk associated with infections in patients with left ventricular assist devices (LVAD). It highlights the development of a clinical risk prediction score based on factors like diabetes, type of Staphylococcus aureus infection, and treatment approaches including surgical debridement and flap reconstruction. Results indicate varying survival rates based on risk scores, suggesting that tailored surgical interventions may improve outcomes for patients with LVAD infections.

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April 23, 2024
Cardiac Rehab

Comprehensive Cardiac Rehabilitation Following Acute Myocardial Infarction Improves Clinical Outcomes Regardless of Exercise Capacity

This study evaluates the impact of comprehensive cardiac rehabilitation (CR) on patients with acute myocardial infarction (AMI) and varying exercise capacities. Involving 610 patients who underwent percutaneous coronary intervention, it found that those participating in CR showed a significantly lower incidence of major adverse cardiovascular events (MACE) over an average of 6.1 years compared to non-participants. This benefit was consistent across patients with both reduced and preserved exercise capacities, highlighting CR’s essential role in AMI recovery.

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April 22, 2024
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