Perfusion-Uk最新文献

IntroductionAscending aortic pseudoaneurysm is a rare postoperative complication of cardiac surgery, often linked to infection and dehiscence at sites of aortotomy, cannulation, cross-clamp sites, and proximal coronary anastomoses.Case ReportWe present a case of an ascending aortic pseudoaneurysm in 48-year-old woman who underwent atrial septal defect repair at 8 years old. Based on pre-operative imaging and intra-operative findings, the pseudoaneurysm developed from previous cardioplegia cannula site. She underwent emergency surgery where the pseudoaneurysm was resected and repaired with a Gelweave patch. The patient recovered well with no post-operative chest pain or dyspnoea at 5-months follow-up.ConclusionCardioplegia cannula remains a rare but significant iatrogenic cause of aortic pseudoaneurysm. Prevention of pseudoaneurysm formation can be achieved by inserting the cardioplegia cannula tip through full-thickness purse-strings and/or addition of separate oversewing sutures after decannulation during the primary operation.

IntroductionVacuum-assisted venous drainage (VAVD) has been proposed as a better alternative option than conventional gravitational venous drainage (GVD) in cardiac surgery. However, the literature reports conflicting results between both methods in terms of post-cardiac surgery complications. Therefore, we aimed to perform a meta-analysis to compare clinical outcomes between VAVD and GVD in patients undergoing cardiac surgery.MethodsPubMed, Scopus, and Web of Science databases were searched for any randomized control trials or cohort studies that compared clinical outcomes between VAVD and GVD in patients undergoing cardiac surgery.ResultsSixteen studies with 8426 patients were included in our study. The pooled effect estimate of the postoperative results showed a statistically significant association between VAVD and decreased blood loss/chest tube drainage (MD = -88.7, 95% CI = -154.71 to -22.69, p-value = 0.008), amount of packed red blood cells (pRBC) transfusion (MD = -0.25, 95% CI = -0.27 to -0.22, p < 0.00,001), re-exploration (RR = 0.6, 95% CI = 0.35 to 1, p = 0.05), and re-operation (RR = 0.47, 95% CI = 0.23 to 0.99, p-value = 0.05). However, our study revealed no significant difference between both groups in terms of postoperative mortality, hospital/ICU stay, other blood product transfusions, change of free hemoglobin at 24 h, and other clinical outcomes.ConclusionOur study revealed that VAVD is at least equivalent and may provide some benefits compared to GVD in patients undergoing cardiac surgery. While, VAVD requires specific expertise and training in order to optimize its outcomes, its ability to reduce blood loss and blood transfusion, support its use as a valuable alternative for GVD in high-risk groups.

BackgroundElevated central venous pressure during cardiac surgery can lead to increased renal venous pressure, subsequently resulting in renal insufficiency. However, there is a lack of animal models available for studying this phenomenon. Therefore, we have successfully established a rat model of renal vascular congestion under cardiopulmonary bypass (CPB), providing a solid foundation for further investigations into the potential mechanisms underlying acute kidney injury (AKI) caused by renal hyperemia.Materials and methodsLigation of the inferior vena cava between the renal veins of male SD rats resulted in hyperemia only in the left kidney. The left and right kidney control was formed under CPB and the left renal vein pressure was monitored. Six hours after operation, two kidneys were analyzed by molecular and histological techniques. The degree of tubulointerstitial injury, inflammatory infiltration, expression of inflammatory factors and molecular damage substances were evaluated in kidneys with and without venous stasis.ResultHistological examination showed that the left kidney, which received the intervention, exhibited congested renal tubules formed protein tubules and dilated. In addition, there were inflammatory cell infiltration in the interstitium and edema and necrosis in the local renal tubules. The right kidney, which did not receive the intervention, also showed similar changes, but the damage is mild. Immunohistochemistry showed that the expression of IL-6, IL-10 and KIM-1 in the left kidney was higher than that in the right kidney. Moreover, western blotting showed that the expression of KIM-1 and TNF-αin the left kidney was higher than that in the right kidney.ConclusionRenal vein congestion not only exacerbated structural damage to the kidneys in rats but also intensified the inflammatory response during CPB.

BackgroundPeripheral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) cannulation in children poses a significant clinical challenge due to wide variations in body size, vessel caliber, and risk profiles.PurposeThis literature review examines current cannulation practices in pediatric patients.Research design Study sample & Data collectionThe study analyzed large datasets from the Extracorporeal Life Support Organization (ELSO) registry, focusing on neurologic and limb complications associated with carotid versus femoral artery use.ResultsDespite general recommendations favoring carotid cannulation in children under 15-20 kg and femoral access in larger, ambulatory patients, ELSO data show a persistent reliance on carotid cannulation even in older children. In four major ELSO studies, carotid use ranged from 45% to 94% among children over 5 years of age. Neurologic complication rates varied widely, from 7% to 23%, with some studies linking carotid access to higher risk of CNS injury, while others found no significant difference. Femoral cannulation, although theoretically safer neurologically, carried notable risks of limb ischemia-reported between 7.5% and 20%-and potential need for vascular interventions or amputations.ConclusionsThis review highlights the lack of standardized practice and the influence of local expertise, anatomical variability, and data limitations. It also underscores the need for clearer definitions and better reporting in future studies. While carotid cannulation remains prevalent across age groups, growing evidence of limb complications with femoral access invites reconsideration of the "transition point" in pediatric ECMO cannulation strategies. Until more definitive data emerge, individualized decision-making guided by patient characteristics and institutional experience remains essential.

IntroductionAtrial fibrillation (AF) is the most common arrhythmia worldwide, yet long-term outcomes in conflict-affected regions are poorly understood. Gender-based disparities in AF outcomes have been reported in high-income countries but remain unexplored in fragile healthcare systems.MethodsWe conducted a retrospective cohort study at Latakia's University Hospital in Latakia, Syria between June/2021-November/2023. Adult patients admitted with primary AF were followed for 1 year to assess unplanned readmissions. Data on unplanned readmissions were defined as non-elective hospitalisations occurring within 1 year after index discharge. These were unscheduled admissions, usually prompted by recurrence of symptoms, acute decompensation, or cardiovascular events. Data were collected from medical records.ResultsOf the included 657 patients (52% male, median age 60 years), 422 (64%) had at least one unplanned readmission within 1 year. Cardiac causes accounted for 67% of readmissions, with recurrent AF responsible for 75% of those. Females had higher all-cause (73% vs 56%) and cardiovascular (53% vs 34%) readmission rates than males (both p < 0.001). On multivariable analysis, independent predictors of readmission included female sex (HR 1.7, 95% CI 1.4-2.0), age ≥60 (HR 3.7, 95% CI 2.9-4.6), diabetes mellites (DM) (HR 1.5, 95% CI 1.2-1.8), and congestive heart failure (CCF) (HR 3.3, 95% CI 2.6-4.6). Females were more likely to have two (44%) or three or more (44%) readmissions than males.ConclusionsOne-year readmissions after AF admission were high, particularly among females. Female gender was an independent risk factor, highlighting the need for gender-sensitive follow-up strategies in resource-limited settings.

BackgroundThe impact of the duration of invasive mechanical ventilation (IMV) before venovenous extracorporeal membrane oxygenation (VV ECMO) on patient outcomes in COVID-19 remains unclear.Methods and settingData from the COVID-19 Critical were used to investigate whether the duration of IMV prior to VV ECMO initiation was associated with ICU mortality between January 1st 2020 and December 31st, 2022. Multivariable Cox regression models were used to evaluate the role of the duration of IMV before ECMO on patient outcomes after adjusting for calendar date and key patient covariates.Results919 adult patients with median age 50 and severe COVID-19 infection requiring IMV and VV ECMO were included in the analysis. The ICU mortality for ECMO performed on the same day as IMV was 43%, compared to 47% when ECMO was initiated between 1 and 7 days and 54% when ECMO was initiated at 8+ days. The 8+ day group of IMV received more prone positioning (71%), neuromuscular blockade (80%), and vasopressor support (74%). The multivariable analysis showed the mortality risk increased when ECMO was initiated within the first 7 days from commencement of IMV (Hazard ratio, HR: 1.37; 95% CI: 1.08 to 1.73) or later (HR: 1.51; 1.02 to 2.22), compared with same-day initiation.ConclusionAnalysis indicated a positive association between time on IMV before VV ECMO initiation and ICU mortality, but effects sizes exhibited high uncertainty after adjusting for other patient characteristics. Further studies are needed to confirm our findings.

BackgroundMediastinal masses in children secondary to malignancy can cause significant airway and great vessel compression, leading to respiratory and cardiovascular compromise. Extracorporeal membrane oxygenation (ECMO) has been described as a bridge to diagnosis and treatment for masses causing cardiopulmonary instability.ObjectivesTo evaluate outcomes of pediatric oncologic patients requiring ECMO for mediastinal masses.MethodsWe conducted a sub-analysis of a previously published multicenter cohort study examining ECMO outcomes in pediatric hematologic and oncologic patients from 2009 to 2021. Patients less than 19 whose disease presented as a mediastinal mass were included. Presenting features, ECMO characteristics, and outcomes were analyzed.ResultsEleven patients with mediastinal masses were identified, 7 with solid tumors and 4 with hematologic malignancies. The indications for ECMO were combined cardiac and respiratory failure in 64%, respiratory failure in 27%, and cardiac failure in 9%. ECMO survival was 72% (8/11), and survival to hospital discharge was 45% (5/11). Upon separation into solid tumor and hematologic malignancy groups, the ECMO survival was 71% (5/7) and 75% (3/4), and survival to hospital discharge was 29% (2/7) and 75% (3/4), respectively. Patients with solid tumors had longer intensive care unit (ICU) lengths of stay (LOS) and hospital LOS.ConclusionsOur study supports ECMO cannulation for patients with mediastinal masses secondary to hematologic malignancies that require advanced cardiopulmonary support. However, due to poorer outcomes in solid tumors, ECMO candidacy should be carefully considered in this population.

BackgroundThe effect of the anticoagulant, dabigatran, and its antagonist, idarucizumab, on coagulation remains poorly quantified. There are few pharmacokinetic-pharmacodynamic data available to describe the interaction in humans or animals undergoing cardiopulmonary bypass.MethodsSix sheep were given intravenous dabigatran infusion while undergoing cardiopulmonary bypass. Blood samples were collected for thromboelastographic reaction time (R-time) and drug assay at 1. 5, 15, 30, 60, 90, and 120 min after starting dabigatran. Further reaction times were measured at 1 min, 5 min, 15 min, 60 min, 4 h and 24 h after initiation of idarucizumab infusion. Plasma dabigatran concentrations, the dabigatran- idarucizumab interaction and R-times were analyzed using an integrated pharmacokinetic-pharmacodynamic model with non-linear mixed effects.ResultsA 2-compartment model described dabigatran pharmacokinetics with a clearance (CL 0.0509 L/min/70 kg), intercompartment clearance (Q 0.229 L/min/70 kg), central volume of distribution (V1 3.89 L/70 kg), peripheral volume of distribution (V2 11.4 L/70 kg). The peripheral volume was 2.25 times larger during bypass. The effect compartment model estimates for an E_MAX model using reaction time had an effect site concentration (Ce₅₀ 40.8 mg/L) eliciting half of the maximal effect (E_MAX 180 min). A potency factor for the antagonist, idarucizumab (EA₅₀ 29.9 mg/L), moved the dabigatran response relationship to the left.ConclusionsDabigatran reversibly binds to the active site on the thrombin molecule, preventing activation of coagulation factors. Expansion of peripheral volume of distribution of dabigatran was observed during cardiopulmonary bypass, contributing to observed concentrations lower than predicted. A competitive interaction model adequately described dabigatran reversal by idarucizumab. These data and consequent parameter estimates inform future clinical studies in both animals and humans.

We report a case of successful treatment for a severe acute pulmonary hypertension crisis in a patient with Eisenmenger syndrome (ES) associated with patent ductus arteriosus following trauma-related spine surgery, utilizing both veno-arterial (V-A) and veno-venous (V-V) ECMO. The patient's clinical course was complicated by right ventricular failure amid a pulmonary hypertensive crisis, necessitating V-A ECMO support. Persistent hypoxia, despite improved right heart function, warranted transition to V-V ECMO. This case demonstrates that peripheral V-A ECMO can be safely employed to decompress the right heart in the presence of a significant PDA shunt. Furthermore, weaning from ECMO in these patients requires a much higher hematocrit in order to compensate for the chronic hypoxia.