Perfusion-Uk最新文献

Myocardial protection during cardiac surgery is crucial for preventing ischemia-reperfusion injury and preserving myocardial function. Cardioplegia, a solution used to induce electromechanical cardiac arrest, is the fundamental method for myocardial protection during on-pump procedures. Del Nido cardioplegia, developed in the 1990s, has gained increasing popularity in adult cardiac surgeries over the past two decades. Del Nido cardioplegia is a crystalloid-based solution used to achieve depolarized arrest. Its mechanism of action also involves preventing intracellular calcium overload, a key driver of reperfusion injury. Numerous studies have evaluated the safety and efficacy of del Nido cardioplegia in adult cardiac surgeries, including coronary artery bypass grafting and valve procedures. Compared to standard blood cardioplegia, del Nido cardioplegia has demonstrated reduced hemodilution, transfusion requirements and shorter cardiopulmonary bypass times due to its extended arrest duration. Many studies have reported lower levels of myocardial injury biomarkers and improved myocardial functional recovery with del Nido cardioplegia. It has also been associated with reduced defibrillation requirements, which is attributable to the antiarrhythmic effects of lidocaine. While some studies have reported no significant differences in outcomes between del Nido cardioplegia and blood cardioplegia, others have favored del Nido cardioplegia in terms of myocardial protection, postoperative cardiac function, and perioperative morbidity. The choice between cardioplegia solutions remains subjective and dependent on surgeon preference and institutional practices. However, del Nido cardioplegia has emerged as an acceptable alternative to traditional cardioplegia, offering potential advantages in adult cardiac surgeries.

ObjectiveThis study aims to evaluate the operational feasibility of a self-designed minimally invasive extracorporeal circulation integrated circuit (miECC) type IV system and to assess the effectiveness of the venous gas filter and automatic exhaust mechanism.MethodsA blood recycler was utilized in place of a heart to connect the arteriovenous line, venous gas filter, centrifugal pump head, and integrated membrane-lung connection, thereby establishing a loop circulation model for the miECC IV system. The venous gas filter was linked to a negative pressure suction device positioned at its top. During operation, gas was introduced from the venous end to determine the maximum gas storage capacity of the venous gas filter, the gas removal efficiency of the negative pressure suction device, the conversion capabilities between open and closed operations, and the adequacy of the pipeline design.ResultsThe minimally invasive extracorporeal circulation integrated pipeline demonstrated stable operational performance and successfully facilitated the transition between closed and open states. The venous gas filter exhibited a gas storage capacity of less than 80 mL across various flow rates. Experimental results indicated that at flow rates of 3.0-4.5 L/min, the automatic venting device effectively removed gas when the volume did not exceed 80 mL. At flow rates of 5.0-5.5 L/min, the device also successfully vented gas under the same conditions.ConclusionThe self-designed minimally invasive extracorporeal circulation integrated pipeline operates effectively and can transition between closed and open configurations. The gas filter effectively prevents venous gas accumulation. At the same time, the enhanced automatic gas-exhausting device, utilizing negative pressure, efficiently removes gas from the venous filter, thereby improving the safety of the closed-circulation operation.

BackgroundThe association between sex and cardiovascular risk and different responses to heart failure therapies is well established. However, sex related outcomes of different types of short-term mechanical circulatory support (MCS) therapy remains controversial.MethodsWe performed a systematic review and meta-analysis of studies comparing outcomes of MCS between sexes. We restricted inclusion to propensity score matched studies to minimize the risk of confounding. We pooled binary and continuous outcomes with odds ratio (OR) and mean differences (MD), respectively, under a random effects model.ResultsWe pooled 6 propensity score matched studies evaluating sex related outcomes during short-term MCS, with 18,720 patients, of whom 9442 (50.5%) were male and 9278 (49.5%) were female. Subgroup analysis showed higher 30-day mortality during ECMO (OR 1.11; 95% CI 1.01-1.22; p = .038; I² = 0%) in males, but lower 30-day mortality during Impella® therapy than females (OR 0.87; 95% CI 0.80-0.94; p = .001; I² = 0%). Males had a higher need of myocardial revascularization (OR 3.09; 95% CI 1.56-5.99; p = .001; I² = 0%), but a higher risk of acute kidney injury (OR 1.20; 95% CI 1.09-1.31; p < .001; I² = 18%).ConclusionIn-hospital and 30-day mortality were similar between females and males.

IntroductionBlood transfusion is associated with adverse events and should be prevented. Preoperative identification of patients at risk is necessary and makes subsequent preventive intervention possible. Many risk models have been developed of which the Transfusion Risk and Clinical Knowledge (TRACK) model includes criteria reflecting daily practice. The aim of this study is to validate and update the TRACK model in a low-transfusion-rate adult cardiac-surgery population.MethodsExternal validation of the TRACK model was performed using a database of 4072 adult patients receiving cardiac surgery between 2015 and 2022 (original TRACK model). Subsequently, the original TRACK model coefficients were updated by cross-validation (uTRACK model). Preoperative antiplatelet therapy was added as an extra variable to the updated TRACK model (uTRACK + APT model).ResultsIn our population, 26% of patients received red blood cell transfusions. The original TRACK model demonstrated good discrimination (AUC-ROC of 0.76; 95% CI 0.74 - 0.78) but inadequate calibration (p < .001). Updating TRACK coefficients resulted in improved discrimination (AUC-ROC of 0.78; 95% CI 0.75 - 0.81), calibration (p = .19), and reclassification (Categorical NRI: 0.21; 95% CI [0.17 - 0.24]; p < .001). Adding preoperative antiplatelet therapy did not significantly improve net reclassification improvement (Categorical NRI: 0.01; 95% CI -0.001 - 0.029; p = .40).ConclusionThe original TRACK model overestimates blood transfusion risk in a low-transfusion-rate population. Risk classification significantly improved by updating the original TRACK coefficients. Using the uTRACK model provides more accurate identification of patients at risk of receiving red blood cell transfusions in a low transfusion rate population.Trial RegistryClinicalTrials.gov (https://clinicaltrials.gov), registration number: NCT05581238.

BackgroundThe del Nido cardioplegia (DNC) solution has been widely used for myocardial protection in adult cardiac surgery, however, its use remains unclear in cases with long aortic cross-clamp time. Therefore, this study examined postoperative myocardial injury and the use of intraoperative DNC data of patients with cross-clamp time greater than 100 min in the past 4 years to explore a safe and effective infusion strategy for DNC.MethodsData were collected from 129 patients who underwent cardiac surgery between January 2020 and July 2024 using DNC with aortic occlusion time greater than 100 min. This single-center cross-sectional cohort study aimed to review relationship between the postoperative myocardial injury (myocardial markers) and the use of intraoperative DNC data during extracardiac surgery. Potential confounders included patient demographics (age, sex, weight, height), high-risk factors, preoperative cardiac function and surgical factors. Statistical methods were used to analyze the data using SPSS 27.0.ResultsOn average, the patients underwent cardiopulmonary bypass with duration of 193.43 min. Aortic cross-clamp time was 126.19 min, and 2.22 cardioplegia infusions were administered. Most patients (82.9%) received initial infusion and one re-dose, while 17.1% required two or more re-dose. Postoperative myocardial markers were not correlated with patient demographics but were significantly correlated with cardiopulmonary bypass and aortic cross-clamp time. Particularly, time after the second infusion was the best predictor, with a cutoff of 69.5 min by Receiver Operating Characteristic curve. Patients with longer time after the second infusion had higher myocardial markers and required most postoperative vasoactive support.ConclusionsIn adult cardiac surgery with long aortic cross-clamp time, it is recommended to administer a second infusion within 90 min, and avoid exceeding 70 min to give the third infusion. Multiple infusions do not have a significant effect on postoperative myocardial injury.

IntroductionHeparin induced thrombocytopenia (HIT) with in paediatric population is rare and subsequent anticoagulation management is challenging. Bivalirudin is a viable alternative to heparin for anticoagulating paediatric patients with HIT, though clinical data are limited. We describe the successful management of anticoagulation with bivalirudin from diagnosis through Extracorporeal Membrane Oxygenation (ECMO), Ventricular Assist Device (VAD) implantation, and heart transplantation in a child with dilated cardiomyopathy and HIT.MethodsA 14-year-old girl presented with acute heart failure, intracardiac thrombi, and adenovirus positivity. Heparin was exchanged for bivalirudin once HIT criteria were met, associated with thrombocytopenia and progressive thrombus formation within the right atrium and superior vena cava (SVC). Due to end-organ dysfunction and refractory cardiac failure veno-arterial ECMO was initiated. Failure to achieve sufficient recovery prompted a VAD implantation, and subsequent orthotopic heart transplantation both managed using a modified bivalirudin protocol.ResultsManaging ECMO in the presence of HIT and intracardiac thrombi required careful multidisciplinary planning. We adjusted the bivalirudin infusion from 0.35 to 1.9 mg/kg/hr to maintain an activated Partial Thromboplastin Time (aPTT) of 60-90 s, following our institutional protocol. For VAD implantation, we used citrate for circuit priming and initiated cardiopulmonary bypass without heparin, administering six bivalirudin boluses and escalating the infusion from 1.62 to 10 mg/kg/hr to achieve an Activated Clotting Time (ACT) > 400 s, with continuous ACT monitoring. During transplantation, anticoagulation involved four boluses and increasing the infusion from 0.35 to 5 mg/kg/hr to maintain an ACT >400 s. Despite significant post-CPB coagulopathy, which required delayed chest closure to control bleeding, no thrombotic events occurred. The bivalirudin protocols allowed safe progression through all three phases.ConclusionBivalirudin strategy provided safe, effective antithrombotic management across ECMO, VAD implantation, and heart transplantation in a paediatric patient with HIT. Monitoring its effectiveness at higher anticoagulation levels remains challenging, and patients may require higher doses to achieve desired endpoints.

ObjectiveTo compare and evaluate, a new viscoelastic point-of-care device, the Quantra QPlus® parameters with conventional hemostasis tests and TEG-5000® parameters.Design, Material and MethodsThis prospective homocentric observational study took place between January and June 2024 at the main community site Hospital, Jolimont's Hospital on adult patients undergoing elective cardiac surgery using cardiopulmonary bypass (CPB). Paired perioperative citrated and EDTA blood samples were collected and sent directly to the laboratory for analysis. The blood was analyzed in one hand with TEG-5000® (K, MA and alpha angle) in cardiac operating room and afterwards, simultaneously with Quantra QPlus® (CTH, FCS, PCS), citrate platelet count with specific fluorescent agent (PLT-F) and standard haemostasis testing (PT/INR, aPTT, Clauss Fibrinogen).ResultsMethod comparison analysis shows that Quantra's Parameters PCS and FCS were well correlated with PLT-F and Fibrinogen while TEG-5000® parameter were less. FCS and Alpha Angle predicted a Clauss Fibrinogen <150 mg/dL with an area under the curve (AUC) respectively of 0.899 (n = 66) and 0.815 (n = 54). PCS and MA predicted a Platelet count <150k/µL with an AUC of 0.793 (n = 62) and 0.807 (n = 54) respectively. CTH and K predicted an aPTT (actin FS on CS-5100) >29,0s with an AUC of 0.864 (n = 60) and 0.702 (n = 60) respectively.ConclusionStrong correlations were observed between quantra parameters FCS and PCS with Clauss Fibrinogen and Platelet count. While Performance from ROC curves for predicted thrombocytopenia <150k platelet/µL is similar with TEG-5000, they are better for predicted fibrinogen concentration and prolonged aPTT.

BackgroundThis study aimed to investigate the incidence of aortic regurgitation (AR) following continuous-flow left ventricular assist device (LVAD) implantation and to identify associated predisposing factors. Research DesignThe study included 144 patients who underwent LVAD implantation between January 2015 and December 2021. The primary endpoint was defined as the assessment of the development of AR greater than mild. The incidence of and time to AR progression during LVAD therapy, and predisposing factors were evaluated in patients who had none/trivial or mild preoperative AR.ResultsAmong the 144 patients included in the study, significant AR developed in 22 patients (15.3%) after a median of 662 days of LVAD support. Multivariate logistic regression analysis revealed that preoperative mild AR (p = 0.002), female sex (p = 0.013), and increased sinus of Valsalva diameter (p = 0.030) were independent predictive factors for AR progression. Persistent aortic valve opening during each cardiac cycle significantly reduced AR progression (p = 0.004). Advanced age (p = 0.009), smaller body surface area (p = 0.018), and elevated systemic vascular resistance (p = 0.045) were significantly associated with AR development.ConclusionAR is a frequent complication during LVAD support therapy. Identifying patients at risk for AR progression prior to LVAD implantation is critically important for implementing preventive strategies, early intervention, or effective management of AR.