Perfusion-Uk最新文献

There are three reasons why perfusionists and autotransfusionists around the globe still use Normal Saline with cell savers; (1) This what they were taught by their peers and/or didactic educators for decades. (2) This is what cell saver manufacturers have been stating in their Instructions For Use (IFU) for over 5 decades. (3) It is the general assumption that any solution other than what is stated in the IFU, may designate an off-label use of that device. But is the use of Normal Saline for washing salvaged blood physiologically the best solution for this autotransfusion process or is it just the way it has always been done and should not be questioned?

IntroductionBioprosthetic heart valves (BHVs) are increasingly used in valvular heart disease, offering favourable haemodynamics and lower thrombogenic risk compared to mechanical valves. However, long-term durability remains limited by structural valve degeneration (SVD).Case reportA 70-year-old male presented with severe heart failure 4 years after bioprosthetic mitral and aortic valve replacement. Imaging confirmed SVD affecting both valves, necessitating high-risk redo surgery. Postoperatively, the patient developed profound systemic inflammatory response syndrome (SIRS) to cardiopulmonary bypass (CPB), refractory to vasopressors and steroids, and died within 24 hours.DiscussionFurther investigations revealed elevated isolated anti-cardiolipin IgM antibodies, raising suspicion of autoimmune-mediated valve thrombosis as a contributor to this case of early SVD.ConclusionThis case highlights the importance of thorough diagnostic evaluation in cases of early SVD, the need to individualise anticoagulation strategies in at-risk patients, and serves as a critical reminder of the serious inflammatory complications that can occur post-surgery.

Introduction Patients who decline blood transfusion for religious or personal reasons present a unique challenge in cardiac surgery. We developed and validated a preoperative point-based tool to predict the likelihood of achieving transfusion-free success in open proximal thoracic aortic aneurysm repair.Methods We retrospectively analyzed 1074 patients who underwent open proximal thoracic aortic aneurysm repair at a single academic center from 2012 to 2023. A multivariable logistic regression model was developed using cross-validation to identify independent predictors of bloodless success. Model performance was evaluated using area under the curve (AUC), Brier score, and F-score. A point system was derived from weighted coefficients of significant preoperative variables.Results Multivariable analysis identified 8 factors (p < 0.05) associated with bloodless aneurysm repair for the point system: body surface area (BSA), hypertension, reoperation, heart failure, baseline hemoglobin, extent of repair, concomitant procedure, and degree of hypothermia. The model demonstrated good discrimination (AUC = 0.761), calibration (Brier score = 0.192), and balance (F-score = 0.758). BSA ≥1.9 m² and preoperative hemoglobin ≥13.1 g/dL (+8 points each) had the greatest positive influence on likelihood of bloodless operation, while proximal + distal extension in repair (-8 points) had the greatest negative influence on likelihood of bloodless operation.Conclusions This novel point-based scoring tool estimates the probability of transfusion-free success using readily available preoperative factors. It may assist in counseling patients who refuse blood products, guiding perioperative planning, and prioritizing resource-intensive optimization strategies for those at highest risk.

BackgroundAccurate procedural coding is essential for resource allocation, billing integrity, and quality reporting within critical care. Current Procedural Terminology (CPT) coding is largely manual and error-prone, especially in high-acuity environments such as the cardiovascular surgical intensive care unit (CVSICU), where complex procedures like extracorporeal membrane oxygenation (ECMO) are common. Large Language Models (LLMs) may offer scalable solutions for automated coding, but their performance in the CVSICU has not been systematically evaluated.MethodsSix publicly accessible LLMs (GPT-4, Claude 3.7 Sonnet, Perplexity, DeepSeek, Google Gemini 2.5 Pro, Mistral) were tested on CPT code assignment to 47 CVSICU procedures, including 7 ECMO-related interventions, from a single tertiary center (July 2023 to May 2025). Models received prompts in a standardized format and was evaluated based on code accuracy. Statistical comparisons were conducted to assess inter-model performance differences for ECMO and non-ECMO related procedures.ResultsFor non-ECMO procedures, Gemini 2.5 Pro and Perplexity achieved the highest accuracy (88%), followed by Deepseek (78%), Claude 3.7 Sonnet (75%), Mistral (68%), and GPT-4.0 (56%). For ECMO-related codes, Perplexity outperformed all models (86%), followed by Gemini 2.5 Pro (71%), Mistral (43%), DeepSeek (29%), Claude 3.7 Sonnet (14%), and GPT 4.0 (0%). Pairwise comparisons revealed statistically significant inter-model differences.ConclusionsWhile LLMs such as Perplexity and Gemini show promise for automated coding, their limited understanding of context, specifically context-dependent nuances of ECMO, remains a key barrier. Future work should focus on developing domain-specific fine-tuning to capture procedural context before they are employed in high acuity clinical settings.

BackgroundExtracorporeal membrane oxygenation (ECMO) is a life-saving intervention for neonates with severe respiratory or circulatory failure. Due to its complexity, ECMO is often performed in specialized centers, necessitating the transport of eligible patients from non-ECMO centers. While ECMO transport has been deemed safe, limited data exist comparing outcomes between in-house and transported neonates. This study aimed to evaluate the survival and long-term outcomes of neonates requiring ECMO support based on the cannulation location.MethodsA single-center study was conducted at the largest tertiary center in Israel (2009-2025). Patients were categorized based on cannulation site: in-house ECMO (performed at the tertiary center) or on-site ECMO (cannulated at the referring center and transported on ECMO support). Primary endpoints were in-hospital and long-term survival. Secondary outcomes included ECMO-related complications and long-term sequelae.ResultsA total of 53 neonates received ECMO support, with 26 (49.1%) in the in-house group and 27 (50.9%) in the on-site group. Despite pre-cannulation differences, including higher vasoactive-inotropic scores in the in-house group, lower pH and higher pCO2 in the on-site group, there were no statistically significant differences between the groups (53.8% vs 77.8%, p = 0.12). ECMO-related adverse events and long-term sequelae showed no statistically significant differences between groups, though the study was underpowered to detect clinically meaningful differences.ConclusionAlthough survival rates of critically ill neonates requiring on-site ECMO initiation and transport and those connected to ECMO in the in-house setting, did not differ significantly, the study was underpowered to detect potentially meaningful differences. Nonetheless, the findings reinforce the viability of neonatal ECMO transport.

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.