Perfusion-Uk最新文献

Background: Reliable myocardial protection is essential for a good outcome after arterial switch operation.

Patients and methods: We evaluated 56 neonates with arterial switch operation in this retrospective study. Three types of cardioplegia were used: antegrade Custodiol® (CCC) n = 22, antegrade Custodiol® plus paediatric microplegia (mix) n = 14, and antegrade plus retrograde intermittently paediatric microplegia (blood) n = 20. We evaluated the extent of myocardial injury using troponin I, Creatine kinase (CK), CK-MB (CK in myocardial cells) and vasoactive inotrope score (VIS), immediately- and the first postoperative day, as well as outcome parameters. A statistical analysis was conducted using multiple linear regression, with adjustments made for the RACHS score and ischemia time, at a significance level of 5%.

Results: Preoperative data were comparable between the three groups. Aortic cross clamp time was significantly different between the three groups (CCC: 115 ± 26 min: mix: 162 ± 35 min: blood: 153 ± 31 min). We found significantly lower troponin I release in the blood group 14 ng/mL [CI95 10; 18] versus CCC group 36 ng/mL [CI95 27; 48] and versus mix group 27 ng/mL [CI95 19; 38]; troponin I 24 h blood group 8 ng/mL [CI95 6; 11] versus CCC group 14 ng/mL [CI95 10; 19]. No significant differences were found in CK, CK-MB, VIS, as well as in outcome parameters 30-day mortality, ventilation time, hospital stay or ECMO implantation.

Conclusions: Intermittent paediatric microplegia led to a significantly lower release of troponin I, despite significantly longer ischemia times than after application of Custodiol®. Paediatric microplegia can be safely performed in neonates and also offers the advantage of miniaturization of the Cardiopulmonary bypass setup.

Coronary artery aneurysms are a relatively uncommon finding during coronary angiography and can present certain challenges in terms of treatment options. This may be due to unclear underlying mechanisms and varying presentations, as well as a lack of large-scale outcome data. In this case report we present the successful use of percutaneous coronary intervention (PCI) in treating a 43-year-old male patient who presented with acute myocardial infarction and was discovered during angiography to have a saccular coronary aneurysm.

Objectives: Sternotomy is rarely performed for veterinary therapeutic or recovery models in quadrupeds because of difficulties with breathing, ambulation, and pain control. Central cannulation for cardiopulmonary bypass (CPB) is infrequent and typically performed through full thoracotomies. Experienced clinical surgeons and perfusionists should provide guidance for new therapeutic interventions and translational research. We sought to develop, validate, and detail a contemporary model for minimally-invasive central cannulation, CPB, and cardioplegic arrest. Methods: After induction of anesthesia and sterile preparation, a right second-interspace parasternal mini-thoracotomy was performed, the ascending aorta was cannulated using Seldinger technique, and a cardioplegia needle was placed. A dual-stage cannula was introduced through the right atrial appendage and CPB commenced. The aorta was clamped and Buckberg 4:1 induction cardioplegia was administered. Arrest was maintained for 30 minutes. CPB was discontinued after 2 hours and the great vessels were decannulated. Hemostasis was achieved and the wound was closed. Initial recovery was accomplished in intensive care with subsequent transfer to the vivarium.Results: Ten consecutive Yorkshire swine (45 ± 5 kg) were minimally invasively placed on CPB including cardioplegic arrest using central cannulation through a right parasternal mini-thoracotomy. There was no operative or late mortality. Morbidity appeared minimal. Planned euthanasia and scheduled necropsy were performed to exclude clinically-occult major complications. None were identified. Following initial supervision, veterinary and resident surgeons completed the procedures autonomously with excellent results.Conclusion: The described protocols should facilitate safe veterinary cardiac surgical care and humane translational research.

Introduction: There is no consensus on the dose of heparin to be used intraoperatively in cardiac myxomas, so the goal of this study was to look into the differences in the clinical effects on the perioperative period of patients with cardiac myxomas when different doses of heparin were used intraoperatively.

Methods and analysis: 70 patients who had cardiac myxomas excision via cardiopulmonary bypass between January 2024 and July 2024. The 70 patients were separated into two groups based on the heparin dose administered prior to cardiopulmonary bypass heparinization. 42 patients in group A had a dose of ≤400 U/kg, while 28 patients in group B received a dose of >400 U/kg.

Result: PT, INR, and APTT were significantly prolonged in patients with cardiac myxomas in group A in the postoperative period 24 h after surgery, which was statistically significant (P < .05) compared with that in group B. Intraoperative heparin dose appeared to influence changes in coagulation at 24 h postoperatively, but was mainly dominated by APTT. Also, heparinized doses showed a weak positive correlation with 24-h postoperative drainage volume. In addition, the dimension of the cardiac myxomas appeared to have some correlation with the patient's preoperative APTT and age.

Conclusion: When patients with cardiac myxomas were heparinized intraoperatively with varying doses of heparin, the enhancement of coagulation in the 24 h after surgery was more pronounced in the group given higher doses of heparin, and endogenous coagulation pathways were activated much more than exogenous coagulation pathways in the 24 h after surgery.

Background: Coronary artery bypass surgery (CABG) is the most common cardiac surgical procedure worldwide. The Internet is often the first place for patients to obtain medical information and may influence their health-seeking behaviour. This study aimed to assess the quality of online CABG information for patients.

Methods: A review was conducted on the available CABG information online using four search terms in Google: "coronary artery bypass grafting", "CABG", "bypass surgery", and "coronary surgery". Websites on the first three pages of each search term were assessed by two independent assessors using the Ensuring Quality Information for Patients (EQIP) tool (score 0-36).

Results: 71 websites in total were eligible for the evaluation. Most websites originated from the USA and the UK (35% for both). The median EQIP score was 16.5. Most websites used everyday language (94%) in short sentences (83%). More than half (60%) of the websites addressed qualitative complications and risks of surgery. Only 1/3 of the websites described treatment alternatives, precautions before surgery, and warning signs after surgery. Only about 1/10 of websites could address quality-of-life issues and resolution of complications.

Conclusion: Most online sites concerning CABG scores were low in EQIP tool assessment in terms of quality and readability with insufficient sources. Minimal information is provided regarding the quantitative risks and complications. Enhancement of the credibility and informativeness of websites is needed to reduce patients' anxiety about surgical procedures and help with treatment options for coronary artery disease. Education and investigation on the consistency of high-quality websites may help patient identify high quality medical information.

Aims: This study aimed to investigate the effect of hemoadsorption (HA) on plasma-free hemoglobin (pfHb) levels during cardiopulmonary bypass (CPB) and the clinical outcomes in patients with acute type A aortic dissection (ATAAD).

Methods: In this single-center randomized trial, patients were assigned to either a group using the HA380 device or a control group without it. The primary outcome was changes in pfHb levels during CPB and within the first 48 hours after surgery. The study concentrated on comparing compared the data between the two groups using analysis of variance for repeated measures. Concurrently, both correlation and linear regression analyses were employed to identify the factors influencing pfHb levels.

Results: The mean pfHb concentration was lower in the HA380 group than in the control group,but there were no significant differences between the two groups (F = 2.883, 95% confidence interval CI: -0.006 to 0.072, p = .093) using a repeated measures analysis of covariance model. Linear regression analysis identified body mass index (BMI) as the primary factor influencing the adsorption effect (B = 0.01, 95% CI: 0.36-1.24, p = .001). Additionally, the major postoperative complications within the first 48 hours did not show significant differences between the groups, including acute kidney injury (AKI) (25% HA380 group vs 36% control group, p = .261) and postoperative liver dysfunction (PLD) (5% HA380 group vs 16% control group, p = .106).

Conclusion: The use of the HA380 device in CPB during cardiac operations may contribute to reduced pfHb levels. However, the difference was statistically non-significant because pfHb adsorption was notably influenced by the patient's BMI. Consequently, BMI should be considered when deploying HA380 in prolonged CPB procedures, including ATADD repair. Enhancing either the number of devices or the duration of HA in patients with overweight or obesity may potentially improve postoperative clinical outcomes.

Introduction: Neurologic complications remain one of the major risks after pediatric cardiac surgery. Cerebral autoregulation (CA) is a physiologic mechanism regulating cerebral perfusion. A dynamic intraoperative evaluation can possibly detect the impairment of the cerebral regulatory function during surgery. The aim of the present study was to evaluate the utility of dynamic cerebral blood perfusion monitoring using cerebral oxygenation index (COx) as CA parameter during pediatric cardiac surgery without cardiopulmonary bypass (CPB) requiring intraoperative cross-clamping of one carotid artery to perform the procedure.

Materials and methods: Prospective intraoperative autoregulation monitoring was performed in 14 children under the age of 1 year requiring elective cardiac surgery with intraoperative cross-clamping of one of carotid artery. Procedures requiring the use of CPB and redo surgeries were excluded.

Results: Impaired CA could be measured during 33.8% of cross-clamping time on the ipsilateral side and 30.1% on the contralateral side. The difference in COx was not significant before (p = 0.7), during (p = 0.29) and after cross clamping (p = 0.63), but a significant difference in COx levels throughout the entire cohort was noted individually. The mean ABP during normal (COx <0.4) CA was 61.8 mmHg (95% CI 60.7 - 62.9) and 62.9 mmHg (95% CI 61.9 - 63.9) for cross clamped and opposite side. During impaired (COx >0.4) CA the ABP values were 58.9 mmHg (95% CI 57.7 - 60.1, p < 0.05) and 56 mmHg (95% CI 54.8 - 57.3, p < 0.05) respectively.

Conclusions: A dynamic intraoperative monitoring of CA during pediatric cardiac surgery is possible and allows to confirm the impairment of autoregulation during cross-clamping of one of the carotid arteries.