Perfusion-Uk最新文献

Objective: Acute aortic dissection type A (AADA) is a condition that affects both genders and requires urgent surgical intervention as non-operative treatment is often associated with a poor prognosis. Studies have proven that less aggressive surgical treatments influence the outcome for female patients in the fields of several diseases. The purpose of this study was to report and analyze our results in the selective cohort of female patients with AADA to detect differences in the treatment of this group of patients.

Methods: Between January 2000 and July 2018, 141 adult female patients with acute aortic dissection (AAD) underwent repair of the aorta in our department. A total of 75 patients received a proximal arch. replacement (group A), and 66 patients received a subtotal (replacement of the brachiocephalic trunk) and/or total arch. replacement with elephant trunk or frozen elephant trunk (group B).

Results: The median age in group A was 70.7 years (range 60.7-74.7 years) and in group B 66.3 years (range 55.6-71.3 years). Operation times were significantly longer in group B (total operation time: A = 286.9 min (range 225.0-341.0 min), B = 341 min (range 266.0-392 min), p = .003; cardiopulmonary bypass time: A = 189.0 min (range 139.0-138 min), B = 238 min (range 176.8-300.5 min), p < .001; circulatory arrest time: A = 27.0 min (range 21.0-37.0 min), B = 42.0 min (range 32.0-56.3 min), p < .001). There were no significant differences between the groups regarding 30-day mortality (A = 24% (n = 18), B = 19.7% (n = 13), p = .538) and rate of reoperation (A = 13.3% (n = 10), B = 15.2% (n = 10), p = .757) or the preoperative characteristics.

Conclusion: Our study showed no significant difference in mortality rate depending on the type of operation. Based on these results, a proximal arch. replacement should be considered as the first line of operation technique if the individual situation allows. For inexperienced clinics and surgeons in particular, we recommend limited aortic repair in patients with AADA. Finally, location of the intimal tear remains the essential factor for the evaluation of the surgical treat.

Background: Approaches that require less invasive procedures, offer heal in a shorter time and provide better cosmetic results have gained importance with the technological and modern developments in cardiac surgery. Esthetically preferred results can be achieved after heart valve surgery using a periareolar incision, especially in female patients. In the present study, we aimed to present our results after surgery using periareolar incision in female patients.

Methods: We retrospectively evaluated the 1-year follow-up results in the postoperative period of isolated mitral valve replacement and tricuspid valve repair with mitral valve replacement using a periareolar incision with direct observation in 32 patients between 2020 and 2023. At the end of 1-year follow-up, we evaluated the patients' visual satisfaction with the incision site using a visual analog scale.

Results: According to the postoperative follow-up results, no prosthetic mitral valve dysfunction was detected in any of the patients at the 1st year echocardiography controls. Mild tricuspid valve insufficiency was detected in 3 patients who underwent tricuspid valve repair. Besides, a high level of satisfaction was observed in the patients' incision site evaluations with a visual analog scale at the end of the first year, and no numbness was reported in the periareolar region in any of the patients.

Conclusion: Our study shows that surgical results similar to conventional methods can be achieved with the periareolar approach, and patient satisfaction and recovery times are shorter and more satisfying. We also think that the periareolar incision can be made without videoassisted equipment and this may reduce the surgical cost.

Introduction: Veno-venous extracorporeal membrane oxygenation has increasingly been utilized to support patients in respiratory failure as a bridge to recovery or lung transplantation. As patients progress from cannulation to recovery or transplantation, it has been shown that physical therapy and ambulation are possible and beneficial for patient outcomes.

Methods: We sought to evaluate the feasibility of managing these ambulatory VV-ECMO patients in a non-ICU setting by conducting a single-center, retrospective cohort study to characterize the daily data collection (i.e., CXRs, blood draws, etc.) and ICU and ECMO interventions and events (i.e., oxygenator/cannula exchange, sweep or flow adjustments, etc.).

Results: A total of 28 ECMO runs from patients ≥18 years of age who ambulated ≥100 feet while on VV ECMO between 2014 and 2020 were included for analysis. Patients were supported on ECMO a median of 33 [18-79.5] days with a mean of 4.0 (3.8,4.1) data collections per day. There was a mean of 1.1 (1.0,1.2) anticoagulation changes, 1.5 (1.4,1.6) ECMO interventions, and 0.40 (0.34,0.46) ICU interventions per day. There were very few instances of cannula repositioning or oxygenator exchanges - 0.05 (CI 0.04, 0.06) per day.

Conclusion: Our data suggests that ambulatory VV-ECMO patients may tolerate less than ICU level of care and may even progress to outpatient management as ECMO technology continues to advance.

Background: Q-Fever is a rare condition with an often insidious presentation. Endocarditis is a serious complication of up to 5% of Q-Fever cases, with a higher incidence and mortality in patients with prosthetic valves.Case-history: A 67-year-old man presented with a 6-weeks history of breathlessness on a background of previous bioprosthetic aortic valve replacement in 2018. Subsequent echocardiograms showed severe eccentric aortic regurgitation, a 2 cm vegetation, and severely impaired biventricular function. Routine blood cultures were negative, but later PCR testing for non-culturable microorganisms, performed due to the high probability of endocarditis, was positive for Coxiella Burnetii. The patient denied any recent constitutional symptoms and previous exposure to animal reservoirs. He underwent a successful urgent redo sternotomy and aortic valve replacement with a bioprosthesis. Prosthetic valve PCR testing was positive for Coxiella Burnetii, and he completed a long antibiotic course with follow-up serology to guide therapy. Clinic follow-up 3 months later showed good recovery with no complications.Conclusions: This case emphasises the high index of suspicion and routine screening needed in culture-negative cases to diagnose Q-Fever endocarditis, especially in the absence of acute symptoms and exposure to known sources of transmission. The complexities in management and timing of surgery are discussed.

Introduction: The impact of non heparin-induced thrombocytopenia on the clinical outcomes for pediatric cardiac surgery patients who required veno-arterial extracorporeal membrane support (VA-ECMO) for failure to wean from cardiopulmonary bypass (CPB) is uncertain. This study aimed to investigate the relationship between thrombocytopenia and prognosis in these patients.

Methods: This retrospective study enrolled 96 pediatric patients (age < 18) who received VA-ECMO directly transitioned from CPB at Fuwai Hospital from January 2010 to June 2020. The association between relative decrease in platelet count (△PLT) post-ECMO 24 h and clinical outcomes was explored.

Results: There were significant differences in Post-ECMO 24 h platelet counts, platelet count nadir, and duration of platelet decline between the survivors and non-survivors in CPB-ECMO groups. A positive correlation was found between △PLT post-ECMO 24 h and plasma-free hemoglobin (pFHb) (p = .014, r = 0.305), peak serum creatinine (p = .016, r = 0.299), peak AST (p = .014, r = 0.302), duration of platelet transfusion (p = .032, r = 0.270),The △PLT post-ECMO 24 h had predictive value on in-hospital mortality [(p < .001, AUROC = 0.781 (95% CI: 0.670-0.892)], massive bleeding (p = .001, AUROC 95% CI: 0.627-0.870), hemolysis (p = .046, AUROC 95% CI: 0.510-0.780), and nosocomial infection (p = .020, AUROC 95% CI: 0.536-0.801). Multivariate logistic regression showed that △PLT post-ECMO 24 h was associated with in-hospital mortality and hemolysis.

Conclusions: The relative early decrease in platelet count 24 h following transition to ECMO is associated with increased patient mortality, and is positively associated with adverse outcomes in pediatric cardiac surgery patients transferred from CPB to ECMO. Moreover, this decline rate can predict in-hospital survival, major bleeding, hemolysis, and hospital-acquired infections.

Background: ECMO plays a crucial role in treating severe respiratory and cardiac failure in pediatric patients. However, its impact on the regulation of erythropoietin (EPO) and erythropoiesis remains poorly understood. Factors such as improved oxygenation, inflammation, and hemodilution associated with ECMO treatment may influence EPO production and erythropoiesis. This study aimed to examine the effects of ECMO on EPO regulation and erythropoiesis in pediatric patients.

Methods: This retrospective study serially quantified EPO serum levels, measured markers of erythropoiesis, and tabulated clinical outcomes of pediatric ECMO patients. Descriptive statistics and Pearson correlation coefficients were used to identify associations between biomarkers and clinical care parameters.

Results: Preliminary findings suggest a disconnection between elevated EPO levels and reduced markers of erythropoiesis or iron metabolism, indicating ineffective erythropoiesis. Patients receiving more than 10 mL/kg/day of RBC transfusions had higher reticulocyte counts. Non-survivors had sustained elevations of EPO serum levels but reduced erythropoietic activity.

Conclusion: In ECMO-treated pediatric patients, ineffective erythropoiesis is a significant concern and may be associated with higher mortality rates. Understanding the mechanisms behind this pathology could better inform clinical approaches and optimize management strategies. Further research is imperative to uncover the factors resulting in ineffective erythropoiesis in these patients and to develop targeted interventions.

Objective: The purpose of this study was to compare the ability of four obesity indicators, including waist circumference (WC), body mass index (BMI), body adiposity index (BAI), and waist-to-height ratio (WHtR) on prediction for incident cardiovascular disease (CVD) in Chinese Han population.

Methods: We analyzed data from a prospective population cohort of 3598 participants aged 35 to 74 years from Jiangsu China. The logistic regression model was used to analyze the association between four obesity indicators and CVD risk. The ROC curve was used to assess and compare the diagnostic performance of four obesity indicators.

Results: During 8 years (median 6.3 years) of follow-up time, 82 CVD endpoints were collected during follow up (36 men and 46 women). After adjustment for age, smoking status, alcohol consumption and family history of CVD, in men, WC, BMI, and BAI were associated with triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and hypertension. In women, WC, BMI and WHtR were associated with TG, HDL-C, hyperglycemia and hypertension, BAI was only associated with HDL-C, hyperglycemia, and hypertension. ROC curve analysis indicated that BAI have the highest area under the curve to identify CVD, and BMI has the lowest area under the curve to identify CVD in Chinese males. WHtR has the highest area under the curve to identify CVD, and BMI has the lowest area under the curve to identify CVD in Chinese females.

Conclusions: CVD risk was more consistently correlated with BAI in Chinese men and more consistently correlated with WHtR and WC in Chinese women.

Background: In recent years, during the decannulation process for veno-arterial extracorporeal membrane oxygenation (VA-ECMO), methods for suturing the femoral artery have included the pre- and post-closure techniques. The safety and efficacy of the pre-closure technique are widely recognised; however, reports on the post-closure technique are scarce. This study aimed to evaluate the safety and efficacy of the post-closure technique using ProGlide (Abbott Healthcare, Green Oaks, IL, USA) device during VA-ECMO decannulation.

Methods: We reviewed 170 patients who underwent VA-ECMO between January 2021 and June 2023. All patients had their femoral artery puncture sites closed using the post-closure technique upon decannulation. The success rate of this technique and incidence of lower limb complications were recorded and analysed.

Result: Technical success was achieved in 157 (92.4%) patients. Sixteen patients (9.4%) experienced lower limb-related complications, including 8 (4.7%) with lower limb arterial thrombosis and 11 (6.5%) with pseudo-aneurysms. Among all lower limb-related complications, four patients (2.4%) required interventional procedures. This study included 170 patients: 80 in the 'S' (15-16 F) group and 90 in the 'M' (17-19 F) group. In the univariate analysis of different arterial cannula sizes for in-hospital lower limb-related complications, the differences were not statistically significant (p > 0.05). The multivariate logistic model indicated that, compared to the S (15-16 F) group, the M (17-19 F) group was not associated with an increased rate of in-hospital lower limb-related complications.

Conclusions: The suture-mediated closure of the femoral artery during VA-ECMO decannulation is a promising therapeutic strategy.

Pump Controlled Retrograde Trial Off (PCRTO) is a relatively new technique in trialing-off Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO). Literature on the use of PCRTO in children remains scarce. We describe our centre's initial experience with PCRTO in a neonate and an older child and review its potential advantages and disadvantages compared to traditional weaning methods. More research and shared best practices are required in children to facilitate wider adoption of this technique.

Post-infarct ventricular septal defect (VSD) carries high mortality. Since emergent repair of post-infarct VSD is challenging, hemodynamic stabilization utilizing temporary mechanical circulatory support crucially provides time to delay intervention and allows necessary scar tissue formation which improves the fragility of myocardium and leads to a definitive repair. To date, there remains no standard for achieving hemodynamic stability, including usage and mode of temporary mechanical circulatory support. We describe a patient with acute post-infarct VSD in cardiogenic shock successfully supported with Impella 5.5 for 67 days as a bridge to surgical repair and coronary artery bypass grafting.