Perfusion-Uk最新文献

{"title":"Optimal timing of surgical intervention for post-myocardial infarction ventricular septal rupture: A comprehensive evidence review.","authors":"Irfan Rasheed, Muhammad Arif, Shyam Sunder Kolvekar","doi":"10.1177/02676591261499955","DOIUrl":"https://doi.org/10.1177/02676591261499955","url":null,"abstract":"<p><p>BackgroundVentricular septal rupture (VSR) is a rare but devastating complication of acute myocardial infarction, historically associated with extremely high mortality rates. The optimal timing of surgical repair-balancing the risks of operating on friable, acute necrosis against the dangers of progressive cardiogenic shock during a waiting period-remains a central clinical dilemma.MethodsA systematic narrative review was conducted following PRISMA guidelines. PubMed/MEDLINE, Embase, and Cochrane Library databases were searched from 2000 to 2024 for studies comparing early (≤7 days) versus delayed (>7 days) surgical repair of post-MI VSR. Data were extracted on patient characteristics, mechanical circulatory support (MCS) use, surgical techniques, and clinical outcomes, including operative mortality, reoperation rates, and long-term survival.ResultsEvidence from contemporary observational studies confirms that delayed surgical repair is associated with significantly lower operative mortality compared to early repair, primarily due to superior tissue integrity and lower rates of residual shunt. However, this mortality gap has substantially narrowed in the contemporary era with routine use of advanced MCS, particularly veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and Impella devices. These technologies enable hemodynamic stabilization, transforming early repair from a salvage procedure to a more controlled intervention. Modern management has evolved from a rigid temporal dichotomy to a patient-tailored strategy emphasizing immediate stabilization, risk stratification, and selective MCS bridging to the optimal surgical window.ConclusionWhile delayed repair remains preferred for hemodynamically stable patients, early repair supported by advanced MCS represents a viable and often necessary strategy for patients with refractory shock. The decision paradigm has shifted toward \"stabilize, support, then repair,\" requiring multidisciplinary heart team collaboration. Future directions include standardized MCS protocols, validated risk scores, and exploration of hybrid percutaneous-surgical approaches to further improve outcomes for this high-risk population.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261499955"},"PeriodicalIF":1.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of patient demographic and clinical data on the assessment of cerebral oxygen monitoring values during coronary artery bypass grafting.","authors":"Tuna Şahin, Suat Karaca","doi":"10.1177/02676591261499535","DOIUrl":"https://doi.org/10.1177/02676591261499535","url":null,"abstract":"<p><p>ObjectivesTo determine the effects of patient demographic and clinical data on regional cerebral oxygen saturation (rSO2) values.DesignProspective observational study.SettingTraining and research hospital.ParticipantsEighty patients who were scheduled for elective on-pump coronary artery bypass grafting.InterventionsNear-infrared spectroscopy was used to monitor bilateral brain oxygen saturation at twelve time points (T1-T12).Measurements and main resultsThe right and left rSO2 values showed a ≥20% decrease pattern from T3 to T12. Patients with a ≥20% decline in the right rSO2 were older and had a higher baseline mean arterial pressure (MAP) and longer cardiopulmonary bypass (CPB) times. Patients with a ≥20% decline in the left rSO2 had a higher baseline MAP. Age, baseline MAP, female sex and CPB time for the right rSO2 and baseline MAP values and female sex for the left rSO2 values were positively associated with a ≥20% decline in univariate logistic regression analyses. Baseline MAP and CPB time for the right rSO2 values and baseline MAP for the left rSO2 values retained their statistical significance in multivariate logistic regression analyses. Activated clotting time (ACT) showed a statistically significant and inverse relationship with the left rSO2 values.ConclusionsHigher baseline MAP values for right and left rSO2 values and longer CPB times for right rSO2 values were independently associated with a ≥20% decline. ACT was inversely associated with a ≥20% decline in the left rSO2 values. Univariate analysis revealed that older age and female sex were associated with a ≥20% decline in rSO2values.Clinical trial numberThe study was registered at Clinicaltrials.gov (NCT07228546).</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261499535"},"PeriodicalIF":1.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombin III use in pediatric and neonatal ECMO: A systematic review and meta-analysis.","authors":"Rachel Moss, Niriksha Ravi, Gloria Willson, Ramya Sivasubramanian, Vineeta Maddali, Sandeep Tripathi, Shubhi Kaushik","doi":"10.1177/02676591261497852","DOIUrl":"https://doi.org/10.1177/02676591261497852","url":null,"abstract":"<p><p>BackgroundAntithrombin (AT) supplementation has been increasingly incorporated into pediatric extracorporeal membrane oxygenation (ECMO) anticoagulation protocols to address heparin resistance and optimize anticoagulation. However, considerable variability exists in monitoring practices, replacement strategies, and reported clinical outcomes. We performed a systematic review and meta-analysis to evaluate contemporary evidence regarding AT supplementation in pediatric ECMO.MethodsA systematic search of PubMed, Embase, Scopus, and Web of Science identified studies evaluating AT monitoring or supplementation during neonatal or pediatric ECMO through September 2025. Two reviewers independently screened studies and extracted data on monitoring strategies, replacement protocols, anticoagulation parameters, thrombosis, bleeding, and mortality. Comparative studies reporting extractable dichotomous outcomes were included in random-effects meta-analyses.ResultsTwenty-five studies met inclusion criteria, consisting predominantly of retrospective single-center cohorts. Marked heterogeneity was observed in indications for supplementation, replacement thresholds (50-100%), therapeutic targets (60-120%), formulations, dosing strategies, and anticoagulation monitoring. AT supplementation consistently increased AT activity, improved anti-factor Xa measurements, and in several studies, reduced unfractionated heparin requirement. However, higher anti-Xa levels and increased AT activity did not consistently translate into improved clinical outcomes. Meta-analysis demonstrated no significant association between AT supplementation and thrombosis (OR 1.10, 95% 0.54-2.24), bleeding (OR 1.15, 95% CI 0.85-1.54), or mortality (OR 1.24, 95% CI 0.63-2.43). Pharmacokinetic investigations suggested standard dosing frequently underestimates replacement requirements in pediatric ECMO.ConclusionCurrent evidence supports the role of AT supplementation in improving laboratory markers of anticoagulation, but does not demonstrate consistent reductions in bleeding, thrombosis, or mortality. Wide variation in monitoring, dosing, and outcome definitions limits comparisons across studies. Future multicenter investigations should prioritize standardized definitions, age-specific therapeutic targets, and prospective evaluation of replacement strategies to better define the role of AT supplementation in pediatric ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261497852"},"PeriodicalIF":1.3,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of preoperative intra-aortic balloon pump insertion in high-risk coronary artery bypass grafting: A decade of single-centre experience.","authors":"Hazem Aljasem, Jason Kho, Umar Shafiq, Sanjay Asopa, Sunil Ohri","doi":"10.1177/02676591261496714","DOIUrl":"https://doi.org/10.1177/02676591261496714","url":null,"abstract":"<p><p>BackgroundThe role of prophylactic preoperative intra-aortic balloon pump (IABP) in patients undergoing coronary artery bypass grafting (CABG) remains uncertain. This study aims to evaluate the safety and outcomes of preoperative IABP insertion in high-risk CABG patients.MethodsA retrospective review of outcomes of patients who had preoperative IABP insertion undergoing isolated CABG at a single United Kingdom quaternary centre was conducted between January 2015 and June 2025. Indications for IABP insertion were divided into prophylactic (critical coronary anatomy) and non-prophylactic insertion (haemodynamic instability and persistent angina). Primary outcome was 30-day mortality, and secondary outcomes included 90-day mortality, incidence of postoperative complications, specific complications related to IABP insertion and postoperative length of stay. Comparative analysis was performed between the two groups. Kaplan-Meier survival analyses were performed.Results610 patients underwent isolated CABG with preoperative IABP; 302 (49.5%) received prophylactic IABP and 308 (50.5%) had non-prophylactic insertion. There were 14 (2.3%) 30-day mortality and 20 (3.3%) 90-day mortality, with no significant difference in mortality between the two groups. Mean postoperative length of hospital stay was 11 ± 7 days; this was significantly longer in the non-prophylactic group (12 ± 8 vs 10 ± 7 days, <i>p</i> < 0.01). Postoperative neurological dysfunction occurred in 42 patients (6.9%) and dialysis in 5 (0.8%), with no differences between the two groups. There were 25 (4.1%) IABP-related complications; 8 localised haematoma managed conservatively, 4 wound infections treated with intravenous antibiotics, 5 lower limb ischaemia (3 required surgical re-vascularisation), 2 fatal bowel ischaemia, 2 renal and splenic malperfusion, 2 localised femoral artery dissection and 2 retroperitoneal haematoma (1 required emergency laparotomy).ConclusionThis study supports the selective use of prophylactic IABP in patients undergoing high-risk CABG. In this selected cohort, preoperative IABP use was associated with low early mortality, favourable long-term survival and an acceptable complication profile.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261496714"},"PeriodicalIF":1.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight-stratified analysis of the heterogeneous effects of miniaturized cardiopulmonary bypass on perioperative outcomes in children with congenital heart disease: A retrospective cohort study.","authors":"Yunxing Ti, Yuanxiang Wang, Sheshe Zhang, Xing Zhou, Huaipu Liu, Pengcheng Wang, Huiya Yang, Wenzhi Wu, Fengnan Zheng, Rensen Zhang, Junzhe Du, Baorong Chen, Baoying Meng, Zhongdong Hua","doi":"10.1177/02676591261496746","DOIUrl":"https://doi.org/10.1177/02676591261496746","url":null,"abstract":"<p><p>IntroductionMiniaturized cardiopulmonary bypass (CPB) circuits may reduce intraoperative transfusion in pediatric cardiac surgery, but their effects across body weight categories remain unclear. This study compared transfusion and outcomes between conventional and miniaturized CPB circuits, emphasizing weight-stratified analyses.MethodsThis retrospective study included 3,196 pediatric cardiac surgery patients (2015-2024) receiving conventional (<i>n</i> = 548) or miniaturized (<i>n</i> = 2,648) circuits. Primary outcomes were transfusion avoidance during CPB, in the ICU, and combined. Secondary outcomes included ICU length of stay, mechanical ventilation, ultrafast-track extubation, 24-h chest tube drainage (normalized to mL/kg), and hematocrit dynamics. Multivariable logistic regression and subgroup analyses were performed.ResultsMiniaturized circuits improved CPB transfusion avoidance overall (47.9% vs. 29.0%; <i>P</i> < 0.001), especially in children weighing 3-9 kg (all <i>P</i> < 0.01). ICU transfusion avoidance was lower with miniaturized circuits overall (82.1% vs. 94.5%; <i>P</i> < 0.001), except in the 1-2 kg subgroup. Combined avoidance was higher with miniaturized circuits across 3-9 and 12-13 kg (all <i>P</i> < 0.05). ICU length of stay was shorter with miniaturized circuits in most weight subgroups, whereas it was prolonged in the 2-3 kg subgroup (150 vs. 75 h; <i>P</i> < 0.001). Overall mean 24-h chest tube drainage was significantly lower in the miniaturized group (9.05 ± 9.10 vs. 10.82 ± 7.76 mL/kg; <i>P</i> < 0.001); however, stratified analysis showed a significant increase only in the 4-5 kg subgroup (14.52 ± 7.88 vs. 11.96 ± 6.69 mL/kg; <i>P</i> = 0.046), with no differences in other weight strata. Multivariable analysis indicated that miniaturized circuits were an independent predictor of increased ICU transfusion risk (OR 2.59; <i>P</i> < 0.001), whereas higher body weight was associated with reduced risk (OR 0.76 per kg; <i>P</i> < 0.001).ConclusionsMiniaturized CPB circuits reduce intraoperative transfusion, particularly in children weighing 3-9 kg, but are associated with higher postoperative ICU transfusion and variable effects on chest tube drainage that are weight-dependent. The net benefit appears weight-dependent. These findings underscore the need for weight-stratified circuit selection, although further prospective studies are warranted.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261496746"},"PeriodicalIF":1.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Di(2-ethylhexyl) phthalate (DEHP) exposure during cardiopulmonary bypass: A narrative review of human clinical evidence and future directions.","authors":"Selwan Hamza Elgazzar, Yasmin Moustafa Ayoub, Ahmed G Elkhouly, Amr A Arafat","doi":"10.1177/02676591261499217","DOIUrl":"https://doi.org/10.1177/02676591261499217","url":null,"abstract":"<p><p>BackgroundDi(2-ethylhexyl) phthalate (DEHP) is widely used as a plasticizer in polyvinyl chloride medical devices employed during cardiopulmonary bypass (CPB). Although migration from these devices and blood-storage systems has long been recognized, the human clinical evidence remains limited and methodologically heterogeneous.MethodsThis narrative review used a structured search of PubMed/MEDLINE, Scopus, and Google Scholar from database inception through 23 August 2026. Original peer-reviewed human clinical studies measuring parent DEHP or its metabolites in blood, plasma, or urine among patients undergoing CPB were eligible for the primary synthesis. Relevant mechanistic, biomaterial, transfusion-medicine, guideline, and regulatory sources were used for context.ResultsThe searches identified 237 database records; 33 duplicates were removed, and 204 unique records were screened. Thirteen full-text reports were assessed, and seven human clinical studies published between 1983 and 2025 were included. Across adult and pediatric settings, perioperative increases in parent DEHP and/or urinary or circulating metabolites were documented. The studies implicated multiple sources, including CPB components, blood-storage systems, and ancillary blood-contacting devices, but none provided complete patient-level source apportionment. DEHP-free tubing reduced, but did not eliminate, exposure. RBC washing reduced DEHP and MEHP in vitro, but a reduction in patient-level internal exposure has not been established.ConclusionHuman clinical evidence consistently demonstrates internal exposure to DEHP or its metabolites during cardiac surgery involving CPB. However, small heterogeneous cohorts, variable analytes and sampling schedules, and limited outcome follow-up preclude causal inference regarding clinical harm. Prospective multicenter studies using standardized biomonitoring and source-apportionment methods are required.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261499217"},"PeriodicalIF":1.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation after transcatheter and surgical bioprosthetic aortic valve replacement: A narrative review.","authors":"Sammy Arab, Karanjot Chhatwal, Rasi Mizori, Arnav Rustogi, Muhtasim Fuad, Balamrit Singh Sokhal, Issam Motairek, Nader Al-Shakarchi, Raheel Ahmed, Monjur Showkat, Prakash Punjabi","doi":"10.1177/02676591261496740","DOIUrl":"https://doi.org/10.1177/02676591261496740","url":null,"abstract":"<p><p>BackgroundBioprosthetic aortic valve replacement, specifically surgical (SAVR) and transcatheter (TAVR), is among the most frequently performed cardiac interventions globally, yet anticoagulation strategies after implantation remain incompletely defined. Atrial fibrillation, notably prevalent pre- and post-operatively in these patients, substantially amplifies thromboembolic risk and complicates decision-making in an already elderly, frail, and comorbid population.ObjectivesTo critically evaluate current anticoagulation strategies after bioprosthetic aortic valve replacement across sinus rhythm and atrial fibrillation in both SAVR and TAVR, and to identify evidence gaps and guideline inconsistencies.MethodsWe conducted a narrative review of major international guidelines (ESC/EACTS 2025, ACC/AHA 2020, and NICE 2021) and key clinical trials on antithrombotic therapy in valve replacement populations. Focus was placed on bioprosthetic aortic valve replacement, with mechanical and non-aortic valves excluded.ResultsAspirin monotherapy is the most consistently supported strategy after bioprosthetic TAVR in sinus rhythm, though guidelines diverge on duration and recommendation strength. In atrial fibrillation, all three guidelines apply uniform CHA₂DS₂-VASc-based frameworks irrespective of AF phenotype, procedural context, or detection modality, reflecting lacking evidence rather than deliberate clinical judgement. No trial has enrolled patients specifically with new-onset post-procedural AF or stratified by AF subtype, and subclinical AF after bioprosthetic AVR remains entirely uncharacterised.ConclusionsGuideline divergence reflects a structurally inadequate evidence base rather than genuine clinical equipoise. Individualised decisions informed by procedure type, AF phenotype, frailty, and bleeding risk are required to guide clinical practice, alongside an adequately powered stratified randomised trial incorporating mandatory continuous rhythm monitoring.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261496740"},"PeriodicalIF":1.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the ECMO nursing self-efficacy Perception scale: A validity and reliability study.","authors":"Sevil Güler, Hafize Savas, Hülya Bulut, İsmail Karakaya","doi":"10.1177/02676591261496709","DOIUrl":"https://doi.org/10.1177/02676591261496709","url":null,"abstract":"<p><p>Caring for patients receiving ECMO in the ICU is a complex process that requires advanced knowledge, technical skills, and confident clinical decision-making from nurses. Despite the increasing use of ECMO in Türkiye, no comprehensive, validated tool exists to measure ICU nurses' self-efficacy in ECMO care. This methodological study aimed to develop the ECMO Nursing Self-Efficacy Perception Scale (ECMO-SEPS) and evaluate its psychometric properties. The scale was developed in two stages. In the first stage, an item pool was generated through an extensive literature review and qualitative interviews with seven ICU nurses experienced in ECMO care. In the second stage, the scale's content and construct validity were assessed using confirmatory factor analysis, including convergent and discriminant validity evaluations. Reliability analyses included internal consistency, evaluated by Cronbach's alpha coefficients, and test-retest reliability, assessed with intraclass correlation coefficients. The final scale consists of 37 items across three subscales: cognitive, affective, and psychomotor, collectively explaining 70.5% of the total variance. Confirmatory factor analysis supported the three-factor structure with acceptable to good model fit indices. The overall Cronbach's alpha was 0.97, with 0.97, 0.81, and 0.96 for the cognitive, affective, and psychomotor subscales, respectively, indicating high internal consistency. Test-retest results demonstrated excellent stability over time. In conclusion, the ECMO-SEPS is a valid and reliable instrument for objectively assessing ICU nurses' self-efficacy in ECMO care. Its use may facilitate standardized evaluations and inform evidence-based education, workforce planning, and clinical practice in ECMO programs.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261496709"},"PeriodicalIF":1.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dabigatran and reversal during cardiopulmonary bypass: In vitro human volunteer studies and a porcine model.","authors":"Iqbal H Jaffer, John W Eikelboom, Hatim Alraddadi, Dorathy Okpokam, Ali Alsagheir, James C Fredenburgh, Timothy Ryan, Peng Liao, Andrew Dooley, Paul Hunter, Qilong Yi, Jeffrey I Weitz, Richard P Whitlock","doi":"10.1177/02676591261496744","DOIUrl":"https://doi.org/10.1177/02676591261496744","url":null,"abstract":"<p><p>ObjectivesTo characterize how dabigatran, unfractionated heparin (UFH), and their reversal agents influence activated clotting time (ACT) and dabigatran-sensitive assays during cardiopulmonary bypass (CPB).DesignIn vitro human whole blood experiments and a controlled porcine cardiopulmonary bypass model.SettingLaboratory and animal operating suite.ParticipantsHealthy volunteers (<i>n</i> = 3) provided whole blood for in vitro testing; 9 pigs underwent 90-min cardiopulmonary bypass.InterventionsWhole blood was incubated with unfractionated heparin and/or dabigatran with reversal by protamine or idarucizumab. Pigs received unfractionated heparin alone (<i>n</i> = 2; protamine at CPB end); dabigatran alone (<i>n</i> = 4; idarucizumab at CPB end); or dabigatran plus unfractionated heparin (<i>n</i> = 3; on-pump idarucizumab during bypass and protamine at CPB end).Measurements and Main ResultsACT, dTT-derived dabigatran concentration, circuit pressures, and arterial filters were assessed. In vitro, UFH and dabigatran each prolonged ACT, although dabigatran produced only modest ACT prolongation at clinically relevant concentrations; combined exposure produced greater ACT prolongation than either drug alone and was reversed by the drug-specific antidotes. In vivo, UFH achieved target ACT with no gross circuit dysfunction. Dabigatran-only anticoagulation at supratherapeutic concentrations was associated with arterial filter thrombosis in 2 of 4 pigs. In the combination group, on-pump idarucizumab reduced dabigatran levels and was followed by an abrupt ACT decrease in 2 of 3 pigs, prompting supplemental UFH boluses.ConclusionsIn this porcine feasibility model and dosing strategy, dabigatran alone did not provide reliable circuit anticoagulation and was associated with filter thrombosis signals. When idarucizumab is administered during CPB after heparinization, ACT can decrease abruptly, because the dabigatran contribution to ACT prolongation is removed, potentially resulting in inadequate anticoagulation.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261496744"},"PeriodicalIF":1.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under pressure- test, test, maybe? A survey of heat exchanger integrity testing at cardiac centres in Australia and New Zealand.","authors":"Martin Gill","doi":"10.1177/02676591261495416","DOIUrl":"https://doi.org/10.1177/02676591261495416","url":null,"abstract":"<p><p>IntroductionHeat exchanger (HE) integrity is vital for patient safety during cardiopulmonary bypass (CPB), as failures can lead to severe complications including haemolysis and toxemia. While manufacturers mandate pre-use integrity testing, adherence and methods vary significantly. This study aimed to identify current practices across Australia and New Zealand and assess the mechanical efficacy of manufacturers recommended testing protocols.MethodsA telephone survey was conducted of the most senior perfusionist available at all 80 cardiac surgical hospitals in Australia and New Zealand regarding HE testing customs and known failures. Simultaneously, an in vitro assessment measured the pressures generated by two common heater cooler units (HCUs)- the 3T and HCU40, in conjunction with oxygenator and cardioplegia HEs to evaluate the generated pressures during usage.ResultsNine unverified historical HE failure events were recalled by surveyed senior perfusionists across the region. While 100% of programs were successfully surveyed, only 49% complete perfusion teams consistently perform pre-clinical integrity testing. Of those that test, the most common method (82%) is running water through the HE, as per manufacturers instructions. However, <i>in vitro</i> data revealed that while the HCU40 maintains positive pressure, the 3T HCU generates negative pressure at the HE outlet during use. This negative pressure gradient creates a theoretical risk of masking defects near the outlet during a standard 'water-run' test, as a positive pressure gradient is not uniformly maintained across the HE. Such an occurrence would render the manufacturers \"water-run\" test insufficient for detecting defects near the outlet.ConclusionCurrent HE testing practices are non-uniform and often limited by logistical barriers. Reliance on fluid-based testing is hemodynamically flawed in certain HCU configurations. To enhance adherence and safety, manufacturers should validate gas pressure testing for end users, and perfusion departments should adopt standardised, positive-pressure testing protocols and documented emergency failure algorithms.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261495416"},"PeriodicalIF":1.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}