Perfusion-Uk最新文献

{"title":"Hemoadsorption during cardiopulmonary bypass to absorb plasma-free hemoglobin in patients with acute type a aortic dissection: A randomized controlled trial.","authors":"Yu Bao, XiaoJun Wang, YunFeng Zi, Xu Qian, YongBo Li, ShuXi Li, Zhao Wang","doi":"10.1177/02676591241305276","DOIUrl":"https://doi.org/10.1177/02676591241305276","url":null,"abstract":"<p><strong>Aims: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>F</i> = 2.883, 95% confidence interval CI: -0.006 to 0.072, <i>p</i> = .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 (<i>B</i> = 0.01, 95% CI: 0.36-1.24, <i>p</i> = .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, <i>p</i> = .261) and postoperative liver dysfunction (PLD) (5% HA380 group vs 16% control group, <i>p</i> = .106).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241305276"},"PeriodicalIF":1.1,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774192","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":"Letter re: The COMICS trial: Randomization to MiECC significantly decreases serious adverse events.","authors":"Kyriakos Anastasiadis, Polychronis Antonitsis, Serdar Gunaydin, Aschraf El-Essawi, Mark Bennett, Gabor Erdoes, Pascal Starinieri, Ignazio Condello, Cyril Serrick, John Murkin, Thierry Carrel","doi":"10.1177/02676591241305280","DOIUrl":"https://doi.org/10.1177/02676591241305280","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241305280"},"PeriodicalIF":1.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734190","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":"MiECC reloaded.","authors":"Kyriakos Anastasiadis, Polychronis Antonitsis, Prakash Punjabi","doi":"10.1177/02676591241305273","DOIUrl":"https://doi.org/10.1177/02676591241305273","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241305273"},"PeriodicalIF":1.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734192","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":"Non-invasive cerebral autoregulation monitoring during paediatric cardiac surgery without cardiopulmonary bypass requiring intraoperative cross-clamping of one of the carotid arteries.","authors":"Rafal Berger, Sebastian Ewert, Rodrigo Sandoval Boburg, Felix Neunhoeffer, Harry Magunia, Mario Lescan, Christian Schlensak, Migdat Mustafi","doi":"10.1177/02676591241304100","DOIUrl":"https://doi.org/10.1177/02676591241304100","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>p</i> = 0.7), during (<i>p</i> = 0.29) and after cross clamping (<i>p</i> = 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, <i>p</i> < 0.05) and 56 mmHg (95% CI 54.8 - 57.3, <i>p</i> < 0.05) respectively.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241304100"},"PeriodicalIF":1.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717426","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":"ECMO bi-femoral distal perfusion as a salvage option in femoral artery dissection complication.","authors":"Michael Antonopoulos, Ioannis Nenekidis, Konstantinos Perreas, Stavros Dimopoulos","doi":"10.1177/02676591241303841","DOIUrl":"https://doi.org/10.1177/02676591241303841","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241303841"},"PeriodicalIF":1.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734188","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":"Female patients with acute aortic dissection type A (AADA): A gender-selective evaluation of the intensity of the surgical treatment.","authors":"Morsi Arar, Andreas Martens, Linda Rudolph, Heike Krueger, Victoria Arar, Erik Beckmann, Malakh Shrestha, Tim Kaufeld","doi":"10.1177/02676591241303325","DOIUrl":"https://doi.org/10.1177/02676591241303325","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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), <i>p</i> = .003; cardiopulmonary bypass time: A = 189.0 min (range 139.0-138 min), B = 238 min (range 176.8-300.5 min), <i>p</i> < .001; circulatory arrest time: A = 27.0 min (range 21.0-37.0 min), B = 42.0 min (range 32.0-56.3 min), <i>p</i> < .001). There were no significant differences between the groups regarding 30-day mortality (A = 24% (<i>n</i> = 18), B = 19.7% (<i>n</i> = 13), <i>p</i> = .538) and rate of reoperation (A = 13.3% (<i>n</i> = 10), B = 15.2% (<i>n</i> = 10), <i>p</i> = .757) or the preoperative characteristics.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241303325"},"PeriodicalIF":1.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710246","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":"Early results of female patients who underwent mitral valve surgery through periareolar incision approach.","authors":"Alper Selim Kocaoglu, Cengiz Ovali","doi":"10.1177/02676591241303850","DOIUrl":"https://doi.org/10.1177/02676591241303850","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241303850"},"PeriodicalIF":1.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717415","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":"Non-intensive care unit feasibility for ambulatory veno-venous extracorporeal membrane oxygenation patients.","authors":"Aakash Shah, Stephen Stachnik, Joshua L Leibowitz, Leena Ramadan, Jason Ejimogu, Shreya Singireddy, Warren Naselsky, Alison Grazioli, Joseph Rabin, Zhongjun J Wu, Bartley P Griffith","doi":"10.1177/02676591241302959","DOIUrl":"https://doi.org/10.1177/02676591241302959","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241302959"},"PeriodicalIF":1.1,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693825","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":"Q-Fever endocarditis: Prosthetic valve infection in the absence of zoonotic exposure.","authors":"Walid Mohamed, Omar Dihmis, David Thirukumaran, Suvitesh Luthra","doi":"10.1177/02676591241303313","DOIUrl":"https://doi.org/10.1177/02676591241303313","url":null,"abstract":"<p><p><i>Background:</i> 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.<i>Case-history:</i> 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 <i>Coxiella Burnetii</i>. 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 <i>Coxiella Burnetii</i>, 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.<i>Conclusions:</i> 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.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241303313"},"PeriodicalIF":1.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693779","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":"The early decline in platelet count is associated with increased adverse outcomes in non heparin-induced thrombocytopenia pediatric patients undergoing VA-ECMO.","authors":"Yu Jin, He Wang, Chun Zhou, Peiyao Zhang, Zhangyu Lin, Wenting Wang, Peng Gao, Jia Liu, Jinping Liu","doi":"10.1177/02676591241301614","DOIUrl":"https://doi.org/10.1177/02676591241301614","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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) (<i>p</i> = .014, r = 0.305), peak serum creatinine (<i>p</i> = .016, r = 0.299), peak AST (<i>p</i> = .014, r = 0.302), duration of platelet transfusion (<i>p</i> = .032, r = 0.270),The △PLT post-ECMO 24 h had predictive value on in-hospital mortality [(<i>p</i> < .001, AUROC = 0.781 (95% CI: 0.670-0.892)], massive bleeding (<i>p</i> = .001, AUROC 95% CI: 0.627-0.870), hemolysis (<i>p</i> = .046, AUROC 95% CI: 0.510-0.780), and nosocomial infection (<i>p</i> = .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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241301614"},"PeriodicalIF":1.1,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644975","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}