Perfusion-Uk最新文献

{"title":"From Technology to Teamwork: The Evolving Landscape of Extracorporeal Support.","authors":"Dirk W Donker","doi":"10.1177/02676591261479910","DOIUrl":"10.1177/02676591261479910","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1083-1086"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800784","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":"How does rewarming temperature affect bleeding after mitral valve repair?","authors":"Yu-Hua Cheng, Yun-Fei Han, Jian-Wen Zeng, Wei-Guo Ma, Kai Sun, Shao-Qing Lei, Wei-Qin Huang","doi":"10.1177/02676591261422997","DOIUrl":"10.1177/02676591261422997","url":null,"abstract":"<p><p>ObjectiveSo far, evidence is scarce regarding the impact of rewarming temperature on bleeding after cardiac surgery under cardiopulmonary bypass (CPB). We seek to evaluate how rewarming temperature affects postoperative bleeding in patients undergoing mitral valve repair.MethodsClinical, anesthesia and CPB data were analyzed for 379 adults undergoing isolated mitral regurgitation repair. Platelet levels (1000/μL) were divided into three groups: low, 53-164 (<i>n</i> = 128); medium, 165-208 (<i>n</i> = 126); and high, 209-906 (<i>n</i> = 125). The primary endpoint was chest drainage volume (mL) at 24 postoperative hours. To delineate the degree and impact of rewarming, a variable \"rewarming/cooling ratio\" was defined as: peak rewarming temperature (°C) divided by nadir cooling temperature (°C). General linear models were used to evaluate factors associated with the volume of 24-h chest drainage.ResultsMean flow rate was 2.7 ± 0.1 L/min/m², nadir core temperature 30.7 ± 1.3°C and peak rewarming temperature 36.2 ± 0.5°C. The \"rewarming/cooling ratio\" averaged 1.133 ± 0.044.Postoperatively, nadir platelet count was 115 ± 46 k/μL, and chest drainage averaged 344 ± 181 mL at 24 h. Two patients underwent re-exploration for bleeding (0.5%). Transfusion was required in 85 patients (22.4%).Gender (F = 20.585, <i>p</i> < 0.001), platelet count (F = 3.875, <i>p</i> = 0.024), fibrinogen (F = 4.241, <i>p</i> = 0.040), and chest incision (F = 58.097, <i>p</i> < 0.001), rather than the rewarming temperature (F = 2.322, <i>p</i> = 0.128), were factors significantly associated with 24-h chest drainage.A significant interaction existed between platelet levels and \"rewarming/cooling ratio\" (F = 3.717, <i>p</i> = 0.025), i.e., with a higher \"rewarming/cooling ratio\", 24-h chest drainage tended to increase in the low platelet group, and to decrease in patients with high and medium platelet levels.ConclusionsIn this series of patients undergoing isolated mitral regurgitation repair, gender, platelet count, fibrin and chest incision, rather than rewarming temperature, were independent factors significantly associated with postoperative bleeding. The impact of rewarming temperature on postoperative bleeding was modified by preoperative platelet levels. It is advisable to avoid excessive cooling during CPB and keep the cooling temperature at maximally allowable level.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1289-1297"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158399","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":"Successful EXCOR biventricular assist device weaning because of recovery in a child.","authors":"Morgane Chave, Amir-Reza Hosseinpour, Fabrizio De Rita, Sylvain Mauron, Maik Meissner, Rainer Rebmann, Eleonora Dal Sasso, Stefano Di Bernardo, Maria-Helena Perez","doi":"10.1177/02676591251390665","DOIUrl":"10.1177/02676591251390665","url":null,"abstract":"<p><p>IntroductionVentricular assist devices (VADs) are used in children usually as a bridge to transplantation and occasionally also as a bridge to recovery, e.g., for acute myocarditis. However, in cases of recovery, weaning criteria are not well defined and protocols are scarce.Case reportWe report our first experience with weaning of biventricular assist device (EXCOR® Pediatric, Berlin Heart GmbH, Germany) in a 3-year-old boy due to recovery.DiscussionThe weaning and explantation processes were based on clinical experience, local hospital practices, and collaboration with the Berlin Heart team.ConclusionRegular echocardiographic assessments, weaning attempts, and downsizing of the EXCOR pumps may facilitate device weaning.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1304-1306"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent cardiopulmonary bypass for the management of intrabronchial descending aortic aneurysm rupture.","authors":"Martin Bennett, Brad Schultz, Ben Turner, Catherine Deshaies, Igor E Konstantinov, Edward Buratto","doi":"10.1177/02676591251395484","DOIUrl":"10.1177/02676591251395484","url":null,"abstract":"<p><p>IntroductionMycotic thoracic aneurysms in children are rare and carry high mortality, particularly when complicated by erosion into adjacent pulmonary structures. Early recognition and surgical intervention are essential to prevent catastrophic outcomes.Case ReportA 14-year-old presented with respiratory symptoms. Imaging revealed a large mycotic aneurysm of the aorta with compression of multiple mediastinal structures. During induction of anaesthesia, aneurysm rupture caused haemoptysis and hypovolemic arrest. Emergent femoral cannulation enabled initiation of cardiopulmonary bypass and novel use of endotracheal suction with autologous cell salvage facilitated surgical exposure and successful aneurysm repair.DiscussionThoracic mycotic aneurysms present diagnostic complexity and potential catastrophic outcomes. In this patient, rapid multidisciplinary coordination, dual-arterial cannulation and intraoperative blood-salvage techniques proved critical to restoring circulation and achieving surgical control.ConclusionThoracic mycotic aneurysms in children require extreme vigilance and adaptable surgical strategies. This case demonstrates that survival is possible with innovative management in the face of life-threatening complications.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1320-1322"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483604","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-free VV-ECMO for a child with intractable pulmonary hemorrhage: A case report.","authors":"Alexandra Cummings, Kristina Murphy, Richard D Glick, Christian McEvoy, Marcia Zinger, Grace Fisler","doi":"10.1177/02676591251394856","DOIUrl":"10.1177/02676591251394856","url":null,"abstract":"<p><p>IntroductionSystemic anticoagulation (AC) is standard practice in extracorporeal membrane oxygenation (ECMO). Adults on ECMO have been successfully managed AC-free. However, slower flow rates in pediatric circuits have mostly prevented this strategy. Thus, ECMO is often avoided in children with intractable hemorrhage.Case ReportA 12-year-old female with microscopic polyangiitis was admitted with diffuse alveolar hemorrhage and acute on chronic renal failure requiring venovenous (VV)-ECMO and continuous kidney replacement therapy (CKRT). Systemic AC was withheld entirely, and the CKRT circuit was regionally anticoagulated with citrate. High ECMO flow rates and positioning of the CKRT return line pre-oxygenator enabled an effective AC-free VV-ECMO run of 15 days.DiscussionThis highlights an innovative approach to a rare but successful pediatric VV-ECMO run without systemic AC in conjunction with regional AC for CKRT.ConclusionAlterations to ECMO circuitry including high flow rates and regional anticoagulation may liberalize candidacy for children with hemorrhage.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1311-1316"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432330","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":"Prediction of primary graft dysfunction and survival in heart transplantation using normothermic ex-vivo perfusion of the donor heart.","authors":"Julius Borger, Marion Bäuerlein, Michael Berchtold-Herz, Matthias Eschenhagen, Thilo Fleck, Gerd Haimerl, Christoph Benk, Friedhelm Beyersdorf, Martin Czerny, Sven Maier, David Schibilsky","doi":"10.1177/02676591251413738","DOIUrl":"10.1177/02676591251413738","url":null,"abstract":"<p><p>IntroductionEx vivo perfusion (EVP) in heart transplantation (HTX) enables transportation of explanted organs over longer distances as well as monitoring of cardiac metabolism under unloaded coronary perfusion, thereby expanding the possible pool of suitable donors for HTX. We aimed at identifying possibly modifiable risk factors predicting impaired outcome after HTX through analysis of perfusion parameters, donor and recipient characteristics.MethodsWe included 64 patients after HTX using EVP (TransMedics Organ Care System) between February 2010 and October 2022 in this retrospective, single-center analysis. Blood gas analyses were taken during EVP in a standardized manner.ResultsHTX recipients were 44.8 ± 16.2 years old, six patients being younger than 18 years at the time of transplantation. High urgency listing status was present in 79.7%, and 67.2% had previous cardiac surgery. Lower base excess during EVP predicted severe primary graft dysfunction (PGD) (-5.55 ± 1.95 vs -3.94 ± 2.38 mmol/L, <i>p</i> = 0.043). With every additional minute of warm ischemia, the risk of PGD was 3.7% higher (OR 1.037, 95% CI [1.004; 1.072], <i>p</i> = 0.028). Low donor serum potassium (3.4 ± 0.76 mmol/L vs 4.2 ± 0.60, <i>p</i> = 0.008), high glucose after EVP priming (207.63 ± 99.05 mg/dL vs 146.45 ± 51.99, <i>p</i> = 0.045), and resuscitation of the donor (55.6% vs 18.2%, <i>p</i> = 0.027) were associated with impaired survival after HTX.ConclusionsEVP provides a unique method to assess graft function during the retrieval of hearts for cardiac transplantation. Low base excess, priming glucose, warm ischemia and donor hypokalaemia influence the frequency of adverse outcomes after HTX. Future studies may address possible strategies to safely modify these risk factors.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1223-1230"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946705","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":"Extracorporeal membrane oxygenation in children with mediastinal masses from malignancy: A multicenter sub-analysis.","authors":"Nancy Chung, Sarah Nelin, Andrea Ontaneda, James Thomas, Michael C Mowrer, Saad Ghafoor, Rohit Nair, Agnes Reschke, Lakshmi Raman, Saleh Bhar","doi":"10.1177/02676591251407292","DOIUrl":"10.1177/02676591251407292","url":null,"abstract":"<p><p>BackgroundMediastinal masses in children secondary to malignancy can cause significant airway and great vessel compression, leading to respiratory and cardiovascular compromise. Extracorporeal membrane oxygenation (ECMO) has been described as a bridge to diagnosis and treatment for masses causing cardiopulmonary instability.ObjectivesTo evaluate outcomes of pediatric oncologic patients requiring ECMO for mediastinal masses.MethodsWe conducted a sub-analysis of a previously published multicenter cohort study examining ECMO outcomes in pediatric hematologic and oncologic patients from 2009 to 2021. Patients less than 19 whose disease presented as a mediastinal mass were included. Presenting features, ECMO characteristics, and outcomes were analyzed.ResultsEleven patients with mediastinal masses were identified, 7 with solid tumors and 4 with hematologic malignancies. The indications for ECMO were combined cardiac and respiratory failure in 64%, respiratory failure in 27%, and cardiac failure in 9%. ECMO survival was 72% (8/11), and survival to hospital discharge was 45% (5/11). Upon separation into solid tumor and hematologic malignancy groups, the ECMO survival was 71% (5/7) and 75% (3/4), and survival to hospital discharge was 29% (2/7) and 75% (3/4), respectively. Patients with solid tumors had longer intensive care unit (ICU) lengths of stay (LOS) and hospital LOS.ConclusionsOur study supports ECMO cannulation for patients with mediastinal masses secondary to hematologic malignancies that require advanced cardiopulmonary support. However, due to poorer outcomes in solid tumors, ECMO candidacy should be carefully considered in this population.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1142-1148"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of veno-pulmoarterial ECMO to manage differential oxygenation in a lung transplant candidate.","authors":"Ryo Fujimoto, Asad Usman, Salim Olia, Audrey Spelde, Paulo Gregorio, Zane Mazur, Thomas Richards, Maria Crespo, Christian A Bermudez","doi":"10.1177/02676591251394852","DOIUrl":"10.1177/02676591251394852","url":null,"abstract":"<p><p>A 44-year-old male with pulmonary sarcoidosis related interstitial lung disease and pulmonary hypertension was admitted for pre-transplant evaluation. During hospitalization, he developed cardiac arrest due to worsening respiratory failure and was immediately placed on veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). Despite initial improvement, he developed differential oxygenation, which was managed by converting the support to veno-venoarterial (VVA) ECMO. However, pulmonary artery pressure increased, placing a greater load on the right ventricle, and oxygenation remained inadequate, leading to further optimization of the ECMO settings. The support was switched to veno-pulmoarterial (VPA) ECMO, which improved oxygenation and, through the combined effects of oxygenation and circulatory support, stabilized his condition. After 24 days of ECMO support, the patient underwent successful lung transplantation. His postoperative course was uncomplicated, and he was discharged on postoperative day 32. Over the subsequent 2 years of follow-up, he has remained active, independent of oxygen, and free of functional limitations.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1307-1310"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfusion free Norwood procedure.","authors":"Kevin Charette, Amy Falconer-Harris, Brian Perfette, Kailey Fuegmann, Navriti Sharma, Moore Phillips, Christina Greene, David Mauchley, David M McMullan, Lyubomyr Bohuta","doi":"10.1177/02676591251395163","DOIUrl":"10.1177/02676591251395163","url":null,"abstract":"<p><p>PurposeTo reduce and avoid the use of exogenous blood products for neonates and infants, our center limits the use of packed red blood cells and does not use fresh frozen plasma in our cardiopulmonary bypass (CPB) circuit primes. This practice has resulted in several bloodless neonatal open heart surgical procedures including the entire post operative hospital stays. This case report describes a patient with Hypoplastic Left Heart Syndrome who underwent the Norwood procedure without the use of exogenous blood products. No other report of a bloodless Norwood procedure could be found in the literature.MethodsMiniaturized cardiopulmonary bypass circuitry, including shortened arterial and venous lines, minimized modified ultrafiltration and cardioplegia circuits, low holdup volume vents and autologous bypass circuit priming, was used to preserve adequate oxygen carrying capacity at CPB initiation and during the entire surgical procedure.OutcomeNo exogenous blood products were administered to this patient during their entire hospitalization.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1317-1319"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566132","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":"Protocols for anticoagulation management in pediatric extracorporeal membrane oxygenation: A comparative retrospective study.","authors":"Mirte L Jansen, Nina C Boom, Nienke Schalij, Peter Paul Roeleveld, Eelco Van Es, Oliver Karam, Ariane Willems","doi":"10.1177/02676591261416084","DOIUrl":"10.1177/02676591261416084","url":null,"abstract":"<p><p>IntroductionIn children undergoing Extracorporeal Membrane Oxygenation (ECMO), anticoagulation is given to counterbalance the risk of thrombosis. Several laboratory tests are available to monitor heparin, but the ideal method still needs to be determined.MethodsThis retrospective cohort study included all patients under 18 years on ECMO support between 2010 and 2021. At our institution, the test used to monitor unfractionated heparin changed over time, dividing patients into three periods, using either activated clotting time (ACT) (2010-2014), activated partial thromboplastin time (aPTT) (2014-2018) or anti-Xa (2018-2021). The primary objective was to compare the occurrence of hemorrhagic complications. Secondary objectives included thrombotic complications, neurological complications, and survival.ResultsWe included 118 ECMO runs of which 30 ACT-guided, 40 aPTT-guided, and 48 anti-Xa-guided. No statistically significant differences were found in hemorrhagic complications [respectively 46.7% vs. 52.5% vs. 60.4%; <i>p</i> = 0.48], thrombotic complications (<i>p</i> = 0.15), neurological complications (<i>p</i> = 0.13), or 30-days survival (<i>p</i> = 0.84). Duration of ECMO and length of hospital stay were both the shortest in the anti-Xa-guided group (respectively <i>p</i> = 0.02; <i>p</i> = 0.02). During ECMO, the anti-Xa-guided group received a higher unfractionated heparin dose compared to the aPTT- and ACT-guided group [respectively 839 [651-981] vs. 543 [407-692] vs. 330 [223-489] IU/kg d^-1, <i>p</i> < 0.001].ConclusionIn our study, the test or titration method used to guide heparin-dosing in children on ECMO, was not associated with hemorrhagic complications and death. Of note, the dose of unfractionated heparin was significantly higher in the anti-Xa-guided group. Combined testing may be more effective than a single method, more studies are needed to establish the optimal strategy.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1251-1259"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}