Perfusion-Uk最新文献_第8页

CytoSorb® haemoadsorption in high-risk cardiac surgery: A focused review with proposed tiered patient selection. CytoSorb®血液吸附在高危心脏手术中的应用：分级患者选择的重点综述

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2026-05-14 DOI: 10.1177/02676591261452060

Sunil K Ohri

{"title":"CytoSorb® haemoadsorption in high-risk cardiac surgery: A focused review with proposed tiered patient selection.","authors":"Sunil K Ohri","doi":"10.1177/02676591261452060","DOIUrl":"10.1177/02676591261452060","url":null,"abstract":"Cardiopulmonary bypass (CPB) activates a well-characterised systemic inflammatory response that contributes substantially to postoperative morbidity and mortality, particularly in high-risk patient subgroups. CytoSorb® (CytoSorbents Corporation, Princeton, NJ) is a polystyrene-divinylbenzene copolymer haemoadsorption device capable of removing hydrophobic molecules of up to 55 kDa, including pro-inflammatory cytokines, myoglobin, bilirubin, and direct oral anticoagulants (DOACs) from whole blood during CPB. Whilst aggregate meta-analyses have not demonstrated consistent benefit across unselected surgical populations, subgroup analyses and targeted clinical series consistently identify meaningful benefit in high-risk phenotypes: infective endocarditis (IE), complex aortic surgery under hypothermic circulatory arrest, heart transplantation, emergency surgery in patients on antiplatelet or anticoagulant therapy, and patients developing vasoplegia or septic shock. This focused narrative review critically appraises the current evidence base, examines the mechanistic rationale, and proposes a clinically applicable patient-selection framework to guide rational integration of CytoSorb® into high-risk cardiac surgical practice. Regulatory considerations including the recent United States Food and Drug Administration (FDA) De Novo denial for the related DrugSorb-ATR device are discussed in context.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"829-836"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943486","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}

引用次数: 0

Outcomes of robotically-assisted aortic valve surgery: A systematic review. 机器人辅助主动脉瓣手术的结果：系统综述。

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2026-03-30 DOI: 10.1177/02676591261439577

Hon Fung Alvin Leung, Yssela Erquiaga, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra

{"title":"Outcomes of robotically-assisted aortic valve surgery: A systematic review.","authors":"Hon Fung Alvin Leung, Yssela Erquiaga, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra","doi":"10.1177/02676591261439577","DOIUrl":"10.1177/02676591261439577","url":null,"abstract":"IntroductionAortic valve disease is a noteworthy public health burden, with aortic valve surgery commonly being used to treat the condition. While aortic valve surgery is traditionally performed using an open approach involving median sternotomy, less invasive surgical methods have been developed over the years as an endeavour to improve surgical outcomes, such as the incorporation of robotic assistance. However, information and research regarding robotically-assisted aortic valve surgery remains scarce.MethodsThrough this original systematic review, which is the first of its kind, the outcomes of robotically-assisted aortic valve surgery were investigated. Ultimately, 26 papers involving a total of 362 cases were included in this study. Data items that directly relate to surgical outcomes were comprehensively recorded and tabulated. ResultsAnalyses of the data demonstrated that robotically-assisted aortic valve surgery is a feasible procedure with apparent safety and a relatively low risk for complications and adverse events. However, the level of existing evidence remains low due to several limitations including a lack of existing literature and potential publication bias.ConclusionTo accurately determine the safety profile of robotically-assisted aortic valve surgery and make meaningful comparisons between the procedure and other alternatives, future large-scale, multicenter cohort studies with comparators, or ideally randomised controlled trials followed by a meta-analysis of the results should be performed.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"850-859"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576363","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}

引用次数: 0

Integrating a chatbot into simulation-based perfusion training: A pilot randomized controlled trial. 将聊天机器人集成到基于模拟的灌注训练中：一项先导随机对照试验。

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2025-11-04 DOI: 10.1177/02676591251394841

Ashton Warlick, Chandler Clifton, Thuc Trinh, Ramandeep Kaur, Allison Weinberg, Julie Collins

{"title":"Integrating a chatbot into simulation-based perfusion training: A pilot randomized controlled trial.","authors":"Ashton Warlick, Chandler Clifton, Thuc Trinh, Ramandeep Kaur, Allison Weinberg, Julie Collins","doi":"10.1177/02676591251394841","DOIUrl":"10.1177/02676591251394841","url":null,"abstract":"PurposeChatbots have enhanced student engagement and learning outcomes in education. Simulation-based training is critical in perfusion education, providing risk-free environments for skill mastery and clinical readiness. This research aimed to assess whether a chatbot (PerfusionPal) impacted students' learning outcomes.MethodsThis pilot randomized, controlled trial, conducted in 2024, included 21 university students enrolled in the Cardiovascular Perfusion Master's Program. Students were randomly assigned to the experimental group, receiving the PerfusionPal intervention, or the control group, without PerfusionPal. Two simulated scenarios were utilized. The primary outcome was pre-simulation and post-simulation assessment scores.ResultsIn simulation 1, there were no significant differences between the control and experimental groups in pre- and post-simulation assessment scores (p = 0.539 and p = 0.276, respectively), completion time (p = 0.197), or the number of reservoir checks (p = 0.072). However, the experimental group had significantly longer average times between reservoir checks compared to the control group (p = 0.036). In simulation 2, no significant differences were found in pre- and post-simulation assessment scores (p = 0.832 and p = 0.605, respectively), completion time (p = 0.350), or number of reservoir checks (p = 0.061). The experimental group showed significantly higher average times between reservoir checks (p = 0.043).ConclusionThis pilot study found that although the PerfusionPal chatbot did not significantly improve assessment scores or simulation performance, it influenced reservoir monitoring. More research is needed to optimize its integration into simulation training and to assess its feasibility and generalizability.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"886-892"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446330","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}

引用次数: 0

Unsupervised machine learning to explore inflammation following cardiopulmonary bypass. 无监督机器学习探索体外循环后的炎症。

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2025-08-27 DOI: 10.1177/02676591251372507

Enrico Squiccimarro, Roberto Lorusso, Paolo Vetuschi, Michela Rauseo, Gianluca Paternoster, Giuseppe Speziale, Richard P Whitlock, Domenico Paparella

{"title":"Unsupervised machine learning to explore inflammation following cardiopulmonary bypass.","authors":"Enrico Squiccimarro, Roberto Lorusso, Paolo Vetuschi, Michela Rauseo, Gianluca Paternoster, Giuseppe Speziale, Richard P Whitlock, Domenico Paparella","doi":"10.1177/02676591251372507","DOIUrl":"10.1177/02676591251372507","url":null,"abstract":"IntroductionCardiac surgery with cardiopulmonary bypass (CPB) often induces systemic inflammatory reaction syndrome (SIRS), affecting postoperative outcome. We aimed to explore adaptive/maladaptive inflammation using unsupervised machine learning.MethodsWe conducted a post hoc analysis of 1908 adult patients who underwent elective cardiac surgery with CPB between June 2016 and June 2020 at a single institution. Patients were assessed for SIRS 12 hours post-surgery and clustered using the partitioning around medoids (PAM) algorithm based on Gower distance. The influence of SIRS on a composite outcome comprising death, stroke/TIA, renal replacement therapy, reoperation for bleeding, mechanical circulatory support, and ICU stay >96 hours was analyzed via multivariable logistic regression.ResultsSIRS occurred in 28.7% of patients (median age 69 years; 68.7% male). Clustering revealed two subgroups: maladaptive SIRS (52.9%) with higher preoperative risk and worse outcomes, and adaptive SIRS (47.1%) with favorable outcomes. Maladaptive SIRS patients had higher 30-day mortality (21.7% vs 1.6%, p < .001). Adaptive SIRS patients had outcomes similar to SIRS-negative controls. In selected clusters, SIRS was independently associated with a lower risk of the composite outcome (OR 0.44; 95% CI 0.26-0.74, p = .002).ConclusionUnsupervised machine learning effectively identifies adaptive and maladaptive SIRS in cardiac surgery patients, providing a basis for personalized postoperative care. Several clinical and procedural factors associated with maladaptive SIRS may be modifiable, supporting future precision strategies to reduce harmful inflammation after cardiac surgery.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1042-1054"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976574","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}

引用次数: 0

Erector spinae plane block facilitating rapid weaning in an anticoagulated V-V ECMO patient with chest trauma. 直立脊柱平面阻滞促进胸腔外伤抗凝V-V ECMO患者快速脱机。

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2025-09-06 DOI: 10.1177/02676591251377577

Rohit P Silhi, Chris Langrish, Luigi Camporota

引用次数: 0

Flow monitoring of venovenous and venoarterial ECMO to detect circuit obstructions using hemodynamic modeling. 应用血流动力学模型对静脉-静脉-动脉ECMO进行血流监测以检测电路阻塞。

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2025-10-16 DOI: 10.1177/02676591251389786

Ruth White, Srivats Sarathy, Aditya Badheka, Joseph W Turek, Madhavan L Raghavan, Venkat Keshav Chivukula

{"title":"Flow monitoring of venovenous and venoarterial ECMO to detect circuit obstructions using hemodynamic modeling.","authors":"Ruth White, Srivats Sarathy, Aditya Badheka, Joseph W Turek, Madhavan L Raghavan, Venkat Keshav Chivukula","doi":"10.1177/02676591251389786","DOIUrl":"10.1177/02676591251389786","url":null,"abstract":"IntroductionCurrent extracorporeal membrane oxygenation (ECMO) monitoring methods for circuit obstructions have limitations. In this study, we test the hypothesis that changes in flow in a pre-existing shunt tubing of the ECMO circuit can be used as a predictor of obstructions for both venovenous (V-V) and venoarterial ECMO (V-A ECMO) circuits using a computational hemodynamic model.MethodsA custom computational hemodynamic model (CHM) representing the blood flow within the V-A ECMO and V-V ECMO circuit and native cardiovascular system was developed for a hemodynamic parametric analysis. Several degrees of obstructions within the oxygenator and outlet cannula were simulated, and the flow in the ECMO circuit and shunt was monitored to assess its sensitivity to circuit obstructions. Over 500 cases were analyzed to investigate various clinically-relevant levels of ECMO support (2 - 5.5 L/min).ResultsOur model demonstrated that shunt flow changed linearly with increasing oxygenator obstruction for all oxygenator obstruction scenarios tested, which matched experimental data. Similar relationships were also seen for all outflow cannula obstructions.ConclusionsThe findings are consistent with our hypothesis, indicating the sensitivity of the shunt flow rate as a predictor of ECMO circuit obstructions for both V-A and V-V ECMO circuits. The data supports that shunt flow responds to hemodynamic changes throughout the ECMO-patient circuit and thus can be used as an early indicator for ECMO system obstructions regardless of V-A or V-V ECMO setup, indicating its robustness as an early warning indicator of ECMO system obstructions.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"917-927"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309791","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}

引用次数: 0

Is body mass index associated with hypoxic-ischemic brain injury risk in extracorporeal cardiopulmonary resuscitation? 体外心肺复苏中体重指数与缺氧缺血性脑损伤风险相关吗？

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2025-10-31 DOI: 10.1177/02676591251394847

Shi Nan Feng, Jin Kook Kang, Winnie L Liu, Christopher J Wilcox, Bo Soo Kim, Patricia Brown, Glenn J R Whitman, Sung-Min Cho

{"title":"Is body mass index associated with hypoxic-ischemic brain injury risk in extracorporeal cardiopulmonary resuscitation?","authors":"Shi Nan Feng, Jin Kook Kang, Winnie L Liu, Christopher J Wilcox, Bo Soo Kim, Patricia Brown, Glenn J R Whitman, Sung-Min Cho","doi":"10.1177/02676591251394847","DOIUrl":"10.1177/02676591251394847","url":null,"abstract":"AimTo characterize the impact of BMI (body mass index) on HIBI (hypoxic-ischemic brain injury) in patients receiving ECPR, with the hypothesis that elevated BMI is associated with increased risk of HIBI.MethodsThe Extracorporeal Life Support Organization (ELSO) registry was queried for patients who received ECPR during 2020-2024. Patients were categorized into 5 standard BMI groups. Normal Weight was used as the reference group. Generalized additive model (GAM) analysis was performed to identify the BMI range with greatest predicted HIBI risk. Multivariable logistic regression was used to compare odds of HIBI and post-HIBI mortality between standard BMI groups and Normal Weight.ResultsOf 6413 included patients (median age = 57.4, 68.6% male, median BMI = 28.1), 10.5% of Class 1 Obesity patients experienced HIBI compared to 5.0% of Normal Weight patients, 9.6% of Class 2 Obesity patients, 6.3% of Overweight patients, and 3.6% of Underweight patients (p < 0.001). GAM analysis showed a non-linear relationship between BMI and HIBI with highest predicted HIBI risk for Class 1 Obesity patients, which was confirmed by multivariable regression (adjusted odds ratio (aOR) = 1.86, 95%CI = 1.09, 3.20, p = 0.02). HIBI led to >90% mortality in all BMI categories, with increased odds of post-HIBI mortality for Class 1 Obesity patients compared to Normal Weight (aOR = 1.97, 95%CI = 1.14, 3.47, p = 0.016). There was no significant difference in odds of HIBI or post-HIBI mortality for any other BMI category compared to Normal Weight.ConclusionsECPR patients with Class 1 Obesity had increased odds of HIBI and post-HIBI mortality compared to Normal Weight patients after adjusting for covariates.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"893-899"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422927","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}

引用次数: 0

The treatment of status asthmaticus in the intensive care unit: A narrative review. 重症监护室状态哮喘的治疗：叙述性回顾。

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2026-03-24 DOI: 10.1177/02676591261438969

Andrew A Alberter, Eric W Robbins, Taylor Miller, Matthew J Mackin, Erin Niles, Elizabeth K Powell

引用次数: 0

The TEG6s-Derived R ratio accurately reflects the anti-Xa level after cardiac surgery: A proof-of-concept study. teg6s衍生R比值准确反映心脏手术后抗xa水平：一项概念验证研究。

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2025-10-09 DOI: 10.1177/02676591251388353

Takahiro Tamura, Tatsuro Yokoyama

{"title":"The TEG6s-Derived R ratio accurately reflects the anti-Xa level after cardiac surgery: A proof-of-concept study.","authors":"Takahiro Tamura, Tatsuro Yokoyama","doi":"10.1177/02676591251388353","DOIUrl":"10.1177/02676591251388353","url":null,"abstract":"IntroductionIn the postoperative intensive care setting after cardiac surgery with cardiopulmonary bypass (CPB), particularly in patients requiring continued anticoagulation for prosthetic devices such as mechanical valves or extracorporeal support, unfractionated heparin (UFH) is commonly monitored using the activated partial thromboplastin time (aPTT). However, it may inadequately reflect anticoagulant activity in critically ill patients. The TEG6s system is a viscoelastic testing platform that enables bedside coagulation monitoring. This proof-of-concept study aimed to evaluate the utility of TEG6s-derived indices for estimating the anti-Xa level following CPB.MethodsWe prospectively enrolled 131 adult patients undergoing elective cardiac or aortic surgery with CPB. Paired blood samples were collected at intensive care unit admission and 4 h later. Heparin concentrations were measured using a chromogenic anti-Xa assay. Thromboelastography (TEG) parameters including the reaction times for the citrated kaolin without and with heparinase assays and their ratio (R ratio) and difference were obtained. Their correlations with the anti-Xa level were assessed using Pearson's and Spearman's analyses. Linear and polynomial regression models were used to evaluate predictive performance.ResultsThe R ratio and reaction time difference showed strong correlations with the plasma anti-Xa level (r = 0.738 and r = 0.733, respectively; p < 0.001). These correlations were comparable to that of the aPTT ratio (r = 0.813). The second-order polynomial regression model using the R ratio had the highest predictive accuracy (R2 = 0.584, root mean square error = 0.134).ConclusionsThe R ratio may be a supplementary indicator of a residual heparin effect, particularly in cases with discordant aPTT findings.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"937-946"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259420","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}

引用次数: 0

Renal vein congestion aggravates renal injury associated with cardiopulmonary bypass. 肾静脉充血加重体外循环相关肾损伤。

IF 1.3 4区医学

Perfusion-Uk Pub Date : 2026-09-01 Epub Date: 2025-12-18 DOI: 10.1177/02676591251407307

Yi He, Lanxin Hu, Lei Wang, Duanqi Zhu, Xinyi Bu, Hongwei Shi, Lihai Chen, Yali Ge

{"title":"Renal vein congestion aggravates renal injury associated with cardiopulmonary bypass.","authors":"Yi He, Lanxin Hu, Lei Wang, Duanqi Zhu, Xinyi Bu, Hongwei Shi, Lihai Chen, Yali Ge","doi":"10.1177/02676591251407307","DOIUrl":"10.1177/02676591251407307","url":null,"abstract":"BackgroundElevated central venous pressure during cardiac surgery can lead to increased renal venous pressure, subsequently resulting in renal insufficiency. However, there is a lack of animal models available for studying this phenomenon. Therefore, we have successfully established a rat model of renal vascular congestion under cardiopulmonary bypass (CPB), providing a solid foundation for further investigations into the potential mechanisms underlying acute kidney injury (AKI) caused by renal hyperemia.Materials and methodsLigation of the inferior vena cava between the renal veins of male SD rats resulted in hyperemia only in the left kidney. The left and right kidney control was formed under CPB and the left renal vein pressure was monitored. Six hours after operation, two kidneys were analyzed by molecular and histological techniques. The degree of tubulointerstitial injury, inflammatory infiltration, expression of inflammatory factors and molecular damage substances were evaluated in kidneys with and without venous stasis.ResultHistological examination showed that the left kidney, which received the intervention, exhibited congested renal tubules formed protein tubules and dilated. In addition, there were inflammatory cell infiltration in the interstitium and edema and necrosis in the local renal tubules. The right kidney, which did not receive the intervention, also showed similar changes, but the damage is mild. Immunohistochemistry showed that the expression of IL-6, IL-10 and KIM-1 in the left kidney was higher than that in the right kidney. Moreover, western blotting showed that the expression of KIM-1 and TNF-αin the left kidney was higher than that in the right kidney.ConclusionRenal vein congestion not only exacerbated structural damage to the kidneys in rats but also intensified the inflammatory response during CPB.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"870-878"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776205","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}

引用次数: 0