Pubblicazioni recenti - cardiopulmonary bypass
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Epicardial cavernous haemangioma; A case report of a unique incidental finding.
Eur Heart J Case Rep2024 Apr;8(4):ytae146. doi: 10.1093/ehjcr/ytae146.
Cheaban Rayan, Piran Misagh, Opacic Dragan, Gummert Jan F, Rojas Sebastian V,
Abstract
BACKGROUND:
Primary cardiac tumours are rare, accounting for only 0.002-0.03% at autopsy. Cardiac haemangiomas are benign vascular tumours and constitute for 0.28% of all primary cardiac tumours. Cavernous haemangiomas, capillary haemangiomas, and arteriovenous haemangiomas are three distinct types. Cardiac haemangiomas are often misdiagnosed as myxomas and must be differentiated from malignant angiosarcomas.
CASE SUMMARY:
We present a 44-year-old Mediterranean male patient with a cavernous haemangioma in the inferior vena cava and right atrium, detected on transthoracic echocardiography. The patient experienced palpitations and dyspnoea on exertion. Computed tomography (CT) angiography revealed a 7.5 × 6 × 5?cm mass suspected to be perfused by the distal right coronary artery. A watch-and-wait approach was suggested, leading to a cardiac magnetic resonance imaging (MRI) with contrast 6 months later. T mapping exhibited a prolonged relaxation time and isointensity to the myocardium. T mapping revealed a homogenous hyperintense mass with heterogenous late enhancement. Surgical excision was performed using a bicaval cannulation technique on cardiopulmonary bypass. Intraoperatively, no connection to the coronaries was noted. At 1 year follow-up, the patient reported restored physical resilience, with no evidence of tumour recurrence.
DISCUSSION:
Clinical symptoms of cardiac cavernous haemangiomas are unspecific and become evident once the tumour grows. To investigate the nature and vascular involvement of the tumour, a contrast-enhanced CT angiography or MRI can be performed. Cardiac haemangiomas are often misdiagnosed and must be differentiated from malignant angiosarcomas. Clear guidelines for the treatment of cardiac haemangiomas in adult patients are lacking. Primary cardiac tumours require thorough investigation, and surgical intervention should be tailored to the individual's case.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Congenital Absence of Pericardium: A Case Report and Technical Considerations in Cardiac Surgery.
Cureus2024 Mar;16(3):e56885. doi: 10.7759/cureus.56885.
Balaji Ayush, Makam Rishab, Hussein Nabil, Loubani Mahmoud,
Abstract
This case report describes a rare instance of left-sided congenital pericardial agenesis (CPA) encountered during coronary artery bypass grafting (CABG) in a 77-year-old male. In this unique case, the presence of an unusual strip of left pericardium containing the phrenic nerve posed significant surgical challenges. Special attention was required for the graft lay, ensuring adequate filling of the heart during assessment before closure, as well as emphasis on the need for generous graft length. Additionally, the evaluation of graft positioning prior to cardiopulmonary bypass was crucial. Despite these complexities, CABG was successfully performed with no complications to note. This case underscores the importance of adaptability in surgical technique to manage the unique challenges posed by CPA, leading to a positive outcome despite the atypical cardiac anatomy.
Copyright © 2024, Balaji et al.
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Acute Dapagliflozin Administration Ameliorates Cardiac Surgery-Associated Acute Kidney Injury in a Rabbit Model.
Circ J2024 Apr;():. doi: 10.1253/circj.CJ-23-0864.
Matsuda Kensaku, Mitsuo Hiroshi, Nishijima Takuya, Uchiyama Hikaru, Nita Tobuhiro, Matsunaga Shogo, Fujimoto Noriko, Ushijima Tomoki, Ando Yusuke, Kan-O Meikun, Shinohara Gen, Kimura Satoshi, Sonoda Hiromichi, Shiose Akira,
Abstract
BACKGROUND:
?Several studies have shown that sodium-glucose cotransporter-2 inhibitors have a renoprotective effect on acute kidney injury (AKI), but their effect on cardiac surgery-associated AKI is unknown.Methods?and?Results: ?AKI was induced in 25 rabbits without diabetes mellitus by cardiopulmonary bypass (CPB) for 2?h and they were divided into 5 groups: sham; dapagliflozin-treated sham; CPB; dapagliflozin-treated CPB; and furosemide-treated CPB (n=5 in each group). Dapagliflozin was administered via the femoral vein before initiating CPB. Kidney tissue and urine and blood samples were collected after the surgical procedure. There were no differences in the hemodynamic variables of each group. Dapagliflozin reduced serum creatinine and blood urea nitrogen concentrations, and increased overall urine output (all P
CONCLUSIONS:
?Acute intravenous administration of dapagliflozin protects against CPB-induced AKI. Dapagliflozin may have direct renoprotective effects in renal tubular cells.
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Angiotensin Receptor-Neprilysin Inhibitor Suppresses Renin-Angiotensin-Aldosterone System Activation After Cardiac Surgery Using Cardiopulmonary Bypass.
Circ J2024 Apr;():. doi: 10.1253/circj.CJ-23-0879.
Hoshino Joji, Saito Shunsuke, Shibasaki Ikuko, Sairenchi Toshimi, Okubo Shohei, Matsuoka Taiki, Hirota Shotaro, Yokoyama Shohei, Kanazawa Yuta, Tezuka Masahiro, Takei Yusuke, Tsuchiya Go, Konishi Taisuke, Ogata Koji, Fukuda Hirotsugu,
Abstract
BACKGROUND:
Sacubitril/valsartan, being both a neprilysin inhibitor and angiotensin receptor blocker, exhibits a renin-angiotensin-aldosterone system (RAAS) inhibitory effect. However, no study has investigated the administration of sacubitril/valsartan in patients early after surgery using cardiopulmonary bypass.Methods?and?Results: This was a prospective observational study of 63 patients who underwent open heart surgery and were treated with sacubitril/valsartan. No serious adverse events occurred. Among the 63 patients, sacubitril/valsartan was discontinued in 13 due to hypotension (n=10), renal dysfunction (n=2), and dizziness (n=1). Atrial natriuretic peptide concentrations increased significantly from Day 3 of treatment (P=0.0142 vs. Postoperative Day 1) and remained high thereafter. In contrast, plasma renin activity was significantly suppressed from Day 3 onwards (P=0.00206 vs. Postoperative Day 1). A decrease in creatinine concentrations and an increase in the estimated glomerular filtration rate were observed on Day 3; this improvement in renal function was not observed in the historical control group, in which patients did not receive sacubitril/valsartan. New postoperative atrial fibrillation was less frequent in the study group compared with the historical control (12.7% vs. 38.0%; P=0.0034).
CONCLUSIONS:
Sacubitril/valsartan administration was safe immediately after open heart surgery in patients without postoperative hypotension. It enhanced serum atrial natriuretic peptide concentrations and suppressed RAAS activation.
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Effects of dexmedetomidine on renal function after cardiac surgery for infective endocarditis: An interim analysis of a randomized controlled trial.
Asian J Surg2024 Apr;():. doi: S1015-9584(24)00688-2.
Ham Sung Yeon, Shim Jae-Kwang, Lee Sak, Ko Seo Hee, Soh Sarah, Kwak Young-Lan,
Abstract
BACKGROUND:
Patients undergoing cardiac surgery for infective endocarditis (IE) are at a high risk of postoperative acute kidney injury (AKI) owing to heightened systemic inflammation. Therefore, we aimed to investigate the effect of dexmedetomidine on postoperative AKI in patients who underwent cardiac surgery for IE.
METHODS:
A total of 63 patients who underwent cardiac surgery for IE were randomly assigned to receive either intravenous dexmedetomidine infusion of 0.4 ?g kg h (DEX group) or normal saline infusion (control group) for 24 h after induction of anesthesia. The occurrence of AKI within seven days postoperation, epinephrine, norepinephrine, and interleukin-6 levels, as well as postoperative morbidities, were assessed. An intertrim analysis was conducted using Pocock's alpha spending function at ? = 0.05 and ? = 0.2.
RESULTS:
This trial was early terminated according to the results of interim analysis performed when 60 % of the pre-set number of patients have been collected. The incidence of AKI was significantly lower in the DEX group than in the control group (32.3 % vs. 9.4 %, p = 0.025). Patients in the DEX group had significantly lower epinephrine levels than those in the control group, whereas norepinephrine and interleukin-6 levels were similar. Perioperative mean arterial pressure or heart rate did not differ between the groups.
CONCLUSIONS:
Dexmedetomidine administration for 24 h starting from induction of anesthesia significantly reduced the incidence of postoperative AKI after cardiac surgery for IE (by 29 % vs. control) without hemodynamic side effects. This was accompanied by a significant attenuation of postoperative increase in serum epinephrine levels.
Copyright © 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Published by Elsevier B.V. All rights reserved.
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Single Center Prospective Study of Cross-Clamp versus Balloon Occlusion in Robotic Mitral Surgery.
Ann Thorac Surg2024 Apr;():. doi: S0003-4975(24)00291-1.
Ergi Defne Gunes, Rowse Phillip G, Daly Richard C, Crestanello Juan A, Schaff Hartzell V, Dearani Joseph A, Todd Austin, Arghami Arman,
Abstract
BACKGROUND:
Both transthoracic aortic cross-clamp and endoaortic balloon occlusion have been shown to have comparable safety profiles for aortic occlusion. Since most surgeons use only one technique, we sought to compare the outcomes when a homogeneous group of surgeons changed their occlusion technique from aortic cross-clamp to balloon occlusion.
METHODS:
We changed our technique from aortic cross-clamp to balloon occlusion in November 2022. This allowed us to conduct a prospective treatment comparison study in the same group of surgeons. Propensity score matching (PSM) was used to match cases(balloon occlusion) 1:3 to controls (aortic cross-clamp) based on age, gender, body mass index, concomitant maze, and tricuspid valve repair.
RESULTS:
Total of 411 patients underwent robotic mitral surgery from 2020 through 2023. Using PSM, 56 balloon occlusion patients were matched to 168 aortic cross-clamp patients. Median age was 65 years (interquartile range[IQR],55.6-70.0) and the majority were males(n=119,53%). All valves were successfully repaired. Balloon occlusion had a shorter median cardiopulmonary bypass (CPB) time compared to aortic cross-clamp (84.0 vs. 94.5 min,p=0.006). Median cross-clamp time (64.0 vs. 64.0 min,p=0.483) and total surgery time (5.9 vs. 6.1 hours,p=0.495) did not differ between groups. There was no in hospital death. There were five surgeons who performed various combinations of console and bedside roles. CPB, cross-clamp, and surgery durations were not significantly affected by the different surgeon combinations.
CONCLUSIONS:
Compared to aortic cross-clamp, balloon occlusion has similar perioperative and early postoperative outcomes. Additionally, it likely introduces a 10-minute reduction in total CPB time.
Copyright © 2024. Published by Elsevier Inc.
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Remote ischemic preconditioning and cognitive dysfunction following coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials.
Saudi J Anaesth2024 ;18(2):187-193. doi: 10.4103/sja.sja_751_23.
Siburian Reynold, Fadillah Rizki, Altobaishat Obieda, Umar Tungki Pratama, Dilawar Ismail, Nugroho Dimas Tri,
Abstract
INTRODUCTION:
Postoperative cognitive dysfunction (POCD) is a common neurological issue following cardiopulmonary bypass (CPB)-assisted heart surgery. Remote ischemic preconditioning (RIPC) increases the tolerance of vital organs to ischemia/reperfusion injury, leading to reduced brain injury biomarkers and improved cognitive control. However, the exact mechanisms underlying RIPC's neuroprotective effects remain unclear. This systematic review aimed to explore the hypothesis that RIPC lowers neurocognitive dysfunction in patients undergoing CPB surgery.
METHOD:
All relevant studies were searched in PubMed, ScienceDirect, EBSCOhost, Google Scholar, Semantic Scholar, Scopus, and Cochrane Library database. Assessment of study quality was carried out by two independent reviewers individually using the Cochrane Risk of Bias (RoB-2) tool. Meta-analysis was performed using a fixed-effect model due to low heterogeneity among studies, except for those with substantial heterogeneity.
RESULTS:
A total of five studies with 1,843 participants were included in the meta-analysis. RIPC was not associated with reduced incidence of postoperative cognitive dysfunction (five RCTs, odds ratio [OR:] 0.79, 95% confidence interval [CI]: 0.56-1.11) nor its improvement (three RCTs, OR: 0.80, 95% CI: 0.50-1.27). In addition, the analysis of the effect of RIPC on specific cognitive function tests found that pooled SMD for RAVLT 1-3 and RAVLT LT were -0.07 (95% CI: -0.25,012) and -0.04 (95% CI: -0.25-0.12), respectively, and for VFT semantic and phonetic were -0.15 (95% CI: -0.33-0.04) and 0.11 (95% CI: -0.40-0.62), respectively.
CONCLUSION:
The effect of RIPC on cognitive performance in CABG patients remained insignificant. Results from previous studies were unable to justify the use of RIPC as a neuroprotective agent in CABG patients.
Copyright: © 2024 Saudi Journal of Anesthesia.
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Intraoperative central venous pressure during cardiopulmonary bypass is an alternative indicator for early prediction of acute kidney injury in adult cardiac surgery.
J Cardiothorac Surg2024 Apr;19(1):262. doi: 10.1186/s13019-024-02734-7.
Wang Lei, Hu Lanxin, Yan Dai Qiong, Qi HaoYu, Wang ZhenHong, Chen Xin,
Abstract
BACKGROUND:
The relationship between venous congestion in cardiopulmonary bypass (CPB) and acute kidney injury (AKI) in cardiac surgery has not utterly substantiated. This study aimed at investigate the relationship between CVP in CPB and the occurrence of AKI.
METHODS:
We retrospectively reviewed 2048 consecutive patients with cardiovascular disease undergoing cardiac procedure with CPB from January 2018 to December 2022. We used the median CVP value obtained during CPB for our analysis and patients were grouped according to this parameter. The primary outcomes were AKI and renal replacement therapy(RRT). Multivariable logistic regression was used to explore the association between CVP and AKI.
RESULTS:
A total of 2048 patients were enrolled in our study and divided into high CVP group (CVP???6.5 mmHg) and low CVP group (CVP?6.5 mmHg) according to the median CVP value. Patients in high CVP group had the high AKI and RRT rate when compared to the low CVPgroup[(367/912,40.24%)vs.(408/1136,35.92%),P?=?0.045;(16/912,1.75%vs.9/1136;0.79%), P?=?0.049]. Multivariate logistic regression analysis displayed CVP played an indispensable part in development of renal failure in surgical.
CONCLUSIONS:
Elevated CVP(??6.5mmHOmmHg) in CPB during cardiac operation is associated with an increased risk of AKI in cardiovascular surgery patients. Clinical attention should be paid to the potential role of CVP in predicting the occurrence of AKI.
© 2024. The Author(s).
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Perfusion quality odds (PEQUOD) trial: validation of the multifactorial dynamic perfusion index as a predictor of cardiac surgery-associated acute kidney injury.
Eur J Cardiothorac Surg2024 Apr;():. doi: ezae172.
Ranucci Marco, Baryshnikova Ekaterina, Anguissola Martina, Mazzotta Vittoria, Scirea Chiara, Cotza Mauro, Ditta Antonio, de Vincentiis Carlo,
Abstract
OBJECTIVES:
The multifactorial dynamic perfusion index was recently introduced as a predictor of cardiac surgery-associated acute kidney injury. The multifactorial dynamic perfusion index was developed based on retrospective data retrieved from the patient files. The present study aims to prospectively validate this index in an external series of patients, through an on-line measure of its various components.
METHODS:
inclusion criteria were: adult patients undergoing cardiac surgery with cardiopulmonary bypass. Data collection included preoperative factors, and cardiopulmonary bypass-related factors. These were collected on-line using a dedicated monitor. Factors composing the multifactorial dynamic perfusion index are the nadir hematocrit, the nadir oxygen delivery, the time of exposure to a low oxygen delivery, the nadir mean arterial pressure, cardiopulmonary bypass duration, the use of red blood cell transfusions, and the peak arterial lactates.
RESULTS:
200 hundred adult patients were investigated The multifactorial dynamic perfusion index had a good (c-statistics 0.81) discrimination for cardiac surgery-associated acute kidney injury (any stage) and an excellent (c-statistics 0.93) discrimination for severe patterns (stage 2-3). Calibration was modest for cardiac surgery-associated acute kidney injury (any stage) and good for stage 2-3. The use of vasoconstrictors was an additional factor associated with cardiac surgery-associated acute kidney injury.
CONCLUSIONS:
The multifactorial dynamic perfusion index is validated for discrimination of cardiac surgery-associated acute kidney injury risk. It incorporates modifiable risk factors, and may help in reducing the occurrence of cardiac surgery-associated acute kidney injury.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Impact of Clinical and Sociodemographic Factors on Quality of Life Following Coronary Artery Bypass Grafting: A Mixed-Methods Study.
Cureus2024 Mar;16(3):e56781. doi: e56781.
Alzahrani Abdulmajeed A, AlAssiri Abdullah K, Al-Ebrahim Khalid E, Ganbou Zeyad T, Alsudais Meshal M, Khafagy Abdulmajeed M,
Abstract
INTRODUCTION:
Coronary artery bypass grafting (CABG) is an essential surgical management modality for patients with coronary artery disease. Health-related quality of life (HRQoL) has become important because of the significant decrease in the mortality rate associated with CABG. We aimed to explore the factors that affect the quality of life after CABG.
METHODS:
This study used a descriptive correlational design to assess the determinants of HRQoL using the 36-item Short Form Health Survey questionnaire (SF-36). Patients who underwent CABG at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between March 2015 and December 2021 were enrolled in this study. Overall, 275 participants were eligible for our study, of which 84 were found to be valid for analysis. Phone contacts were made directly with the patient after briefly explaining the study. Scores and clinical data were investigated using multivariable linear regression analysis.
RESULTS:
Subscales of role limitations due to physical issues had the lowest mean scores, followed by vitality and general health (57.4 ± 44.7; 60.4 ± 25.6; 64.1 ± 22.6), respectively. However, social functioning (78.9 ± 29.0) and pain (75.1 ± 29.9) had the highest scores of all subscales. A history of congestive heart failure (CHF) was independently associated with lower scores for physical role limitations (p = 0.021), vitality (p = 0.001), general health (p 0.05).
CONCLUSION:
The postoperative decline in HRQoL was attributed to comorbidities such as CHF and PVD, postoperative complications including bleeding and wound infection, as well as unemployment and widowed status. Therefore, choosing the appropriate patients for surgery and post-discharge follow-up may enhance HRQoL.
Copyright © 2024, Alzahrani et al.
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Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study.
J Chest Surg2024 Apr;():. doi: 10.5090/jcs.23.156.
Yoon Tae-Hong, Lee Han Sol, Jang Jae Seok, Cho Jun Woo, Lee Chul Ho,
Abstract
BACKGROUND:
Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions. Emergency surgery is typically performed under cardiopulmonary bypass immediately after diagnosis, which involves lowering the body temperature to induce total circulatory arrest. Selection of the arterial cannulation site is a critical consideration in cardiac surgery and becomes more challenging in patients with AD. This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs).
METHODS:
This retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center.
RESULTS:
Among the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p
CONCLUSION:
Surgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.
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Perioperative serum syndecan-1 concentrations in patients who underwent cardiovascular surgery with cardiopulmonary bypass and its association with the occurrence of postoperative acute kidney injury: a retrospective observational study.
BMC Anesthesiol2024 Apr;24(1):154. doi: 154.
Miyazaki Atsushi, Hokka Mai, Obata Norihiko, Mizobuchi Satoshi,
Abstract
BACKGROUND:
Various factors can cause vascular endothelial damage during cardiovascular surgery (CVS) with cardiopulmonary bypass (CPB), which has been suggested to be associated with postoperative complications. However, few studies have specifically investigated the relationship between the degree of vascular endothelial damage and postoperative acute kidney injury (pAKI). The objectives of this study were to measure perioperative serum syndecan-1 concentrations in patients who underwent CVS with CPB, evaluate their trends, and determine their association with pAKI.
METHODS:
This was a descriptive and case?control study conducted at the National University Hospital. Adult patients who underwent CVS with CPB at a national university hospital between March 15, 2016, and August 31, 2020, were included. Patients who were undergoing preoperative dialysis, had preoperative serum creatinine concentrations greater than 2.0 mg dl, who were undergoing surgery involving the descending aorta were excluded. The perioperative serum syndecan-1 concentration was measured, and its association with pAKI was investigated.
RESULTS:
Fifty-two patients were included. pAKI occurred in 18 (34.6%) of those patients. The serum syndecan-1 concentration increased after CPB initiation and exhibited bimodal peak values. The serum syndecan-1 concentration at all time points was significantly elevated compared to that after the induction of anesthesia. The serum syndecan-1 concentration at 30 min after weaning from CPB and on postoperative day 1 was associated with the occurrence of pAKI (OR?=?1.10 [1.01 to 1.21], P?=?0.03]; OR?=?1.16 [1.01 to 1.34], P?=?0.04]; and the cutoff values of the serum syndecan-1 concentration that resulted in pAKI were 101.0 ng ml (sensitivity?=?0.71, specificity?=?0.62, area under the curve (AUC)?=?0.67 (0.51 to 0.83)) and 57.1 ng ml (sensitivity?=?0.82, specificity?=?0.56, AUC?=?0.71 (0.57 to 0.86)). Multivariate logistic regression analysis revealed that the serum syndecan-1 concentration on postoperative day 1 was associated with the occurrence of pAKI (OR?=?1.02 [1.00 to 1.03]; P?=?0.03).
CONCLUSION:
The serum syndecan-1 concentration at all time points was significantly greater than that after the induction of anesthesia. The serum syndecan-1 concentration on postoperative day 1 was significantly associated with the occurrence of pAKI.
TRIAL REGISTRATION:
This study is not a clinical trial and is not registered with the registry.
© 2024. The Author(s).
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A systematic review of cardiac surgery clinical prediction models that include intra-operative variables.
Perfusion2024 Apr;():2676591241237758. doi: 10.1177/02676591241237758.
Jones Ceri, Taylor Marcus, Sperrin Matthew, Grant Stuart W,
Abstract
BACKGROUND:
Most cardiac surgery clinical prediction models (CPMs) are developed using pre-operative variables to predict post-operative outcomes. Some CPMs are developed with intra-operative variables, but none are widely used. The objective of this systematic review was to identify CPMs with intra-operative variables that predict short-term outcomes following adult cardiac surgery.
METHODS:
Ovid MEDLINE and EMBASE databases were searched from inception to December 2022, for studies developing a CPM with at least one intra-operative variable. Data were extracted using a critical appraisal framework and bias assessment tool. Model performance was analysed using discrimination and calibration measures.
RESULTS:
A total of 24 models were identified. Frequent predicted outcomes were acute kidney injury (9/24 studies) and peri-operative mortality (6/24 studies). Frequent pre-operative variables were age (18/24 studies) and creatinine/eGFR (18/24 studies). Common intra-operative variables were cardiopulmonary bypass time (16/24 studies) and transfusion (13/24 studies). Model discrimination was acceptable for all internally validated models (AUC 0.69-0.91). Calibration was poor (15/24 studies) or unreported (8/24 studies). Most CPMs were at a high or indeterminate risk of bias (23/24 models). The added value of intra-operative variables was assessed in six studies with statistically significantly improved discrimination demonstrated in two.
CONCLUSION:
Weak reporting and methodological limitations may restrict wider applicability and adoption of existing CPMs that include intra-operative variables. There is some evidence that CPM discrimination is improved with the addition of intra-operative variables. Further work is required to understand the role of intra-operative CPMs in the management of cardiac surgery patients.
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Effect of geography on the use of ultrafiltration during cardiac surgery with cardiopulmonary bypass.
Perfusion2024 Apr;():2676591241246080. doi: 10.1177/02676591241246080.
Patel Kirti P, Stammers Alfred H, Tesdahl Eric A, Chores Jeffrey, Beckmann Scott R, Baeza Jennifer, Petterson Craig M, Thompson Ty, Baginski Alexander, Firstenberg Michael, Jacobs Jeffrey P,
Abstract
BACKGROUND:
Ultrafiltration (UF) is a common practice during cardiopulmonary bypass (CPB) where it is used as a blood management strategy to reduce red blood cell (RBC) transfusion, minimize adverse effects of hemodilution, and reduce proinflammatory mediators. However, its clinical utilization has been shown to vary throughout the continents.
PURPOSE:
The purpose of this investigation was to assess the distribution of UF use across the United States.
DATA COLLECTION:
Data on UF use during cardiac surgery was obtained from a national (United States) perfusion database for adult cardiac procedures performed from January 2016 through December 2018.
STUDY SAMPLE:
Four geographical regions were established: Northeast (NE), South (SO), Midwest (MW) and West (WE). The primary endpoint was the use of UF with secondary endpoints UF volume, CPB and anesthesia asanguineous volumes, intraoperative allogeneic RBC transfusion, nadir hematocrit and urine output (UO). 92,859 adult cardiac cases from 191 hospitals were reviewed.
RESULTS:
The NE and the WE had similar usages of UF (59.9% and 59.7% respectively), which were higher than the MW and the SO (38.6% and 34.9%,
CONCLUSIONS:
Across the United States there is geographic variation on the use of UF. Further research is warranted to investigate why these practice variations exist and to better understand and determine their reasons for use.
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Early Impairment of Cerebral Bioenergetics After Cardiopulmonary Bypass in Neonatal Swine.
World J Pediatr Congenit Heart Surg2024 Apr;():21501351241232077. doi: 10.1177/21501351241232077.
Aronowitz Danielle I, Geoffrion Tracy R, Piel Sarah, Benson Emilie J, Morton Sarah R, Starr Jonathan, Melchior Richard W, Gaudio Hunter A, Degani Rinat E, Widmann Nicholas J, Weeks M Katie, Ko Tiffany S, Licht Daniel J, Hefti Marco, Gaynor J William, Kilbaugh Todd J, Mavroudis Constantine D,
Abstract
We previously demonstrated cerebral mitochondrial dysfunction in neonatal swine immediately following a period of full-flow cardiopulmonary bypass (CPB). The extent to which this dysfunction persists in the postoperative period and its correlation with other markers of cerebral bioenergetic failure and injury is unknown. We utilized a neonatal swine model to investigate the early evolution of mitochondrial function and cerebral bioenergetic failure after CPB. Twenty piglets (mean weight 4.4?±?0.5 kg) underwent 3?h of CPB at 34 °C via cervical cannulation and were followed for 8, 12, 18, or 24?h (n?=?5 per group). Markers of brain tissue damage (glycerol) and bioenergetic dysfunction (lactate to pyruvate ratio) were continuously measured in cerebral microdialysate samples. Control animals (n?=?3, mean weight 4.1?±?1.2 kg) did not undergo cannulation or CPB. Brain tissue was extracted immediately after euthanasia to obtain ex-vivo cortical mitochondrial respiration and frequency of cortical microglial nodules (indicative of cerebral microinfarctions) via neuropathology. Both the lactate to pyruvate ratio (?.0001) and glycerol levels (?=?.01) increased in cerebral microdialysate within 8?h after CPB. At 24?h post-CPB, cortical mitochondrial respiration was significantly decreased compared with controls (?=?.046). The presence of microglial nodules increased throughout the study period (24?h) (?=?.01, =?0.9). CPB results in impaired cerebral bioenergetics that persist for at least 24?h. During this period of bioenergetic impairment, there may be increased susceptibility to secondary injury related to alterations in metabolic delivery or demand, such as hypoglycemia, seizures, and decreased cerebral blood flow.
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Impact of postoperative cerebral complications in acute infective endocarditis: a retrospective single-center study.
J Cardiothorac Surg2024 Apr;19(1):254. doi: 254.
Sugiyama Kayo, Watanuki Hirotaka, Tochii Masato, Kai Takayuki, Koiwa Daisuke, Matsuyama Katsuhiko,
Abstract
BACKGROUND:
The treatment of patients with infective endocarditis (IE) who have preoperative cerebral complications remains less understood. Therefore, this study aimed to retrospectively evaluate the clinical outcomes of patients with acute IE based on preoperative intracranial findings.
METHODS:
Of 32 patients with acute IE treated at our hospital between August 2015 and March 2022, 31 patients of whom preoperative intracranial imaging evaluation was available were included in our analysis and compared with those with and without intracranial findings. We controlled the mean arterial blood pressure and activated clotting time (ACT) to prevent abnormally high perfusion pressures and ACTs during cardiopulmonary bypass (CPB). The preoperative background, and postoperative courses focusing on postoperative brain complications were reviewed.
RESULTS:
Among the 31 patients, 20 (65%) had preoperative imaging findings. The group with intracranial findings was significantly older, with more embolisms in other organs, positive intraoperative pathology findings, and longer CPB times. A new cerebral hemorrhage developed postoperatively in one patient without intracranial findings. There were no early deaths; two patients had recurrent infections in each group, and one died because of sepsis in the late phase in the group with intracranial findings.
CONCLUSIONS:
Positive intracranial findings indicated significantly active infectious conditions preoperatively but did not affect the postoperative course. Patients without preoperative cerebral complications can develop serious cerebral hemorrhage. Although meticulous examination of preoperative cerebral complications in all patients with IE is essential, a strategy should be adopted to prevent cerebral hemorrhage, even in patients without intracranial findings.
© 2024. The Author(s).
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[Management of Constrictive Pericarditis : A study of 43 operated cases].
Ann Cardiol Angeiol (Paris)2024 Apr;73(3):101742. doi: 10.1016/j.ancard.2024.101742.
Wazaren Hicham, Idrissa Abdelmalik, Boussaadani Badre El, Bakkali Abderahmane,
Abstract
Chronic constrictive pericarditis is a rare condition characterized by clinical signs of right heart failure, due to the symphysis of the two pericardial leaflets. Our study focused on a retrospective analysis of 43 CCP surgery observations collected over an 11-year period (2003-2013). The mean age of the patients was 32 years; 65% were male; exercise dyspnea (95%) was the most frequent sign. Two main etiologies were observed: tuberculosis 58% and idiopathic causes 42%. All of our patients received a subtotal pericardectomy per median sternotomy, of which 95% had no cardiopulmonary bypass.
Copyright © 2024 Elsevier Masson SAS. All rights reserved.
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Risk Prediction Models for Renal Function Decline After Cardiac Surgery Within Different Preoperative Glomerular Filtration Rate Strata.
J Am Heart Assoc2024 Apr;():e029641. doi: 10.1161/JAHA.123.029641.
Wang Chunrong, Gao Yuchen, Ji Bingyang, Li Jun, Liu Jia, Yu Chunhua, Wang Yuefu,
Abstract
BACKGROUND:
Our goal was to create a simple risk-prediction model for renal function decline after cardiac surgery to help focus renal follow-up efforts on patients most likely to benefit.
METHODS AND RESULTS:
This single-center retrospective cohort study enrolled 24?904 patients who underwent cardiac surgery from 2012 to 2019 at Fuwai Hospital, Beijing, China. An estimated glomerular filtration rate (eGFR) reduction of ?30% 3?months after surgery was considered evidence of renal function decline. Relative to patients with eGFR 60 to 89?mL/min per 1.73?m (4.5% [531/11733]), those with eGFR ?90?mL/min per 1.73?m (10.9% [1200/11042]) had a higher risk of renal function decline, whereas those with eGFR ?59?mL/min per 1.73?m (5.8% [124/2129]) did not. Each eGFR stratum had a different strongest contributor to renal function decline: increased baseline eGFR levels for patients with eGFR ?90?mL/min per 1.73?m, transfusion of any blood type for patients with eGFR 60 to 89?mL/min per 1.73?m, and no recovery of renal function at discharge for patients with eGFR ?59?mL/min per 1.73?m. Different nomograms were established for the different eGFR strata, which yielded a corrected C-index value of 0.752 for eGFR ?90?mL/min per 1.73?m, 0.725 for eGFR 60-89?mL/min per 1.73?m and 0.791 for eGFR ?59?mL/min per 1.73?m.
CONCLUSIONS:
Predictors of renal function decline over the follow-up showed marked differences across the eGFR strata. The nomograms incorporated a small number of variables that are readily available in the routine cardiac surgical setting and can be used to predict renal function decline in patients stratified by baseline eGFR.
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A Rare Presentation of Myocardial Bridging With Heart Failure Symptoms.
Cureus2024 Mar;16(3):e56462. doi: e56462.
Mohan Riya, Dayanand Pradeep, Mirza Sajid, Ghumman Waqas, Faber Cristiano,
Abstract
Myocardial bridging is an under-recognized cause of angina. This congenital anomaly occurs when a segment of the epicardial coronary artery has a short intra-myocardial course. A significant intra-myocardial course may lead to ischemia, causing anginal symptoms. In this case report, we discuss a rare presentation of myocardial bridging with symptoms of heart failure. The pathology led to a marked degree of ventricular dysfunction and a significant drop in cardiac output (CO), and the patient had severe exertional dyspnea and functional limitations. The ischemic workup with diagnostic imaging and angiograms failed to explain the severity of symptoms, which were only evident in hemodynamic studies and cardiopulmonary exercise testing.
Copyright © 2024, Mohan et al.
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En Bloc Inferior Vena Cava (IVC) Resection Without Reconstruction With Right Hepatectomy and Right Nephrectomy for a Large IVC Leiomyosarcoma.
Ann Surg Oncol2024 Apr;():. doi: 10.1245/s10434-024-15254-4.
Varty Gurudutt P, Patkar Shraddha, Nandy Kunal, Goel Mahesh,
Abstract
BACKGROUND:
Radical resection remains the only potential cure in the management of inferior vena cava (IVC) leiomyosarcomas with multivisceral resections often needed (Borghi et al. in J Cardiovasc Surg (Torino) 63:649-663, 2022). This video describes the technical nuances of surgical resection of a large retrohepatic IVC leiomyosarcoma.
PATIENT AND METHODS:
Computed tomography of a 60-year-old woman revealed a 12 × 12 × 9.5 cm mass in the right suprarenal region infiltrating the IVC with intraluminal extension up to the hepatic venous confluence. The mass involved the right hepatic vein with infiltration of segment 7 of the liver and splaying of the right portal vein. Robust lumbar venous drainage from the infratumoral IVC was seen. En bloc IVC resection without reconstruction along with a right hepatectomy and right nephrectomy was performed via a right thoracoabdominal approach.
RESULTS:
After a Catell-Braasch maneuver, the surgery can be broadly divided into four major steps: (1) Right retroperitoneal mobilization of the tumor and right kidney with infratumoral IVC control, (2) mobilization of the right liver with suprahepatic IVC control, (3) division of the right portal structures with right hepatectomy, and (4) en bloc resection of the IVC tumor. Reconstruction of the IVC was not performed owing to the presence of venous collaterals (Langenbecks et al. in Arch Surg 407:1209-1216, 2022). Final histopathology showed a high-grade leiomyosarcoma with histologic organ invasion in the liver and right kidney with resected margins free of the tumor (R0).
CONCLUSIONS:
Meticulous preoperative planning and expertise in liver resection and retroperitoneal surgeries facilitates such radical yet safe multivisceral resection for a large retrohepatic IVC leiomyosarcoma without the need for a cardiopulmonary bypass.
© 2024. Society of Surgical Oncology.
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