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Pubblicazioni recenti - cardiopulmonary bypass
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Is robotic assistance an added value in minimally invasive mitral valve surgery? A meta-analysis from propensity score-matched series.
Asian Cardiovasc Thorac Ann2023 Mar;():2184923231166352. doi: 10.1177/02184923231166352.
Jegaden Olivier, Al Shamry Adel, Ashafy Salah, Mahdi Alhaitham, Eker Armand,
Abstract
OBJECTIVES:
There is still ongoing debate about the benefits of robotic assistance (R-MVS) in comparison with video assistance (V-MVS) in minimally invasive mitral valve surgery. This study aims to update the current evidence.
METHODS:
Three propensity score-matched studies published from 2011 to 2021 were included with a total of 1193 patients operated on from 2005 (R-MVS: 536, V-MVS: 657). Data regarding early mortality, postoperative event, and time-related outcomes were extracted and submitted to a meta-analysis using weighted random-effects modeling.
RESULTS:
The incidence of early mortality, stroke, renal failure, conversion, atrial fibrillation, and prolonged ventilation were similar, all in the absence of heterogeneity. Reoperation for bleeding (odds ratio [OR]: 0.36, 95% confidence interval [CI] 0.16-0.81, ?=?0.01) and the need for blood transfusion (OR: 0.30, 95% CI, 0.20-0.56, ?=?0.001) were significantly lower in V-MVS group. Regarding time-related outcomes, there was evidence for important heterogeneity of treatment effect among the studies. Operative times were longer in R-MVS: differences in means were 20.7?min for cross-clamp time (95% CI, 9.07-32.3, ?=?0.001), 20.7?min for cardiopulmonary bypass time (95% CI, 2.5-38.9, ?=?0.03) and 40.2?min for total operative time (95% CI, 24.5-55.8, ?0.001). Intensive care unit stay and hospital stay were reported in one study, and longer after R-MVS compared to V-MVS; the differences in means were 0.17 days (?=?0.005) and 0.6 days (?=?0.017), respectively. Total cost of both procedures was reported in an additional dedicated propensity score-matched series including 448 patients; it was 21% higher for R-MVS than for V-MVS.
CONCLUSIONS:
This meta-analysis showed excellent outcomes of both video and robotic techniques with low incidence of morbidity and mortality. However, there is no evidence for an added value of robotic assistance in comparison with video assistance; the drawbacks of mini access are reported higher regardless the induced over cost.
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Management of Renal Cell Carcinoma With Intra-atrial Tumour Thrombus: A Case Report.
Cureus2023 Feb;15(2):e35380. doi: 10.7759/cureus.35380.
Alam Ahmad S, Yashi Kanica, Elkhawaga Mostafa,
Abstract
Renal cell cancer (RCC) is at times associated with intravascular tumour thrombus (TT), which in rare cases can extend to the right atrium. The management of RCC with intravascular tumour thrombus is complex and requires a multidisciplinary approach involving urologists, vascular surgeons, and cardiologists. The pre-operative workup is extensive and includes imaging studies to determine the extent of the tumour thrombus and assess the patient's overall health status. Here, we present a case report detailing the operative and perioperative management of a patient presenting with renal cell cancer and intravascular TT.
Copyright © 2023, Alam et al.
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Extracorporeal Circulation and Optic Nerve Ultrasound: A Pilot Study.
Medicina (Kaunas)2023 Feb;59(3):. doi: 445.
Ta?k?n Öztürk, Demir Ufuk,
Abstract
: Cardiopulmonary bypass (CPB) is an extracorporeal circuit that provides surgical access to an immobile and bloodless area, allowing for technical and procedural advances in cardiothoracic surgery. CBP can alter the integrity of the blood-brain barrier and cause changes in intracranial pressure (ICP) postoperatively. Optical nerve sheath diameter (ONSD) measurement is among the alternative non-invasive methods for ICP monitoring. In this study, we aimed to evaluate the optic nerve sheath diameter measurements under the guidance of ultrasonography for ICP changes during the extracorporeal circulation process. : The study population included 21 patients over 18 years of age who required extracorporeal circulation. Demographic data of the patients, such as age, gender, comorbidity, American Society of Anesthesiologists (ASA) classification and reason for operation (coronary artery disease or mitral or aortic valve disease) were recorded. The ONSD was measured and evaluated before the extracorporeal circulation (first time) and at the 30th minute (second time), 60th minute (third time) and 90th minute (fourth time) of the extracorporeal circulation. Non-invasive ICP (ICP ONSD) values were calculated based on the ONSD values found. : The mean ONSD values measured before the extracorporeal circulation of the patients were found to be 4.13 mm (3.8-4.6) for the right eye and 4.36 mm (4.1-4.7) for the left eye. Calculated nICPONSD values of 11.0 mm Hg (1.0-21.0) for the right eye and 10.89 mm Hg (1.0-21.0) for the left eye were found. It was observed that there was a significant increase in the ONSD and nlCPONSD values recorded during the extracorporeal circulation of all patients compared to the baseline values (
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Conventional Biological versus Sutureless Aortic Valve Prostheses in Combined Aortic and Mitral Valve Replacement.
Life (Basel)2023 Mar;13(3):. doi: 737.
Zubarevich Alina, Szczechowicz Marcin, Arjomandi Rad Arian, Amanov Lukman, Ruhparwar Arjang, Weymann Alexander,
Abstract
BACKGROUND:
Sutureless aortic valve prostheses have proven to provide a significant decrease in procedural, cardiopulmonary bypass and cross-clamp time, leading to a significant reduction in mortality risk in elderly high-risk cohorts. In this study, we sought to review our institutional experience on the sutureless aortic valve replacement (SU-AVR) and the concomitant mitral valve replacement (SMVR), comparing the combined conventional surgical aortic valve replacement (SAVR) with SMVR.
METHODS AND MATERIAL:
Between March 2018 and July 2022, 114 consecutive patients underwent a combined aortic and mitral valve replacement at our institution. We stratified the patients according to the operative procedures into two groups and matched them 1:2: Group 1 underwent a combined conventional SAVR and SMVR (n = 46), and Group 2 included combined SU-AVR with Perceval prosthesis and SMVR (n = 23).
RESULTS:
No significant differences in the preoperative characteristics were present. SU-AVR combined with SMVR demonstrated excellent haemodynamic performance, comparable to that of SAVR plus SMVR, with median postoperative gradients over the aortic valve of 4 mmHg (IQR 3.0-4.0) in Group 1 and 4 mmHg (IQR 3.0-4.0) in Group 2 ( = 0.67). There was no significant difference in the occurrence of postoperative major adverse events such as death, stroke, myocardial infarction and kidney failure between the groups. There was also no significant difference in the permanent pacemaker implantation rate, paravalvular leakage or valve dislocation. We also could not detect any significant difference in postoperative mortality between the groups.
CONCLUSIONS:
SU-AVR has proven to be a reliable alternative to conventional valve prostheses in patients with multivalve disease undergoing combined aortic and mitral valve replacement, offering shorter procedural time and outstanding hemodynamic performance compared to the conventional surgical method.
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Use of Renal Near-Infrared Spectroscopy and Urinary Neutrophil Gelatinase-Associated Lipocalin Monitoring as Indicators of Acute Kidney Injury in Pediatric Cardiac Surgery.
J Clin Med2023 Mar;12(6):. doi: 2085.
Wakamatsu Yoshihito, Nakanishi Keisuke, Satoh Takanori, Kawasaki Shiori, Amano Atsushi,
Abstract
Acute kidney injury (AKI) is a common complication following cardiac surgery under cardiopulmonary bypass (CPB) in children. A prospective study for examining urinary neutrophil gelatinase-associated lipocalin (NGAL) and renal near-infrared spectroscopy (NIRS) trends during AKI was conducted among pediatric patients undergoing cardiac surgery with CPB. Urinary NGAL showed a significant difference between intensive care unit admission (0 h) and 2 h post-admission (
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Cannabinoid Receptor Agonist WIN55, 212-2 Attenuates Injury in the Hippocampus of Rats after Deep Hypothermic Circulatory Arrest.
Brain Sci2023 Mar;13(3):. doi: 525.
Yu Ming-Huan, Yang Qin, Zhang You-Peng, Wang Jia-Hui, Zhang Ren-Jian-Zhi, Liu Zhi-Gang, Liu Xiao-Cheng,
Abstract
OBJECTIVES:
Postoperative neurological deficits remain a challenge in cardiac surgery employing deep hypothermic circulatory arrest (DHCA). This study aimed to investigate the effect of WIN55, 212-2, a cannabinoid agonist, on brain injury in a rat model of DHCA.
METHODS:
Twenty-four male Sprague Dawley rats were randomly divided into three groups: a control group (which underwent cardiopulmonary bypass (CPB) only), a DHCA group (CPB with DHCA), and a WIN group (WIN55, 212-2 pretreatment before CPB with DHCA). Histopathological changes in the brain were evaluated by hematoxylin-eosin staining. Plasma levels of superoxide dismutase (SOD) and proinflammatory cytokines including interleukin (IL)-1?, IL-6, and tumor necrosis factor-alpha (TNF-a) were determined using an enzyme-linked immunosorbent assay (ELISA). The expression of SOD in the hippocampus was detected by Western blot and immunofluorescence staining. Levels of apoptotic-related protein caspase-3 and type 1 cannabinoid receptor (CB1R) in the hippocampus were evaluated by Western blot.
RESULTS:
WIN55, 212-2 administration attenuated histopathological injury of the hippocampus in rats undergoing DHCA, associated with lowered levels of IL-1?, IL-6, and TNF-? (
CONCLUSIONS:
the administration of WIN55, 212-2 alleviates hippocampal injury induced by DHCA in rats by regulating intrinsic inflammatory and oxidative stress responses through a CB1R-dependent mechanism.
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Early postoperative weight-based fluid overload is associated with worse outcomes after neonatal cardiac surgery.
Pediatr Nephrol2023 Mar;():. doi: 10.1007/s00467-023-05929-7.
Brandewie Katie L, Selewski David T, Bailly David K, Bhat Priya N, Diddle John W, Ghbeis Muhammad, Krawczeski Catherine D, Mah Kenneth E, Neumayr Tara M, Raymond Tia T, Reichle Garrett, Zang Huaiyu, Alten Jeffrey A, ,
Abstract
OBJECTIVES:
Evaluate the association of postoperative day (POD) 2 weight-based fluid balance (FB-W)?>?10% with outcomes after neonatal cardiac surgery.
METHODS:
Retrospective cohort study of 22 hospitals in the NEonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) registry from September 2015 to January 2018. Of 2240 eligible patients, 997 neonates (cardiopulmonary bypass (CPB) n?=?658, non-CPB n?=?339) were weighed on POD2 and included.
RESULTS:
Forty-five percent (n?=?444) of patients had FB-W?>?10%. Patients with POD2 FB-W?>?10% had higher acuity of illness and worse outcomes. Hospital mortality was 2.8% (n?=?28) and not independently associated with POD2 FB-W?>?10% (OR 1.04; 95% CI 0.29-3.68). POD2 FB-W?>?10% was associated with all utilization outcomes, including duration of mechanical ventilation (multiplicative rate of 1.19; 95% CI 1.04-1.36), respiratory support (1.28; 95% CI 1.07-1.54), inotropic support (1.38; 95% CI 1.10-1.73), and postoperative hospital length of stay (LOS 1.15; 95% CI 1.03-1.27). In secondary analyses, POD2 FB-W as a continuous variable demonstrated association with prolonged durations of mechanical ventilation (OR 1.04; 95% CI 1.02-1.06], respiratory support (1.03; 95% CI 1.01-1.05), inotropic support (1.03; 95% CI 1.00-1.05), and postoperative hospital LOS (1.02; 95% CI 1.00-1.04). POD2 intake-output based fluid balance (FB-IO) was not associated with any outcome.
CONCLUSIONS:
POD2 weight-based fluid balance?>?10% occurs frequently after neonatal cardiac surgery and is associated with longer cardiorespiratory support and postoperative hospital LOS. However, POD2 FB-IO was not associated with clinical outcomes. Mitigating early postoperative fluid accumulation may improve outcomes but requires safely weighing neonates in the early postoperative period. A higher resolution version of the Graphical abstract is available as Supplementary information.
© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.
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Sinus node dysfunction and related permanent pacemaker implantation after major cardiac surgeries, systematic review, and meta-analysis.
Front Cardiovasc Med2023 ;10():1091312. doi: 1091312.
Hosseini Dolama Reza, Eghbal Amir Hosein, Rezaee Malihe, Farahani Ali Vasheghani, Jalali Arash, Hosseini Kaveh,
Abstract
BACKGROUND:
There is no concise evidence or clinical guidelines regarding the incidence of sinus node dysfunction (SND) and permanent pacemaker (PPM) implantation following cardiac surgeries and their management approaches.
OBJECTIVE:
We aim to systematically review current evidence on the prevalence of SND, PPM implantation concerning it, and its risk factors in patients undergoing cardiac surgery.
METHOD:
Four electronic databases (Cochrane Library, Medline, SCOPUS, and Web of Science) were systematically searched for articles regarding SND after cardiovascular surgeries and reviewed by two independent researchers, and a third review in case of discrepancies. Using the random-effects model, a proportion meta-analysis was performed on data regarding PPM implantation. Subgroup analysis was performed for different interventions, and the possible effect of different covariates was evaluated using meta-regression.
RESULTS:
From the initial 2012 unique records, 87 were included in the study, and results were extracted. Pooled data from 38,519 patients indicated that the overall prevalence of PPM implantation due to SND after cardiac surgery was 2.87% (95% CI [2.09; 3.76]). The incidence of PPM implantation in the first post-surgical month was 2.707% (95% CI [1.657; 3.952]). Among the four main intervention groups, including valve, maze, valve-maze, and combined surgeries, maze surgery was associated with the highest prevalence (4.93%; CI [3.24; 6.92]). The pooled prevalence of SND among studies was 13.71% (95% CI [8.13; 20.33]). No significant relationship was observed between PPM implantation and age, gender, cardiopulmonary bypass time, or aortic cross-clamp time.
CONCLUSION:
Based on the present report, patients undergoing the maze and maze-valve procedures are at higher risk of post-op SND, whereas lone valve surgery had the lowest prevalence of PPM implantation.
SYSTEMATIC REVIEW REGISTRATION:
PROSPERO (CRD42022341896).
Copyright © 2023 Hosseini Dolama, Eghbal, Rezaee, Farahani, Jalali and Hosseini.
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Stem cells mobilization by cardiopulmonary bypass after coronary artery bypass grafting.
Postepy Kardiol Interwencyjnej2022 Dec;18(4):450-458. doi: 10.5114/aic.2022.122874.
Kowalówka Adam R, Wojakowski Wojciech, Bachowski Ryszard, Deja Marek A,
Abstract
INTRODUCTION:
Expression of haematopoietic stem and progenitor cells occurs as a result of an inflammatory reaction caused by a damaged organ. Patients undergoing coronary artery bypass surgery (CABG) using cardiopulmonary bypass (CPB) are exposed to an inflammatory reaction, which may be a trigger in the mobilization of regenerative cells.
AIM:
To assess the impact of CPB on stem and progenitor cells mobilization in patients scheduled for CABG.
MATERIAL AND METHODS:
Twenty patients with stable coronary disease, who were scheduled for CABG, were included in the study. Peripheral blood samples were collected perioperatively: 2 h before surgery, before CPB, at CPB weaning, 24 h postoperatively, and on the 6 postoperative day. Analyses of immune-labelled cells were carried out on an ImageStream (IS) system.
RESULTS:
The following cell populations were identified during cardiac surgery: haematopoietic stem cells (HSC), mesenchymal cells (MSC), endothelial progenitors (EPC), and very small embryonic-like cells (VSEL). The profile of cell mobilization coincides with the perioperative inflammatory response. Mobilization of stem and progenitor cells induced by CPB did not occur in any of the isolated cell lines ( > 0.05). The expression profile of stem and progenitor cells was related with the inflammatory reaction associated with traumatic stress in all cell lines. Type 2 diabetes is a disease that is hampering the trend of MSC mobilization.
CONCLUSIONS:
Mobilization of haematopoietic stem and progenitor cells was not related with CPB. The inflammatory reaction was associated with perioperative trauma. Cell release was inhibited in patients with diabetes.
Copyright: © 2022 Termedia Sp. z o. o.
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Off-Pump Coronary Bypass Surgery: Time for the Myths to Face Reality.
Heart Lung Circ -
Valvular Complex and Tissue Remodeling in Ovine Functional Tricuspid Regurgitation.
Eur J Cardiothorac Surg2023 Mar;():. doi: ezad115.
Iwasieczko Artur, Gaddam Manikantam, Gaweda Boguslaw, Goodyke Austin, Mathur Mrudang, Lin Chien-Yu, Zagorski Joseph, Solarewicz Monica, Cohle Stephen, Rausch Manuel, Timek Tomasz A,
Abstract
BACKGROUND:
Pathophysiology of function tricuspid regurgitation (FTR) is incompletely understood. We set out to comprehensively evaluate geometric and tissue remodeling of the tricuspid valve complex in ovine FTR.
METHODS:
Twenty adult sheep underwent left thoracotomy and pulmonary artery banding (PAB) to induce right heart pressure overload and FTR. After 8 weeks, 17 surviving animals and 10 healthy controls (CTL) underwent sternotomy, echocardiography, and implantation of sonomicrometry crystals on right ventricle and tricuspid valvular apparatus. Hemodynamic and sonomicrometry data were acquired in all animals after weaning from cardiopulmonary bypass. Leaflet tissue was harvested for pentachrome histologic analysis and biomechanical testing.
RESULTS:
Animal weight was 62±5 and 63±3?kg for CTL and PAB, respectively (p?=?0.6). At terminal procedure, systolic pulmonary artery pressure was 22±3 and 40±7?mmHg for CTL and PAB, respectively (p?=?0.0001). Mean TR grade (+0-4) was 0.8±0.4 and 3.2±1.2 (p?=?0.0001) for control and banded animals, respectively. RV volume (126±13 vs 172±34?ml, p?=?0.0019), tricuspid annular area (651±109 vs 865±247?mm2, p?=?0.037), and area between papillary muscle tips (162±51 vs 302±75?mm2, p?=?0.001) increased substantially while systolic excursion of anterior leaflet decreased significantly (23.8±6.1 vs 7.4±4.5?deg, p?=?0.001) with banding. Total leaflet surface area increased from 806±94 to 953±148?mm2 (p?=?0.009), and leaflets became thicker and stiffer.
CONCLUSIONS:
Detailed analysis of the tricuspid valve complex revealed significant ventricular, annular, subvalvular, and leaflet remodeling to be associated with ovine functional tricuspid regurgitation. Durable surgical repair of severe FTR may require a multi-level approach to the valvular apparatus.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Haemodynamic effects of prophylactic post-operative hydrocortisone following cardiopulmonary bypass in neonates undergoing cardiac surgery.
Cardiol Young2023 Mar;():1-7. doi: 10.1017/S1047951123000537.
Landry Lily M, Gajula Viswanath, Knudson Jarrod D, Jenks Christopher L,
Abstract
Multiple studies have endeavoured to define the role of steroids in paediatric congenital heart surgery; however, steroid utilisation remains haphazard. In September, 2017, our institution implemented a protocol requiring that all neonates undergoing cardiac surgery with the use of cardiopulmonary bypass receive a five-day post-operative hydrocortisone taper. This single-centre retrospective study was designed to test the hypothesis that routine post-operative hydrocortisone administration reduces the incidence of capillary leak syndrome, leads to favourable postoperative fluid balance, and less inotropic support in the early post-operative period. Data were gathered on all term neonates who underwent cardiac surgery with the use of bypass between September, 2015 and 2019. Subjects who were unable to separate from bypass, required long-term dialysis, or long-term mechanical ventilation were excluded. Seventy-five patients met eligibility criteria (non-hydrocortisone group = 52; hydrocortisone group = 23). For post-operative days 0-4, we did not observe a significant difference in net fluid balance or vasoactive inotropic score between study groups. Similarly, we saw no major difference in secondary clinical outcomes (post-operative duration of mechanical ventilation, ICU/hospital length of stay, and time from surgery to initiation of enteral feeds). In contrast to prior analyses, our study was unable to demonstrate a significant difference in net fluid balance or vasoactive inotropic score with the administration of a tapered post-operative hydrocortisone regimen. Similarly, we saw no effect on secondary clinical outcomes. Further long-term randomised control studies are necessary to validate the potential clinical benefit of utilising steroids in paediatric cardiac surgery, especially in the more fragile neonatal population.
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The use of CytoSorb® in a prasugrel-loaded patient undergoing emergent coronary artery bypass graft surgery.
Clin Case Rep2023 Mar;11(3):e6990. doi: e6990.
Moresco Erich, Dejaco Hannes, Humbert Volker, Thoma Matthias,
Abstract
Patients with acute coronary syndrome (ACS), failed percutaneous coronary intervention (PCI) and with an indication for emergent coronary artery bypass graft surgery (CABG) are at an increased risk of perioperative bleeding. Integration of the CytoSorb® (CS) adsorber into the cardiopulmonary bypass appears to bind prasugrel and minimize the risk of perioperative bleeding.
© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
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Gut microbe-derived milnacipran enhances tolerance to gut ischemia/reperfusion injury.
Cell Rep Med2023 Mar;4(3):100979. doi: 100979.
Deng Fan, Hu Jing-Juan, Lin Ze-Bin, Sun Qi-Shun, Min Yue, Zhao Bing-Cheng, Huang Zhi-Bin, Zhang Wen-Juan, Huang Wen-Kao, Liu Wei-Feng, Li Cai, Liu Ke-Xuan,
Abstract
There are significant differences in the susceptibility of populations to intestinal ischemia/reperfusion (I/R), but the underlying mechanisms remain elusive. Here, we show that mice exhibit significant differences in susceptibility to I/R-induced enterogenic sepsis. Notably, the milnacipran (MC) content in the enterogenic-sepsis-tolerant mice is significantly higher. We also reveal that the pre-operative fecal MC content in cardiopulmonary bypass patients, including those with intestinal I/R injury, is associated with susceptibility to post-operative gastrointestinal injury. We reveal that MC attenuates mouse I/R injury in wild-type mice but not in intestinal epithelial aryl hydrocarbon receptor (AHR) gene conditional knockout mice (AHR) or IL-22 gene deletion mice (IL-22). Collectively, our results suggest that gut microbiota affects susceptibility to I/R-induced enterogenic sepsis and that gut microbiota-derived MC plays a pivotal role in tolerance to intestinal I/R in an AHR/ILC3/IL-22 signaling-dependent manner, revealing the pathological mechanism, potential prevention and treatment drugs, and treatment strategies for intestinal I/R.
Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.
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Effect of different priming fluids on extravascular lung water, cell integrity and oxidative stress in cardiopulmonary bypass surgery.
Cardiovasc J Afr2023 Mar;34():1-5. doi: 10.5830/CVJA-2023-006.
Ulugöl Halim, Can Meltem Güner, Aksu U?ur, Vardar Kübra, Ökten Murat, Toraman Fevzi,
Abstract
BACKGROUND:
Discussions continue on the ideal priming fluid in adult cardiac surgery. The purpose of this prospective study was to evaluate the effects of different types of priming fluids on extravascular lung water, cell integrity and oxidative stress status.
METHODS:
Thirty elective coronary artery bypass surgery patients were randomised prospectively into two groups. The first group received colloid priming fluid, while the second group received crystalloid priming fluid. Extravascular lung water index, advanced oxidative protein products, total thiol, free haemoglobin, ischaemic modified albumin and sialic acid levels were measured. Moreover, intra-operative and postoperative outcomes were reviewed.
RESULTS:
There were no significant differences between the groups with regard to extravascular lung water index, oxidative stress parameters or cell integrity ( > 0.05). Similarly, no significant differences were observed between the patients with regard to intra-operative and postoperative outcomes ( > 0.05).
CONCLUSIONS:
The presumed superiority of colloidal priming for cardiopulmonary bypass could not be confirmed in our study.
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Hypothermia is an independent risk factor for prolonged ICU stay in coronary artery bypass surgery: an observational study.
Sci Rep2023 Mar;13(1):4626. doi: 4626.
Wang Yi-Chia, Huang Hsing-Hao, Lin Pei-Ching, Wang Ming-Jiuh, Huang Chi-Hsiang,
Abstract
Maintenance of normothermia is a critical perioperative issue. The warming process after hypothermia tends to increase oxygen demand, which may lead to myocardial ischemia. This study explored whether hypothermia was an independent risk factor for increased morbidity and mortality in patients receiving CABG. We conducted a retrospective observational study of CABG surgeries performed from January 2018 to June 2019. The outcomes of interest were mortality, surgical site infection rate, ventilator dependent time, intensive care unit (ICU) stay, and hospitalization duration. Data from 206 patients were analysed. Hypothermic patients were taller (p?=?0.012), had lower left ventricular ejection fraction (p?=?0.016), and had off-pump CABG more frequently (p?=?0.04). Our analysis noted no incidence of mortality within 30 days. Hypothermia was not associated with higher surgical site infection rate or longer intubation time. After adjusting for sex, age, cardiopulmonary bypass duration, left ventricular ejection fraction, and EuroSCORE II, higher EuroSCORE II (p?0.001; odds ratio 1.2) and hypothermia upon ICU admission (p?=?0.04; odds ratio 3.8) were independent risk factors for prolonged ICU stay. In addition to EuroSCORE II, hypothermia upon ICU admission was an independent risk factor for prolonged ICU stay in patients receiving elective CABG.
© 2023. The Author(s).
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Andexanet alfa in acute aortic syndrome: first UK experience.
Eur J Cardiothorac Surg2023 Mar;():. doi: ezad100.
Al-Attar Nawwar, Sedeek Ahmed F, McCall Philip, Travers Jennifer,
Abstract
Andexanet alfa was employed to reverse the anticoagulant effect of direct oral anticoagulants in 3 patients who required emergent surgery for repair of type A aortic dissection. Its use was instrumental in securing haemostasis. However, we caution against the administration of Andexanet alfa prior to cardiopulmonary bypass as it can induce heparin resistance and complicate the perioperative monitoring of anticoagulation during CPB.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Comparison of the effects of conventional method and primary sutureless techniques on early postoperative rhythm problems in patients with total abnormal pulmonary venous return anomaly.
Cardiol Young2023 Mar;():1-6. doi: 10.1017/S1047951123000513.
Ozturk Erkut, Sisko Sezen Gulumser, Sahin Gulhan Tunca, Tan?d?r Ibrahim Cansaran, Guzeltas Alper, Haydin Sertac, Hatemi Ali Can, Ergul Yakup,
Abstract
BACKGROUND:
Total abnormal pulmonary venous return anomaly is a CHD characterised by abnormal pulmonary venous flow directed to the right atrium. In this study, we aimed to compare the effects of these techniques on early rhythm problems in total abnormal pulmonary venous return anomaly cases operated with conventional or primary sutureless techniques.
METHOD:
Seventy consecutive cases (median age 1 month, median weight 4 kg) who underwent total abnormal pulmonary venous return anomaly repair with conventional or primary sutureless technique between May 1 2020 and May 1 2022 were evaluated. The rate, diagnosis, and possible risk factors of postoperative arrhythmias were investigated. The results were evaluated statistically.
RESULTS:
When the total abnormal pulmonary venous return anomaly subgroup of 70 cases was evaluated, 40 cases were supracardiac, 18 cases were infracardiac, 7 cases were cardiac, and 5 cases were mixed type. Twenty-eight (40%) cases had a pulmonary venous obstruction. Primary sutureless technique (57%, supracardiac n = 24, mixed = 3, infracardiac = 13) was used in 40 patients. Median cardiopulmonary bypass time (110 versus 95 minutes) and median aortic clamp time (70 versus 60 minutes), median peak lactate (4.7 versus 4.8 mmol/l) in the first 72 hours, and median peak vasoactive inotropic score in the first 72 hours of the primary sutureless and conventional technique used cases value (8 versus 10) were similar. The total incidence of arrhythmias in the conventional group was significantly higher than in the primary sutureless group (46.7% versus 22.5%, p = 0.04). Supraventricular early beat was observed in 3 (7.5%), sinus tachycardia was seen in 6 (15%), junctional ectopic tachycardia was seen in 1 (2.5%), intra-atrial reentry tachycardia was seen in 1 (2.5%), usual supraventricular tachyarrhythmia was seen in 2 cases (5%) in the primary sutureless group. In the conventional group, supraventricular early beat was observed in six of the cases (20%), sinus tachycardia in five (16.7%), junctional ectopic tachycardia in four (13.3%), intra-atrial reentry tachycardia (10%) in three, and supraventricular tachyarrhythmia in seven cases (23.3%). In the first 30 days, there was a similar mortality rate (10% versus 10%), with four patients in the primary sutureless group and three in the conventional group. The median follow-up period of the cases was 8 months (interquartile range (IQR) 6-10 months). In the follow-up, arrhythmias were detected in two cases (one supraventricular tachyarrhythmia and one intra-atrial reentry tachycardia) in the primary sutureless group and three cases (two supraventricular tachyarrhythmia, one intra-atrial reentry tachycardia) in the conventional technique. All cases were converted to normal sinus rhythm with cardioversion and combined antiarrhythmic therapy.
CONCLUSION:
Different arrhythmias can be observed in the early period in patients with operated total abnormal pulmonary venous return anomaly. Although a higher rate of rhythm problems was observed in the early period in the conventional method compared to the primary sutureless technique, no significant effect was found on mortality and morbidity between the groups.
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Hypothermia-induced accelerated idioventricular rhythm after cardiac surgery; a case report.
BMC Cardiovasc Disord2023 Mar;23(1):142. doi: 142.
Hosseini Saeid, Salari Soheila, Banar Sepideh, Rezaei Yousef, Tajik Atieh, Zahedmehr Ali, Emkanjoo Zahra,
Abstract
BACKGROUND:
Accelerated idioventricular rhythm (AIVR) is a slow ventricular arrhythmia, commonly due to myocardial ischemia in coronary artery disease. It is a transitory rhythm that rarely causes hemodynamic instability or necessitates any specific therapy. Besides, the common predisposing factors for ventricular arrhythmias after open-heart surgery are hemodynamic instability, electrolyte imbalances, hypoxia, hypovolemia, myocardial ischemia and infarction, acute graft closure, reperfusion injury, and administration of inotropes and antiarrhythmic drugs. Here we report a case of AIVR after cardiac surgery, mostly due to hypothermia that to our knowledge, it is the first report.
CASE PRESENTATION:
We describe a 76-year-old man presenting with typical chest pain. Following routine investigations, the patient underwent coronary artery bypass grafting. Postoperatively, he was transferred to the intensive care unit with good hemodynamic status. However, about 3 h later, he developed rhythm disturbances, leading to hemodynamic instability without response to volume replacement or inotropic support. His rhythm was AIVR, although, at first glance, it resembled the left bundle branch block. Given his unstable hemodynamic status, he was emergently transferred to the operating room. Cardiopulmonary bypass (CPB) was resumed for hemodynamic support. After the patient was rewarmed to about 35 ºC, AIVR returned to normal. He was weaned from CPB successfully and with an uneventful hospital course.
CONCLUSIONS:
Hypothermia is a potential cause of rhythm disturbance. Preventing the causes of arrhythmias, including hypothermia, is the best strategy.
© 2023. The Author(s).
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Misplacement of left ventricular vent into the aortic root during a re-do Bentall procedure: a case report.
JA Clin Rep2023 Mar;9(1):16. doi: 16.
Kumamoto Taisuke, Hiraoka Chieko, Murakami Kotaro, Fujita Miki, Kunitoku Yuji, Kato Kiyohiko,
Abstract
BACKGROUND:
The left ventricular (LV) vent is commonly inserted via the right superior pulmonary vein (RSPV) and directed toward the LV cavity through the mitral valve. We report a rare case in which the tip of the LV vent was misplaced into the aortic root across the aortic valve.
CASE PRESENTATION:
An 88-year-old man was scheduled to undergo the Bentall procedure. After initiation of cardiopulmonary bypass, the LV vent was inserted via the RSPV. Anterograde cardioplegia was administered via the aortic root cannula after the ascending aorta was cross-clamped. The electrocardiogram did not result in complete cardiac arrest, even after delivery of two-thirds of the planned dose. A transesophageal echocardiographic examination showed that the tip of the LV vent was misplaced into the aortic root across the aortic valve.
CONCLUSIONS:
It is important to confirm the tip position by transesophageal echocardiography to prevent severe complications associated with the LV vent.
© 2023. The Author(s).
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