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Stephen A Kunz, Lachlan F Miles, Damian J Ianno, Kelly L Mirowska-Allen, George Matalanis, Rinaldo Bellomo, Siven Seevanayagam
INTRODUCTION: Accurate dosing of protamine reversal following on-pump cardiac surgical procedures is challenging, with both excessive and inadequate administration recognised to increase bleeding risk. We aimed to examine the relationship between three ratios for heparin reversal and markers of haemostasis. METHODS: A retrospective analysis of a prospectively collected database was undertaken at a single tertiary cardiac unit, reviewing all cases of on-pump coronary artery bypass grafts and single valve replacements from 01/01/2011 to 31/12/2015...
March 1, 2018: Perfusion
Kate M Richmond, Katharine G Warburton, Simon J Finney, Sachin Shah, Benjamin A J Reddi
INTRODUCTION: Comprehensive clinical examination can be compromised in patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Adjunctive diagnostic imaging strategies range from bedside imaging only to routine computed tomography (CT). The risk-benefit of either approach remains to be evaluated. Patients retrieved to the Royal Brompton Hospital (RBH) on VV-ECMO routinely undergo admission CT imaging of head, chest, abdomen and pelvis. This study aimed to identify how frequently changes in therapy or adverse events could be attributed to routine CT scanning...
March 1, 2018: Perfusion
Gerry Capatos, Christopher R Burke, Mark T Ogino, Roberto R Lorusso, Thomas V Brogan, D Michael McMullan, Heidi J Dalton
AIM: As experience with extracorporeal life support (ECLS) increases, indications for its use have expanded to diverse patient populations, including those with HIV infection. Pneumocystis jirovecii pneumonia (PJP) is a particularly devastating complication of HIV infections. The objective of this study was to review ECLS use in HIV-positive patients, with particular emphasis on those with concomitant PJP infection. METHODS: All patients were treated by the same ECLS team, consisting of an ECLS specialist intensivist, cardiothoracic surgeon and allied medical professionals at three healthcare institutions...
March 1, 2018: Perfusion
Laurence Weinberg, David Story, Rinaldo Bellomo
No abstract text is available yet for this article.
March 1, 2018: Perfusion
Yoshinari Niimi, Seiichiro Murata, Yumi Mitou, Yusuke Ohno
We developed a novel open cardiopulmonary bypass (CPB) system, a drainage flow servo-controlled CPB system (DS-CPB), in which rotational speed of the main roller pump is servo-controlled to generate the same amount of flow as the systemic venous drainage. It was designed to safely decrease the priming volume while maintaining a constant reservoir level, even during fluctuations of the drainage flow. We report a successful use of a novel DS-CPB system in an elderly Jehovah's Witness patient with dehydration who underwent mitral valve replacement...
March 1, 2018: Perfusion
Prashant Rao, Jarrod Mosier, Joshua Malo, Vicky Dotson, Christopher Mogan, Richard Smith, Roy Keller, Marvin Slepian, Zain Khalpey
Cardiogenic shock and cardiac arrest are life-threatening emergencies that result in high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via peripheral cannulation is an option for patients who do not respond to conventional therapies. Left ventricular (LV) distention is a major limitation with peripheral VA-ECMO and is thought to contribute to poor recovery and the inability to wean off VA-ECMO. We report on a novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula...
February 1, 2018: Perfusion
Philippe Grieshaber, Tobias Schneider, Lukas Oster, Coskun Orhan, Peter Roth, Bernd Niemann, Andreas Böning
INTRODUCTION: Prophylactic intra-aortic balloon counterpulsation (pIABC) is recommended for high-risk patients undergoing coronary artery bypass grafting (CABG) surgery. Criteria for high-risk patients benefiting from pIABC are unclear. This study aimed to specifically describe the effect of pIABC on outcomes of patients with acute myocardial infarction (AMI) undergoing CABG. METHODS: In 178 of 484 AMI patients (non-ST-segment elevation myocardial infarction [NSTEMI] or ST-segment elevation myocardial infarction [STEMI] ≤5 days before surgery) without cardiogenic shock who underwent CABG between 2008 and 2013, pIABC was initiated preoperatively...
February 1, 2018: Perfusion
Liangshan Wang, Xing Hao, Xiaomeng Wang, Chengxiong Gu, Hong Wang, Xiaotong Hou
BACKGROUND: Coronary artery bypass grafting (CABG) combined with coronary endarterectomy (CE) can be associated with high operative mortality and morbidity. An intra-aortic balloon pump (IABP) has been the most widely used mechanical circulatory support device during perfusion treatment. However, the benefits of preoperative IABP in CABG combined with CE remain unknown. We conducted a retrospective observational study to evaluate the efficacy of preoperative IABP therapy in patients undergoing adjunctive right coronary artery (RCA) endarterectomy...
February 1, 2018: Perfusion
R Peter Alston
No abstract text is available yet for this article.
February 1, 2018: Perfusion
Lowell Ling, Kai Man Chan
BACKGROUND: There is a lack of consensus on the timing of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) liberation. VA-ECMO weaning usually consists of serial decrements until an idling flow is achieved, supported by echocardiographic and haemodynamic assessments. Even with minimal idling flow, right ventricular (RV) preload is reduced and, hence, right heart function is not fully tested under adequate loading conditions. Following the use of a novel technique called Pump Controlled Retrograde Trial Off (PCRTO) in neonate VA-ECMO weaning, we report the use of this technique in seven adult patients on VA-ECMO...
February 1, 2018: Perfusion
Byoung-Won Park, So-Ryoung Lee, Min-Ho Lee, Duk Won Bang, Min-Su Hyon, Won-Ho Chang, Hong Chul Oh, Young Woo Park, Suyeon Park
BACKGROUND: Percutaneous cannulation of femoral vessels has been widely used for the rapid deployment of extracorporeal life support (ECLS). Limb ischaemia is a devastating complication in patients receiving ECLS. Our aim was to evaluate the predictors of limb ischaemia during ECLS and to determine the role of preventative distal perfusion. METHODS: Two hundred and fifty-five consecutive patients who received veno-arterial ECLS due to cardiac and/or respiratory failure were enrolled from January 2009 to December 2015...
February 1, 2018: Perfusion
Sisse Anette Thomassen, Benedict Kjærgaard, Aage Kristian Olsen Alstrup, Ole Lajord Munk, Jørgen Frøkiær, Anders Larsson, Bodil Steen Rasmussen
BACKGROUND: Mean arterial blood pressure (MAP) and/or pump flow during normothermic cardiopulmonary bypass (CPB) are the most important factors of cerebral perfusion. The aim of this study was to explore the influence of CPB blood flow on cerebral blood flow (CBF) measured by dynamic positron emission tomography (PET) using 15O-labelled water with no pharmacological interventions to maintain the MAP. METHODS: Eight pigs (69-71 kg) were connected to normothermic CPB...
January 1, 2018: Perfusion
Richard Devasagayaraj, Nicholas C Cavarocchi, Hitoshi Hirose
INTRODUCTION: Patients who develop severe acute respiratory distress syndrome (ARDS) despite full medical management may require veno-venous extracorporeal membrane oxygenation (VV ECMO) to support respiratory function. Survival outcomes remain unclear in those who develop acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) during VV ECMO for isolated severe respiratory failure in adult populations. METHODS: A retrospective chart review (2010-2016) of patients who underwent VV ECMO for ARDS was conducted with university institutional review board (IRB) approval...
January 1, 2018: Perfusion
Nils Reiss, Thomas Schmidt, Stephanie Mommertz, Christina Feldmann, Jan Dieter Schmitto
In patients with left ventricular assist devices (LVAD), exercise capacity is a decisive factor regarding the quality of life. When evaluating exercise capacity, precise information about the total cardiac output generated is crucial. To date, complex measurements using a right-heart catheter were necessary in order to determine total cardiac output. The inert gas rebreathing method facilitates non-invasive, direct and valid measurement of total cardiac output as well as associated parameters, like the difference in arteriovenous oxygen saturation, both at rest and during exercise...
January 1, 2018: Perfusion
Linda Mongero, Alfred Stammers, Eric Tesdahl, Andrew Stasko, Samuel Weinstein
OBJECTIVE: Ultrafiltration (UF) during cardiopulmonary bypass (CPB) is a well-accepted method for hemoconcentration to reduce excess fluid and increase hematocrit, platelet count and plasma constituents. The efficacy of this technique may confer specific benefit to certain patients presenting with acquired cardiac defects. The purpose of this study was to retrospectively evaluate the effect of UF on end-CPB hematocrit by cardiac surgical procedure type. METHODS: A review of 73,506 cardiac procedures from a national registry (SCOPE) was conducted between April 2012 and October 2016 at 197 institutions...
January 1, 2018: Perfusion
John M Toomasian
No abstract text is available yet for this article.
April 2018: Perfusion
Prakash P Punjabi
No abstract text is available yet for this article.
March 2018: Perfusion
Michele Heath, Julie Walker, Atilio Barbeito, Adam Williams, Ian Welsby, Cory Maxwell, Mani Daneshmand, John Haney, Maureane Hoffman
We present a case series of seven patients with suspected cold agglutinin antibodies, discovered after initiation of bypass. Laboratory analysis of blood samples intraoperatively determined the cause of the aggregation to be rouleaux formation in three of the patients and cold agglutinins in the other four.
March 2018: Perfusion
Geoff Lockwood
No abstract text is available yet for this article.
January 2018: Perfusion
Ya-Yang Liu, Fu-Shan Xue, Hui-Xian Li, Gui-Zhen Yang
No abstract text is available yet for this article.
January 2018: Perfusion
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