Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis

2019 ◽  
Author(s):  
Taylor M. James ◽  
Sotiris C. Stamou ◽  
Cristiano Faber ◽  
Marcos A. Nores
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Whole Blood ◽  
Operative Mortality ◽  
Control Group ◽  
Actuarial Survival ◽  
Intra Aortic Balloon Pump ◽  
Cold Blood ◽  
Chi Square Analysis ◽  
Adult Cardiac Surgery

Abstract Objectives Few studies have evaluated the outcomes of whole blood microplegia in adult cardiac surgery. Our novel protocol includes removing the crystalloid portion and using the Quest Myocardial Protection System (MPS) for the delivery of del Nido additives in whole blood. This study sought to compare early and late clinical outcomes of whole blood del Nido microplegia (BDN) versus cold blood cardioplegia (CBC) following adult cardiac surgery. Methods A total of 361 patients who underwent cardiac surgery using BDN were compared with a contemporaneous control group of 934 patients receiving CBC. Propensity matching yielded 289 BDN and 289 CBC patients. Chi-square analysis and Fisher's exact test were performed to compare preoperative, operative, and postoperative characteristics on the matched data. Primary outcome was operative mortality, and secondary outcomes included clinical outcomes such as stroke, cardiac arrest, and intra-aortic balloon pump use. The Kaplan–Meier method was used to compare actuarial survival between the two groups using a log-rank test. Results After matching, preoperative characteristics and surgery type were similar between groups. Cardioplegia type did not affect the primary end point of operative mortality. The rate of postoperative intra-aortic balloon pump was lower in BDN patients compared with CBC patients (0 vs. 2%; p = 0.01). There was no difference in late survival. Conclusions Our novel protocol BDN was comparable with CBC, with similar clinical outcomes and no difference in operative mortality or actuarial survival. Further studies should evaluate the long-term outcomes of this technique.

Prestorage Leukoreduction of Transfused Red Cells Is Associated with Significant Ongoing 2–12 Month Survival Benefit in Cardiac Surgery Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 578-578 ◽  
Author(s):  
Lynn Boshkov ◽  
Grace Chien ◽  
Donna VanWinkle ◽  
Antony P. Furnary ◽  
Yingxing Wu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Survival Benefit ◽  
Operative Mortality ◽  
Artery Bypass ◽  
P Value ◽  
Short Term ◽  
Double Blind ◽  
Term Survival ◽  
To Receive ◽  
Adult Cardiac Surgery

Abstract Introduction: Red cell (RBC) transfusion (vs no transfusion) in cardiac surgery is associated with higer operative mortality and shortened long-term survival. Studies have suggested use of leukoreduced RBCs vs standard RBCs in transfused cardiac surgery patients is associated with improved short term (60 day) survival. It is unclear if this benefit persists longer term. Study Aim: This prospective, randomized, double-blind, 3-center trial compared short term and intermediate-term mortality (2–12 mos) in adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB) randomized to receive either prestorage leukoreduced RBCs (LR-RBCs) vs standard RBCs (S-RBCs) Methods: 1226 cardiac surgery patients (undergoing coronary artery bypass grafting, cardiac valve replacement, or a combination of the two) were pre-operatively randomized to receive either LR- or S-RBCs. Patients were operated on by the same group of surgeons. Patients and clinicians were blinded as to product type. All deaths were verified by National Death Index records. Results: 562 patients (45.8%) were transfused: 304 received LR-RBCs and 258 S-RBCs. Groups were statistically equivalent demographically and by all Society of Thoracic Surgery risk criteria. Operative mortality was not affected. However a survival benefit for the LR-RBC group was evident at 60 days which persisted for 12 months (see Table 1). Mortality for non-transfused patients was significantly lower than for patients receiving either LR- or S-RBCs at all time points (p<0.0001). Conclusion: In adult cardiac surgery patients undergoing CPB who require transfusion, use of LR-RBCs vs S-RBCs is associated with significant improvement in survival at 2 months, and this survival advantage persists for up to 1 year. Table 1: Percent (%) Mortality--Operative (Op) and Cumulative by Month (mo) Post-operative Op 2 mo 4 mo 6 mo* 9 mo* 12 mo* *Kaplan-Meier (KM) analysis LD-RBCs 4.9 4.9 5.3 5.9 5.9 7.0 S-RBCs 7.0 9.7 9.7 10.1 11.3 11.7 p-value 0.305 0.029 0.044 0.070 0.025 0.053

scholarly journals The Effect of Different Types of Mechanical Circulatory Support on Mortality of Patients after Adult Cardiac Surgery: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 23 (4) ◽  
pp. E537-E545
Author(s):  
Zhiyuan Guan ◽  
Xiaoqing Guan ◽  
Kaiyun Gu ◽  
Yanqi Li ◽  
Jin Lin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Mechanical Circulatory Support ◽  
Web Of Science ◽  
Meta Analysis ◽  
Circulatory Support ◽  
Pooled Data ◽  
Different Types ◽  
Postcardiotomy Shock ◽  
Adult Cardiac Surgery

Objectives: Sample size may limit the ability of individual studies to detect differences in clinical outcomes between extracorporeal membrane oxygenation (ECMO) alone and ECMO plus intra-aortic balloon pump (IABP) after adult cardiac surgery. Therefore, we undertook a meta-analysis of the best evidence available on the comparison of clinical outcomes of ECMO alone and ECMO plus IABP after adult cardiac surgery. Methods: PubMed, EMBASE, Web of Science, and Cochrane Center Registry of Controlled Trials were searched for studies comparing the use of ECMO alone and ECMO plus IABP after adult cardiac surgery. A meta-analysis and a sensitivity analysis were conducted. Results: Among the 472 screened articles, 24 studies (1302 cases of ECMO plus IABP and 1603 cases of ECMO) were included. A significant relationship between patient risk profile and benefits from IABP plus ECMO was found in terms of the 30-day mortality (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.62 to 0.91; P = .004) with postcardiotomy shock (PCS). However, ECMO alone was associated with lower in-hospital mortality (OR 1.75; 95% CI 1.06 to 3.01; Z = 2.19; P = .03) compared with ECMO plus IABP without PCS. Conclusions: Pooled data show that patients receiving IABP plus ECMO with PCS have lower 30-day mortality than those receiving ECMO also, which in turn show higher 30-day mortality in patients with IABP plus ECMO without PCS. Further randomized studies are warranted to corroborate these observational data.

Modified Whole Blood Microplegia vs Buckberg Cardioplegia in Adult Cardiac Surgery with Prolonged Bypass Time

2019 ◽  
Vol 229 (4) ◽  
pp. S47-S48
Author(s):  
Nicole Lin ◽  
Taylor James ◽  
Cristiano Faber ◽  
Marcos A. Nores ◽  
Sotiris C. Stamou
Keyword(s):  
Cardiac Surgery ◽  
Whole Blood ◽  
Adult Cardiac Surgery

Modified del Nido versus blood cardioplegia in congenital cardiac surgery

2021 ◽  
pp. 021849232110483
Author(s):  
Pitipong Sithiamnuai ◽  
Teerapong Tocharoenchok
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Clinical Outcomes ◽  
Risk Category ◽  
Blood Cardioplegia ◽  
Congenital Cardiac Surgery ◽  
Significant Difference ◽  
Cold Blood ◽  
Siriraj Hospital ◽  
And Gender

Background Lactated Ringer-based del Nido cardioplegia has been reported to be safe for acquired cardiac surgery. The original Plasma-Lyte-based solution has been proved for congenital cardiac surgery but its modification has not been adequately examined. We compared the clinical outcomes of congenital cardiac surgery using lactated Ringer-based del Nido cardioplegia versus cold blood cardioplegia. Methods Between September 2018 and November 2020, 116 consecutive patients with congenital heart disease undergoing operations with cardioplegic arrest performed by a single surgeon at Faculty of Medicine Siriraj hospital; 66 with modified del Nido solution and 50 with institutional's blood cardioplegia. The patient risk profiles, operative details, mortality rates, care durations, inotrope use, blood transfusion and complications were compared. Results Preoperative characteristics were similar between groups, including median age (2.5 vs. 3.1 years; p = 0.49), size, and gender. The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score of 3 to 5 was more prevalent in the del Nido group (24.2% vs. 10%; p = 0.049). There were 4 deaths in the modified del Nido group (risk category score of 4) but none in the cold blood group (p = 0.13). There was no significant difference in median intubation duration, length of intensive care unit stay, and vasoactive medications immediately and 24 h after the operation. The del Nido group required 70 to 100 ml less blood transfusion (p = 0.04). All complications were similar between the two groups. Conclusions Clinical outcomes of lactated Ringer-based del Nido cardioplegia were comparable to those of blood cardioplegia in congenital cardiac surgery.

Clinical experience with a novel endotoxin adsorbtion device in patients undergoing cardiac surgery

Perfusion ◽  
2009 ◽  
Vol 24 (1) ◽  
pp. 13-17 ◽  
Author(s):  
S Blomquist ◽  
V Gustafsson ◽  
T Manolopoulos ◽  
L Pierre
Keyword(s):  
Cardiac Surgery ◽  
Platelet Count ◽  
Whole Blood ◽  
Blood Clot ◽  
Artery Bypass ◽  
Ease Of Use ◽  
Control Group ◽  
Valvular Surgery ◽  
Number Of Patients ◽  
Flow Through

Endotoxaemia is thought to occur in cardiac surgery using extracorporeal circulation (ECC) and a positive correlation has been proposed between the magnitude of endotoxaemia and risk for postoperative complications. We studied the effects of a new endotoxin adsorber device (Alteco® LPS adsorber) in patients undergoing cardiac surgery with ECC, with special reference to safety and ease of use. Fifteen patients undergoing coronary artery bypass and/or valvular surgery were studied. In 9 patients, the LPS Adsorber was included in the bypass circuit between the arterial filter and the venous reservoir. Flow through the adsorber was started when the aorta was clamped and stopped at the end of perfusion. Flow rate was kept at 150 ml/min. Six patients served as controls with no adsorber in the circuit. Samples were taken for analysis of endotoxin, TNFα, IL-1ß and IL-6 as well as complement factors C3, C4 and C1q. Whole blood coagulation status was evaluated using thromboelastograpy (TEG) and platelet count. No adverse events were encountered when the adsorber was used in the circuit. Blood flow through the device was easily monitored and kept at the desired level. Platelet count decreased in both groups during surgery. TEG data revealed a decrease in whole blood clot strength in the control group while it was preserved in the adsorber group. Endotoxin was detected in only 2 patients and IL-1ß in 4 patients. IL-6 decreased in both groups whereas no change in TNF concentrations was found. C3 fell in both groups, but no changes wer found in C4 and C1q. The Alteco® LPS adsorber can be used safely and is easy to handle in the bypass circuit. No complications related to the use of the adsorber were noted. The intended effects of the adsorber, i.e. removal of endotoxin from the blood stream could not be evaluated in this study, presumably due to the small number of patients and the relatively short perfusion times.

Preservation of collagen-induced whole blood platelet aggregation by tranexamic acid therapy in primary cardiac valve surgery

Perfusion ◽  
2000 ◽  
Vol 15 (6) ◽  
pp. 507-513 ◽  
Author(s):  
Tetsuya Miyashita ◽  
Takahiko Kamibayashi ◽  
Yoshihiko Ohnishi ◽  
Junjiro Kobayashi ◽  
Masakazu Kuro
Keyword(s):  
Cardiac Surgery ◽  
Platelet Aggregation ◽  
Tranexamic Acid ◽  
Platelet Function ◽  
Whole Blood ◽  
Blood Platelet ◽  
Acid Group ◽  
Valve Surgery ◽  
Control Group ◽  
Blood Platelet Aggregation

Haemostatic disorder is one of the most common complications following cardiac surgery with cardiopulmonary bypass (CPB). Tranexamic acid reduces blood loss and allogeneic blood transfusion requirement in cardiac surgery. It had been thought that tranexamic acid inhibited fibrinolysis alone following CPB. In the present study, the haemostatic effects of tranexamic acid (20 mg/kg body weight bolus after induction of anaesthesia followed by continuous infusion at 2 mg/kg/h), including fibrinolysis and platelet function, were investigated in 22 patients (tranexamic acid group n = 12; control group n = 10) undergoing primary cardiac valve surgery. Fibrinolysis following CPB was reduced significantly in the tranexamic acid group. Following protamine administration, the reduction of collagen-induced whole blood platelet aggregation was mitigated significantly in the tranexamic acid group compared with the control group (36% reduction in the tranexamic acid group vs 58% in the control group; p = 0.011), although platelet counts did not differ between the two groups. In conclusion, tranexamic acid not only inhibits fibrinolysis directly, but also may preserve platelet function following CPB.

scholarly journals Clostridioides difficile infection after cardiac surgery: Assessment of prevalence, risk factors and clinical outcomes—retrospective study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9972
Author(s):  
Anna Rzucidło-Hymczak ◽  
Hubert Hymczak ◽  
Aldona Olechowska-Jarząb ◽  
Anna Gorczyca ◽  
Boguslaw Kapelak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Coronary Disease ◽  
Control Group ◽  
Malignant Neoplasms ◽  
Prolonged Stay ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
History Of

Background Clostridioides difficile infection (CDI) is the most common cause of hospital-acquired diarrhea. There is little available data regarding risk factors of CDI for patients who undergo cardiac surgery. The study evaluated the course of CDI in patients after cardiac surgery. Methods Of 6,198 patients studied, 70 (1.1%) developed CDI. The control group consisted of 73 patients in whom CDI was excluded. Perioperative data and clinical outcomes were analyzed. Results Patients with CDI were significantly older in comparison to the control group (median age 73.0 vs 67.0, P = 0.005) and more frequently received proton pump inhibitors, statins, β-blockers and acetylsalicylic acid before surgery (P = 0.008, P = 0.012, P = 0.004, and P = 0.001, respectively). In addition, the presence of atherosclerosis, coronary disease and history of malignant neoplasms correlated positively with the development of CDI (P = 0.012, P = 0.036 and P = 0.05, respectively). There were no differences in the type or timing of surgery, aortic cross-clamp and cardiopulmonary bypass time, volume of postoperative drainage and administration of blood products between the studied groups. Relapse was more common among overweight patients with high postoperative plasma glucose or patients with higher C-reactive protein during the first episode of CDI, as well as those with a history of coronary disease or diabetes mellitus (P = 0.005, P = 0.030, P = 0.009, P = 0.049, and P = 0.025, respectively). Fifteen patients died (21.4%) from the CDI group and 7 (9.6%) from the control group (P = 0.050). Emergent procedures, prolonged stay in the intensive care unit, longer mechanical ventilation and high white blood cell count during the diarrhea were associated with higher mortality among patients with CDI (P = 0.05, P = 0.041, P = 0.004 and P = 0.007, respectively). Conclusions The study did not reveal any specific cardiac surgery-related risk factors for development of CDI.

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