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.

Abstract 14873: Is There Difference in Clinical Outcomes Following Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS) between Hospitals With and Without Onsite Cardiac Surgery Backup?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tomonori Akasaka ◽  
Seiji Hokimoto ◽  
Noriaki Tabata ◽  
Kenji Sakamoto ◽  
Kenichi Tsujita ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Bleeding Complications ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
The Impact

Background: Based on 2011 ACCF/AHA/SCAI PCI guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, recent data suggests that there is no significant difference in clinical outcomes following primary or elective PCI between hospitals with and without onsite cardiac surgery. The proportion of PCI centers without onsite cardiac surgery comprises approximately more than half of all PCI centers in Japan. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI to ACS. Methods: From Aug 2008 to March 2011, subjects (n=2288) were enrolled from the Kumamoto Intervention Conference Study (KICS), which is a multicenter registry, and enrolling consecutive patients undergoing PCI in 15 centers in Japan. Patients were assigned to two groups treated in hospitals with (n=1954) or without (n=334) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored other events those were non-cardiovascular deaths, bleeding complications, revascularizations, and emergent CABG. Results: There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery (9.6%vs9.5%; P=0.737). There was also no significant difference when events in primary endpoint were considered separately. In other events, only revascularization was more frequently seen in hospitals with onsite cardiac surgery (22.1%vs12.9%; P<0.001). Kaplan-Meier analysis for primary endpoint showed that there was no significant difference between two groups (Log Rank P=0.943). By cox proportional hazards model analysis for primary endpoint, without onsite cardiac surgery was not a predictive factor for primary endpoint (HR 0.969, 95%CI 0.704-1.333; P=0.845). We performed propensity score matching analysis to correct for the disparate patient numbers between two groups, and there was also no significant difference for primary endpoint (6.9% vs 8.0%; P=0.544). Conclusions: There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.

Intermittent Tepid Blood Cardioplegia Improves Clinical Outcome

2003 ◽  
Vol 11 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Teing Ee Tan ◽  
Sulman Ahmed ◽  
Hugh S Paterson
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Protection ◽  
Contractile Function ◽  
Perioperative Myocardial Infarction ◽  
Blood Cardioplegia ◽  
Cerebrovascular Events ◽  
Significant Difference ◽  
Cold Blood ◽  
Clinical Benefits ◽  
Cold Blood Cardioplegia

Intermittent antegrade cold blood cardioplegia is the predominant method of myocardial protection, but recent studies suggest that warm or tepid blood cardioplegia may improve the return of myocardial metabolic and contractile function. Data were collected prospectively on 1,533 patients undergoing cardiopulmonary bypass in a single surgeon's practice. The use of intermittent antegrade cold (4°C) blood cardioplegia in 951 consecutive patients from September 1994 to November 1997 was compared with intermittent antegrade tepid (28°C) blood cardioplegia in 582 consecutive patients from July 1998 to July 2000. The two groups were similar, but the symptom class was more severe and there were more redo and combined procedures and more operations within 7 days of myocardial infarction in the tepid group. Significant clinical benefits identified in the tepid group included reduced usage of intraaortic balloon pumping postoperatively (4.4% versus 2.2%) and reduced incidence of postoperative atrial fibrillation (25.7% versus 20.6%). There was no significant difference in mortality, perioperative myocardial infarction, cerebrovascular events, or use of inotropics between the groups. Intermittent tepid blood cardioplegia is clinically appropriate and safe to use in patients undergoing cardiac surgery.

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.

scholarly journals A Cohort of Gender-Based Outcomes in Hepatitis B and C after Cardiac Surgery

2020 ◽  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hepatitis B ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cardiopulmonary Bypass Time ◽  
Predictors Of Mortality ◽  
Significant Difference ◽  
Gender Based ◽  
And Gender

Objective: Our research article aimed to determine if six-month mortality amongst hepatitis B and C patients undergoing cardiac surgery varied according to gender, post-operatively. Secondarily, we highlighted the significant differences among the two genders in their pre-operative, operative, and post-operative characteristics and deduced significant predictors of mortality. Methods: We obtained approval from the International Review Board of the Dow University of Health Sciences, and conducted a retrospective study targeting hepatitis B and C patients who had undergone cardiac surgery between January 2013 to October 2018 at the Ruth Pfau Civil Hospital, Karachi, Pakistan. The data was analysed using the Statistical Package for Social Sciences (Version 20.0). The population was divided into two groups, based on gender. Chi-squared test was used to compare categorical variables and odd ratios with 95% confidence interval were also computed. Differences in continuous variables were assessed using independent T-test or Mann-Whitney U test. Results: There was no significant difference in six-month mortality between the genders, with a 22.5% mortality in males and 20.0% mortality in females. Post-operatively, males had higher creatinine (p=0.003) levels but females tended to have a longer ward stay (p=0.032). On multivariate logistic regression, duration of intubation (aOR=1.131, 95% CI: 1.002-1.275), cardiopulmonary bypass time (aOR=1.030, 95% CI: 1.002-1.059) and duration of ward stay (aOR=1.100, 95% CI: 1.031-1.175) were found to be significant predictors of mortality. Conclusion: There is no association between six-month mortality and gender among hepatitis B and C patients undergoing cardiac surgery. Additionally, duration of intubation, cardiopulmonary bypass time and duration of ward stay are significant predictors of six-month mortality.

Does Cardioplegia Type Affect Outcome and Survival in Patients With Advanced Left Ventricular Dysfunction?

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Joseph E. Flack ◽  
James R. Cook ◽  
Susanne J. May ◽  
Stanley Lemeshow ◽  
Richard M. Engelman ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Solution Temperature ◽  
Blood Cardioplegia ◽  
Late Death ◽  
Retrograde Cardioplegia ◽  
Significant Difference ◽  
Cold Blood ◽  
Antegrade Cardioplegia

Background —There is controversy regarding which cardioplegic solution, temperature, and route of administration provides superior protection. The CABG Patch Trial enrolled a high-risk group of coronary artery disease patients with an ejection fraction of <36%. Thus, they constitute an ideal group to benefit most from optimal cardioplegic protection. Methods and Results —All patients randomized into the trial were compared with respect to the use of blood and crystalloid cardioplegia. In addition, a questionnaire was sent to surgeons requesting blood cardioplegic temperature and route. Patients receiving crystalloid cardioplegia versus those receiving blood cardioplegia were found to have significantly more operative deaths (2% versus 0.3%, P =0.02), postoperative myocardial infarctions (10% versus 2%, P <0.001), shock (13% versus 7%, P =0.013), and postoperative conduction defects (21.6% versus 12.4%, P =0.001). Despite this, early death (6% crystalloid versus 4% blood cardioplegia) and late death (24% crystalloid versus 21% blood cardioplegia) statistics were not significantly different. Patients receiving normothermic blood had less postoperative right ventricular dysfunction (10%) than did patients receiving cold blood (25%) or cold blood with warm reperfusion (30%) ( P =0.004). There was no significant difference in early or late death. Finally, patients who received combined antegrade and retrograde cardioplegia had significantly less inotrope use (71% versus 84%, P =0.002), right ventricular dysfunction (23% versus 41%, P =0.001), and postoperative balloon pump use (12% versus 19%, P =0.02) than did those who received antegrade cardioplegia. There was no difference in survival. Conclusions —Blood cardioplegia and combined antegrade and retrograde cardioplegia are superior to crystalloid and antegrade cardioplegia alone for postoperative morbidity. Despite this, there is no significant difference in early or late survival.

Appropriateness and Timeliness of Initial Thromboprophylaxis in Patients with a Hospital Acquired Venous Thrombosis in a Single Center: A Case Control Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4359-4359
Author(s):  
Jason Suh ◽  
Josephine Dela Cruz ◽  
Amishi Desai ◽  
Anusiyanthan Mariampillai ◽  
Christopher Avanzato ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Bleeding Risk ◽  
Categorical Variables ◽  
Risk Category ◽  
Age And Gender ◽  
Therapeutic Anticoagulation ◽  
Significant Difference ◽  
And Gender ◽  
Hospital Acquired ◽  
Chemical Prophylaxis

Abstract Abstract 4359 Introduction: Venous Thromboembolism (VTE) remains the number one preventable cause of hospital acquired morbidity and mortality (1). To mitigate this, guidelines are published for the prevention of VTE (2). Currently, the rate of adherence to guidelines is between 16 and 60% (3). Studies show even short periods of immobilization can increase risk for VTE (4), thus we postulated that delays in prophylaxis may correlate with more VTEs. Methods: Between January 2009 and December 2011, hospital acquired VTEs were identified at a 600 bed teaching hospital. Control cases were selected from consecutive admissions in February 2011 to match the VTE cases by risk category, age and gender. Patients younger than 18 years, or initiated on therapeutic anticoagulation were excluded.VTE was confirmed by imaging, and timing was recorded from time of presentation to time of administration. Prophylaxis appropriateness was determined according to published guidelines (2). Categorical variables were compared using Chi-squared test for independence. Normally distributed continuous variables were compared using 2 tailed T-test. Results: 179 cases of hospital acquired VTE were found between 2009 and 2011. 9 cases were excluded due to age or therapeutic anticoagulation. 170 control cases were matched by risk category, age and gender. The patient characteristics are summarized in Table 1. Appropriate prophylaxis rate was lower in the VTE group.(p< 0.0001)(55% vs 80%) There was a higher rate in VTE risk assessment in the VTE group (p=0.021) (90% vs 82%). There was no significant difference (p=0.67) in the timing of initial prophylaxis. (33.4hrs vs 34.8hrs) Prophylaxis choices are summarized in Table 2. The rate of sequential compression devices (SCDs) ordered but undocumented is high in both groups. In many cases, it was the sole prophylaxis ordered, and would have been sufficient (11% VTE, 12% control). Documented contraindications to chemical prophylaxis are shown in table 3. Notably, several cases were listed as “high bleeding risk” but had no identifiable risk. Also among the cases listing thrombocytopenia, only one had less than 50k platelets. Conclusion: Between 2009 to 2011, 170 evaluable cases of VTE were compared against matched controls. There was no difference in the time to prophylaxis in both groups; however the 34 hour delay shows a need for improvement. The statistically lower adherence rate to guidelines in the VTE group is in keeping with other published series (3). This is made more poignant by the higher risk assessment rate in the VTE group, which should increase adherence rates. The low documentation rate of SCDs in both groups stresses the need for standardized documentation. Adherence rates would be higher since SCDs would be sufficient in many cases. Incorrect risk assessment, especially with regard to bleeding risk and thrombocytopenia highlight the need for improved understanding of true chemical prophylaxis contraindications. This study demonstrates the importance of continued adherence to prophylaxis throughout hospitalization. Disclosures: No relevant conflicts of interest to declare.

Evaluation of Erythropoietin Stimulating Agents (ESA) and Their Effect on Blood Optimization for Cardiac Surgery

2020 ◽  
pp. 089719002096927
Author(s):  
Kristina S. Gill ◽  
Abigail D. Antigua ◽  
A. Kacee Barnett ◽  
Aubrey J. Hall ◽  
Charles T. Klodell
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Retrospective Cohort ◽  
Blood Transfusions ◽  
Transfusion Rate ◽  
Blood Products ◽  
Single Center ◽  
Drug Reactions ◽  
Significant Difference ◽  
Erythropoietin Stimulating Agents

Background: Cardiovascular surgeries increase the risk of receiving blood transfusions. Erythropoietin stimulating agents (ESAs) have been used to decrease the transfusion rate. The objective of this study was to evaluate the administration of blood products post-cardiothoracic surgery after receiving ESAs. Methods: This is a single-center, retrospective cohort study. Results: Between May 2017 to May 2018, 52 adult patients underwent cardiac surgery and received ESAs pre-operatively and/or post-operatively. A total of 35 patients were included in the study and 21 (60%) patients did not require a blood transfusion while 14 (40%) patients required a blood transfusion ( p = 0.597). The change in hemoglobin (Hgb = 0.773 g/dL, 1.7 g/dL; p = 0.002) and hematocrit (Hct = 2.31%, 4.3%; p = 0.04) was significantly different in patients who received ESAs alone versus ESAs with blood transfusion. Adverse drug reactions showed no significant difference between groups. Conclusions: In patients undergoing cardiac surgery, ESAs did not significantly reduce the need for blood transfusion. Future and larger studies are necessary to evaluate the effect of ESAs on blood transfusion.

Abstract 12910: Safety and Utility of Cardiac Catheterization in the Early Postoperative Period Following Congenital Cardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kimberly I Mills ◽  
Lisa B Bergersen ◽  
Matthew Jolley ◽  
Sarah A Teele ◽  
John E Mayer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Cardiac Catheterization ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Early Postoperative Period ◽  
Multivariable Model ◽  
Mechanically Ventilated ◽  
Congenital Cardiac Surgery ◽  
Case Duration

Introduction: In patients with clinical concern for residual anatomic or physiologic lesions after congenital cardiac surgery, the risk to benefit ratio of early postoperative cardiac catheterization (EPOC) remains unclear. Methods: Retrospectively, patients undergoing EPOC (catheterization ≤42 days after surgery and prior to discharge) were identified from a single institutional database between 1/1/06 to 10/31/13. Patient, procedural and high-severity adverse event (HSAE) data were obtained from the Congenital Cardiac Catheterization Outcomes Project. Univariate analysis identified risk factors for HSAEs and a multivariable model was created to describe their relationship. Utility of EPOC was determined by re-intervention (surgical and/or catheter-based). Results: In the cohort, 561 EPOCS occurred on median POD 10 (5, 19) in 413 subjects with median age of 4.6 mos (3.2, 9.9) and weight 4.4 kg (0.8, 18.2). The majority of cases were not elective (92%), performed on inotropes (62%) and mechanically ventilated (96%). Residual defects were found in 75% of the cases: 50% requiring catheter-based interventions, 15% necessitating re-operation and 10% underwent both catheter-based intervention and re-operation. There were 70 HSAEs (12.5%) including 1 death, 2 emergent surgeries and 5 ECMO cannulations. Vascular tears occurred at surgical anastomotic sites in 11 of 198 (6%) cases involving angioplasty. HSAEs were associated with low patient weight (p=0.02), interventional procedures (p=0.03), greater number of interventions (p<0.01), higher procedure risk group (p=0.03), blood transfusion (p<0.01) and longer case duration (p<0.01). In multivariable analysis, HSAEs were associated with case duration (OR 1.008, 95% CI 1.003-1.012), blood transfusion (OR 0.431, 95% CI 0.25-0.745) and male gender (OR 0.573, 95% CI 0.331-0.992). Time from surgery to EPOC was not associated with an increased rate of HSAEs (p=0.5). Conclusions: EPOC carried an increased rate of HSAEs with no association between POD and the rate of HSAEs. EPOC identified significant residual defects in the majority of patients necessitating re-intervention. EPOC should be considered in patients with unexpected cardiopulmonary concerns following congenital cardiac surgery.

Modified crystalloid-blood cardioplegia combined with low volume cardioplegic system in pediatric congenital cardiac surgery

2019 ◽  
Vol 16 (1) ◽  
pp. 5-15
Author(s):  
G.G. Khubulava ◽  
A.B. Naumov ◽  
S.P. Marchenko ◽  
O.Yu. Tereshenko ◽  
E.S. Kulemin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Cardioplegia ◽  
Congenital Cardiac Surgery ◽  
Low Volume
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