Effect of subzero-balanced ultrafiltration on postoperative outcome of patients after cardiopulmonary bypass

Objective: To evaluate the effect of a new ultrafiltration technique — subzero-balanced ultrafiltration technique — on early postoperative outcomes of adult patients undergoing cardiac operations with cardiopulmonary bypass. Methods: A total of 120 patients who required cardiopulmonary bypass for cardiac surgery were randomized into two groups, 60 in each group. Patients in the treatment group received subzero-balanced ultrafiltration during cardiopulmonary bypass, while patients in the control group received routine cardiopulmonary bypass. Postoperative outcomes, including hospital mortality and morbidity of the two groups, were analyzed. Results: Hospital mortality was 0% (0 of 60) in the treatment group versus 1.8% (1 of 60) in the control group (P=1.000). Total hospital complications was lower in the treated patients (11 of 60 [18.3%] versus 22 of 60 [36.7%], P=0.025). Duration of intubation time was shorter and transfusion volume within 24 hours postoperatively was less in patients having received subzero-balanced ultrafiltration during cardiopulmonary bypass (14.35 ± 1.66 versus 18.64 ± 1.57 h, P=0.036 and 1.54 ± 1.56 versus 3.64 ± 2.67 U/patient, P=0.032). Length of stay on the intensive care unit, duration of hospital stay, need for infusion of inotropic agent and drainage volumes within 24 h postoperatively between the two groups were comparable. Conclusions: Subzero-balanced ultrafiltration during cardiopulmonary bypass can effectively decrease the patients’ hospital morbidity and the volume of blood transfusion: it also may promote early postoperative recovery of patients. Routine application of subzero-balanced ultrafiltration during adult cardiac operations should not be necessary, but the technique should be compared to other techniques, e.g. MUF, in further studies.

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Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

Circulation ◽

10.1161/circ.104.suppl_1.i-253 ◽

2001 ◽

Vol 104 (suppl_1) ◽

Author(s):

Giovanni Battista Luciani ◽

Tiziano Menon ◽

Barbara Vecchi ◽

Stefano Auriemma ◽

Alessandro Mazzucco

Keyword(s):

Cardiopulmonary Bypass ◽

Hospital Stay ◽

Heart Surgery ◽

Open Heart Surgery ◽

Group Versus ◽

Control Group ◽

Continuous Variables ◽

Transfusion Requirements ◽

The Impact ◽

Cardiac Operations

Background Extracorporeal circulation contributes to morbidity after open-heart surgery by causing a systemic inflammatory reaction. Modified ultrafiltration is a technique able to remove the fluid overload and inflammatory mediators associated with use of cardiopulmonary bypass. It has been shown to reduce morbidity after cardiac operations in children, but the impact on adult cardiac procedures is unknown. Methods and Results Five hundred seventy-three consecutive adult patients were prospectively randomized to either ultrafiltration after cardiopulmonary bypass (treatment) or to no ultrafiltration (control). Parsonnet score was used to assess the severity of the patients’ clinical conditions. Analysis was done with Student’s t test or Mann-Whitney U test for continuous variables and Fisher’s exact test or Pearson’s χ 2 for discrete variables. Hospital mortality was 2.5% (7 of 284) in the treatment group versus 3.8% (11 of 289) in the control group ( P =0.357). Hospital morbidity was lower in treated patients (66 of 284 [23.2%] versus 117 of 289 [40.5%], P =0.0001). Cardiac morbidity was similar (26 of 284 [9.1%] versus 35 of 289 [12.1%], P =0.251), whereas significantly lower rates of respiratory (20 of 284 [7.0%] versus 36 of 289 [12.5%], P =0.029), neurological (5 of 284 [1.8%] versus 14 of 289 [4.8%], P =0.039), and gastrointestinal (0 of 284 versus 4 of 289 [1.4%], P =0.044) complications were found in treated patients. Transfusion requirements were also lower in treated patients (1.66±2.6 versus 2.25±3.8 U/patient, P =0.039). Duration of intensive care (39.9±49.2 versus 46.3±72.8 hours, P =0.218) and hospital stay (7.6±3.5 versus 7.9±4.4 days, P =0.372) were comparable. Conclusions Modified ultrafiltration after cardiopulmonary bypass is associated with a lower prevalence of early morbidity and lower blood transfusion requirements. The impact on length of hospital stay needs further analysis. Routine application of modified ultrafiltration after adult cardiac operations is warranted.

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Regression of cardiac amyloid deposits with novel therapeutics: reaching new frontiers in cardiac ATTR amyloidosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2117 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Chacko ◽

A Martinez-Naharro ◽

T Kotecha ◽

R Martone ◽

D Hutt ◽

...

Keyword(s):

Treatment Group ◽

Cardiac Amyloidosis ◽

T1 Mapping ◽

Group Versus ◽

Control Group ◽

Cardiac Amyloid ◽

Attr Amyloidosis ◽

Amyloid Load ◽

The Impact

Abstract Background Cardiac involvement is the main driver of outcome in ATTR amyloidosis. Advances in therapeutics hold potential in transforming the course of the disease but the impact on cardiac amyloid load is unknown. The aim of this study was to evaluate the impact of patisiran, a new double stranded RNA based gene silencing therapy and a stabilizer, diflunisal, on cardiac amyloid load as measured by CMR and T1 mapping, in patients with ATTR amyloidosis. Methods and results Thirty-two patients with hereditary cardiac amyloidosis were studied. Sixteen patients received treatment with patisiran, and sixteen control subjects did not receive any disease modifying treatment. Patients were assessed with echocardiogram, CMR, NT-proBNP and six-minute walk time measurements at baseline and at 1 year (Mean interval 11.45±3.08 months in treatment group, mean interval 12.82±5.06 months in the control group). CMR analysis comprised LV volumes, T1 mapping to measure the extracellular volume (ECV) occupied by amyloid, T2 mapping and late gadolinium enhancement imaging. At 1-year follow-up, there was a substantial reduction in cardiac amyloid burden, in keeping with cardiac amyloid regression in 45% of patients on treatment. Overall the treatment group showed a reduction in ECV at 1 year follow up compared to an increase in ECV at 1 year in the control group (−1.37%, 95% CI: −3.43 to 0.68% versus 5.02%, 95% CI: 2.86% to 7.18% respectively, p<0.001). The treatment group also showed an improvement in change in 6MWT at 1 year follow up compared to 6MWT at 1 year in the control group (−8.12 meters, 95% CI: −50.8 to 34.6 meters in the treatment group versus −132.27 meters, 95% CI: −216 to −48.6 meters in the control group, p=0.002). The treatment group showed a reduction in BNP at 1 year follow up compared to an increase in the control group (−567.87, 95% CI: −1288.90 to 153.15 in the treatment group versus 2004, 95% CI: 12.82 to 3995.45 in the control group, p<0.001). There was no significant difference from baseline and 1-year data between the control and treatment groups for the difference in echocardiographic parameters, native T1, T2. There was a significant reduction in the percentage of injected dose by 99Tc-DPD scintigraphy in treated patients at 1 year compared to baseline. Conclusions These findings provide the first compelling evidence of substantial cardiac amyloid regression in ATTR amyloidosis, as well as the potential for CMR to be used to track response in treated patients with ATTR cardiac amyloidosis. Combination therapy with transthyretin knock down and stabilizing agents may well be synergistic given enhanced stoichiometry of stabilizers in the face of much reduced plasma transthyretin concentration. Funding Acknowledgement Type of funding source: None

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Complete blood cell count risk score as a predictor of in-hospital mortality and morbidity among patients undergoing cardiac surgery with cardiopulmonary bypass

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.03.227 ◽

2015 ◽

Vol 187 ◽

pp. 60-62 ◽

Cited By ~ 1

Author(s):

Ana Paula Porto Rödel ◽

Manuela Borges Sangoi ◽

Larissa Garcia de Paiva ◽

Jossana Parcianello ◽

José Edson Paz da Silva ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Blood Cell ◽

Hospital Mortality ◽

Cell Count ◽

Risk Score ◽

Complete Blood Cell Count ◽

Blood Cell Count ◽

Mortality And Morbidity

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Randomized, surgical adjuvant clinical trial of recombinant interferon alfa-2a in selected patients with malignant melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.11.2776 ◽

1995 ◽

Vol 13 (11) ◽

pp. 2776-2783 ◽

Cited By ~ 197

Author(s):

E T Creagan ◽

R J Dalton ◽

D L Ahmann ◽

S H Jung ◽

R F Morton ◽

...

Keyword(s):

Treatment Group ◽

High Risk ◽

Malignant Melanoma ◽

Group Versus ◽

Interferon Alfa ◽

Stage I ◽

Stage Ii ◽

Control Group ◽

Recombinant Interferon ◽

Ifn Alpha

PURPOSE We conducted a randomized prospective trial in selected patients with fully resected high-risk stage I and II malignant melanoma. PATIENTS AND METHODS Interferon alfa-2a (IFN-alpha 2a) 20 x 10(6) U/m2 was administered three times each week for 12 weeks by the intramuscular route. Both the treatment group (n = 131) and the control group (n = 131) were evenly balanced with regard to relevant prognostic discriminants. RESULTS The median disease-free survival (DFS) time was 2.4 years for the IFN-alpha 2a group and 2.0 years for the observation group (log-rank P = 0.19). The median survival times were 6.6 years for IFN-alpha 2a and 5.0 years for observation (log-rank P = .40). For stage I patients (n = 102), there was no apparent therapeutic advantage from IFN-alpha 2a therapy. The DFS for stage II patients was a median of 10.8 months in the control group versus 17 months in the treatment group. The overall survival time was 4.1 years for the treatment group versus 2.7 years for the control group. The differences in DFS for stage II patient were significant in a Cox model. These results must be interpreted cautiously because of subset analysis. A severe flu-like toxicity occurred in 44% of patients, 13% lost at least 10% of their baseline weight, and 45% experienced a worsening of Eastern Cooperative Oncology Group (ECOG) performance score. CONCLUSION Our findings indicate trends that suggest a possible benefit for selected patients with high-risk malignant melanoma. The results will require further study in a larger patient population for confirmation.

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The Effect of Optimized Ultrafiltration on Perioperative Pulmonary Function During Cardiopulmonary Bypass in Infants Under 10 kg

Frontiers in Pediatrics ◽

10.3389/fped.2021.602034 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jianhong Niu ◽

Guangdi Zhai ◽

Aibin Zheng ◽

Juanying Zhou ◽

Shengqi Jiang ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Treatment Group ◽

Lung Function ◽

Pulmonary Function ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Combination Method ◽

Control Group ◽

Acid Base Balance ◽

Significant Difference

Objective: This study aims to investigate the effect of optimized ultrafiltration on perioperative electrolytes, acid–base balance, and pulmonary function during cardiopulmonary bypass (CPB) in infants with low body weight (under 10 kg), using traditional balanced ultrafiltration and modified ultrafiltration.Methods: A total of 30 children who underwent surgical correction for congenital heart disease in Changzhou Children's Hospital between January 2018 and December 2019 were randomly divided into two groups. In the treatment group, ultrafiltration pre-treatment was carried out with blood-containing priming fluid prior to CPB. Balanced ultrafiltration was performed during the operation, and optimized and modified ultrafiltration were conducted before closing and extubation. In the control group, traditional balanced ultrafiltration was used during the operation, and a modified ultrafiltration combination was used before closing and extubation. Indexes such as blood gas analysis and electrolytes were measured perioperatively, and pulmonary function was observed.Results: No deaths were reported in either group. The ventilator-assisted breathing time was shorter in the treatment group than in the control group (P < 0.05). The indexes of the treatment group were closer than those of the control group to the optimal physiological values. The concentrations of potassium ion (K+), lactate (Lac), and blood glucose (Glu) decreased, and there was significant difference between the two groups (P < 0.05) at the end of CPB. Hemoglobin (Hb) and hematocrit (HCT) in the treatment group increased (P < 0.01). Alveolar-arterial differences for oxygen (A-aDO2) and respiratory index (RI) increased significantly in both groups after operation. Children in the treatment group began to recover lung function earlier than children in the control group. Both A-aDO2 and RI were lower in the treatment group than in the control group at each time point after operation (P < 0.05).Conclusion: Optimizing and modifying the traditional ultrafiltration combination method can effectively shorten the ultrafiltration time, reduce the adverse impacts of the ultrafiltration technique, and improve the lung function of infants after operation.

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Effects of Chengqi Decoction on Complications and Prognosis of Patients with Pneumonia-Derived Sepsis: Retrospective Cohort Study

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/8475727 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Zhipeng Huang ◽

Xiaoxin Cai ◽

Yao Lin ◽

Bojun Zheng ◽

Li Jian ◽

...

Keyword(s):

Treatment Group ◽

Retrospective Cohort ◽

Conventional Treatment ◽

Abdominal Distension ◽

Antibiotic Use ◽

Control Group ◽

Vasoactive Agents ◽

Mortality And Morbidity ◽

And Control ◽

Significant Covariates

Purpose. A specific and efficacious method for treatment of pneumonia-derived sepsis is lacking. Chengqi decoction has been used for treatment of pneumonia-derived sepsis, but a clinical trial on patients with pneumonia-derived sepsis is lacking, a gap in the literature that we sought to fill. Patients and Methods. 282 patients with pneumonia-derived sepsis admitted to the intensive care unit of our hospital were selected. They were divided into the treatment group (141 cases) and control group (141 cases). Both groups underwent conventional treatment, but Chengqi decoction (in the form of enema) was given to the treatment group. Mortality, morbidity (abdominal distension and gastrointestinal bleeding), duration of antibiotic use, and use of vasoactive agents were documented 28 days after the drug was used. Results. The treatment group reduced mortality and morbidity (abdominal distension) ( P < 0.05 ). After adjustment for significant covariates, 28-day survival was similar for the whole group (hazard ratio (HR): 0.48; 95% confidence interval (CI): 0.23–0.97; P = 0.037 ), for the subgroup (n = 120) with Acute Physiology and Chronic Health Evaluation II score ≥25 (HR: 0.180; 95% CI: 0.032–0.332; P = 0.039 ) and for the subgroup (n = 66) with N-terminal B-type natriuretic peptide <1800 (0.059, 0.004–0.979, and 0.019). There was no difference between the two groups for the duration of antibiotic use, major bleeding, or use of vasoactive drugs. Conclusions. Chengqi decoction improved 28-day survival and reduced the prevalence of abdominal distension in patients with pneumonia-derived sepsis.

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Treatment with Antithrombin or Thrombomodulin and Mortality from Heatstroke-Induced Disseminated Intravascular Coagulation: A Nationwide Observational Study

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0039-1700520 ◽

2019 ◽

Vol 45 (08) ◽

pp. 760-766

Author(s):

Hiroyuki Ohbe ◽

Shunsuke Isogai ◽

Taisuke Jo ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

...

Keyword(s):

Treatment Group ◽

Confidence Interval ◽

Hospital Mortality ◽

Disseminated Intravascular Coagulation ◽

Risk Difference ◽

Control Group ◽

Robust Analysis ◽

Intravascular Coagulation ◽

Doubly Robust ◽

Inpatient Database

AbstractHeatstroke-induced disseminated intravascular coagulation represents potential targets for specific intensive treatments. However, the effect of antithrombin or thrombomodulin treatment remains uncertain. Using a large nationwide inpatient database in Japan, this study aimed to evaluate whether treatment with antithrombin or thrombomodulin could reduce mortality among patients with heatstroke-induced disseminated intravascular coagulation. Using the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2017, we identified heatstroke patients who developed disseminated intravascular coagulation. We allocated patients who started treatment with antithrombin or thrombomodulin within 2 days after admission to the treatment group and allocated others to the control group. A primary outcome was in-hospital mortality. We used a doubly robust analysis to ensure the robustness of our findings. We also conducted two sensitivity analyses for thrombomodulin versus others and antithrombin versus others. We identified 1,606 eligible patients during the 81-month study period. Of these, 556 (35%) received antithrombin or thrombomodulin. The doubly robust analysis demonstrated that in-hospital mortality was significantly lower among patients in the treatment group than among those in the control group (risk difference −6.5%; 95% confidence interval: −12 to −1.4%). In-hospital mortality was significantly lower in patients with thrombomodulin than in others (risk difference −5.5%; 95% confidence interval: −9.5 to −1.6%). There was no significant difference in in-hospital mortality between patients with antithrombin and others (risk difference −4.2%; 95% confidence interval: −9.3 to 0.9%). Treatment with recombinant human thrombomodulin may be associated with lower in-hospital mortality among patients with heatstroke-induced disseminated intravascular coagulation.

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Involvement of Hemopexin in the Pathogenesis of Proteinuria in Children with Idiopathic Nephrotic Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm10143160 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3160

Author(s):

Agnieszka Pukajło-Marczyk ◽

Danuta Zwolińska

Keyword(s):

Nephrotic Syndrome ◽

Treatment Group ◽

Idiopathic Nephrotic Syndrome ◽

Group Versus ◽

First Episode ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Disease Course ◽

Serum And Urine

Hemopexin (Hpx) is considered a factor in the pathogenesis of idiopathic nephrotic syndrome (INS). The aim of the study was to evaluate the serum and urine values of Hpx (sHpx and uHpx) in children with INS, analyze the role of Hpx, and assess its usefulness as a marker of the disease course. 51 children with INS and 18 age-matched controls were examined. Patients were divided into subgroups depending on the number of relapses (group IA—the first episode of INS, group IB—with relapses) and according to method of treatment (group IIA treated with gluco-corticosteroids (GCS), group IIB treated with GCS and other immunosuppressants). Hpx concentrations were determined by enzyme-linked immunosorbent assay (ELISA). sHpx and uHpx values in relapse were elevated in the whole INS group versus controls (p < 0.000). In remission their levels decreased, but still remained higher than in the control group (p < 0.000). In group IB uHpx levels were increased during remission as compared to group IA (p < 0.006). No significant impact of immuno-suppressants on sHpx was observed, but uHpx excretion in group IIA was higher in relapse (p < 0.026) and lower in remission (p < 0.0017) as compared to group IIB. The results suggest the role of Hpx in the pathogenesis of INS. Hpx may be a useful indicator for continuation of treatment, but it requires confirmation by further controlled studies.

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Outcomes of Cardiac Surgery with Very Prolonged Cardiopulmonary Bypass Times

10.22541/au.161486705.54871224/v1 ◽

2021 ◽

Author(s):

Nicholas Hess ◽

Ibrahim Sultan ◽

Yisi Wang ◽

Floyd Thoma ◽

Arman Kilic

Keyword(s):

Cardiopulmonary Bypass ◽

Postoperative Complications ◽

Operative Mortality ◽

Prolonged Mechanical Ventilation ◽

Cardiac Surgical Procedures ◽

Probability Analysis ◽

Mechanical Support ◽

Mortality And Morbidity ◽

One Year ◽

Cardiac Operations

Background: This study evaluated outcomes of cardiac operations with very prolonged cardiopulmonary bypass (CPB) times. Methods: This was a retrospective study of cardiac surgical procedures with very-long CBP times (≥300 minutes) performed at a single institution. Primary outcomes of operative (≤30-day) and one-year mortality were evaluated, and secondary outcomes included use of mechanical support and postoperative complications. A probability analysis was also conducted to identify the correlation between operative mortality and CPB time. Results: 293 patients were included with a Society of Thoracic Surgeons predicted risk of mortality of 2.51% (IQR 1.32%- 4.70%), and median CPB time of 340 minutes (IQR 315.0-385.0). Preoperative mechanical support included intra-aortic balloon pump (IABP, n=4, 1.4%), Impella (n=0), or extracorporeal membrane oxygenation (ECMO, n=2, 0.7%). Intraoperative and operative mortality were 5.1% and 22.5%, respectively. Intraoperative or postoperative mechanical support were utilized in 90 (30.7%) cases, including IABP (n=65, 22.2%), Impella (n=2, 0.68%), or ECMO (n=23, 7.8%). Postoperative complications included prolonged mechanical ventilation (n=121, 41.3%), renal failure (n=71, 24.2%), stroke (n=20, 6.8%), and reoperation (n=95, 32.4%). One-year survival for the overall cohort was 61.4%. Probability analysis identified a CPB time of 446 minutes to be associated with 50% odds of operative mortality. Conclusions: Cardiac operations requiring very-long CPB times are associated with high rates of operative mortality and morbidity, with a 50% operative mortality rate predicted for those with a CPB time of 446 minutes or longer. Nonetheless, the majority of patients survive at least 1 year, and these cases should not be considered futile.

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Bilirubin Adsorption Versus Plasma Exchange for Hyperbilirubinemia in Patients After Cardiac Surgery: A Retrospective Study

10.21203/rs.3.rs-432559/v1 ◽

2021 ◽

Author(s):

Ke Kan ◽

He Zhang ◽

Kai Zhong ◽

Haitao Zhang ◽

Zeshi Li ◽

...

Keyword(s):

Cardiac Surgery ◽

Treatment Group ◽

Hospital Mortality ◽

Plasma Exchange ◽

Treatment Method ◽

Circulatory Support ◽

Mortality And Morbidity ◽

Treatment Groups ◽

Before And After ◽

Bilirubin Adsorption

Abstract Objective: Hyperbilirubinemia after cardiac surgery increases in-hospital mortality and is associated with poor prognosis. Our present study aimed to compare the efficacy of bilirubin adsorption (BA) and plasma exchange (PEX) in patients with hyperbilirubinemia after cardiac surgery.Methods: We retrospectively included patients who underwent BA treatment or PEX treatment due to severe hyperbilirubinemia after cardiac surgery in our center from 2015 to 2020. We collected examinations of urine and liver function before and after treatment and compared the in-hospital mortality and morbidity between two treatment groups. Results: A total of 56 patients were enrolled in this study, 14 patients received BA treatment and 42 patients received PEX treatment. BA group provided a statistically significant reduction in the TBil (p=0.016) and DBil (p=0.036) compared to PEX group. The in-hospital mortality was 85.7% (48/56) in the whole group, BA group had lower mortality than PEX group (71.4% vs. 90.5%, p=0.078). BA group showed better circulatory support, including lower risks of IABP (21.4% vs. 52.4%, p=0.044), ECMO (21.4% vs. 50.0%, p=0.061), re-intubation (64.3% vs. 40.5%, p=0.122) and ventricular arrhythmias (64.3% vs. 45.2%, p=0.217). The in-hospital mortality was still lower in BA treatment group than PEX treatment group (71.4% vs. 100%, p=0.049) in matched cohort.Conclusions: BA treatment had higher removal ability of bilirubin in patients with hyperbilirubinemia and could reduce the mortality and risks of poor clinical outcomes compared to PEX treatment. BA treatment should be considered as an effective treatment method for patients with higher TBil level or Dbil level.

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