Myocardial protection in cardiac surgery: how limited are the options? A comprehensive literature review

Perfusion ◽  
2020 ◽  
pp. 026765912094265
Author(s):  
Abigail Whittaker ◽  
Maryam Aboughdir ◽  
Samiha Mahbub ◽  
Amna Ahmed ◽  
Amer Harky
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Protection ◽  
Mode Of Delivery ◽  
Crystalloid Solution ◽  
Advantages And Disadvantages ◽  
Comprehensive Literature Review ◽  
Improved Outcomes ◽  
Successful Recovery ◽  
History Of ◽  
Delivery Approach

For patients undergoing cardiopulmonary bypass, myocardial protection is a key for successful recovery and improved outcomes following cardiac surgery that requires cardiac arrest. Different solutions, components and modes of delivery have evolved over the last few decades to optimise myocardial protection. These include cold and warm and blood and crystalloid solution through antegrade, retrograde or combined cardioplegia delivery approach. However, each method has its own advantages and disadvantages, posing a challenge to establish a gold-standard cardioplegic solution with an optimised mode of delivery for enhanced myocardial protection during cardiac surgery. The aim of this review is to provide a brief history of the development of cardioplegia, explain the electrophysiological concepts behind myocardial protection in cardioplegia, analyse the current literature and summarise existing evidence that warrants the use of varying cardioplegic techniques. We provide a comprehensive and comparative overview of the effectiveness of each technique in achieving optimal cardioprotection and propose novel techniques for optimising myocardial protection in the future.

scholarly journals Cardioplegia between Evolution and Revolution: From Depolarized to Polarized Cardiac Arrest in Adult Cardiac Surgery

2021 ◽  
Vol 10 (19) ◽  
pp. 4485
Author(s):  
Alessandra Francica ◽  
Filippo Tonelli ◽  
Cecilia Rossetti ◽  
Ilaria Tropea ◽  
Giovanni Battista Luciani ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Adverse Effects ◽  
Perioperative Care ◽  
Myocardial Protection ◽  
High Potassium ◽  
Crystalloid Solution ◽  
K Concentration ◽  
Cardioplegic Solutions ◽  
Adult Cardiac Surgery

Despite current advances in perioperative care, intraoperative myocardial protection during cardiac surgery has not kept the same pace. High potassium cardioplegic solutions were introduced in the 1950s, and in the early 1960s they were soon recognized as harmful. Since that time, surgeons have minimized many of the adverse effects by lowering the temperature of the heart, lowering K+ concentration, reducing contact K+ time, changing the vehicle from a crystalloid solution to whole-blood, adding many pharmacological protectants and modifying reperfusion conditions. Despite these attempts, high potassium remains a suboptimalway to arrest the heart. We briefly review the historical advances and failures of finding alternatives to high potassium, the drawbacks of a prolonged depolarized membrane, altered Ca2+ intracellular circuits and heterogeneity in atrial-ventricular K+ repolarization during reanimation. Many of these untoward effects may be alleviated by a polarized membrane, and we will discuss the basic science and clinical experience from a number of institutions trialling different alternatives, and our institution with a non-depolarizing adenosine, lidocaine and magnesium (ALM) cardioplegia. The future of polarized arrest is an exciting one and may play an important role in treating the next generation of patients who are older, and sicker with multiple comorbidities and require more complex operations with prolonged cross-clamping times.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

THERAPEUTIC MANAGEMENT OF ASCITES IN SPITZ DOG IN BANGLADESH WITH A BRIEF REVIEW ON CANINE ASCITES

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
M. A. Samad
Keyword(s):  
Ascitic Fluid ◽  
Clinical Examination ◽  
Clinical Case ◽  
Abdominal Distension ◽  
Multiple Organ ◽  
Therapeutic Management ◽  
Vitamin Supplement ◽  
Case Record ◽  
Successful Recovery ◽  
History Of

Background: Ascites is one of the most important clinical syndromes, caused by multiple organ disorders, characterized by abdominal distension with accumulation of fluid of various colors and consistencies depending on the etiology that are encountered commonly in canine practice worldwide. Although it has been reported from different countries including India but it has not yet been documented from Bangladesh. Objectives: To evaluate the successful therapeutic management of a clinical case of ascites in dog supported with its brief review for its appropriate application Materials and Methods: A female Spitz dog two and half years old brought for treatment with the history of abdominal distension on 1st November 2009. Clinical examination, abdominocentesis and laboratory examination of ascitic fluid were used for the diagnosis of ascites in dog. Results: Clinical examination revealed dyspnea, discomfort, lethargy, weakness, pale mucous membrane, normal rectal temperature 103.2 0F and distended abdomen with fluid thrill on palpation. Examination of ascitic fluid revealed clear white fluid (pure transudate) which is mainly hepatic origin resulting portal hypertension and hypoproteinaemia. Treatment with restricted sodium diet, antibiotic (amoxicillin), diuretic (furosemide; Lasix, Sanofi Aventis) and vitamin B-complex and C- vitamin supplement with regular monitoring assisted in successful recovery. The recovered dog survived for next five years up to 2014 and then died due to other reasons. Conclusions: This clinical case record on canine ascites with successful treatment along with review especially on the methods of diagnosis and cause-wise treatment would certainly help the clinician for proper management of the clinical cases of canine ascites. Keywords: Ascites, Spitz dog, Diagnosis, SAAG, Therapeutic management, Brief review

An overview of Osmotic Drug Delivery System: An update review

2017 ◽  
Vol 6 (7) ◽  
pp. 5426 ◽  
Author(s):  
Hiren J. Patel ◽  
Vaishnavi P. Parikh
Keyword(s):  
Drug Delivery ◽  
Drug Delivery Systems ◽  
Life Cycle Management ◽  
Delivery Systems ◽  
Osmotic Pump ◽  
Factors Affecting ◽  
Advantages And Disadvantages ◽  
New Chemical Entities ◽  
History Of ◽  
Novel Drug

The pharmaceutical industry has faced several marked challenges in order to bring new chemical entities (NCEs) into the market over the past few decades. Various novel drug delivery approaches have been used as a part of life cycle management from which Osmotic drug delivery systems look the most promising one. After discussing the history of osmotic pump development, this article looks at the principles, advantages and disadvantages of osmotic drug delivery systems. Then, the basic components of osmotic pump and factors affecting the design of oral osmotic drug delivery systems are discussed in detail. In the later part of the manuscript, various types of osmotic pumps available in the market and evaluation methods for osmotic drug delivery systems are discussed in detail.

scholarly journals The Ocular Gene Delivery Landscape

Biomolecules ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1135
Author(s):  
Bhubanananda Sahu ◽  
Isha Chug ◽  
Hemant Khanna
Keyword(s):  
Gene Therapy ◽  
Genetic Diseases ◽  
Gene Therapies ◽  
Advantages And Disadvantages ◽  
Fda Approval ◽  
New Information ◽  
Efficient Delivery ◽  
Delivery Routes ◽  
History Of ◽  
Different Parts

The eye is at the forefront of developing therapies for genetic diseases. With the FDA approval of the first gene-therapy drug for a form of congenital blindness, numerous studies have been initiated to develop gene therapies for other forms of eye diseases. These examinations have revealed new information about the benefits as well as restrictions to using drug-delivery routes to the different parts of the eye. In this article, we will discuss a brief history of gene therapy and its importance to the eye and ocular delivery landscape that is currently being investigated, and provide insights into their advantages and disadvantages. Efficient delivery routes and vehicle are crucial for an effective, safe, and longer-lasting therapy.

scholarly journals Surveillance and control of M. chimaera infections in the Tuscany Region, Italy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B Casini ◽  
B Tuvo ◽  
M Totaro ◽  
A Baggiani ◽  
G Privitera
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Water Sample ◽  
Case Finding ◽  
Microbial Count ◽  
Clinical Specimens ◽  
Open Chest ◽  
Microbiological Parameters ◽  
History Of ◽  
And Control

Abstract Background Disseminated M. chimaera infections among patients who underwent open-chest surgery with cardiopulmonary bypass have been associated with the contamination of heater-cooler devices (HCDs). The Tuscany region in the Decree 3822/2019 issued recommendations for the surveillance and control of M. chimaera infections. Methods In three Tuscan cardiac surgery centers, the case finding was carried out through evaluation and testing of patients with a history of HCD exposure (past 6 years) was performed. Water and aerosol samples were analyzed from each HCDs to determine the microbiological parameters required by the Directive 98/83/CE and to assess the presence of non-tuberculous mycobacteria (NTMs), according to the regional protocol. Results M. chimaera infection was not found in any patient and all clinical specimens tested negative. 22 HCDs were sampled (n.12 LivaNova, n.1 Terumo and n.9 Maquet) for a total of 114 samples (45, 8, 2 and 59 respectively). All the microbiological parameters were compliant, excepted for total microbial count at 36 °C that exceeded 100 CFU/ml in 50% (57/114) of samples and for the presence of P.aeruginosa in 10% (12/114). NTMs were detected in 16% (18/114) of HCDs: M. chimaera was identified in 11% (13/114) of samples and in 4% (5/114) M. gordonae. All aerosol samples were negative for NTMs, but in the HCDs Maquet, B.cereus were detected in 7% (4/59) of the samples, K.oxytoca in 2% (1/59), B.ursincola in 2% (1/59) and S. paucimobilis in 3% (2/59). Only S. paucimobilis was isolated also in the same HCD water sample. Conclusions The implementation of maintenance and disinfection procedures of HCDs was able to reduce the risk of contamination and aerosolization by NTMs but not of other microorganisms. Key messages Further strategies should be put in place for the cases finding. Moreover, reliable decontamination and identification of agents that can disrupt biofilms and increase chlorine susceptibility of mycobacteria are required.

scholarly journals How birth outcomes among a cohort of Guatemalan women with a history of prior cesarean vary by mode or birth across different interpregnancy intervals

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Margo S. Harrison ◽  
Ana Garces ◽  
Lester Figueroa ◽  
Jamie Westcott ◽  
Michael Hambidge ◽  
...  
Keyword(s):  
Mode Of Delivery ◽  
Secondary Analysis ◽  
Vaginal Birth ◽  
Global Network ◽  
Vaginal Birth After Cesarean ◽  
Cesarean Birth ◽  
Dilation And Curettage ◽  
History Of ◽  
Interpregnancy Intervals ◽  
Hospital Births

Abstract Objectives Our objectives were to analyze how pregnancy outcomes varied by cesarean birth as compared to vaginal birth across varying interpregnancy intervals (IPI) and determine if IPI modified mode of birth. Methods This secondary analysis used data from a prospective registry of home and hospital births in Chimaltenango, Guatemala from January 2017 through April 2020, through the Global Network for Women’s and Children’s Health Research. Bivariate comparisons and multivariable logistic regression were used to answer our study question, and the data was analyzed with STATA software v.15.1. Results Of 26,465 Guatemalan women enrolled in the registry, 2794 (10.6%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI, all p-values > p = 0.05. Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR ranged from 0.009 to 0.10), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2), but again IPI was not associated with the outcome. Conclusion Outcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI.

scholarly journals A brief history of cardiac surgery: A pictorial overview

2015 ◽  
Vol 24 ◽  
pp. e68-e69
Author(s):  
Charles Jenkinson ◽  
Kelly Holmes ◽  
David Andrews
Keyword(s):  
Cardiac Surgery ◽  
History Of
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