Noteworthy Literature Published in 2018 for Cardiothoracic Anesthesiologists

The year 2018 was marked by high-quality, impactful articles spanning the basic, translational, and clinical spectrum in the field of cardiothoracic anesthesia. In this article, we present several hand-picked articles from the past year that we feel were the most significant in shaping our specialty. Large multicenter, randomized controlled trials presenting clinical outcome data dominated the publishing arena: is a restrictive red blood cell transfusion strategy superior to a liberal red blood cell transfusion strategy during cardiopulmonary bypass? Does a low mean arterial blood pressure strategy during cardiopulmonary bypass increase stroke incidence? Does the obesity paradox apply to cardiac surgery? Advancing technology continues to revolutionize our field: can the MitraClip be used to effectively treat secondary mitral regurgitation? Can stem cells improve cardiac function in patients with left ventricular assist devices? These studies allow us to shape our practice in an evidence-based manner, so that we may evolve as a specialty and deliver the best care to our patients.

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Associations of Preimplant Red Blood Cell Distribution Width with Clinical Outcomes Among Individuals with Left Ventricular Assist Devices

ASAIO Journal ◽

10.1097/mat.0000000000000431 ◽

2016 ◽

Vol 62 (6) ◽

pp. 677-683 ◽

Cited By ~ 3

Author(s):

P. Elliott Miller ◽

Brian A. Houston ◽

Andrea L. C. Schneider ◽

Aaron L. Bush ◽

Glenn J. Whitman ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Cell Distribution ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Distribution Width ◽

Left Ventricular Assist ◽

Red Blood Cell Distribution

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In Vitro Comparison of Blood Pump Induced Platelet Microaggregates between a Centrifugal and Roller Pump During Cardiopulmonary Bypass

The International Journal of Artificial Organs ◽

10.1177/039139880202500610 ◽

2002 ◽

Vol 25 (6) ◽

pp. 549-555 ◽

Cited By ~ 19

Author(s):

J. Linneweber ◽

T.W. Chow ◽

M. Kawamura ◽

J.L. Moake ◽

Y. Nosè

Keyword(s):

Cardiopulmonary Bypass ◽

Blood Cell ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Blood Pump ◽

Left Ventricular Assist Devices ◽

Free Hemoglobin ◽

Roller Pump ◽

Flow Cytometric ◽

Perioperative Assessment

Platelets are consumed during cardiopulmonary bypass (CPB) and mechanical ventricular assistance, at least partly as a result of the formation of platelet microaggregates in the blood pump. There is no commonly accepted method currently available to detect platelet microaggregates during the use of CPB or left ventricular assist devices (LVAD). The purpose of this study was to develop a flow cytometric method for the quantification of platelet microaggregates generated in blood pumps, and to evaluate the effect of cellular fragments from hemolyzed erythrocytes on the perioperative assessment of platelet counts during CPB. Method Fresh human anticoagulated blood (1IU heparin /mL, activated clotting time 250 ± 24 sec.) was circulated for 120 minutes in an artificial circulatory system, containing either a centrifugal pump (CP) or roller pump (RP). Whole blood was used to quantify platelet consumption and to detect circulating platelet microaggregates in a flow cytometer. Platelet consumption was additionally analyzed using an automated “Coulter” blood cell counter. Hemolysis was analyzed by measurement of plasma free hemoglobin (fHb), as well a by flow cytometric detection of red blood cell (RBC) fragments. Results Flow cytometric analysis demonstrated significantly more circulating platelet aggregates and platelet consumption in the RP than in the CP (p<0.01). Quantification of RBC fragments and plasma free hemoglobin (fHb) levels also indicated significantly increased hemolysis in the RP than in the CP (p<0.01). In contrast, the Coulter count data indicated less platelet consumption in the PP compared to the CP. Conclusion Fragments from hemolyzed erythrocytes have the same size distribution as intact platelets and the number of RBC fragments correlates with the extent of pump-induced hemolysis during CPB. Our data suggest that assessment of platelets by “Coulter counting” cannot distinguish platelets from RBC fragments and may underestimate platelet consumption in the presence of hemolysis during CPB. We conclude that flow cytometry is more accurate in the perioperative assessment of platelet count and platelet aggregation during CPB and LVAD support.

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Red blood cell mechanical fragility as potential metric for assessing blood damage caused by implantable durable ventricular assist devices: Comparison of two types of centrifugal flow left ventricular assist devices

Progress in Pediatric Cardiology ◽

10.1016/j.ppedcard.2020.101198 ◽

2020 ◽

Vol 56 ◽

pp. 101198

Author(s):

M. Tarasev ◽

S. Chakraborty ◽

L. Light ◽

K. Alfano ◽

F.D. Pagani

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Assist Devices ◽

Blood Damage ◽

Left Ventricular Assist

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Using arterial-venous oxygen difference to guide red blood cell transfusion strategy

Critical Care ◽

10.1186/s13054-020-2827-5 ◽

2020 ◽

Vol 24 (1) ◽

Cited By ~ 1

Author(s):

Alberto Fogagnolo ◽

Fabio Silvio Taccone ◽

Jean Louis Vincent ◽

Giulia Benetto ◽

Elaine Cavalcante ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Transfusion Strategy ◽

Oxygen Difference

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BLOOD TRANSFUSION IN CARDIAC SURGERY- NEED TO FOLLOW BASICS!

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0703.01 ◽

2020 ◽

Vol 7 (3) ◽

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Transfusion Strategy ◽

Transfusion Threshold ◽

Restrictive Transfusion ◽

Conflicting Evidence ◽

American Society

More and more data is coming in recent times about hazards of blood transfusion. In a landmark TRICC1 trial Euvolemic patients in the intensive care unit (ICU) with Hb<9 g/dl were randomized to a restrictive transfusion strategy for transfusion of PRBCs (transfused if Hb<7 g/dl to maintain Hb between 7 and 9 g/dl) or a liberal strategy (transfused if Hb<10 g/dl to maintain Hb 10-12 g/dl). Mortality was similar in both groups, indicating that liberal transfusions were not beneficial. An Updated Report by the American Society of AnaesthesiologistsTask Force on Perioperative Blood Management tells us restrictive red blood cell transfusion strategy may be safely used to reduce transfusion administration. It further states that The determination of whether hemoglobin concentrations between 6 and 10 g/dl justify or require red blood cell transfusion should be based on potential or actual on going bleeding (rate and magnitude), intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve. Should we extrapolate these guidelines in Cardiac surgery? TRACS2 trial concluded that among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity.They advocated use of restrictive strategy, but 5 years later, the authors 3concluded that A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. With this conflicting evidence, by which way anaesthesiologist to go?

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