Ultrafiltration in Pediatric Cardiac Surgery Review

2019 ◽  
Vol 10 (6) ◽  
pp. 778-788 ◽  
Author(s):  
Joel Bierer ◽  
Roger Stanzel ◽  
Mark Henderson ◽  
Suvro Sett ◽  
David Horne
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Heart Surgery ◽  
Fluid Overload ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Pediatric Cardiac Surgery ◽  
Significant Heterogeneity ◽  
Study Protocols ◽  
The Impact

Introduction: The use of cardiopulmonary bypass in pediatric cardiac surgery is associated with significant inflammation, fluid overload, and end-organ dysfunction yielding morbidity and mortality. For decades, various intraoperative ultrafiltration techniques such as conventional ultrafiltration, modified ultrafiltration (MUF), zero-balance ultrafiltration (ZBUF), and combination techniques (ZBUF-MUF) have been used to mitigate these toxicities and promote improved postoperative outcomes. However, there is currently no consensus on the ultrafiltration technique or strategy that yields the most benefit for infants and children undergoing open heart surgery. Methods: A librarian-conducted PubMed literature search from 1990 to 2018 yielded 90 clinical studies or publications on the various forms of ultrafiltration and the impact on physiologic markers and clinical outcomes. All publications were reviewed, summarized, and conclusions synthesized. The data sets were not combined for systematic or meta-analysis due to significant heterogeneity in study protocols and patient populations. Results: Modified ultrafiltration significantly promotes improved myocardial function, reduction in fluid overload, and reduced bleeding and transfusion complications. Furthermore, ZBUF has shown a consistent reduction in inflammatory cytokines and improved pulmonary function and compliance. There is conflicting evidence that MUF, ZBUF, and ZBUF-MUF culminate in reduced ventilation time and intensive care unit stay. Conclusion: Various modes of ultrafiltration have been shown to be associated with improved physiologic function or clinical outcomes in pediatric cardiac surgery. There are some inconsistent trial results that can be explained by heterogeneity in ultrafiltration, clinical staff preferences, and institution protocols. Ultrafiltration has some essential benefit as it is ubiquitously used at pediatric heart centers; however, the optimal protocol could be yet identified.

scholarly journals The Impact of Perioperative Viscoelastic Test Application on Blood Product Usage and Outcome in Cardiac Surgery; Regional Cardiac Surgery Center Experience

2021 ◽  
Author(s):  
Murat Aksun ◽  
Saliha Aksun ◽  
Mehmet Ali Çoşar ◽  
Elif Neziroğlu ◽  
Senem Girgin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Experience ◽  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Control Group ◽  
Open Heart ◽  
Blood Products ◽  
Product Use ◽  
The Impact

Objective: Thromboelastography (TEG) is a diagnostic modality that gives information about coagulation. Despite all blood-preserving precautions in open heart surgery there are blood losses and the use of blood and blood products becomes inevitable. TEG is mostly not available in every center and habits, trends and clinical experience in blood use create the possibility of causing unnecessary use of blood and blood products. In this study, it was aimed to determine the effect of the use of thromboelastography on the use of blood and blood products in cardiac surgery. Methods: Two hundred patients between 18-70 years old who underwent open heart surgery were included in the study. After the cardiopulmonary bypass (CPB), the cases were confirmed to have an Activated Clotting Time (ACT) value in the range of 120-150 sec after protamine administration. In 100 patients in the TEG group, the coagulation status was evaluated with TEG and it was decided how to apply blood and blood product use. Blood and blood product use was applied to 100 patients in the control group based on clinical experience and foresight. The total amount of blood and blood product used, fluid balance, need for inotropics, mechanical ventilator time, complications, duration of intensive care and discharge times were recorded. Results: Use of Fresh Frozen Plasma (FFP) at the after CPB in the TEG group was statistically significantly lower than that of the control group FFP (p<0.05). Postoperative FFP and postoperative platelet use in the study group were statistically significantly lower than in the postoperative FFP and postoperative platelet values of the control group (p <0.05). Conclusion: The use of thromboelastography is a very useful monitoring in terms of reducing FFP use after CPB and reducing FFP and platelet usage in the postoperative period. In this way, the unnecessary use of blood and blood products can be prevented.

Abstract 15598: Population Characteristics and Outcomes of Patients With Constrictive Pericarditis Undergoing Pericardiectomy in the Contemporary Era: A Systematic Review and Metaanalysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aspasia Tzani ◽  
Ilias P Doulamis ◽  
Andreas Tzoumas ◽  
Dimitrios V Avgerinos ◽  
Polydoros Kampaktsis
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Constrictive Pericarditis ◽  
Operative Mortality ◽  
Meta Analysis ◽  
Population Characteristics ◽  
Significant Heterogeneity ◽  
Comorbidity Burden ◽  
The Impact ◽  
Post Cardiac Surgery

Introduction: Studies have described the changing landscape of patients with constrictive pericarditis (CP) in the modern era, however no systematic review or meta-analysis has been performed. Methods: We systematically searched the MEDLINE, Embase and Cochrane databases from their inception to April 1, 2020 for studies assessing the characteristics and outcomes patients with CP undergoing pericardiectomy. A meta-analysis was performed to assess the impact of CP etiology on outcomes. Results: We analyzed 27 eligible studies and 2114 patients. Etiology was most commonly idiopathic (50.2%), post-cardiac surgery (26.2%) and radiation (6.9%)(Figure 1A-B). Patients were mostly men (76%), with a mean age of 58 years and with advanced symptoms (NYHA III/IV 70.1%). Total pericardiectomy was preferred (85.8%) (Figure 1C-D) and concomitant cardiac surgery was relatively common (23.8%). Operative mortality was 6.9% and 5-year mortality was 32.7% (Table 1). Radiation and post-cardiac surgery patients had higher long-term risk for mortality respectively compared to idiopathic pericarditis (HR: 2.15; 95% CI: 1.21-1.36, p=.01 and HR: 3.21; 95% CI: 1.56-6.50, p<.01, respectively). Thirty percent of included studies had more than low bias. A sensitivity analysis did not result in changes in the results. Conclusions: Pericardiectomy is performed mostly in middle-aged men with advanced symptoms and low comorbidity burden and still carries a significant operative mortality. Radiation and post-cardiac surgery patients have a significantly higher risk compared to idiopathic. Several methodological issues and significant heterogeneity limit the generalization of these data.

scholarly journals Invasive Mycobacterium abscessus Infection after Cardiac Surgery: Epidemiology and Clinical Outcomes

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S35-S36
Author(s):  
Arthur W Baker ◽  
Eileen K Maziarz ◽  
Sarah S Lewis ◽  
Jason E Stout ◽  
Deverick J Anderson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Antimicrobial Therapy ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Mycobacterium Abscessus ◽  
Surgical Debridement ◽  
Ventricular Assist Devices ◽  
High Morbidity ◽  
Invasive Infection

Abstract Background We recently mitigated a clonal outbreak of Mycobacterium abscessus, including a large cluster of patients who developed invasive infection after exposure to heater-cooler units (HCU) during cardiac surgery. Recent studies have described a small number of Mycobacterium chimera infections linked to open-heart surgery; however, little is known about the epidemiology and clinical courses of cardiac surgery patients with invasive infection from rapidly-growing mycobacteria, such as M. abscessus. Methods We retrospectively collected clinical data from all patients who underwent cardiac surgery at our hospital and had positive cultures for M. abscessus from 2013 to 2016. We excluded heart transplant recipients and patients who at time of diagnosis had ventricular assist devices. We analyzed patient characteristics, antibiotic treatment courses, surgical interventions, and clinical outcomes. Results Nine cardiac surgery patients who met the case definition developed culture-proven invasive infection from M. abscessus (Figure 1). Seven (78%) infections occurred after surgeries that included valve replacement. Median time from suspected inoculation in the operating room to first positive culture was 49 days (interquartile range, 38–115 days). Seven (78%) patients had bloodstream infections, and six (67%) patients had sternal wound infections. Six (67%) patients developed disseminated disease with infection at multiple sites. All patients received combination antimicrobial therapy. The most common majority regimen (n = 6) was imipenem, amikacin, and tigecycline. Four (44%) patients experienced therapy-limiting antibiotic toxicities (Figure 2). Seven (78%) patients were well enough to undergo at least one surgical debridement. Five (56%) patients stopped therapy due to presumed cure, but four (44%) patients had deaths attributable to M. abscessus infection. Conclusion Invasive M. abscessus infection after cardiac surgery was associated with high morbidity and mortality. Most patients underwent surgical debridement and received prolonged three-drug antimicrobial therapy, which was complicated by numerous antibiotic toxicities. Treatment cured five patients, but four patients died from mycobacterial disease. Disclosures All authors: No reported disclosures.

scholarly journals Analyzing and comparing the impacts and outcomes of two different types of surgeries - Minimally Invasive Surgeries (MIS) and Conventional Surgeries (CVS) on patients suffering from Degenerative Mitral Valve Diseases

2021 ◽  
Vol 2 (1) ◽  
pp. 17-32
Author(s):  
Halim M ◽  
AlSayegh M ◽  
Umenne CA ◽  
Vadithya P ◽  
Panicker SV ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Conventional Surgery ◽  
Minimally Invasive Surgical ◽  
Clinical Benefits

Background: Degenerative Mitral Valve Disease (DMVD) is the most common cause of Mitral Regurgitation (MR) and the main reason for surgical intervention in patients with heart diseases. Traditionally, open-heart surgery or else sternotomy was the main surgical approach used until a few decades ago when Minimally Invasive Surgical (MIS) approaches came into existence. MIS approach is thought to have superior clinical outcomes while minimizing hospital and ICU stay; blood loss translating to fewer blood transfusions, and lower incidence of complications. Despite many promising institutional and regional results of benefits of MIS over the conventional surgery, the adoption of MIS worldwide in Mitral Valve Repair (MVR) has been so poor. There are still arguments on the surgical and clinical benefits of MIS and more importantly the cost and the expertise involved in conducting MIS. Objective: This study aimed at comparing the costs, clinical and surgical outcomes of MIS with conventional sternotomy MVR surgeries in patients with DMVD. Methods: Electronic databases such as MEDLINE, PubMed, Science Direct, and Google Scholar were searched for relevant peer-reviewed articles comparing costs and clinical outcomes of MIS with the conventional surgery/sternotomy in DMVD from January 2013 to November 2020. A total of 7 articles were identified as most relevant and therefore included in the meta-analysis. Results: Findings from the meta-analysis pointed out that repair of the mitral valve using MIS patients with DMVD has benefits such as short ICU, intubation and hospital duration; less loss of blood and therefore less need of blood transfusion; low postoperative infection rates; smaller incisions; early ambulation and return to activities of daily living over conventional surgery while maintaining similar costs of care and clinical outcomes as a sternotomy. Conclusions: Given the added advantages of MIS in mitral valve surgeries, cardiac surgeons should consider it over the conventional open surgeries in patients with DMVD. In this regard, more surgeons and nurses need to gain competency in conducting MIS through training and fellowships; hospitals need to acquire the needed infrastructure to enable the adoption of MIS.

scholarly journals Neurological complications after pediatric cardiac surgery

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Ergin Arslanoğlu ◽  
Kenan Abdurrahman Kara ◽  
Fatih Yiğit ◽  
Cüneyt Arkan ◽  
Ufuk Uslu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Pediatric Patients ◽  
Open Heart Surgery ◽  
Early Period ◽  
Neurological Complications ◽  
Pediatric Cardiac Surgery ◽  
Cranial Computed Tomography ◽  
Formation Mechanisms ◽  
Radiological Results

Abstract Background The number of pediatric patients who survive open-heart surgery has increased in recent years and the complications seen in this patient group continue to decrease with each technological advance, including new surgical and neuroprotective techniques and the improvement in surgeons’ experience with this patient population. However, neurological complications, which are the most feared and difficult to manage, require long-term follow-up, and increase hospital costs remain a leading cause of mortality and morbidity in this cohort. Results We evaluated the neurological physical examination, cranial computed tomography (CT), and magnetic resonance (MRI) records of 162 pediatric patients with neurological symptoms lasting more than 24 h after undergoing heart surgery in our clinic between June 2012 and May 2020. The patients’ ages ranged from 0 to 205 months, with a mean of 60.59 ± 46.44 months. Of the 3849 pediatric cardiac surgery patients we screened, 162 had neurological complications in the early period (the first 10 days after surgery). The incidence was calculated as 4.2%; 69 patients (42.6%) experienced seizures, 17 (10.5%) experienced confusion, 39 (24.1%) had stupor, and 37 (22.8%) had hemiparesis. Of the patients who developed neurological complications, 54 (33.3%) died. Patients with neurological complications were divided into 3 groups: strokes (n = 90), intracranial bleeding (n = 37), and no radiological results (n = 35). Thirty-four patients (37.8%) in the stroke group died, as did 15 (40%) in the bleeding group, and 5 (14.3%) in the no radiological results group. Conclusions Studies on neurological complications after pediatric heart surgery in the literature are currently insufficient. We think that this study will contribute to a more detailed discussion of the issue. Responses to neurological events and treatment in the pediatric group may differ compared to the adult age group. Primary prevention methods should be the main approach in combating neurological complications; their formation mechanisms should be carefully monitored and preventive treatment strategies should be developed.

scholarly journals Safety of Normothermic Cardiopulmonary Bypass in Pediatric Cardiac Surgery: A System Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Tao Xiong ◽  
Lei Pu ◽  
Yuan-Feng Ma ◽  
Yun-Long Zhu ◽  
Xu Cui ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Meta Analysis ◽  
Congenital Heart Surgery ◽  
Mean Difference ◽  
Pediatric Cardiac Surgery ◽  
Controlled Trials ◽  
Cochrane Central Register

Objectives: Hypothermic cardiopulmonary bypass (HCPB) has been used successfully in cardiac surgery for more than half a century, although adverse effects have been reported with its use. Many studies on temperature management during CPB published to date have shown that normothermic CPB (NCPB) provides more benefits to children undergoing cardiac surgery. The present meta-analysis investigated the effect of NCPB on clinical outcomes based on results of randomized controlled trials and observational studies on pediatric cardiac surgery.Methods: Databases such as PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov were searched from inception to May 2021 to identify relevant studies published in English.Results: The present meta-analysis included 13 studies characterizing a total of 837 pediatric patients. The random effects model exhibited that the NCPB group had reduced revision for postoperative bleeding [odds ratio (OR): 0.11; 95% confidence interval (CI): 0.01–0.89; I2 = 0%, P = 0.04], serum lactate 2–4 h after CPB (mean difference: −0.60; 95% CI: −1.09 to −0.11; I2 = 82%, P = 0.02), serum creatinemia 24 h after CPB (mean difference: −2.73; 95% CI: −5.06 to −0.39; I2 = 83%, P = 0.02), serum creatinemia 48 h after CPB (mean difference: −2.08; 95% CI: −2.78 to −1.39; I2 = 0%, P &lt; 0.05), CPB time (mean difference: −19.10, 95% CI: −32.03 to −6.18; I2 = 96%, P = 0.04), and major adverse events (OR: 0.37; 95% CI: 0.15–0.93; Z = 2.12, P = 0.03) after simple congenital surgery compared with the HCPB group.Conclusion: NCPB is as safe as HCPB in pediatric congenital heart surgery. Moreover, NCPB provides more advantages than HCPB in simple congenital heart surgery.

scholarly journals The impact of CYP2C9 and VKORC1 genetic polymorphisms in anticoagulant therapy management after cardiac surgery with extracorporeal circulation

Pharmacia ◽  
2021 ◽  
Vol 68 (1) ◽  
pp. 269-273
Author(s):  
Milena Velizarova ◽  
Julieta Hristova ◽  
Dobrin Svinarov ◽  
Stefka Ivanova ◽  
Stefanija Jovinska ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Anticoagulant Therapy ◽  
Extracorporeal Circulation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Bleeding Risk ◽  
Dosing Regimen ◽  
Increased Risk ◽  
The Impact ◽  
Insight Into

Extracorporeal circulation during cardiac surgery is characterized with increased risk for hypercoagulation because blood is exposed to foreign, nonendothelial cell surfaces. Thus, the usage of extracorporeal circulation is essentially not possible without anticoagulation. Open-heart surgery as well as many perioperative factors, such as acidosis, hypocalcemia, hypothermia, and hemodilution, might affect hemostasis and lead to coagulopathy and bleeding. A new insight into the effectiveness of anticoagulant therapy is applied to modify the dosing regimen with respect to the genetic CYP2C9 and VKORC1allelic variants. A systematic literature search was performed for VKORC1 and CYP2C9 and their association with coumarin anticoagulant therapy and bleeding risk in postoperative period of cardiac surgery with extracorporeal circulation.

P4385Diaphragm dysfunction following cardiac surgery: role of ultrasound imaging for initial and follow-up assessment during cardiac rehabilitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Maranta ◽  
I Cartella ◽  
A Pistoni ◽  
L Cianfanelli ◽  
P Cerea ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Respiratory Cycle ◽  
Diaphragm Dysfunction ◽  
Surgical Interventions ◽  
Diaphragm Function ◽  
The Impact

Abstract Background Diaphragm dysfunction is a common complication of cardiac surgery, often underdiagnosed. Ultrasonography (US) is a promising technique for diaphragmatic assessment. Few trials have been conducted using US after heart surgery and no clear data exist on the recovery of diaphragm function after cardiovascular rehabilitation (CR). Purpose The aim of this study is to evaluate post-cardiac surgery diaphragm dysfunction using US and to assess the impact of an inpatient CR programme on its functional recovery. Methods In a single-centre prospective cohort study 97 consecutive patients hospitalised in our CR Unit were enrolled. 14 patients underwent aortic valve replacement, 38 mitral valve repair or replacement, 14 coronary artery bypass grafting (CABG), 22 combined surgery, and 9 other surgical interventions. We performed diaphragm US at admission and after 10 rehabilitative sessions. The following parameters were assessed: thickening fraction (TF) in B-mode on the right intercostal projections, and excursion, time of inspiration, time of a respiratory cycle and contraction velocity in M-mode on right anterior subcostal projections. Results After cardiac surgery, the incidence of diaphragm dysfunction and paralysis were 60% and 1%, respectively. Patients with TF <20% at admission showed a significant improvement in TF (13.30%, IQR 8.69–17.39 vs 27.27%, IQR 21.05–31.58; p<0.001), excursion (1.67cm, IQR 1.3–2.1 vs 2.23cm, IQR 1.9–2.7; p<0.001), time of inspiration (0.9s, IQR 0.9–1.07 vs 1.01s, IQR 0.87–1.13; p=0.005), time of a respiratory cycle (2.67s, IQR 2.38–3.05 vs 3.07s, IQR 2.68–3.35; p<0.001) and velocity (1.81cm/s, IQR 1.14–2.33 vs 2.24cm/s, IQR 1.92–2.76; p<0.001). On the contrary, in patients with a TF>20%, no additional improvement was observed. In both groups, there was a significant improvement in the parameters of physical performance. In particular, in the group with a TF<20%, the distance covered during the 6MWT (300m, IQR 205–370 vs 555m, IQR 450–612; p<0.001) and the energy cost of physical activity (2.60, IQR 2.13–2.92 vs 4.09, IQR 3.44–4.50; p<0.001) increased while the perception of exertion (Borg Scale 11, IQR 11–13 vs 13, IQR 12–13; p=0.011) was reduced. At the 10th day assessment, 51.5% of the total population had a recovery of diaphragm function, whilst 48.5% had a failure of recovery (TF relative change between admission and discharge <60%). The multivariate analysis identified CABG as an independent predictor of failure of diaphragm recovery (OR 5.44; CI 1.10–26.84, p=0.037). Conclusion US might be a valuable part of routine clinical practice for initial and follow-up assessment of patients after open-heart surgery. CR showed to be an effective strategy to improve diaphragm parameters in patients with post-surgical dysfunction. Progressive evaluation of diaphragm function may drive personalised rehabilitation programmes.

scholarly journals DOES CARDIAC TROPONIN€“I IS RECOGNIZED AS AN EARLY POSTOPERATIVE MARKER FOR MYOCARDIAL DAMAGE IN CHILDREN?

2021 ◽  
Vol 9 (06) ◽  
pp. 279-286
Author(s):  
Masroor H. Sharfi ◽  
◽  
Mohamed H. Mashali ◽  
Abdelmonem Helal ◽  
Abdullah A. Al-Shehri ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Troponin ◽  
Heart Surgery ◽  
Troponin I ◽  
Open Heart Surgery ◽  
Myocardial Damage ◽  
Cardiac Troponin I ◽  
Pediatric Cardiac Surgery ◽  
P Value ◽  
Sensitive Marker

Introduction:Cardiac troponin-I being a sensitive marker of myocardial damage needs to be analyzed in children undergoing cardiopulmonary by-pass surgery, as perioperative myocardial damage may be a significant factor of postoperative cardiac performance. The present study aims to test the prognostic value of Cardiac troponin-I concerning the early postoperative course after pediatric cardiac surgery. Methods:Cardiac troponin – I levels were measured and correlated with intra and postoperative parameters of thirty-three children undergoing open-heart surgery. The cutoff point for the definition of a high and a low-risk group of Cardiac troponin-I values was set at 25 ng/ml. Results:Overall, cTnI peak value was higher than 25 ng/ml in 21 patients among these,4 died, and two of them were reported with the value of >100 ng/ml. 38.7% of the patients were complicated by different types of arrhythmias. Junctional ectopic tachycardia was the most common type of arrhythmia,while heart block complication was found only in one case, which was temporarily treated by pacing for less than 24 hours. The results showed significant correlation of troponin I values with dobutamine dose mg/kg (p-value=0.043), dobutamine duration (p-value=0.020), creatinine (p-value= 0.002), and internalcare unit stay (p-value= 0.003). Conclusion: The present study confirms that troponin I is specific and sensitive marker of myocardial injury after pediatric cardiac surgery.

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