Surgical setup for cardiopulmonary bypass through central cannulation

2021 ◽  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Surgical Care ◽  
Heart Lung Machine ◽  
American College Of Surgeons ◽  
History Of ◽  
Central Cannulation ◽  
First John ◽  
Clinical Advances

The introduction of cardiopulmonary bypass was one of the most important clinical advances of 1952. In that year, John Gibbon performed the first successful cardiac surgery using cardiopulmonary bypass. The procedure has been described as “One of the most impressive evidences of the role of investigative surgery in the history of medicine in the persevering efforts of Dr. Gibbon for more than 20 years, which finally culminated in a practical heart-lung machine”, at the first John H. Gibbon, Jr. Lecture at the annual meeting of the American College of Surgeons. Due to on-going advancements in cardiopulmonary bypass, many patients with complex heart disease requiring surgical care undergo cardiac surgery while the other organs remain adequately oxygenated and perfused. This tutorial discusses the access, surgical technique, and initiation of cardiopulmonary bypass through central cannulation and describes the safeguards and pitfalls.

Weaning from cardiopulmonary bypass, decannulation, and closure

2021 ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Surgical Care ◽  
Cardiac Procedure ◽  
Heart Lung Machine ◽  
American College Of Surgeons ◽  
History Of ◽  
First John ◽  
Clinical Advances ◽  
Lung Machine

In 1952, John Gibbon performed the first successful cardiac procedure using cardiopulmonary bypass, which turned out to be one of the most important clinical advances of that year. Cardiopulmonary bypass has also been described as “One of the most impressive evidences of the role of investigative surgery in the history of medicine in the persevering efforts of Dr. Gibbon for more than 20 years, which finally culminated in a practical heart-lung machine,” at the first John H. Gibbon, Jr, Lecture at the annual meeting of the American College of Surgeons [1]. Due to the subsequent advancement of cardiopulmonary bypass, many patients with complex heart disease requiring surgical care undergo cardiac surgery while the other organs remain adequately oxygenated and perfused.

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.

Hyperglycemia After Cardiac Surgery

2014 ◽  
Vol 25 (3) ◽  
pp. 221-227
Author(s):  
Lynda Stoodley ◽  
Shu-Fen Wung
Keyword(s):  
Cardiac Surgery ◽  
Blood Glucose Control ◽  
Surgical Care ◽  
Patient Characteristics ◽  
Performance Measure ◽  
Adverse Outcomes ◽  
Retrospective Case ◽  
Improvement Project ◽  
History Of ◽  
Surgical Care Improvement Project

Background The Surgical Care Improvement Project #4 (SCIP#4) performance measure is used to evaluate achievement of target blood glucose control after cardiac surgery. Objectives The purpose of this study was to identify patient characteristics and outcomes in patients undergoing cardiac surgery who met the SCIP#4 performance measure versus those who did not. Methods A retrospective case-control design was used. Results Preoperative hemoglobin A1C (HbA1C) level and history of diabetes were 2 major risk factors for failing to meet the SCIP#4 measure. A trend toward a longer length of stay was observed, mortality was 3 times more prevalent, and renal failure was 4 times more frequent in patients who did not meet the SCIP#4 quality measure. Conclusions Not meeting the SCIP#4 measure is associated with adverse outcomes. History of diabetes and preoperative HbAIC level should be considered when evaluating strategies for managing postsurgical hyperglycemia.

scholarly journals 83 The predictive role of neutrophil-to-lymphocyte ratio in post-operative cardiopulmonary bypass surgery

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Valentina Bucciarelli ◽  
Francesco Bianco ◽  
Annaclara Blasi ◽  
Martina Primavera ◽  
Baldinelli Alessandra ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pediatric Patients ◽  
Septal Defect ◽  
Left Ventricular ◽  
Conduction System ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Predictive Role

Abstract Aims Postoperative arrhythmias (POA) are a common complication after cardiac surgical repairs for congenital heart disease (CHD), representing a substantial source of morbidity, mortality, and prolonged total in-hospital stay, with an incidence of 7.5–48% in postoperative pediatric cardiac patients. The etiology is multifactorial, and it has been related to the direct surgical manipulation of the cardiac conduction system, to the local tissue inflammation in the myocardium adjacent to the conduction system and to the arrhythmogenic effects of cardiopulmonary bypass (CPB), inotropes, and electrolyte disturbances. Recently, the prognostic role of neutrophil-to-lymphocyte ratio (NLR), a novel inflammation marker, has been evaluated in pediatric patients after CPB surgery. To evaluate the predictive role of NLR in POA in a population of pediatric CHD patients after CPB. Methods and results We retrospectively collected perioperative clinical and laboratory data of 146 patients (age 8.27 ± 10.79 years; male gender: 60.8%) consecutively admitted to the cardiac surgery intensive care unit (ICU) of our institute after elective cardiac surgery with CPB in 2018. We grouped and analyzed our population over NLR tertiles evaluated at 24 h from CPB and types of POA: supraventricular (SVT) and junctional (JET). The prognostic value of NLR and its association with POA was analyzed. Diagnoses of 146 patients included atrial septal defect (n = 36), ventricular septal defect (n = 20), pulmonary atresia/stenosis (n = 10), tetralogy of Fallot (n = 20), endocardial cushion defect (n = 8), left ventricular outflow tract obstruction (n = 14), anomalous origin of coronary artery (n = 6), complex CHD (n = 13), interrupted/hypoplastic aortic arch (n = 12), anomalous pulmonary venous return (n = 3). The mean CPB time was 121.6 ± 84.6 min. The median ICU hospitalization was 48 h [Q1, Q3: 24, 96]. Twelve patients experienced POA: 6 SVT and 6 JET. The frequency of POA incremented over NLR-tertiles (P-Trend 0.017), while SVT onset was associated with higher values of NLR and C-reactive protein (P = 0.034 and P = 0.011, respectively). Patients in the second and third tertiles of NLR had a prolonged hospitalization (log-rank, P = 0.029), especially when associated with POA (log-rank, P = 0.012). At the multivariable analysis, higher age and NLR values were independently associated with SVT [OR per year 1.22; 95% CI (1.02, 1.25), P = 0.043 and OR per point 1.91; 95% CI (1.29, 2.82), P = 0.012, respectively], but not with JET. Conclusions 24-h post-CPB NLR can predict postoperative SVT in a population of pediatric CHD patients. Our data suggest that the NLR could be a useful, easy-to-obtain marker for postoperative outcome in pediatric patients who had undergone elective CPB.

scholarly journals The role of the department of surgical diseases №2 in the formation of cardiovascular surgery service in the Republic of Tatarstan (to the 80th anniversary of the department)

2015 ◽  
Vol 96 (6) ◽  
pp. 893-900
Author(s):  
R K Dzhordzhikiya
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiovascular Surgery ◽  
Heart Valve Disease ◽  
High Tech ◽  
City Hospital ◽  
Clinical Hospital ◽  
Diagnostic Center ◽  
The Republic

The main stages of development and formation of the cardiovascular surgery in the Republic of Tatarstan and the role of the department of surgical diseases №2, on the basis of which this branch of surgery engendered in the 60s of XX century, are represented. The first demonstrational cardiac surgeries (closed mitral commissurotomy) were performed in Kazan at the premises of the 3d city hospital by academician A.A. Vishnevsky in 1958. In 1963 the 6th city hospital became the main base of the department of surgical diseases №2 in Kazan, and the first cardiac surgery intervention was performed on April 15, 1963 on 26 years old patient with mitral stenosis of rheumatic etiology. In the 70s of XX century cardiac surgery service at the premises of 6th city clinical hospital got the status of Interregional cardiac surgery center. From the beginning of the 1990s, cardiopulmonary bypass surgery became leading in the department of cardiac surgery. In 1992 the cardiac surgery department of the 6th city clinical hospital was reorganized and became the Kazan Center of Cardiovascular Surgery with 75 beds, since 1995 bearing the name of professor N.P. Medvedev. In 2000 the department was headed by associate professor R.K. Dzhordzhikiya (doctoral thesis «Minimally invasive surgery of acquired heart valve disease», 2004). In 2005 more than 300 cardiopulmonary bypass surgeries has been performed in the clinic. In 2006 employees of the center in almost full strength moved to the Interregional clinical diagnostic center, the first cardiac surgery at the center was performed in September 2006. Annually the number of high-tech operations increases. At the same time scientific research work is carrying out. The generalizing research studing the results of the preservation of annulo-papillary continuity when replacing valve in the mitral position with mechanical prosthesis in patients with rheumatic disease conducted at the center was one of the first in Russia. The past 80 years of the history of the Department of Cardiovascular Surgery and the stable foundation laid by previous generations of researchers and clinicians, the glorious representatives of the Kazan school of cardiovascular surgery, serve as a guarantee of successive development of scientific and clinical work of the department and the whole cardiac surgery service in the Republic of Tatarstan.

P1395The role of hyponatremia in the development of atrial fibrillation after cardiac surgery

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Pavlikova ◽  
A Shevelyok ◽  
N Vatutin
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Serum Sodium ◽  
Sodium Level ◽  
Cox Regression ◽  
Serum Sodium Level ◽  
History Of ◽  
The Impact

Abstract Background. Atrial fibrillation (AF) is one of the most common complication after cardiac surgeries. Age, valvular heart disease, heart failure, chronic obstructive pulmonary disease and a history of AF are well known risk factors for postoperative AF. On the other hand, hyponatremia is also a frequent disorder in patients undergoing cardiac surgery but its relationship with AF has not been studied. Purpose. We evaluated the impact of hyponatremia on the incidence of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods. The retrospective study included case history of 222 patients (174 men and 48 women, median age 64.5 [range 58.0; 69.0] years) who underwent cardiac surgery with cardiopulmonary bypass between January 2015 and December 2018.  In all patients intraoperative sodium level was analyzed. Hyponatremia was defined as serum sodium level < 135 mmol/l. Primary outcome was the episode of AF in postoperative period. Results. The incidence of postoperative AF was 18.9% (95% confidence interval (CI) 14.1-24.3 P = 0.05). Patients with AF more often had obesity, diabetes mellitus and a history of myocardial infarction and were more likely to perform combined surgery compared to non-AF patients (all Ps < 0.05). The prevalence of hyponatremia was significantly higher among AF group compared with non-AF (95.2% versus 77.8%, P = 0.017). Hyponatremia was the independent risk factors of postoperative AF in Cox regression models adjusted for covariates (odds ratio 5.31; 95% CI 1.42-18.7; P = 0.017). Conclusion.  In this analysis serum sodium level was closely associated with the risk of AF. These findings suggest that hyponatremia may cause the development of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass.

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