Cross-clamping Research Articles

The effect of surgery started at different time point during the day on the clinical outcomes of mitral valve surgery.

The clinical prognosis of mitral valve surgery at morning, afternoon, and evening is not yet clear. The aim of the study is to investigate the impact of different time periods of surgery in the morning, afternoon and evening on the short-term and long-term results of mitral valve surgery. From January 2018 to December 2020, 947 patients with mitral valve surgery in our department were selected. These patients were divided into 3 groups according to the starting time of surgery. Morning group (operation start time 8:00-10:30, n = 231), afternoon group (operation start time 12:00-14:30, n = 543), and evening group (operation start time 17:30-20:00, n = 173). The short-term and long-term results of the three groups were compared. There were no significant difference in the long-term mortality, long-term risk of stroke and reoperation. And there were no significant difference in in-hospital outcomes, including mortality, stroke, cardiopulmonary bypass time, aortic cross clamp time, mitral valve repair convert to mitral valve replacement, number of aortic cross clamp ≥2 times, unplanned secondary surgery during hospitalization (including thoracotomy hemostasis, thoracotomy exploration, redo mitral valve surgery, and debridement), intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous renal replacement therapy, mechanical ventilation time, and intensive care unit length of stay. There is no significant difference in the risk of short-term and long-term survival and adverse events after mitral valve surgery at different time periods in the morning, afternoon, and evening. Mitral valve surgery at night is safe.

A Single-Center Experience in Low Ejection Fraction Coronary Artery Bypass Surgery

Background. Coronary artery bypass graft (CABG) in patients with an ejection fraction (EF) ≤ 35% predisposes them to higher complications and mortality risks. Given the usually compromised status of other end organs in low EF patients, ONCAB, involving cardiopulmonary bypass (CPB) and aortic cross-clamping, might intuitively pose more complications than OPCAB. Objective. To explore short- and long-term outcomes between ONCAB and OPCAB procedures in patients with EF ≤ 35%. Methods. A retrospective and observational analysis was conducted in 196 patients with EF ≤ 35% who underwent ONCAB (n = 58) or OPCAB (n = 138) procedures at a single center between January 2015 and May 2023. Baseline characteristics were well matched using the stabilized inverse probability treatment weighted matching technique. Results. After matching, ONCAB and OPCAB had comparable 30-day mortality and 30-day cardiac mortality. OPCAB exhibited significantly shorter length of hospital and ICU stays, with a trend towards more discharges to home. Rates of composite complication and its individual components such as acute kidney injury, reoperation bleeding, stroke, pneumonia, GI disease, and atrial fibrillation were similar between the two groups. Rates of sepsis, liver dysfunction, and blood transfusion were significantly lower in the OPCAB group. As assessed by EF and LVDD, neither procedure showed superiority in improving cardiac function. Median follow-up time was 4.9 (interquartile range: 2.1–7.2) years. After matching, long-term overall survival (1, 3, 7 years) and cardiac mortality rates were comparable between OPCAB and ONCAB. Cumulative rates of cardiac arrest, heart failure, myocardial infarction (MI), atrial fibrillation (Afib), renal disease, and readmission (overall and cardiac) at 7 years were similar. Conclusion. This study demonstrates comparable short-term and long-term outcomes between ONCAB and OPCAB in patients with reduced EF, with OPCAB favoring faster recovery. OPCAB appears as a safer and equally effective option for low EF CABG patients. Larger samples and longer follow-ups are needed for conclusive clinical evidence.

Comparison of definitive approaches for conotruncal defects following bidirectional Glenn procedure

BackgroundStaged repair is common for complex conotruncal defects, often involving bidirectional Glenn (BDG) procedure. Following the cavopulmonary shunt, both Fontan completion and biventricular conversion (BiVC) serve as definitive approaches. The...

Innovations in Aortic Valve Replacement: A Comprehensive Overview of the Intuity Rapid Deployment Valve

Rapid deployment/sutureless (RDS) valves have recently emerged as an innovative surgical solution, providing an alternative to traditional methods of surgical aortic valve replacement (SAVR) by eliminating the need for suture placement and tying. This innovation leads to a reduction in aortic crossclamp and cardiopulmonary bypass times, enhancing the efficiency of the procedure. Among the 2 available RDS valves, the Edwards Intuity valve in particular has been demonstrated to be a particularly promising substitute in the field of SAVR. The Intuity valve distinguishes itself from other RDS and conventional valves by yielding superior outcomes, such as a significant reduction in mortality, increase in the longevity of the valve, and a marked decrease in both mean and peak transvalvular pressure gradients. These benefits collectively contribute to its appeal as a favorable new solution. However, further investigation is needed to conclusively determine the long-term outcomes and safety of RDS valves. Nevertheless, the utilization of the Intuity valve presents an exciting solution to the existing limitations of conventional and minimally invasive SAVR, especially for patients afflicted with severe aortic stenosis.

The effects of venovenous bypass use in liver transplantation with piggyback technique: a propensity score-weighted analysis.

Venovenous bypass (VVB) use during liver transplantation (LT) is notably variable among the centres and it is actually restricted to surgically complex cases, severely unstable recipients or grafts from high-risk donors. Historically, VVB was associated with the classical LT with caval cross clamping, while not much is known about the safety of this technique applied to piggyback LT. This retrospective observational study evaluated the effects of VVB applied to piggyback LT on mortality, hospital outcomes, postoperative graft and other organ dysfunction. We retrospectively collected data about recipient status, surgical complexity and graft quality of all the piggyback LTs performed at the Transplant Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy, from January 2012 to December 2022. A propensity score (PS) was built taking into account the variables possibly associated with either VVB choice and the investigated outcomes with the average treatment overlap method. PS-weighted general linear models (GLMs) were developed to investigate the adjusted effect of VVB use on the selected outcomes. The final analysis included 874 LT cases, of whom 74 (8.5%) underwent VVB. The effective sample sizes after PS-weighting were 280.2 and 64.3 patients in the no-VVB and VVB groups, respectively. PS-weighted GLMs did not show any differences regarding hospital and graft-related outcomes. However, significantly higher odds ratios for serum creatinine > 2mg/dL and AKIN stage 2 or 3 during the first 24h after ICU admission together with a higher renal replacement therapy need during ICU stay were reported for VVB exposure in the weighted analyses. This study suggests similar mortality and length of stay but a higher risk for postoperative acute kidney injury in patients undergoing piggyback LT with VVB.

Right Anterior versus Right Transaxillary Access for Minimally Invasive Aortic Valve Replacement: A Propensity Matched Competitive Analysis.

(1) Background: Right anterior thoracotomy (RAT-AVR) has been the sole established sternum-sparing technique for minimally invasive aortic valve replacement (MICS-AVR) thus far. Nevertheless, transaxillary access, known as Minimally Invasive Cardiac LATeral Surgery (MICLATS-AVR), represents the latest and innovative advancement in sternum-sparing MICS-AVR access routes. In this study, procedural and clinical outcomes of a substantial transaxillary MICS-AVR cohort are compared to those of a RAT-AVR control group; (2) Patients and Methods: This retrospective study included 918 consecutive patients who underwent MICS-AVR at our facility between 2014 and 2022. This cohort was divided into two surgical access-related groups: RAT-AVR (n = 492) and MICLATS-AVR (n = 426). Procedural data, operative morbidity, and mortality were compared between groups. Further analysis was performed using propensity score matching; (3) Results: After matching, 359 pairs of patients were included and analyzed. There were no notable differences observed between the two groups regarding major adverse cardio-cerebral events. Despite longer cardiopulmonary bypass time in the MICLATS-AVR group (63.1 ± 20.4 min vs. 66.4 ± 18.2 min; p ≤ 0.001) the skin-to-skin time (129.4 ± 35.9 min. vs. 126.5 ± 29.8 min.; p = 0.790) and the aortic cross-clamp time was comparable between both groups (41.9 ± 13.3 min. vs. 43.5 ± 14.4 min.; p = 0.182). The overall hospital stay was significantly shorter in the MICLATS-AVR cohort (9.7 ± 5.2 days vs. 9.2 ± 4.5 days; p = 0.01). Both groups were comparable in terms of postoperative morbidities. However, significantly lower rates of postoperative impaired wound healing were noted in the MICLATS-AVR group (11.7% vs. 3.9%, p < 0.001); (4) Conclusions: In comparing MICLATS-AVR and RAT-AVR, our study found MICLATS-AVR to be at least as safe and time-efficient as RAT-AVR, with no significant differences in MACCE. MICLATS-AVR showed a shorter hospital stay and lower postoperative wound issues, indicating its feasibility and safety as an alternative. Notably, MICLATS-AVR is sternum- and bone-sparing, preserving the right mammary artery, and facilitates combined procedures like multiple valve surgeries.

Determination of the prevalence of fever after congenital cardiac surgery in children

undergoing congenital heart surgery and causes anxiety in the surgeon and the patient's parents. Proper diagnosis and management of fever requires careful preoperative patient evaluation, targeted physical examination, and comprehensive knowledge about the prevalence and common causes of fever. The aim of this study was to determine the prevalence of fever after congenital heart surgery in children. Subjects and Methods This was a descriptive-analytical study on children under 10 years of age undergoing congenital heart surgery in the cardiac operating room of Golestan Hospital of Ahvaz in 2021. Data collection tools included a two-section checklist. The first section was related to demographic characteristics and the second addressed patients' clinical status and causes of fever. Data were analyzed using SPSS software. Results After surgery, 21 patients (31.8%) developed fever and the prevalence of fever was not significantly associated with age, sex, presence of genetic syndrome, type of disease, type of operation, cardio pulmonary bypass, duration of aortic cross clamp, duration of cardiopulmonary bypass, or duration of operation. However, it was significantly correlated with the mean length of ICU stay (P&gt; 0.05). Conclusion The prevalence of fever in patients undergoing congenital heart surgery was relatively high and had a significant relationship with the length of ICU stay.

Renal sympathetic denervation improves pressure-natriuresis relationship in cardiorenal syndrome: insight from studies with Ren-2 transgenic hypertensive rats with volume overload induced using aorto-caval fistula

The aim was to evaluate the effects of renal denervation (RDN) on autoregulation of renal hemodynamics and the pressure-natriuresis relationship in Ren-2 transgenic rats (TGR) with aorto-caval fistula (ACF)-induced heart failure (HF). RDN was performed one week after creation of ACF or sham-operation. Animals were prepared for evaluation of autoregulatory capacity of renal blood flow (RBF) and glomerular filtration rate (GFR), and of the pressure-natriuresis characteristics after stepwise changes in renal arterial pressure (RAP) induced by aortic clamping. Their basal values of blood pressure and renal function were significantly lower than with innervated sham-operated TGR (p < 0.05 in all cases): mean arterial pressure (MAP) (115 ± 2 vs. 160 ± 3 mmHg), RBF (6.91 ± 0.33 vs. 10.87 ± 0.38 ml.min–1.g–1), urine flow (UF) (11.3 ± 1.79 vs. 43.17 ± 3.24 µl.min–1.g–1) and absolute sodium excretion (UNaV) (1.08 ± 0.27 vs, 6.38 ± 0.76 µmol.min–1.g–1). After denervation ACF TGR showed improved autoregulation of RBF: at lowest RAP level (80 mmHg) the value was higher than in innervated ACF TGR (6.92 ± 0.26 vs. 4.54 ± 0.22 ml.min–1.g–1, p < 0.05). Also, the pressure-natriuresis relationship was markedly improved after RDN: at the RAP of 80 mmHg UF equaled 4.31 ± 0.99 vs. 0.26 ± 0.09 µl.min–1.g–1 recorded in innervated ACF TGR, UNaV was 0.31 ± 0.05 vs. 0.04 ± 0.01 µmol min–1.g–1 (p < 0.05 in all cases). In conclusion, in our model of hypertensive rat with ACF-induced HF, RDN improved autoregulatory capacity of RBF and the pressure-natriuresis relationship when measured at the stage of HF decompensation.

Effects of Pulsatile and Non-Pulsatile Cardiopulmonary Bypass Techniques in Coronary Artery Bypass Grafting Surgeries on Cerebral Perfusion.

We aimed to evaluate the effects of cardiopulmonary bypass (CPB) machines used in coronary artery bypass grafting surgeries on cerebral perfusion by performing cerebral oximetry monitoring [near-infrared spectroscopy (NIRS)], S100-β protein measurements, and neurocognitive function assessment tests using both pulsatile and non-pulsatile modes. A total of 44 patients, 22 non-pulsatile (Group NP) and 22 pulsatile (Group P), were included in the study. Hemodynamic parameters, arterial blood gas values, NIRS values and blood S100β protein levels were analyzed at five points: pre-induction (T1), initiation of CPB (T2), termination of CPB (T3), end of surgery (T4), and postoperative 24 h (T5). Two different neuropsychological tests were administered to patients in the preoperative and postoperative periods. There were no significant differences between the groups for demographic characteristics such as age, gender, body mass index, aortic cross-clamping, CPB, and operation durations. The mean arterial blood pressure and PaO2 values for the T2 measurements were significantly higher in group NP (P < 0.05). Regional cerebral oxygen saturation (rSO2) (NIRS) values at T3 and T4 were significantly higher in group P (P < 0.05). Serum S100β measurement values at T3 and T5 were significantly higher in group NP than in group P (P < 0.05). Serum S100β protein levels at T3 correlate with rSO2 results. There was no statistically significant difference between the two groups in terms of pH, lactate, glucose, partial pressure of carbon dioxide, and peripheral oxygen saturation values. Despite no difference between the two groups for neurocognitive function tests, we believe that pulsatile perfusion may be more beneficial for cerebral perfusion when S100β protein and NIRS values are considered. Further clinical studies are needed to evaluate the benefits of the pulsatile technique for cerebral perfusion.

Coronary Artery Bypass Grafting for Refractory Ventricular fibrillation after the Release of the Aortic Cross-Clamp in Patients Undergoing Aortic Valve Replacement: A Case Report

Background: Ventricular fibrillation (VF) is a known complication after the release of the aortic cross-clamp (ACC) during cardiopulmonary bypass (CPB) surgery. Various factors contribute to persistent refractory VF, making its management challenging. This case report describes the successful treatment of postoperative refractory VF by coronary artery bypass grafting (CABG) in a patient undergoing aortic valve replacement (AVR) with ACC release. Case Presentation: A 52-year-old woman with a history of hypertension and ischemic cerebral infarction presented with symptoms of chest tightness, dyspnoea and palpitations. She underwent a modified maze procedure of radiofrequency ablation, mitral repair, left atrial appendage closure and mechanical AVR under a CPB procedure. Following the ACC release, the patient experienced recurrent VF that was unresponsive to standard interventions such as lidocaine, amiodarone and direct current shocks. The suspicion of right coronary artery (RCA) insufficiency led to the decision to perform CABG using the great saphenous vein. After the CABG procedure, the patient's heart rhythm gradually returned to sinus rhythm, and she had an uneventful recovery. Discussion and Conclusions: Refractory VF after the ACC release can pose diagnostic and treatment challenges. In this case, RCA insufficiency was suspected as the cause of refractory VF. The absence of blood flow in the proximal RCA and the presence of distal blood return during cardiac surface exploration supported this suspicion. Coronary artery bypass grafting using the great saphenous vein successfully restored normal sinus rhythm, confirming the diagnosis. This case emphasises the importance of considering coronary artery stenosis or occlusion as a potential cause of refractory VF after the ACC release during CPB, with CABG serving as a viable alternative treatment.

Succesful Continuous Renal Replacement Therapy (CRRT) for Acute Kidney Injury (AKI) with Septic Shock Underwent Long Coronary Artery Bypass Graft Procedure (CABG)

Background : AKI occurs in significant numbers of patients undergoing cardiopulmonary bypass surgery for coronary artery disease. Patient with AKI requiring renal replacement therapy (RRT) after cardiac surgery were at a higher risk of postoperative mortality. One of mode of RRT is CRRT. CRRT can keep hemodynamic of the patient stable, excellent control of azotemia, sypport beneficial immunomodulation,increase clearance of inflammatory mediators and potentially less ongoing or repeated renal ischaemia. As an alternative to traditional intermittent hemodialysis, CRRT has now emerged as the leading form of RRT for patients with AKI post CABG because the CRRT can keep hemodynamic still stable. Case: We report a case report of patient who had long aorta cross clamp in CABG procedure. He got AKI with shock condition during hospitalization in ICU, had been done with CRRT and had good response after the procedure. Discussion: The incidence of AKI after cardiac surgery in this patient may increase with several risk factors, such as surgical bleeding, diabetes mellitus, pre operative renal dysfunction, low LVEF, the use of CPB machine and infection. An imbalance between renal oxygen supply and oxygen demand will induce AKI. This patient had done CRRT and showed good clinical and laboratory condition after that. Conclusion : CRRT is a good choice for AKI patient post CABG procedure with shock condition.

Comparison of Perioperative and Postoperative Outcomes Among 3 Left Atrial Incisions: Conventional Direct, Transseptal, and Superior Septal Left Atriotomy.

Achieving optimal exposure of the mitral valve during surgical intervention poses a significant challenge. This study aimed to compare perioperative and postoperative outcomes associated with 3 left atriotomy techniques in mitral valve surgery-the conventional direct, transseptal, and superior septal approaches-and assess differences during the surgical procedure and the postoperative period. Inclusion criteria were patients undergoing mitral valve surgery from January 2010 to December 2020, categorized into 3 cohorts: group 1 (conventional direct; n = 115), group 2 (transseptal; n = 33), and group 3 (superior septal; n = 59). To bolster sample size, the study included patients undergoing mitral valve surgery independently or in conjunction with other procedures (eg, coronary artery bypass grafting, aortictricuspid surgery, or maze procedure). No substantial variance was observed in the etiology of mitral valve disease across groups, except for a higher incidence of endocarditis in group 3 (P = .01). Group 1 exhibited a higher frequency of elective surgeries and isolated mitral valve procedures (P = .008), along with reduced aortic clamping and cardiopulmonary bypass durations (P = .002). Conversely, group 3 patients represented a greater proportion of emergency procedures (P = .01) and prolonged intensive care unit and hospital stays (P = .001). No significant disparities were detected in terms of permanent pacemaker implantation, postoperative complications, or mortality among the groups. Mitral valve operations that employed these 3 atriotomy techniques demonstrated a safe profile. The conventional direct approach notably reduced aortic clamping and cardiopulmonary bypass durations. The superior septal method was primarily employed for acute pathologies, with no significant escalation in postoperative arrhythmias or permanent pacemaker implantation, although these patients had prolonged intensive care unit and hospital stays. These outcomes may be linked to the underlying pathology and nature of the surgical intervention rather than the incision method itself.

Meta-analysis: Bilateral and Unilateral Cerebral Perfusion in Type A Dissection.

This meta-analysis compared the outcomes of bilateral cerebral perfusion (BCP) and unilateral cerebral perfusion (UCP) in aortic surgery for acute type A aortic dissection. A systematic literature search identified 12 studies involving 4,547 patients. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to analyze perioperative characteristics, short-term mortality rates, and postoperative neurological complications. No significant differences were found between the BCP and UCP groups in terms of cardiopulmonary bypass time, aortic cross clamp time, lowest body temperature, and lower body circulatory arrest time. Short-term mortality rates (OR [95% CI] = 0.87 [0.64-1.19], p = 0.40) and permanent neurological deficits (OR [95% CI] = 1.01 [0.69-1.47], p = 0.96) were comparable between the groups. However, subgroup analysis of studies exclusively involving total arch replacement showed a lower short-term mortality rate (OR [95% CI] = 0.42 [0.28-0.63], p < 0.01) and permanent neurological deficits (OR [95% CI] = 0.53 [0.30-0.92], p = 0.03) in the BCP group. The BCP group also had a lower rate of temporary neurological deficits (OR [95% CI] = 0.70 [0.53-0.93], p = 0.01), particularly in studies exclusively involving total arch replacement (OR [95% CI] = 0.58 [0.40-0.85], p < 0.01). This meta-analysis suggests that BCP and UCP yield comparable outcomes. However, BCP may be associated with lower short-term mortality rates and reduced incidence of neurological complications, particularly in cases requiring total arch replacement. BCP should be considered as a preferred cerebral perfusion in specific patient populations.

Factors that determine cell-free hemoglobin concentration in blood prime during cardiac surgery with cardiopulmonary bypass: a prospective observational study

INTRODUCTION: Plasma cell-free hemoglobin (Hbf) has a negative effect on the results of cardiac surgery. OBJECTIVE: Analysis of the dynamics of the Hbf during cardiosurgical operations with CPB. Identification of the main factors for increasing the Hbf. MATERIALS AND METHODS: A prospective, single-center, cohort study included 50 patients who underwent cardiac surgery with CPB. Hbf was monitored before surgery, during CPB (10 minutes after the start, then every 30 minutes) and every 6 hours for two days. RESULTS: An increase in Hbf levels was found in 90 % of surgical procedure. In 8 % of cases, hemolysis was mild (0.1 &lt; Hbf ≤ 0.4 g/l), in 48 % — moderate (0.4 &lt; Hbf &lt; 1 g/l), severe (Hbf ≥ 1 g/l) was after 34 % of operations. After weaning from CPB Hbf rapidly decreases and after 12 hours drop to the preoperative level. Aortic cross-clamping is a risk factor with an odds ratio of 1.038 (p = 0.036). A positive correlation was established between the Hbf level and the duration of CPB (r = 0.76; p &lt; 0.001). In ROC-analysis, a good predictive ability for development of severe hemolysis was demonstrated by the time of CPB: AUC 0.74 (p = 0.014) with a threshold value of 76 minutes. During CABG, severe hemolysis developed significantly less frequently than during valve corrections — 12.5 % versus 44.1 %, p = 0.026. Hbf content was significantly lower with an initial hemoglobin concentration &lt; 140 g/l than in patients with an initial hemoglobin level ≥ 140 g/l — 0.7 (0.5; 0.95) g/l versus 0.9 (0.7; 1.28) g/l, p = 0.036. CONCLUSIONS: Hemolysis is typical for the cardiac surgeries with CPB. The time of aoral clamping and CPB, the type of surgcry, the hemoglobin content before surgcry have an impact on the severity of hemolysis.

Custodiol Histidine-Tryptophan-ketoglutarate Versus Blood Cardioplegia in Totally Thoracoscopic Cardiac Surgery

Objective: The present study aimed to evaluate and compare the myocardial protection performance between Custodial histidine-tryptophan-ketoglutarate cardioplegic solution and blood cardioplegic solution in the context of totally thoracoscopic cardiac surgery. Methods: A total of 101 patients who underwent thoracoscopic cardiac surgery adopting either blood cardioplegic or histidine-tryptophan-ketoglutarate solution at Guangdong Provincial People’s Hospital from January 2021 to December 2021 were retrospectively enrolled. Postoperative outcomes assessed by myocardial enzyme level, the capacity of return to spontaneous rhythm, left ventricle ejection fraction, myocardial infarction, vasoactive-inotropic score, mechanical ventilation time, intensive care unit stay, hospital stay, mechanical circulatory support, and in-hospital mortality were compared between the two groups. Results: 69 and 32 patients adopted blood cardioplegic and histidine-tryptophan-ketoglutarate solutions, respectively. The cardiac troponin I and creatine kinase-MB at the peak period or at the postoperative period of &lt;24h, 24-48h, and &gt;48h were similar between the two groups (p&gt;0.05). There was also no significance regarding the postoperative left ventricle ejection fraction, vasoactive-inotropic score, and incidence of myocardial infarction (p&gt;0.05). However, blood cardioplegic solution administration resulted in a significantly more occurrence of return to spontaneous rhythm in contrast to the histidine-tryptophan-ketoglutarate solution (p=0.025). Multivariate logistic regression for outcomes revealed that histidine-tryptophan-ketoglutarate administration was associated with a lower possibility to return to spontaneous rhythm (odds ratio (OR)=0.238; confidence interval CI=0.072-0.783; p=0.018]. Additionally, increased aortic cross-clamp time per 10 mins was associated with a higher risk of myocardial infarction (OR=1.499; CI=1.161-1.934; p=0.002) while increased total volume was associated with a lower risk of myocardial infarction (OR=0.997; CI=0.994-0.999; p=0.029) Conclusion: Delivery of histidine-tryptophan-ketoglutarate solution offered equivalent myocardial protection to the delivery of blood cardioplegic solution in patients undergoing totally thoracoscopic cardiac surgery. In this setting, the histidine-tryptophan-ketoglutarate seems to be associated with decreased incidence of postoperative return to spontaneous rhythm.

A Predictive Nomogram for Intensive Care-Acquired Weakness after Cardiopulmonary Bypass.

Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB. Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models. Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram. A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making.

Effect of Optimizing Regional Cerebral Oxygen Saturation during Infant Cardiac Surgery on the Incidence of Postoperative Delirium: A Retrospective Study.

To investigate the effect of optimizing regional cerebral oxygen saturation (rScO2) on the incidence of postoperative delirium and surgical outcome in infants with congenital heart disease. Sixty-one infants experienced desaturation in rScO2 of 10% from baseline for more than 30 seconds during surgery between January 2020 and January 2022. Among them, 32 cases (Group A) received the corresponding treatment in the process of desaturation and 29 cases (Group B) were observed without receiving any treatment. General information, cerebral oxygen saturation, the incidence of postoperative delirium, and other relevant clinical data were collected. The duration and severity of intraoperative rScO2 desaturation in Group A were significantly lower than those in Group B. The incidence of postoperative delirium in Group A was significantly lower than that in Group B. There was no significant difference in the positive screening score for delirium between the two groups. Binary logistic regression analysis showed that the aortic cross-clamp time, mechanical ventilation duration, and severity of intraoperative rScO2 desaturation were significantly correlated with the occurrence of postoperative delirium. Aggressive rScO2 desaturation treatment is associated with a lower incidence of postoperative delirium and improved surgical outcomes.

The long-term results of using 3-patch technique for supravalvular aortic stenosis

The objective of this study evaluated the results of using 3-patch technique for supravalvular aortic stenosis [1]&#x0D; Methods: This was a review of seri cases: using 3-path technique for supravalvular aortic stenosis from 1/2012 to 12/2018&#x0D; Results: There were 8 patients who underwent using 3-patch technique, include 5 males and 3 females. The mean of age was 12,4 years (range 4 to 32 year), 7 childrents and 1 adult. The left ventricular outflow tract gradient was 62 mmHg. The time of cardiopulmonary bypass, aortic clamping and ventilator were: 104 minutes; 72 minutes. 7 patients were used pericardium path and 1 patient was another graft. There was not intrahospital mortality. Echocardiography post -operation: left ventricular outflow tract gradient was 11,8 mmHg. During follow-up time 7,8 years after surgery, there was no late death; there were 3 patients who had to reoperation include 2 patient with stenotic distal anastomosis postoperation 5 years and 1 patient with severe aortic valve stenosis postoperation 8 years Conclusion: The long-term of using 3-patch technique for supravalvular aortic stenosis were satisfaction and longer follow-up was essential to find-out about risks of reoperation.

The results of total repair for tetralogy of fallot with an abnormal coronary artery

The objective of this study evaluated the results of total repair for tetralogy of Fallot with an abnormal coronary artery.&#x0D; Methods: This was a review of seri Tetralogy of Fallot with an abnormal coronary artery cases who underwent total repair from 1/2018 to 6/2023.&#x0D; Results: There were 10 patients who underwent complete surgical repair, include 6 males and 4 females. The mean age was 6,8 months (range 4 months to 17 months)and the mean weight was 7,2 kilograms. 6 patients had Left Anterior Descending (LAD) artery originating from Right Coronary Artery (RCA), 3 patients with RCA originating from LAD and 1 patient with one major banche of RCA crossing the infundibulum. There were 7 patients with Pulmonary Valve Preserve (PVP) and 3 patients with Conduit Using (CU). The time of cardiopulmonary bypass, aortic clamping and ventilator were: 90 mins; 63 mins and 16 hours. There was not intrahospital mortality. Echocardiography post -operation: in PVP group all patient had a competence pulmonary valve and mean gradient was 12,5 mmHg; in CU group, there were not pulmonary valve regurgitation and mean gradient was 9 mmHg. During follow-up time 30 months after surgery, there was no late death; 2 patient in PVP group who had moderate pulmonary valve regurgitation and mean gradient was 22 mmHg; in CU group, there was a competence pulmonary valve with mean gradient 26 mmHg.&#x0D; Conclusion: There was a good result of total repair for tetralogy of Fallot with an abnormal coronary artery.

Early outcome of minimally invasive repair of tetralogy of fallot via right vertical infra-axillary incision

Background: Recently, several authors have detailed their experiences with small cohorts of patients in using minimal invasive surgery (MIS) to treat Tetralogy of Fallot (TOF) with innovative approaches and satisfactory results. The goal of this study was to review an new innovative MIS technique that results in using minimal right vertical infra-axillary incision (RVIAI). &#x0D; Methods: Our retrospective study reviewed 45 patients that were diagnosed with TOF and underwent minimally invasive surgery through RVIAI at Children City Hospital from June 2020 to June 2023. &#x0D; Results: Mean age was 9,4 ± 6,6 months, mean body weight was 7,4 ± 1,7 kg, the male/female ratio was 2,1/1. Mean size of pulmonary annulus was 9,58 ± 1,53 mm (-0,47 ± 1,04 Zscore). Central cannulation was accessed in all patients. There were no deaths or conversions to sternotomy. Average durations of aortic cross-clamp and cardiopulmonary bypass (CPB) were 188,7 ± 50,6 min and 124,6 ± 35,8 min, respectively. During the follow-up of 5.4–32.3 months, 11,1% of these patients were found to have moderate residual pulmonary stenosis. There was no severe residual pulmonary stenosis, residual shunt, severe tricuspid regurgitation. No reoperation, no new onset of chest deformities and no sclerosis were observed during the follow-up.&#x0D; Conclusions: The right axillary incision allows a safe and effective approach for Tetralogy of Fallot complete repair and is a potential new standard of care for many patients.