Duration Of Cardiopulmonary Bypass Research Articles

Exploring Acute Kidney Injury Following Aortic Dissection: A Comprehensive Review of Machine Learning Models for Predicting Risk, Management Strategies, Complications, and Racial and Gender Disparities.

Both types of aortic dissection (AD), Stanford type A and type B, can result in complications such as acute kidney injury (AKI) and aortic rupture. Renal complications in AD arise from compromised renal perfusion affecting the renal arteries. Understanding the intricate connection between AD and AKI is crucial for navigating the complexities of tailored treatment and formulating specific management plans. Concerning machine learning models, in patients with type A aortic dissection, factors such as decreased platelet count on admission, increased D-dimer level, longer cardiopulmonary bypass duration, elevated white blood cell levels, the need for blood transfusion, longer aortic clamp time, extended surgery duration, advanced age, and an elevated body mass index were positively associated with the development of AKI. For the risk of AKI after type B aortic dissection, elevated Nt-pro brain natriuretic peptide, prolonged activated partial thromboplastin time, elevated admission systolic blood pressure, and a higher contrast agent requirement during operative repair were found to predict the risk. Male gender was associated with a higher risk of AKI, and nonwhite race was linked to a higher risk of AKI, a greater likelihood of requiring more urgent procedures, and lower levels of insurance coverage. The treatment of AKI following AD requires a multifaceted approach. Identifying and addressing the underlying cause, such as low blood pressure, renal artery involvement, or medication-induced injury, is crucial for effective management and preventing further kidney damage. Maintaining proper fluid balance is essential for improving renal perfusion, but careful monitoring is necessary to avoid complications. The evolving landscape of research, particularly in biomarkers and AI programs, reveals a promising role in predicting the risk for and managing AKI post-AD.

#624 The impact of hemoadsorption in patients with borderline chronic kidney disease undergoing coronary artery bypass grafting

Abstract Background and Aims With an annual incidence of up to 30%, cardiac surgery–associated acute kidney injury (CSA-AKI) may be one of the most underappreciated yet frequent complications and renal protective adjustments are crucial. We evaluated the impact of hemoadsorption as adjunctive therapy on clinical outcome in Kidney Disease Improving Global Outcomes (KDIGO) G2/A2) patients undergoing coronary artery bypass grafting (CABG). Method During a three-year period, 40 patients undergoing CABG with borderline chronic kidney disease (KDIGO-G2/A2) were treated with adjunctive hemoadsorption therapy and were compared by propensity score-matched 40 patients (KDIGO G2/A2) (Control). Primary endpoints were the need for renal replacement therapy (RRT)/dialysis and/or worsening of KDIGO stage in the perioperative period. Secondary endpoints were the change in inflammatory biomarkers, vasopressor requirement and ICU/hospital stay. In the study group, a 300 mL hemoadsorber (Cytosorbents Inc, NJ) was used for the entire duration of cardiopulmonary bypass (CPB). All patients were prepared via enhanced recovery after surgery (ERAS) protocol and surgical procedures were performed under moderate hypothermia with pulsatile flow and ultrafiltration. Patients with septic shock, limited life expectancy and refused to give consent were excluded. Results After institutional ethics committee approval was obtained, written informed consent was received from each patient. No significant difference was noted between groups in demographic, operative data and preoperative baseline laboratory. At the end of CPB; s-Creatinine (mg/dL) (1.85 ± 0.6 vs 2.751 ± 0.6; p = 0.035), NT-proBNP (pg/L) (130 ± 30 vs 180 ± 40; p = 0.04), IL-6 (pg/mL) (8.2 ± 4 vs 22.2 ± 4; p = 0.012) and myoglobulin (pg/L) (210 ± 75 vs 310 ± 80; p = 0.04) levels were significantly lower in the study group versus control. Clinical outcome is summarized in Figure. Conclusion This pioneering study demonstrated the additional protective effects of hemoadsorption in patients with borderline chronic kidney disease (KDIGO-G2/A2) undergoing CABG. Elimination of inflammatory parameters might be a complementary mechanism resulting in lesser worsening of kidney function/need of RRT and ICU stay. These findings require validation in large, multicenter trials.

Comparison of Partial Upper Sternotomy Versus Median Sternotomy for Total Arch Replacement in Patients With Type A Aortic Dissection

Objective: Comparative studies of median sternotomy and partial upper sternotomy in total arch replacement for type A aortic dissection are rare, and the safety and benefits of partial upper sternotomy need further evaluation. This study aimed to explore the effectiveness and prognosis of partial upper sternotomy in total arch replacement among patients with type A aortic dissection. Methods: This is a retrospective study of patients who underwent total arch replacement for type A aortic dissection at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2016 and December 2019. They were grouped into the median sternotomy and partial upper sternotomy groups according to the different treatment methodologies. The intra-operative and prognostic indicators were compared between both groups. Results: Forty-nine patients were included: 31 in the median sternotomy group and 18 in the partial upper sternotomy group. The partial upper sternotomy group had a shorter incision ((9.0 ± 0.8) cm vs. (25.5 ± 1.3) cm, P = 0.02) and smaller postoperative total drainage volume (885 mL vs. 1,820 mL, P = 0.03) than the median sternotomy group. The differences between the 2 groups with respect to other intra-operative indicators such as operation duration, cardiopulmonary bypass duration, aortic occlusion duration, hypothermic circulatory arrest duration, and intra-operative blood loss, and prognostic indicators such as red blood cell infusion, ventilator aid duration, cardiac intensive care unit stay, postoperative hospital stay, and postoperative complications were not significantly different (all P > 0.05). Conclusions: The utilization of partial upper sternotomy in patients with type A aortic dissection resulted in a smaller incision and more aesthetically pleasing scar, along with reduced drainage volume compared to median sternotomy.

Intraoperative haemoadsorption for antithrombotic drug removal during cardiac surgery: initial report of the international safe and timely antithrombotic removal (STAR) registry.

Intraoperative antithrombotic drug removal by haemoadsorption is a novel strategy to reduce perioperative bleeding in patients on antithrombotic drugs undergoing cardiac surgery. The international STAR registry reports real-world clinical outcomes associated with this application. All patients underwent cardiac surgery before completing the recommended washout period. The haemoadsorption device was incorporated into the cardiopulmonary bypass (CPB) circuit. Patients on P2Y12 inhibitors comprised group 1, and patients on direct-acting oral anticoagulants (DOAC) group 2. Outcome measurements included bleeding events according to standardised definitions and 24-hour chest-tube-drainage (CTD). 165 patients were included from 8 institutions in Austria, Germany, Sweden, and the UK. Group 1 included 114 patients (62.9 ± 11.6years, 81% male) operated at a mean time of 33.2h from the last P2Y12 inhibitor dose with a mean CPB duration of 117.1 ± 62.0min. Group 2 included 51 patients (68.4 ± 9.4years, 53% male), operated at a mean time of 44.6h after the last DOAC dose, with a CPB duration of 128.6 ± 48.4min. In Group 1, 15 patients experienced a BARC-4 bleeding event (13%), including 3 reoperations (2.6%). The mean 24-hour CTD was 651 ± 407mL. In Group 2, 8 patients experienced a BARC-4 bleeding event (16%) including 4 reoperations (7.8%). The mean CTD was 675 ± 363mL. This initial report of the ongoing STAR registry shows that the intraoperative use of a haemoadsorption device is simple and safe, and may potentially mitigate the expected high bleeding risk of patients on antithrombotic drugs undergoing cardiac surgery before completion of the recommended washout period.Clinical registration number: ClinicalTrials.gov identifier: NCT05077124.

Clinical Outcomes of Surgical Revascularization Strategies Guided by Quantitative Flow Ratio in Primary Noncoronary Cardiac Surgery.

Information regarding quantitative flow ratio (QFR) usage in coronary artery bypass grafting (CABG) is lacking. We compared the incidence of postoperative long-term adverse cardiovascular and cerebrovascular events after QFR-guided or coronary angiography-guided adult cardiac surgery with concurrent bypass surgery. This study included 432 patients who underwent cardiopulmonary bypass (CPB) at our institution with at least 1 angiographical coronary artery lesion (diameter stenosis: 30% to 90%) between January 2015 and January 2016. The QFR of each patient was calculated. Patients who only underwent intraoperative coronary revascularization following the principles of optimal revascularization strategy were assigned to group A. Patients with coronary lesions not meeting the above criteria were placed in group B. The average number of distal anastomoses of patients with combined CABG in group B was similar to that in Group A (1.9±1.0 vs. 1.7±0.9; P=0.081). Group A had a shorter CPB duration (114.4±49.2 vs 135.8±55.2 minutes; P<0.001) and shorter aortic cross-clamping time (83.6±36.2 vs 101.1±40.6 minutes; P<0.001). The rates of perioperative mortality and major complications did not differ between groups. Long-term major adverse cardiovascular and cerebrovascular events (MACCEs) were less common in group A than in group B (14.7% vs 29.5%; P<0.001). In primary noncoronary cardiac surgery, despite the similar average numbers of distal anastomoses, the group with target vessels treated using an optimal coronary revascularization strategy presented shorter CPB time and aortic cross-clamping time than the other group. Multivariate analyses also showed a lower incidence of long-term MACCEs.

The impact of cardiopulmonary bypass time on the Sequential Organ Failure Assessment score after cardiac surgery.

Postoperative organ dysfunction is common after cardiac surgery, particularly when cardiopulmonary bypass (CPB) is used. The Sequential Organ Failure Assessment (SOFA) score is validated to predict morbidity and mortality in cardiac surgery. However, the impact of CPB duration on postoperative SOFA remains unclear. This is a retrospective study. Categorical values are presented as percentages. The comparison of SOFA groups utilized the Kruskal-Wallis chi-squared test, complemented by ad hoc Dunn's test with Bonferroni correction. Multinomial logistics regressions were employed to evaluate the relationship between CPB time and SOFA. A total of 1032 patients were included. CPB time was independently associated with higher postoperative SOFA scores at 24 h. CPB time was significantly higher in patients with SOFA 4-5 (**P = 0.0022) or higher (***P < 0.001) when compared to SOFA 0-1. The percentage of patients with no/mild dysfunction decreased with longer periods of CPB, down to 0% for CPB time >180min (50% of the patients with >180m in of CPB presented SOFA ≥ 10). The same trend is observed for each of the SOFA variables, with higher impact in the cardiovascular and renal systems. Severe dysfunction occurs especially >200 min of CPB (cardiovascular system >100 min; other systems mainly >200 min). CPB time may predict the probability of postoperative SOFA categories. Patients with extended CPB durations exhibited higher SOFA scores (overall and for each variable) at 24 h, with higher proportion of moderate and severe dysfunction with increasing times of CPB.

FACTORS AFFECTING MAJOR ADVERSE EFFECTS AFTER CORONARY ARTERY BYPASS SURGERY

OBJECTIVE: The present study aimed to evaluate the patient population who underwent coronary artery bypass grafting (CABG) operation in terms of mortality and major adverse effects (MAE) incidence and examine the factors affecting MAE incidence. MATERIAL AND METHODS: 169 consecutive patients who underwent CABG surgery between January 2017 and December 2019 were retrospectively analyzed. Mortality, myocardial infarction, reoperation, cardiac tamponade, stroke, renal failure, sternal infection, need for extracorporeal membrane oxygenator and cardio pulmonary resuscitation were defined as MAO. RESULTS: The mean age of the patients was 63.19 ±0.72 years, the mean duration of cardiopulmonary bypass (CPB) was 106.95 ±27 minutes, and the mean duration of aortic cross-clamp was 44.87 ±1.05 minutes. Extracorporeal membrane oxygenator support was provided to 11 (6.5%) patients, 7 (4.1%) patients underwent reoperation, 5 (3%) patients experienced a postoperative stroke, 5 (3%) patients required cardiopulmonary resuscitation, and postoperative myocardial infarction was observed in 1 (0.6%) patient. In total, MAE was determined in 28 (16.6%) patients. Mortality occurred in 9 (5.3%) patients. In the univariate analysis, Euroscore, mean arterial pressure during CPB, and ultrafiltration volume were associated with MAE (p=0.004, p=0.026, and p=0.037, respectively). However, in multivariate analysis, only Euroscore (odds ratio: 1.453, 95% CI 1.166-1.811 p=0.001) and ultrafiltration volume (odds ratio:-0.002, 95% CI 0.996-1 p=0.04) were correlated to MAE. CONCLUSIONS: In our study, we observed that high Euroscore levels increased not only mortality but also the incidence of MAO, and increased ultrafiltration volumes reduced the incidence of MAO. We believe that it should be kept in mind during CABG surgery that appropriate ultrafiltration and CPB strategy can reduce the incidence of MAO.

Systemic inflammatory response syndrome after on-pump cardiac surgery in emergency coronary artery bypass grafting: a retrospective trial

INTRODUCTION: The frequency, spectrum and pathophysiological relationships of systemic inflammatory response syndrome in acute coronary artery bypass grafting is not fully understood. OBJECTIVE: To determine the clinical significance of systemic inflammatory response syndrome (SIRS) in emergency coronary artery bypass grafting (CABG) performed with cardiopulmonary bypass. MATERIALS AND METHODS: We examined 60 patients (38 men and 22 women, aged 65 ± 9 years) who underwent emergency CABG (3 ± 1 bypass), with cardiopulmonary bypass (CPB) (97 ± 47 min). We retrospectively studied clinical and laboratory data of the perioperative and early postoperative period from emergency and elective coronary bypass surgery. RESULTS: In urgently operated patients (n = 30) in the early postoperative period, a higher frequency (53.3 and 13.3 %; p = 0.0022) of the development of systemic manifestations of the inflammatory response (neutrophilic leukocytosis, fever, postperfusion vasoplegia), as well as respiratory complications (70 and 10 %; p &lt; 0.001) was noted. A pathophysiological relationship was established between the manifestations of SIRS and respiratory dysfunction during emergency interventions. CONCLUSIONS: SIRS pathophysiologically associated with respiratory dysfunction is characteristic of emergency CABG. It is during emergency myocardial revascularization that the duration of cardiopulmonary bypass and myocardial ischemia (MI) are predictors of SIRS.

Predictors for negative clinical outcome in acute mesenteric ischemia after on-pump cardiac surgery: a retrospective observational trial

INTRODUCTION: Acute mesenteric ischemia (AMI) is one of the most dangerous complications of cardiac surgery using cardiopulmonary bypass (CPB). Several factors may contribute to the development of AMI, such as: age over 70 years, prolonged CBP, postoperative heart failure, cardiogenic shock, mechanical circulatory support and others. The mortality rate in AMI reaches 85 %. OBJECTIVE: To identify predictors of a negative clinical outcome in the development of acute mesenteric ischemia in patients after on-pump cardiac surgery. MATERIALS AND METHODS: A single-center retrospective observational cohort study included 53 patients in the intensive care unit who developed AMI after cardiac surgery performed using CPB. All patients with AMI included in the study were divided into two groups — survivors (n = 31) and non- survivors (n = 22) to identify predictors of negative clinical outcome. RESULTS: At the preoperative stage, the left ventricular ejection fraction (LVEF) was impaired in both groups, but in non-survived patients was significantly lower: 34.6 (25.4–52.4) in survivors and 28.7 (25.2–42.7) in non-survivors (p = 0.05). 12 hours after the surgery, the cardiac index (CI) (p = 0.01) and the index of left ventricular work (ILVW) were significantly (p = 0.03) lower in non-survivors. The average duration of CPB was 124 minutes (95–142) in survivors and 164 minutes in non-survivors (145–176) (p = 0.02). Also, 72.7 % of n0n-survivers received high doses of adrenomimetics in the postoperative period, in survivors — 41.9 % (p = 0.03). The rate of long-term mechanical respiratory support usage in non-survivors reached 86.3 %, in survivors — 35.4 % (p = 0.003). CONCLUSIONS: The key predictors of a negative outcome of OMI in cardiac surgery patients are: prolonged use of CBP, low CI, LVWI before and after surgery, high doses of adrenomimetics, prolonged mechanical respiratory support, as well as high concentrations of blood lactate 12 hours after the end of the surgery.

Аналіз якості життя в пацієнтів з ішемічною хворобою серця та супутньою патологією аортального клапана у віддалений період після протезування аортального клапана з реваскуляризацією міокарда

The aim – to conduct an analysis of the quality of life in the long-term period after the use of a hybrid approach, involving a combination of surgical aortic valve replacement (AVR) and endovascular methods of myocardial revascularization, in patients with coronary heart disease and an aortic valve disease.Materials and methods. For this one-center study, medical records of adult patients (over 18 years old) who underwent surgical AVR along with myocardial revascularization in the period from 2018 to 2022 were selected.Results and discussion. We selected 130 patients who underwent AVR together with myocardial revascularization (the first group (n = 51) – a combination of AVR and percutaneous coronary interventions (PCI); the second group (n = 79) – a combination of AVR and coronary artery bypass grafting (CABG). Damage to the left main coronary artery was recorded by 5.60 times less often (p = 0.018) in the patients of the first group compared to the patients of the second group. The duration of cardiopulmonary bypass and aorta cross clamping in the patients of the first group was, respectively, by 1.5 times and by 1.4 times significantly lower compared to the second group (p = 0.0001). The pain index after 6 months according to the SF-36 questionnaire was found to be 13.5 % (p = 0.017) significantly higher in patients of the first group compared to the second group, while other indicators did not differ among the study groups.Conclusions. Patients with the hybrid approach of treatment were characterized by a similar level of postoperative complications with the surgical group. At the same time, this cohort of patients had a better SF-36 pain index 6 months after the hybrid intervention.

Аналіз предикторів виникнення несприятливих серцево-судинних і цереброваскулярних подій після операції Бенталла

The aim – to analyze the risk factors for the occurrence of major adverse cardiac and cardiovascular events in the early period after the Bentall procedure.Materials and methods. The study analyzed the medical records of adult patients (aged 18 to 75 years) who underwent Bentall procedure for ascending aortic aneurysm between 2012 and 2021. Univariate and multivariate analysis (logistic regression) were used to determine prognostic risk factors.Results and discussion. In patients with MACCE grade 3 hypertension was observed by 14.4 % (p = 0.048) more often, duration of cardiopulmonary bypass was by 14.1 % (p = 0.017) longer, the cross-clamping of the aorta duration was by 16.3 % (p = 0.039) longer, and the lactate level at the end of the surgery was by 23.6 % (p = 0.036) higher compared to patients without MACCE. Further multivariate logistic regression analysis established two main predictors of the development of MACCE in the early postoperative period – the presence of the 3rd degree arterial hypertension (OD 2.030 95 % CI 0.578–7.161, p = 0.018) and the duration of aortic clamping (OD 1.102 95 % CI 0.931–2.136, p = 0.018).Conclusions. The 3rd degree arterial hypertension and the duration of aortic clamping were independent predictors of the development of MACCE in the early postoperative period.

Perfusion quality odds (PEQUOD) trial: validation of the multifactorial dynamic perfusion index as a predictor of cardiac surgery-associated acute kidney injury.

The multifactorial dynamic perfusion index was recently introduced as a predictor of cardiac surgery-associated acute kidney injury. The multifactorial dynamic perfusion index was developed based on retrospective data retrieved from the patient files. The present study aims to prospectively validate this index in an external series of patients, through an on-line measure of its various components. Inclusion criteria were adult patients undergoing cardiac surgery with cardiopulmonary bypass. Data collection included preoperative factors and cardiopulmonary bypass-related factors. These were collected on-line using a dedicated monitor. Factors composing the multifactorial dynamic perfusion index are the nadir haematocrit, the nadir oxygen delivery, the time of exposure to a low oxygen delivery, the nadir mean arterial pressure, cardiopulmonary bypass duration, the use of red blood cell transfusions and the peak arterial lactates. Two hundred adult patients were investigated. The multifactorial dynamic perfusion index had a good (c-statistics 0.81) discrimination for cardiac surgery-associated acute kidney injury (any stage) and an excellent (c-statistics 0.93) discrimination for severe patterns (stage 2-3). Calibration was modest for cardiac surgery-associated acute kidney injury (any stage) and good for stage 2-3. The use of vasoconstrictors was an additional factor associated with cardiac surgery-associated acute kidney injury. The multifactorial dynamic perfusion index is validated for discrimination of cardiac surgery-associated acute kidney injury risk. It incorporates modifiable risk factors, and may help in reducing the occurrence of cardiac surgery-associated acute kidney injury.

A challenging case of emergency redo surgery for acute type A aortic dissecting aneurysm of ascending and aortic arch with frozen elephant trunk following aortic root replacement

Redo ascending and aortic arch surgeries following previous cardiac or aortic surgery are associated with high risk of morbidity and mortality due to multiple factors included sternal re-entry injury, extensive aortic arch surgery, emergency aortic surgery, prolonged cardiopulmonary bypass duration, poor heart function, and patients with older age. Therefore, appropriate surgical strategies are important. We report a case of a 72-year-old gentleman with previous surgery of aortic root replacement who presented with acute Type A aortic dissecting aneurysm of ascending and aortic arch complicated with left hemothorax, which was successfully treated by emergency redo aortic surgery with frozen elephant trunk (FET) technique.

Mid-Term Outcome after Extracorporeal Life Support in Postcardiotomy Cardiogenic Shock: Recovery and Quality of Life.

Background: Extracorporeal life support (ECLS) therapy for refractory postcardiotomy cardiogenic shock (rPCS) is associated with high early mortality rates. This study aimed to identify negative predictors of mid-term survival and to assess health-related quality of life (HRQoL) and recovery of the survivors. Methods: Between 2017 and 2020, 142 consecutive patients received ECLS therapy following cardiac surgery. The median age was 66.0 [57.0-73.0] years, 67.6% were male and the median EuroSCORE II was 10.5% [4.2-21.3]. In 48 patients, HRQoL was examined using the 36-Item Short Form Survey (SF-36) and the modified Rankin-Scale (mRS) at a median follow-up time of 2.2 [1.9-3.2] years. Results: Estimated survival rates at 3, 12, 24 and 36 months were 47%, 46%, 43% and 43% (SE: 4%). Multivariable Cox Proportional Hazard regression analysis revealed preoperative EuroSCORE II (p = 0.013), impaired renal function (p = 0.010), cardiopulmonary bypass duration (p = 0.015) and pre-ECLS lactate levels (p = 0.004) as independent predictors of mid-term mortality. At the time of follow-up, 83.3% of the survivors were free of moderate to severe disability (mRS < 3). SF-36 analysis showed a physical component summary of 45.5 ± 10.2 and a mental component summary of 50.6 ± 12.5. Conclusions: Considering the disease to be treated, ECLS for rPCS is associated with acceptable mid-term survival, health-related quality of life and functional status. Preoperative EuroSCORE II, impaired renal function, cardiopulmonary bypass duration and lactate levels prior to ECLS implantation were identified as negative predictors and should be included in the decision-making process.

Missed postoperative metabolic acidosis associated with sodium-glucose transporter 2 inhibitors in cardiac surgery patients: a retrospective analysis

The increasing use of sodium glucose transporter 2 inhibitors (SGLT2i) for treating cardiovascular (CV) diseases and type 2 diabetes (T2D) is accompanied by a rise in euglycemic diabetic ketoacidosis occurrences in cardiac surgery patients. Patients undergoing cardiac surgery, due to their pre-existing CV disease which often requires SGLT2i prescriptions, face an increased risk of postoperative metabolic acidosis (MA) or ketoacidosis (KA) associated with SGLT2i, compounded by fasting and surgical stress. The primary aim of this study is to quantify the incidence of SGLT2i-related postoperative MA or KA and to identify related risk factors. We analyzed data retrospectively of 823 cardiac surgery patients, including 46 treated with SGLT2i from November 2019 to October 2022. Among 46 final cohorts treated preoperatively with SGLT2i, 29 (63%) developed postoperative metabolic complications. Of these 46 patients, stratified into two categories based on postoperative laboratory findings, risk factor analysis were conducted and compared. Analysis indicated a prescription duration over one week significantly elevated the risk of complications (Unadjusted OR, 11.7; p = 0.032*; Adjusted OR, 31.58; p = 0.014*). A subgroup analysis showed that a cardiopulmonary bypass duration of 60 min or less significantly raises the risk of SGLT2i-related postoperative MA in patients with a sufficient prescription duration. We omitted the term "diabetes" in describing complications related to SGLT2i, as these issues are not exclusive to T2D patients. Awareness of SGLT2i-related postoperative MA or KA can help clinicians distinguish between non-life-threatening conditions and severe causes, thereby preventing unnecessary tests and ensuring best practice.

Impact of duration of cardiopulmonary bypass on recovery after open heart surgery

Background: Objective of the study was to examine the impact of cardiopulmonary bypass (CPB) duration on recovery from cardiac surgery. Methods: This is an observational retrospective study. Data from adult cardiac surgical patients presented at Queen Alia Heart Institute (QAHI) in the duration between September 2023 and February 2024 was retrospectively analysed. The impact of CPB duration was examined. Patients were divided into groups according to CPB duration (0 to 60 minutes, 60 to 120 minutes, 120 to 180 minutes, 180 to 240 minutes and 240 to 300 minutes). For each group intra-operative and post-operative variable were examined. The intra-operative variables studied were need for blood transfusion, haemofiltration and intra-aortic balloon pump. The post-operative variables studied were duration of post-operative mechanical ventilation, intensive care unit (ICU) stay, hospitalization time and mortality. Results: Consecutive data of 202 adult cardiac surgical patients (34 females and 168 males) was analysed. Average age of patients was 57.149 years. Average duration of CPB was 109.9 minutes (ranged from 29 to 300 minutes). Half of the patients (50.5%) had CPB duration between 1 and 2 hours. Blood transfusion was needed in 88 patients (43.6%). Haemofiltration was used in 32 patients (15.8%) and intra-aortic balloon pump (IABP) was used in 29 patients (14.4%). The average postoperative time of mechanical ventilation was 34 hours and the average ICU stay was 5.5 days. Chest re-exploration was needed in 30 patients (15%). Hospital stay was on average 12 days and in-hospital mortality was witnessed in 20 patients (9.9%). Patients who had CPB for less than one hour (17.3%) had the lowest incidence of blood transfusion (37.1%), lowest incidence of haemofiltration (8.6%), low incidence of IABP use (11%). They also had lowest incidence of chest re-opening (5.7%), shortest time of postoperative mechanical ventilation (13 hours) and shortest ICU and hospital stay (4.1 and 8.5 days, respectively). There was a significant increase in postoperative sternal re-opening and postoperative mortality when the duration of CPB exceeded 3 hours. Conclusions: Duration of CPB is a key predictor of recovery and outcome of cardiac surgery. Shorter CPB time was associated with earlier extubation, less ICU stay and shorter hospitalisation time. Prolonged CPB was associated with higher rates of complications, delayed recovery, longer ICU stay, protracted hospitalisation and higher mortality rates.

Nosocomial Infections After Pediatric Congenital Heart Disease Surgery: Data from National Center for Cardiovascular Diseases in China.

Infection prevention and control (IPC) has a significant impact on the prognosis after pediatric cardiac surgery. This study aimed to provide surveillance data on the incidence and density of various infections during the COVID-19 epidemic and explore the influence of multi-drug resistant organisms (MDRO) on in-hospital prognosis after congenital heart disease surgery. This single-center retrospective study included pediatric patients who underwent cardiac surgery between 2021 and 2022. The results of the postoperative bacterial and fungal cultures and antimicrobial stewardship were collected. The demographic characteristics (age and weight), operation-related parameters (RACHS-1 grade, duration of cardiopulmonary bypass, and aortic cross clamp), and surgical outcomes (extracorporeal membrane oxygenation, delayed sternal closure, mortality, duration of mechanical ventilation, length of intensive care unit stay and hospital stay, and hospitalization costs) of MDRO and non-MDRO patients were compared. A total of 4776 patients were included. There were 101 infectious culture results after the operation, with a nosocomial infection rate of 2.1%. There were 40 MDRO specimens from 36 patients, 50 non-MDRO specimens from 30 patients, and 11 fungal specimens from 10 patients. The incidence of pneumonia was 1.5%, with a ventilator-associated pneumonia incidence density of 7.2/1000 patient-days. The incidence of sepsis was 0.4%, with a catheter-related bloodstream infection incidence density of 0.24/ 1000 patient-days. The incidence density of catheter-associated tract infection was 0.45/ 1000 patient-days. The incidence of surgical site infection was 0.06%. The culture proportion before commencing antibiotics was 93% and the antibiotic consumption intensity was 30.7 DDD/100 bed-days. The length of intensive care unit stay in MDRO infection patients increased compared with that in non-MDRO infection patients, 30 (18,52) vs 17 (7,62) days, p=0.05). The IPC performance of Fuwai Hospital achieved satisfactory results. MDRO infection can lead to prolonged intensive care unit stay.

Single-Center Prospective Study of Cross-Clamp vs Balloon Occlusion in Robotic Mitral Surgery

BackgroundTransthoracic aortic cross-clamp and endoaortic balloon occlusion have both been shown to have comparable safety profiles for aortic occlusion. Because most surgeons use only one technique, we sought to compare the outcomes when a homogeneous group of surgeons changed their occlusion technique from aortic cross-clamp to balloon occlusion. MethodsWe changed our technique from aortic cross-clamp to balloon occlusion in November 2022. This allowed us to conduct a prospective treatment comparison study in the same group of surgeons. Propensity score matching was used to match cases (balloon occlusion) 1:3 to controls (aortic cross-clamp) based on age, sex, body mass index, concomitant maze procedure, and tricuspid valve repair. ResultsTotal of 411 patients underwent robotic mitral surgery from 2020 through 2023. Propensity score matching was used to match 56 balloon occlusion patients to 168 aortic cross-clamp patients. The 224 patients were a median age of 65 years (interquartile range, 55.6-70.0 years), and 119 (53%) were men. All valves were successfully repaired. Balloon occlusion had a shorter median cardiopulmonary bypass (CPB) time compared with aortic cross-clamp (84.0 vs 94.5 minutes, P = .006). Median cross-clamp time (64.0 vs 64.0 minutes, P = .483) and total surgery time (5.9 vs 6.1 hours, P = .495) did not differ between groups. There were no in-hospital deaths. There were 5 surgeons who performed various combinations of console and bedside roles. CPB, cross-clamp, and surgery durations were not significantly affected by the different surgeon combinations. ConclusionsCompared with aortic cross-clamp, balloon occlusion has similar perioperative and early postoperative outcomes. Additionally, it likely introduces a 10-minute reduction in total CPB time.

Factors associated with in-hospital mortality and morbidity of patients with dissection of aorta type A, undergoing repair surgery

Aim: Acute aortic dissection type A (AADA) is a life-threatening emergency with high mortality rates. Surgical intervention is the preferred and potentially life-saving treatment, but perioperative mortality remains a significant concern. Identifying the risk factors associated with surgical mortality, morbidity, and survival rates is essential. Therefore, this study aimed to characterize the preoperative and intraoperative risk factors for death during surgical repair of AADA. Material and Methods: We included 64 consecutive patients who underwent surgical repair between April 2013 and March 2021 in a tertiary heart center. Perioperative characteristics and variables were collected and analyzed to find any correlation between them and in-hospital Outcomes. Results: Aortic dissection surgery was performed on an average of 8 patients annually, accounting for approximately 1.7% (64/3757) of all open-heart surgery cases. The in-hospital mortality rate was 28% (18/64). The main predisposing factors for in-hospital death were cardiac failure (11.1%), stroke (16.7%), uncontrollable hemorrhage (27.8%), renal failure (11.1%), respiratory failure (11.1%), and postoperative multi-organ failure (22.2%). We found no associations between cardiopulmonary bypass duration and mortality. During the routine use of cerebral protective perfusion, we did not encounter any cases of coma. Left ventricular hypertrophy, a short distance of intimal tear to the aortic valve, and renal failure were associated with postoperative bleeding tendency. Conclusion: Our study showed that multiple factors such as heart failure, uncontrolled bleeding, and respiratory failure increase in-hospital mortality of patients with dissection of aorta type A, but duration of surgery does not have any association with in-hospital death.

Tricuspid repair: short and long-term results of suture annuloplasty techniques and rigid and flexible ring annuloplasty techniques

BackgroundFunctional tricuspid regurgitation may arise from left heart valve diseases or other factors. If not addressed concurrently with primary surgical intervention, it may contribute to increased morbidity and mortality rates during the postoperative period. This study investigates the impact of various repair techniques on crucial factors such as systolic pulmonary artery pressure (SPAP), tricuspid valve regurgitation, and New York Heart Association (NYHA) functional capacity class in the postoperative period.Materials and methodsFrom April 2007 to June 2013, 379 adults underwent open-heart surgery for functional tricuspid regurgitation. Patients were categorized into four groups: Group 1 (156) with De Vega suture annuloplasty, Group 2 (60) with Kay suture annuloplasty, Group 3 (122) with Flexible Duran ring annuloplasty, and Group 4 (41) with Semi-Rigid Carpentier-Edwards ring annuloplasty. Demographic, clinical, operative, and postoperative data were recorded over a mean follow-up of 35.6 ± 19.1 months. Postoperative SPAP values, tricuspid regurgitation grades, and NYHA functional capacity classes were compared among the groups.ResultsNo statistically significant differences were observed among the groups regarding age, gender, preoperative disease diagnoses, history of previous cardiac operations, or echocardiographic characteristics such as preoperative ejection fraction, SPAP, and tricuspid regurgitation. Hospital and intensive care unit length of stay and postoperative complications also showed no significant differences. However, patients in Group 3 exhibited longer Cardio-Pulmonary Bypass duration, cross-clamp duration, and higher positive inotrope requirements. While the mortality rate within the first 30 days was higher in Group 1 compared to the other groups (p: 0.011), overall mortality rates did not significantly differ among the groups. Significant regression in functional tricuspid regurgitation and a notable decrease in SPAP values were observed in patients from Group 3 and Group 4 (p: 0.001). Additionally, patients in Group 3 and Group 4 showed a more significant reduction in NYHA functional capacity classification during the postoperative period (p: 0.001).ConclusionAmong the repair techniques, ring annuloplasty demonstrated superiority in reducing SPAP, regressing tricuspid regurgitation, and improving NYHA functional capacity in functional tricuspid regurgitation repairs.