Extracorporeal Circulation System Research Articles

Carbon nitride reinforced chitosan/sodium alginate hydrogel as high-performance adsorbents for free hemoglobin removal in vitro and in vivo

Removing free hemoglobin generated during extracorporeal circulation remains a challenge. Currently, there is no adsorbent with specificity and good biosafety for removing hemoglobin. In this study, a new chitosan/sodium alginate/carbon nitride (CS/SA/C3N4) hydrogel adsorbent was prepared by blending SA with C3N4 to drop into CS/CaCl2 solution. The physicochemical properties of CS/SA/C3N4 hydrogel were evaluated using some techniques, including scanning electron microscope, Zeta potential measurement, and thermogravimetric analysis. Hemoglobin adsorption in vitro, stability, hemocompatibility, cell compatibility, inflammatory reaction and blood extracorporeal circulation in vivo were also evaluated. The findings revealed that the CS/SA/C3N4-0.4 % hydrogel exhibited an impressive adsorption capacity of 142.35 mg/g for hemoglobin. The kinetic data of hemoglobin adsorption were well-described by pseudo second-order model, while the isothermal model data conformed to the Langmuir model. The hardness and modulus of CS/SA/C3N4-0.4 % was 11.7 KPa and 94.66 KPa respectively, which indicated robust resistance to breakage. CS/SA/C3N4 demonstrated excellent hemocompatibility, biocompatibility and anti-inflammatory properties. In addition, the results of in vivo rabbit extracorporeal blood circulation experiment demonstrated that CS/SA/C3N4 could adsorb free hemoglobin from blood while maintaining high biosafety standard. Consequently, CS/SA/C3N4 hydrogel emerges as a promising candidate for use as a hemoglobin adsorbent in extracorporeal blood circulation system.

A computationally guided study of a blood heat exchanger and the construction of an extracorporeal circulation system for selective brain cooling

A computationally guided study of a blood heat exchanger and the construction of an extracorporeal circulation system for selective brain cooling

Can a low prime volume arterial filter be used as an alternative for a venous bubble trap in minimal extracorporeal circulation? An in vitro investigation.

During cardiac surgery the use of a minimal extracorporeal circulation (MiECC) system may reduce the adverse effects for the patient. This is probably caused by reduced inflammation and hemodilution. For the use of a MiECC circuit, a venous bubble trap (VBT) is warranted for safety reasons. The aim of this study was to assess if an arterial filter with a small prime volume has the same (or better) air removal capacities as a VBT in a MiECC circuit and subsequentially may be used as an alternative. In an in vitro study, air removal properties were compared between the arterial filter and three VBT's on the market, VBT160 (Getinge), VBT 8 (LivaNova and VARD (Medtronic). In a MiECC circuit, the filter devices were placed in a venous position and challenged with massive and micro air. Gaseous microemboli (GME) were measured with a bubble counter proximal and distal of the VBT device. More than 99.9 % of the air was removed after a bolus air challenge by all VBT's. Both the VARD and the AF100 showed better GME removal properties (not significant for the AF100) compared to the other devices. All filters showed GME generation after a challenge with massive air. Compared to the other filters, only the VARD showed no passing of larger bubbles when a volume of 50mL of air was present in the filter. The AF100 seems to be a safe and low prime alternative for use in a MiECC system as a venous air trap. A word of caution, placement of the AF100 arterial filter in the venous line is off label use.

Comparison of minimal invasive extracorporeal circulation versus standard cardiopulmonary bypass systems on coronary artery bypass surgery.

In this study, we shared our experience with the minimal invasive extracorporeal circulation system for coronary artery bypass grafting patients. A total of 163 patients were included in the retrospective study, with 83 patients (63 males, 20 females; mean age: 61.9±8.9 years; range, 35 to 81 years) undergoing coronary artery bypass grafting with minimal invasive extracorporeal circulation and 80 patients (65 males, 15 females; mean age: 60.5±8.8 years; range, 43 to 82 years) undergoing coronary artery bypass grafting with conventional cardiopulmonary bypass between July 2021 and April 2023. Elective coronary bypass performed by same surgical team were included in the study. Mortality, major adverse cardiac and cerebrovascular event, hospital stays and transfusion requirements were evaluated. There were no significant differences in sex distribution, age, comorbidities, and blood values between the two groups. Intraoperatively, the minimal invasive extracorporeal circulation group had a slightly higher number of distal anastomoses and comparable times for aortic cross-clamp and cardiopulmonary bypass. Postoperative outcomes such as tamponade, bleeding, atrial fibrillation, left ventricular ejection fraction improvement or reduction, and postoperative drainage were similar between the two groups. However, the minimal invasive extracorporeal circulation group had fewer transfusions of packed red blood cells and fresh frozen plasma and a shorter length of stay in the intensive care unit. The minimal invasive extracorporeal circulation system effectively preserves blood, works with lower activated clotting time values without additional complications in coronary artery bypass grafting, and could present a better option for patients with anemia or patients with a relatively high risk for high-dose heparinization.

Impact of extracorporeal circulation support systems on blood product resources during the course of intensive care unit treatment

Abstract Background Extracorporeal circulatory support systems necessitate careful blood product management due to the large cannulas and exposure of blood components to artificial surfaces in the circuits. Blood component derangements can occur during implantation and the operational period of these systems, posing a significant complication. To enhance patient safety and bolster the body's own blood reserves, accurate characterization of the extent of necessary blood product substitution is imperative. Methods We analyzed data from consecutive patients who received extracorporeal circulatory support systems (Impella, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), or ECMella) over a 5-year period (2016-2021). We obtained information on blood product usage, costs, and various clinical parameters. We assessed the vascular access site according to the Bleeding Academic Research Consortium (BARC) and Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries (GUSTO) criteria, and hemolysis was evaluated using serum free hemoglobin (fHb). Results We studied 370 patients (Table 1) who received extracorporeal circulatory support systems (Impella, VA-ECMO, and ECMella) from 2016 to 2021. The median number of RBC transfusions was 7 (3 - 12) for the entire cohort, with ECMella patients requiring the highest amount (12.5 (6.7 - 27.5)) and VA-ECMO patients requiring the most within the first 24 hours (57%, p < 0.05). Hemolysis was present in all groups, with Impella patients having the highest levels (49.8 µmol / L (21.3 – 113.1), p < 0.01). ECMella patients required the highest overall blood product substitution (Figure 1) and incurred the highest associated costs (1642.4 EUR (1079.1 – 3660.3), p < 0.01). Bleeding complications in the groin area were moderate in 45% of patients, with VA-ECMO patients having the highest incidence (58%, p < 0.05). Type 3a bleeding according to the BARC criteria was most common (31.7%). Conclusion Although extracorporeal circulatory support systems have made technical advances, significant resources are still required during the operational period to maintain coagulation homeostasis, particularly in ECMella patients. Complications at the insertion site are also common, with bleeding being expected, especially in emergency situations when a VA-ECMO is used. To ensure patient safety, interdisciplinary teams should establish standardized follow-up protocols to detect peripheral complications early.

Minimal invasive extracorporeal circulation in comorbid patients

Background: As the severity of comorbid diseases increases, risks of cardiopulmonary bypass (CPB) complications significantly increase. A complex of the procedure’s damaging factors provokes a systemic inflammatory response that in some cases is accompanied by the damage to target organs, transitioning from chronic organ dysfunctions into acute ones. Some studies on the use of minimal invasive extracorporeal circulation (MiECC) systems show their advantage over conventional extracorporeal circulation (CECC); however, the diversity of MiECC systems, patients, and outcomes precludes us from confidently extrapolating these data to older comorbid patients.Objective: To compare the severity of systemic inflammation and treatment outcomes in comorbid patients who underwent cardiac surgery with CECC and MiECC.Methods: We conducted a retrospective cohort study of 760 patients who consecutively underwent elective cardiac operations in 2019-2022. Inclusion criteria: comorbid status (age-adjusted Charlson Comorbidity Index score of ≥6); CPB time ≥90 min. Exclusion criteria: emergency surgery, refusal to participate in the study. A total of 68 patients met the inclusion criteria. We formed 2 study groups based on the extracorporeal circulation method: CECC group (n = 51) and MiECC group (n = 17). Control points: before CPB and 24 hours after the surgery (lactate; creatinine; oxygenation index, hemolysis level). For systemic inflammatory response markers: 1 hour after the CPB start and 24 hours after the CPB end (interleukin 6; interleukin 10; procalcitonin; C-reactive protein; soluble Triggering Receptor Expressed on Myeloid Cells-1 [sTREM-1]). We evaluated respiratory and renal complications, drainage-related hemorrhages, hemostatic disorders, the need for sympathomimetic drugs, and the length of stay in an intensive care unit and inpatient hospital.Results: Between the groups there were no statistically significant differences in gender and anthropometric characteristics, surgery types, and main perfusion parameters. In the CECC group, we observed significantly higher doses of vasoconstrictors (norepinephrine) as well as a decrease in urine output and lung injury and an increase in lactate and hemolysis. The systemic inflammatory response markers were also significantly higher.Conclusion: Compared with CECC, MiECC does not significantly affect the frequency of organ dysfunctions; however, it reduces the severity of the systemic inflammatory response and immune suppression that are trigger mechanisms for multiple organ dysfunction syndrome. It is particularly important for patients with chronic organ dysfunctions. A range of indications for MiECC systems should be defined given its high cost and off-target effect on pleiotropic factors of systemic inflammatory response development. Received 6 April 2023. Revised 17 August 2023. Accepted 18 August 2023. Funding: The study was conducted within the framework of the research project "Development of minimally invasive and hybrid technologies for surgical treatment of heart diseases". Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.Sh. Revishvili, G.P. Plotnikov, V.A. PopovData collection and analysis: R.A. Kornelyuk, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. ZemskovStatistical analysis: L.B. BerikashviliDrafting the article: R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili Critical revision of the article: G.P. PlotnikovFinal approval of the version to be published: A.Sh. Revishvili, R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. Zemskov, V.A. Popov

Development of an in-vitro model for extracorporeal blood pumps to study the effects of artificial pulsatility on human blood.

The application of extracorporeal circulation (ECC) systems is known to be associated with several implications regarding hemolysis, inflammation, and coagulation. In the last years, systems with pulsatile blood flow are increasingly used with the intention to improve hemodynamics in reperfusion. However, their implications on the aforementioned aspects remain largely unknown. To investigate the effects of pulsatility, this ex-vivo study was initiated. Test circuits (primed with human whole blood) were set up in accordance with the recommendations of international standards for in-vitro evaluation of new components and systems of ECC. Diagonal pumps were either set up with non-pulsatile (n = 5, NPG) or pulsatile (n = 5, PG) pump settings and evaluated for 6 h. All analyses were conducted with human whole blood. Blood samples were repeatedly drawn from the test circuits and analyzed regarding free hemoglobin, interleukin 8 (IL-8), platelet aggregation and acquired von Willebrand syndrome (AVWS). After 1 h of circulation, a significant coagulation impairment (impaired platelet function and AVWS) was observed in both groups. After 6 h of circulation, increased IL-8 concentrations were measured in both groups (NPG: 0.05 ± 0.03 pg./mL, PG: 0.03 ± 0.01 pg./mL, p = 0.48). Pulsatile pump flow resulted in significantly increased hemolysis after 6 h of circulation (NPG: 37.3 ± 12.4 mg/100 L; PG: 59.6 ± 14.5 mg/100 L; p < 0.05). Our results indicate that the coagulative impairment takes place in the early phase of ECC. Pulsatility did not affect the occurrence of AVWS ex-vivo. Prolonged durations of pulsatile pump flow led to increased hemolysis and therefore, its prolonged use should be employed cautiously in clinical practice with appropriate monitoring.

Risk Factors for Patients with Hepatitis B and C in Hemodialysis Unit

Background: Risk factors for HCV, HBV transmission are blood transfusions and surgeries before 1992, intravenous drug use, contaminated parenteral drugs and other invasive non-medical procedures (tattooing, piercing). Based on these risk factors, high-risk groups are: multiramified patients (i.e., hemophiliacs), health personnel, intravenous drug users, inmates, individuals with high-risk sexual behaviors (early sex life, high number of sexual partners and prostitution). Other populations at risk are patients on extracorporeal circulation system, such as end-stage kidney disease patients on hemodialysis program. Study aim: To determine risk factors for patients with hepatitis B and C in hemodialysis unit. Methodology: A descriptive study design was conducted at Al-Najaf city in the southern region of Iraq in Al-Sadder Medical City and Al-Hakim General Hospital from February 20th, 2023, to May 23th, 2023, in order to assess risk factors for patients with hepatitis B and C in hemodialysis unit. The methodological strategies for data collection used an assessment questionnaire survey. Results: As the study shows, that the risk factors that cause the most infection are hemodialysis sessions, contact with infected persons, and injected medication, while the lowest risk factors to spread infection are children born with infected hepatitis and unprotected sexual contacted. Conclusion: The study concludes that the first leading risk factor for infection is the hemodialysis session, while the contact with infected persons and contaminated injections of medication comes in the second place. Recommendations: Careful monitoring and strict adherence to infection control procedures among patients undergoing hemodialysis treatment, including commitment to sterilization of hemodialysis devices and the use of all preventive measures when starting the hemodialysis procedure.

Gene Expression of Inflammatory Cytokines in Major Organs by Extracorporeal Circulation.

(1) Background: Extracorporeal circulation (ECC) is indispensable for cardiac surgery. Despite the fact that ECC causes non-physiological damage to blood components, its pathophysiology has not been fully elucidated. In our previous study, we constructed a rat ECC system and observed a systemic inflammatory response during and after blood tests assessing ECC, while the damage per organ localization caused by ECC was not examined. In this study, we used a rat model to assess the gene expression of inflammatory cytokines in major organs during ECC. (2) Methods: The ECC system consisted of a membranous oxygenator, tubing line, and a small roller pump. Rats were divided into a SHAM (which received surgical preparation only, without ECC) group and an ECC group. Proinflammatory cytokines were measured using real-time PCR in major organs after ECC to evaluate local inflammatory responses in the organs. (3) Results: Interleukin (IL)-6 levels were significantly elevated in the ECC group compared to the SHAM group, especially in the heart and lungs. (4) Conclusions: This study suggests that ECC promotes organ damage and the inflammatory response, but the degree of gene expression of proinflammatory cytokines varies from organ to organ, suggesting that it does not uniformly cause organ damage.

Prosthesis-prosthesis anastomosis using barbed sutures compared to conventional sutures under high, long-term pressure; in vitro extracorporeal circulation setup.

While barbed sutures have been extensively utilized in other disciplines, they have not been widely adopted in cardiac surgery. The lack of safety and feasibility data has limited its use within the field. To aide in the further understanding of how cardiac surgeons can use barbed sutures, we sought to develop a high-pressure in vitro simulation model. We compared knotless barbed sutures in a highly pressurized anastomosis to conventional sutures. Ten specimens in total were utilized in prosthesis anastomosis, using 34mm Gelweave Plexus (Terumo Aortic, Sunrise, FL 33325, USA) and 34mm Hemabridge (Intergard Woven Hemabridge, Getinge, Göteborg, Sweden). Five models of size 3-0 barbed suture anastomoses using non-absorbable, barbed, self-retaining, monofilament polypropylene sutures (Filbloc® 3-0, Assut Europe, Rome, Italy) were compared against five conventional anastomoses using size 4-0 polypropylene monofilament (Ethicon, USA). The systems were connected using a novel-designed extracorporeal circulation system. Pressure was rapidly increased in the specimen to a mean pressure of 300-350mmHg, running then for a minimum of 48hours to assess anastomosis strength and endurance. No anastomotic dehiscence or rupture was recorded. Complex, angular anastomosis required extra stitch leakage sutures in both conventional and barbed suture specimens. Using knotless barbed sutures with an additional self-locking maneuver for prosthesis-prosthesis anastomosis in cardiac surgery is feasible in an in vitro model under long term, high-mean pressure when compared to conventional sutures. In vivo trials should be performed to further validate the in vitro findings.

Safety of bloodless open-heart surgery on cardiopulmonary bypass in selected children: A single center experience with minimal invasive extracorporeal circulation.

Bloodless cardiac surgery refers to open-heart surgery without blood or blood products. The cardiopulmonary bypass (CPB) circuits are primed with crystalloid solely, and there is no intraoperative blood transfusion. Our program considers bloodless congenital cardiac surgery with a minimal invasive extracorporeal circulation (MiECC) system for patients above 10kg of weight. We performed a single-center retrospective cohort study of all consecutive patients undergoing bloodless cardiac surgery for congenital heart defects between January 2016 and December 2018. A total of 164 patients were reviewed (86 male and 78 female) at a median age of 9.6years (interquartile range (IQR), 4.5-15), a weight of 32kg (IQR, 16-55), preoperative hemoglobin 13.7g/dl (IQR, 12.6-14.9), and preoperative hematocrit of 40.4% (IQR, 37.2-44.3). Median CPB time was 81.5min (IQR, 58-125), and median hematocrit coming off CPB was 26% (IQR, 23-29.7). The congenital heart surgery risk (STAT) category was distributed in STAT 1 for 70, STAT 2 for 80, STAT 3 for 9, and STAT 4 for 5 patients. Most patients (95%) were extubated in the operating room with a low complication rate during the hospital stay (14.6%). Only 6 (4%) patients needed a blood transfusion during the postoperative period, with a higher incidence of complications during the hospital course (p < 0.001). Bloodless congenital heart surgery with MiECC system is safe in low-surgical-risk patients. Our patients had a low rate of complications and short hospital stays.

Preventive effect of surface charge on encrustation of biodegradable ureteral stents

Prevention of encrustation on the surface has always been the biggest challenge for urological implants. In the field of ureteral stent design, biodegradability has attracted much attention in recent years, because biodegradable ureteral stents not only avoid secondary intervention, but also prevent encrustation due to surface renewal by degradation process. Furthermore, researches have focus on some surface parameters to provide guidance for the development of stent materials, such as hydrophilicity or surface charge. In this work, we synthesized two types of poly(ester-carbonate)s, poly(L-lactide-co-5-amino-1,3-dioxan-2-one) (P(LA-co-AC)) containing amino, and poly (L-lactide-co-5-methyl-5-carboxyl-1,3-dioxan-2-one) (P(LA-co-MCC)) containing carboxyl. Blending P(LA-co-AC) and P(LA-co-MCC) with poly(L-lactide-co-Ɛ-caprolactone) (PLACL) respectively, two types of ureteral stent materials were prepared. Due to the influence of ions formed by the dissociation of amino and carboxyl, two types of materials show differences in surface charge analyses. We further developed a dynamic urinary extracorporeal circulation (DUEC) system to assess in vitro encrustation of materials with different surface charges. The results of this comparative study identified that the materials with strong negative surface charge were most favorable for use as ureteral stent, and provided a new approach to surmount the problems faced by urological surgery which complied with the future trend of biodegradable ureteral stent design.

Kalp Cerrahisi Olan Hastalarda Minimal Ekstrakorporeal Dolaşım ve Konvansiyonel Dolaşım Sistemlerinin Karşılaştırılması

Introduction and Aim: Systemic inflammatory response syndrome and hemodilution during cardiopulmonary bypass are important factors in morbidity and mortality. Extracorporeal circulatory systems were modified to reduce this problem and the minimal extracorporeal circulatory system (MECC) was developed. Our study aimed to compare the MECC and conventional extracorporeal circulatory systems in patients who underwent isolated coronary artery bypass graft (CABG) surgery.&#x0D; Materials and Methods: The study was conducted retrospectively on patients who underwent isolated CABG surgery in our clinic between September 1, 2013-December 31, 2018. The patients were divided into those in whom the MECC system (Group 1) and the conventional extracorporeal circulatory system (Group 2) were used.&#x0D; Results: The study was performed on a total of 140 CABG patients, 71 of which were performed with MECC (Group 1) and 69, with the conventional extracorporeal circulatory system (Group 2). Group 1 had higher mean age, ASA, and New York Heart Association values, and an increased rate of chronic obstructive pulmonary disease (p

Is there a difference in serum lactate level between conventional and minimal extracorporeal circulation systems?

Objectives: This study aims to evaluate the effect on tissue perfusion by comparing serum lactate levels in conventional and minimal extracorporeal circulation systems in coronary artery bypass graft operations. Patients and methods: Forty consecutive patients (32 males, 8 females; mean age: 65.0±10.5 year; range, 42 to 85 year) who underwent isolated coronary artery bypass graft between November 2017 and November 2018 were included in this retrospective cross sectional study. The patients were divided into two groups: the conventional group (Group 1, n=20) and the mini-circuit group (Group 2, n=20). Results: The mean activated clotting time was 440.8±33.4 sec in Group 1 and 286.4±38.2 sec in Group 2 (p &lt;0.001). The mean volume of drainage was 800 mL in Group 1 (range, 300 to 2000 mL), whereas in Group 2, it was 450 mL (range, 300 to 1000 mL). According to the groups, the amount of drainage was found to be significantly different in the traditional group, almost twice the MECC group. (p&lt;0.001). The median serum lactate level of the conventional group was higher than the mini-circuit group on postoperative 0th and 3rd days (p=0.043 ve p=0.023, respectively). Conclusion: The use of the mini-circuit system in the extracorporeal circulation reduces the serum lactate level more than the conventional system, yielding better tissue perfusion. The minimal extracorporeal circulation system is a safe alternative perfusion method for risky patients.

P50 IMPLEMENTATION OF PROTOCOLS FOR “ENHANCED RECOVERY AFTER CARDIAC SURGERY” IN AORTIC VALVE SURGERY

Abstract Objective Although, the use of protocols for “enhanced recovery after surgery” (ERAS) have been associated with improved results in different surgical disciplines, no data are available for EARS in cardiac surgery, thus far. In the late 2016 a mutlidisciplinary ERAS program to treat patients who require AVR was implemented in our institution. The aim of this study was to assess safety and 30 day outcomes in patients receiving ERAS management. Methods To improve multidisciplinary ERAS program, our mini–invasive approach (Fig. 1), that goes beyond a small incision, includes: (i) mini–surgical access (ministernotomy–minithoracotomy), to reduce the traumatic impact, postoperative pain and to increase patient’s satisfaction; (ii) minimal invasive extracorporeal circulation system, to improve end–organ protection and decrease systemic inflammatory response; (iii) ultra fast–track anaesthesia, to decrease the rate of postoperative complications and assure better and earlier recovery (Fig. 2). Results Between September 2016 and December 2021, 600 consecutive patients (mean age 72 years, Euroscore II 1,62%) underwent isolated mini–AVR in our institution. UFT anaesthesia was used in 195 patients (32.5%) and MiECC in 173 (28.8%). All patients received a timely rehabilitation therapy (3–6 hours after surgery) and an early family contact in ICU. At 30 days, the overall mortality and stroke rates were 0,3% (n = 2) and 0,5% (n = 3), respectively. Respiratory insufficiency occurred in 16 pts (2,5%). Median blood loss at 12 hours was 174,5 cc; blood transfusions were reduced to minimum intraoperatively and avoided in 66% of patients. Twenty three patients (3,8%) received definitive pacemaker implantation. The median ICU and in–hospital lengths of stay were 1 and 6 days, respectively. Conclusions Findings from our study confirms that mini–AVR yields excellent clinical outcomes with very low mortality and morbidity rates. The implementation of ERAS protocol in patients undergoing mini–AVR demonstrated to be safe and was associated with promising results. Thus, by reducing surgical injury and promoting faster recovery, ERAS management may further enhance minimally invasive interventions.

Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support.

Extracorporeal circulation (ECC) systems, including cardiopulmonary bypass, and extracorporeal membrane oxygenation have been an irreplaceable part of the cardiothoracic surgeries, and treatment of critically ill patients with respiratory and/or cardiac failure for more than half a century. During the recent decades, the concept of extracorporeal circulation has been extended to isolated machine perfusion of the donor organ including thoracic organs (ex-situ organ perfusion, ESOP) as a method for dynamic, semi-physiologic preservation, and potential improvement of the donor organs. The extracorporeal life support systems (ECLS) have been lifesaving and facilitating complex cardiothoracic surgeries, and the ESOP technology has the potential to increase the number of the transplantable donor organs, and to improve the outcomes of transplantation. However, these artificial circulation systems in general have been associated with activation of the inflammatory and oxidative stress responses in patients and/or in the exposed tissues and organs. The activation of these responses can negatively affect patient outcomes in ECLS, and may as well jeopardize the reliability of the organ viability assessment, and the outcomes of thoracic organ preservation and transplantation in ESOP. Both ECLS and ESOP consist of artificial circuit materials and components, which play a key role in the induction of these responses. However, while ECLS can lead to systemic inflammatory and oxidative stress responses negatively affecting various organs/systems of the body, in ESOP, the absence of the organs that play an important role in oxidant scavenging/antioxidative replenishment of the body, such as liver, may make the perfused organ more susceptible to inflammation and oxidative stress during extracorporeal circulation. In the present manuscript, we will review the activation of the inflammatory and oxidative stress responses during ECLP and ESOP, mechanisms involved, clinical implications, and the interventions for attenuating these responses in ECC.

Combined Use of Fast Track Anesthesia and Minimal Extracorporeal Circulatory Systems in an Advanced Age and Comorbid Patient Undergoing Coronary Artery Bypass Surgery

Combined Use of Fast Track Anesthesia and Minimal Extracorporeal Circulatory Systems in an Advanced Age and Comorbid Patient Undergoing Coronary Artery Bypass Surgery

Design and 3D-model of a dynamic bubble trap for cardiopulmonary bypass

The use of extracorporeal circulation systems (cardiopulmonary bypass pumps, ECMO) can lead to brain and coronary artery microembolism, which significantly reduces postoperative rehabilitation and often leads to severe complications. Microembolism occurs when oxygen or air microbubbles (MBs) enter the arterial system of patients. Existing CPB pumps come with built-in bubble trap systems but cannot remove bubbles in the circuit. ECMO devices have arterial filters but cannot reliably filter out &lt;40 μm bubbles in a wide flow range. We have proposed an alternative method that involves the use of an efficient dynamic bubble trap (DBT) for both large and small bubbles. The design includes development of two DBT variants for hemodynamic conditions of adult and pediatric patients. The device is installed in the CPB pump and ECMO outlet lines. It provides sufficient bubble separation from the lines in a blood flow of 3.0–5.0 L/min for adults and 0.5–2.0 L/min for children. The developed computer models have shown that MBs smaller than 10 μm can be filtered. The use of this device will greatly reduce the likelihood of air embolism and provide the opportunity to reconsider the concept of expensive arterial filters.

Quality Management of a Comprehensive Blood Conservation Program During Cardiopulmonary Bypass

BackgroundRed blood cell transfusion is common and associated with adverse outcomes for cardiac surgery, while present blood conservation guidelines have not been fully implemented until now. This study evaluated our comprehensive blood conservation program after quality management and explored its impact on blood transfusion and outcomes in patients undergoing cardiopulmonary bypass (CPB). MethodsWe retrospectively compared blood transfusions and outcomes of patients from 2 different periods, before and after initiation of the quality management of the comprehensive blood conservation program. The comprehensive program included restrictive transfusion protocols, conventional ultrafiltration, cell salvage, residual pump blood ultrafiltration, and a modified minimal extracorporeal circulation system. A 1:1 propensity score matching and subgroup analysis were conducted. ResultsThere were 3977 pairs. A significant decrease of red blood cell transfusion was observed before vs after the comprehensive blood conservation program during CPB (28.4% vs 18.6%, P < .001), in the operation (40.7% vs 34.3%, P < .001), and after the operation (6.2% vs 4.3%, P < .001). Also reduced were 30-day mortality and some major complications. Subgroup analysis showed that the comprehensive blood conservation program was more beneficial for patients aged >60 years, male, and with a medium-risk European System for Cardiac Operative Risk Evaluation (EuroSCORE) of score 3 to 5. ConclusionsThe comprehensive blood conservation program during CPB is safe and effective in adult cardiac operations, reducing blood use, with no adverse outcomes. For patients who are older, male, and have a EuroSCORE of 3 to 5, blood transfusion should be more cautious.

Minimal Invasive Extracorporeal Circulation (MiECC) in Car-diac Surgery: A Narrative Review

The heart remained a mystery for many years and was considered surgically untouchable. With the use of extracorporeal circulation, there has been a revolution in this area. Due to its mechanical components and interactions with blood, cardiopulmonary bypass (CPB) can cause significant changes in the body. Factors such as contact between artificial materials and blood, continuous flow, hemodilution, hypothermia and anticoagulation affect all organs during CPB, and may result in various complications. The minimally invasive extracorporeal circulation (MiECC) system was developed to minimize the contact of blood with air and foreign surfaces during conventional CPB. In addition, the biocompatibility of the components that make up the MiECC circuits increased, which reduced the inflammatory response. The absence of a venous reservoir and shorter lines allow the prime volume to be used to decrease, which also reduces the damage to the blood elements, and consequently, the need for blood transfusion. The MiECC system also has its downsides, the most important one being the difficulty in removing the air that can enter through the venous line, the impairment of the pump function, and embolization. During the use of these systems, perfusion safety and communication with the whole team must be at the highest level. In line with this information, the use of these systems can become standard in cardiac surgery with new technological additions.