Minimally invasive extracorporeal circulation versus conventional cardiopulmonary bypass in patients undergoing cardiac surgery (MiECS): Rationale and design of a multicentre randomised trial.

Introduction: The ultimate answer to the question whether minimal invasive extracorporeal circulation (MiECC) represents the optimal perfusion technique in contemporary clinical practice remains elusive. The present study is a real-world study that focuses on specific perfusion-related clinical outcomes after cardiac surgery that could potentially be favourably affected by MiECC and thereby influence the future clinical practice.

Methods: The MiECS study is an international, multi-centre, two-arm randomized controlled trial.

Conventional versus minimally invasive extra-corporeal circulation in patients undergoing cardiac surgery: A randomized controlled trial (COMICS).

Introduction: The trial hypothesized that minimally invasive extra-corporeal circulation (MiECC) reduces the risk of serious adverse events (SAEs) after cardiac surgery operations requiring extra-corporeal circulation without circulatory arrest.

Methods: This is a multicentre, international randomized controlled trial across fourteen cardiac surgery centres including patients aged ≥18 and <85 years undergoing elective or urgent isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR) surgery, or CABG + AVR surgery. Participants were randomized to MiECC or conventional extra-corporeal circulation (CECC), stratified by centre and operation.

Implications of High Sensitivity Troponin Levels After Lung Transplantation.

Trends in high-sensitivity cardiac troponin I (hs-cTnI) after lung transplant (LT) and its clinical value are not well stablished. This study aimed to determine kinetics of hs-cTnI after LT, factors impacting hs-cTnI and clinical outcomes. LT recipients from 2015 to 2017 at Toronto General Hospital were included.

Beyond the Surgical Safety Checklist: Using Intraoperative Handoff to Facilitate Team Situation Awareness in the OR.

Background: The surgical safety checklist (SSC) has been credited with improving team situation awareness (SA) in the operating room. Although the SSC may support team SA at the outset of the operative case, intraoperative handoff provides an opportunity for either SA breakdown or, more preferably, SA reinforcement. High-functioning surgical teams demonstrate a high level of continued SA, whereas teams deficient in SA are more likely to be affected by surgical errors and adverse events.

Platelet preservation in cardiac surgery using minimally invasive extracorporeal circulation versus optimized cardiopulmonary bypass.

Background: Minimally invasive extracorporeal circulation (MiECC) is employed as a strategy to attenuate the physiologic disturbance caused by cardiopulmonary bypass. The aim of this study was to compare the coagulation profile of MiECC to an optimized conventional extracorporeal circuit (OpECC) with regards to platelet function, rotational thromboelastometry and blood product usage.

Methods: A retrospective analysis of coronary artery bypass grafting operations using either MiECC or OpECC was performed at a single institution.

2021 MiECTiS focused update on the 2016 position paper for the use of minimal invasive extracorporeal circulation in cardiac surgery.

The landmark 2016 Minimal Invasive Extracorporeal Technologies International Society (MiECTiS) position paper promoted the creation of a common language between cardiac surgeons, anesthesiologists and perfusionists which led to the development of a stable framework that paved the way for the advancement of minimal invasive perfusion and related technologies. The current expert consensus document offers an update in areas for which new evidence has emerged. In the light of published literature, modular minimal invasive extracorporeal circulation (MiECC) has been established as a safe and effective perfusion technique that increases biocompatibility and ultimately ensures perfusion safety in all adult cardiac surgical procedures, including re-operations, aortic arch and emergency surgery.

Titrated versus conventional anticoagulation management for thrombin generation in cardiac surgery: a randomized controlled trial.

Purpose: Optimal heparin titration during cardiopulmonary bypass (CPB) may reduce coagulation system activation and preserve hemostatic function post-CPB. Our objective was to assess if the Heparin Management System (HMS) Plus improves heparin titration, thereby leading to higher thrombin generation post-CPB compared with activated clotting time (ACT)-guided management.

Methods: We conducted a randomized controlled trial of 100 patients undergoing cardiac surgery with CPB at a single center.

The association of thrombin generation with bleeding outcomes in cardiac surgery: a prospective observational study.

Background: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with coagulopathic bleeding. Impaired thrombin generation may be an important cause of coagulopathic bleeding but is poorly measured by existing hemostatic assays. We examined thrombin generation during cardiac surgery, using calibrated automated thrombography, and its association with bleeding outcomes.

Protamine Test Dose: Impact on Activated Clotting Time and Circuit Integrity.

Background: Recurrent observation of clot in the cardiopulmonary bypass circuit after the administration of a protamine test dose (PTD) prompted concern over the effects of PTDs on patient activated clotting times (ACTs).

Methods: Data were prospectively collected on 120 patients who had cardiopulmonary bypass while undergoing a variety of cardiac surgical procedures from July to October 2018 at the Toronto General Hospital, Toronto, Canada. ACTs were documented before cardiopulmonary bypass termination, after PTDs, and after protamine full doses.

A comparative analysis of four activated clotting time measurement devices in cardiac surgery with cardiopulmonary bypass.

Background: In cardiac surgery on cardiopulmonary bypass (CPB), heparin anticoagulation is monitored by point-of-care measurement of activated clotting time (ACT). The objective of this study was to compare four ACT systems in cardiac surgery in terms of their reproducibility, agreement and potential clinical impact at relevant medical decision points.

Methods: The study included 40 cardiac surgery patients.

A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation.

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart failure. Multiple small-animal models of heart transplantation have been used to study the acute and long-term effects of novel therapies. However, few are tested and demonstrated success in clinical trials.

Hearts Donated After Circulatory Death and Reconditioned Using Normothermic Regional Perfusion Can Be Successfully Transplanted Following an Extended Period of Static Storage.

Background: There has been an increased interest in donation after circulatory death (DCD) to expand donor pool for cardiac transplantation. Normothermic regional perfusion (NRP) allows in situ assessment of DCD hearts, allowing only acceptable organs to be procured. We sought to determine if extended cold storage was possible for DCD hearts following NRP and to compare hearts stored using standard cold storage with a novel cardioprotective solution designed for room temperature storage.

Normothermic ex vivo liver perfusion using steen solution as perfusate for human liver transplantation: First North American results.

The European trial investigating normothermic ex vivo liver perfusion (NEVLP) as a preservation technique for liver transplantation (LT) uses gelofusine, a non-US Food and Drug Administration-approved, bovine-derived, gelatin-based perfusion solution. We report a safety and feasibility clinical NEVLP trial with human albumin-based Steen solution. Transplant outcomes of 10 human liver grafts that were perfused on the Metra device at 37 °C with Steen solution, plus 3 units of erythrocytes were compared with a matched historical control group of 30 grafts using cold storage (CS) as the preservation technique.

Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS).

Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society was founded to create an international forum for the exchange of ideas on clinical application and research of minimal invasive extracorporeal circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations for the clinical practice.

A prospective comparison of the platelet sequestration ability of three autotransfusion devices.

Although current autotransfusion devices have platelet sequestration capabilities, each has a unique technology to achieve the final platelet product. The purpose of this study was to assess the quality and quantity of platelets sequestered by three different autotransfusion devices. The three commercially available autotransfusion devices evaluated were Fresenius C.

Partial bowls using the Haemonetics Cell Saver 5: does it produce a quality product?

Controversy still exists on the validity of processing a partial bowl during the collection of shed blood lost through surgery during cell salvaging. The purpose of this study was to assess the quality of red blood cells produced from a partial bowl of autologous suctioned blood using the Haemonetics Cell Saver 5. Suctioned blood was collected from 17 patients undergoing cardiac surgery.

Quality of red blood cells using the Dideco Electa autotransfusion device.

The purpose of this study was to evaluate the quality of washed, concentrated red blood cells (RBCs) produced by the new Electa autotransfusion device from Cobe Cardiovascular (Dideco). Blood was collected intraoperatively in 16 patients undergoing cardiac surgery for whom routine cell savage was being used and then washed using the Electa. According to the manufacture's protocol.

Quality of red blood cells using autotransfusion devices: a comparative analysis.

Cell salvage devices are routinely used to process and wash red blood cells (RBCs) shed during surgical interventions. Although the principle theory of cell saving is the same, the actual process to achieve this is very different from one device to another. The purpose of this study was to compare the quality of washed, concentrated RBC produced by five very different cell-saving devices, specifically the Cobe BRAT 2, Medtronic Sequestra 1000, Haemonetics Cell Saver 5, Medtronic Autolog, and the Fresenius CATS.

The influence of cardiopulmonary bypass flow characteristics on the clinical outcome of 1820 coronary bypass patients.

Objective: To determine whether pulsatile perfusion is clinically beneficial for adult cardiac operations.

Methods: Data concerning consecutive patients undergoing isolated coronary bypass surgery (n=1820) from January 1, 1997 to July 31, 1999 were reviewed.

Results: Nine hundred fifteen patients received pulsatile perfusion (PP) while perfusion in the remaining 905 patients was nonpulsatile (NP).