The Role of Continuous Monitoring of Venous Drainage Flow and Integrated Oxygen Extraction (ERO) via Bilateral Near-Infrared Spectroscopy in Cerebral Perfusion During Aortic Arch Surgery.

Effective cerebral perfusion monitoring is essential in aortic arch surgery, particularly when employing the Kazui technique under moderate hypothermia. Near-infrared spectroscopy (NIRS) provides real-time regional oxygen saturation (rSO) measurements, while the continuous monitoring of venous drainage flow and oxygen extraction ratio (ERiO) delivers additional insights into cerebral oxygenation and metabolic balance. This study investigates the correlation between NIRS-derived rSO, venous drainage flow, and ERiO during selective antegrade cerebral perfusion (SACP) to better understand their interplay and clinical significance.

Comparative Analysis of Irrigation Mist and CO vs. Direct CO Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity Incidence.

In coronary artery bypass grafting (CABG) on pump, achieving optimal visualization is critical for surgical precision and safety. The use of blowers to clear the CABG anastomosis poses risks, including the formation of micro-embolic gas bubbles, which can be insidious and increase the risk of cerebral or myocardial complications. This retrospective study compares the effectiveness of the use of irrigation mist and CO versus a direct CO blower without irrigation in terms of visualization, postoperative fibrillation, and micro-embolic gas activity.

Health Technology Assessment of Cardiopulmonary Bypass Circuit with and without Phosphorylcholine Coating: A Retrospective Study on Safety and Efficiency in Cardiac Surgery.

Background: Phosphorylcholine has emerged as a potential adjunctive agent in cardiopulmonary bypass (CPB) circuits. Phosphorylcholine serves as a coating for the CPB circuit, potentially enhancing biocompatibility and reducing thrombotic events. However, its impact on specific patient populations and procedural outcomes remains underexplored.

Evolocumab Treatment in Dyslipidemic Patients Undergoing Coronary Artery Bypass Grafting: One-Year Safety and Efficacy Results.

The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. From January 2017 to December 2022, 180 dyslipidemic patients who underwent coronary artery bypass were included in the study.

Hemadsorption to Contain Postoperative Cell-Free Hemoglobin and Haptoglobin Preservation for Extended Cardiopulmonary Bypass Time in Cardiac Surgery for Acute Kidney Injuries Prevention.

Introduction: Prevention of acute kidney injury during cardiopulmonary bypass (CPB) is still a challenge and has been the object of numerous studies. The incidence of acute kidney injury in the context of CPB is related to a multifactorial etiology. The role of hemadsorption in relation to cell-free hemoglobin and haptoglobin preservation is not well defined in the literature on CPB during cardiac surgery procedures.

Emergent Conversion to Open Heart Surgery during Transcatheter Aortic Valve Implantation: The Presence of a Rescue Team Improves Outcomes.

Objective: Transcatheter aortic valve implant (TAVI) is the gold standard for the high-surgical-risk group of patients with aortic valve disease and it is an alternative to surgery in patients at intermediate risk. Lethal complications can occur, and many of these are manageable only with emergent conversion to open heart surgery. We retrospectively evaluate the outcome of all patients undergoing TAVI in our departments and the impact of a complete cardiac rescue team to reduce 30-day mortality.

Cardiopulmonary Bypass Settings for the Prevention of Early Hypotension During CABG.

Background: Vasoplegic syndrome is a form of vasodilatory shock that can occur before, during or after cardiopulmonary bypass (CPB). We introduce a strategy to reduce the incidence of early hypotension phenomena during Coronary Artery Bypass Graft (CABG) procedures.

Materials And Methods: In this prospective cohort study, 100 patients underwent elective CABG with two perioperative CPB settings.

Evaluation of (Wet) and (Dry) Mediastinal Chest Drainage in Minimally Invasive and Conventional Cardiac Surgery.

Background: Drainage of fluid and evacuation of air from the pericardial and pleural spaces after cardiothoracic surgery is necessary to prevent effusion, tamponade, and pneumothorax, and also to detect hemorrhage. For this purpose, negative-pressure drains are placed in the mediastinum and pleural cavities. We compared the efficacy and safety of two systems wet and dry drainage for the management and monitoring of negative pressure and anti-reflux valve safety systems, to promote healing of the pleural and pericardial cavities.

Hybrid approach for long-standing persistent atrial fibrillation: immediate versus staged treatment.

Background: The hybrid approach has become the most effective treatment option for restoring sinus rhythm and reducing the risk of atrial fibrillation (AF) recurrence. However, several issues remain to be clearly defined, including the appropriate timing of the staged procedure and the most effective strategy.

Methods: Over a 12-year period of activity, we performed 609 AF ablation procedures via a right mini-thoracotomy.

Clinical Evaluation of Micro-Embolic Activity with Unexpected Predisposing Factors and Performance of Horizon AF PLUS during Cardiopulmonary Bypass.

During Cardiopulmonary Bypass (CPB) gaseous micro-emboli (GMEs) decrease the quality of the blood flow and the capillary oxygen delivery, increasing the incidence of postoperative neurocognitive disorders (POCD) following cardiac surgery. In these circumstances, the use of an efficient device, could be crucial for the removal and reduction of micro-embolic activity. From February 2022 to March 2022, we prospectively collected data from 40 consecutive patients undergoing conventional and minimally invasive cardiac surgery that used the Horizon AF PLUS (Eurosets, Medolla, Italy).

Retrograde Autologous Priming for Minimally Invasive Mitral Valve Surgery.

Objectives: Little is known about the safety and clinical utility of retrograde autologous priming (RAP) in patients undergoing minimally invasive mitral valve surgery. The study authors hypothesized that RAP would increase the oxygen delivery index (DO2i) while decreasing red blood cell transfusion requirements compared to valve surgery without RAP.

Design: The study was an observational analysis.

Perioperative incidence of ECMO and IABP on 5901 mitral valve surgery procedures.

Background: Report the incidence and results of peri-operative extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) of patients undergoing mitral valve surgery (MVS) through right mini-thoracotomy (RT) and conventional full sternotomy (FS) for a period of 6 years from eleven tertiary Cardiac Surgery Institutes of GVM Care & Research Italia.

Methods: From January 2016 to November 2021, a total of 5901 consecutive patients underwent MVS through RT and FS. The primary outcome of the study was the mortality and incidence of low cardiac output syndrome (LCOS) treated with intra-aortic balloon pump (IABP) with or without inotropic support and the incidence of Postcardiotomy Cardiogenic Shock (PCS) treated with Veno-arterial (VA) Extracorporeal Membrane Oxygenation (ECMO) on patients undergoing mitral valve surgery (MVS) through right mini-thoracotomy (RT) versus conventional full sternotomy (FS).

The Evolution of Temperature Management for Cardiac Surgery: A Historical Perspective.

Intraoperative temperature regimen usually is planned preoperatively by a "team." Selecting and understanding the impact of the temperature regimen (normothermia, or mild, moderate, or severe hypothermia) usually are related to the type of cardiac surgery (eg, using circulatory arrest or open-heart surgery). Cardiopulmonary bypass constitutes a challenging situation for monitoring temperature because of the rapid and extraordinary degree of heat transferred through the bypass circuit during heating and cooling.

A modified technique for aortic prosthesis implantation after prosthetic valve endocarditis complicated by complex paraannular aortic abscess.

The aim of this study is to describe a modified technique for aortic prosthesis implantation in the sinuses of Valsalva without the use of a patch for aortic annular reconstruction in patients with prosthetic valve endocarditis complicated by aortic abscess. From January 2008 to March 2021, 47 patients underwent aortic valve replacement due to prosthetic aortic valve endocarditis. The new aortic prosthesis was implanted into the sinuses of Valsalva above the abscess left open to drain.

Surgical treatment of valve endocarditis in high-risk patients and predictors of long-term outcomes.

Infective endocarditis represents a surgical challenge associated with perioperative mortality. The aim of this study is to evaluate the predictors of operative mortality and long-term outcomes in high-risk patients. We retrospectively analyzed 123 patients operated on for infective endocarditis from January 2011 to December 2020.

Minimally invasive mitral valve reconstruction: Is it an "all-comers" procedure?

Background And Aim Of The Study: The debate on the usefulness of the minimally invasive approach in mitral valve surgery is still open. The aim of this study is to describe a single-center case series of all comers undergoing minimally invasive mitral valve reconstruction.

Methods: From 2010 to 2019, all the data recorded in the medical records of 893 consecutive patients undergoing mitral valve reconstruction through a right mini-thoracotomy were retrospectively collected.

Prone Positioning in Postoperative Cardiac Surgery Patients: A Narrative Review.

Limited data are available on the use of the prone position in cardiac surgery. Concerns in performing this maneuver in open cardiac surgery due to the risk of post-sternotomy wound infections and hemodynamic instability do not seem to be supported by existing evidence. Indeed, available data show that prone positioning may improve gas exchange in cardiac surgery patients as well.

Management algorithms and artificial intelligence systems for cardiopulmonary bypass.

This article introduces management algorithms to support operators in choosing the best strategy for metabolic management during cardiopulmonary bypass using artificial intelligence systems. We developed algorithms for the identification of the optimal way for assessing metabolic parameters. Different management algorithms for extracorporeal procedures interfaced with metabolic monitoring systems already exist on the market and are applied in clinical practice.

Propofol pharmacokinetics and pharmacodynamics-a perspective in minimally invasive extracorporeal circulation.

There is limited evidence as to the pharmacokinetic changes expected in adults with extracorporeal technologies. Drugs may be taken up by various components of the cardiopulmonary bypass circuit itself. Issues include the increased volume of the circuit leading to haemodilution; the sequestration of lipophilic drugs within the circuit tubing; and the absorption of proteins, especially albumin, onto the circuit, which can result in increased free drug.

Air, inflammation and biocompatibility of the extracorporeal circuits.

The inflammatory response in cardiac surgery using extracorporeal circulation (ECC) has been widely discussed in the literature with analysis on cytokines released in humans; demonstrating manifold trigger causes. To mitigate this response-mainly linked to the contact and recognition by the blood of a "non-self" surface-many efforts have been made to make the circuits of the extra-corporeal circulation "biomimetics"; trying to emulate the cardio-vascular system. In other words, biomedical companies have developed many biocompatible products in order to reduce the invasiveness of the ECC.

Trans-septal course of anomalous left main coronary artery originating from single right coronary ostium presenting with atrial fibrillation in a severely obese patient: a case report.

Background: To present a case of anomalous origin of the left coronary artery evaluated with invasive coronary angiography (ICA) and ECG-gated coronary computed tomography (CCT).

Case Presentation: A patient (55 years old, male) with a past medical history of respiratory failure and atrial fibrillation underwent ICA to rule out coronary artery disease. Subsequently, the patient underwent ECG-gated CCT to evaluate a suspected anomalous aortic origin of the left coronary artery, since the interventional cardiologist was not able to properly identify the left coronary artery and its distal branches.

Associations between oxygen delivery and cardiac index with hyperlactatemia during cardiopulmonary bypass.

Objective: Metabolism management plays an essential role during cardiopulmonary bypass (CPB). There are different metabolic management devices integrated to heart-lung machines; the most commonly used and accepted metabolic target is indexed oxygen delivery (DO) (280 mL/min/m) and cardiac index (CI) (2.4 L/min/m), which can be managed independently or according to other metabolic parameters.