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Lung transplantation surgeries are performed without extracorporeal life support (ECLS) by using an off-pump technique; however, in cases of hypoxemia or hemodynamic instability, intraoperative ECLS may be required. Cardiopulmonary bypass (CPB) has traditionally been the standard practice for ECLS but has been associated with an increased risk of bleeding in the perioperative period, increased transfusion requirements, prolonged postoperative intubation, and possibly primary graft dysfunction. More recently, because of the flexibility of using extracorporeal membrane oxygenation (ECMO) in bridging to transplantation and during postoperative recovery, its use has increased. CPB and ECMO each has advantages and disadvantages; however, because comparisons of CPB and ECMO have been limited to small retrospective observational and single-institution studies, more research is required to determine the superiority of one modality. In this review, we critically examine the pros and cons of performing lung transplantation surgery off-pump or by using the ECLS modalities of ECMO and CPB support during lung transplantation surgery. [ABSTRACT FROM AUTHOR]

The innovations leading to the development of a new technology such as extracorporeal membrane oxygenation (ECMO) and its progress over the years have been inspiring. Many great personalities were associated with the genesis and re-designing the multiple essential components of ECMO to make it more biocompatible. We discussed the brief history of cardiopulmonary bypass and ECMO. We elucidated the establishment of a commanding center, Extracorporeal Life Support Organization (ELSO) in the USA, ECMO society of India in the sub-continent and the birth of South and West Asia Chapter (SWAC) of ELSO initially, which became South and West Asia, Africa chapter (SWAAC) ELSO later after amalgamation of Africa to this sub-chapter of ELSO. [ABSTRACT FROM AUTHOR]

Purpose: On-pump beating-heart coronary artery bypass grafting represents a merger of standard on and off-pump techniques and is thought to benefit patients by coupling the dual absence of cardioplegic arrest (conventional coronary surgery), with the hemodynamic instability during manipulation seen in off-pump surgery. However, the clinical benefits are still under discussion. We improvised on the standard on-pump beating-heart surgeries by introducing use of "intermittent" bypass as and when required. Methods: This study involved 108 patients. "Intermittent" on-pump-beating heart coronary artery bypass grafting was done using suction stabilizer and placing aortic and venous cannula, electively in all patients (group 1) who were supported by pump intermittently (n = 54). Retrospective data of patients who underwent off-pump surgery electively by the same surgeon (group 2, n = 54) was collected. Results: There was a significant advantage in the number of grafts performed for the lateral surface (circumflex branches) using the new technique compared to conventional technique (68vs22). Similarly, significant advantage was also noted in terms of total number of grafts along with shorter operating times. There were no mortalities in the new group compared to the off-pump group and blood loss was also lesser. Conclusions: "Intermittent" on-pump coronary revascularization is a technically reliable method of coronary revascularization taking advantage of the off-pump and conventional on-pump techniques while considerably eliminating the disadvantages of both. It has shown its superiority in safety, number of grafts, blood loss, operating time and perioperative course. [ABSTRACT FROM AUTHOR]

Background: Extracardiac Fontan (ECF) is currently the final operation of choice for patients with a univentricular heart. Performing this procedure without cardiopulmonary bypass (CPB) carries potential benefits. In this study, we report the early results of ECF without CPB.Patients and methods: Between 2012 and 2015, 72 consecutive patients underwent Fontan without CPB. Their medical records were examined in detail.Results: Mean age was 11.8 ± 5.2 (range 5 to 23, median 10) years. Intraoperative mean superior vena cava clamp time was 15.19 ± 3.8 min, and the inferior vena cava clamp time was 16.93 ± 3.31 min. There were three early deaths. No patient required conversion from off-CPB to CPB. Mean inotropic score was 4.73 ± 5.9 (range 0 to 25, median 2.5). Mean time to extubation was 9.5 ± 5.82 (range 3 to 29, median 8) hours. Pleural drainage in intensive care unit (ICU) was 551.57 ± 452.77 (median 470) ml, and mean ICU stay was 2.27 ± 3.09 (median 1.5) days. Mean daily pleural drainage after discharge from the ICU was 163.7 ± 88.01 (median 140) ml, and mean time to removal of pleural tubes was 15.76 ± 8.4 (median 14) days. Total hospital stay was 17.03 ± 8.62 (median 15) days. At an early follow-up of 2-40 (median 25) months, all survivors (n = 69) had a patent Fontan circuit with normal ventricular function on echocardiography. There were no late deaths or thromboembolic complications.Conclusions: Off-pump ECF is a low-risk procedure that avoids the harmful effects of CPB. Post-operative course of these patients is predictable with substantial savings in costs. [ABSTRACT FROM AUTHOR]

Objective: Conventionally, the bidirectional Glenn procedure (BDG) is performed on cardiopulmonary bypass (CPB) using aortobicaval cannulation. This study discusses the procedural details of open anastomosis technique of the BDG and outcomes. Method: Between September 2013 and November 2014, 15 patients (age 49 ± 47.9 months, weight 14.1 ± 10.3 kg) underwent BDG using the open technique (OT). CPB was instituted by aortic cannulation and a single venous cannula in the right atrium. Superior vena cava (SVC) was not cannulated and all the venous return from it was returned via a cardiotomy sucker. This facilitated an open anastomosis. Parameters studied were CPB time, Glenn pressure, SVC clamp time, neurocognitive score, near-infrared spectrometry (NIRS), inotropic score, SpO2, intensive care unit (ICU) stay, hospital stay and immediate complications. Results: Saturation increased from pre-operative 64 to 87 % after operation. Post-operative Glenn pressure was 15 ± 3.8 mmHg. CPB time was 28.6 ± 17.4 min, inotropic score was 8.0 ± 2.5, duration of ventilator support was 8.8 ± 3.6 h, ICU stay was 17.78 ± 3.14 h and hospital stay was 4.4 ± 0.5 days. There was progressive increase of the neurocognitive function post-operatively. NIRS monitoring showed no significant drop in values from base line level in OT group suggesting adequate cerebral perfusion. There were no deaths or major morbidity. Conclusions: BDG can be performed quickly and safely with open anastomosis technique on CPB. [ABSTRACT FROM AUTHOR]

Cerebral air embolism is a known complication of open-heart surgery with devastating consequences. Neurological injury after cardio-pulmonary bypass can be broadly divided into 2 categories: Increasing evidence points to cerebral embolization as the principal culprit. Since the early days of modern cardiac surgery, surgeons have attempted to reduce embolization by various means. One of the early techniques propounded was carbon dioxide insufflation of the pericardial cavity. Carbon dioxide, was uniquely positioned for this, being denser than air, more soluble than air, and easily managed perioperatively if the blood levels became unphysiological.. The technique did not find favor, since there was no instrumentation, in the early days of cardiopulmonary bypass to measure and establish its impact on the actual outcomes. A literature search was done using the key words carbon dioxide, open heart, cardiac across Pubmed, Google and Cochrane databases in an attempt to find out the role of carbon dioxide flooding in modern cardiac surgery. Our effort yielded over 244 articles, of which 48 were deemed to be relevant in answering our question. Reviewing all the information we conclude that with proper technique, carbon dioxide flooding does significantly reduce embolic counts. However, there are no studies at this point in time, which show a direct correlation between the practice and improved neurocognitive outcome. [ABSTRACT FROM AUTHOR]

Background. Transmyocardial laser revascularisation (TMR) is increasingly used in the management of intractable angina in the absence of graftable vessels, however it’s role in combination with coronary artery bypass remains undefined. The aim of this pilot study was to investigate the impact of the combination therapy. Methods. Patients (20) undergoing elective coronary artery bypass surgery with one or more non-graftable coronary arteries were prospectively randomized to either have bypass graft surgery alone (CABG) or bypass graft surgery and transmyocardial revascularization with a holmium — YAG laser to non-graftable areas (CABG+TMR). All patients had exercise tolerance test preoperatively and at 6 and 18 months follow-up. Stress echocardiography was performed on 17 patients 18 months following surgery. Wall motion analysis (1=normal, 2=hypokinesis, 3=akinesis, 4=dyskinesis) using the 16 segment model of the left ventricle and rest and stress perfusion analysis were performed. Results. Both groups of patients were similar in preoperative demographics and operative data. There was no perioperative mortality. There was no difference between the two groups in angina scoring at 6 and 18 months follow-up. Exercise tolerance improved by a mean of 46.8±20.0 seconds per patient in the CABG group and by 199.2±66.5 seconds per patient in the CABG+TMR group (p<0.05) and this was maintained at 18 months (157±46.3 vs 61±39.2 seconds; p<0.05). Regional wall motion score index (WMSI) (total score/number of segments) was calculated in non-revascularizable myocardium treated with TMR and compared to areas that were not lased. Although the WMSI in TMR regions is lower at each stage of dobutamine stress, this does not reach statistical significance. Conclusion. The combination of coronary artery bypass and transmyocardial laser revascularization is safe and improves exercise tolerance in patients in whom complete revascularization cannot be achieved by bypass graft surgery alone. [ABSTRACT FROM AUTHOR]