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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. Moreover, it was recognized that incorporation of MiECC strategies advances minimal invasive cardiac surgery (MICS) by combining reduced surgical trauma with minimal physiologic derangements. Minimal Invasive Extracorporeal Technologies International Society considers MiECC as a physiologically-based multidisciplinary strategy for performing cardiac surgery that is associated with significant evidence-based clinical benefit that has accrued over the years. Widespread adoption of this technology is thus strongly advocated to obtain additional healthcare benefit while advancing patient care. [ABSTRACT FROM AUTHOR]

The article discusses review of research on cerebral oximetry. Topics include use of near-infrared spectroscopy (NIRS) for monitoring cerebral oxygenation in cardiopulmonary bypass (CPB), limitations of testing various monitoring devices such as testing expenses, inadequate obtainability of frontal surface area of patient and gradually adopting the technology, and near-infrared spectroscopy devices. Conclusive study of limited evidence on the implication of NIRS is mentioned.

The relationship between the gut microbiome and various organ systems has gained interest throughout the scientific community in recent times. The understanding of these complex relationships has greatly improved with clinical benefits now being seen. Cardiopulmonary bypass (CPB) is a form of extracorporeal circulation that provides circulatory and respiratory support during cardiac surgery. This physiological support facilitates a still and bloodless field facilitating operations on the heart to be performed. Through various mechanisms CPB results in a systemic inflammatory response syndrome (SIRS). This response can vary from mild hypotension to multiple organ failure. It remains difficult to predict the degree to which a patient will experience SIRS post-operatively. The relationship between the composition of the gut microbiome and inflammatory processes associated with disease has been seen across several fields including gastroenterology, neurology, psychiatry and cardiology. To date, minimal research has been undertaken to examine the impact the gut microbiome has on outcomes following cardiac surgery. This review paper explores the pathophysiology behind the SIRS response associated with CPB for cardiac surgery and the hypothesis that a correlation exists between a patients gut microbiome composition and the degree of inflammatory response experienced following cardiac surgery. [ABSTRACT FROM AUTHOR]

C-reactive protein is a well-known marker of inflammation and may be preoperatively elevated in the absence of infection in adult cardiac surgery patients, indicating a baseline inflammatory process. We conducted a literature search to assess the available evidence on whether there is an association between preoperative C-reactive protein and acute kidney injury after coronary artery bypass grafting. Included only were observational studies which investigated this association. We excluded abstracts, case reports, animal studies and articles in languages other than English. Altogether, 199 papers were retrieved from the search strategy reported, of which 6 studies were included in the final review. The study types, publication details, patient groups and key results are tabulated. A qualitative assessment of these papers was conducted. We conclude that there is some evidence to support the association between high preoperative C-reactive protein level and postoperative acute kidney injury and complications after coronary artery bypass grafting. Owing to variability in acute kidney injury definitions and C-reactive protein levels for different cohorts in the observational studies reviewed, it is unclear from current evidence what serum C-reactive protein cut-off level is significantly associated with postoperative acute kidney injury. Further evidence is needed to investigate whether raised preoperative C-reactive protein in the absence of an infective cause could have a role in risk prediction models for cardiac surgery–associated acute kidney injury. [ABSTRACT FROM AUTHOR]

Introduction: This paper seeks to identify which of three published formulas used for estimating the blood volume of normal human subjects correlates most closely with blood volumes measured in a published study where erythrocyte volume was determined by a method using 51Cr and a nonradioactive dye was used to determine the plasma volume. Methods: Blood volumes predicted by three published algorithms were compared with blood volume estimates from a study by Retzlaff et al. using the two-tailed Wilcoxon signed rank test and a robust version of the Bland–Altman test. Results: When applied to a sample of normal subjects selected from Mayo Clinic personnel and patients, the Nadler formula correlated more closely with blood volume measured using a radio nucleotide technique than did the Allen formula or one based on a saline haemodilution technique. Conclusions: The Nadler formula correlated more closely with blood volume measurements derived from Retzlaff's study than the other formulas for estimating blood volume in a population with height and weight distribution more consistent with that seen in North America. It should be used in preference to the Allen formula for estimating blood volume in adult patients currently undergoing cardiac surgical procedures. Saline haemodilution techniques used to measure blood volume require validation against more recently developed nuclear medicine techniques using statistical methods other than regression analysis. Until validated, they should be used with caution for estimating blood volume in adult patients currently undergoing cardiac surgical procedures. If a formula using height, weight and sex is used to estimate blood volume in the context of cardiac surgery, then it must be derived using a much more comprehensive sample of the population to which it is applied than has occurred to date. In particular, it should include broader distributions of height, weight and the presence or absence and type of significant valvular disease. [ABSTRACT FROM AUTHOR]

71.759 surgical procedures were performed in 2019 with the aid of cardiopulmonary bypass in Germany. To adjust the patient's body temperature on extracorporeal circulation, the application of a heater-cooler unit (HCU) is mandatory. However, in case of insufficient sanitisation of HCU, life-threatening infections can be transmitted by the device to the patients, including Legionella bacteria, Mycobacterium chimaera, Pseudomonas aeruginosa. To avoid disease transmission, as a requirement for safe medical practice established by regulatory authorities, HCUs must be regularly disinfected by hazardous chemicals posing a danger for both handling humans and the environment. Therefore, to comply with regulations, HCU manufacturers have introduced both timely and financially extensive sanitisation procedures. Our paper describes a novel, effective and easy to handle disinfection method for the above problematics without utilising hazardous chemicals. The method's technical principle is electrolysis, resulting in drinking water quality regarding the analysed germs in the worldwide most commonly utilised heater-cooler device. The main aim of the study was to prove the efficacy and reliability of the device cleansing process. Furthermore, the economic impact of the novel method was evaluated. Therefore, we have undertaken 60 microbiological sampling series between December 2019 and November 2020 from a conventional HCU (3T LivaNova, Germany). During the total investigational period, no contamination with Pseudomonas aeruginosa or Legionellae could have been demonstrated in the HCU. The extreme slow-growing nontuberculous M. chimaera was detected only in one sample obtained from diamond electrode cleansed HCU water, and source of contamination was promptly eliminated by a simple technical modification of the device test-site. Additionally, the diamond electrode application is beneficial for eliminating potentially hazardous cleansing material from the process, which may affect otherwise both patients operated on cardiopulmonary bypass and the perfusionists. [ABSTRACT FROM AUTHOR]

Heparin resistance (HR) during cardiac operations is a common feature. Its aetiology often recognizes a decrease in circulating antithrombin III (AT III) due to a preoperative heparin treatment. Nevertheless, some papers highlighted the existence of HR in patients with normal values of AT III. This paper was designed in order to identify this subgroup of AT III-independent heparin-resistant patients. Five hundred consecutive patients scheduled for coronary revascularization with cardiopulmonary bypass were enrolled in this prospective trial. HR was identified in 104 (20.8%) patients. Thirty-six of them (7.2% of the total population) had a preoperative AT III activity ≥100%, and were defined as AT III-independent heparin-resistant patients. This subgroup significantly differs from the AT III-dependent heparin-resistant group being affected by a less severe degree of HR and including less patients pretreated with heparin. Unlike the other heparinresistant patients, these subjects do not respond to AT III supplementation aimed at reaching supranormal AT III activity values. [ABSTRACT FROM AUTHOR]

The article discusses a study which assessed the common cardioplegic solutions including microplegia, del Nido, Custodio HTK and 4:1 blood cardioplegia to determine what is the ideal cardioplegic solution to be used in cardiac surgical procedures. The study presents a systematic review of publications on cardioplegia as used in myocardial protection. It also recommends the need for comparative effectiveness studies of the cardioplegic solutions to fully answer the research question.

Objectives: To establish the impact of the COVID-19 pandemic on adult cardiac surgery by reviewing current data and use this to establish methods for safely continuing to carry out surgery. Methods: Conduction of a literature search via PubMed using the search terms: '(adult cardiac OR cardiothoracic OR surgery OR minimally invasive OR sternotomy OR hemi-sternotomy OR aortic valve OR mitral valve OR elective OR emergency) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)'. Thirty-two articles were selected. Results: Cardiac surgery patients have an increased risk of complications from COVID-19 and require vital finite resources such as intensive care beds, also required by COVID-19 patients. Thus reducing their admission and potential hospital-acquired infection with COVID-19 is paramount. During the peak, only emergencies such as acute aortic dissections were treated, triaging patients according to surgical priority and cancelling all elective procedures. Screening and 2-week quarantine prior to admission were essential changes, alongside additional levels of PPE. Focus was on reducing length of stay and switching to day-cases to reduce post-operative transmission risk, whilst several hospitals adopted 'hot' and 'cold' operating theatres for covid-confirmed and covid-negative patients. Conclusions: This paper suggests a 'CARDIO' approach for reintroducing elective procedures: 'Care, Assess, Re-Evaluate, Develop, Implement, Overcome'; prioritising the mental and physical health of the workforce, learning from and sharing experiences and objectively prioritising patients to improve case load. [ABSTRACT FROM AUTHOR]

Background and Aim: Enhanced Recovery After Surgery (ERAS) protocols are a series of perioperative interventions well-established in improving the care and outcomes of patients. With recent emergence of studies on its implementation in cardiac surgery, this paper represents the first systematic review on current evidence of ERAS efficacy in this field. Methods: Two reviewers independently searched through Pubmed, Cochrane, Google Scholar, Web of Science, Embase and Scopus. Comparative studies with controls that described the implementation of ERAS in all types of cardiac operations from 2001 to 2020 were included. Data extracted included patient demographics, components of ERAS protocol described, types of cardiac surgery, and postoperative outcomes. Results: In the final analysis, nine studies were included, of which there were one randomized controlled trial (RCT), one quasi-experiment and seven retrospective/prospective studies. Significant improvement in hospital and ICU length of stay, as well as reduction in postoperative opioid consumption were demonstrated. No increase in postoperative complications were reported. Conclusion: ERAS in cardiac surgery has shown to be potentially safe and effective in improving certain postoperative outcomes. However, the evidence is limited by the lack of high-quality RCTs. We also found the lack of practice of class 1 recommended interventions set forth by the ERAS Cardiac Society. Furthermore, majority of studies only evaluated the immediate postoperative outcomes of patients, and not the long-term outcomes. RCTs that fully implement measures recommended by the ERAS Cardiac Society, with assessments on both immediate and long-term outcomes, are warranted. [ABSTRACT FROM AUTHOR]

The decision to embark on a miniature cardiopulmonary bypass programme requires careful planning. The objective of this paper is to present our experience and initial findings for consideration by our multidisciplinary peers, who may wish to implement this technology at their own hospitals. The paper reviews the evolution of our programme over the first 150 clinical cases and our current position on the advantages and disadvantages of miniature cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Reduced oxygen delivery (DO2) during cardiopulmonary bypass (CPB) was proposed as a risk factor for the development of postoperative neurological complications (PONCs), including cerebrovascular accidents (CVA), delirium, and postoperative cognitive dysfunction (POCD). We aimed to review the current evidence on the association between intraoperative DO2 and the incidence of PONCs.MEDLINE, Embase, the Cochrane Library, and Web of Science were electronically searched to identify comparative studies from inception until July 2023 that reported the association between intraoperative DO2 levels and the incidence of PONCs (as defined by the scales and diagnostic tools utilized by the studies’ authors) in adults patients undergoing cardiac surgery using CPB.Of the 2513 papers identified, 10 studies, including 21,875 participants, were included. Of these, three studies reported on delirium, two on POCD, and five on CVA. Eight studies reported reduced intraoperative DO2 in patients who developed delirium and CVA. There was a lack of consensus on the cut-off of DO2 levels or the correlation between the period below these threshold values and the development of PONC.Limited data suggest that maintaining intraoperative DO2 above the critical threshold levels and ensuring adequate intraoperative cerebral perfusion may play a role in minimizing the incidence of neurological events in adult patients undergoing cardiac surgery on cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Cardiac surgery utilizing cardiopulmonary bypass has come a long way since its introduction nearly 60 years ago. In the early days, end-organ damage was linked to contact of the blood with the extracorporeal circuit. One potential cardiac surgery complication known to result in significant morbidity and mortality is acute kidney injury (AKI). Causes of AKI are multifaceted, but most of them are associated with techniques that perfusionists employ during extracorporeal circuit management. These can cause patients to either go on dialysis or renal replacement therapy. Patients with AKI have longer lengths of stay and consume significant resources beyond those with normal kidney function. Few current evidence-based markers determine if the kidneys are adequately protected during surgery. Most relevant literature does not address perfusion-specific techniques that reduce the incidence of AKI. This paper reviews the pathophysiology of the kidney and focuses on perfusion techniques that may reduce the incidence of AKI. [ABSTRACT FROM PUBLISHER]

The new Perfusion Simulation Center at the Medical University of South Carolina provides a new level of high fidelity simulation training for perfusion students. A key component is the Orpheus Perfusion Simulator which is a computer-driven simulator integrated with the mechanical connections of the heart-lung machine to allow for real time operative procedures and perfusion incidents. Due to the ability to consistently reproduce cardiac surgical scenarios, it is possible to develop both basic perfusion skills as well as advanced emergency skills more effectively than with animal models. The purpose of this paper is to provide details about advanced simulation for perfusionists and to illustrate how simulation can be used to promote the assets of good communication, team work, and surgical awareness. Two sets of four cardiac surgical scenarios were recorded in the perfusion simulation operating room. Scenario team member roles included a cardiac surgeon, an anesthesiologist, a perfusionist and an operating room nurse. The scripted surgical scenarios were viewed by a focus group of students charged with identifying key personality traits of different members of the operating team and to characterize them using a list of descriptive words adapted from the Medical University of South Carolina’s Peer Review Tool. In the first set of scenarios, initial scores were negative, with irresponsibility, impatience, and carelessness listed as the top behavioral characteristics leading to human error. In the second set of scenarios, logical, clear-thinking, and attentive were the most common personality traits observed of the effective team members. Simulation has become an invaluable tool for perfusion education and the goal of improving patient safety during cardiopulmonary bypass. The opportunities for advanced training in the perfusion simulation environment will certainly expand in the future. [ABSTRACT FROM PUBLISHER]

This paper presents the clinical testing of a new capnograph designed to measure the carbon dioxide tension at the oxygenator exhaust outlet in cardiopulmonary bypass (CPB). During CPB, there is a need for reliable, accurate and instant estimates of the arterial blood CO2 tension (PaCO2) in the patient. Currently, the standard practice for measuring PaCO2 involves the manual collection of intermittent blood samples, followed by a separate analysis performed by a blood gas analyser. Probes for inline blood gas measurement exist, but they are expensive and, thus, unsuitable for routine use. A well-known method is to measure PexCO2, ie, the partial pressure of CO2 in the exhaust gas output from the oxygenator and use this as an indirect estimate for PaCO2. Based on a commercially available CO2 sensor circuit board, a laminar flow capnograph was developed. A standard sample line with integrated water trap was connected to the oxygenator exhaust port. Fifty patients were divided into six different groups with respect to oxygenator type and temperature range. Both arterial and venous blood gas samples were drawn from the CPB circuit at various temperatures. Alfa-stat corrected pCO2 values were obtained by running a linear regression for each group based on the arterial temperature and then correcting the PexCO2 accordingly. The accuracy of the six groups was found to be (±SD): ±4.3, ±4.8, ±5.7, ±1.0, ±3.7 and ±2.1%. These results suggest that oxygenator exhaust capnography is a simple, inexpensive and reliable method of estimating the PaCO2 in both adult and pediatric patients at all relevant temperatures. [ABSTRACT FROM AUTHOR]

Neutrophil elastase is known to be released from the activated leukocytes as a result of cardiopulmonary bypass (CPB). However, its biological effect on organ injury is questionable because it is quickly bound by natural proteinase inhibitors (PIs). Recently, membrane-bound elastase (MBE) was found to be able to resist the PIs' process and, thus, is biologically more active. This paper studies the effect of CPB on the kinetic change of MBE and its possible link to postoperative inflammation and organ function. CPB induces increased MBE expression on neutrophils with its peak at the end of CPB. Lack of association between neutrophil MBE and clinical markers suggests that multiple systems might be involved in the post-CPB inflammatory reaction and organ dysfunction. [ABSTRACT FROM AUTHOR]

Variability in organ preservation strategy has thus far prevented meaningful analysis of clinical donor heart cardioplegia strategies. This paper describes our donor heart procurement protocol, techniques, and recovery team responsibilities. We present 21 patients receiving cardiac transplantation at our institution with an adopted cardioplegia protocol. The procurement team perfusionist ensures consistent attention to myocardial protection with standards that are similar to those applied to native hearts for all congenital heart surgeries. [ABSTRACT FROM AUTHOR]

To completely cover a topic such as this and to do justice to all of the people who were involved in the evolution of cardiac surgery is virtually impossible. Many texts and papers have been written regarding the early days of cardiac surgery and one has to draw on the information derived from various specific publications to have a grasp of the overall picture. Many important contributions were made and reported in various countries and the publications may have been in many different languages. The twentieth century was preceded by a few significant milestones, which laid the groundwork for the cautious approach to heart surgery (the first 40 years), followed by the veritable explosion of developments after which cardiac surgery would never be the same. These significant stepping stones were chosen purely arbitrarily by me because of the great impact they would have upon future developments. In the period from 1768 to 1772, William Heberden published his thoughts regarding the clinical picture of angina pectoris, which he described in such accurate detail that it remains the classic model of the manifestations of angina. In 1912, James B. Herrick published in the 'Journal of the American Medical Association' his observations of the correlation of coronary thrombosis found at autopsy in five cases to the clinical picture of angina pectoris. This was the first firm evidence that angina was caused by occlusive coronary artery disease.

Leukocyte filtration has evolved as an important technique in cardiac surgery with cardiopulmonary bypass to prevent pathogenic effector functions mediated by activated leukocytes. The underlying mechanisms that result in an improvement of laboratory variables as well as clinical outcome are not resolved yet. Moreover, the optimum strategy for the use of current filtration technology has not been systematically evaluated. This paper, therefore, reviews how activated leukocytes may lead to tissue damage, summarizes the known effects of leukocyte filtration on clinical outcome and laboratory parameters, and deals with current experimental and clinical efforts to further limit the pathogenic effects of leukocytes in cardiac surgery. [ABSTRACT FROM AUTHOR]

A new cardioplegia heat exchanger has been developed by Sorin Biomedica. A three-dimensional computer-aided design (CAD) model was optimized using computational fluid dynamics (CFD) modelling. CFD optimization techniques have commonly been applied to velocity flow field analysis, but CFD analysis was also used in this study to predict the heat exchange performance of the design before prototype fabrication. The iterative results of the optimization and the actual heat exchange performance of the final configuration are presented in this paper. Based on the behaviour of this model, both the water and blood fluid flow paths of the heat exchanger were optimized. The simulation predicted superior heat exchange performance using an optimal amount of energy exchange surface area, reducing the total contact surface area, the device priming volume and the material costs. Experimental results confirm the empirical results predicted by the CFD analysis. [ABSTRACT FROM AUTHOR]

The cost and high-profile nature of coronary surgery means that this is an area of close public scrutiny. As much pioneering work in data collection and risk analyses has been carried out by cardiac surgeons, substantial information exists and the correct interpretation of that data is identified as an important issue. This paper considers the background and history of risk-adjustment in cardiac surgery, the uses of quality data, examines the observed/expected mortality ratio and looks at issues such as cost and reactions to outliers. The conclusion of the study is that the continuation of accurate data collection by the whole operative team and a strong commitment to constantly improving quality is crucial to its meaningful application. [ABSTRACT FROM AUTHOR]

Introduction: Depressive illness has a high prevalence in patients undergoing coronary artery bypass graft surgery (CABG). The first line treatment for depression are selective serotonin reuptake inhibitors (SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal membrane and uptake by platelets, inhibiting subsequent serotonin-mediated platelet activation. This presents a theoretically increased risk of bleeding and subsequent postoperative mortality. This review aims to investigate the effects of SSRIs on postoperative bleeding, defined as the need for transfusions and re-operation for bleeding, as well as 30-day mortality in patients undergoing CABG. Method: Four hundred and thirty-seven papers were screened with seven meeting the full inclusion criteria. Results: Meta-analysis demonstrated that SSRI use increased the risk of red blood cell transfusion (odds ratio (OR) = 1.15; 95% confidence interval (CI): 1.06-1.26), but resulted in no difference in the rate of re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI use had no effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09) or fresh frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on the mortality rate (OR =1.03; 95 CI: 0.90-1.17). Conclusion: This review demonstrates that SSRIs are largely safe in cardiac surgery as no increase in mortality was observed. However, there is a significantly raised chance of red blood cell transfusion. The heterogeneous nature of the current evidence base highlights the need for further research into SSRIs and whether any effect on patient outcomes in cardiac surgery occurs. [ABSTRACT FROM AUTHOR]

Biosensor technology has been used in portable medical diagnostic instrumentation since the 1980s, mainly for the home monitoring of blood glucose in diabetics. Numerous types of sensor have been developed and reported in the literature and instrumentation which incorporates biosensors is now available for use in the emergency rooms and intensive care units for some critical parameters. However, there are still many opportunities for the development of rapid assays using biosensors which could be of assistance in cardiac surgery. This paper discusses the biosensor concept and where the key opportunities for biosensor development arise in current and future cardiac surgery. [ABSTRACT FROM AUTHOR]

Significant progress has been made over the last several years in the area of minimally invasive cardiac surgery with beneficial clinical results and increased patient satisfaction. With the addition of robotic technology to the cardiac operating room come improvements in technical manual dexterity and decreased surgical trauma. This paper reports an endoscopic pericardial patch closure of an ostium secundum atrial septal defect (ASD) using a combination of the daVinci™ Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) and the PORT ACCESS™ System (CardioVations, Sommerville, NJ, USA) for full cardiopulmonary bypass (CPB). CPB, aortic occlusion, and cardioplegia delivery were accomplished via peripheral cannulation with the PORT ACCESS™ System. Two robotic arms, one endoscopic camera, and one working incision were placed through ports in the thorax. The ASD was closed with a gluteraldehyde fixed pericardial patch using both running and interrupted suture. CPB and aortic occlusion times were 160 and 93 min, respectively. The patient was discharged on the second postoperative day and returned to normal lifestyle shortly thereafter. The benefits of peripheral access CPB and robotic technology to patients who do not want a median sternotomy provide an alternative method to traditional surgical intervention. [ABSTRACT FROM AUTHOR]

The deleterious effects of cardiotomy suction have been well recognized and well documented for some time. The use of cardiotomy suction results in the exposure of blood to the defoaming sock, aspiration of stagnant pericardial blood into the systemic circulation, and the entrainment of both fatty and gaseous microemboli. The purpose of this paper is to describe a technique using heparinbonded cardiopulmonary circuits (HBCs) without the use of a cardiotomy reservoir or cardiotomy suction. Our group has previously demonstrated improved clinical outcomes using HBCs and a low-dose anti-coagulation protocol. It is our goal to further improve clinical outcomes and further attenuate the deleterious effects of cardiopulmonary bypass by eliminating the potential complications attributed to the use of cardiotomy suction. [ABSTRACT FROM AUTHOR]

This paper reviews the basic fluid dynamics underlying extracorporeal membrane oxygenation (ECMO) cannula design. General cannula features and their effect on flow are discussed and the specific requirements of different ECMO circuits are explained. The current commercially available cannula options for veno-arterial and veno-venous circuits are reviewed and the main characteristics presented. [ABSTRACT FROM AUTHOR]

Improved knowledge of the pathophysiological processes experienced in response to cardiopulmonary bypass has led to new developments in extracorporeal technology and understanding. The use of mini extracorporeal circuits (MECC) is rapidly expanding in clinical practice. The mini extracorporeal circuit differs by a greatly reduced tubing length and the number of components when compared with current circuit designs. The MECC is believed to offer potential benefits to the surgical patient by reducing the systemic inflammatory response that remains strongly implicated in post-operative organ dysfunction. We present a review of the available literature and find the MECC to show an acceptable safety profile with a reduction in post-operative complications and transfusion requirements and no evidence of any negative impairment to the surgeon, anaesthetist or perfusionist. The observed post-bypass inflammatory response is seen to be lower after MECC bypass and this is of clear clinical benefit. [ABSTRACT FROM AUTHOR]

The Great Britain and Ireland (GBI) recommendations for standards of monitoring and alarms during cardiopulmonary bypass (CPB) came into force in January 2004. While perfusion departments in Great Britain and Ireland should now have a good baseline level of safety, it is important that department-specific safety is also considered. Patient safety is paramount, but safety within our speciality must also take into account the protection of the perfusionists' health and the protection of their careers. These different aspects of safety are fundamentally interrelated. This paper focuses on the importance of careful assessment, implementation and documentation when a new component or technique is being introduced to the CPB circuit, even when the aim is to increase safety. Knowledge of the civil justice system and the trends in medical negligence claims are an integral part of perfusionist safety. Perfusion in Great Britain and Ireland is rightly striving for professional recognition from the Health Professions Council (HPC). As we raise the profile of perfusion, we educate more people about the importance of our role and level of responsibility within the cardiac operating team. This will increase the potential for medical negligence claims to be directed specifically at our speciality. All these issues are discussed in detail. [ABSTRACT FROM AUTHOR]

How safe is safe? The design intent of perfusion safety systems is to offer maximum flexibility, low-cost and failsafe features. While easily said, these requirements are difficult to deliver in a perfusion world where standardization is uncommon. This paper reviews the challenges all manufacturers face as they strive to offer the ultimate in safety, keeping the price affordable for the technology deployed and the usability common sense for the perfusionist using the equipment. As microprocessors are able to assist designers in providing intelligent, multilevel safety systems, care must be taken during the design process to balance technological ability with intuitive use. In the final analysis, however, it is the perfusionist who is the primary safety system, and the technology is his or her backup. [ABSTRACT FROM AUTHOR]

In this article, the author comments on the article "The use of percutaneous ECMO support as a 'bridge to bridge' in heart failure patients: a case report." The author says that doctors keep a fully functioning primary console as a backup along with an additional motor and a flow probe when doing a surgery on heart failure patients. The author further says that a perfusionist would not be there if this device was just placed in a ventricular assist position as a CentriMag.

Introduction: Evidence-based practice (EBP) has been widely studied and adopted in allied health professions education. Current practitioners may have challenges in adopting EBP into current practice. EBP skills have not been previously assessed in perfusionists, therefore, the purpose of this study is to identify a preliminary analysis of perfusionists’ EBP knowledge and its possible relationship to clinical behavior and educational level Methods: A non-randomized convenience study using the Evidence-Based Practice Questionnaire (EBPQ) was used to measure EBP of practicing U.S. perfusionists. The EBPQ is a validated survey instrument designed to measure EBP practice, attitude and knowledge subscales. The EBPQ consisted of 24 items on a 1 to 7 Likert Scale, with higher numbers indicating frequent use of skill. Practitioner experience, educational background and employment type were also collected. Results: Two hundred and fifty-four responses met the inclusion criteria and were analyzed. The mean EBPQ score was 5.0 (SD = 0.9) with similar means for the subscales. There were important differences found in the EBPQ scores, depending on the educational level and work status. There was a positive correlation between the knowledge and practice subscales, demonstrating a relationship in the sample and a possible relationship in the population as a whole. Conclusion: The results suggest that perfusionists’ use of EBP in practice does vary, based upon educational level and employment type. The findings also demonstrated areas of lower EBP aptitude. The correlation between EBP knowledge and practice may guide educational efforts at improving EBP practice. [ABSTRACT FROM AUTHOR]

The article discusses a study which compared two techniques in calculating total blood volume (TBV) in cardiac surgical patients. Results of using a dilution technique in comparison with using the traditional Allen formula and weight-based formula are presented. The study suggests that the traditional techniques lack the desired accuracy compared to the dilution method.

The article discusses a study conducted to determine Total blood volume (TBV) by hemodilution (TBVHD) for patients with valve disease and compared the results with the Allen Formula and weight based estimates of TBV. It is noted that the study included 194 consecutive adult patients who have underwent non-emergent cardiac surgery between October 15, 2012 and February 1, 2013 and found that Allen Formula improve accuracy in mathematical estimates of TBV.

The article discusses a study conducted to analyze the effect of conventional ultrafiltration on allogenic blood transfusion and clinical outcome in infants after cardiac surgery. Topics discussed include details of the method, subjects, results and conclusion of the study, which find no significant differences between the groups in relation to demographics or hematological and cardiopulmonary bypass data.

The article discusses a study conducted to know retinal vascular caliber (RVC), ocular pulse amplitude (OPA), peripapillary retinal nerve fiber layer (RNFL) and macular thickness in coronary artery bypass grafting (CABG) surgery patients. It is noted that the study included twenty-six patients who had a history of CABG surgery and 26 age-sex-matched healthy participants and found that CABG surgery does not affect retinal structures and pulsatile ocular blood flow in the long-term follow-up.

The article discusses a study which reviews institutional data from more than a decade, from December 2001 and June 2013, to discuss risk factors for adverse outcome after Extracorporeal Life Support (ECLS). It is noted that the study revealed that ECLS therapy provides one-year survival to one quarter of patients and need to avoid prolonged metabolic deterioration in combination with high-dose vasopressor support.

The prevalence of anaemia is increasing globally. It has a close association with perioperative blood transfusion which, in turn, results in an increased risk of postoperative complications. Undesirable effects are not only limited to short-term, but also have long-term implications. Despite this, many patients undergo cardiac surgery with undiagnosed and untreated anaemia. We designed a retrospective, observational study to estimate the prevalence of anaemia in patients having cardiac surgery in Auckland District Health Board, blood transfusion rates and associated clinical outcome. Two hundred of seven hundred and twelve (28.1%) patients were anaemic. Red blood cell (RBC) transfusion rates were significantly higher in the anaemic group compared to the non-anaemic group (160 (80%) vs. 192 (38%), p-value <0.0001, RR (CI 95%) 2.133 (1.870-2.433)). Transfusion rates for fresh frozen plasma (FFP), cryoprecipitate and platelets were also higher in the anaemic group. Anaemia was significantly associated with the development of new infection (14 (7%) vs. 15 (2.9%), p-value 0.0193, RR (CI 95%) 2.389 (1.175-4.859)), prolonged ventilation time (47.01 hours vs. 23.59 hours, p-value 0.0076) and prolonged intensive care unit (ICU) stay (80.23 hours vs. 50.27, p-value 0.0011). Preoperative anaemia is highly prevalent and showed a clear link with significantly higher transfusion rates and postoperative morbidity. It is vital that a preoperative management plan for the correction of anaemia should be sought to improve patient safety and outcome. [ABSTRACT FROM AUTHOR]

Minimally invasive extracorporeal circulation (MiECC) has been developed in an attempt to integrate all advances in cardiopulmonary bypass technology in one closed circuit that shows improved biocompatibility and minimizes the systemic detrimental effects of CPB. Despite well-evidenced clinical advantages, penetration of MiECC technology into clinical practice is hampered by concerns raised by perfusionists and surgeons regarding air handling together with blood and volume management during CPB. We designed a modular MiECC circuit, bearing an accessory circuit for immediate transition to an open system that can be used in every adult cardiac surgical procedure, offering enhanced safety features. We challenged this modular circuit in a series of 50 consecutive patients. Our results showed that the modular AHEPA circuit design offers 100% technical success rate in a cohort of random, high-risk patients who underwent complex procedures, including reoperation and valve and aortic surgery, together with emergency cases. This pilot study applies to the real world and prompts for further evaluation of modular MiECC systems through multicentre trials. [ABSTRACT FROM PUBLISHER]

The article discusses a study where a balanced, rapidly degradable 6% HES 130/0.42 solution was compared to Ringer's acetate solution as a priming fluid for the cardiopulmonary bypass (CPB) circuit. Topics discussed include the application of the ANOVA test for repeated measurements to compare differences and the use of a paired t-test to compare differences and findings that maximum clot firmness (MCF) in the HES group recovered faster than in the RIN group.

The article discusses a study that evaluated the effects of cardiopulmonary bypass (CPB) on pulmonary function under the conditions of one-lung ventilation (OLV) and carbon dioxide pneumothorax. Topics discussed include the methods used including anesthesia, establishment of cardiopulmonary bypass and respiratory management and implications of a lung-protective ventilation strategy and improved CPB technique to protect pulmonary function and prevent hypoxia during robotic cardiac surgery.

The article discusses a retrospective analysis of clinical results from using the new Sorin Inspire 6 oxygenator from medical technology company Sorin Group, based on its ability to limit hemodilution, red blood cell (RBC) transfusion rate and postoperative acute kidney injury (AKI) rate. Findings discussed include Inspire 6 oxygenator to allow significant hemodilution containment during cardiopulmonary bypass (CPB), reducing RBC transfusions and postoperative AKi risks.

The article discusses hypothesis of renal haemodynamics optimization by maintenance of high mean arterial blood pressure (MAP) level during cardiac surgery. Topics include research on probable acute kidney injury (AKI), cardiopulmonary bypass for cardiac surgery patients, and testing for haemodialysis.

The use of cardioplegia solution has substantially increased the safety of cardiac surgery. It protects the myocardium by inducing a rapid and complete diastolic arrest, minimizing myocardial energy requirements, preventing ischaemic damage during the arrest phase and minimizing or preventing reperfusion injury once coronary blood flow is restored.This article is a summary of important information that has accumulated in the literature about cardioplegia and describes how our understanding of cardioplegia has evolved. The basic principles of myocardial ischaemia and reperfusion injury and how they relate to myocardial protection are described. Blood and crystalloid cardioplegia are compared with respect to biochemical and physiological differences.Recent patient demographic changes, with surgeons operating on older, more complex patients who have more severe and diffuse disease, are discussed. This cohort of patients potentially requires prolonged elective ischaemia; hence, improved myocardial protection would be of benefit. We highlight areas of study that have demonstrated a new concept of myocardial protection, known as polarized arrest. Many pharmacological agents have been shown (in experimental studies) to have the ability to induce a polarized arrest and to provide improved protection. [ABSTRACT FROM PUBLISHER]

Cerebral embolization during pediatric cardiac surgery may be an underappreciated source of subsequent neurodevelopmental impairment. Transcranial Doppler ultrasound is a neuromonitoring tool that can provide intraoperative surveillance for cerebral embolization. We hypothesized that increased cerebral embolic signals detected during infant cardiac surgery would be associated with worse neurodevelopmental outcomes at follow-up. A study group of 24 children who underwent infant cardiac surgery with transcranial Doppler detection of cerebral embolic signals returned at intermediate follow-up for standardized neurodevelopmental assessment. The children were evaluated using two neurocognitive tests and the parents completed two questionnaires regarding observed behavior. Statistical analysis assessed for correlation between the number of cerebral embolic signals at surgery and the results of the neurodevelopmental assessment. Of the 67 test parameters analyzed, five showed a significant association with the number of embolic signals, yet, all in the contrary direction of the clinical hypothesis, likely representing a Type I error. Thus, in this small cohort of patients, the number of cerebral embolic signals detected during infant cardiac surgery was not shown to be associated with worse neurodevelopmental outcomes at intermediate follow-up. A larger study is probably necessary to ascertain the potential influence of cerebral embolic signals on eventual neurologic outcomes in children. The clinical relevance of cerebral embolic signals during pediatric cardiac surgery remains undetermined and deserves further investigation. [ABSTRACT FROM PUBLISHER]

The article presents a study on the impact of autologous priming on blood conservation in patients after cardiac surgery. Topics include the need for alternative perfusion techniques to lower hemodilution, the effectiveness of a protocol of retrograde autologous prime (RAP) and venous antegrade prime (VAP), and the increase in postoperative hematocrits. It also discusses the use of a retrospective review to examine patients' data on their surgeries.

Myocardial protection during cardiac surgery can be accomplished by different cardioplegic solutions. The aim of this study was to assess myocardial damage after heart valve surgery performed with myocardial protection of a single dose of Celsior cardioplegia or with repeated cold blood cardioplegia. After the stratification of 139 valvular patients by means of matching according to cross-clamp and cardiopulmonary bypass time, 32 patients were retained for comparison (16 patients received Celsior and 16 patients received cold blood cardioplegia). Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) release were evaluated until six days after the operation. Pre-operative characteristics were similar in both groups. In the Celsior group, CK-MB and cTnI values were significantly higher from the first up to the sixth post-operative day. Peak cTnI values were 19.4±13.4 and 9.7±7 ng/mL (p=0.01) in the Celsior and the Cold Blood group, respectively. Peak CK-MB values were 79.6±58.8 and 45.9±20.6 U/L (p=0.07) in the Celsior and the Cold Blood group, respectively. Cold blood cardioplegia reduces perioperative myocardial damage compared to the Celsior solution in elective cardiac valve operations. [ABSTRACT FROM PUBLISHER]

The article presents a study that analyzes the effects of retrograde autologous priming (RAP) on the use of intraoperative packed red cell (PRC) or blood product transfusion. The study was conducted on patients who underwent coronary artery bypass grafting (CABG) for the first time. The results of the study show that the practise of RAP does not necessarily lessen RPG and other blood product transfusion requirements.

The article presents a study that analyzes the effect of synthetic colloids on blood coagulation and blood loss on patients who underwent on-pump coronary artery bypass graft (CABG) procedures. The study was conducted among six selected CABG patients administered with Ringer's solution mixed with hydroxyethyl starch. The results of the study show that there is no significant differentce in blood loss or blood coagulation in adults after on-pump CABG procedures.

The article presents a study that evaluates the effects of blood flow, cardiopulmonary bypass (CPB) and anemia on tissue oxygen tension (pO2) in the medulla and renal cortex. The study is conducted among that underwent normothermic cardiopulmonary bypass (CPB) and measuring their renal blood flow (RBF) and tissue PO2. The results of the study show that the difference in the level of hypoxia in the medulla and renal cortex can be useful in understanding the progress of medullary hypoxia.

The article presents a study on the capacity of biocompatible coatings to attenuate the effects of cardiopulmonary bypass. It notes that biocompatible circuits (BCC) are designed to decrease blood activation to the artificial cardiopulmonary bypass (CPB) surface. The study concludes that BCC, though not harmful, are ineffective in preserving tromboelastography (TEG).