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Nowadays, the necessity of having a cardioplegia circuit capable of being adapted in order to administer different types of cardioplegia is strategically fundamental, both for the perfusionist and for the cardiac surgeon. This allows to avoid cutting tubes, guarantees sterility and, most of all, limits the number of cardioplegia circuits for the different strategies of cardiac arrest. The novel "ReverseTWO cardioplegia circuit system" is the development of the precedent "Reverse system" where mainly the 4:1 and crystalloid cardioplegia were used, It has the advantage of allowing immediate change of cardioplegia set-up versus four types of cardioplegia technique, when the strategy is unexpectedly changed before the beginning of cardiopulmonary bypass (CPB), is safe and enables the perfusionist to use one single custom pack of cardioplegia. Two pediatric roller pumps are usually used in our centre for cardioplegia administration; they have a standardized calibration (the leading with ¼ inch and the follower with 1/8 inch) and the circuit consequently has two different tube diameters for the two different pumps. The presence in the circuit of two different shunts coupled with two different coloured clamps allows the immediate set-up for different cardioplegia administration techniques utilizing a colour-coding mechanism The aim of this manuscript is to present the new ReverseTWO Circuit. This novel system allows to administer four different cardioplegic solutions (4:1, 1:4, crystalloid, ematic) based on multiple tubes, which can be selectively clamped, identified through a color-coding method. The specificity of this circuit is the great versatility, which leads to numerous advantages, such as reduced risk of perfusion accident and reduced costs related not only to the purchase of different cardioplegia kits but also to the storage. https://youtu.be/ovJBE4ok2Ds [ABSTRACT FROM AUTHOR]

Mycobacterium chimaera infections have mainly been associated with the heater-cooler unit (HCU) and, ultimately, linked to contaminated aerosols in the operation room. The contamination status of HCUs seems to be influenced by the maintenance, therefore, according to the manufacturer's recommendations, peracetic acid (Puristeril) was introduced to increase HCU cleaning and disinfection protocol maintenance. Aerosol dispersion from Puristeril during maintenance can cause adverse effects to nearby workers. We aim to describe our technique to reduce the impact of Puristeril on operating room staff and to limit dispersion of its aerosol in the environment by performing the cleaning procedure through a closed circuit. [ABSTRACT FROM AUTHOR]

The autonomic nervous system is an underestimated target of systemic sclerosis alterations. In this review we analyzed the major manifestations of its involvement, reconsidering the main theories of its pathogenesis. [ABSTRACT FROM AUTHOR]

In recent years, the popularity of simplified intraoperative ablation approaches to treat atrial fibrillation (AF) has been progressively increasing. Our group has described a left atrial procedure based on epicardial radio frequency ablation on cardiopulmonary bypass (CPB). We report our CPB and myocardial protection strategy in 157 patients who underwent AF ablation combined with open-heart surgery from February 1998 to February 2002. Since epicardial ablations are performed on CPB on the beating heart, the CPB strategy is crucial. Total normothermic CPB allows a safe dissection around the pulmonary veins on the decompressed heart; after the ablating catheter has been positioned, an adequate filling of the left atrium favours a uniform contact with the atrial wall. After crossclamping, low-flow retrograde cardioplegia delivery is administered while ablating endocardially to protect the main coronary arteries in the atrio-ventricular groove from radio frequency-related trauma. All patients were successfully weaned from CPB. Sinus rhythm was restored in 152 of 157 (96.8%) patients immediately after surgery. No procedure-related complications were recorded. Epicardial ablations allowed us to reduce significantly the aortic crossclamping time required for ablations. The conduct of CPB and myocardial protection play a central role in the surgical strategy by improving intraoperative feasibility and effectiveness of radio frequency ablation and preventing some of the potential postoperative complications related to the procedure. [ABSTRACT FROM AUTHOR]