Circulación extracorpórea

Versión para imprimir Versión PDF

Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease

Extracorporeal circulation - Jue, 07/03/2025 - 10:00

Sci Rep. 2025 Jul 3;15(1):23690. doi: 10.1038/s41598-025-09461-6.

ABSTRACT

Due to advances in medical and surgical care, there are more adults than children living with congenital heart disease (CHD). Acute kidney injury (AKI) is a common complication following cardiac surgery in patients with CHD, with creatinine lacking sensitivity for early detection. Renal functional reserve (RFR), the kidney's capacity to increase filtration under stress, has emerged as a potential predictor of AKI. Our primary study objective was to evaluate whether preoperative RFR, using both creatinine clearance (CrCl) and cystatin C estimated glomerular filtration rate (eGFR) methods, predicts AKI following cardiopulmonary bypass in young adults with CHD. As a secondary objective, we compared RFR in CHD patients to that of healthy controls. This prospective cohort study included 30 young adults (ages 18-40) with acyanotic CHD and 8 healthy controls with normal baseline kidney function by serum creatinine. Preoperative RFR was measured using CrCl and cystatin C eGFR before and after a protein load. Postoperative AKI was diagnosed using the Kidney Disease Improving Global Outcomes criteria. Twelve (40%) CHD patients developed AKI, exhibiting significantly lower RFR when compared to those without AKI (median CrCl RFR: 9.6 vs. 35.0 mL/min/1.73m2; cystatin C eGFR RFR: 5.5 vs. 11.5 mL/min/1.73m2; P < 0.01). The ROC curve area for AKI prediction was 1.0 (CrCl RFR) and 0.88 (95% CI: 0.72-1.00, cystatin C eGFR RFR). CHD patients had lower RFR than controls (median CrCl: 25.5 vs. 56.4 mL/min/1.73m2, P < 0.01; median cystatin C eGFR: 9.0 vs. 13.5 mL/min/1.73m2, P = 0.03). In conclusion, preoperative RFR accurately predicts AKI in young adults with acyanotic CHD, providing a tool for the identification of high-risk patients and potentially improving perioperative care.

PMID:40604226 | DOI:10.1038/s41598-025-09461-6

Access to pediatric extracorporeal membrane oxygenation: a geospatial analysis of the racial/ethnic composition of areas with and without access

Extracorporeal circulation - Mié, 07/02/2025 - 10:00

Int J Equity Health. 2025 Jul 1;24(1):187. doi: 10.1186/s12939-025-02571-7.

ABSTRACT

BACKGROUND: We propose that all communities should have access to lifesaving technologies like pediatric extracorporeal membrane oxygenation (ECMO), and that distance is one actionable component to accessibility. We chose to examine whether geographic access by distance to pediatric ECMO differs by race/ethnicity for populations historically excluded from health services and technologies.

METHODS: Population data was obtained from the US Census Bureau's American Community Survey. Pediatric ECMO program data was obtained from the Extracorporeal Life Support Organization Registry. We compared the proportion of individuals that are American Indian/Alaska Native, Black/African American, Hispanic/Latina(o), or White that live within and outside of a 200-mile distance from pediatric ECMO programs.

RESULTS: 43% of the total US land area falls outside of the US catchment area for pediatric ECMO; and 4.91% of the US population (or 16,433,563 persons) does not have access to a Pediatric ECMO center. One of every four individuals that identify as American Indian/Native American, one of every 100 who identify as Black/African American, one of every 12 that identify as Hispanic/Latina(o), and one of every 21 that identify as White live outside of the pediatric ECMO catchment area for the United States.

CONCLUSIONS: American Indian/Native Americans and Hispanic/Latina(o)s lack access to pediatric ECMO by proximity. While Black/African Americans live close to ECMO programs, previous studies show that this population has less access to primary and specialized care. Distance is one actionable measurement that should be used to extend access to medical technologies for populations that have historically been excluded.

PMID:40597164 | DOI:10.1186/s12939-025-02571-7

Development and internal validation of the PROFIT and POSITIVE prognostic nomograms for patients undergoing VA-ECMO therapy

Extracorporeal circulation - Mié, 07/02/2025 - 10:00

Sci Rep. 2025 Jul 1;15(1):20573. doi: 10.1038/s41598-025-06607-4.

ABSTRACT

This study was aimed at developing and internally validating nomograms for predicting mortality during venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and in-hospital mortality risk in patients treated with VA-ECMO. A total of 7260 patients treated with VA-ECMO from January 2017 to December 2023 were extracted from the Chinese society of extra corporeal life support registry database. The entire cohort was randomly assigned to derivation and validation cohorts at a ratio of 2:1. Multivariable Cox proportional hazards regression was conducted using bootstrapping with the likelihood ratio test and Akaike information criterion. Approximately 24% of patients died during VA-ECMO assistance, and 51% died in the hospital. The nomogram PROFIT was constructed with ten pre- and immediately post-ECMO parameters: age, body mass index (BMI), intra-aortic balloon pump before VA-ECMO, history of cardiac arrest, worst mean arterial pressure (MAP), potential of hydrogen (pH) and serum lactate levels before VA-ECMO, site of ECMO installation, peripheral cannulation and distal perfusion. Additionally, nomogram POSITIVE was also established with ten parameters: age, sex, BMI, history of cardiac arrest, MAP, pH, and serum lactate levels before VA-ECMO support, the occurrence of cardiac arrest before VA-ECMO, type of sedation and prior continuous renal replacement therapy. The area under the receiver operating characteristics (AUC) of the nomogram PROFIT (0.72 [95% CI 0.70-0.74]) and POSITIVE (0.71 [95% CI 0.68-0.73]) outperformed the SAVE score, which indicated that the nomograms were capable of effectively identifying patients with a high risk of mortality. Both nomograms demonstrated outstanding discrimination and calibration in derivation and validation cohorts. In patients treated with VA-ECMO, the nomogram PROFIT may serve as a valuable tool for predicting mortality during VA-ECMO assistance, and the nomogram POSITIVE can predict in-hospital mortality with high reliability. However, these tools still require external validation in other patient populations requiring VA-ECMO support.

PMID:40594967 | PMC:PMC12215877 | DOI:10.1038/s41598-025-06607-4

Head-to-head comparison of V-A ECMO, Impella and ECPELLA in normal ovine hearts

Extracorporeal circulation - Mié, 07/02/2025 - 10:00

Sci Rep. 2025 Jul 1;15(1):21368. doi: 10.1038/s41598-025-06457-0.

ABSTRACT

Temporary mechanical circulatory support (MCS), including veno-arterial extracorporeal membrane oxygenation (ECMO) and micro-axial pumps (Impella), is increasingly used in clinical practice for refractory circulatory failure. Complex physiological responses to each technique or their combination (ECPELLA) remain debated and are often specific to cardiovascular pathology. A paucity of data on physiological responses to MCS in normal subjects makes comprehensive understanding of such responses in variable disease states difficult, as well as during weaning MCS in recovering hearts. This translational investigation compared three MCS techniques with variable pump flows in healthy sheep (n = 7) to establish baseline for future studies in cardiomyopathic models. All MCS techniques increased arterial elastance, but reduced LV myocardial work, coronary arterial flow and LV myocardial oxygen consumption. ECPELLA was more effective in increasing total systemic blood flow and MAP. The overall similarity between the MCS techniques suggests that the more invasive and complex combination of devices (ECPELLA) can only be justified for management of the severe failing heart as the means for decompressing LV. A study investigating the comparative impacts of different regimes and MCS techniques in a cardiomyopathic model is warranted.

PMID:40594422 | PMC:PMC12215061 | DOI:10.1038/s41598-025-06457-0

The progress and trends of the mechanism of cardiopulmonary bypass-associated acute lung injury: A narrative review

Extracorporeal circulation - Lun, 06/30/2025 - 10:00

Medicine (Baltimore). 2025 Jun 27;104(26):e43019. doi: 10.1097/MD.0000000000043019.

ABSTRACT

Studies into the mechanisms of cardiopulmonary bypass-associated acute lung injury have not presented breakthroughs for many years, resulting in the stagnation of management strategies and clinical medicine measures. This is a key factor affecting the prognoses of open-heart surgery patients. Future studies should focus on key targets of inflammation, such as neutrophils, macrophages, and the glycocalyx cell coat, and further explore advanced technologies, such as gene editing and single-cell sequencing, to reveal the underlying mechanisms of cardiopulmonary bypass-associated acute lung injury and to find effective prevention and treatment strategies.

PMID:40587734 | PMC:PMC12212844 | DOI:10.1097/MD.0000000000043019

Management of Anaesthesia and Cardiopulmonary Bypass in Paediatric Patients With Abdominal Tumours Invading the Inferior Vena Cava and Right Atrium: A Case Series of a Tertiary Children's Medical Centre in China

Extracorporeal circulation - Dom, 06/29/2025 - 10:00

Cancer Rep (Hoboken). 2025 Jul;8(7):e70268. doi: 10.1002/cnr2.70268.

ABSTRACT

OBJECTIVES: Paediatric patients with abdominal tumours associated with tumour thrombus in the inferior vena cava (IVC) and right atrium are relatively rare in clinical practice. Hence, we summarised the management strategies for anaesthesia and cardiopulmonary bypass (CPB) used during surgical treatment for these conditions through multidisciplinary cooperation.

METHODS: We collected the clinical data of paediatric patients who underwent surgery for tumour thrombus removal via CPB from January 2012 to December 2022 because their abdominal tumours had invaded the IVC and right atrium. We explored the strategies used to manage anaesthesia and CPB, assessed the incidence of intraoperative haemorrhage and arterial blood gas analysis, reported the incidence of blood transfusion and described the postoperative outcome and follow-up.

RESULTS: A total of six paediatric patients underwent surgery under CPB to remove the tumour thrombus. Among them, two patients had nephroblastoma, one had renal clear cell carcinoma and three had hepatoblastoma. The average age of the six patients was 25.8 months. The average operation time was 459.8 min, and the average anaesthesia time was 553.1 min. The average CPB time was 150.3 min, and the average aortic block time was 46.1 min. The average hypothermic circulatory arrest time was 20 min. The average quantity infused was as follows: red blood concentrate (RBC): 5.1 units, cryoprecipitate: 3.2 units, fresh frozen plasma (FFP): 200 mL and platelets (PLTs): 4.2 units. The time of extubation ranged from 4 h to 8 days, and the average time spent in the intensive care unit (ICU) was 6.2 days after surgery. No serious complications occurred during the follow-up period.

CONCLUSIONS: The present retrospective study aims to share our clinical experience with the management strategies of anaesthesia and CPB. Steady induction of anaesthesia, intraoperative massive haemorrhage and critical intraoperative situations are the major challenges in anaesthesia management.

PMID:40582963 | PMC:PMC12206560 | DOI:10.1002/cnr2.70268

Left Ventricular Assist Device Implantation Under Argatroban Anticoagulation in Heparin-Induced Thrombocytopenia: A Literature Review and Clinical Case Presentation

Extracorporeal circulation - Jue, 06/26/2025 - 10:00

J Clin Med. 2025 Jun 9;14(12):4083. doi: 10.3390/jcm14124083.

ABSTRACT

This review provides an in-depth analysis of argatroban as an alternative anticoagulant in cardiac surgery, with a focus on its use in patients with heparin-induced thrombocytopenia (HIT). We examine argatroban's pharmacokinetics and dosing regimens and the challenges associated with cosnventional monitoring methods-such as activated clotting time (ACT) and activated partial thromboplastin time (aPTT)-to evaluate its safety and effectiveness in high-risk surgical settings. Drawing on data from multiple case reports and series, our review highlights both the potential benefits and limitations of argatroban, including complications such as clot formation in extracorporeal circulation systems and prolonged postoperative coagulopathy. In addition to the literature review, we present a detailed clinical case of urgent HeartMate 3 left ventricular assist device implantation in a patient with advanced heart failure and active HIT. In this case, despite targeting an ACT above 400 s, intraoperative complications such as clot formation in the heart-lung machine and difficulty achieving hemostasis highlight the need for improved monitoring and dosing protocols. Our findings call for refined anticoagulation strategies and advanced monitoring techniques to optimize argatroban use in cardiac surgery, offering valuable insights for clinicians managing complex scenarios where conventional heparin therapy is contraindicated.

PMID:40565829 | PMC:PMC12194504 | DOI:10.3390/jcm14124083

Sex Differences in In-Hospital Mortality Among Patients Receiving Veno-Arterial Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation: A Propensity Score-Matched Analysis

Extracorporeal circulation - Mar, 06/24/2025 - 10:00

J Am Heart Assoc. 2025 Jul;14(13):e039541. doi: 10.1161/JAHA.124.039541. Epub 2025 Jun 23.

ABSTRACT

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used in cardiogenic shock, but sex-specific outcomes remain unclear. This study investigated in-hospital mortality differences by sex among patients receiving extracorporeal cardiopulmonary resuscitation (ECPR).

METHODS: We retrospectively reviewed adults with cardiogenic shock treated with VA-ECMO at National Taiwan University Hospital between 2010 and 2021. After propensity score matching to improve comparability between groups, survival outcomes were assessed using Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate the effect of sex on in-hospital mortality.

RESULTS: Of the 1329 patients (average age: 57.1±15.0 years; 953 men), 670 underwent VA-ECMO for ECPR. Women in the VA-ECMO group exhibited a lower prevalence of out-of-hospital cardiac arrest (6.7% versus 10.7%, P=0.031), a lower body mass index (24.0±4.4 versus 25.0±4.3, P<0.001), and lower rates of diabetes (26.2% versus 33.2%, P=0.017) and coronary artery disease (20.9% versus 28.6%, P=0.005) after propensity score matching. No discernible sex differences were observed in the baseline characteristics of the ECPR subgroup. Kaplan-Meier analyses showed no significant sex differences in mortality for VA-ECMO (log-rank P=0.1), but significant disparities were noted for ECPR (log-rank P=0.006). In the ECPR group, female patients exhibited higher mortality rates compared with men (hazard ratio, 1.37 [95% CI, 1.09-1.72]; P=0.007), independent of Survival After Veno-Arterial ECMO score severity.

CONCLUSIONS: Women who underwent ECPR had higher in-hospital mortality rates regardless of the severity of their Survival After Veno-Arterial ECMO scores, despite the absence of significant sex differences in VA-ECMO mortality. This emphasizes the necessity for sex-based strategies in ECPR administration.

PMID:40551319 | DOI:10.1161/JAHA.124.039541

Aortic annulus reconstruction with bovine pericardium during aortic valve replacement for severe calcific aortic stenosis

Extracorporeal circulation - Mar, 06/24/2025 - 10:00

J Cardiothorac Surg. 2025 Jun 24;20(1):272. doi: 10.1186/s13019-025-03505-8.

ABSTRACT

OBJECTIVE: To explore the application and effect of aortic annulus reconstruction (AAR) with bovine pericardium during surgical aortic valve replacement (SAVR) for severe calcific aortic stenosis (AS).

METHODS: We retrospectively reviewed 12 patients with severe calcified AS who underwent bovine pericardium aortic annulus reconstruction between January 2021 to December 2023. The average age of the patients was 58 ± 8.8 years. All patients were diagnosed with severe AS, along with aortic valve and annulus calcification, through chest computed tomography (CT) and transthoracic echocardiography (TTE) prior to surgery. After the resection of severely calcified aortic annulus tissue, all patients were given a bovine pericardial patch to repair the annular defect, and five of these patients underwent Y-incision aortic annular enlargement (AAE). The patients were followed up for a duration of 0.5 to 2 years.

RESULTS: A total of 12 patients undergoing SAVR were enrolled, and all received bovine pericardial patches to repair the annular defects, with a mean preoperative indexed effective orifice area (iEOA) of 0.58 ± 0.098 cm²/m². The average extracorporeal circulation time during the operation was 150.83 ± 34.5 min, and the average cross-clamp time was 95.42 ± 17.46 min. Postoperative evaluations indicated that the structural integrity of the valve annulus remained intact, demonstrating hemodynamic stabilization without any recorded fatalities among participants. Compared to preoperative levels, the aortic valve mean gradient (4.67 ± 1.15 vs. 59.67 ± 17.94 mmHg, P < 0.001), peak gradient (13 [10-15.75] vs. 92 [82.25-110.25] mmHg, P < 0.001), mean aortic jet velocity (99.67 ± 15.44 vs. 367.17 ± 58.13 cm/s, P < 0.001), and peak aortic jet velocity (182.25 ± 23.40 vs. 495.67 ± 61.74 cm/s, P < 0.001) significantly decreased after 0.5 years of follow-up. There were no complications such as hemolysis, perivalvular leakage, thrombosis or endocarditis during follow-up.

CONCLUSION: In patients with severe calcified AS, the AAR technique using bovine pericardium during SAVR is safe and effective, with stable hemodynamic performance and satisfactory clinical outcomes.

PMID:40556029 | PMC:PMC12186314 | DOI:10.1186/s13019-025-03505-8

Total thyroidectomy performed under general anesthesia with venovenous extracorporeal membrane oxygenation during a thyroid storm: a case report

Extracorporeal circulation - Mar, 06/24/2025 - 10:00

J Cardiothorac Surg. 2025 Jun 25;20(1):273. doi: 10.1186/s13019-025-03491-x.

ABSTRACT

BACKGROUND: Thyroid storm (TS) is an endocrine emergency requiring aggressive medical management. In severe cases, hemodynamic instability may necessitate extracorporeal membrane oxygenation (ECMO) support as a bridge to definitive surgical treatment. ECMO is categorized into two types: venoarterial (V-A) ECMO, which provides both cardiac and pulmonary support, and venovenous (V-V) ECMO, which supports only pulmonary function. Surgery is generally not recommended for patients with unstable TS due to the high risk of complications, even when ECMO support is in place. Here, we present a case of a 44-year-old man initially improved with V-A ECMO for TS with cardiogenic shock, but later developed refractory hypoxemia due to pulmonary thromboembolism (PTE). He subsequently underwent emergency thyroidectomy with continuous support from V-V ECMO.

CASE PRESENTATION: A 44-year-old man presented to our hospital with complaints of palpitations. He had a recent history of coronavirus disease of 2019 (COVID-19) infection, which may have exacerbated undiagnosed hyperthyroidism, leading to thyroid storm and cardiogenic shock (left ventricular ejection fraction [LVEF], 13%). Heart failure improved with immediate medical management and V-A ECMO for 4 days, resulting in LVEF, 30%. V-A ECMO provide both respiratory and cardiac support, allowing myocardial recovery. Although the patient's cardiac output improved, uncontrolled tachycardia persisted. Medical treatment for hyperthyroidism-associated tachycardia was continued after V-A ECMO weaning but failed to achieve adequate rate control. Ten days after weaning V-A ECMO, the patient suddenly developed pulmonary thromboembolism and hypoxia despite ongoing heparinization. To manage refractory hypoxia, V-V ECMO was initiated, as it exclusively provides respiratory support. Given that persistent TS was the underlying cause of the patient's instability, we proceeded with thyroidectomy under general anesthesia with V-V ECMO support, despite the associated risks. On postoperative day 4, the patient was successfully weaned off V-V ECMO. By postoperative day 18, he was discharged without complications, with an improved LVEF of 52.5%.

CONCLUSIONS: This is the first reported case of total thyroidectomy performed while on V-V ECMO support for TS complicated by PTE. Although V-V ECMO is more susceptible to hemodynamic instability than V-A ECMO, this case demonstrates that thyroidectomy can be successfully performed with appropriate anesthesia management. Additionally, careful selection of the ECMO modality based on the patient's condition is crucial for optimal management.

PMID:40556009 | PMC:PMC12188653 | DOI:10.1186/s13019-025-03491-x

Nursing care for patients with cardiorenal syndrome after heart transplantation undergoing continuous renal replacement therapy: A case report and literature review

Extracorporeal circulation - Lun, 06/23/2025 - 10:00

Medicine (Baltimore). 2025 Jun 20;104(25):e43043. doi: 10.1097/MD.0000000000043043.

ABSTRACT

RATIONALE: Heart transplantation (HT) represents the optimal treatment for patients with end-stage heart disease. However, it is prone to numerous postoperative complications, among which cardio-renal syndrome (CRS) is particularly serious and carries a high mortality rate. Continuous renal replacement therapy is an essential supportive treatment for these patients, but its efficacy is highly dependent on precise nursing management. Currently, there are few reports on the care of CRS complicating HT both domestically and internationally. This case is presented in this report to provide reference for clinical work.

PATIENT CONCERNS: This report details the case of a 31-year-old man who underwent an in situ HT due to dilated cardiomyopathy with class IV cardiac function. Following the operation, he developed CRS, which led to oliguria, rapid deterioration of renal function, and cardiac failure.

DIAGNOSES: Cardiorenal syndrome, chronic kidney disease stage 4, post-dilated cardiomyopathy surgery, HT status, heart function class IV (NYHA classification).

INTERVENTIONS: This includes implementing a personalized continuous renal replacement therapy (CRRT) program and providing excellent CRRT care; closely monitoring for rejection and the side effects of immunosuppressants; and offering comprehensive psychological support.

OUTCOMES: After undergoing CRRT for 5 weeks, the patient's 24-hour urine volume, glomerular filtration rate, and N-terminal brain natriuretic peptide precursor levels stabilized, leading to discharge with improved renal function.

LESSONS: The key to a favorable renal function prognosis is the use of CRRT for precise volume management. Careful management of internal jugular vein catheterization is crucial for preventing infections in post-heart transplant patients. Additionally, monitoring the side effects of immunosuppressive drugs and signs of rejection are essential nursing points for patients with cardiorenal syndrome. Providing psychological care in various forms to patients and their families can help improve disease outcomes and ensure long-term efficacy after transplantation.

PMID:40550023 | PMC:PMC12187291 | DOI:10.1097/MD.0000000000043043

Pulsatile Normothermic Perfusion With Cardiopulmonary Bypass for Thoracic Organ Recovery in Donation After Uncontrolled Circulatory Death: A Feasible Strategy for Expanding the Donor Pool

Extracorporeal circulation - Lun, 06/23/2025 - 10:00

Exp Clin Transplant. 2025 May;23(5):317-327. doi: 10.6002/ect.2025.0089.

ABSTRACT

OBJECTIVES: Donation after circulatory death offers a promising solution to expand the thoracic organ donor pool, yet its application remains limited because of warm ischemia and technical barriers, especially in uncontrolled donation after circulatory death. We aimed to evaluate a pulsatile normothermic car-diopulmonary bypass-based strategy for thoracic organ recovery of uncontrolled donors after circulatory death and the effects of this strategy on graft function and recipient outcomes.

MATERIALS AND METHODS: In this prospective single-center study, we studied thoracic organs recovered from uncontrolled donors after circulatory death after ≥60 minutes of unsuccessful cardiopulmonary resuscitation. After heparinization and pharmacologic optimization, donors underwent median sternotomy and were connected to a cardiopulmonary bypass circuit with pulsatile flow. Organ assessment was performed in vivo. Donor, graft, and recipient functional data were recorded, with follow-up results studied through at least 1 year.

RESULTS: Forty-two donors were included. All hearts (n = 42) and 40 lungs (from 84 donors) were successfully transplanted. Despite prolonged cardiopulmonary resuscitation, no graft failure or recipient mortality occurred. One year survival for both heart and lung recipients was 100%. Heart grafts showed progressive improvement in functional status, including left ventricular ejection fraction, lactate levels, and New York Heart Association classification; lungs demonstrated sustained gains in gas exchange, pulmonary function tests, and 6-minute walk distance. Mild primary graft dysfunction (grade 1-2) occurred in 10% of lung recipients (all unilateral transplants). Pericardial effusion increased, likely because of trauma before procurement, but resolved without effects on function.

CONCLUSIONS: Pulsatile normothermic cardiopulmonary bypass enables successful procurement of thoracic organs from uncontrolled donors after circulatory death with excellent outcomes. This low-cost physiological approach may offer a viable strategy to expand availability of donors in resource-limited settings.

PMID:40548529 | DOI:10.6002/ect.2025.0089

The effects of extracorporeal blood purification (oXiris) in patients with cardiogenic shock who require VA-ECMO (CLEAN ECMO): a prospective, open-label, randomized controlled pilot study

Extracorporeal circulation - Vie, 06/20/2025 - 10:00

Crit Care. 2025 Jun 20;29(1):255. doi: 10.1186/s13054-025-05495-4.

ABSTRACT

BACKGROUND: A systemic inflammatory response can contribute to poor outcomes in an advanced stage of cardiogenic shock (CS). We investigated the efficacy of extracorporeal endotoxin and cytokine adsorption using oXiris in patients with CS undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO).

METHODS: In this prospective, single-center, randomized, open-label pilot trial, 40 patients with CS who were undergoing VA-ECMO were randomly assigned to receive either oXiris for 24 h (n = 20) or usual care (n = 20). The primary endpoint was endotoxin levels at 48 h. Secondary endpoints included changes in inflammatory cytokines, vasoactive-inotropic score (VIS), ECMO weaning success, and in-hospital and 30-day mortality.

RESULTS: The median endotoxin levels at 48 h were 0.5 (IQR 0.4-1.0) in the oXiris group and 0.4 (IQR 0.2-0.5) in the control group, with no significant difference between them (P = 0.097). The oXiris group showed significant temporal reductions in GDF-15 and IL-6 levels, with IL-6 revealing significant reductions from baseline to 24 h (P = 0.020) and from baseline to 7 days (P = 0.003). VIS decreased significantly from baseline to 48 h (-13.63, 95% CI: -20.90 - -6.34, P < 0.001) and 7 days (-12.19, 95% CI: -21.0 - -3.31, P = 0.007) in the oXiris group, but intergroup differences were insignificant. ECMO weaning success, duration of ECMO support, and mortality rates were similar between the groups.

CONCLUSION: In this pilot study conducted on CS patients requiring VA-ECMO, oXiris treatment did not significantly reduce endotoxin levels or improve patient centered clinical outcomes.

TRIAL REGISTRATION: NCT05642273, registered 8 December 2022.

PMID:40542431 | PMC:PMC12181899 | DOI:10.1186/s13054-025-05495-4

Extracorporeal Membrane Oxygenation in Spontaneous Coronary Artery Dissection Complicated by Left Ventricular Free Wall Rupture: A Case Report and Management Insights

Extracorporeal circulation - Vie, 06/20/2025 - 10:00

JACC Case Rep. 2025 Jun 18;30(15):103679. doi: 10.1016/j.jaccas.2025.103679.

ABSTRACT

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction, distinctly from atherosclerotic disease. Conservative management is typically recommended, but the incidence of mechanical complications is poorly defined, with only 7 cases reported. We describe a 62-year-old woman with SCAD complicated by left ventricular free wall rupture. Despite initial conservative management, she developed in-hospital cardiac arrest just moments before discharge and was treated with extracorporeal membrane oxygenation (ECMO), stabilizing her condition and enabling emergency surgical repair. This case underscores the potential role of ECMO in managing SCAD with life-threatening complications and underscores the need for a tailored approach to the management of SCAD patients, which differ from classical atherosclerotic myocardial infarction.

PMID:40541339 | PMC:PMC12198654 | DOI:10.1016/j.jaccas.2025.103679

Iatrogenic aortic dissection in minimally invasive cardiac surgery for atrioventricular valves and atrial structures†

Extracorporeal circulation - Jue, 06/19/2025 - 10:00

Eur J Cardiothorac Surg. 2025 Jun 3;67(6):ezaf135. doi: 10.1093/ejcts/ezaf135.

ABSTRACT

OBJECTIVES: In the last decades, minimally invasive cardiac surgery has emerged as an alternative approach to conventional median sternotomy. However, some reports state an increased risk of iatrogenic acute aortic dissection. Evidence remains limited regarding preoperative diagnostics for risk reduction and the appropriate adjustment of surgical procedures if acute aortic dissection is detected intraoperatively.

METHODS: In this retrospective single-centre observational study, we analysed 1065 patients who underwent minimally invasive cardiac surgery via right anterolateral thoracotomy for atrioventricular valves and atrial structures with femoral cannulation for cardiopulmonary bypass from August 2009 to June 2021. Occurrence of iatrogenic acute aortic dissection was evaluated, along with patient profiles and the primary composite outcome of major adverse cardiovascular events (non-fatal stroke, myocardial infarction or cardiovascular death). An optimal perioperative strategy was subsequently described.

RESULTS: Intraoperative iatrogenic acute aortic dissection was observed in 8 patients (0.75%). It was identified at the start of cardiopulmonary bypass in 4 patients (50.0%). All patients underwent conversion to full sternotomy; 7 patients underwent additional aortic surgery with circulatory arrest thereafter. In-hospital mortality was 37.5% (n = 3), including 1 intraoperative death. Non-fatal stroke was observed in 12.5% (n = 1). A preoperative computed tomography scan was missing in 3 patients with aortic calcification (n = 1) and hostile peripheral arteries (n = 2).

CONCLUSIONS: Intraoperative aortic dissection in minimally invasive cardiac surgery remains a rare complication. Frequent major adverse cardiovascular events highlight the importance of preoperative imaging based procedure planning. Intraoperatively, early diagnosis with standardized monitoring and time- and location-specific surgical adaptations might increase safety and outcomes.

PMID:40534225 | PMC:PMC12199776 | DOI:10.1093/ejcts/ezaf135

Phase-Specific Hemodynamic Criteria and Outcomes in Patients With Cardiogenic Shock Receiving Percutaneous Ventricular Assist Devices

Extracorporeal circulation - Mié, 06/18/2025 - 10:00

J Am Heart Assoc. 2025 Jul;14(13):e042249. doi: 10.1161/JAHA.125.042249. Epub 2025 Jun 18.

ABSTRACT

BACKGROUND: Standardized protocols with optimal hemodynamic targets for percutaneous ventricular assist device (PVAD) management remain undefined. We aimed to evaluate the proportion of phase-specific hemodynamic criteria achieved during PVAD support and their association with outcomes in patients with cardiogenic shock.

METHODS: This multicenter retrospective study enrolled patients with cardiogenic shock requiring PVAD (Impella). Patients were evaluated at 24 hours post-PVAD, venoarterial extracorporeal membrane oxygenation weaning, and PVAD weaning. Hemodynamic criteria consisted of key targets, including mean arterial pressure ≥60 mm Hg, lactate <2.0 mmol/L, right atrial pressure <15 mm Hg, pulmonary artery wedge pressure <20 mm Hg, pulmonary artery pulsatility index ≥1.0, and cardiac power output ≥0.6 W. The primary outcome was a composite of 30-day all-cause mortality and unplanned mechanical circulatory support reintroduction.

RESULTS: A total of 501 patients were enrolled: 206 (41%) with PVAD alone and 295 (59%) with PVAD and venoarterial extracorporeal membrane oxygenation. The majority of patients were supported with Impella CP (406, 81%). Fulfillment of criteria was observed in 37%, 52%, and 45% at 24 hours post-PVAD, venoarterial extracorporeal membrane oxygenation weaning, and PVAD weaning, respectively. Patients with unfulfilled criteria at each evaluation point were at high risk for the primary outcome (hazard ratio, 3.2 [95% CI, 2.1-4.8]; hazard ratio, 2.1 [1.2-3.7]; and hazard ratio, 2.0 [95% CI, 1.1-3.6]). Hemodynamic criteria achievement consistently stratified the risk of the primary outcome across different subgroups, including shock cause, shock stage, and concomitant use of venoarterial extracorporeal membrane oxygenation.

CONCLUSIONS: Phase-specific hemodynamic criteria are often unmet and are associated with significantly higher risks of short-term fatal events.

PMID:40530483 | DOI:10.1161/JAHA.125.042249

Evaluation of Systemic Microcirculatory Vessel Density in the Early Postoperative Period of Heart Valve Surgery: an Observational Study

Extracorporeal circulation - Mié, 06/18/2025 - 10:00

Braz J Cardiovasc Surg. 2025 Jun 18;40(4):e20240039. doi: 10.21470/1678-9741-2024-0039.

ABSTRACT

INTRODUCTION: The present study evaluated systemic microcirculatory alterations occurring in the early postoperative period of cardiopulmonary bypass-assisted heart valve surgery compared to preoperative parameters through noninvasive point-of-care microcirculatory imaging of the sublingual area using incident dark field imaging.

METHODS: This was a single-center cross-sectional observational study that included 23 patients aged 49 ± 13 years. Sublingual microcirculatory density and perfusion were evaluated using a handheld camera based on incident dark field imaging before surgery and in the early postoperative period.

RESULTS: The total number of capillary vessels (1029 ± 13, P=0.0006), total length of capillary vessels (29.4 ± 3.2 mm, P=0.0005), and capillary vessel density (16.8 ± 1.8 mm/mm2, P=0.0005) were all higher after surgery. On the other hand, the total number of noncapillary vessels (85 ± 34, P=0.05), total length of noncapillary vessels (1.9 ± 0.8 mm, P=0.07), and noncapillary vessel density (1.1 ± 0.5 mm/mm2, P=0.07) were similar before and after surgery. The total number of capillary vessels was higher after surgery (1109 ± 92) in patients who received milrinone infusion (P=0.002) but not in patients who did not receive milrinone (986 ± 129, P=0.05).

CONCLUSION: After cardiac valve surgery, there was an improvement in microvascular parameters concerning capillary vessels and in the total number of microvessels. Moreover, significant positive correlations were found between the use of milrinone and these parameters. The study demonstrated the usefulness of handheld cameras for bedside evaluation of the microcirculation.

PMID:40530991 | PMC:PMC12175618 | DOI:10.21470/1678-9741-2024-0039

Transcutaneous Monitoring of Carbon Dioxide to Optimize Ventilator Weaning in At-Risk Adults After Cardiopulmonary Bypass

Extracorporeal circulation - Mar, 06/17/2025 - 10:00

Clin Nurse Spec. 2025 Jul-Aug 01;39(4):180-184. doi: 10.1097/NUR.0000000000000904.

ABSTRACT

BACKGROUND: Cardiopulmonary bypass use during surgery disrupts microcirculation, which can contribute to lung injury, particularly in patients with pulmonary comorbidities. Continuous transcutaneous carbon dioxide (CO2) monitoring assists clinicians to trend values related to metabolic and respiratory status between intermittent arterial blood gas measurements. We sought to review the literature to support adoption of this technology to optimize weaning in patients with pulmonary comorbidities following open heart surgery.

METHODS: Multiple databases were reviewed. Inclusion criteria were limited to results of peer-reviewed articles in English published within the past 5 years. The findings were presented to relevant levels of hospital leadership, who approved adoption of the technology for this population. From there, monitors were positioned in 4 surgical intensive care unit rooms for monitoring of patients up to the point of extubation.

RESULTS: The literature review yielded 12 articles, with a majority deeming transcutaneous monitoring feasible and appropriate in the postoperative patient, including those having cardiopulmonary bypass. Clinical interventions and trending were valuable additions to improve patient outcomes and nursing autonomy. During the fiscal quarter following adoption of the technology, mean time spent on the ventilator dropped 30%, reintubation dropped 4%, and mortality decreased by 24%.

CONCLUSIONS: Transcutaneous monitoring of CO2, with improved specificity over end-tidal CO2 monitoring, offers meaningful trending to inform clinician decision-making around readiness to wean. Additionally, transcutaneous monitoring allows for noninvasive, reliable continuous metabolic monitoring to serve as an early clinical indicator for at-risk patients.

PMID:40526768 | DOI:10.1097/NUR.0000000000000904

The utility of sTREM-1 and presepsin to predict infection in pediatric patients receiving mechanical circulatory support

Extracorporeal circulation - Lun, 06/16/2025 - 10:00

J Extra Corpor Technol. 2025 Jun;57(2):96-104. doi: 10.1051/ject/2025008. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: It is difficult to clinically detect a new infection in patients with Mechanical Circulatory Support (MCS; including veno-arterial and veno-veno extracorporeal membrane oxygenation, and ventricular assist devices). The prompt, accurate identification of new infection utilizing plasma biomarkers could prompt earlier initiation of antimicrobial agents and may improve outcomes.

METHODS: We utilized ELISA to evaluate novel biomarkers, soluble Triggering Receptor Expressed on Myeloid cells (sTREM-1) and Presepsin, as well as existing biomarkers (C-Reactive Protein (CRP) and Procalcitonin) before MCS, daily for the first week of MCS and for the 72 h in advance of the development of a new infection for patients prospectively enrolled in a biobank and who developed a culture positive infection.

RESULTS: Serial samples from 18 patients were analyzed. On average post-cannulation Presepsin and sTREM-1 values were not significantly different, however they have higher baseline values than reported in other patient populations. On average during periods of infection, Presepsin was 41% lower (51,462-30,188 pg/mL) (P = 0.001) and procalcitonin was 51% lower (0.77-0.38 ng/mL) (P < 0.001) compared to non-infected periods. Neither CRP or sTREM-1 were significantly different between infected and un-infected periods.

CONCLUSION: Presepsin and Procalcitonin decreased in advance of the development of a new infection in the MCS patient population, a direction of change different than expected. These findings highlight the importance of biomarker studies specifically performed in the MCS patient population, and the potential lack of translatability of biomarkers in other patient populations to the MCS patient population.

PMID:40523137 | PMC:PMC12169701 | DOI:10.1051/ject/2025008

Perfusion practices and safety standards in Pakistan: Insights from a preliminary nationwide survey

Extracorporeal circulation - Lun, 06/16/2025 - 10:00

J Extra Corpor Technol. 2025 Jun;57(2):82-88. doi: 10.1051/ject/2025007. Epub 2025 Jun 16.

ABSTRACT

INTRODUCTION: Perfusion safety in cardiothoracic surgery is critical, particularly in Pakistan where variability in practice standards exists. This survey investigates the current perfusion practices among Pakistani perfusionists, focusing on the adherence to safety standards during cardiopulmonary bypass (CPB) procedures.

METHODS: The survey was conducted over two weeks to explore key areas of perfusion practice, including the use of bubble detectors, level detectors, arterial filters, and saturation monitoring during CPB procedures. Out of approximately 350 practicing perfusionists in Pakistan, 66 responded, resulting in a response rate of 18.9%. The data was collected through an online platform, ensuring anonymity and voluntary participation. The survey included mainly Yes/No questions. To ensure reliability and validity, the questionnaire was reviewed by experts, pilot tested, and refined based on feedback, ensuring it was effective in gathering meaningful insights.

RESULTS: The survey results indicate a variable use of essential safety devices such as bubble and level detectors, arterial filters, and continuous venous saturation and cerebral saturation monitoring. While some perfusionists adhere to recommended safety protocols, gaps in the use of critical monitoring equipment were evident.

CONCLUSION: The findings highlight the need for standardized perfusion practices in Pakistan to ensure safety and efficacy during CPB. Addressing the gaps in the use of safety and monitoring equipment could lead to improved patient outcomes. Further research is needed to explore the barriers to uniform safety standards and to develop strategies for enhancing perfusion safety across the country.

PMID:40523135 | PMC:PMC12169702 | DOI:10.1051/ject/2025007

Distribuir contenido