Comparative evaluation of blood salvage techniques in patients undergoing cardiac surgery with cardiopulmonary bypass

Background: The primary objective of this study was to test and compare the efficacy of currently available intraoperative blood salvage systems via a demonstration of the level of increase in percentage concentration of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in the end product. Methods: In a prospective, randomized study, data of 80 patients undergoing elective cardiac surgery with cardiopulmonary bypass in a 6-month period was collected, of which the volume aspirated from the surgical field was processed by either the HemoSep Novel Collection Bag (Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased from 23.05%±2.7 to 43.02%±12 in Group 1 and from 24.5±2 up to 55.2±9 in Group 2 (p=0.013). The mean number of platelets rose to 225200±47000 from 116400 ±40000 in the HemoSep and decreased from 125200±25000 to 96500±30000 in the cell-saver group (p=0.00001). The leukocyte count was concentrated significantly better in Group 1 (from 10100±4300 to 18120±7000; p=0.001). IL-6 levels (pg/dL) decreased from 223±47 to 83±21 in Group 1 and from 219±40 to 200±40 in Group 2 (p=0.001). Fibrinogen was protected significantly better in the HemoSep group (from 185±35 to 455±45; p=0.004). Conclusions: Intraoperative blood salvage systems functioned properly and the resultant blood product was superior in terms of red blood cell species. The HemoSep group had significantly better platelet and leukocyte concentrations and fibrinogen content

Fogarty® catheter dilatation of veins smaller than 2.5 mm after completion of the anastomosis during arteriovenous fistula creation

Introduction. Risk of failure after surgical creation of the AVF was linked to the diameter and flow dynamics of the vessel that is to be quantified by preoperative ultrasound mapping. We aimed to report our results using a different technique consisting of Fogarty® catheter dilatation of the cephalic vein after completion of the anastomosis. Material and methods. A total of 23 patients, aged between 35 to 70 years, with a cephalic vein diameter of ≤ 2.5 mm received a dilatation technique for arteriovenous creation. Patients having reoperations, aneurysmatic or thrombosed veins and multiple risk factors were not considered eligible and access failure within 60 days was defined as early fistula failure. Results. Mean cephalic vein diameter was 2.03 ± 0.28 mm and mean radial artery diameter was 2.33 ± 0.16 mm. At 15th day visit, 21 of 23 patients (91.3%) had patent arteriovenous fistula. Mean time of follow-up was 7.2 ± 1.67 months and was complete in 20 of 21 patients with a patent fistula. Overall patency was 18/23 (78.2%) in patients with survived AVFs. Conclusion. Fogarty® catheter dilatation of the cephalic vein after completion of the anastomosis during arteriovenous fistula creation is effective and safe in patients with small calibrated veins

The role of hemoadsorption in cardiac surgery - a systematic review

BACKGROUND: Extracorporeal blood purification has been widely used in intensive care medicine, nephrology, toxicology, and other fields. During the last decade, with the emergence of new adsorptive blood purification devices, hemoadsorption has been increasingly applied during CPB in cardiac surgery, for patients at different inflammatory risks, or for postoperative complications. Clinical evidence so far has not provided definite answers concerning this adjunctive treatment. The current systematic review aimed to critically assess the role of perioperative hemoadsorption in cardiac surgery, by summarizing the current knowledge in this clinical setting. METHODS: A literature search of PubMed, Cochrane library, and the database provided by CytoSorbents was conducted on June 1st, 2023. The search terms were chosen by applying neutral search keywords to perform a non-biased systematic search, including language variations of terms "cardiac surgery" and "hemoadsorption". The screening and selection process followed scientific principles (PRISMA statement). Abstracts were considered for inclusion if they were written in English and published within the last ten years. Publications were eligible for assessment if reporting on original data from any type of study (excluding case reports) in which a hemoadsorption device was investigated during or after cardiac surgery. Results were summarized according to sub-fields and presented in a tabular view. RESULTS: The search resulted in 29 publications with a total of 1,057 patients who were treated with hemoadsorption and 988 control patients. Articles were grouped and descriptively analyzed due to the remarkable variability in study designs, however, all reported exclusively on CytoSorb$^{®}$ therapy. A total of 62% (18/29) of the included articles reported on safety and no unanticipated adverse events have been observed. The most frequently reported clinical outcome associated with hemoadsorption was reduced vasopressor demand resulting in better hemodynamic stability. CONCLUSIONS: The role of hemoadsorption in cardiac surgery seems to be justified in selected high-risk cases in infective endocarditis, aortic surgery, heart transplantation, and emergency surgery in patients under antithrombotic therapy, as well as in those who develop a dysregulated inflammatory response, vasoplegia, or septic shock postoperatively. Future large randomized controlled trials are needed to better define proper patient selection, dosing, and timing of the therapy

CLINICAL IMPACT AND BIOMATERIAL EVALUATION OF BONE MARROW ASPIRATE AND PLATELET GEL IN CARDIAC SURGERY

WOS: 000264089500062

Novel ultrafiltration technique for blood conservation in cardiac operations

The performance characteristics and clinical outcome of a novel hemoconcentrator, the HemoSep (Brightwake, Nottingham, United Kingdom), for reusing salvaged blood postoperatively were evaluated. HemoSep concentrates blood by removing the fluid component from a pooled volume of blood salvaged at the end of the operation from the heart-lung machine. During a 6-month period, 102 patients were prospectively randomized into two groups. In group 1 (n = 52), salvaged blood in the venous reservoir after the cessation of cardiopulmonary bypass was reused by the HemoSep device and the processed blood was retransfused to the patients. In group 2 (n = 50), the control group, the operation proceeded using conventional method without using the hemoconcentrator. The mean amount of processed blood was 775 ± 125 mL. The efficacy of the HemoSep device was confirmed by the percentage concentration of the hematocrit at 15 and 40 minutes. Serum albumin and factor VII levels were concentrated more than threefold at 40 minutes vs baseline measurements. Patients who received processed blood had significantly less need for an allogeneic transfusion. The HemoSep device functions as designed and without technical failures, offering a complementary technique in blood management during cardiac operations

Minimized cardiopulmonary bypass techniques and technologies

Traditional cardiopulmonary bypass (CPB) techniques have suffered from a number of disadvantages including haemodilution, inflammation and post-operative bleeding. Minimised cardiopulmonary bypass techniques use developments in perfusion technology to significantly reduce foreign surface-blood interactions to make bypass simpler and safer. This important book reviews key developments and issues relating to this promising technology. Part one covers the broad range of CPB pathophysiology, including anticoagulant protocols, the impact of CPB circuit surfaces, optimal haemodilution levels, and the important issue of CPB-induced systemic inflammatory response syndrome. Part two focuses on the issues of the new equipment developed for mini-CPB, optimal myocardial protection protocols and CPB perfusate options. Part three discusses clinical issues, including patient selection, coronary and valve surgery protocols and, among others, paediatric patients. With its distinguished editors and international team of expert contributors, Minimized cardiopulmonary bypass techniques and technologies is a valuable reference for cardiac surgery teams and those researching this important technology. - See more at: http://www.woodheadpublishing.com/en/book.aspx?bookID=2055#sthash.ev7PDoLU.dpu

Perioperative blood conservation strategies in pediatric patients undergoing open-heart surgery: impact of non-autologous blood transfusion and surface-coated extracorporeal circuits

WOS: 000290519400006PubMed: 21339244Background: The aim of this study was to explore the relative clinical and biomaterial effects of blood transfusions (Tx) and novel low-prime, surface-coated circuitry on perioperative outcome in a pediatric population undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: Over a 12-month period, 80 patients weighing > 10 kg undergoing ventricular septal defect (VSD) repair with CPB were prospectively randomized into two groups according to the type of CBP circuit used, then each randomized group was enrolled into two groups again, according to the need for transfusion (N=20): Group 1-Tx-free procedures on low-prime, surface-coated extracorporeal circuitry (FX05, Terumo); Group 2-procedures requiring Tx on coated circuitry; Group 3-Tx-free procedures with standard uncoated circuitry (D902, Sorin); Group 4 (Control)-procedures requiring Tx on uncoated circuitry. Blood samples were collected at baseline (T1), at the end of the CPB (T2) and 24 h (T3) postoperatively. rSO(2) desaturation risk score > 6000 (Invos, Somanetics) was calculated by multiplying rSO(2) 6000 (%) was 15.7 +/- 9 in Group 1 and 26.8 +/- 11 in control (p 10 kg by using combined blood management strategies

Clinical Performance and Biocompatibility of Novel Hyaluronan-Based Heparin-Bonded Extracorporeal Circuits

We tested documented in vitro and ex vivo advantages of novel hyaluronan based heparin bonded extracorporeal circuits in a prospective randomized study. During the period from June until September 2005, 40 patients undergoing reoperation for coronary artery bypass grafting were allocated into two equal groups (n = 20): Group 1 was treated with hyaluronan-based heparin-bonded circuits and group 2 was treated with uncoated control circuits. Complete blood count, fibrinogen, albumin, C3a, interleukin-2 levels, and thromboelastographic data were documented after induction of anesthesia (T1) and heparin administration before cardiopulmonary bypass (CPB) (T2), 15 minutes after initiation of CPB (T3), before cessation of CPB (T4), 15 minutes after reversal with protamine (T5), and the first postoperative day at 8:00 a.m. (T6). Hollow fibers were collected for consecutive biomaterial analysis by optical and scanning electron microscopy (SEM). Desorbed protein deposition on fibers was compared by spectrophotometry. Leukocyte counts were lower in T4-T6 in group 1 (p < .05). Platelet counts demonstrated significant differences at T4 and T5 in coated group (p < .05). Albumin and fibrinogen levels were better preserved in Group 1 at T4, T5 and T4, T6, consecutively (p < .05). C3a and IL-2 levels were lower at T3-T5 and T4-T5 in intervention group (p < .05). Postoperative hemorrhage was 412 ± 50 mL in group 1 and 684 ± 50 ml in group 2 (p < .05). Respiratory support time was shorter in group 1 versus control (p < .05). Platelet adhesion was significantly lower in intervention group. Amount of desorbed protein was 1.44 ± 0.01 mg/dL in group 1 and 1.94 ± 0.01 mg/dL in control (p < .05). SEM and spectrophotometry demonstrated better surface preservation in the hyaluronan coated group. Novel hyaluronan-based heparin-bonded circuits reduce platelet adhesion-aggregation and protein adsorption and provide better perioperative clinical parameters through platelet, albumin, and fibrinogen-sparing effects

Clinical Performance And Biocompatibility Of Hyaluronan-Based Heparin-Bonded Extracorporeal Circuits In Different Risk Cohorts

This prospective randomized study compares novel hyaluronan-based heparin-bonded circuits vs. uncoated controls across EuroSCORE patient risk strata including biomaterial evaluation. Over a two-year period, 90 patients undergoing coronary artery bypass grafting were prospectively randomized to one of the two perfusion protocols: Group 1 was treated with hyaluronan-based heparin-bonded preconnected circuits (Vision HFO-GBS (TM), Gish, CA, USA) and Group 2 with identical uncoated controls. Each group was composed of three subgroups (n = 15) with respect to preoperative evaluation of low (EuroSCORE 0-2), medium (3-5) and high (6+) risk patients. Blood samples were collected after induction (T1) and heparinization (T2), 15 min after cardiopulmonary bypass start (T3), before cessation of CPB (T4), 15 min after reversal (T5), and the first postoperative day (T6). In high-risk patients, platelet counts demonstrated significant preservation at T4, T5 and leukocyte counts were lower at T5 in hyaluronan group (P <= 0.05 vs. control). C3a (ng.ml(-1)) levels were significantly lower at T3 (0.2 +/- 0.04 vs. 0.31 +/- 0.05), T4 (0.25 +/- 0.04 vs. 0.51 +/- 0.05), T5 (0.38 +/- 0.04 vs. 0.56 +/- 0.05) and interleukin-6 (pg.ml(-1)) at T4 (91 +/- 18 vs. 124 +/- 20), T5 (110 +/- 20 vs. 220 +/- 25) in coated group vs. control (P <= 0.05). Protein desorption (microalbumin) on fibers (mg.mm(-3)) was less in hyaluronan vs. control groups (P <= 0.05). Hyaluronan coating reduced platelet adhesion and cell adsorption, and modulated inflammatory response in high-risk patients. (c) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.WoSScopu