International pediatric perfusion practice: 2011 survey results.

New cardiopulmonary bypass devices and new innovative methods are frequently reported in the literature; however, the actual extent to which they are adopted into clinical practice is not well known. We distributed an electronic survey to 289 domestic and international pediatric congenital surgery centers in an effort to measure attributes of current clinical practice. The survey consisted of 107 questions relating to program demographics, equipment, and techniques. Responses were received from 146 (51%) of queried centers and were stratified into five distinct geographic regions (North America, Central and South America, Oceana, Europe, and Asia). Most of the responding centers reported use of hard shell venous reservoirs. Closed venous systems were used at 50% of reporting centers in Central and South America as compared with only 3% in North America and 10% in Asia. Seventy-one percent of the programs used some form of modified ultrafiltration. Use of an arterial bubble detection system varied between 50% use (Central and South America) vs. 100% (North America and Oceana). Del Nido cardioplegia is more common in North America (32%) than any other continent, whereas Custodial HTK solution is much more prevalent in Europe (31%). Wide variation in practice was evident across geographic regions, suggesting opportunities for further investigation and improvement

Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer?

Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as conventional, inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015. Variation in equipment and management practices reflecting key areas of CPB is described across 47 centers (ANZCPR: 9; PERForm: 38). We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100%), as were all-but-cannula biopassive surface coatings (\u3e90%), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85% vs. PERForm: 64%). ANZCPR participants had 640 mL absolute higher net prime volumes, attributed in part to higher total prime volume (1,462 mL vs. 1,217 mL) and lower adoption of retrograde autologous priming (20% vs. 81%). ANZCPR participants had higher nadir hematocrit on CPB (27 vs. 25). Minimal absolute differences existed in exposure to high arterial outflow temperatures (36.6 degrees C vs. 37.0 degrees C). We report substantial center and registry differences in both the type of equipment used and CPB management strategies. These findings suggest that the term conventional bypass may not adequately reflect real-world experiences. Instead of using this term, authors should provide key details of the CPB practices used in their patients

Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer?

Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as conventional, inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015. Variation in equipment and management practices reflecting key areas of CPB is described across 47 centers (ANZCPR: 9; PERForm: 38). We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100%), as were all-but-cannula biopassive surface coatings (\u3e90%), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85% vs. PERForm: 64%). ANZCPR participants had 640 mL absolute higher net prime volumes, attributed in part to higher total prime volume (1,462 mL vs. 1,217 mL) and lower adoption of retrograde autologous priming (20% vs. 81%). ANZCPR participants had higher nadir hematocrit on CPB (27 vs. 25). Minimal absolute differences existed in exposure to high arterial outflow temperatures (36.6°C vs. 37.0°C). We report substantial center and registry differences in both the type of equipment used and CPB management strategies. These findings suggest that the term conventional bypass may not adequately reflect real-world experiences. Instead of using this term, authors should provide key details of the CPB practices used in their patients