Mastering the Best Practices:A Comprehensive Look at the European Guidelines for Cardiopulmonary Bypass in Adult Cardiac Surgery

The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.</p

a rare case of pacemaker lead endocarditis successfully treated with open heart surgery

Background: Cardiac device-related endocarditis has emerged as a serious complication in the era of advanced medical technology. Pacemaker related infections are rare and life-threatening with incidence from 0.06% to 7% and high mortality rate (30-35%). Diagnosis is hard, frequently delayed and could be even missed due to poor clinical findings. The average delay in diagnosis is 5.5 month. We report a case of the late-onset of pacemaker lead endocarditis caused by S. epidermidis successfully treated with open heart surgery. Case Report: Patient with persistent high fever for 11 month and suspicion for infective endocarditis was admitted in Cardiovascular Institute. No clinical signs of endocarditis were observed. TTE revealed large vegetation 30 × 17 mm attached to the atrial electrodes with high embolic potential. This finding was verified by transesophageal echocardiography (TEE), although CT scan did not reveal vegetation. Blood cultures were negative. A sternotomy with cardiopulmonary bypass was performed and electrodes were extracted with large vegetation. Intraoperative finding revealed large thrombus with vegetation around pacemaker leads. Cultures of the electrodes and vegetation revealed Staphylococcus epidermidis. Surgery was followed up with antibiotic treatment for 6 weeks. He has been followed up for the next 2 years, and without complications. Conclusion: The absence of criteria for endocarditis and negative blood cultures should not keep the physician from ruling out lead endocarditis. This complication carries high risk of mortality if left untreated

Changes in the muscular outputs of young judoists during resistance exercises performed on unstable equipment: A case study

Background and Study Aim: Resistance exercises under unstable conditions have gained popularity among athletes. The aim of the study was to investigate the changes in muscular outputs (peak power and velocity of movement) during bench presses and squats under unstable conditions in comparison to the outputs under stable conditions. Material/Methods: A total of 20 participants, divided into two groups, took part in the study The first group consisted of 9 top-level young male judoists, while the second group consisted of 11 students. All of the exercises were performed once 70% of one-repetition maximum (1RM) was determined. Results: The analysis showed a significant reduction in muscular outputs during squats under unstable conditions (the BOSU ball) in comparison to stable conditions for the group of judoists. However, there was no significant reduction in muscular outputs during the bench presses under unstable conditions (the Swiss ball) compared to the stable flat bench. For the group of students, the analysis showed a significant reduction in muscular outputs during the bench press under unstable conditions when compared to the stable flat bench. In addition, for this group the muscular outputs were significantly lower during squats under unstable in comparison to stable conditions. Conclusions: The bench press as a resistance exercise performed on a Swiss ball with reduced training load cannot be recommended as an effective training model for judoists. Nevertheless, the squat with reduced training load under unstable conditions provided sufficient challenges to the neuromuscular system and could be incorporated into training programs. © ARCHIVES OF BUDO|SCIENCE OF MARTIAL ARTS

Pneumonia in medical professionals during COVID-19 outbreak in cardiovascular hospital

OBJECTIVES:The pandemic of coronavirus associated disease (COVID-19) placed the health care workers at high risk. We investigated clinical and treatment characteristics of infected medical professionals in a cardiovascular hospital. METHODS: The study was retrospective, conducted in tertiary cardiovascular hospital and included employees with confirmed coronavirus infection. They filled out a questionnaire about health status, symptoms, admission to hospital and treatment. The vaccination status against tuberculosis, hepatitis B and seasonal influenza was assessed. Pneumonia was defined as CT finding of ground glass opacifications (GGO) with consolidations typical for COVID-19. RESULTS: The study included 107 confirmed cases of COVID - 19 out of 726 employees (15%). Most of the infected were from cardiac surgery department (74/107, 69%). Substantial number of employees did not have any symptoms [31 (28.9%)] and 38 patients (35.5%) were admitted to hospital. The average hospital length of stay was 8.1 ± 5.6 days. Seventy-five of 107 (70.1%) received seasonal influenza vaccine. Pneumonia with CT features of GGO and consolidation occurred in 25/107 (23.4%) patients of which 14/107 (13.1%) had bilateral involvement. In multivariate logistic regression analysis including recognized characteristics associated with worse outcomes in COVID-19 (obesity, diabetes mellitus, coronary artery disease, cerebrovascular disease, current smoking, heart failure, influenza immunization), only influenza immunization remained an independent predictor of occurrence of bilateral pneumonia (OR 0.207; 95%CI[0.050 – 0.847]; p = 0.029). CONCLUSIONS: The association of influenza immunization and less aggressive form of pneumonia might provide a finding that supports the institution of preventive measures that can be beneficial in reduction of global coronavirus burden

Pulmonary Vein Isolation Outcome Degree Is a New Score for Efficacy of Atrial Fibrillation Catheter Ablation

This study introduces the pulmonary vein isolation outcome degree (PVIOD) as a new semiquantitative measure for the efficacy of atrial fibrillation (AF) catheter ablation and reports the determination of predictors associated with PVIOD. The median follow-up periods of 117 patients after the first and last ablation were, respectively, 82 (IQR 15) and 72 (IQR 30) months. PVIOD 1 included 32.5% of patients, those with successful single pulmonary vein isolation (PVI); PVIOD 2 included 29.1% of subjects, those with success after multiple procedures; PVIOD 3 comprised 14.5% of patients, those with clinical success; and PVIOD 4 included 23.9% of cases, those with procedural and clinical failure. In the multivariate ordinal logistic regression analysis, PVIOD 1–4 were independently associated with longstanding persistent AF with paroxysmal AF as the referent category (odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.1–10.7 (p = 0.031)), left atrial (LA) diameter (OR, 1.2; 95% CI, 1.1–1.3 (p = 0.001)) and left ventricular ejection fraction (LVEF) (OR, 0.9; 95% CI, 0.86–1.0 (p = 0.038)). LA size > 41 mm, LVEF ≤ 50% and longstanding persistent AF are strong predictors of AF recurrence. PVIOD 1–4 offer the most exact long-term prognosis of PVI. The purpose of the present article is to expand the quantitative measure of procedural success in the medical and biological fields