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Fitzgerald DC, Wu X, Dickinson TA, Nieter D, Harris E, Curtis S, Mauntel E, Crosby A, Paone G, Goldberg JB, DeLucia A, Mandal K, Theurer PF, Ling C, Chores J, Likosky DS. Perfusion Measures and Outcomes (PERForm) registry: First annual report. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2024; 56:55-64. [PMID: 38888548 PMCID: PMC11185137 DOI: 10.1051/ject/2024006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/14/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology. METHODS This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (≥18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized. Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported. RESULTS A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 hospitals. Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years. Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time. The use of conventional ultrafiltration decreased over the study period (2019 vs. 2022; 27.1% vs. 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs. 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs. 75.9%). CONCLUSION Few robust clinical registries exist to collect data regarding the practice of CPB. Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.
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Affiliation(s)
- David C. Fitzgerald
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Medical University of South Carolina College of Health Professions 151-A Rutledge Avenue, A321 Charleston SC 29425 USA
| | - Xiaoting Wu
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Department of Cardiac Surgery, Michigan Medicine, University of Michigan 1500 E Medical Center Dr., 5144 Cardiovascular Center Ann Arbor MI 48109-5864 USA
| | - Timothy A. Dickinson
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Division of Cardiovascular Surgery, Mayo Clinic 200 First Street SW Rochester MN 55905 USA
| | - Donald Nieter
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Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative Arbor Lakes Building 3 #3130/4251 Plymouth Road Ann Arbor MI 48105 USA
| | - Erin Harris
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Medical University of South Carolina College of Health Professions 151-A Rutledge Avenue, A321 Charleston SC 29425 USA
| | - Shelby Curtis
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Medical University of South Carolina College of Health Professions 151-A Rutledge Avenue, A321 Charleston SC 29425 USA
| | - Emily Mauntel
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Medical University of South Carolina College of Health Professions 151-A Rutledge Avenue, A321 Charleston SC 29425 USA
| | - Amanda Crosby
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Department of Perfusion Services, University of Tennessee Medical Center 1924 Alcoa Hwy Knoxville TN 37920 USA
| | - Gaetano Paone
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Division of Cardiothoracic Surgery, Emory University School of Medicine 550 Peachtree Street, NE Davis-Fischer Bldg, 4th Floor Atlanta GA 30308 USA
| | - Joshua B. Goldberg
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Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital 525 E 68th St M 404 New York NY 10065 USA
| | - Alphonse DeLucia
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Department of Cardiac Surgery, University of Michigan Health West 2122 Health Dr. SW, Suite 133 Wyoming MI 49519 USA
| | - Kaushik Mandal
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Cardiovascular Services, Detroit Medical Center Sinai Grace Hospital 6001 West Outer Drive Suite POB 321 Detroit MI 48235 USA
| | - Patricia F. Theurer
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Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative Arbor Lakes Building 3 #3130/4251 Plymouth Road Ann Arbor MI 48105 USA
| | - Carol Ling
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Department of Cardiac Surgery, Michigan Medicine, University of Michigan 1500 E Medical Center Dr., 5144 Cardiovascular Center Ann Arbor MI 48109-5864 USA
| | - Jeffrey Chores
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Cardiovascular Services, Ascension St. John Providence Health System 16001 West Nine Mile Road Southfield MI 48075 USA
| | - Donald S. Likosky
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Department of Cardiac Surgery, Michigan Medicine, University of Michigan 1500 E Medical Center Dr., 5144 Cardiovascular Center Ann Arbor MI 48109-5864 USA
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Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative Arbor Lakes Building 3 #3130/4251 Plymouth Road Ann Arbor MI 48105 USA
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Durai Samy NK, Taksande K. Revolutionizing Cardiac Anesthesia: A Comprehensive Review of Contemporary Approaches Outside the Operating Room. Cureus 2024; 16:e55611. [PMID: 38586747 PMCID: PMC10995652 DOI: 10.7759/cureus.55611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
This review article provides a comprehensive examination of the evolution of cardiac anesthesia, emphasizing contemporary approaches beyond the traditional operating room (OR) setting. Tracing the historical roots of cardiac anesthesia from its inception in the mid-20th century, the narrative explores the significant paradigm shift driven by technological advancements and changing procedural approaches. The review highlights the emergence of non-OR environments, such as hybrid operating rooms, catheterization laboratories, and electrophysiology labs, as integral spaces for cardiac interventions. Key findings underscore the importance of patient selection, preoperative assessment, and specialized anesthetic management in optimizing outcomes. Implications for the future of cardiac anesthesia include the potential for enhanced patient-centered care, reduced complications, and improved resource utilization through the integration of advanced technologies. The call to action involves encouraging ongoing research and fostering collaboration among healthcare professionals to refine protocols further, address challenges, and propel the field toward continued innovation in contemporary cardiac interventions.
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Affiliation(s)
| | - Karuna Taksande
- Anaesthesiology, Jawaharlal Nehru Medical College, Wardha, IND
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Holman WL, Timpa J, Kirklin JK. Origins and Evolution of Extracorporeal Circulation: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2022; 79:1606-1622. [PMID: 35450579 DOI: 10.1016/j.jacc.2022.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 01/19/2023]
Abstract
Midway through the 20th century, direct open-heart operations were not yet a reality, awaiting safe methods to support the cardiopulmonary circulation during cardiac surgery. The scientific advancements collectively leading to safe cardiopulmonary bypass are considered some of the most impactful advances of modern medicine. Stimulated by the work of physiologists and engineers in the late 19th century, primitive pump and oxygenator designs were the forerunners of major work by DeBakey and others in roller pump design and by Gibbon in oxygenator development. Following Gibbon's historic successful closure of an atrial septal defect in 1953 with his heart-lung machine, it was left to Lillehei and Kirklin to first successfully repair large series of cardiac malformations. The history leading to these historic events and the subsequent evolution of cardiopulmonary bypass machines for short- and longer-term support is filled with engineering and surgical brilliance, daring innovations, and serendipity.
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Affiliation(s)
- William L Holman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph Timpa
- Cardiovascular Perfusion, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - James K Kirklin
- Division of Cardiothoracic Surgery, Kirklin Institute for Research in Surgical Outcomes (KIRSO), Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Pulmonary complications following cardiac surgery. ACTA ACUST UNITED AC 2020; 4:e280-e285. [PMID: 32368683 PMCID: PMC7191937 DOI: 10.5114/amsad.2019.91432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/24/2019] [Indexed: 12/19/2022]
Abstract
Coronary heart disease is a common diseases of atherosclerosis. Despite the development of noninvasive therapies and the advancement of pharmacological methods and extensive drug regimens, coronary artery bypass grafting surgery is still the ultimate treatment option in many patients. Among the various complications following open heart surgery, one of the common difficulties is pulmonary complications associated with subsequent morbidity and mortality, which should be studied according to preoperative, perioperative, and postoperative factors. Preoperative factors include genetics, age, family history of pulmonary disease, smoking, coexisting disease, etc. Perioperative factors include surgical procedures like sternotomy incision, cardioplegia, and internal mammary artery harvesting; anaesthesia procedure effects like pulmonary collapse, maintenance drugs and morphine administration; and cardiopulmonary bypass pump by systemic inflammatory response syndromes. And finally, postoperative factors, especially mediastinitis and the role of nursing in the intensive care unit. Pulmonary complications after cardiac surgery include atelectasis, pleural effusions, pneumonia, pulmonary oedema, cardiogenic pulmonary oedema, acute respiratory distress syndrome, pulmonary embolism, phrenic nerve injury, pneumothorax, sternal wound infection, and mediastinitis, with different outbreaks in patients reported. Although the preoperative, perioperative, and postoperative factors play an important role in the occurrence of these complications, the preoperative factors, as factors that can be adjusted, should be considered more than the others and explained to the patient, and the preoperative patient’s assessment should be noted. Also, postoperative care with the goal of reducing infections and pulmonary complications should be addressed by the nursing team.
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Bauer A, El-Essawi A, Gehron J, Böning A, Harringer W, Hausmann H. Systemminimalisierung im Rahmen der extrakorporalen Zirkulation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-019-00348-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yi B, Wang J, Yi D, Zhu Y, Jiang Y, Li Y, Mo S, Liu Y, Rong J. Remote Ischemic Preconditioning and Clinical Outcomes in On-Pump Coronary Artery Bypass Grafting: A Meta-Analysis of 14 Randomized Controlled Trials. Artif Organs 2017; 41:1173-1182. [PMID: 28741665 DOI: 10.1111/aor.12900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
The purpose of this article is to perform the first pooled analysis on remote ischemic preconditioning (RIPC) used for the improvement of clinical outcomes of patients only undergoing on-pump coronary artery bypass grafting (CABG) in randomized controlled trials (RCTs). A systematic search was performed using PubMed, the Cochrane Library, and the Web of Science to identify studies that described the effect of RIPC on postoperative mortality in patients only undergoing on-pump CABG. The outcomes included postoperative mortality, postoperative morbidity (including incidence of myocardial infarction, atrial fibrillation, stroke, acute kidney injury, and renal replacement therapy), mechanical ventilation (MV), intensive care unit length of stay (ICU LOS), and hospital length of stay (HLOS). A total of 14 RCTs (2830 participants) were included. Our meta-analysis found that RIPC failed to reduce the postoperative mortality in patients only undergoing on-pump CABG compared with control individuals (odds ratio, 0.81; 95% confidence interval, [0.40, 1.64]; P = 0.55; I2 = 25%). Moreover, there were no differences in postoperative morbidity, ICU LOS, and HLOS between the two groups. However, MV in the RIPC group was shorter than that in control individuals (standard mean difference, -0.41; 95% confidence interval, [-0.80, -0.01]; P = 0.04; I2 = 73%). The present meta-analysis found that RIPC failed to improve most of clinical outcomes in patients only undergoing on-pump CABG; however, MV was reduced. Adequately powered trials are warranted to provide more evidence in the future.
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Affiliation(s)
- Bin Yi
- Department of Cardiothoracic Surgery, Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.,Department of Extracorporeal Circulation, Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Jianhui Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dingwu Yi
- Department of Cardiac Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanling Zhu
- Department of Extracorporeal Circulation, Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Yumei Jiang
- Department of Extracorporeal Circulation, Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Yi Li
- Department of Extracorporeal Circulation, Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Shaoyan Mo
- Department of Extracorporeal Circulation, Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Yi Liu
- Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian Rong
- Department of Extracorporeal Circulation, Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
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Allareddy V, Prakasam S, Rampa S, Stein K, Nalliah RP, Allareddy V, Rengasamy Venugopalan S. Impact of Periapical Abscess on Infectious Complications in Patients Undergoing Extracorporeal Circulation Auxiliary to Open-Heart Surgical Procedures. J Evid Based Dent Pract 2016; 17:13-22. [PMID: 28259310 DOI: 10.1016/j.jebdp.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Extracorporeal circulation auxiliary to open-heart surgeries (ECAOHS) may exert nonphysiological stresses on periapical abscessed tissues leading to hematogenous spread of microbes. The aim of this report was to estimate risk of postoperative infectious complications in patients with periapical abscesses and undergoing ECAOHS. METHODS A retrospective analysis of Nationwide Inpatient Sample (years 2009 and 2010) was conducted. All patients (aged 19 to 65 years) who underwent ECAOHS were selected. International Classification of Diseases-9-Clinical Modification codes were used to identify the presence of periapical abscess and infectious complications. Multivariable logistic regression models were used to examine the associations between the presence of periapical abscess and occurrence of infectious complications. RESULTS A total of 265,235 patients underwent an ECAOH procedure. Of these, 431 patients had a periapical abscess. Septicemia developed in 16% of those with periapical abscess (compared with 4.2% in those without periapical abscess). Those with periapical abscess had higher rates of any of the infectious complications when compared with those without periapical abscess (30.2% vs 11.6%, respectively). After adjustment for multiple confounders, those with periapical abscess were associated with higher odds for developing septicemia (odds ratio = 2.51, 95% confidence interval = 1.06-5.91, P = .04) and any of the infectious complications (odds ratio = 2.23, 95% confidence interval = 1.08-4.59, P = .03) when compared with those who did not have periapical abscess. CONCLUSIONS Those with periapical abscess are associated with higher odds for infectious complications when compared with those without periapical abscess.
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Affiliation(s)
- Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, IA, USA.
| | - Sivaraman Prakasam
- Department of Periodontology, Oregon Health & Science University, Portland, OR, USA
| | - Sankeerth Rampa
- Health Services Research & Administration Department, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kyle Stein
- Department of Oral and Maxillofacial Surgery, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, IA, USA
| | - Romesh P Nalliah
- Department of Cariology, Restorative Sciences, and Endodontics, Office of Patient Services, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Veerajalandhar Allareddy
- Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA, USA
| | - Shankar Rengasamy Venugopalan
- Department of Orthodontics and Dentofacial Orthopedics, University of Missouri, Kansas City School of Dentistry, Kansas City, MO, USA
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Mai CL, Ahmed Z, Maze A, Noorulla F, Yaster M. Pediatric transport medicine and the dawn of the pediatric anesthesiology and critical care medicine subspecialty: an interview with pioneer Dr. Alvin Hackel. Paediatr Anaesth 2016; 26:475-80. [PMID: 26992643 DOI: 10.1111/pan.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/29/2022]
Abstract
Dr. Alvin 'Al' Hackel (1932-) Professor Emeritus of Anesthesiology, Perioperative and Pain Medicine, and Pediatrics at the Stanford University School of Medicine, has been an influential pioneer in shaping the scope and practice of pediatric anesthesia. His leadership helped to formally define the subspecialty of pediatric anesthesiology ('who is a pediatric anesthesiologist?') and the importance of specialization and regionalization of expertise in both patient transport and perioperative care. His enduring impact on pediatric anesthesia and critical care practice was recognized in 2006 by the American Academy of Pediatrics when it bestowed upon him the profession's highest lifetime achievement award, the Robert M. Smith Award. Of his many contributions, Dr. Hackel identifies his early involvement in the development of pediatric transport medicine as well as the subspecialty of pediatric anesthesiology as his defining contribution. Based on a series of interviews held with Dr. Hackel between 2009 and 2014, this article reviews the early development of transportation medicine and the remarkable career of a pioneering pediatric anesthesiologist.
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Affiliation(s)
- Christine L Mai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Zulfiqar Ahmed
- Anesthesia Associates of Ann Arbor, Wayne State University, Detroit, MI, USA
| | - Aubrey Maze
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA
| | | | - Myron Yaster
- Departments of Anesthesiology, Critical Care Medicine and Pediatrics, The Johns Hopkins University, Baltimore, MD, USA
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Abstract
Cardiopulmonary bypass (CPB) is indispensable for cardiac surgery but leads to systemic inflammatory responses and leukocyte activation, possibly due to blood contact with the surface of the CPB unit, surgical, ischemic reperfusion injury, etc. Systemic inflammatory responses during CPB result in increased morbidity and mortality. Activation of leukocytes is an important part of this process and directly contributes to coagulopathy and hemorrhage. This inflammatory response may contribute to the development of postoperative complications, including myocardial dysfunction, respiratory failure, renal and neurologic dysfunction, altered liver function and ultimately, multiple organ failure. Various pharmacologic and mechanical strategies have been developed to minimize the systemic inflammatory response during CPB. For example, leukocyte removal filters were developed in the 1990s for incorporation into the CPB circuit. However, studies of this approach have yielded conflicting findings. The purpose of this was to review the studies of a novel leukocyte removal filter in patients undergoing CPB.
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Affiliation(s)
- Yutaka Fujii
- a Department of Artificial Organs , National Cerebral and Cardiovascular Center Research Institute , Osaka , Japan
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