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Raimondo P, Intini G, Lauletta G, Teora V, Lenoci SD, Rubino G, Villani MA, Armenise A, Stripoli A, Colantuono G, Di Bari N, Fiore G, Paternoster G, Grasso S. Cryoglobulinemia: the "cold" problem in cardiac surgery, a single-center experience and a literature review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:6. [PMID: 38273411 PMCID: PMC10811818 DOI: 10.1186/s44158-024-00141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
Cardiac surgery with cardiopulmonary bypass (CBP) is essential for different cardiac procedures in order to perform surgery with a clear sight field.To safely perform surgery with CPB and preserve brain, kidney, and patient tissue from ischemic damage, cold cardioplegia, and mild to deep hypothermia are induced during the operation.Cryoglobulinemia is a hematological/infective-related disease (in certain cases idiopathic) in which temperature-dependent antibodies tend to aggregate and form emboli in the vascular system causing tissue damage if exposed to low temperature.The patient with cryoglobulinemia (known and unknown) can be at risk of a major ischemic event during CPB and induced hypothermia.This article's aim is to evaluate the present scientific literature in order to understand how, in years, the therapeutic or preventive approach, is evolving, and to analyze and make improvements to the management of a cryoglobulinemic patient who must undergo elective or emergency cardiac surgery.In the last part of our article, we expose our single-center experience during a 32-month-long period of survey.In all cases, our medical team (anesthesiologists, perfusionists, and cardiac surgeons) opted for a normothermic cardiopulmonary bypass to lower the risk of cryoglobulin-associated complications.In our experience, along with therapeutic intervention to lower the cryoglobulin titer, normothermic management of cardiopulmonary bypass is as safe as hypothermic management.Notwithstanding our results, further studies with a larger population are needed to confirm this perioperative management in a cardiac surgery setting.
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Affiliation(s)
- Pasquale Raimondo
- Anesthesia and Intensive Care II, AOUC Policlinico Di Bari, Bari, Italy.
| | - Gianmarco Intini
- Division of Anesthesia and Intensive Care, University of Bari, Bari, Italy
| | - Gianfranco Lauletta
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Valentina Teora
- Division of Cardiac Surgery, AOUC Policlinico Di Bari, Bari, Italy
| | | | - Giovanni Rubino
- Anesthesia and Intensive Care II, AOUC Policlinico Di Bari, Bari, Italy
| | | | - Agnese Armenise
- Anesthesia and Intensive Care II, AOUC Policlinico Di Bari, Bari, Italy
| | - Antonia Stripoli
- Anesthesia and Intensive Care II, AOUC Policlinico Di Bari, Bari, Italy
| | | | - Nicola Di Bari
- Division of Cardiac Surgery, AOUC Policlinico Di Bari, Bari, Italy
| | - Giuseppe Fiore
- Anesthesia and Intensive Care II, AOUC Policlinico Di Bari, Bari, Italy
| | - Gianluca Paternoster
- Cardiovascular Anesthesia and Intensive Care, San Carlo Hospital Potenza, Potenza, Italy
| | - Salvatore Grasso
- Anesthesia and Intensive Care II, AOUC Policlinico Di Bari, Bari, Italy
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Edmiston M, Darehzereshki A, Badhwar V, Mehaffey JH. Perioperative management of cryoglobulinemia in patients requiring cardiac surgery. JTCVS Tech 2023; 21:92-94. [PMID: 37854811 PMCID: PMC10580163 DOI: 10.1016/j.xjtc.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Michael Edmiston
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Ali Darehzereshki
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J. Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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