Posts by Luc Puis
Platelet Aggregation in Whole Blood is Not Impaired by A Platelet-Sparing Leukoreduction Filter and Instead Depends Upon the Presence of Leukocytes
WB filtration results in platelet count reduction and leukocyte removal; however, platelet IA is not degraded by passage through the filter. Apparent declines in platelet IA responses can be fully attributed to the reduction in platelet count and the removal of leukocytes.
Read MoreEffect of 6% Hydroxyethyl Starch 130/0.4 on Inflammatory Response and Pulmonary Function in Patients Having Cardiac Surgery: A Randomized Clinical Trial
Our investigation found no significant difference in the concentrations of inflammatory markers and measures of pulmonary function between cardiac surgical patients who received 6% HES 130/0.4 versus 5% albumin.
Read MoreOptimizing Cerebral Perfusion and Hemodynamics During Cardiopulmonary Bypass Through Cannula Design Combining In Silico, In Vitro And In Vivo Input
From this we propose another easy-to-manufacture cannula design (opti2CAN) that decreases areas burdened by high WSS, while preserving physiological cerebral flow and favorable hemodynamics. With this novel cannula design, we propose a cannulation option to reduce neurological complications and the prevalence of stroke in high-risk patients after CPB.
Read MoreBalanced Forced-Diuresis as A Renal Protective Approach in Cardiac Surgery: Secondary Outcomes of Electrolyte Changes
Balanced forced-diuresis with the RG reduced AKI rates after on-pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.
Read MoreEarly Motor Outcomes in Infants with Critical Congenital Heart Disease are Related to Neonatal Brain Development and Brain Injury
Neonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.
Read MoreSurvey of Practice Pattern in Patients With Heparin-Induced Thrombocytopenia Requiring Cardiopulmonary Bypass
Most responding SCA and AmSECT members reported that their institution used a protocol or guideline for HIT/CPB cases, and most guidelines directed the use of bivalirudin as an alternative anticoagulant. Various other methods such as plasmapheresis are also being used with success in this patient population. Further research, including comparison studies of alternative anticoagulant strategies, is required to elucidate the best approach to these difficult cases.
Read MoreA Real-Time Analysis of Intraoperative Interruptions in Relation to Use of Simple Preventive Measures Including A Sign On The Door and A Checklist-Based Team Brief
Our findings revealed significantly reduced interruptions after a simple preventive measure including team brief and the placement of a warning sign for unnecessary door openings.
Read MoreHeparin Resistance — Clinical Perspectives and Management Strategies
Heparin resistance is suspected when more heparin than usual is needed to achieve a therapeutic range of activated partial-thromboplastin time. Management may include increasing the heparin dose, supplementing antithrombin III levels, and using direct thrombin inhibitors.
Read MoreAcute Kidney Injury During Extracorporeal Membrane Oxygenation: VA ECMO Versus VV ECMO
Although mortality rates related to AKI/severe AKI during VV ECMO are high, the occurrence of AKI/severe AKI during VA ECMO should be given greater attention, as these instances are considered strong indicators of patient deterioration and even death. Additional studies are needed to corroborate these findings.
Read MoreProne Positioning in Postoperative Cardiac Surgery Patients: A Narrative Review
The aim of this article is to provide an overview of available literature, which seems to suggest the efficacy of prone positioning, and to make an in-depth analysis of the studies on this topic by evaluating the efficacy of this maneuver on hard endpoints.
Read MoreComparison of the Effects of Ringer’s Lactate and 6% Hydroxyethyl Starch 130/0.4 on Blood Loss and Need for Blood Transfusion After Off-Pump Coronary Artery Bypass Graft Cardiac Surgery
Crystalloids (RL) provide similar outcomes to HES and can be used as substitutes to colloids during cardiac surgery. However, further large-scale multicenter studies with varied indications can be suggested to substantiate the equivalence of crystalloids to colloids in perioperative management.
Read MorePostoperative Nadir Hemoglobin and Adverse Outcomes in Patients Undergoing On-Pump Cardiac Operation
Compared with the risks when nadir hemoglobin is 9.0 to 9.9 g/dL, the risk of composite adverse events increases when postoperative nadir hemoglobin is below 9.0 g/dL, whereas risk of death increases when nadir hemoglobin is below 7.0 g/dL.
Read MoreAn Update From The Society of Thoracic Surgeons Workforce on Evidence-Based Surgery: Improving the Implementation of Clinical Practice Guidelines
Indirect evidence on the impact of CPGs may also be derived from observing temporal trends in practice patterns and outcomes before and after publication of CPGs. A better understanding of when, how, and how completely CPGs are implemented in various practice settings is currently lacking, and more research is needed to address existing hurdles in implementation of CPGs.
Read MorePatient Blood Management and Blood Conservation – Complimentary Concepts and Solutions for Blood Establishments and Clinical Services in South Africa and Beyond
In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immed
Read MoreElimination of CO2 Insufflation-Induced Hypercapnia in Open Heart Surgery Using an Additional Venous Reservoir
An additional venous reservoir for the evacuation of blood from the open surgical wound eliminates CO2Â insufflation-induced hypercapnia in open heart surgery keeping PaCO2Â and sweep gas flow constant. This prevents possible CO2-induced hyperperfusion of the brain and decreases the risk of cerebral particulate embolization during CO2Â insufflation for de-airing in open heart surgery.
Read MoreWhich Factors Have a Great Impact on Coagulopathy and Hemostatic Impairment after Cardiopulmonary Bypass in Cardiovascular Surgery? An Analysis Based on Rotational Thromboelastometry
In perioperative hemostatic management using ROTEM, attention should be given to the effects of these multiple factors.
Read MoreNon-Governmental Organizations Delivering Global Cardiac Surgical Care: A Quantitative Impact Assessment
NGOs effectively address the burden of cardiac surgical disease in LMICs and contribute to local capacity-building. Increased, more detailed, and standardized reporting of the impact and outcomes of NGOs is necessary to better understand annual cardiac surgical volume and to support local centers working towards independent services.
Read MoreHigh Socioeconomic Deprivation and Coronary Artery Bypass Grafting Outcomes: Insights from Michigan
Isolated CABG patients residing in the highest areas of socioeconomic deprivation differed with respect to demographic and clinical characteristics, and experienced worse short and long-term outcomes compared with those not in the top ADI decile.
Read MoreCerebral Microemboli during Extracorporeal Life Support: A Single-Centre Cohort Study
Our results indicate that adult ECLS patients are continuously exposed to many gaseous and, frequently, to few solid cerebral microemboli. Prolonged cerebral microemboli formation may contribute to neurological morbidity related to ECLS treatment.
Read MoreAcute Kidney Injury and Extracorporeal Membrane Oxygenation: Review on Multiple Organ Support Options
The combination of CRRT and ECMO can be considered a form of multiple organ support therapy, but this approach still requires optimization in timing, set-up, anticoagulation, prescription and delivery. The aim of this report is to review the pathophysiology of AKI, the CRRT delivery, anticoagulation strategies and outcomes of patients with AKI treated with ECMO.
Read MoreThe Association of Matrix Metalloproteinases With Acute Kidney Injury Following CPB-Supported Cardiac Surgery
Although the pilot study may have limitations, it has demonstrated that the serum and urine levels of activity of MMP-2 and MMP-9 are associated with the clinical endpoint of AKI and appear to have earlier rising levels as compared with those of serum creatinine. Furthermore, in depth, exploration is underway with a larger sample size to attempt validation of the analytical performance and reproducibility of the assay for MMP-2 and MMP-9 to aid in earlier diagnosis of AKI following CPB-supported cardiac surgery.
Read MoreThe Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass
This study demonstrated that a low AFR (<9.35) during CPB was an independent risk factor for AKI in VSD infants following cardiac surgery with CPB.
Read MoreCentrifugal and Roller Pumps in Neonatal & Pediatric Extracorporeal Membrane Oxygenation
A total of four studies with 9111 patients were included. There was a statistically significant difference in in-hospital mortality, favoring the groups where roller pumps were used. Roller pumps were associated with fewer episodes of hemolysis, mechanical complications, cardiac complications, renal complications, and less inotropic support. ECMO with roller pumps may be associated with lower mortality in children. Roller pumps were associated with fewer complications, as well as reduced hemolysis and use of inotropes.
Read MoreDynamic and Hybrid Configurations for Extracorporeal Membrane Oxygenation
We concluded that dynamic or hybrid ECMO configurations were used in various underlying diseases, in which V-AV was most commonly used. Patients receiving VV ECMO for respiratory support initially, who then converted to other configurations for both respiratory and circulatory support, had significantly worst outcomes among the groups studied. The initial configuration should be selected carefully after thorough assessment of patient condition.
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