A prospective randomised multicentre clinical comparison of a minimised perfusion circuit versus conventional cardiopulmonary bypass☆☆☆

El-Essawi, Aschraf; Hájek, Tomáš; Skorpil, J; Böning, Andreas; Sabol, František; Hausmann, Harald; Ostrovsky, Yuri; Harringer, Wolfgang

doi:10.1016/j.ejcts.2010.01.035

Cited by 37 publications

(29 citation statements)

References 24 publications

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“…As mentioned above, the importance of nonelective presentation cannot be overemphasized, 4 with emergency status and hemodynamic instability conferring a uniform high risk. 21 Reduction in cardiac arrhythmias with routine arrhythmia prophylaxis has shown promise. 18Y20 In this large data set, however, reoperation was a very important risk factor (ranking similarly to renal failure and cardiogenic shock), and a uniform and similar negative effect was observed across the procedural types.…”

Section: Discussionmentioning

confidence: 99%

Outcome Characteristics of Multiple-Valve Surgery

Vassileva

Thourani

et al. 2014

Innovations�(Phila)

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Objective Multiple-valve (MUV) procedures currently exhibit higher operative mortality than do single-valve procedures, but a paucity of scientific information exists to explain the observation. This topic was examined using The Society of Thoracic Surgeons Database. Methods All patients in the The Society of Thoracic Surgeons data set undergoing valve surgery (except pulmonary valve and aortic root operations) from 1993 through 2007 were identified (N = 623,039). Baseline characteristics and postoperative outcomes were contrasted between all seven combinations of single-valve and MUV procedures involving aortic, mitral, and tricuspid valves. Seven independent logistic regression analyses were performed, based on the seven procedures, and multivariable risk factors for mortality were compared, with emphasis on single-valve versus MUV procedures. Results Baseline characteristics for MUV procedures (n = 67,926) shared many similarities to those for single-valve procedures (n = 555,113), including age, ejection fraction, and comorbidities. Preoperative renal failure, New York Heart Association class III to IV, nonelective presentation, and reoperation were slightly more common in MUV subsets, and coronary bypass was less frequent. Operative mortality was almost double for MUV as compared with single-valve procedures (10.7% vs 5.7%, P = 0.0001). Categorical predictors with the largest odds ratios for mortality were emergency status, renal failure, and second reoperation. However, predictors for mortality were generally consistent in order and magnitude between the single-valve and MUV subgroups. Conclusions Despite similarities in preoperative profiles of the patients undergoing single-valve and MUV procedures, mortality for MUV surgery remains considerably higher. Determinants of operative mortality and morbidity differ little across the procedural groups, and these findings serve as a benchmark for future studies, as well as suggest a continued search for explanations of poorer MUV outcomes.

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Section: Discussionmentioning

confidence: 99%

Outcome Characteristics of Multiple-Valve Surgery

Vassileva

Thourani

et al. 2014

Innovations�(Phila)

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“…CPB can impact upon the cellular and non-cellular elements of blood resulting in the activation of different pro-inflammatory cascades (Anselmi, et al, 2004;Hill, 1998;Khoynezhad, Jalali, & Tortolani, 2004;Rinder, 2006;Suleiman, Zacharowski, & Angelini, 2008). It is now generally accepted that CPB is a direct trigger of cardiac injury since miniaturized cardiopulmonary bypass is associated with less cardiac injury compared to conventional bypass (El-Essawi, et al, 2010;Nguyen, et al, 2014;Remadi, Rakotoarivelo, Marticho, & Benamar, 2006;Skrabal, Steinhoff, & Liebold, 2007). More importantly, miniaturized cardiopulmonary bypass is associated with less inflammatory response (Remadi, et al, 2006;Skrabal, et al, 2007;van Boven, Gerritsen, Waanders, Haas, & Aarts, 2004).…”

Section: Systemic Inflammatory Response During Surgerymentioning

confidence: 95%

Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery

Zakkar

Ascione

James

et al. 2015

Pharmacology & Therapeutics

191

129

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Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that occurs in up to 60% of patients. POAF is associated with increased risk of cardiovascular mortality, stroke and other arrhythmias that can impact on early and long term clinical outcomes and health economics. Many factors such as disease-induced cardiac remodelling, operative trauma, changes in atrial pressure and chemical stimulation and reflex sympathetic/parasympathetic activation have been implicated in the development of POAF. There is mounting evidence to support a major role for inflammation and oxidative stress in the pathogenesis of POAF. Both are consequences of using cardiopulmonary bypass and reperfusion following ischaemic cardioplegic arrest. Subsequently, several anti-inflammatory and antioxidant drugs have been tested in an attempt to reduce the incidence of POAF. However, prevention remains suboptimal and thus far none of the tested drugs has provided sufficient efficacy to be widely introduced in clinical practice. A better understanding of the cellular and molecular mechanisms responsible for the onset and persistence of POAF is needed to develop more effective prediction and interventions.

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“…In another randomized trial, Skrabal et al (Skrabal et al 2007) reported lower myocardial damage with lower levels of creatine-kinase MB and troponine T in patients operated on with MECC system. In a prospective randomized multicenter study (El-Essawi et al 2010), comparing MECC system with conventional ECC, the Authors found statistical differences in need of total transfusion and blood product transfusion. Moreover a lower incidence rate of postoperative atrial fibrillation was detected in MECC group.…”

Section: Miniaturized Extracorporeal Circulation and Isolated Cabg Opmentioning

confidence: 99%

“…The oxygenator of the MECC circuit is one of the most important components of the circuit itself. Oxygenators have the oxygenation membrane of either microporous polypropylene (El-Essawi et al 2010;Wippermann et al 2005) or polymethylpentene (Anastasiadis et al 2011;Puehler et al 2010;Formica et al 2009;Remady et al 2006;). In the latter case the membrane is considered as a diffusion membrane Usually the oxygenator has an integrated heat exchanger and one of the largest gas exchange surface areas, reaching about 2.4 m 2 .…”

Section: Anatomy Of the Miniaturized Extracorporeal Circulation Systemmentioning

confidence: 99%