Extensive cell salvage and postoperative outcomes following thoracoabdominal and descending aortic repair

Kiser, Kelsie; Tanaka, Akiko; Sandhu, Harleen K.; Miller, Charles C.; Leonard, Samuel D.; Safi, Hazim J.; Estrera, Anthony L.

doi:10.1016/j.jtcvs.2020.06.005

Cited by 11 publications

(8 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the 2017 EACS/EACTA guidelines, CS has a category IIa recommendation for routine use as a component of PBM strategies during cardiac surgery in adult patients with the goal of minimizing the need for allogeneic blood products ( 12 ). While advantageous, however, this savage strategy has been shown to reduce coagulation factors and contribute to higher rates of postoperative infective morbidity ( 13 , 14 ). This is particularly important given that infections are the most common non-cardiac complication following cardiac surgical procedures and they have a pronounced impact on patient survival and readmission rates ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

Zhou

Chen

et al. 2023

Front. Med.

View full text Add to dashboard Cite

BackgroundThis study was designed to explore factors associated with the incidence of positive bacterial culture of salvaged red blood cells (sRBCs) recovered with a Cell Saver instrument during cardiac surgery and the impact of such positive outcomes on postoperative infection-related morbidity.MethodsThe cohort study enrolled 204 patients scheduled for cardiac surgery with intraoperative blood cell salvage and retransfusion from July 2021 to July 2022. These patients were stratified into two groups based on intraoperative sRBCs bacterial culture results: culture (+) and culture (−) groups. Preoperative and intraoperative variables were compared between these groups aim to detect possible predictors of positive culture in sRBCs. In addition, differences in postoperative infection-related morbidity and other clinical outcomes were compared between these groups.ResultsOf these patients, 49% were sRBCs culture (+), with Staphylococcus epidermidis as the most commonly identified pathogen. Risk factors independently associated with the risk of positive culture in sRBCs included BMI ≥25 kg/m2, a history of smoking, an operative duration ≥277.5 min, the higher number of staff in the operating room and higher surgical case order. Patients in the sRBCs culture (+) group exhibited a longer average ICU stay [3.5 days (2.0–6.0) vs. 2 days (1.0–4.0), P < 0.01], a longer duration of ventilation [20.45 h (12.0–17.8) vs. 13 h (11.0–17.0, P = 0.02)], underwent more allogeneic blood transfusions, exhibited higher transfusion-related costs [2,962 (1,683.0–5,608.8) vs. 2,525 (1,532.3–3,595.0), P = 0.01], and had higher rates of postoperative infections (22 vs. 9.6%, P = 0.02) as compared to patients in the sRBCs culture (−) group. In addition, culture (+) in sRBCs was an independent risk factor for postoperative infection (OR 2.62, 95% CI 1.16–5.90, P = 0.02).ConclusionStaphylococcus epidermidis was the most common pathogen detected in sRBCs in the culture (+) group in this study, identifying it as a potential driver of postoperative infection. Positive sRBCs culture may contribute to postoperative infection and its incidence was significantly associated with patient BMI, history of smoking, operative duration, the number of staff in the operating room and surgical case order.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

Zhou

Chen

et al. 2023

Front. Med.

View full text Add to dashboard Cite

show abstract

“…However, additional risk factors are known to contribute to its onset, and should be considered when implementing or developing methods of kidney protection. In 2022, Kiser and colleagues identified intensive use of cell salvage during LHB as a risk factor for AKI and operative mortality 68 . The common strategy of reinfusing unwashed, salvaged blood into the patient circulation is a likely cause of significant intravascular haemolysis.…”

Section: Additional Risk Factorsmentioning

confidence: 99%

Kidney Protection During Surgery on the Thoracoabdominal Aorta: A Systematic Review

Bennett,

Shirley,

Wilm

et al. 2024

Preprint

View full text Add to dashboard Cite

ObjectivesPost-operative acute kidney injury (AKI) is a common complication of surgery to repair the thoracoabdominal aorta, and is associated with increased risks of dialysis and early mortality. Perfusion techniques are routinely used during surgery to reduce renal injury. We conducted a systematic review of renal and mortality outcomes by perfusion technique, to evaluate their effectiveness in providing kidney protection.MethodsWe searched PubMed, Web of Science,ClinicalTrials.govand ClinicalTrialsRegister.EU to identify relevant studies published from 1995 to 2023. Included studies were quality assessed, and data extracted. Findings of the highest quality studies were used to synthesise a narrative discussion.Results44 studies were included in our analysis, featuring three systemic perfusion strategies: Left heart bypass (LHB; n=24), cardiopulmonary bypass with deep hypothermic circulatory arrest (DHCA; n=17), and partial cardiopulmonary bypass (pCPB; n=11). Three categories of selective renal perfusion (SRP) strategy were identified: Warm blood, cold blood and cold crystalloid. Our analysis found that operative mortality was 0-22.0% following LHB, 2.2-12.5% following DHCA and 0-42.1% following pCPB. The incidence of post-operative renal replacement therapy (RRT) was 0-40.0% following LHB, 0-13.8% following DHCA and 0-31.6% following pCPB.ConclusionsIntra-operative perfusion strategies can facilitate kidney protection through improved oxygenation or hypothermic preservation. Distal aortic perfusion (DAP), with LHB or pCPB, is associated with lower rates of dialysis and operative mortality than simple aortic cross clamping. Whilst DHCA is associated with low rates of AKI, its use has not been evaluated through high-quality research. For extensive aneurysm repairs, adjunctive SRP with cold blood or crystalloid fluids is shown to enhance kidney protection during DAP, whereas warm blood SRP is associated with increased rates of AKI and operative mortality. We identify the optimisation of warm blood SRP and the attenuation of intravascular haemolysis as urgent areas of research to address the problem of AKI.

show abstract

“…When cell salvage amount exceeds 30 to 40 units, appropriate blood products should be given to correct the coagulopathy. 21 In cases of persistent coagulopathy, vacuum-assisted closure of the abdomen with sponge and pad packing may be instituted. Infusion of platelet-rich plasma may also be considered to reduce the intraoperative bleeding.…”

Section: Hemostasis and Closurementioning

confidence: 99%

Open Treatments for Thoracoabdominal Aortic Aneurysm Repair

Tanaka¹,

Smith²,

Safi³

et al. 2023

Methodist DeBakey Cardiovascular Journal

Self Cite

View full text Add to dashboard Cite

Thoracoabdominal aortic aneurysms (TAAA) represent a unique pathology that is associated with considerable mortality if untreated. While the advent of endovascular technologies has introduced new modalities for consideration, the mainstay of TAAA treatment remains open surgical repair. However, the optimal conduct of open TAAA repair requires careful consideration of patient risk factors and a collaborative team effort to mitigate the risk of perioperative complications. In this chapter, we briefly outline the history of treating TAAA, preoperative preparation and postoperative care, and our operative techniques for treatment.

show abstract

Extensive cell salvage and postoperative outcomes following thoracoabdominal and descending aortic repair

Cited by 11 publications

References 14 publications

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

Kidney Protection During Surgery on the Thoracoabdominal Aorta: A Systematic Review

Open Treatments for Thoracoabdominal Aortic Aneurysm Repair

Contact Info

Product

Resources

About