Perfusion
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Coronary artery bypass (CABG) surgery with cardiopulmonary bypass (CPB) has been the "gold standard" for many years. However, methods to conduct off-pump coronary artery bypass (OPCAB) surgery with a beating heart have decreased the use of CPB. Improvements in cardiopulmonary bypass technology, using low-prime circuits with retrograde autologous prime, have demonstrated a reduction in blood use while maintaining the surgical advantage of increased revascularization associated with on-pump surgery. ⋯ Based on the decision-analysis model, a relatively low major event rate (defined as myocardial infarction, need for angioplasty or surgery) at 4 years of 2% can eliminate the savings associated with OPCAB when compared to a low-prime circuit with RAP. Using a 5% major event rate at 4 years, the predicted cost savings of LP/RAP over OPCAB is $510 per patient or $51,036,746 per 100,000 patients. The development and implementation of low-prime circuits with retrograde autologous prime is an import step in matching the outcomes associated with OPCAB surgery.
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Cardiac surgical procedures assisted by cardiopulmonary bypass (CPB) impair cognitive functions. Several studies, however, showed that cognitive functions were unaffected in patients undergoing either primary coronary artery bypass grafting (CABG) or more complex surgery assisted by CPB. Therefore, we conducted a straightforward study to compare patient groups who differed significantly in terms of risk factors such as prolonged CPB times. ⋯ In primary CABG patients, CoA improved at one month after surgery (p = 0.002) and, after six months, not only CoA (p = 0.003), but also QoEM and SoM were improved (p = 0.001 and p = 0.030, respectively). The test performance was similar in non-primary and primary CABG patients after surgery. Our present study shows a post-operative improvement of cognitive composite scores after cardiac surgery assisted by CPB in both non-primary CABG and in primary CABG patients.
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Minimally invasive aortic valve replacement has been established in many centres over the last decade. Although numerous modifications have been described to date, these solely involve variations of the utilized operative incision. Total miniaturized cardiopulmonary bypass (tMCPB) offers the theoretical potential of reducing even further the overall procedural "invasiveness". We describe our initial experience of an application of MCPB for aortic valve replacement through a minimal incision.
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Extracorporeal life support systems (ECLS) have become common in cardiothoracic surgery, but are still "Terra Incognita" in other medical fields due to the fact that perfusion units are normally bound to cardiothoracic centres. The Lifebridge B2T is an ECLS that is meant to be used as an easy and fast-track extracorporeal cardiac support to provide short-term perfusion for the transport of a patient to a specialized centre. With the Lifebridge B2T it is now possible to provide extracorporeal bypass for patients in hospitals without a perfusion unit. ⋯ BioMedicus (Medtronic, Minneapolis, MN, USA) venous cannula. The "Plug and Play" philosophy, with semi-automatic priming, integrated check-list, a long battery time of over two hours and instinctively designed user interface, makes this device very interesting for units with high-risk interventions, such as catheterisation labs. If a system is necessary in an emergency unit, the Lifebridge can provide a high security level, even in centres not acquainted with cardiopulmonary bypass.