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This study investigated the effect of hemodynamic data during cardiopulmonary bypass (CPB) on neurocognitive impairment in patients undergoing coronary artery bypass graft (CABG) surgery using machine learning algorithms. Twenty-eight CABG patients were included in the study. Systolic and diastolic blood pressure, pulse (PLS), and SpO 2 were recorded at 2.4-second intervals, yielding 730,870 data points (450,548 after artefact removal). Data were analyzed using Random Forest classification and Partial Dependence Plots (PDPs) to evaluate the collective and individual effects of parameters on neurocognitive outcomes. Separate analyses were conducted for the surgery period, bypass, and cross-clamp periods. Cognitive impairment was assessed using the Montreal Cognitive Assessment (MoCA), with a decrease of ≥ 2 points considered indicative of impairment. The highest classification accuracy (86%) was achieved during the bypass period when all parameters were analyzed together. Parameter importance varied by surgical phase: PLS was most significant during the surgery period and bypass periods. PDPs revealed specific optimal parameter ranges for each surgical phase. This study highlights the complex and dynamic role of hemodynamic parameters in preserving neurocognitive function during CABG surgery. Findings suggest that monitoring specific combinations of parameters during different surgical phases could help reduce neurocognitive risks. The significant importance of PLS data and its relationship with mean arterial pressure (MAP) values indicates that pulsatile flow may play a crucial role in neurocognitive protection. Future research should validate these findings in larger cohorts and develop phase-specific monitoring strategies for clinical implementation.

Cardiac surgery associated acute kidney injury (CSA-AKI) is a frequent and severe complication. Goal Directed Perfusion (GDP) during cardiopulmonary bypass (CPB) has been developed to reduce post-operative complications, in particular CSA-AKI. Hence, we aimed to assess the implementation of a GDP strategy during CPB on the incidence of CSA-AKI in a large, unselected cardiac surgery population. We conducted a retrospective, before and after study, including all patients admitted to our surgical intensive care unit (ICU) following a cardiac surgery with CPB in the year prior to GDP implementation (No-GDP group), and in the year following its implementation (GDP group). Primary endpoint was the incidence of acute kidney injury (AKI) according to KDIGO classification in each group. Secondary endpoints were ICU mortality and length of stay, and the main post-operative complications after cardiac surgery. Risk factors of AKI were evaluated using a multivariable logistic regression model. Among 903 patients in our analysis, 314 (34 %) developed AKI. The incidence of AKI was lower after the implementation of GDP strategy (n = 111; 27.6 % vs n = 203; 40.5 %, p < 0.001). In the multivariable analysis, GDP was an independent factor of AKI reduction (OR 0.37, 95 %CI [0.27–0.52], p < 0.001). This benefit was significant regarding stage 1 AKI, but not stage 2 or 3 AKI. GDP was not associated with a change in post-operative ICU mortality, length of stay or any other post-operative complication. GDP strategy implantation during CPB is associated with a reduction of postoperative AKI. •Cardiac surgery associated acute kidney injury (CSA-AKI) is one of the most frequent and severe complications after cardiac surgery.•CSA-AKI is related to low oxygen delivery (DO2) to the kidney during cardiopulmonary bypass (CPB).•Goal Directed perfusion (GDP) enables the targeting of an optimal DO2 value during CPB.•Implementation of GDP strategy during CPB is associated with a reduction of CSA-AKI.

Purpose This study aimed to evaluate the clinical effects of sodium bicarbonate Ringer’s solution(BRS) as a priming fluid for cardiopulmonary bypass (CPB). Methods A total of 159 patients undergoing CPB cardiac surgery at Gaozhou People’s Hospital between August 2020 and August 2021 were enrolled. Participants were assigned to receive either sodium bicarbonate Ringer’s solution (designated as the BRS group) or lactated Ringer’s solution (designated as the control group). Blood gas variables were monitored at predetermined intervals: pre-surgery (T1), 30 min after CPB initiation (T2), upon CPB completion (T3), 6 h post-surgery (T4), and 24 h post-surgery (T5). To ensure comparability between groups, clinical variables were balanced using propensity score matching (PSM). Results Following PSM, the BRS group had significantly lower blood calcium levels ( P  < 0.001) at T2. By T3, the BRS group also presented lower standard bicarbonate, extracellular base excess and blood calcium levels, alongside significantly higher hematocrit levels compared to controls (all P  < 0.05). At T5, the BRS group continued to show decreased levels of blood sodium and calcium (both P  < 0.05). Conclusion BRS was associated with better maintenance of acid-base balance and electrolyte stability compared to lactated Ringer’s solution, suggesting it is a favorable priming option for CPB.

Post-pump chorea (PPC) is characterized by the development of choreiform movements following cardiopulmonary bypass (CPB) surgery. PPC occurs almost exclusively in children, and its pathophysiology remains unclear. Here we present an adult case of PPC after bovine aortic valve replacement (AVR) which exhibited dramatic and reproducible response to steroid, suggesting the presence of occult neuroinflammation. This observation suggests a novel underlying mechanism in certain subgroups of PPC, which is likely a heterogeneous condition to start with. Further research into the pathomechanisms of PPC could offer insights into managing this otherwise symptomatic control-only condition.

Stress caused by cardioplegic ischemic arrest was shown to alter the expression levels of heat shock proteins (Hsp), but little is known about their effects, particularly on pediatric hearts. This study aimed to investigate whether myocardial cellular stress and apoptotic response changes due to different cardioplegia (CP) solutions during cardiopulmonary bypass (CPB) in infants and to determine their influence on surgical/clinical outcomes. Therefore, twenty-seven infants for surgical closure of ventricular septal defect were randomly assigned to a CP solution: normothermic blood (BCP), delNido (dNCP), and Custodiol (CCP). Hsp levels and apoptosis were determined by immunoblotting in cardiac tissue from the right atrium before and after CP, and their correlations with cardiac parameters were evaluated. No significant change was observed in Hsp27 levels. Hsp60, Hsp70, and Hsp90 levels decreased significantly in the BCP-group but increased markedly in the CCP-group. Decreased Hsp60 and increased Hsp70 expression were detected in dNCP-group. Importantly, apoptosis was not observed in dNCP- and CCP-groups, whereas marked increases in cleaved caspase-3 and -8 were determined after BCP. Serum cardiac troponin-I (cTn-I), myocardial injury marker, was markedly lower in the BCP- and dNCP-groups than CCP. Additionally, Hsp60, Hsp70, and Hsp90 levels were positively correlated with aortic cross-clamp time, total perfusion time, and cTn-I release. Our findings show that dNCP provides the most effective myocardial preservation in pediatric open-heart surgery and indicate that an increase in Hsp70 expression may be associated with a cardioprotective effect, while an increase in Hsp60 and Hsp90 levels may be an indicator of myocardial damage during CPB.

Background Despite advancements in perioperative management, patients undergoing complex tracheal surgery still face increased risks of morbidity and mortality. Extracorporeal life support (ECLS) can be utilized to maintain hemodynamic and respiratory stability during surgical procedures, but there is currently no evidence-based practice protocol in place. This study seeks to evaluate the safety and benefits of various ECLS modes in critical tracheal surgery and establish a practical protocol for the application of ECLS. Methods Single center, retrospective, cohort study. This retrospective study collected data on patients who underwent tracheal procedures on ECLS between January 2000 and December 2020. Patients were divided into three groups according to configuration: cardiopulmonary bypass (CPB), modified CPB and extracorporeal membrane oxygenation (ECMO). Baseline characteristics, in-hospital complications, ECLS details, adverse events, and overall survival were assessed and compared between three groups. Results Over twenty years period, from 462 primary tracheal disease patients, 67 patients were identified from our institutional medical registry as having received CPB, modified-CPB or ECMO during the procedure (26.9%, 22.4% and 50.7% respectively). Heparin free ( n  = 30, 44.8%) or low dose heparin ( n  = 17, 26.6%) therapy was frequently utilized in ECMO and modified-CPB group. The Median pump duration of CPB, modified-CPB, VV, and VA ECMO was 43, 64, 139, and 127 min. Anastomotic complications were significantly lower in the VV-ECMO group (7.1%), while the duration of mechanical ventilation was significantly longer in the VA-ECMO group (66, [2–178]). Surgical bleeding was significantly higher in the CPB group (460 ± 73 ml). More patients in the CPB group (9/18) required blood transfusions; however, there was no significant difference in the volume of packed red blood cells between the groups. Conclusion Despite intraoperative ECLS being rarely used in tracheal and carinal disease, programmed extracorporeal life support with VV-ECMO demonstrated high effectiveness with an acceptable mortality and morbidity rate in high-risk tracheal surgery.

Cardiopulmonary bypass (CPB) is a fundamental approach for managing complex congenital heart diseases (CHD). This study aims to examine the changes in respiratory function before and after CPB in children under 12 years diagnosed with CHD with different types of shunts. A retrospective analysis was conducted on the clinical data of 60 pediatric patients with CHD admitted to the hospital between January 2022 and December 2023. Based on shunt type, the patients were divided into Group A (increased pulmonary blood flow, n = 30) and Group B (decreased pulmonary blood flow, n = 30). Changes in the diameters of the pulmonary artery and aorta, as well as respiratory mechanics before and 24 hours after CPB, were assessed in both groups. There were no significant differences in general characteristics between the two groups ( > 0.05). The external diameter of the pulmonary artery among patients in Group A was significantly larger than that in Group B (2.50±0.38 vs 1.31±0.29 cm, < 0.05), while the external diameter of the aorta was significantly smaller in those in Group A compared to Group B (1.60±0.26 vs 1.91±0.37, < 0.05). Significant differences were observed in the respiratory mechanics indexes before and after CPB within and between the two groups, including peak airway pressure, plateau airway pressure, inspiratory resistance, expiratory resistance, and lung-thorax compliance ( < 0.05). Significant differences in the diameters of the pulmonary artery and aorta were observed among pediatric patients with CHD, depending on the type of shunt used. Dynamic monitoring of respiratory mechanics before and after CPB is essential for optimizing clinical respiratory management to facilitate timely adjustments in respiratory support strategies.

Background The increasing preference for off-pump coronary artery bypass grafting (CABG) reflects efforts to reduce complications associated with cardiopulmonary bypass (CPB). A lower incidence of postoperative delirium (POD) after off-pump procedures suggests that embolic load during CPB may contribute to postoperative neurocognitive impairment. Oxygenator design may influence the generation and transmission of gaseous microemboli (GME) during CPB. This study aimed to determine whether differences in oxygenator design affect the GME-handling characteristics of the CPB circuit and to evaluate the clinical implications of microembolic burden in patients undergoing on-pump CABG. Methods In this prospective, non-interventional observational study, 102 adult patients undergoing first-time isolated on-pump CABG were included. Patients were supported with one of three contemporary membrane oxygenators (Capiox FX25, Inspire 8, or Inspire 8 F). Gaseous microemboli number and cumulative volume were continuously measured proximal and distal to the oxygenator using an ultrasonic microbubble counter. Postoperative delirium was assessed every 12 h during the first postoperative week using the Confusion Assessment Method for the ICU and the Richmond Agitation–Sedation Scale by assessors blinded to oxygenator type. Results Baseline characteristics, operative variables, and venous GME burden were comparable among groups. Use of the Capiox FX25 oxygenator was associated with significantly lower arterial GME volume and the greatest reduction in microembolic volume compared with both Inspire oxygenators. Inspire 8 demonstrated the lowest reduction in GME number. Postoperative delirium occurred in 29.4% of patients and was least frequent in the Capiox FX25 group. Conclusions Oxygenator design significantly influences intraoperative gaseous microembolic burden and is associated with differences in postoperative delirium after on-pump CABG. Oxygenator selection may represent a modifiable intraoperative factor affecting postoperative neurocognitive outcomes. Trial registration As this was a non-interventional, observational study with no deviation from standard clinical practice, registration in a public clinical trial registry was not required.

BackgroundUltrafiltration (UF) is used for fluid removal during and after infant cardiopulmonary bypass (CPB) surgery to reduce fluid overload. Excessive UF may have the opposite of its intended effect, resulting in acute kidney injury (AKI), oliganuria, and fluid retention.MethodsThis is a single-center, retrospective review of infants treated with conventional and/or modified UF during CPB surgery. UF volume was indexed to weight. AKI was defined using serum creatinine “Kidney Disease Improving Global Outcome (KDIGO)” criteria. Fluid balance was defined according to: total intakemL−total outputmLpreoperative weightgx100. Peak fluid overload was determined on postoperative day 3. Multivariable logistic regression adjusted for multiple covariates was used to explore associations with UF, AKI, and fluid overload.ResultsFive hundred thirty subjects < 1 year of age underwent CPB-assisted congenital heart surgery with UF. Sixty-four (12%) developed postoperative AKI. On multivariable regression, higher indexed total UF volume was associated with increased AKI risk (OR 1.11, 95% CI=1.04–1.19, p = 0.003). UF volume > 119.9 mL/kg did not reduce peak fluid overload. Subjects with AKI took longer to reach a negative fluid balance (2 vs. 3 days, p = 0.04). Those with more complex surgery were at highest AKI risk (STAT 3 [25–75 percentile: 3–4] in AKI group versus STAT 3 [25–75 percentile: 2–4] in non-AKI group, p = 0.05). AKI was reduced in subjects undergoing more complex surgery and treated with UF volume < 119.9 mL/kg.ConclusionsJudicious use of UF in more complex congenital cardiac surgery reduces the risk of AKI.

BackgroundEvaluating patients’ risk for acute kidney injury (AKI) is crucial for positive outcomes following cardiac surgery. Our aims were first to select candidate risk factors from pre- or intra-operative real-world parameters collected from routine medical care and then evaluate potential associations between those parameters and risk of onset of post-operative cardiac surgery-associated AKI (CSA-AKI).MethodWe conducted two cohort studies in Japan. The first was a single-center prospective cohort study (n = 145) to assess potential association between 115 clinical parameters collected from routine medical care and CSA-AKI (≥ Stage1) risk in the population of patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB). To select candidate risk factors, we employed random forest analysis and applied survival analyses to evaluate association strength. In a second retrospective cohort study, we targeted patients undergoing cardiac surgery with CPB (n = 619) and evaluated potential positive associations between CSA-AKI incidence and risk factors suggested by the first cohort study.ResultsVariable selection analysis revealed that parameters in clinical categories such as circulating inflammatory cells, CPB-related parameters, ventilation, or aging were potential CSA-AKI risk factors. Survival analyses revealed that increased counts of pre-operative circulating monocytes and neutrophils were associated with CSA-AKI incidence. Finally, in the second cohort study, we found that increased pre-operative circulating monocyte counts were associated with increased CSA-AKI incidence.ConclusionsCirculating monocyte counts in the pre-operative state are associated with increased risk of CSA-AKI development. This finding may be useful in stratifying patients for risk of developing CSA-AKI in routine clinical practice.