Hemophilia is an X-linked recessive inherited bleeding disorder. Despite the improved treatment in recent years with the advent of replacement therapies, the progression of atherosclerosis is not slowed down after the reduction of clotting factors in hemophilia. As life expectancy increases, more hemophilia patients will suffer from age-related cardiovascular diseases. Since cardiac surgery needs heparinization and cardiopulmonary bypass (CPB), it is extremely challenging to balance hemostasis and coagulation in patients with hemophilia. Here we report three cases of hemophilia patients who underwent cardiac surgery successfully.
Cardiac Surgical Procedures/adverse effects* ; Cardiopulmonary Bypass ; Hemophilia A/complications* ; Humans

Cardiopulmonary Bypass ; adverse effects ; methods ; Child ; Hemofiltration ; adverse effects ; methods ; Humans

OBJECTIVETo compare the perioperative release levels of cardiac troponin I (cTnI) between off-pump coronary artery bypass grafting (OPCAB) or conventional coronary artery bypass grafting (CCABG) in an attempt to detect myocardial injury.

METHODSFifty-nine patients with instable angina underwent coronary artery bypass grafting by OPCAB in 34 patients aged (59.15 +/- 1.71) years or CCABG in 25 patients, aged (54.46 +/- 1.81) years.

RESULTSBaseline characteristics were similar. The number of grafts was similar (OPCAB, mean 2.90; CCABG, mean 3.2), and no patient died. Postoperative myocardial serum enzyme measures were significantly lower in OPCAB, suggesting less myocardial injury. OPCAB patients did not receive blood transfusion, and had higher hematocrit at discharge. Most of OPCAB patients were extubated in 4 hours.

CONCLUSIONSCompared with CCABG, OPCAB may achieve similar outcomes; it reduces transfusion volume and creates less myocardial injury.

Cardiomyopathies ; blood ; etiology ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; adverse effects ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Troponin T ; blood

Cardiopulmonary bypass surgery is one of the most common major problems in many hospitals and the benefits of this surgery are now accepted. The majority of these patients have extensive arteriosclerotic cardiovascular disease and the surgery carries a risk. About 50% of these patients have significant surgical complications, 2-5% have complications in the central nervous system and 0.1% have hearing loss. Rare instances of unilateral hearing loss with incomplete recovery in these patients have been reported and attributed to either embolism or perfusion failure. In 1971, Arenberg et al., for the first time, reported on a 57 year old female who had a unilateral sudden hearing loss with some improvement in the early post-operative period. In 1975, Wright and Saunders reported on a 59 year old male, who had a sudden loss of hearing which did not improve. In 1981, Plasse et al,. reported seven cases, all with early post-operative hearing loss, four of whom improved some degree but none recovered completely. Shapiro et al. (1981) reported two cases of bilateral loss of hearing with no indication of improvement in hearing. Brownson et al. (1971), in a prospective study of 50 patients, found no significant changes in hearing following open heart surgery. The purpose of this paper is to present the consecutive audiological findings in a case with a sudden unilateral sensorineural hearing loss with subsequent complete recovery following an open heart surgery.
Audiometry, Pure-Tone ; Cardiopulmonary Bypass/adverse effects* ; Hearing Loss, Sensorineural/etiology* ; Human ; Male ; Middle Age

BACKGROUND: Postoperative pneumonia (POP) is one of the most common infections following heart valve surgery (HVS) and is associated with a significant increase in morbidity, mortality, and health care costs. This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score. METHODS: Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study. Patients were randomly assigned to the derivation and validation sets at 1:1 ratio. A prediction model was developed with multivariable logistic regression analysis in the derivation set. Points were assigned to independent risk factors based on their regression coefficients. RESULTS: POP occurred in 316 of the 3853 patients (8.2%). Multivariable analysis identified ten significant predictors for POP in the derivation set, including older age, smoking history, chronic obstructive pulmonary disease, diabetes mellitus, renal insufficiency, poor cardiac function, heart surgery history, longer cardiopulmonary bypass, blood transfusion, and concomitant coronary and/or aortic surgery. A 22-point risk score based on the multivariable model was then generated, demonstrating good discrimination (C-statistic: 0.81), and calibration (Hosmer-Lemeshow χ2 = 8.234, P = 0.312). The prediction rule also showed adequate discriminative power (C-statistic: 0.83) and calibration (Hosmer-Lemeshow χ2 = 5.606, P = 0.691) in the validation set. Three risk intervals were defined as low-, medium-, and high-risk groups. CONCLUSION: We derived and validated a 22-point risk score for POP following HVS, which may be useful in preventive interventions and risk management. TRIAL REGISTRATION Chictr.org, ChiCTR1900028127; http://www.chictr.org.cn/showproj.aspx?proj=46932.
Adult ; Aged ; Cardiac Surgical Procedures/adverse effects* ; Cardiopulmonary Bypass ; Heart Valves ; Humans ; Pneumonia ; Risk Factors

OBJECTIVETo investigate the difference in circulating endothelial cell (CECs) injuries following on-pump and off-pump coronary-artery bypass surgery.

METHODSWe randomly assigned 48 patients scheduled for urgent or elective coronary artery bypass grafting into two groups to receive on-pump and off-pump procedures. Blood samples were obtained before anesthesia, at the end of operation, and on days 1 and 3 after the operation, and CECs were isolated and counted using dynabeads coated with the specific antibody of CD146. Single cell gel electrophoresis was used to observe the morphological changes of the CECs.

RESULTSIn the cardiopulmonary bypass (CPB) group, the number of CECs was significantly greater than that in non-CPB group (P<0.05) at the end of surgery and 1 day after the operation. On postoperative day 3, the number CECs was similar between the two groups (P>0.05). The length of the comet tail was longer in CPB group with stronger fluorescence intensity than in the non-CPB group.

CONCLUSIONCompared with of-pump coronary artery bypass grafting, on-pump coronary artery bypass grafting results in more serious CEC injury, which is closely related to the prognosis.

Aged ; Cardiopulmonary Bypass ; adverse effects ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Coronary Disease ; surgery ; Endothelial Cells ; pathology ; Endothelium, Vascular ; cytology ; Female ; Humans ; Male ; Middle Aged

Humans ; Retrospective Studies ; Cardiopulmonary Bypass/adverse effects* ; Coronary Artery Bypass/adverse effects* ; Coronary Artery Disease/surgery* ; Acute Kidney Injury/etiology* ; Postoperative Complications ; Risk Factors ; Treatment Outcome

OBJECTIVETo study the protective effects of Ginkgo biloba extract (EGb) on the lung injury of dogs undergoing hypothermic cardiopulmonary bypass (CPB).

METHODSFourteen healthy hybrid dogs were randomly divided into the control group and the EGb group, 7 in each group. EGb (8 mg/kg) was intravenously dripped to dogs in the EGb group before thoracotomy after anesthesia, while equal volume of normal saline was intravenously dripped to those in the control group. The lung tissue was collected after 60-min CPB and 120-min recovery of heart beat. The lung tissues were collected to detect the wet weight-dry weight ratio and the permeability. The contents of malondialdehyde (MDA), the activities of myeloperoxidase (MPO) and total superoxide dismutase (T-SOD) in the lung tissues were detected by biochemical assay. The levels of IL-1beta, IL-8, tumor necrosis factor alpha (TNF-alpha), platelet activating factor (PAF) in the lung tissue were detected by enzyme linked immunosorbent assay (ELISA).

RESULTSCompared with the control group, the wet weight-dry weight ratio was reduced and the permeability of the lung tissue decreased (P < 0.05), the MDA content was reduced, the activity of MPO decreased, and the activity of T-SOD increased (P < 0.05), and the levels of IL-1beta, IL-8, and PAF obviously decreased (P < 0.05).

CONCLUSIONSEGb showed better protective effects on the lung injury of dogs undergoing hypothermic CPB. Its possible mechanisms might be associated with alleviating ischemia-reperfusion injury of in vitro circulation and systemic inflammatory response.

Animals ; Cardiopulmonary Bypass ; adverse effects ; methods ; Dogs ; Ginkgo biloba ; Lung Injury ; etiology ; prevention & control ; Plant Extracts ; pharmacology

The present study was to examine the effect of stellate ganglion block (SGB) on bilateral regional cerebral oxygen saturation (rSO2) and postoperative cognitive function. Eighty patients undergoing selective coronary artery bypass graft with cardiopulmonary bypass (CPB) were randomly and equally divided into two groups. The patients in group S were given right SGB with ropivacaine, while the patients in group C were injected with normal saline. We compared the bilateral rSO2 after SGB. Minimum Mental State Examination (MMSE), Visual Verbal Learning Test (VVLT), and Digital Span Test (DST) were applied to observe the effect on cognitive function. We found that the incidence of postoperative cognitive dysfunction (POCD) 7 days after surgery in group S was lower than that in group C. The level of blocked side rSO₂ of S group were significantly higher before CPB time of rewarming than that before SGB (P < 0.05), much higher than corresponding non-blocked side rSO₂ before CPB (P < 0.05), and much higher than rSO₂ level in group C before CPB and after CPB (P < 0.05). The non-blocked side rSO₂ in group S before anesthesia were much lower than basic levels and those in group C (P < 0.05). It could be concluded from the above results that there was significant increase in the blocked-side rSO₂ compared to the non-blocked side and there was significant decrease in the incidence of POCD compared to the control group after SGB.
Autonomic Nerve Block ; adverse effects ; Cardiopulmonary Bypass ; adverse effects ; Cerebrum ; physiology ; Cognition ; Cognition Disorders ; Coronary Artery Bypass ; adverse effects ; Humans ; Incidence ; Oxygen ; physiology ; Oxygen Consumption ; Postoperative Complications ; Stellate Ganglion

BACKGROUNDPatients presenting with severe left ventricular dysfunction (SLVD) undergoing conventional coronary artery bypass grafting (CCABG) are at an increased risk of perioperative mortality and morbidity. The aim of this study was to assess the risk factors responsible for mortality and morbidity among patients with SLVD by comparing CCABG and off-pump coronary artery bypass surgery (OPCAB).

METHODSWe retrospectively evaluated 186 consecutive patients with SLVD who underwent coronary artery bypass grafting (CABG), including 102 by CCABG and 84 by OPCAB. Registry database, medical notes, and charts were studied for preoperative and postoperative data of the patients. Different variables and risk factors (preoperative, intraoperative, and postoperative) were evaluated and compared. The morbidity and mortality outcomes were compared in the two groups. The follow-up results and quality of life were assessed after surgery.

RESULTSThe two groups had similar percentage of patients with preoperative high-risk profiles and no significant differences were found between groups in baseline variables such as age or comorbidities. There was a significant difference in the number of grafts used between the two groups. CCABG patients received (3.6 +/- 0.5) grafts per patient, while OPCAB patients had (2.7 +/- 0.6) grafts (P < 0.05). Completeness of revascularization was also significantly different between the two groups (CCABG 91.1% vs OPCAB 73.8%, P < 0.05). The hospital mortality was similar in the two groups (4.8% in OPCAB vs 5.9% in CCABG). The risk-adjusted mortality, according to the calculated propensity score, did not reach statistical significance in the two groups. In this study, OPCAB seemed to have a beneficial effect on reducing reoperation for bleeding, blood transfusion requirement, and the length of stay at ICU. But the incidence of perioperative myocardial infarction was more common in the off-pump group (P < 0.05). The degree of improvement in angina and quality of life did not differ significantly between the two groups.

CONCLUSIONSUsing cardiopulmonary bypass is not an independent predictor of mortality and morbidity in patients with SLVD. Isolated CABG can be safely performed in SLVD patients with acceptable postoperative morbidity and mortality in addition to encouraging home discharge rates and higher quality of life. Therefore, CCABG remains a viable option in selected patients with SLVD.

Aged ; Cardiopulmonary Bypass ; adverse effects ; China ; epidemiology ; Coronary Artery Bypass ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Morbidity ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Ventricular Dysfunction, Left ; epidemiology ; mortality ; surgery