Management of Challenging Cardiopulmonary Bypass Separation

SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research

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RARITAN, NJ, March 28, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson today announced the VOYAGER PAD study met its primary efficacy and principal safety endpoints, demonstrating the XARELTO® (rivaroxaban) vascular dose (2.5 mg twice daily) plus aspirin (100 mg once daily) was superior to aspirin alone in reducing the risk of major adverse limb and cardiovascular (CV) events by 15 percent in patients with symptomatic peripheral artery disease (PAD) after lower-extremity revascularization, with similar rates of TIMI[1] major bleeding. VOYAGER PAD is the only study to show a significant benefit...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
RARITAN, N.J., March 20, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today that it will unveil late-breaking data from its leading cardiovascular and metabolism portfolio during the virtual American College of Cardiology’s 69th Annual Scientific Session together with the World Congress of Cardiology (ACC.20/WCC) on March 28-30, 2020. Notably, four late-breaking abstracts for XARELTO® (rivaroxaban) will be presented, including data from the Phase 3 VOYAGER PAD study in patients with symptomatic peripheral artery disease (PAD) after lower-extremity revascularization.Click to ...
Source: Johnson and Johnson - Category: Pharmaceuticals Source Type: news
ConclusionInterventional paediatric catheterisation has grown remarkably in Morocco. These procedures have become the treatment of choice for many cardiac lesions, and serve as alternatives or adjuncts to surgical treatment.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperativ...
Source: Revista Brasileira de Cirurgia Cardiovascular - Category: Cardiovascular & Thoracic Surgery Source Type: research
Introduction: PH is common in the sicker subsets of ILD. ILD transbronchial cryobiopsy (ILD-C) guidelines (Hetzel 2018, Dhooria et al 2019) mention PH [echocardiographic pulmonary artery pressure (PASP)> 40mmHg] as a relative contraindication (RC) due to risk of bleeding and worsening hypoxemia. These recommendations are extrapolated from surgical sampling.Aim: We analysed ILD-C high-PH (PASP> 40mmHg) in real world situations, and the role of pre-optimization in facilitating ILD-C in this group, otherwise contraindicated for ILD-C.Methods: Retrospective review of 150 ILD-C procedures, identifying patients with PASP&g...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional pulmonology Source Type: research
Background: Transbronchial lung cryobiopsy (TBLC) is a promising new biopsy technique for diffuse parenchymal lung disease (DPLD) diagnosis, with a 70-80% reported diagnostic yield.Aims: To assess the diagnostic yield and safety of a recently introduced TBLC performance protocol.Methods: A retrospective study performed at an academic tertiary-care centre from April-December 2017 of patients who underwent TBLC. Pre-procedural evaluation protocol included blood tests, pulmonary function tests, transthoracic echocardiography and chest CT. Bleeding diathesis, inability to hold anticoagulant/antiplatelet agents or diffuse bullo...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional Pulmonology Source Type: research
Publication date: Available online 27 June 2018Source: Anaesthesia &Intensive Care MedicineAuthor(s): Sarah Smith, Alyson WalkerAbstractA diagnosis of congenital heart disease (CHD) increases perioperative risk for children having surgical procedures. Some will require anaesthesia at a specialist cardiac centre, while for others it is safe and appropriate to have their procedure in a local district general hospital (DGH). Children with complex CHD and poor physiological status carry the highest risk of cardiac arrest and mortality. Clinical features of cardiomyopathy, cyanosis, pulmonary hypertension, arrhythmia and ca...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Publication date: June 2018Source: Anaesthesia &Intensive Care Medicine, Volume 19, Issue 6Author(s): Jonathan Weale, Andrea A. KelleherAbstractContinued advances in the understanding and management of congenital heart disease (CHD) mean that over 90% of children born with CHD now survive to adulthood. This in turn results in greater numbers of adult patients presenting for medical and surgical care at non-specialist centres. A simple classification of adult congenital heart disease (ACHD) according to complexity can help clinicians to understand the implications of the specific cardiac anomaly encountered. Issues rela...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 27 June 2018Source: Anaesthesia &Intensive Care MedicineAuthor(s): Sarah Smith, Alyson WalkerAbstractA diagnosis of congenital heart disease (CHD) increases perioperative risk for children having surgical procedures. Some will require anaesthesia at a specialist cardiac centre, while for others it is safe and appropriate to have their procedure in a local district general hospital (DGH). Children with complex CHD and poor physiological status carry the highest risk of cardiac arrest and mortality. Clinical features of cardiomyopathy, cyanosis, pulmonary hypertension, arrhythmia and ca...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Publication date: June 2018Source: Anaesthesia &Intensive Care Medicine, Volume 19, Issue 6Author(s): Jonathan Weale, Andrea A. KelleherAbstractContinued advances in the understanding and management of congenital heart disease (CHD) mean that over 90% of children born with CHD now survive to adulthood. This in turn results in greater numbers of adult patients presenting for medical and surgical care at non-specialist centres. A simple classification of adult congenital heart disease (ACHD) according to complexity can help clinicians to understand the implications of the specific cardiac anomaly encountered. Issues rela...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
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