The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Gianclaudio Mecozzi - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of miniaturized versus standard Extracorporeal Circulation in aortic valve surgery
The Annals of Thoracic Surgery, 2019Co-Authors: F R Halfwerk, Kees Knol, Silvia Mariani, Jan G Grandjean, Gianclaudio MecozziAbstract:Background Complications related to Extracorporeal Circulation remain serious. Although a minimal invasive extra corporeal Circulation (MiECC) system was developed to cope with these complications, its effectivity on patient-related outcomes such as blood loss remain uncertain. Therefore, the aim of this study is to compare MiECC to an advanced standard system with respect to blood loss. Methods A total of 128 adult patients undergoing elective isolated aortic valve replacement were enrolled in a randomized clinical trial. Patients who had undergone previous heart surgery and with preexisting kidney failure were excluded. The primary end point was postoperative blood loss after 12 hours and at drain removal. Secondary end points included intensive care and total length of stay and intubation time. At 1 hour and 12 hours after surgery, clinical laboratory data were determined. Early clinical outcomes and long-term survival were determined. Results MiECC patients (n = 63) had a significant lower blood loss (230 mL, 95% confidence interval: 203 to 261 mL) than regular patients (n = 62) after 12 hours (288 mL, 95% confidence interval: 241 to 344 mL, p = 0.04). A preservation of hemoglobin levels 1 hour and 12 hours after surgery in the MiECC group were observed (p Conclusions This randomized controlled trial compares MiECC and an advanced system for aortic valve replacement with blood loss as primary end point. We conclude that using MiECC is clinically equal for short- and long-term follow-up regarding blood loss. Clinical trial registration: NTR3378.
Thierry Carrel - One of the best experts on this subject based on the ideXlab platform.
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initial experiences with a centrifugal pump based minimal invasive Extracorporeal Circulation system in pediatric congenital cardiac surgery
Journal of Thoracic Disease, 2019Co-Authors: Alexander Kadner, Paul Philipp Heinisch, Hansjoerg Jenni, Balthasar Eberle, Maris Bartkevics, Serena Wyss, Gabor Erdoes, Thierry CarrelAbstract:Background: Minimal invasive Extracorporeal Circulation (MiECC) circuits are an established alternative to conventional Extracorporeal Circulation (CECC). Based on the positive effects and improved perioperative outcomes of MiECC in adult cardiac surgery, this perfusion concept appears particularly attractive to pediatric cardiac surgery. So far, there are no reports on the clinical application of a MiECC system for corrective surgery in neonates and children. We report our initial experiences by using a MiECC system in pediatric cardiac surgery. Methods: A total of 38 pediatric patients underwent surgical interventions for a variety of congenital heart disease from March 2017 until August 2018 with a MiECC. Following the classification of MiECC circuits by the Minimal invasive Extra-Corporeal Technologies International Society (MiECTIS), type I and type III perfusion circuits were assembled depending on the planned intervention: type I for closed heart interventions and type III for open heart procedures. Primary outcome was conversion to CECC, secondary endpoints included major adverse cardiac or cerebrovascular events (MACCE). Results: MiECC perfusion was successfully performed in all patients (100%). Median patient age was 9.5 months (range, 0.2–176 months) with a median weight of 8.1 kg (range, 2.3–49 kg). For both MiECC types no system related technical complications were encountered. Beating heart procedures were performed in 23 cases (60%) at normothermia, while in 15 (40%) interventions cardioplegic cardiac arrest was induced at mild hypothermia. All patients had an uneventful perioperative course with no in-hospital mortality. MACCE did not occur during the hospitalization period. Conclusions: MiECC can be performed by using standard techniques for closed and open cardiac procedures for the correction of a variety of malformations in neonates and children with good results and uneventful postoperative course.
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from minimal invasive Extracorporeal Circulation type i to type iii the perfusionist s view
Journal of Thoracic Disease, 2019Co-Authors: Hansjoerg Jenni, Paul Philipp Heinisch, Alexander Kadner, Balthasar Eberle, Fabian Gisler, Thierry CarrelAbstract:The main challenge of modern cardiac perfusion technologies is the achievement of optimal biocompatibility for Extracorporeal Circulation (ECC) circuits. The unfavorable pathophysiological side effects of conventional cardiopulmonary bypass (CPB) circuits on the organ systems are triggered by complement system activation through foreign surfaces, hemodilution due to the priming volume, blood-air contact as well as negative and positive pressures in the reservoir (1,2).
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minimally invasive Extracorporeal Circulation excellent outcome and life expectancy after coronary artery bypass grafting surgery
Swiss Medical Weekly, 2017Co-Authors: Bernhard Winkler, Paul Philipp Heinisch, Grzegorz Zuk, Katarzyna Zuk, Brigitta Gahl, Hansjoerg Jenni, Alexander Kadner, Christoph Huber, Thierry CarrelAbstract:The concept of the minimally invasive Extracorporeal Circulation circuit (MiECC) was introduced to minimise pathophysiological side effects of conventional Extracorporeal Circulation.
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minimally invasive Extracorporeal Circulation circuit is not inferior to off pump coronary artery bypass grafting meta analysis using the bayesian method
The Annals of Thoracic Surgery, 2017Co-Authors: Bernhard Winkler, Paul Philipp Heinisch, Brigitta Gahl, Soheila Aghlmandi, Hans Jorg Jenni, Thierry CarrelAbstract:The pathophysiologic side effects of cardiopulmonary bypass have already been identified. Minimally invasive Extracorporeal Circulation technologies (MiECT) and off-pump coronary artery bypass graft surgery (OPCABG) aim to reduce these problems. This meta-analysis provides a comparison of MiECT and OPCABG in randomized and observational studies. A fully probabilistic, Bayesian approach of primary and secondary endpoints was conducted. MiECT does not give inferior results when compared with OPCABG. However, there is a trend to borderline significantly higher blood loss in this group in randomized controlled trials. The question whether MiECT is equivalent to OPCABG can be answered with the affirmative, but long-term follow-up data are needed to detect any advantage over time.
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minimal Extracorporeal Circulation is a promising technique for coronary artery bypass grafting
The Annals of Thoracic Surgery, 2007Co-Authors: Franz F Immer, Andreas Ackermann, Erich Gygax, Mario Stalder, Lars Englberger, Friedrich S Eckstein, Hendrik Tevaearai, Juerg Schmidli, Thierry CarrelAbstract:Background Minimal Extracorporeal Circulation (MECC) is a promising perfusion technology, taking the advantage of an ECC while having a significantly reduced priming volume. We analyzed the actual possible benefits of using MECC in patients undergoing CABG procedures and compared the results with conventional Extracorporeal Circulation (CECC). Methods One thousand fifty-three consecutive patients underwent CABG surgery using the MECC perfusion technique. Subgroup analyses focused on perioperative myocardial markers (cardiac troponin I [cTnI]), incidence of atrial fibrillation (AF), and perioperative evaluation of inflammatory markers and data were compared with those of patients who underwent CABG using CECC. A propensity score analysis was performed. Results Patient characteristics and distribution of EuroSCORE risk were similar in both groups. Severity of coronary artery disease and extent of revascularization were also comparable in both groups (number of distal anastomoses: 3.2 ± 1.1 in CECC vs 3.2 ± 0.9 in MECC; p = not significant [ns]). The cTnI was significantly lower in the MECC group (11.0 ± 10.8 μg/L in MECC vs 24.7 ± 25.3 μg/L in CECC; p p p Conclusions Minimal Extracorporeal Circulation is a safe perfusion technique for CABG and may therefore concurrence OPCAB and traditional CABG under CECC.
F R Halfwerk - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of miniaturized versus standard Extracorporeal Circulation in aortic valve surgery
The Annals of Thoracic Surgery, 2019Co-Authors: F R Halfwerk, Kees Knol, Silvia Mariani, Jan G Grandjean, Gianclaudio MecozziAbstract:Background Complications related to Extracorporeal Circulation remain serious. Although a minimal invasive extra corporeal Circulation (MiECC) system was developed to cope with these complications, its effectivity on patient-related outcomes such as blood loss remain uncertain. Therefore, the aim of this study is to compare MiECC to an advanced standard system with respect to blood loss. Methods A total of 128 adult patients undergoing elective isolated aortic valve replacement were enrolled in a randomized clinical trial. Patients who had undergone previous heart surgery and with preexisting kidney failure were excluded. The primary end point was postoperative blood loss after 12 hours and at drain removal. Secondary end points included intensive care and total length of stay and intubation time. At 1 hour and 12 hours after surgery, clinical laboratory data were determined. Early clinical outcomes and long-term survival were determined. Results MiECC patients (n = 63) had a significant lower blood loss (230 mL, 95% confidence interval: 203 to 261 mL) than regular patients (n = 62) after 12 hours (288 mL, 95% confidence interval: 241 to 344 mL, p = 0.04). A preservation of hemoglobin levels 1 hour and 12 hours after surgery in the MiECC group were observed (p Conclusions This randomized controlled trial compares MiECC and an advanced system for aortic valve replacement with blood loss as primary end point. We conclude that using MiECC is clinically equal for short- and long-term follow-up regarding blood loss. Clinical trial registration: NTR3378.
Eduardo Tavares Costa - One of the best experts on this subject based on the ideXlab platform.
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ultrasonic pulsed doppler blood flowmeter for use in Extracorporeal Circulation
Artificial Organs, 2000Co-Authors: Ricardo G Dantas, Eduardo Tavares CostaAbstract:: In cardiac surgeries, it is frequently necessary to make the external blood Circulation and oxygenation artificially. This procedure is called Extracorporeal Circulation (EC) or heart-lung bypass. During EC, one of the most important parameters, which demands continuous monitoring, is the blood flow. In many cases, the blood flow is estimated by the pump velocity (in roller pumps) or measured with transducers based on electromagnetic methods (in centrifugal pumps). This article presents an ultrasonic Doppler blood flowmeter to be used in the arterial line of an Extracorporeal Circulation system. The ultrasonic probe is coupled to a half-inch tube connector of the Extracorporeal arterial line, is not disposable, and does not need sterilization. The developed flowmeter revealed itself to be efficient and reliable and can be inserted in a closed-loop pump controller system or be used as stand-alone equipment.
Christos Papakonstantinou - One of the best experts on this subject based on the ideXlab platform.
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use of minimal Extracorporeal Circulation improves outcome after heart surgery a systematic review and meta analysis of randomized controlled trials
International Journal of Cardiology, 2013Co-Authors: Kyriakos Anastasiadis, Polychronis Antonitsis, Annabettina Haidich, Helena Argiriadou, Apostolos Deliopoulos, Christos PapakonstantinouAbstract:Abstract Background The question whether use of minimal Extracorporeal Circulation (MECC) influences patients' outcome remains unanswered. We performed a systemic review of the literature and a meta-analysis of randomized controlled trials to evaluate the impact of MECC compared to conventional Extracorporeal Circulation (CECC) on mortality and major adverse cardiovascular events in patients undergoing heart surgery. Methods We independently conducted a systemic review of English and non-English articles using Medline, Embase and Cochrane database. Random allocation to treatment with a minimum of 40 patients in both groups was considered mandatory for inclusion in the meta-analysis. Primary outcomes were operative mortality and major adverse cardiac and cerebrovascular events comprising death before discharge, myocardial infarction and neurologic damage. Results We included 24 studies comparing MECC vs. CECC with a total of 2770 patients. Use of MECC was associated with a significant decrease in mortality (0.5% vs. 1.7%, P =0.02), in the risk of postoperative myocardial infarction (1.0% vs. 3.8%, P =0.03) and reduced rate of neurologic events (2.3% vs. 4.0%, P =0.08). Additionally, MECC was associated with reduced systemic inflammatory response as measured by polymorphonuclear elastase, hemodilution as calculated by hematocrit drop after procedure, need for red blood cell transfusion, reduced levels of peak troponin release, incidence of low cardiac output syndrome, need for inotropic support, peak creatinine level, occurrence of postoperative atrial fibrillation, duration of mechanical ventilation and intensive care unit stay. Conclusions Use of MECC in heart surgery resulted in improved short-term outcome as reflected by reduced mortality and morbidity compared with conventional Extracorporeal Circulation.
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neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional Extracorporeal Circulation a randomised controlled pilot study
Heart, 2011Co-Authors: Kyriakos Anastasiadis, Polychronis Antonitsis, Helena Argiriadou, Mary H Kosmidis, Kalliopi Megari, Evanthia Thomaidou, Eleni Aretouli, Christos PapakonstantinouAbstract:Objective Neurocognitive impairment can be a debilitating complication after cardiac surgery. The aim of this study was to assess the effect of minimal Extracorporeal Circulation (MECC) versus conventional Extracorporeal Circulation (CECC) on neurocognitive function after elective coronary artery bypass grafting (CABG) and whether this can be attributed to improved cerebral perfusion intraoperatively. Methods and results 64 patients scheduled for elective CABG surgery were prospectively randomly assigned to surgical revascularisation with MECC versus CECC. All patients were continuously monitored for changes in cerebral oxygenation with near-infrared spectroscopy during the procedure. Neurocognitive assessment was performed before surgery, on the day of discharge and at 3 months postoperatively using a battery of standardised neurocognitive tests. Both groups were comparable in terms of demographic and clinical data. MECC was associated with improved cerebral perfusion during cardiopulmonary bypass (CPB). Eleven patients operated on with MECC and 17 with CECC experienced at least one episode of cerebral desaturation (38% vs 55%, p=0.04) with similar duration (10 vs 12.3 min, p=0.1). At discharge patients operated on with MECC showed a significantly improved performance on complex scanning, visual tracking, focused attention and long-term memory. At 3 months significantly improved performance was also evident on visuospatial perception, executive function, verbal working memory and short-term memory. Patients operated on with MECC experienced a significantly lower risk of early cognitive decline both at discharge (41% vs 65%, p=0.03) and at 3-month evaluation (21% vs 61%, p Conclusions Use of MECC attenuates early postoperative neurocognitive impairment after coronary surgery compared with conventional CPB. This finding may have important implications on the surgical management strategy for coronary artery disease. Clinical trial registration number The study is registered at ClinicalTrials.gov, number NCT01213511.
