Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcome
Background: Pulmonary endarterectomy (PEA) using deep hypothermic circulatory arrest (DHCA) and cardiopulmonary bypass (CPB) is the preferred treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Crystalloid priming solutions cause hemodilution with disadvantages, and no standard exis...
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Elsevier
2025-08-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000485 |
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| author | K. Furrer, MD D. Bettex, MD T. Horisberger I. Inci, MD N.G. Nagaraj H.-T. Morselli B. Battilana R. Schuepbach, MD S. Ulrich, MD M. Hebeisen, MSc I. Opitz, MD |
| author_facet | K. Furrer, MD D. Bettex, MD T. Horisberger I. Inci, MD N.G. Nagaraj H.-T. Morselli B. Battilana R. Schuepbach, MD S. Ulrich, MD M. Hebeisen, MSc I. Opitz, MD |
| author_sort | K. Furrer, MD |
| collection | DOAJ |
| description | Background: Pulmonary endarterectomy (PEA) using deep hypothermic circulatory arrest (DHCA) and cardiopulmonary bypass (CPB) is the preferred treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Crystalloid priming solutions cause hemodilution with disadvantages, and no standard exists for PEA. This study evaluates CTEPH patient outcomes after adding 5% human albumin (HA) to the CPB-prime and hemodilution solution during PEA. Methods: The effect of the CPB-protocol change was evaluated by comparing patients operated under the old and new protocols in a 1:1 propensity score match based on age, sex, and preoperative peripheral vascular resistance (PVR). Results: Matching resulted in 56 patients (28 per group) between July 1, 2010, and May 31, 2020. The new protocol group had a lower intraoperative fluid balance (1.85 vs 6.76 liters, p < 0.001), vasoactive-inotropic score (VIS) (8.7 vs 17.7, p = 0.04), shorter operative- (407 vs 451 min, p = 0.03), and hospitalization time (LOS) (18 vs 27 days, p = 0.008). Morbidity and mortality at 30- and 90-days were similar in both groups. The new protocol was associated with reduced intraoperative fluid balance after adjustment for operative time (−3.7 liters [95% CI −5.2, −2.1], p < 0.0001). Lower intraoperative fluid balance was associated with shorter hospitalization in the intensive care unit, intubation time, LOS, and lower VIS (p = 0.0011, 0.0013, 0.008, <0.0001, respectively). The protocol change shortened LOS, independent of operative time, by 27% [95% CI, 44%, 6%], p = 0.02. Conclusions: Priming and maintenance protocol for CPB with the addition of 5% HA had a beneficial effect on intraoperative fluid balance and improved outcome after PEA for patients with CTEPH. |
| format | Article |
| id | doaj-art-6f155da23b834f66888faa92fccebc1e |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-6f155da23b834f66888faa92fccebc1e2025-08-20T04:00:55ZengElsevierJHLT Open2950-13342025-08-01910025310.1016/j.jhlto.2025.100253Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcomeK. Furrer, MD0D. Bettex, MD1T. Horisberger2I. Inci, MD3N.G. Nagaraj4H.-T. Morselli5B. Battilana6R. Schuepbach, MD7S. Ulrich, MD8M. Hebeisen, MSc9I. Opitz, MD10Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandInstitute of Anesthesiology, University Hospital Zurich, Zurich, SwitzerlandInstitute of Anesthesiology, University Hospital Zurich, Zurich, SwitzerlandDepartment of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandDepartment of Perfusion, University Hospital Zurich, Zurich, SwitzerlandDepartment of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandDepartment of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandInstitute of Intensive Care Medicine, University and University Hospital Zurich, Zurich, SwitzerlandDepartment of Pulmonology, University Hospital Zurich, Zurich, SwitzerlandDepartment of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, SwitzerlandDepartment of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Corresponding author: Isabelle Opitz, MD, FEBTS, Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Telephone: +41 44 255 88 04.Background: Pulmonary endarterectomy (PEA) using deep hypothermic circulatory arrest (DHCA) and cardiopulmonary bypass (CPB) is the preferred treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Crystalloid priming solutions cause hemodilution with disadvantages, and no standard exists for PEA. This study evaluates CTEPH patient outcomes after adding 5% human albumin (HA) to the CPB-prime and hemodilution solution during PEA. Methods: The effect of the CPB-protocol change was evaluated by comparing patients operated under the old and new protocols in a 1:1 propensity score match based on age, sex, and preoperative peripheral vascular resistance (PVR). Results: Matching resulted in 56 patients (28 per group) between July 1, 2010, and May 31, 2020. The new protocol group had a lower intraoperative fluid balance (1.85 vs 6.76 liters, p < 0.001), vasoactive-inotropic score (VIS) (8.7 vs 17.7, p = 0.04), shorter operative- (407 vs 451 min, p = 0.03), and hospitalization time (LOS) (18 vs 27 days, p = 0.008). Morbidity and mortality at 30- and 90-days were similar in both groups. The new protocol was associated with reduced intraoperative fluid balance after adjustment for operative time (−3.7 liters [95% CI −5.2, −2.1], p < 0.0001). Lower intraoperative fluid balance was associated with shorter hospitalization in the intensive care unit, intubation time, LOS, and lower VIS (p = 0.0011, 0.0013, 0.008, <0.0001, respectively). The protocol change shortened LOS, independent of operative time, by 27% [95% CI, 44%, 6%], p = 0.02. Conclusions: Priming and maintenance protocol for CPB with the addition of 5% HA had a beneficial effect on intraoperative fluid balance and improved outcome after PEA for patients with CTEPH.http://www.sciencedirect.com/science/article/pii/S2950133425000485Pulmonary endarterectomy (PEA)Chronic thromboembolic pulmonary hypertension (CTEPH)Cardiopulmonary bypass (CPB)Crystalloid priming solutions5% humanAlbumin (HA) priming |
| spellingShingle | K. Furrer, MD D. Bettex, MD T. Horisberger I. Inci, MD N.G. Nagaraj H.-T. Morselli B. Battilana R. Schuepbach, MD S. Ulrich, MD M. Hebeisen, MSc I. Opitz, MD Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcome JHLT Open Pulmonary endarterectomy (PEA) Chronic thromboembolic pulmonary hypertension (CTEPH) Cardiopulmonary bypass (CPB) Crystalloid priming solutions 5% human Albumin (HA) priming |
| title | Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcome |
| title_full | Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcome |
| title_fullStr | Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcome |
| title_full_unstemmed | Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcome |
| title_short | Fluid management of cardiopulmonary bypass during pulmonary endarterectomy for CTEPH patients impacts perioperative outcome |
| title_sort | fluid management of cardiopulmonary bypass during pulmonary endarterectomy for cteph patients impacts perioperative outcome |
| topic | Pulmonary endarterectomy (PEA) Chronic thromboembolic pulmonary hypertension (CTEPH) Cardiopulmonary bypass (CPB) Crystalloid priming solutions 5% human Albumin (HA) priming |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000485 |
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