CPB Related

Cardiopulmonary bypass (CPB) is a procedure used during open-heart surgery and other procedures that require temporary substitution or support of heart and lung function. While it is widely accepted as the predominant method to carry out these procedures, it is not without possible complications[5]. Here are some of the common complications of cardiopulmonary bypass:

• Respiratory complications: These include postoperative pulmonary complications that manifest early as arterial hypoxemia, during the later course as pneumonia, and in rare cases also as acute respiratory distress syndrome[2].
• Cardiovascular complications: Using the cardiopulmonary bypass often leads to other adverse cardiovascular effects. These effects may be due to the inflammatory response causing aggravation to the heart, or just due to the fact that the heart is being operated on, manipulated, often frozen, and changed[6].
• Renal complications: Increased mortality, renal replacement therapy, and acute kidney injury are some of the renal complications that may arise from cardiopulmonary bypass[6].
• Neurological complications: Stroke, cognitive dysfunction, and delirium are some of the neurological complications that may arise from cardiopulmonary bypass[6].
• Inflammatory complications: The use of the cardiopulmonary bypass machine causes adverse effects on a patient’s body and cognitive functions. These include complications of the inflammatory system[6].
• Mechanical complications: These include oxygenator failure, pump malfunction, clotting in the circuit, tubing rupture, gas supply failure, and electrical failure due to the cardiopulmonary bypass circuit[1].

It is important to note that CPB can be seen as the ultimate “team sport” as it includes and is dependent on contributions from multiple professionals including anesthesiologists, cardiothoracic surgeons, and perfusion technicians. Therefore, it is essential to troubleshoot any complications that may arise during the procedure, which often requires the involvement of other essential team members[5].

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613602/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775118/
[3] https://www.uptodate.com/contents/postoperative-complications-among-patients-undergoing-cardiac-surgery
[4] https://derangedphysiology.com/main/required-reading/cardiothoracic-intensive-care/Chapter%20827/complications-attributed-cardiopulmonary-bypass-circuit
[5] https://scholarlycommons.hcahealthcare.com/cgi/viewcontent.cgi?article=1525&context=hcahealthcarejournal
[6] https://digitalcommons.liberty.edu/cgi/viewcontent.cgi?article=1259&context=honors

Anterior Vs. Posterior

There is no clear consensus in the search results on whether anterior or posterior leaflet disease is more common. However, there is some information on the outcomes of mitral valve repair for anterior versus posterior leaflet disease. A study published in the Journal of Thoracic and Cardiovascular Surgery found that mortality was 4.2% and 0%, respectively, in the group of patients with anterior and posterior leaflet prolapse1. Another study published in the same journal found no long-term survival or reoperation difference between posterior and anterior repair23. Therefore, surgeons at centers of excellence should aim for repair of both anterior and posterior leaflet pathology with the same decision-making threshold over valve replacement for degenerative mitral disease2. It is important to note that mitral valve prolapse is a common disorder, afflicting 2% to 3% of the general population45.