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Medicina
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Clinical Advances in Cardiopulmonary Bypass Surgery: Innovations and Impacts on...
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Clinical Advances in Cardiopulmonary Bypass Surgery: Innovations and Impacts on Patient Outcomes

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 31 January 2026 | Viewed by 962

Special Issue Editors

Prof. Dr. Irina-Iuliana Costache

E-Mail Website1 Website2
Guest Editor
Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
Interests: ischemic heart disease; arterial hypertension; pulmonary embolism; heart failure; biomarkers
Special Issues, Collections and Topics in MDPI journals
Dr. Ștefania-Teodora Duca

E-Mail Website
Guest Editor Assistant
1. Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania
2. Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
Interests: chronic heart failure; cardiac biomarker; ischemic cardiomyopathy; cardiac imaging; heart disease
Dr. Lucian Stoica

E-Mail Website
Guest Editor Assistant
Cardiovascular Surgery Department, Cardiovascular Diseases Institute, Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
Interests: ischemic heart disease; biomarkers; cardiovascular surgery; coronary artery bypass surgery; aortic dissection surgery; mechanical prosthesis surgery

Special Issue Information

Dear Colleagues,

Background and history of this topic: The field of cardiovascular surgery is highly dynamic, continuously evolving and improving. The cardiopulmonary bypass has revolutionized cardiac surgery for decades, allowing for complex procedures to be performed. However, the field has witnessed significant advancements in recent years, driven by technological innovations, an improved understanding of physiological processes, and the pursuit of better patient outcomes.

Aim and scope of the Special Issue: This Special Issue aims to explore cutting-edge advancements in cardiopulmonary bypass, focusing on how recent innovations have improved clinical outcomes and the quality of care in cardiac surgery. The Issue will provide insights into new technologies, surgical techniques, and strategies that have the potential to improve patient outcomes.

Cutting-edge research: We invite contributions on topics such as innovative or minimally invasive CPB techniques, patient monitoring systems, hemodynamic optimization, and novel approaches to managing complications and postoperative care.

What kind of papers we are soliciting: By highlighting the latest advancements in cardiopulmonary bypass surgery, this Special Issue aims to contribute to the ongoing improvement of patient care and outcomes. We encourage reseachers to submit their original research, comprehensive reviews, clinical studies, and case reports that offer practical solutions or novel insights into cardiopulmonary bypass. Submissions should advance the understanding of cardiopulmoary bypass’ clinical applications and highlight its impact on patient safety, recovery, and long-term outcomes.

Prof. Dr. Irina-Iuliana Costache
Guest Editor

Dr. Ștefania-Teodora Duca
Dr. Lucian Stoica
Guest Editor Assistants

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiac surgery
  • cardiopulmonary bypass
  • patient outcome
  • surgical techniques
  • extracorporeal circulation
  • postoperative care
  • perfusion strategies

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (1 paper)

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Research

23 pages, 1967 KB  
Article
Evaluation of Myocardial Protection in Prolonged Aortic Cross-Clamp Times: Del Nido and HTK Cardioplegia in Adult Cardiac Surgery
by Murat Yücel, Emre Demir Benli, Kemal Eşref Erdoğan, Muhammet Fethi Sağlam, Gökay Deniz, Hakan Çomaklı and Emrah Uğuz
Medicina 2025, 61(8), 1420; https://doi.org/10.3390/medicina61081420 - 6 Aug 2025
Viewed by 335
Abstract
Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic [...] Read more.
Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiopulmonary Bypass Surgery: Innovations and Impacts on Patient Outcomes)
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