ArticleInterdisciplinary cardiovascular and thoracic surgery2026
Blood-Based Versus Crystalloid Cardiopulmonary Bypass Priming in Left Ventricular Assist Device Surgery: Impact on End-Organ Function and Survival.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesCardiopulmonary bypass (CPB) priming may influence haemodilution, bleeding, and end-organ injury during HeartMate 3 (HM3) implantation, but evidence in contemporary left ventricular assist device (LVAD) surgery is limited.
methodsWe retrospectively analysed 92 HM3 implantations (2015-2025) by priming strategy (blood-based [FFP + RBC], n = 36; crystalloid, n = 56). The primary end-point was postoperative right heart failure (RHF; Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS]). Multivariable regression and propensity score-based inverse probability of treatment weighting (IPTW) sensitivity analyses were performed.
resultsBaseline characteristics were balanced between groups, with comparable age (blood-based: 58 [49.5-66.0]; crystalloid: 62 [55.8-68.2]; P = .069) and female sex (blood-based: n = 3/36 [8.3%]; crystalloid: n = 8/56 [14.3%]; P = .518). Right heart failure was lower with blood-based priming (blood-based: n = 3/36 [8.3%]; crystalloid: n = 17/56 [30.4%]; P = .012; adjusted OR 0.23 [95% confidence interval (CI) 0.06-0.86]; P = .030). Dialysis was lower unadjusted (blood-based: n = 4/36 [11.1%]; crystalloid: n = 18/56 [32.1%]; P = .021), with a directionally lower adjusted estimate (OR 0.30 [95% CI, 0.09-1.01]; P = .053). Delirium was lower with blood-based priming (blood-based: n = 3/36 [8.3%]; crystalloid: n = 16/56 [28.6%]; P = .019; adjusted OR 0.22 [95% CI, 0.06-0.84]; P = .027). Survival did not differ significantly (log-rank P = .055; adjusted HR 0.59 [95% CI, 0.27-1.32]; P = .201). IPTW analyses showed lower delirium (OR 0.23 [95% CI, 0.06-0.84]) and an attenuated RHF association (OR 0.35 [95% CI, 0.10-1.23]).
conclusionsBlood-based CPB priming was associated with lower RHF and delirium, and directionally lower dialysis rates, after HM3 implantation. Survival estimates were not statistically significant. Findings require prospective validation. CLINICAL REGISTRATION NUMBER: Ethics Committee of the Medical Faculty of RWTH Aachen (EK 25-154).
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