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Cryoglobulinemia: the "cold" problem in cardiac surgery, a single-center experience and a literature review
Pasquale Raimondo1, Gianmarco Intini2, Gianfranco Lauletta3
1Anesthesia and Intensive Care II, AOUC Policlinico Di Bari, Bari, Italy. prraimondo@iol.it.
Insights
Patients with cryoglobulinemia undergoing cardiac surgery can safely use normothermic cardiopulmonary bypass (CPB). This approach minimizes the risk of cryoglobulin-associated complications, offering an alternative to traditional hypothermic CPB.
Area of Science:
- Cardiology
- Hematology
- Vascular Surgery
Background:
- Cardiac surgery often requires cardiopulmonary bypass (CPB) and induced hypothermia.
- Cryoglobulinemia, a condition involving temperature-dependent antibody aggregation, poses a risk of ischemic events during hypothermia.
- Patients with cryoglobulinemia undergoing cardiac surgery require careful management to prevent complications.
Purpose of the Study:
- To review the evolving therapeutic and preventive strategies for managing cryoglobulinemia patients during cardiac surgery.
- To analyze and improve the perioperative management of these high-risk patients.
- To present single-center experience with normothermic CPB in cryoglobulinemia patients.
Main Methods:
- Literature evaluation of therapeutic and preventive approaches.
- Single-center retrospective analysis of 32 months of patient data.
- Implementation of normothermic cardiopulmonary bypass in all cases.
Main Results:
- Normothermic cardiopulmonary bypass (CPB) was utilized in all cryoglobulinemia patients.
- This approach, combined with cryoglobulin titer reduction, was found to be safe.
- Normothermic CPB demonstrated comparable safety to hypothermic management for these patients.
Conclusions:
- Normothermic CPB is a safe alternative to hypothermic CPB for cardiac surgery patients with cryoglobulinemia.
- Further large-scale studies are needed to validate these findings in a broader cardiac surgery setting.
Abstract:
Cardiac surgery with cardiopulmonary bypass (CBP) is essential for different cardiac procedures in order to perform surgery with a clear sight field.To safely perform surgery with CPB and preserve brain, kidney, and patient tissue from ischemic damage, cold cardioplegia, and mild to deep hypothermia are induced during the operation.Cryoglobulinemia is a hematological/infective-related disease (in certain cases idiopathic) in which temperature-dependent antibodies tend to aggregate and form emboli in the vascular system causing tissue damage if exposed to low temperature.The patient with cryoglobulinemia (known and unknown) can be at risk of a major ischemic event during CPB and induced hypothermia.This article's aim is to evaluate the present scientific literature in order to understand how, in years, the therapeutic or preventive approach, is evolving, and to analyze and make improvements to the management of a cryoglobulinemic patient who must undergo elective or emergency cardiac surgery.In the last part of our article, we expose our single-center experience during a 32-month-long period of survey.In all cases, our medical team (anesthesiologists, perfusionists, and cardiac surgeons) opted for a normothermic cardiopulmonary bypass to lower the risk of cryoglobulin-associated complications.In our experience, along with therapeutic intervention to lower the cryoglobulin titer, normothermic management of cardiopulmonary bypass is as safe as hypothermic management.Notwithstanding our results, further studies with a larger population are needed to confirm this perioperative management in a cardiac surgery setting.
