Background: Peri-operative coagulation management of patients receiving apixaban, a new oral anticoagulant, is difficult. The CytoSorb^® hemoadsorption device might represent a therapeutic option to reduce apixaban’s pharmacological and inflammatory effects during high-risk surgery. Case presentation: An 83-year-old woman treated with Apixaban underwent emergent redo mitral valve replacement for prosthetic valve endocarditis. A CytoSorb^® cartridge was added to the cardio-pulmonary bypass (CPB) circuit. Apixaban-specific anti-factor Xa activity (AFXaA) were measured peri-operatively. After 100 minutes of CPB, a 50% AFXaA rate decrease was observed as compared to pre-CPB values. Furthermore, we noticed 39% and 44% reductions of AFXaA levels in comparison to the expected levels in patients with normal or altered renal function, respectively. Conclusion: Insertion of a CytoSorb^® cartridge in the CPB was safe and associated with rapid correction of Apixaban-associated anticoagulation.

Extracorporeal circulation (ECC) such as cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO) may induce a complex activation of the i

Background: The management of hemostasis in patients medicated with apixaban (Eliquis) undergoing emergency cardiac surgery is exceedingly difficult. The body’s natural elimination pathways for apixaban prove ineffective in emergency situations, and the impact of hemodialysis is limited. The application of Cytosorb^® may attenuate the concentration of apixaban, thereby facilitating the stabilization of these patients. Case presentation: An 84-year-old man treated with apixaban, underwent emergency ascending aorta replacement surgery due to an acute type A aortic dissection. To address the challenges induced by apixaban, we integrated Cytosorb^® cartridge into the Cardiopulmonary bypass circuit. There was a 63.7% decrease in perioperative apixaban-specific anti-factor Xa activity. The patient’s postoperative course was favourable. Conclusion: Hemoadsorption with Cytosorb^® may offers a safe and feasible approach for reducing apixaban concentration in emergency cardiac surgery, thereby mitigating the risk of hemorrhagic complications.

The optimal surgical approach for right ventricular outflow tract obstruction in Tetralogy of Fallot aims to preserve the native pulmonary valve annulus, as this is associated with better long-term outcomes. Pediatric humanitarian patients often present with a delayed diagnosis and lack access to preoperative palliative treatments, reducing the likelihood of pulmonary valve annulus preservation and potentially compromising long-term outcomes. This study aims to identify independent predictors of successful pulmonary valve-sparing repair in pediatric humanitarian patients undergoing corrective surgery for Tetralogy of Fallot. Between January 2019 and May 2023, pediatric humanitarian patients with Tetralogy of Fallot underwent surgical correction at our center. We performed a comparative analysis of preoperative, intraoperative, and postoperative variables, followed by univariate and multivariate logistic regression to identify independent predictors of pulmonary valve-sparing repair. A lower body mass index (OR = 0.711; p = 0.021; 95% CI = 0.533–0.949), a larger pulmonary valve annulus measured in centimeters (OR = 28.653; p = 0.008; 95% CI = 2.360-347.890) and a higher Z-score of pulmonary valve annulus (OR = 1.606; p = 0.023; 95% CI = 1.067–2.418) were identified as independent predictors of pulmonary valve-sparing repair. Successful pulmonary valve-sparing repair was associated with lower BMI and a larger pulmonary valve annulus (both measurements in centimeters and Z-score). These findings may help guide clinical and policy strategies to promote more equitable and effective surgical care in resource-limited settings.

Background: Pulmonary valve-sparing repair in Tetralogy of Fallot is associated with better long-term outcomes, but its feasibility remains uncertain in pediatric humanitarian patients, who often present late, with complex anatomy and comorbidities. Objective: To develop a simple and interpretable decision tree model to predict the likelihood of pulmonary valve-sparing repair based on preoperative data in a humanitarian pediatric cohort. Methods: A post-hoc classification and regression tree analysis was conducted on 115 pediatric humanitarian patients with Tetralogy of Fallot who underwent surgical correction at our center, between 2019 and 2023. Predictor variables included demographic, anthropometric, and anatomical parameters. Results: The model achieved an overall accuracy of 80.0%, with a sensitivity of 88.2% and specificity of 56.7%. The pulmonary valve annulus diameter (> 0.855 cm) was the primary discriminator for pulmonary valve-sparing repair. Conclusion: A simple decision tree model using preoperative anatomical variables may support surgical planning in humanitarian contexts. Its interpretability and high sensitivity suggest potential value as a preoperative triage and planning aid.