Anaes Cases · Cardiac anaesthesia & cardiopulmonary bypass
The failure to wean from the CPB
The hot case — the failure to wean. The re-bypass, the TEE diagnosis (the poor LV, the RV failure, the air, the graft-occlusion, the prosthetic-dysfunction), the inotropes, the IABP, the VAD if refractory.
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ANZCAFRCAABAEDAIC
Prompt
The patient fails to separate from the CPB after the mitral valve replacement — the low cardiac output, the TEE showing the poor LV contractility. Manage.
Presentation
After the mitral valve replacement, on the first attempt to wean from the CPB, the systemic pressure is only 65 mmHg, the CVP is 18, the PA pressure is 40, and the TEE shows the poor LV contractility (EF estimated at 25 per cent) with global hypokinesis. Manage.
References2ShowHide
- [5]Fraile-Gutierrez V, et al. Transesophageal echocardiography: A comprehensive assessment of the critically ill patient. Medicina Intensiva, 2026.PMID 42020231
- [4]Zheng C, et al. Microcirculation and cardioprotection in cardiac surgery. Front Cardiovasc Med, 2026.PMID 42325669