About this Research Topic
Cardiac surgery performed in infants and children using cardiopulmonary pulmonary bypass (CPB), is accomplished through modulating a complex hemostatic balance to facilitate perfusion without thromboembolism yet attaining sufficient procoagulant activity and stability to minimize bleeding at the end of surgery. Multiple factors impact this fluctuating balance; including bypass circuit features and management, anticoagulant and antifibrinolytic strategies, surgical techniques, cardiothoracic anatomy and hemodynamics, developmental hemostasis, transfusion support and post-operative management.
Also, new pharmacologic agents, technological advances and increasingly complex cardiac physiology of neonates and children who survive longer than previously possible, all challenge existing diagnostic and management strategies. These patients are not anatomically or physiologically “small adults”, hence interventions and goals applicable to adults undergoing CPB may not be appropriate for them.
This Frontiers topic aims to address current knowledge, innovations and future research to optimize identification, characterization and management of hemostatic challenges experienced intra-and post-operatively in the neonatal and pediatric population undergoing CPB. Appropriate hemostatic balance impacts all phases of patient care and difficulty at any stage can compromise subsequent convalescence and outcomes. Shared knowledge of advances in mechanical technology, diagnostic methods, hemostatic agents and transfusion support will help optimize practice and identify knowledge gaps for future research.
Examples of themes to be included in this Frontiers topic could include:
• CPB circuit features and management; management of CPB anticoagulation with heparin or heparin alternatives
• The role and use of antifibrinolytics in CPB
• Hemostatic monitoring during and after CPB
• Hemostatic strategies at/after separation from CPB
• The role and use of novel/new hemostatic agents (systemic, topical)
• Management of massive hemorrhage
• Challenges and management implanting/incorporating extracorporeal support
• Hemostasis management of extracorporeal support
• Transfusion support guidelines, assessments and outcomes including new products
• Indications, agents, monitoring and reversal of chronic anticoagulation
Types of manuscripts considered could include: original basic science research, clinical trials, case series, novel case reports, state-of-the-science reviews, (patho)physiology reviews, practice surveys, QA projects
Keywords: Cardiac surgery, neonatal cardiac surgery, pediatric cardiac surgery, congenital cardiac surgery, extracorporeal circulation, ventricular assist devices, cardiac transplant, cardiopulmonary bypass, hemostasis, anti-coagulation, blood management, platelet mapping
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.