Priority 7 from the Heart Surgery PSP

UNCERTAINTY: How do we minimise damage to organs from heart-lung machine/heart surgery (heart, kidney, lung, brain and gut)? (JLA PSP Priority 7)
Overall ranking	7
JLA question ID	0088/7
Explanatory note	Organ injury or failure affecting the heart, lung, brain, or kidneys, complicates up to 50% of all cardiac surgery operations. Organ protection is a major theme in cardiac surgery research and strategies tailored to optimise this outcome are considered in all major guidelines. However, despite decades of research, the pathogenesis of these conditions remains poorly understood and effective organ protection interventions are not in widespread use. ~ Can something with cardiopulmonary bypass (CPB) be done to prevent inflammatory aspects of heart surgery? How do myocardial protection techniques impact on outcome of heart surgery? Does use of cerebral oximetry during CPB reduce acute renal failure in cardiac surgical patients? Can stroke be prevented post-surgery?
Evidence	Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R., Cerebral near‐infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database of Systematic Reviews. 2018(1); Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5-33.
Health Research Classification System category	Cardiovascular

Extra information provided by this PSP
Original uncertainty examples	What research is being done to help reduce the risk of major organ failure following heart surgery? ~ How do myocardial protection techniques impact on long-term PROMs? ~ Are there any improvements in cardiopulmonary bypass (CPB) that can be made to prevent inflammatory aspects of heart surgery? ~ Has the routine use of cerebral oximetry during CPB reduced creatinine rise/ARF (acute renal failure) in cardiac surgical patients? ~ Can stroke be prevented post-surgery?
Submitted by	8 x patient, 8 x carer, 79 x healthcare professional, 7 x others

Extra information provided by this PSP

Original uncertainty examples

What research is being done to help reduce the risk of major organ failure following heart surgery? ~ How do myocardial protection techniques impact on long-term PROMs? ~ Are there any improvements in cardiopulmonary bypass (CPB) that can be made to prevent inflammatory aspects of heart surgery? ~ Has the routine use of cerebral oximetry during CPB reduced creatinine rise/ARF (acute renal failure) in cardiac surgical patients? ~ Can stroke be prevented post-surgery?

Submitted by

8 x patient, 8 x carer, 79 x healthcare professional, 7 x others

PSP information
PSP unique ID	0088
PSP name	Heart Surgery
Total number of uncertainties identified by this PSP.	45 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	11 July 2019