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Objectives Cardiac support systems are being used increasingly more due to the growing prevalence of heart failure and cardiogenic shock. Reducing cardiac afterload, intracardiac pressure, and flow support are important factors. Extracorporeal membrane oxygenation (ECMO) and intracardiac microaxial pump systems (Impella) as non-permanent MCS (mechanical circulatory support) are being used increasingly. Methods We reviewed the recent literature and developed an international European registry for non-permanent MCS. Results Life-threatening conditions that are observed preoperatively often include reduced left ventricular function, systemic hypoperfusion, myocardial infarction, acute and chronic heart failure, myocarditis, and valve vitia. Postoperative complications that are commonly observed include severe systemic inflammatory response, ischemia-reperfusion injury, trauma-related disorders, which ultimately may lead to low cardiac output (CO) syndrome and organ dysfunctions, which necessitates a prolonged ICU stay. Choosing the appropriate device for support is critical. The management strategies and complications differ by system. The “heart-team” approach is inevitably needed.However despite previous efforts to elucidate these topics, it remains largely unclear which patients benefit from certain systems, when is the right time to initiate (MCS), which support system is appropriate, what is the optimal level and type of support, which therapeutic additive and supportive strategies should be considered and ultimately, what are the future prospects and therapeutic developments. Conclusion The European cardiac surgical register ImCarS has been established as an IIT with the overall aim to evaluate data received from the daily clinical practice in cardiac surgery. Interested colleagues are cordially invited to join the register. Clinical registration number: DRKS00024560. Positive Ethics Vote: AZ 246/20 Faculty of Medicine, Justus-Liebig-University-Gießen.

Objectives: The noble gas xenon has recently been amended to the list of prohibited substances because it is supposed to trigger the production of HIF-1α and subsequently erythropoietin. While any performance-enhancing treatments are strictly prohibited in sport competitions researcher and clinician have opened a debate about the potential transfer of these promising findings into clinical context. Methods: The objective of this study was to evaluate the effect of xenon anesthesia on serum levels of erythropoietin in patients that underwent cardiac surgery. Therefore we performed a secondary analysis of serum samples and dataset of patients from a prospective randomized controlled trial in cardiac surgery. Serum levels of erythropoietin and testosterone were measured in serum samples that were collected prior to surgery, at admission to the ICU and 24 hours thereafter. In 30 patients, we evaluated the effect of xenon anesthesia on the perioperative serum levels of erythropoietin and its association with testosterone and postoperative hemoglobin levels. Results: Patients in the xenon group showed a significant increase of circulating serum levels of erythropoietin 24 hours after xenon anesthesia (12.9 ± 7.4 versus 8.7 ± 4.3 at baseline; p = 0.017) The testosterone levels were comparable between the xenon and sevoflurane group. The postoperative hemoglobin levels trended to be higher in the xenon group, whereas no difference was found with respect to the intraoperative administration of fluids or blood products (Fig. 1). Conclusion: This study provides first evidence for a xenon triggered effect on circulating serum levels of erythropoietin during cardiac surgery. Further validation in a larger trial is needed.

Objective: Cardiac preconditioning with brief cycles of hypoxia or volatile anesthetics like isoflurane leads to a significant protection from subsequent ischemia/reperfusion injury. The crosstalk between different cardiac cell types (cardiomyocytes, fibroblasts, endothelial cells) has come into focus of current research. One possibility is the intercellular exchange of cardioprotective mediators like heat shock proteins (HSP). In this context exosomes, which are small membrane vesicles that are actively secreted, have emerged as possible communication mediators. Recent publications indicate, that exosomes might be involved in hypoxic preconditioning, but mechanistical data still lacks. In addition it remains to be investigated whether other preconditioning stimuli, like volatile anaesthetics also trigger the release of vesicles and if these exosomes differ in their protein composition. Methods: Primary cardiac fibroblasts were isolated from neonatal rats via trypsin digestion and subsequent preplating. Cells were exposed to different preconditioning stimuli like isoflurane (1.5 vol%, 4h) or hypoxia (

Introduction: The protective effects of late phase preconditioning can be triggered by several stimuli. Unfortunately, the transfer from bench to bedside has proven challenging, as the complex signalling pathways involved are easily influenced by concomitant medication or disease. Methods: In an established model of primary neonatal rat cardiomyocytes, we analysed the cardioprotective effects of three different stimulating agents that are clinically established. Twentyfour hours prior to hypoxia, cells were preconditioned either by isoflurane, levosimendan or xenon. The influence of these three stimuli on hypoxia-inducible factor-1α and vascular endothelial growth factor were analysed by polymerase chain reaction and western blotting. Results: 5 hours of hypoxia reduced cell survival in unpreconditioned control cells to 0.44 ± 0.04. Surviving cell count was significantly higher in cells preconditioned by either 2x15 isoflurane (0.70 ± 0.16; p = 0.005) or xenon (0.59 ± 0.08; p = 0.049). Xenon-preconditioned cells showed a significantly elevated content of VEGF (0.025 ± 0.010 vs. 0.003 ± 0.006 in controls; p = 0.0003). The protein expression of HIF-1a was increased both by Levosimendan (0.563 ± 0.175 vs. 0.142 ± 0.042 in controls; p = 0.0289) and Xenon (0.868 ± 0.222; p