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Background: Pulmonary artery catheter (PAC) is a diagnostic and haemodynamic monitoring tool. The PAC is used by clinicians in adult medical ICUs, cardiac catheterization laboratories and coronary care units (CCUs). Objective: To determine the indications for the use of pulmonary artery catheter (PAC) in patients undergoing cardiac surgery and to study the outcome of patients with PAC undergoing cardiac surgery. Methods: The present study was carried out in Department of Anesthesiology, Narayana Hrudayalaya, Bangalore. In our study 1000 patients with PAC were assessed retrospectively and data of patients was collected from 2017-2019. EuroSCORE of patients was calculated to assess preoperative condition of the patient prior to surgery. Results: Data of one thousand patients with PAC was collected. The following observations were seen. 71.5% patients were of age <60 years. 77.8% patients were males, and 22.8% patients were female. The most common indication for PAC insertion was PAH (pulmonary artery hypertension) (37.2%), followed by hemodynamic monitoring (33.2%), followed by heart failure with reduced ejection fraction (low EF) (24.3%), hypertrophic obstructive cardiomyopathy (HOCM) (3.1%), severe right ventricular (RV) dysfunction (1.0%), ventricular assist device (VAD) & cardiac transplant (0.8%), others (0.4%). During PAC insertion 0.5% patients developed transient cardiac arrhythmia, 0.2% patients had mild bleeding at insertion site. Postoperative data analysis showed that in patients with PAC post op 23.5% required IABP, 13.9% had cardiac arrest, death (12.9%), stroke (5%), septicemia (4.1%). Among patient with (EuroSCORE 1-3, n=188), (EuroSCORE 4-6, n=529), (EuroSCORE 7-10, n=212), (EuroSCORE >10, n=55); ICU stay was >10 days in 15.4%, 16.44%, 20.75%, 60% respectively with p<0.001. Hospital stay was 10 ±5days in 47.3 % cases, 23 ± 7days among 38.5% patients, 38 ± 7 among 14.8% patients, 53 ± 7days among 0.4% patients and 75 ± 14.5among 0.3% patients. Conclusion: PAC is an important tool to monitor continuous cardiac output, systemic vascular resistance, pulmonary artery pressure. Use of PAC has shown to guide appropriate vasopressor and ionodilator therapy. Our study showed 0.7 % complications during procedure which were reversible and could be managed conservatively. Patient with high EuroSCORE and severe cardiac dysfunction had higher mortality, and hence mortality cannot be directly attributed to PAC. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study was to analyse the preoperative medication management within the cardiac surgery patient population and measure the effectiveness of an interprofessional intervention in routine care. Methods: A jointly developed preoperative medication management was implemented in routine care on multiple levels (inclusion in admission letter to primary care, hotline for inquiries, pocket cards for physicians and correspondence with referring centres). The effectiveness was evaluated by analysing preoperative management before and after implementation. The primary endpoint was the number of drugs managed correctly according to the guidelines after implementation. Secondary endpoints consisted amongst others of bleeding on the intensive care unit, re-thoracotomy, postoperative infarction and cerebrovascular complications. Additionally, possible associations between the correct management and different variables were investigated by multivariate analysis. Results: After the implementation, the number of drugs managed correctly according to guidelines increased from 54.0 to 73.5% (P < .001). The effect was more prominent for direct oral anticoagulants and prophylactic aspirin where the guideline adherence increased from 29.2 to 74.5% and from 78.6 to 95.1%, respectively. No difference was seen for sodium–glucose transporter-2 inhibitors, metformin, vitamin-K antagonists and dual-antiplatelet therapy. Secondary endpoints showed no safety signals with regard to bleeding or thrombotic events. In multivariate analysis, the intervention was effective (odds ratio 2.17, 95% confidence interval [1.32–3.62]) after adjusting for possible confounders. Conclusion: An interprofessional programme was effective to improve preoperative medication management in cardiac surgery patients. Sodium–glucose transporter-2 inhibitors, metformin and direct oral anticoagulants appear to be especially at risk for incorrect management before cardiac surgery with possible adverse events. [ABSTRACT FROM AUTHOR]

Patients with cardiovascular disease have depression more often than the general population does. The aim of the study was to detect the associations between the psychological state and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The prospective study was performed during 2008–2012 in Kaunas, Lithuania. The psychological state of 233 patients was assessed by using the Symptom Checklist-90-Revised instrument. The assessment was carried out at 1.5 months, 1 year, and 2 years after the surgery. A sample of 531 measurements of psychological states was used. To investigate the relationships between psychological scores and daily weather variables, a mixed linear model was used adjusting for sex, the type of surgery, age, the marital status, the presence of arterial hypertension, diabetes, major depressive disorders, dysthymic disorders, agoraphobia, smoking before surgery, and myocardial infarction in the anamnesis. The mean somatisation score and air temperature on the second day prior to the survey were found to have a negative correlation in the multivariate model. Lower mean scores of anxiety and depression were linked to hotter days (air temperature >16.25°C on the second day) that did not occur in July or August. During colder days (air temperature <0.35°C), a higher mean score of anxiety and phobic anxiety was observed. A higher mean score of somatizations, depression, and anxiety was seen on the second day after the day with wind speed ≤2.85 kt and on the day after the day with relative humidity <66%. Both a decrease and an increase in daily atmospheric pressure were associated with a higher depression score. Our results confirm that among patients after open heart surgery, psychosomatic complaints are related to some weather changes. The obtained results can help to determine the complexity of weather patterns linked to poorer psychological health. [ABSTRACT FROM AUTHOR]

Abstract Background To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. Methods A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. Results As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p

Introduction More often, cardiac surgery patients (CSP) receive systematic psychological aid after surgery. However, their need for psychosocial interventions in the perioperative period is underestimated. Objectives The goal is to determine the stages of psychosocial interventions for CSP that could cover the whole period of their treatment and rehabilitation. Methods Analysis of scientific papers and practical experience gained in cardiologic clinic allowed dividing the system of psychosocial interventions for cardiac surgery patients into periods in accordance with actual stages of medical aid for CSPs. Results According to the principles of personalized approach, we determined six consecutive semantically different stages of psychosocial interventions: out-of-hospital pre-surgery, in-hospital pre-surgery, early post-surgery, in-hospital post-surgery, post-surgery rehabilitation, and out-of-hospital rehabilitation. They have different duration and cover the whole period of treatment and rehabilitation of CSPs beginning with the moment of indication to surgery up to the complete rehabilitation and full adaptation to their post-surgery somatic condition. Each stage has its own goals, main objectives and expectations. Duration of the stages is conditional and can change depending on the nature of every clinical situation. Conclusions Determination of clinical stages in the process of psychosocial interventions for CSPs gives ground for selecting optimal psychological methods and techniques for each stage and sets exact goals, achievement of which becomes possible only through a properly organised work of an interdisciplinary team of specialists. Disclosure No significant relationships.

Introduction Cardiac surgery patients (CSP) are cardiovascular patients who undergo surgery to treat their disease. Are their psychological characteristics different from those of other cardiac patients? Objectives The goal is to establish peculiarities of the clinical-and-psychological status of CSPs in different clinical groups. Methods According to clinical parameters, 152 CSPs were divided into three groups. The first group comprised patients with CHD indicated to an open-heart coronary artery bypass grafting, the second one included patients with heart failure who were to undergo aortic valve surgery, and the third group included CHD patients and those with heart rhythm abnormalities indicated to minimally invasive surgery. Results CSPs had a number of cardiologic complaints, mental disturbance manifestations and concomitant somatic diseases. They showed difference in the duration of the disease, previous occurrence of heart surgery or myocardial infarction, and in the degree of heart failure manifestations. Self-assessment of pre-surgery CSPs corresponded to the severity of their clinical condition, while indications of hope for recovery were at the maximum level. The second group showed a moderate level of depression, while the third one – slight depression. All the groups revealed a disharmonic profile of time perspective. Group 1 CSPs showed some manifestations of hostility. We saw different manifestations of CSPs’ personal adaptation resources. While hardiness had insufficient showings at the level of most components, social support was excessive in all groups. Conclusions CSPs as other cardiac patients revealed depressive disorders and hostility. At the same time, they have more social support, which testifies availability of good interpersonal resources. Disclosure No significant relationships.

Introduction Differentiation of targets for psychotherapy allows determining certain ways and priorities in psychological treatment of a patient. Objectives To work out a multi-level system of psychotherapeutic targets for clinical groups of cardiac surgery patients (CSPs). Methods Clinical and psychological analysis of 152 CSPs who were to undergo different types of cardiac surgery treatment. Results We have established four levels of psychotherapeutic targets: a patient’s response to surgery, psychopathologic manifestations, personality’s dysfunctional characteristics, and social interaction specificities. Towards CSPs with open-heart coronary artery bypass grafting, the targets appeared to be as follows: low expectations from surgery, low hopes for recovery, low level of satisfaction with life, depressive disorders with somatic manifestations, cognitive abnormalities, anxiety manifestations, manifestation of hostility, rejection of the past, inclination for fatality, reduced vitality, reduced social activity, expectation of help from closest people.Towards CSPs indicated to open-heart aortic valve repair surgery, psychotherapeutic targets were as follows: high expectations from surgery; moderate fear of death; not feeling well; low spirits; depressive disorders with somatic and cognitive-and-affective manifestations; cognitive abnormalities; anxiety manifestations; manifestation of hostility; rejection of the past; reduced hedonism; expectation of help from closest people; reduced social activity. Towards CSPs indicated to minimally invasive surgery, we set such targets as: moderate expectations from surgery; apparent fear of death; depressive disorders with somatic manifestations; anxiety manifestations; cognitive abnormalities; rejection of the past; expectation of help from closest people; reduced social activity. Conclusions Psychotherapy of CSPs that includes the established targets can contribute to personalized approach in a patient’s treatment. Disclosure No significant relationships.

Background: To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard.Methods: A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients.Results: As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view.Conclusions: The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure. [ABSTRACT FROM AUTHOR]

Introduction. The study aim was to analyse the justification of limitations in physical therapy and activities of daily living in patients after cardiac surgery via sternotomy. Methods. A narrative review design was followed. This study is the result of analysing and comparing the data obtained through investigating sternal closure stability after sternotomy, the load on the sternum during physical therapy, activities of daily living and coughing, as well as the effectiveness of sternum external fixation. Results. Sternum closure stability after sternotomy and the force of the load on the sternum during cough are greater than when performing upper extremity movements and most of the activities of daily living. The benefits of using sternum external fixation are not marked. Mathematically, most of the presented statistical benefits of sternum external fixation were achieved owing to the large number of individuals in the samples. Therefore, it is important to analyse such statistical indicators as odds ratio, attributable risk, the number needed to treat in terms of such a 'harmful factor' as lack of sternum external fixation. The use of sternum external fixation should be biomechanically grounded. Conclusions. Conventional restrictions and recommendations for patients after cardiac surgery via sternotomy lack theoretical justification and research to confirm their necessity. [ABSTRACT FROM AUTHOR]

The study of the structural dominants of stroke as a valid element of the evidence base of the morbid psychotype in cardiosurgical patients with postoperative hypoxic-ischemic injuries is currently a priority. It is mostly due to the actual issues of unresolved problems of patient-oriented strategy of neurological support of cardiosurgical patients, endless contradictions in the tactics of management of this category of patients, frequency and clinical polymorphism of postoperative complications (strokes, encephalopathies, dysfunction, neurosis etc.). Preoperative preparation of patients, transoperative management of patients; issues of premedication, anesthesia; prevention of complications and persistent disabilities, prognosis of efficiency and further quality of life, sometimes social psychoadaptation – all of this require specialists having a deep and comprehensive understanding of the leading components of the nosological prototype, the basic criteria of morphological patterns of the disease. Taking into account the latter, the role and the importance of morphological diagnosis of clinical manifestations is clearly growing among a fairly wide range of complications in cardiac surgery. Aim of research: was to investigate the leading morphological dominants of stroke as a basis for the morbid psychotype in cardiosurgery patients with postoperative hypoxic-ischemic injuries. Material and research methods. Morphological analysis (histological examination) was performed on pieces of brain (gray and white matter), 0.5 cubic cm in size of healthy individuals (infection control, IC, n = 12) and those who belonged to the group of clinical observation, CO, n = 18 (also including thanatological follow-up data from own retrospective annals and archives. The author of the work pays tribute to the bright memory of Professor, Doctor of Medical Sciences A. F. Yakovtsova – Honorary Professor of the Department of Pathological Anatomy, Kharkiv National Medical University, Ministry of Health of Ukraine – for professional consultations during the implementation of this fragment of the dissertation research). The sectional material was carefully removed, pieces with sections of cortical and cerebral matter were separated, and then washed in running water. Fixation was performed for at least 24 hours in 12% formalin solution on phosphate buffer (pH = 7.0-7.2), at t0 =18-200 Co in a glass-ceramic vessel. Dehydration of the material took place through a system of ethyl alcohols solutions from 300 to absolute, poured into resin (paraffin / celloidin according to the needs of the study). From the obtained blocks, using the resources of the microtome “MK-25”, we made a series of histological sections with a thickness of 5-10 μm (in one of three mutually perpendicular planes: frontal, horizontal, sagittal). The obtained sections were stained depending on the research tasks, its strategy, taking into account the type of tissue (hematoxylin-eosin, according to Van Gieson). Histological examination of gray and white matter of the brain was performed by stages. Microscopic analysis of the material was performed using a light optical system of the Lieca microscope (Germany) (x 100; x 300). The cortical and cerebral substances of the cerebral hemispheres and areas of the penumbra were examined. Comparison of control samples with the clinical version was carried out in a comparative aspect. Results. Morphological analysis of native brain preparations samples of healthy individuals, IC (cases of sudden death for the reasons unrelated to pathology of the central and peripheral nervous system) showed in favor of a complete correlation of structural and functional changes with sex-age parameters of postnatal ontogenesis. Gray and white substances are contrast, clearly differentiated, their layers are well marked, they did not contain any signs of foci of inflammation, destructive-degenerative processes, heart attacks and necrosis. The results of the study of the material, from persons belonging to the clinical observation group (ischemic stroke as one of the prototypes of hypoxic-ischemic complications in cardiosurgery patients), showed the presence of ischemic injuries. The latter were characterized by a phased nature, which to some extent depended on the timing of the onset of the stroke phenomenon, the depth of organic damage, microtopography, the volume of areas of destructive and degenerative changes. The foci of edema being inflammatory phenomena and the result of ischemia attracted the attention. The substance of the brain in these loci and adjacent areas is “softened”, brittle, flabby, in a state of dyschromatosis, it is not elastic enough. Some histological preparations observed in the near-term period contained areas of necrosis, with elements of generalizations of ischemic phenomena. Neighboring with damaged areas the fragments of the substance are saturated with leukocyte infiltrates, which are more contrast. Нeart attacks (morphologically thy are trivial focal necrosis) were the leading diagnostic features of ischemic genesis. Conclusion. The pathogenetic scenario of stroke has a number of phases. Its primary leading morphological dominants (as a component of the morbid psychotype of cardiosurgery patients with postoperative hypoxic-ischemic disorders) include the occurrence of focal cerebral infarctions (white, red, mixed). The latter by their nature are necrosis and are caused by ischemia, due to the development of vascular disorders (stasis, thrombosis), lack of blood supply / trophism of the relevant areas of the brain. The final stages of the morphological strategy of stroke are characterized by the appearance of foci of proliferation, astrocytes, collagen fibers, the formation of gliomesodermal, connective tissue scars, cysts.

Brain injury caused by extracorporeal circulation during cardiovascular surgical procedures has been a recurring complication since the implementation of extracorporeal circulation five decades ago. There is no unique cause of brain injury due to the use of extracorporeal circulation, but it is known that brain injury affects about 70% of patients who undergo this procedure. Intracranial pressure assessment is one method that can guide the management of patients undergoing procedures associated with neurological disturbances. This study describes two cases of patients who underwent cardiovascular surgery with extracorporeal circulation in whom clinical protocols for neuroprotection in the postoperative phase were guided by intracranial pressure waveform findings obtained with a novel noninvasive intracranial pressure monitoring method. [ABSTRACT FROM AUTHOR]

Background Corrective cardiac surgery is the standard management for complex congenital heart disease. Cardiopulmonary bypass surgery and post-surgical intensive care may lead to low cardiac output syndrome (LCOS), as a major complication after open heart surgery. To diagnose early LCOS, lactate level, pCO2 gap, and mixed venous oxygen saturation (SvO2) are parameters reported to have correlations with decreased cardiac output, morbidity, and post-cardiac surgery mortality. Objective To determine the usefulness of lactate level, pCO2 gap (arterial-vein), and SvO2 for early detection of LCOS in children post-open heart surgery. Methods This prospective cohort study was done from August to October 2017 in the ICU of the Integrated Cardiac Center, Dr. Cipto Mangunkusumo Hospital, Jakarta. Subjects were pediatric patients who underwent cardiac surgery. After surgery, patients underwent monitoring in the ICU for clinical signs of LCOS and examinations for lactate levels, pCO2 gap, and SvO2 at 15 minutes, 4 hours and 8 hours. Results Thirty-three open heart surgery patients were the subjects. Lactate level at 4 hours and 8 hours post-operative were significantly higher in the LCOS group compared to non-LCOS group. For the pCO2 gap, only the 4-hour post-operative Results were significantly higher in LCOS group compared to non-LCOS groups. In addition, only SvO2 at 4 hours after surgery was significantly lower in LCOS group compared to non-LCOS group. Conclusion Elevated lactate, high pCO2 gap, as well as decreased SvO2 at 4 hours post-operatively are the most reliable markers of LCOS after pediatric open heart surgery. [ABSTRACT FROM AUTHOR]

Rationale: The renin-angiotensin-aldosterone system is a major pathway in regulating blood pressure, glomerular filtration, and fluid homeostasis. During inflammatory diseases, generation of angiotensin II might be disturbed, leading to increased renin concentrations. Cardiac surgery and the use of cardiopulmonary bypass both induce inflammatory response and cardiovascular instability, which can contribute to acute kidney injury (AKI).Objectives: To investigate whether renin concentrations are associated with hypotension and AKI.Methods: This is a single-center, prospective, observational study among patients undergoing cardiac surgery.Measurements and Main Results: The primary endpoint was the occurrence of AKI within 72 hours after cardiac surgery. A total of 197 patients were available for the primary analysis. The median renin serum concentration was 40.2 μU/ml (quartile 1 [Q1]-Q3, 9.3-144.4) at baseline and 51.3 μU/ml (Q1-Q3, 19.1-167.0) 4 hours after cardiac surgery, whereas the difference between postoperation and preoperation concentrations (Δ-renin) was 3.7 μU/ml (Q1-Q3, -22.7 to 50.9). Patients with an elevated Δ-renin developed an AKI significantly more often (43% vs. 12.2%; P < 0.001). High Δ-renin after cardiac surgery was associated with a significantly lower mean arterial pressure, longer time on vasopressors, and longer length of ICU and hospital stay. The area under the curve (AUC) of Δ-renin for the prediction of AKI (AUC, 0.817; 95% confidence interval, 0.747-0.887) was significantly greater compared with the AUC of the postoperative renin concentrations (AUC, 0.702; 95% CI, 0.610-0.793; P = 0.007).Conclusions: Elevated renin concentrations were associated with cardiovascular instability and increased AKI after cardiac surgery. Elevated renin concentrations could be used to identify high-risk patients for cardiovascular instability and AKI who would benefit from timely intervention that could improve their outcomes. [ABSTRACT FROM AUTHOR]

Introduction Depression is one of common comorbid states that accompany cardiovascular diseases. Risk of co-morbidity can rise when patients have to undergo heart surgery, which is an additional stress-factor. Objectives To specify psychological correlations between depressive manifestations in cardiac surgery patients based on the analysis of their time perspective profile. Methods Using the Zimbardo Time Perspective Inventory, we examined 60 cardiac surgery inpatients (80% male, mean age 58.25±10.55). We calculated the statistical estimation of the received data based on the comparison with the norm and the correlation analysis. Results The research revealed that cardiac surgery patients’ indices significantly exceeded the norm on three out of five scales – Negative-Past (t=4.405; p=.000), Positive-Past (t=3.536; p=.000), and Future (t=5.008; p=.000). We also identified essential correlations between the level of depression and the indices of Negative-Past (r=.390; p=.002) and Positive-Past (r=-.270; p=.037). We distinguished a positive correlation of the negative attitude to the past with cognitive-affective (r=.369; p=.004) and somatic (r=.338; p=.008) manifestations of depression, and a negative correlation with the level of education (r=-.292; p=.024). Conclusions The personal time perspective profile in cardiac surgery patients is unbalanced due to a high level of their negative attitude to the past with an optimal level in other time perspectives. The degree of the Negative-Past attitude correlates in the patients with a low level of education and a high risk of depression in all its manifestations. The given correlations should be taken into account when conducting preventive psychological interventions. Disclosure No significant relationships.

Introduction Depressive disorders are common for cardiac patients; however, a surgical intervention enhances their distress. How typical is suicidal ideation for cardiac surgery patients and with what clinical and psychological signs does it correlate? Objectives To estimate the frequency of suicidal ideation and correlations between suicidal ideation, clinical and psychological manifestations in cardiac surgery patients. Methods We examined 60 cardiac surgery patients, aged 25 – 65, prior to their operation. The Pierson correlation between manifestation of suicidal ideation, clinical and psychological signs was calculated with p

Introduction During the pandemic, many surveys studied people’s attitude to COVID-19. However, less information is available about the peculiarities of such attitude of the most vulnerable groups including chronic somatic patients who are in need of operative treatment. Objectives To identify the specificity of preoperative cardiac surgery patients’ attitudes toward COVID-19 as compared to that of healthy people. Methods We used the Attitudes towards COVID-19 questionnaire (Nikolaev E.) to survey 60 preoperative cardiac patients and 327 healthy university students. Difference validity was assessed with significance level of p

Background: It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. Cardiac myxosarcoma is a rare neoplasm that appears to rise from the same cellular source like myxoma. It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Myxosercoma tumor requires surgery and chemoradiotherapy, but myxoma is treated only by surgery. Case Presentation: We describe a case of a 58-year-old patient with a left atrium myxosarcoma, presenting with congestive heart failure. Transthoracic echocardiogram (TTE) showed a large polypoid and mobile mass in the left atrium, the patient underwent cardiac surgery and the tumor was successfully extracted, and histopathological result revealed typical features of myxoma. 15 days after surgery, he underwent explorative laparatomy because of progressive GI bleeding. Laparatomy revealed extensive metastatic masses in abdomen and the pathology diagnoses was myxosaroma. Unfortunately, in spite of supportive care, the patient expired on postoperative day one. Conclusion: It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Maybe magnetic resonance imaging can help us to achieve more data suggesting malignancy. [ABSTRACT FROM AUTHOR]

Les patients opérés cardiaques sont plus âgés; ils présentent parfois des pathologies complexes et sont porteurs de plus de comorbidités, mais ils doivent sortir plus vite de l'hôpital ! Ceci a considérablement modifié les missions des centres de réadaptation cardiaque. En effet, si 15 à 25 % des patients opérés vont présenter une complication postopératoire nécessitant une prise en charge hospitalière (infectieuse, péricardique, rythmique, neurologique, pulmonaire, digestive, etc.), plus des 2/3 de ces événements aigus peuvent être gérés par les centres de réadaptation cardiaque pour un moindre coût. Ainsi, plus le malade est transféré rapidement en réadaptation cardiaque, plus le service de chirurgie cardiaque peut « rentabiliser » ses lits. Les complications infectieuses sont les plus redoutables et en particulier la médiastinite. Patients undergoing cardiac surgery are older, have complex pathologies and several comorbidities, but need to leave the hospital quickly! Therefore, the mission of cardiac rehabilitation centres has substantially changed. Indeed, if 15 to 25% of patients undergoing cardiac surgery will have a postoperative complication requiring a hospital management (infectious, pericardial, rhythmic, neurologic, pulmonary, digestive, etc.), more than 2/3 of these acute events could be managed by cardiac rehabilitation centres for a lower cost. Therefore, the quickest the patient is transferred to a cardiac rehabilitation centre, the easier the cardiac surgery centre could manage his beds. Infectious complications are the most dreadful, particularly mediastinitis. [ABSTRACT FROM AUTHOR]

Abstract The circulatory system is oscillatory in its nature. Oscillatory components linked to physiological processes and underlying regulatory mechanisms are identifiable in circulatory signals. Autonomic regulation is essential for the system's ability to deal with external exposure, and the integrity of oscillations may be considered a hallmark of a healthy system. Loss of complexity is seen as a consequence of several diseases and aging. Heart rate variability is known to decrease after cardiac surgery and remain reduced for up to 6 months. Oscillatory components of circulatory signals are linked to the system's overall complexity. We therefore hypothesize that the frequency distributions of circulatory signals show loss of oscillatory components after cardiac surgery and that the observed changes persist. We investigated the development of the circulatory frequency distributions of eight patients undergoing cardiac surgery by extracting three time series from conventional blood pressure and electrocardiography recordings: systolic blood pressure, heart rate, and amplitude of the electrocardiogram's R‐wave. Four 30‐min selections, representing key events of the perioperative course, were analyzed with the continuous wavelet transform, and average wavelet power spectra illustrated the circulatory frequency distributions. We identified oscillatory components in all patients and variables. Contrary to our hypothesis, they were randomly distributed through frequencies, patients, and situations, thus, not representing any reduction in the overall complexity. One patient showed loss of a 25‐s oscillation after surgery. We present a case where noise is misclassified as an oscillation, raising questions about the robustness of such analyses.

Objective: To assess whether preoperative versus intraoperative insertion of an intra-aortic balloon pump is associated with lower 30-day mortality or reduced length of hospital stay among patients who had an intra-aortic balloon pump inserted for cardiac surgery. Methods: This was an observational study of patients who had an intraaortic balloon pump inserted in the preoperative or intraoperative period of cardiac surgery in our department between 2000 and 2012. We assessed the association between preoperative versus intraoperative insertion of an intra-aortic balloon pump and 30-day mortality in a multivariable logistic regression analysis, including preoperative New York Heart Association class, postoperative atrial fibrillation, reoperation, postoperative creatinine and isolated coronary bypass grafting as cofactors. We used a multivariate linear model to assess whether a preoperative versus intraoperative intra-aortic balloon pump was associated with length of postoperative hospital stay, adjusting for reoperation, isolated coronary bypass grafting, heart valve surgery, sex, age, cardiopulmonary bypass time, aortic cross-clamp time, preoperative patients' status (elective, urgency or emergency surgery) and preoperative myocardial infarction. Results: Overall, 7,540 consecutive patients underwent open heart surgery in our department, and an intra-aortic balloon pump was inserted pre- or intraoperatively in 322 (4.2%) patients. The mean age was 67 ± 10.2 years old, the 30-day mortality was 12.7%, and the median length of hospital stay was 9 days (7 - 13). Preoperative versus intraoperative intra-aortic balloon pump insertion did not affect the incidence of 30-day mortality (adjusted OR = 0.69; 95% CI, 0.15 - 3.12; p = 0.63) and length of postoperative hospital stay (β = 5.3; 95%CI, -1.6 to 12.8; p = 0.13). Conclusion: Preoperative insertion of an intra-aortic balloon pump was not associated with a lower 30- day mortality or reduced length of postoperative hospital stay compared to intraoperative insertion. [ABSTRACT FROM AUTHOR]

The circulatory system is oscillatory in its nature. Oscillatory components linked to physiological processes and underlying regulatory mechanisms are identifiable in circulatory signals. Autonomic regulation is essential for the system's ability to deal with external exposure, and the integrity of oscillations may be considered a hallmark of a healthy system. Loss of complexity is seen as a consequence of several diseases and aging. Heart rate variability is known to decrease after cardiac surgery and remain reduced for up to 6 months. Oscillatory components of circulatory signals are linked to the system's overall complexity. We therefore hypothesize that the frequency distributions of circulatory signals show loss of oscillatory components after cardiac surgery and that the observed changes persist. We investigated the development of the circulatory frequency distributions of eight patients undergoing cardiac surgery by extracting three time series from conventional blood pressure and electrocardiography recordings: systolic blood pressure, heart rate, and amplitude of the electrocardiogram's R‐wave. Four 30‐min selections, representing key events of the perioperative course, were analyzed with the continuous wavelet transform, and average wavelet power spectra illustrated the circulatory frequency distributions. We identified oscillatory components in all patients and variables. Contrary to our hypothesis, they were randomly distributed through frequencies, patients, and situations, thus, not representing any reduction in the overall complexity. One patient showed loss of a 25‐s oscillation after surgery. We present a case where noise is misclassified as an oscillation, raising questions about the robustness of such analyses. [ABSTRACT FROM AUTHOR]

Intra-aortic balloon counterpulsation (IAoBC) is a mechanical circulatory support device that has been used for more than 50 years, mainly for cardiogenic shock. Although its effect on mortality is controversial, IAoBC is still used in a wide variety of pre- and postoperative clinical settings in cardiac surgery centers. IAoBC has a complication rate of approximately 30%, mostly associated with problems during insertion and malpositioning. Thus, an insertion technique based on the use of ultrasound at the patient's bedside in the intensive care unit (ICU) is proposed. [ABSTRACT FROM AUTHOR]

Introduction: Compromise of tissue oxygenation during surgery is associated with increased mortality and morbidity in the postoperative period in patients with congenital cardiac disorders. It may be monitored with near-infrared spectroscopy (NIRS). We aimed to evaluate the tissue oxygenation and factors which may affect it by bilateral cerebral and somatic NIRS levels during cardiopulmonary bypass and to compare the NIRS values of cyanotic and acyanotic patient groups. Material and methods: Two groups of patients with cyanotic and acyanotic congenital heart diseases were included in the study. Each group consisted of 15 patients between 0 and 5 years of age. All data were collected following anesthesia induction (T1), the 10th (T2) and 30th min (T3) of cardiopulmonary bypass (CPB), every 30 min during CPB (T4, T5, T6) and 1 h after (TS). Bilateral and somatic NIRS, blood gases, mean arterial pressure, and temperatures were recorded. Results: Left and right somatic NIRS values in groups at all measurements did not differ significantly. Left and right cerebral NIRS values at T2 and T3 in cyanotic patients were significantly higher than in acyanotic patients. Mean arterial pressure and lactate levels at T1 and T3 measurements were responsible for left cerebral NIRS changes and mean arterial pressure on right cerebral NIRS values. Conclusions: Monitorization of tissue perfusion has critical importance during CPB of patients with congenital heart defects. Oxygenation may easily and reliably be measured with NIRS. Cerebral and somatic NIRS are more pronounced in cyanotic patients and cerebral NIRS is strongly associated with mean arterial pressure and circulating lactate levels. [ABSTRACT FROM AUTHOR]

The brain has high oxygen extraction, thus the regional cerebral tissue oxygen saturation (rSO2) is lower than the central venous oxygen saturation (ScvO2). We hypothesised that diabetes widens the physiological saturation gap between ScvO2 and rSO2 (gSO2), and the width of this gap may vary during various phases of cardiac surgery. Cardiac surgery patients with (n = 48) and without (n = 91) type 2 diabetes mellitus (T2DM) underwent either off-pump coronary artery bypass (OPCAB) or other cardiac surgery necessitating cardiopulmonary bypass (CPB) were enrolled. rSO2 was measured by near-infrared spectroscopy (NIRS) and ScvO2 was determined simultaneously from central venous blood. rSO2 was registered before and after anaesthesia induction and at different stages of the surgery. ScvO2 did not differ between the T2DM and control patients at any stage of surgery, whereas rSO2 was lower in T2DM patients, compared to the control group before anaesthesia induction (60.4 ± 8.1%[SD] vs. 67.2 ± 7.9%, p<0.05), and this difference was maintained throughout the surgery. After anaesthesia induction, the gSO2 was higher in diabetic patients undergoing CPB (20.2 ± 10.4% vs. 12.4 ± 8.6%, p < 0.05) and OPCAB grafting surgeries (17.0 ± 7.5% vs. 9.5 ± 7.8%, p < 0.05). While gSO2 increased at the beginning of CPB in T2DM and control patients, no significant intraoperative changes were observed during the OPCAB surgery. The wide gap between ScvO2 and rSO2 and their uncoupled relationship in patients with diabetes indicate that disturbances in the cortical oxygen saturation cannot be predicted from the global clinical parameter, the ScvO2. Thus, our findings advocate the monitoring value of NIRS in T2DM. [ABSTRACT FROM AUTHOR]

Background: The implementation of the Critical-Care Pain Observation tool (CPOT) in intensive care units (ICU) has been associated with more frequent pain assessments, a reduced number of complications, and improved administration of analgesics and sedatives. So far no German translation exists. Translating this tool into foreign languages requires further validation testing.Objective: The aim of this prospective observational validation study was to translate the original version of the CPOT according to scientific principles for translation and to establish the validity and reliability of the German translation of CPOT for critically ill adult patients.Material and Methods: A total of 292 cardiac surgery patients from 2 ICUs of 2 German university teaching hospitals were included (114 patients at center 1 and 178 patients at center 2). Of the included patients 22.6% were female and 76.4% were male with a mean age of 68.5 years ±9.3 SD. Pain was evaluated with the CPOT, the Bhavioral Pain Scale (BPS) and with the Numeric Rating scale (NRS) at three time points (1. intubated + sedated, 2. intubated + awake, 3. extubated + awake) at rest and during nociceptive stimulus (positioning). Assessments were made separately by trained physicians and nursing staff.Results: Good results for interrater reliability and internal consistency could be demonstrated (weighted Cohen's kappa of 0.73, Cronbach's coefficient alpha of 0.8). Spearman correlation between CPOT and NRS was moderate but significant. The receiver operating characteristic (ROC) analysis to obtain optimal thresholds of CPOT to detect pain revealed different results during rest and stimulus and in intubated and extubated patients.Conclusion: The validated German CPOT translation is a reliable tool for pain assessment in cardiac ICU patients in the absence of patients' ability for self-reporting. The use of this German version of CPOT now allows a better international comparability of corresponding data in future studies. [ABSTRACT FROM AUTHOR]

Recent studies indicate that vitamin D deficiency is associated with increased morbidity and mortality in critically ill patients. Knowledge about the functional role and clinical relevance of vitamin D for patients undergoing cardiac surgery is sparse. Therefore, we investigated the clinical significance of vitamin D levels on outcome of cardiac surgery patients. 92 patients undergoing elective cardiac surgery with cardiopulmonary arrest were included in this prospective observational pilot study. 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25(OH) 2 D) levels were measured prior to surgery, immediately postoperatively as well as 6, 12 and 24 h after surgery. We assessed postoperative organ dysfunctions, infections and death until hospital discharge. The serum concentration of 1,25(OH) 2 D significantly decreased intraoperatively by 29.3% (p < 0.001) and was significantly lower at any postoperative time point compared to baseline values, whereas 25OHD levels did not show significant changes during the observation period. Coronary artery bypass graft (CABG) patients had significant higher baseline 1,25(OH) 2 D values than patients with valve surgery (39.7 ± 13.9 ng/l vs. 30.1 ± 14.1 ng/l, p = 0.010) or CABG + valve surgery (39.7 ± 13.9 ng/l vs. 32.6 ± 11.8 ng/l, p = 0.044). Our data showed a significant odds ratio to develop postoperative organ dysfunction (OR 0.95; p = 0.009) and PCT levels ≥5 μg/l (OR 0.94; p = 0.046) for every ng/l increment in 1,25(OH) 2 D, when performing multivariable analysis and after adjusting for preoperative illness and demographics. In addition, multivariable-adjusted statistical analyses revealed that patients stayed significantly shorter on ICU (−0.21 h; p = 0.001) and in hospital (−2.6 days; p = 0.009) for every ng/l increment in 1,25(OH) 2 D. Our data highlight important evidence about the clinical significance of 1,25(OH) 2 D levels in cardiac surgery patients. Higher levels were associated with significantly less postoperative organ dysfunctions, elevated PCT levels, death and prolonged hospital stay. 1,25(OH) 2 D levels decreased significantly intra- and postoperatively, while serum levels of 25OHD did not. clinicaltrials.gov (NCT 02488876), registered May 1, 2015. [ABSTRACT FROM AUTHOR]

Background: Post-cardiac surgery bleeding can have devastating consequences, and it is unknown if warfarin-induced rapid international normalized ratio (INR) rise during the immediate postoperative period increases bleed risk. Objective: To determine the impact of warfarin-induced rapid-rise INR on post-cardiac surgery bleeding. Methods: This was a single-center, retrospective chart review of post-cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester. Patients were grouped based on occurrence or absence of rapid-rise INR (increase ≥1.0 within 24 hours). The primary outcome compared bleed events between groups. Secondary outcomes assessed hospital length of stay (LOS) and identified risk factors associated with bleed events and rapid rise in INR. Results: During the study period, 2342 patients were included, and 56 bleed events were evaluated. Bleed events were similar between rapid-rise (n = 752) and non-rapid-rise (n = 1590) groups in both univariate (hazard ratio [HR] = 1.22; P = 0.594) and multivariable models (HR = 1.24; P = 0.561). Those with rapid-rise INR had longer LOS after warfarin administration (discharge HR = 0.84; P = 0.0002). The most common warfarin dose immediately prior to rapid rise was 5 mg. Risk factors for rapid-rise INR were low body mass index, female gender, and cross-clamp time. Conclusion and Relevance: This represents the first report to assess warfarin-related rapid-rise INR in post-cardiac surgery patients and found correlation to hospital LOS but not bleed events. Conservative warfarin dosing may be warranted until further research can be conducted. [ABSTRACT FROM AUTHOR]

Background: Protein detection assays are invaluable tools in the field of biomarker discovery. However, only immunoassays are widely used and can measure 10-20 analytes per biosample. The novel SOMAmer-based assay uses nucleotide aptamer technology to measure over 1300 analytes per biosample. We compared the SOMAmer-based platform to traditional approaches to quantify analytes in a clinical setting with paired samples before and after cardiac surgery. Methods: In a substudy of the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury cohort, 54 individuals with acute kidney injury after cardiac surgery were identified. Preoperative and postoperative plasma and urine samples that had been previously evaluated for biomarker concentrations via immunoassays were analyzed via SOMAmerbased assay. Results: Spearman correlations were estimated when >50% of biomarker values were within detectable ranges by immunoassay (plasma biomarkers: preoperative, 26/33; postoperative, 31/33; urine biomarkers: preoperative, 13/16; postoperative, 16/16). Overall, 27% of reportable plasma preoperative biomarkers displayed correlations ≥0.75 between immunoassay and SOMAmer measurements; 23% displayed correlations of 0.50-0.75, and 50% displayed correlations <0.50. In urine these values were 15%, 39%, and 46%, respectively. Forty-two percent of reportable plasma postoperative biomarkers displayed correlations ≥0.75, 16% displayed correlations 0.50-0.75, and 42% displayed correlations <0.50. In urine, these values were 19%, 25%, and 56%, respectively. Conclusions: In cardiac surgery patients, the SOMAmer-based assay detects proteins with moderate to strong correlation to current immunoassay methods. The correlations in urine are weaker than those in plasma. SOMAmer-based assay technology should be further evaluated in multiple settings as a high-throughput screening tool for biomarker discovery. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe and quantify pharmacokinetics of ampicillin used prophylactically in cardiac surgery both with and without cardiopulmonary bypass (CPB) using population pharmacokinetic analysis in order to propose an optimal dosing strategy. Adult patients undergoing cardiac surgery and treated with prophylactic dose of 2 g ampicillin were enrolled to this prospective study. Blood samples were collected according to the study protocol and ampicillin plasma concentrations were measured using HPLC/UV system. A three-stage population pharmacokinetic model using nonlinear mixed-effects modelling approach was developed. Totally 273 blood samples obtained from 20 patients undergoing cardiac surgery with the use of the CPB and 20 patients without CPB use were analyzed. Two-comparmental model best fits ampicillin concentration-time data. Mean ± SD body weight-normalized ampicillin central and peripheral volume of distribution was 0.12 ± 0.02 L/kg and 0.15 ± 0.03 L/kg, respectively, while mean ± SD ampicillin clearance in typical patient with eGFR of 1.5 mL/s/1.73 m 2 was 1.17 ± 0.05 L/h. The use of CPB did not significantly affect the pharmacokinetics of ampicillin. When administering 2 g of ampicillin before surgery, an additional dose should be administered to reach the PK/PD target of fT > MIC = 50% if the operation lasts longer than 430 min in patients with moderate to severe renal impairment, 320 min in patients with mild renal impairment, 220 min in patients with normal renal function status or 140 min in patients with an augmented renal clearance.

El artículo ofrece el texto de las presentaciones del 34 Congreso Nacional de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE). Las obras incluyen una sobre el riesgo nutricional en pacientes sometidos a cirugía cardiaca, una sobre la relación entre la citrulina plasmática y el soporte parenteral y una sobre los niveles de aluminio sérico después de la administración de nutrición parenteral.

Abstract Background Depression affects between 10% and 40% of cardiac surgery patients and is associated with significantly worse outcomes. The incidence and impact of new-onset depression beyond acute follow-up remain ill-defined. The present study aimed to evaluate the incidence, risk factors, and prognostic implication of depression on 90-d readmission rates after coronary artery bypass grafting (CABG) surgery. Methods A retrospective cohort study was performed identifying adult patients without prior depression who underwent CABG surgery using the 2010-2014 National Readmissions Database. CABG patients who were readmitted more than 2 wk but within 90 d of discharge were categorized based on the presence of new-onset depression. Association between the development of new-onset depression and rehospitalization were morbidity, mortality, costs, and length of stay (LOS) and were examined using multivariable regression. Results During the study period, 1,001,945 patients underwent CABG. Of these, 11.7% of patients were readmitted after 14 d but within 90 d of discharge with 5.1% of these patients having a diagnosis of new-onset depression. Postoperative new-onset depression was not associated with increased readmission morbidity, costs, or LOS. Mortality in new-onset depression readmissions was 1.2%, compared with 2.3% in all readmitted patients (P = 0.014). Depression was associated with lower odds of mortality (OR = 0.56, P = 0.02). Conclusions New-onset depression following CABG discharge was not associated with increased odds of mortality, morbidity, costs, or increased LOS on readmission. Rather, new-onset depression is associated with decreased odds of readmission mortality. Overall, CABG readmissions are decreasing, whereas the rate of new-onset depression is slightly increasing. Implementation of routine depression screening tools in postoperative CABG care may aid in early detection and management of depression to enhance postoperative recovery and quality of life. [ABSTRACT FROM AUTHOR]

There has been increased interest in the prophylactic and therapeutic use of high-flow nasal oxygen in patients with, or at risk of, non-hypercapnic respiratory failure. There are no randomised trials examining the efficacy of high-flow nasal oxygen in high-risk cardiac surgical patients. We sought to determine whether routine administration of high-flow nasal oxygen, compared with standard oxygen therapy, leads to reduced hospital length of stay after cardiac surgery in patients with pre-existing respiratory disease at high risk for postoperative pulmonary complications. Adult patients with pre-existing respiratory disease undergoing elective cardiac surgery were randomly allocated to receive high-flow nasal oxygen (n = 51) or standard oxygen therapy (n = 49). The primary outcome was hospital length of stay and all analyses were carried out on an intention-to-treat basis. Median (IQR [range]) hospital length of stay was 7 (6-9 [4-30]) days in the high-flow nasal oxygen group and 9 (7-16 [4-120]) days in the standard oxygen group (p=0.012). Geometric mean hospital length of stay was 29% lower in the high-flow nasal group (95%CI 11-44%, p = 0.004). High-flow nasal oxygen was also associated with fewer intensive care unit re-admissions (1/49 vs. 7/45; p = 0.026). When compared with standard care, prophylactic postoperative high-flow nasal oxygen reduced hospital length of stay and intensive care unit re-admission. This is the first randomised controlled trial examining the effect of prophylactic high-flow nasal oxygen use on patient-centred outcomes in cardiac surgical patients at high risk for postoperative respiratory complications. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) affects pharmacokinetics/dynamics of drugs in unpredictable ways. Anecdotally, ECMO patients require high doses of opioids and sedatives, leading to concerns of tolerance. Methadone is a long-acting synthetic opioid with antagonist properties at the n-methyl-d-aspartate (NMDA) receptor. It has been shown to improve spontaneous breathing trials and weaning from mechanical ventilation; however, there is no literature describing its use in ECMO. We describe two patients from the cardiac surgery intensive care unit at Cedars Sinai (Los Angeles, CA) on ECMO for over 30 days maintained on methadone. [ABSTRACT FROM AUTHOR]

The aim of this randomized control trial, repeated-measure design was to investigate the effects of cold therapy in reducing pain after cardiac surgery during the first 72 postoperative hours. Seventy participants were matched and were randomly assigned to the intervention (n=35) or control group (n=35). The experimental group received a sterile cold gel pack to maintain the skin temperature at 10-15 °C for 20 min. The control group received the routine care. Acute pain was measured using a Thai version of the modified Brief Pain Inventory. The data were analyzed with repeated measures MANOVA. The results showed that the experimental group had significantly lower mean pain than the control group (P<0.001). In addition, pain scores in the experimental group were significantly decreased during the first 72 postoperative hours (P<0.001). Thus, the cold therapy was effective in reducing pain after cardiac surgery during the acute phase. [ABSTRACT FROM AUTHOR]

OBJECTIVES The aim of this study was to analyse the effect of preoperative renal dysfunction on surgical and early outcomes for patients with Type A aortic dissection (AAD). METHODS From January 2016 to December 2016, 140 patients with AAD who underwent surgical treatment at our institution were retrospectively analysed. According to the estimated glomerular filtration rate (eGFR), preoperative renal dysfunction was divided into 4 groups: normal (eGFR ≥90 ml/min/1.73 m2, n  = 76), mild (eGFR 60–89, n  = 40), moderate (eGFR 30–59, n  = 20) and severe (eGFR <30, n  = 4). RESULTS Major complications included prolonged ventilation requiring tracheotomy in 15 patients, renal replacement therapy (RRT) in 28 patients, stroke in 11 patients and paraplegia in 4 patients. The best cut-off value of the eGFR for predicting postoperative RRT was 70 ml/min/1.73 m2 (area under the receiver operating characteristic curve was 0.809). In-hospital mortality was 9.3% (6.5% in the normal group, 5% in the mild group, 20% in the moderate group and 50% in the severe group). Logistic regression analysis showed that age >60 years, moderate and severe renal dysfunction, coronary malperfusion and peripheral malperfusion were risk factors for in-hospital death. CONCLUSIONS Total arch replacement can be safely performed in patients with AAD and preoperative mild renal dysfunction. Preoperative renal dysfunction is a risk factor for postoperative RRT, and eGFR is useful for predicting the requirement for postoperative RRT. Our surgical strategy for total arch replacement and stented elephant trunk for patients with AAD and mild preoperative renal dysfunction has excellent early outcomes. [ABSTRACT FROM AUTHOR]

Study Objective: Dexmedetomidine is widely used during surgery. Recent studies have demonstrated that dexmedetomidine administered perioperatively is associated with lower postoperative mortality and complications in patients undergoing cardiac surgery.Design: This study was designed to investigate the effects of dexmedetomidine during cardiac surgery in Chinese patients.Patients/interventions: We conducted a retrospective review of 1477 consecutive patients who underwent cardiac surgery at our institution. Of these patients, 1077 received dexmedetomidine during their surgery (dexmedetomidine group) and 400 did not (control group). All patients were followed for 1 year. Their short- and long-term outcomes were compared by the inverse-probability of treatment weighted adjustment to reduce treatment selectmen bias. Propensity-score matching yielded two well-matched groups for further comparison.Main Results: After adjusting for differences in baseline risk factors with the inverse probability of treatment weighting, the risk of perioperative mortality (Odds ratio [OR]:1.02; 95% confidence interval [CI]:0.32 to 3.28, P = 0.97) and cardiovascular complications were not significantly different between the two groups. After 1 year of follow-up, the two groups showed no differences in mortality (hazard ratio [HR]:0.70; 95% CI 0.28 to 1.73, P = 0.44) and major adverse cardiovascular and cerebrovascular events (MACCE) (HR 1.08; 95% CI 0.69 to 1.68, P = 0.74).However, postoperative atrial fibrillation was lower in the dexmedetomidine group (OR: 0.53; 95% CI: 0.31 to 0.90, P = 0.02).Conclusions: Dexmedetomidine administered perioperatively reduced postoperative atrial fibrillation, but was not effective in decreasing short and long-term mortality or cardiovascular complications in a Chinese population. [ABSTRACT FROM AUTHOR]