Association between baseline serum bicarbonate and the risk of postoperative delirium in patients undergoing cardiac surgery in the ICU: a retrospective study from the MIMIC-IV database.

BACKGROUND: Although serum bicarbonate is a reliable predictor of various disease complications, its relationship with postoperative delirium (POD) remains unclear. Our research aimed to assess the effect of baseline serum bicarbonate levels on the incidence of POD in cardiac surgery patients. METHODS: A retrospective analysis was conducted on cardiac surgery patients who met specific inclusion and exclusion criteria, using data from the Marketplace for Information in Critical Care Medicine (MIMIC-IV) database. Univariate and multivariate logistic regression models are employed to explore the correlation between serum bicarbonate levels and the risk of POD, and their predictive efficacy is assessed by means of restricted cubic spline regression models (RCS) and receiver operating characteristic curves (ROC). In addition, subgroup and sensitivity analyses are conducted to test the robustness of the results. RESULTS: In this study, 5,422 patients were included, where the incidence of POD was 13.0%. For each 1 mmol/L increase in bicarbonate, a 13% reduction in the risk of POD was observed in the fully adjusted model (OR = 0.87, 95% CI: 0.83-0.91, P < 0.001). The RCS model demonstrated a linear negative correlation between the level of bicarbonate and the risk of POD (P for nonlinearity = 0.987). The ROC curve analysis demonstrated that the bicarbonate level had moderate predictive efficacy (AUC = 0.629). Both subgroup and sensitivity analyses reaffirmed the robustness of these results. CONCLUSIONS: Lower baseline serum bicarbonate levels in cardiac surgery patients are linked to a higher risk of POD. Monitoring and adjusting serum bicarbonate levels may help identify high-risk patients and potentially improve outcomes.

Association between hyperglycemia at ICU admission and postoperative acute kidney injury in patients undergoing cardiac surgery: Analysis of the MIMIC-IV database.

Background: This study aimed to explore the correlation between hyperglycemia at intensive care unit (ICU) admission and the incidence of acute kidney injury (AKI) in patients after cardiac surgery. Methods: We conducted a retrospective cohort study, in which clinical data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Adults (≥18 years) in the database who were admitted to the cardiovascular intensive care unit after cardiac surgery were enrolled. The primary outcome was the incidence of AKI within 7 days following ICU admission. Secondary outcomes included ICU mortality, hospital mortality, ICU length of stay, and the 28-day and 90-day mortality. Multivariable Cox regression analysis was used to assess the association between ICU-admission hyperglycemia and AKI incidence within 7 days of ICU admission. Different adjustment strategies were used to adjust for potential confounders. Patients were divided into three groups according to their highest blood glucose levels recorded within 24 h of ICU admission: no hyperglycemia (<140 mg/dL), mild hyperglycemia (140-200 mg/dL), and severe hyperglycemia (≥200 mg/dL). Results: Of the 6905 included patients, 2201 (31.9%) were female, and the median (IQR) age was 68.2 (60.1-75.9) years. In all, 1836 (26.6%) patients had severe hyperglycemia. The incidence of AKI within 7 days of ICU admission, ICU mortality, and hospital mortality was significantly higher in patients with severe admission hyperglycemia than those with mild hyperglycemia or no hyperglycemia (80.3% vs. 73.6% and 61.2%, respectively; 2.8% vs. 0.9% and 1.9%, respectively; and 3.4% vs. 1.2% and 2.5%, respectively; all P <0.001). Severe hyperglycemia was a risk factor for 7-day AKI (Model 1: hazard ratio [HR]=1.4809, 95% confidence interval [CI]: 1.3126 to 1.6707; Model 2: HR=1.1639, 95% CI: 1.0176 to 1.3313; Model 3: HR=1.2014, 95% CI: 1.0490 to 1.3760; all P <0.050). Patients with normal glucose levels (glucose levels <140 mg/dL) had a higher 28-day mortality rate than those with severe hyperglycemia (glucose levels ≥200 mg/dL) (4.0% vs. 3.8%, P <0.001). Conclusions: In post-cardiac surgery patients, severe hyperglycemia within 24 h of ICU admission increases the risk of 7-day AKI, ICU mortality, and hospital mortality. Clinicians should be extra cautious regarding AKI among patients with hyperglycemia at ICU admission after cardiac surgery.

Incidence of Acute Kidney Injury and Mortality Post Successful Cardiac Surgery in a Kashmiri Cohort: A Prospective Comparison of the RIFLE and KDIGO Criteria.

Background and objectives In critically ill patients, acute kidney injury (AKI) influences mortality and morbidity. Few studies have looked at mortality and the frequency of AKI following successful heart and thoracic operations. The current study investigates the association between AKI and mortality rates among patients undergoing post-cardiac surgery care within the Cardiology & Cardio Vascular Thoracic Surgery (CVTS) Intensive Care Unit (ICU). Methodology In this prospective research, 124 patients who underwent successful cardiovascular and thoracic procedures between June 2022 and June 2023 were admitted to the CVTS ICU. To determine mortality, we contrasted the two scoring methods, Kidney Disease-Improving Global Outcomes (KDIGO) and Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE). Results Based on the KDIGO criteria, AKI was identified in 37.90% (n = 47) of the patients, and it was identified in 15.32% (n = 19) of the patients utilizing RIFLE. Notably, patients diagnosed with AKI using either the RIFLE criteria or KDIGO criteria exhibited considerably higher mortality rates (p< 0.001). Receiver operating characteristic (ROC) analysis demonstrated the effectiveness of both scoring systems in identifying mortality (area under the ROC curve for RIFLE = 0.224 and KDIGO = 0.150). Conclusion Post-cardiac surgery, AKI escalates both mortality and morbidity rates. Despite KDIGO detecting more severe renal injury and mortality, both scoring systems exhibit comparable sensitivity and specificity in predicting death among patients undergoing various cardiovascular and thoracic procedures.

Efficacy and Outcomes of Para-Annular Plication in Mitral Valve Repair via Right Mini-Thoracotomy.

PURPOSE: We aim to assess the efficacy and safety of left atrial plication (LAP), particularly para-annular plication, using a right mini-thoracotomy approach. METHODS: Among 90 mitral valve repair (MVr) procedures performed at our institution between 2016 and 2023, 16 left atrial plication cases for left atrial enlargement (diameter: >50 mm) were assessed; nine cases underwent median sternotomy (conventional) (Group C), and seven cases underwent minimally invasive cardiac surgery (MICS) (Group M). The surgical protocol involved mitral valve repair via a right-sided left atrial approach, incorporating para-annular plication to suture the posterior wall. The mean follow-up duration was 3.3±2.4 years. RESULTS: Mortality within 30 days of surgery or during hospitalization did not occur. Postoperative complications included one case in each group that required reoperation for hemorrhage originating extraneously in the left atrium. Postoperative echocardiographic assessments revealed a comparable reduction in left atrial diameter (C/M: 80.3±7.0/80.7±14.6%; p=0.94), left atrial volume index (55.6±19.3/68.3±34.1%; p=0.36), and aorto-mitral angle (AMA) enlargement (113.8±7.3/107.5±12.2%; p=0.22). The three-year survival rate (88.9%/75.0%; p=0.33) was comparable between groups. CONCLUSION: The synergistic utilization of left atrial plication with para-annular plication via right mini-thoracotomy can enhance the postoperative outcomes of mitral valve repair.

How to treat systolic anterior motion of the anterior mitral valve leaflet during endoscopic minimally invasive surgery.

Systolic anterior motion is characterized by the displacement of the anterior mitral leaflet towards the left ventricle outflow tract. Iatrogenic systolic anterior motion occurs after mitral valve repair as a result of mitral annuloplasty. Possible causes include excess height of a redundant posterior mitral leaflet and/or the use of an undersized ring. The condition is usually diagnosed after weaning from cardiopulmonary bypass by transoesophageal echocardiography. Apart from conservative measures, the treatment of systolic anterior motion may require the restoration of cardiopulmonary bypass and further surgical valve repair. Strategies for systolic anterior motion correction include an edge-to-edge repair or the use of a larger annuloplasty ring. In this tutorial, we present two ways of reducing posterior leaflet height as a simple option to move the leaflet coaptation more posteriorly.

Trial Of Pathogen-reduced Cryoprecipitate vs. Cryoprecipitated AHF to Lower Operative Transfusions (TOP-CLOT): study protocol for a single center, prospective, cluster randomized trial.

BACKGROUND: Intraoperative hemorrhage in cardiac surgery increases risk of morbidity and mortality. Low pre-operative and perioperative levels of fibrinogen, a key clotting factor, are associated with severity of hemorrhage and increased transfusion of blood components. The ability to supplement fibrinogen during hemorrhagic resuscitation is delayed 45-60 min because cryoprecipitated antihemophilic factor (cryo AHF) is stored frozen, due to a short post-thaw shelf life. Pathogen Reduced Cryoprecipitated Fibrinogen Complex (INTERCEPT Fibrinogen Complex, IFC) can be kept thawed, at room temperature, for up to 5 days, making it possible to be immediately available for hemorrhaging patients. This trial will investigate if earlier correction of acquired hypofibrinogenemia with IFC in hemorrhaging cardiac surgery patients reduces the total number of perioperatively transfused allogeneic blood products (red blood cells, plasma, and platelets) as compared to cryo AHF. METHODS: This is a single center, prospective, cluster randomized trial with an adaptive design. Acquired hypofibrinogenemia will be assessed by rotational thromboelastometry (ROTEM) and the threshold for cryo AHF/IFC transfusion defined as FIBTEM A10 ≤ 10 mm in bleeding patients. IFC/cryo AHF will be randomized by 1-month blocks. Cardiac surgery patients will be enrolled in the study if they have an eligible procedure and at least one dose of a cryo AHF/IFC product (approximately 2 g fibrinogen) is transfused. Data from the electronic health record, including the blood bank and lab information systems, will be prospectively collected from the health system's data warehouse. DISCUSSION: This trial aims to provide evidence of the clinical efficacy of utilizing readily available thawed IFC during acute bleeding in the cardiac surgery setting compared to traditional cryo AHF. TRIAL REGISTRATION: ClinicalTrials.gov NCT05711524. Feb 3, 2023.

Pediatric Post-Pump Chorea: Case Report and Implications for Differential Diagnosis.

BACKGROUND: Chorea is a neurological disorder characterized by random, fluid movements that may affect the limbs, trunk, neck, or face. In children, Sydenham's chorea (SC) is the most common cause of acute chorea, mainly following group A beta-hemolytic streptococcal (GABHS) infection. Other autoimmune and metabolic disorders may also cause chorea. CASE PRESENTATION: We report the case of a 6-year-old girl who developed chorea following cardiac surgery for mitral insufficiency. One week after discharge, the patient presented with right-sided hyposthenia, slower speech, mild dysarthria, and sialorrhea. Brain MRI and intracranial MRI angiography revealed a small vascular lesion consistent with a microembolic event. Extensive diagnostic investigations, including serum panels for autoimmune encephalitis, neurotropic viruses, and metabolic disorders, were negative. CONCLUSIONS: Considering the patient's history, clinical course, and the exclusion of other potential causes, a diagnosis of post-pump chorea was made. This case underlines the importance of a thorough differential diagnosis in pediatric chorea and highlights post-pump chorea as a significant postoperative complication in pediatric cardiac surgery. The patient's motor symptoms improved with symptomatic treatment, and follow-up showed good recovery without neurological sequelae.

Identifying Early Risk Factors for Postoperative Pulmonary Complications in Cardiac Surgery Patients.

Background and Objectives: Postoperative pulmonary complications (PPCs) are common in patients who undergo cardiac surgery and are widely acknowledged as significant contributors to increased morbidity, mortality rates, prolonged hospital stays, and healthcare costs. Clinical manifestations of PPCs can vary from mild to severe symptoms, with different radiological findings and varying incidence. Detecting early signs and identifying influencing factors of PPCs is essential to prevent patients from further complications. Our study aimed to determine the frequency, types, and risk factors significant for each PPC on the first postoperative day. The main goal of this study was to identify the incidence of pleural effusion (right-sided, left-sided, or bilateral), atelectasis, pulmonary edema, and pneumothorax as well as detect specific factors related to its development. Materials and Methods: This study was a retrospective single-center trial. It involved 314 adult patients scheduled for elective open-heart surgery under CPB. Results: Of the 314 patients reviewed, 42% developed PPCs within 12 h post-surgery. Up to 60.6% experienced one PPC, while 35.6% developed two PPCs. Pleural effusion was the most frequently observed complication in 89 patients. Left-sided effusion was the most common, presenting in 45 cases. Regression analysis showed a significant association between left-sided pleural effusion development and moderate hypoalbuminemia. Valve surgery was associated with reduced risk for left-sided effusion. Independent parameters for bilateral effusion include increased urine output and longer ICU stays. Higher BMI was inversely related to the risk of pulmonary edema. Conclusions: At least one PPC developed in almost half of the patients. Left-sided pleural effusion was the most common PPC, with hypoalbuminemia as a risk factor for effusion development. Atelectasis was the second most common. Bilateral effusion was the third most common PPC, significantly related to increased urine output. BMI was an independent risk factor for pulmonary edema development.

Renal Outcome in Patients Undergoing Minimally Invasive Total Coronary Revascularization via Anterior Minithoracotomy Compared to Full Median Sternotomy Coronary Artery Bypass Grafting.

Objective: Renal dysfunction and acute renal failure after coronary artery bypass grafting (CABG) are among the main causes of increased mortality and morbidity. A sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced with promising early and midterm outcomes in multivessel coronary artery disease. There are limited data regarding renal complications in patients undergoing the TCRAT technique. The present study analyzed renal outcomes in TCRAT compared to CABG via full median sternotomy (FS). Methods: We analyzed the records of 227 consecutive TCRAT patients (from September 2021 to June 2023) and 228 consecutive FS patients (from January 2017 to December 2018) who underwent nonemergent CABG. Following propensity score matching, preoperative baseline characteristics-including age, sex, diabetes mellitus, arterial hypertension, left ventricular ejection fraction, EuroSCORE II, preoperative serum creatinine, estimated glomerular filtration rate (eGFR), serum urea, and pre-existing chronic renal insufficiency-were comparable between the TCRAT (n = 170) and the FS group (n = 170). The examined postoperative renal parameters and complications were serum creatinine, eGFR, and serum urea on the first postoperative day. Moreover, serum creatinine, eGFR and serum urea at the time of discharge, postoperative ARF, and hemodialysis were investigated. Additionally, the duration of operation, CPB time, aortic cross-clamp time, ICU and hospital stay, ECMO support, rethoracotomy and in-hospital mortality were analyzed. The parameters were compared between groups using a Student's t-test or Mann-Whitney U test. Results: The duration of operation (332 ± 66 vs. 257 ± 61 min; p < 0.05), CPB time (161 ± 40 vs. 116 ± 38 min; p < 0.05), and aortic cross-clamp time (100 ± 31 vs. 76 ± 26; p < 0.05) were longer in the TCRAT group. ICU (1.8 ± 2.2 vs. 2.9 ± 3.6 days; p < 0.05) and hospital (10.4 ± 7.6 vs. 12.4 ± 7.5 days; p < 0.05) stays were shorter in the TCRAT group. There were no differences between groups with regard to the renal parameters examined. Conclusions: Despite a prolonged duration of operation, CPB time, and aortic cross-clamp time when using the TCRAT technique, no increase in renal complications were found. In addition, ICU and hospital stays in the TCRAT group were shorter compared to CABG via full median sternotomy.

Anesthetic Approach for Non-Cardiac Procedures in Patients with a Left Ventricular Assist Device.

Background: The use of durable left ventricular assist devices (LVADs) for advanced heart failure is increasing and a growing number of patients will require anesthesia for non-cardiac procedures (NCPs). The goal of this study was to describe our experience with NCPs for LVAD patients. Methods: All anesthetic procedures performed in LVAD patients at a single center were reviewed from 2014 to 2023. Perioperative management data and complications were assessed. Results: In total, 16 patients had an LVAD implanted and 9 (56.3%) patients underwent anesthesia for a total of 22 NCPs. Most of the procedures took place outside of the operating room, mainly in the endoscopy unit, as gastrointestinal endoscopy was the most common procedure (13, 59.2%). Sedation was provided in 17 procedures (77.3%). Standard monitoring was used in all cases, and invasive monitoring was applied just in cases of major surgeries. There were no intraoperative complications reported. Postoperative complications were recorded after eight (36.4%) of the procedures, consisting mainly of lower gastrointestinal bleeding after lower endoscopy, which increased the length of hospital stay. All procedures were performed by non-cardiac anesthesiologists. Conclusions: Our data suggest that, in most cases, adherence to standard anesthesia practices can be suitable for NCPs in LVAD patients.

Management of Myocardial Infarction and the Role of Cardiothoracic Surgery.

Myocardial infarction (MI) is a leading cause of mortality globally and is predominantly attributed to coronary artery disease (CAD). MI is categorized as ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI), each with distinct etiologies and treatment pathways. The goal in treatment for both is restoring blood flow back to the myocardium. STEMI, characterized by complete occlusion of a coronary artery, is managed urgently with reperfusion therapy, typically percutaneous coronary intervention (PCI). In contrast, NSTEMI involves a partial occlusion of a coronary artery and is treated with medical management, PCI, or coronary artery bypass grafting (CABG) depending on risk scores and clinical judgment. The Heart Team approach can assist in deciding which reperfusion technique would provide the greatest benefit to the patient and is especially useful in complicated cases. Despite advances in treatment, complications such as cardiogenic shock (CS) and ischemic heart failure (HF) remain significant. While percutaneous coronary intervention (PCI) is considered the primary treatment for MI, it is important to recognize the significance of cardiac surgery in treatment, especially when there is complex disease or MI-related complications. This comprehensive review analyzes the role of cardiac surgery in MI management, recognizing when it is useful, or not.

Atrial fibrillation after cardiac surgery: identifying candidate predictors through a Delphi process.

OBJECTIVES: This study was undertaken to identify potential predictors of atrial fibrillation after cardiac surgery (AFACS) through a modified Delphi process and expert consensus. These will supplement predictors identified through a systematic review and cohort study to inform the development of two AFACS prediction models as part of the PARADISE project (NCT05255224). Atrial fibrillation is a common complication after cardiac surgery. It is associated with worse postoperative outcomes. Reliable prediction of AFACS would enable risk stratification and targeted prevention. Systematic identification of candidate predictors is important to improve validity of AFACS prediction tools. DESIGN: This study is a Delphi consensus exercise. SETTING: This study was undertaken through remote participation. PARTICIPANTS: The participants are an international multidisciplinary panel of experts selected through national research networks. INTERVENTIONS: This is a two-stage consensus exercise consisting of generating a long list of variables, followed by refinement by voting and retaining variables selected by at least 40% of panel members. RESULTS: The panel comprised 15 experts who participated in both stages, comprising cardiac intensive care physicians (n=3), cardiac anaesthetists (n=2), cardiac surgeons (n=1), cardiologists (n=4), cardiac pharmacists (n=1), critical care nurses (n=1), cardiac nurses (n=1) and patient representatives (n=2). Our Delphi process highlighted candidate AFACS predictors, including both patient factors and those related to the surgical intervention. We generated a final list of 72 candidate predictors. The final list comprised 3 demographic, 29 comorbidity, 4 vital sign, 13 intraoperative, 10 postoperative investigation and 13 postoperative intervention predictors. CONCLUSIONS: A Delphi consensus exercise has the potential to highlight predictors beyond the scope of existing literature. This method proved effective in identifying a range of candidate AFACS predictors. Our findings will inform the development of future AFACS prediction tools as part of the larger PARADISE project. TRIAL REGISTRATION NUMBER: NCT05255224.

Association Between Red Cell Distribution Width and Liver Injury after Cardiac and Aortic Aneurysm Surgery with Cardiopulmonary Bypass.

OBJECTIVES: This study aimed to investigate the association between preoperative red blood cell distribution width (RDW) levels and liver injury (LI) after cardiac surgery, to highlight RDW's usefulness in the early identification and intervention for patients at high risk of LI. DESIGN: A retrospective observational study. SETTING: A university-affiliated teaching hospital and tertiary referral center. PARTICIPANTS: Adult patients who underwent cardiac and aortic aneurysm surgery at Changhai Hospital in 2021. INTERVENTIONS: Postoperative LI was defined by increased liver enzyme levels and/or hyperbilirubinemia, noted from the time of surgery to discharge. Logistic regression analyses were conducted to examine the RDW-LI relationship, with stratified analyses based on age, gender, and anemia. Survival within 30 days was assessed using the Kaplan-Meier method, with survival curve differences analyzed via the log-rank test. The study included 3 sets of sensitivity analyses. MEASUREMENTS AND MAIN RESULTS: Postoperative LI was observed in 75 patients (10%). Multivariate regression analysis showed a significant association between high RDW levels and postoperative LI (adjusted odds ratio, 3.25; p = 0.033; 95% confidence intefal, 1.10-9.63), even after adjusting for all covariates. This association remained consistent across 3 sets of sensitivity analyses. Subgroup analysis showed men had a higher correlation with LI (p for interaction = 0.041). Kaplan-Meier analysis indicated a significantly lower survival rate in the LI group (76%) compared with the non-LI group (99.6%; p < 0.001). CONCLUSIONS: Preoperative RDW levels are significantly associated with postoperative LI. RDW could serve as a significant useful marker for early detection and intervention in patients at high risk of LI, thereby potentially improving patient outcomes.

Central venus cannulation during cardiac surgery as a possible new additional risk factor for late post-operative atrial fibrillation insurgence.

BACKGROUND: Postoperative atrial fibrillation (POAF) is the most frequent cardiac arrhythmia following cardiac operations. It has been associated with an increased risk of postoperative cerebrovascular complications, morbidity and mortality. The aim of this study is to evaluate if the type of venous cannulation to institute the cardiopulmonary bypass (CPB) during major cardiac surgery procedures can influence the rate of POAF and late FA onset. METHODS: We collected data from 2087 consecutive patients who have been operated at our Institution from January 2016 to December 2018. To obtain two homogenous groups we performed a propensity match analyzes: Group 1 for whom the blood drain of the CPB has been granted via peripheral cannulation (PC) through the right common femoral vein and Group 2 with patients who underwent central cannulation (CC) with insertion of a drainage cannula in the right atrium or in the superior and inferior vein cava. RESULTS: POAF has been observed as statistically similar between the two groups. At 1250-day follow-up, While the incidence of POAF was 2.9% and 8.7% in the PC and CC groups, respectively (p = .04). CONCLUSIONS: our data seems to show that the two groups do not differ in terms of POAF, while the CC group may have a significantly higher rate of atrial fibrillation in the follow-up period.

Randomized Controlled Trial: Does the Use of Occlusive Hydrocolloid Silver-Containing Wound Dressing after Sternotomy Reduce Surgical Site Infection after Cardiac Surgery?

(1) Background: To reduce the incidence of surgical site infections (SSIs) following median sternotomy in cardiac surgery, we compared an occlusive hydrocolloid silver-containing wound dressing (OHSCWD) with a standard wound dressing. (2) Methods: This study was designed as a single-center randomized controlled trial. The primary endpoint was the overall rate of incidence of any kind of SSI. Secondary endpoints were the number of dressing changes, the severity of SSIs, and whether there was a need for treatment. Wounds were monitored daily until the seventh and on the 30th postoperative day. (3) Results: Of the 423 patients included, 352 were analyzed. No differences in demographics, cardiovascular risk factors, intraoperative processes, and postoperative care were found between both groups. Additionally, the incidence or extent of SSI showed no significant differences between the two groups. (4) Conclusions: In summary, out of all pre-, intra-, and postoperative factors, the contribution of postoperative wound care to the development of SSIs appears to play a subordinate role. However, by offering equivalent wound protection and a reduced number of dressing changes, OHSCWD after median sternotomy in cardiac surgery patients could be a good alternative to standard dressings from the point of view of the patient, the staff, and the clinic.

Intravenous Levosimendan versus Inhalational Milrinone in the Management of Pulmonary Hypertension during Adult Cardiac Surgery: A Randomized Clinical Trial.

Introduction: The perioperative management of patients with pulmonary hypertension (PH) undergoing cardiac surgery is challenging, mainly due to the potential risk of right ventricular failure (RVF). Levosimendan is a calcium-sensitizing agent that has primarily been used in the treatment of decompensated heart failure. However, recently levosimendan has been shown to be an effective and safe therapeutic strategy for patients with pulmonary arterial hypertension and PH associated with left heart disease. The aim of this study was to investigate the potential utility of the preemptive administration of levosimendan in cardiac surgical patients with preexisting PH and to compare its effectiveness with milrinone, which represents an already established therapeutic option in the management of PH during cardiac surgery. Materials and Methods: In this study, 40 adult cardiac surgical patients with PH were randomly assigned to receive either levosimendan intravenously or milrinone via inhalation in a double-blind fashion prior to a cardiopulmonary bypass (CPB). Hemodynamic and echocardiographic parameters were recorded and evaluated before and after the administration of the drugs. Results and Conclusions: The results of this study demonstrated that both levosimendan and milrinone administered before CPB in cardiac surgical patients with PH may offer protective benefits, reducing pulmonary artery pressure and preventing the exacerbation of PH and RVF. Pulmonary vasodilation attributed to levosimendan is of longer duration and greater magnitude compared to pulmonary vasodilation afforded by milrinone.

Preoperative Chest Computed Tomography Screening Reduces the Perioperative Stroke Rate in Patients at Risk of Aortic Calcification.

OBJECTIVES: We evaluated the effect of preoperative chest computed tomography (CT) screening on the perioperative stroke rate in cardiosurgical patients at risk of aortic calcification. METHODS: Between May 2019 and April 2020, 129 patients at risk of aortic calcification underwent non-contrast chest CT screening before their procedure. They were assigned to Group 1 and compared with a historical Group 2, who were treated the previous year without a preoperative CT scan. The primary endpoint was to determine postoperative stroke occurrence. The secondary outcomes were the rate reintubation/tracheostomy, the length of hospital stay, and any change in surgical strategy based on the CT findings. RESULTS: Groups 1 and 2 comprised 129 and 261 patients, respectively. Group 1 had a lower left ventricular ejection fraction, less carotid stenosis, a history of carotid endarterectomy, and a longer cross-clamp time. The surgical strategy was changed for 6 patients in Group 1. Group 1 had a significantly lower stroke rate. No significant differences were observed in reintubation and tracheostomy rates, or length of hospital stay. Lack of CT screening, age, aortic valve surgery, aortic surgery, and rethoracotomy were identified as independent risk factors for a stroke. CONCLUSIONS: Preoperative non-contrast chest CT screening of patients at risk of aortic calcification reduces postoperative stroke through adaptation of the surgical approach and should be used routinely in these patients.

Disruption of the Circulating Proteome in Neonates Receiving Extracorporeal Membrane Oxygenation Following Congenital Heart Disease Surgery: A Nested Case-Control Study.

This nested case-control study identified broad dysregulation of the circulating proteome in neonates receiving postoperative extracorporeal membrane oxygenation support after congenital heart disease surgery, including differential responses in those not surviving to hospital discharge. Tissue hypoxia and mitochondrial-associated proteins may represent novel candidate biomarkers for poor extracorporeal membrane oxygenation outcomes.

Plasma-derived exosomal hsa-miR-184 and hsa-mir-6766-3p as promising diagnostic biomarkers for early detection of children's cardiac surgery-associated acute kidney injury.

There is little known about the contribution of exosomal microRNAs (exomiRs) in the children's cardiac surgery-associated acute kidney injury (CSA-AKI). This study aimed to find diagnostic biomarkers for predicting CSA-AKI in children. A prospective observational study was conducted from April 2020 to March 2021.According to the changes of serum creatinine (SCr) value and urine volume within 48 h, the children were divided into acute kidney injury (AKI) group and non-AKI group. Serum samples were collected 4 h after cardiac surgery. Isolation of extracellular vesicles (EVs) and extraction of exomiRs from serum samples. Illumina high-throughput sequencing was used to quantify exomiRs and screen candidate microRNAs (miRNAs). Expression levels of candidate miRNAs were validated using droplet digital polymerase chain reaction (ddPCR). Normal and injuried rats' kidney tissue were collected for tissue validation. In the pre-experimental stage (4 AKI vs. 4 non-AKI), hsa-miR-184, hsa-miR-4800-3p, hsa-miR-203a-3p and hsa-miR-6766-3p were selected as candidate genes. In the verification stage (8 AKI vs. 12 non-AKI), the expression of hsa-miR-184 in AKI group was significantly lower than that in non-AKI group (P = 0.031), and the expression of hsa-miR-4800-3p and hsa-miR-6766-3p in AKI group was significantly higher than that in non-AKI group (P = 0.01 and P = 0.047). There was no significant difference in the expression of hsa-miR-203a-3p between the two groups (P > 0.05). The expression of rats' kidney tissue rno-miR-184 in AKI group was significantly lower than that in the normal group (P = 0.044). The area under the curve (AUC) of AKI predicted by hsa-miR-184 is 0.7865 and the AUC of hsa-miR-6766-3p is 0.7708. Combined with two kinds of miRNAs, the area under the curve of AKI is predicted to be 0.8646. The change of exomiRs level in circulatory system occurred in the early stage after cardiac operation, and the changes of hsa-miR-184 and hsa-miR-6766-3p content in circulatory system could predict CSA-AKI well.