Ascending aortic and proximal hemiarch replacement with antegrade cerebral perfusion for a penetrating aortic ulcer.

We report the surgical repair of a penetrating aortic ulcer in the distal ascending aorta close to the brachiocephalic trunk, by supracoronary ascending aortic and hemiarch replacement via a full sternotomy. The procedure is performed under moderate hypothermia with bilateral antegrade cerebral perfusion.

Vitamin D assessment in perioperative medicine and critical care : A prospective observational pilot study.

BACKGROUND: There is controversy about the impact of acute illness on vitamin D levels. This study was carried out to assess the influence of perioperative fluid loading on 25-hydroxy-vitamin D [25(OH)D] levels. The study evaluated the clinical utility of a commonly available chemiluminescence assay (ECLIA, IDS-iSYS) and liquid chromatography/mass spectrometry (LC-MS/MS) in the diagnosis of vitamin D deficiency in this setting. METHODS: In this prospective observational pilot study in adult patients undergoing cardiovascular surgery on cardiopulmonary bypass (CPB), blood samples drawn at preoperative baseline (t1), after weaning from CPB (t2), on intensive care unit (ICU) admission (t3) and on the first (t4) and second (t5) postoperative days were analyzed. RESULTS: A total of 26 patients (130 samples) were included in this study. Fluid loading by CPB led to a median reduction of 25(OH)D by -22.6% (range -54.5% to -19.5%) between t1 and t2. Cohen's kappa (κ) for method agreement for vitamin D deficiency (tested cut-off values 20 ng/ml and 12 ng/ml), was κ = 0.291 (p < 0.001) and κ = 0.469 (p < 0.001), respectively. The mean difference between measurements by ECLIA and LC-MS/MS was 4.8 ng/ml (±5.7), Pearson's r for correlation was 0.73 (p < 0.001). The biologically inactive C3-epimer did not contribute to 25(OH)D levels assessed by LC-MS/MS. CONCLUSION: The 25(OH)D measurements by chemiluminescence assays can noticeably deviate from those measured by LC-MS/MS, which can be considered the unequivocal gold standard. These assays may still be acceptably reliable in the screening for vitamin D deficiency, especially in the setting of low vitamin D levels. Stricter definitions, e.g. serum 25(OH)D levels lower than 12 ng/ml, may be used to diagnose deficiency with low false positive rate. TRIAL REGISTRATION: DRKS00009216, German Clinical Trials Registry ( www.drks.de ).