Increasing obesity is associated with lower postoperative bleeding in coronary bypass patients.

Objective: Despite inherent comorbidities, obese cardiac surgical patients paradoxically had shown lower morbidity and mortality, although the nature of this association is still unclear. Thus, the authors intended in this large registry-based study to investigate the impact of obesity on short- and long-term postoperative outcomes, focusing on bleeding and transfusion requirements.

Design: Retrospective registry study.

Fewer transfusions are still more-red blood cell transfusions affect long-term mortality in cardiac surgery.

Objectives: Previous studies indicated higher long-term mortality after the transfusion of allogeneic red blood cells (RBC); newer recommendations emphasize lower transfusion rates. The consequences of the transfusion of RBCs in cardiac surgery are unclear because later studies focused on transfusion triggers and short-term outcomes. Reports on long-term complications after cardiac surgery are few.

Arterial and venous blood sampling is equally applicable for coagulation and fibrinolysis analyses.

Objectives: No consensus exists upon whether arterial and venous blood samples are equivalent when it comes to coagulation analyses. We therefore conducted a comparative cohort study to clarify if arteriovenous differences affect analyses of primary and secondary hemostasis as well as fibrinolysis.

Methods: Simultaneous paired blood samplings were obtained from a cannula in the radial artery and an antecubital venipuncture in 100 patients immediately before or one day after thoracic surgery.

Comparison of free arterial and saphenous vein grafting in outcomes after coronary bypass surgery.

. The goal of this study was to examine whether the use of free arterial grafts could reduce the need for repeated revascularization and all-cause mortality in patients undergoing coronary artery grafting. .

Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study.

Background: Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome.

Methods: This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020.

A systematic approach to weaning from extracorporeal membrane oxygenation in patients with refractory cardiac failure.

Background: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is commonly used to provide haemodynamic support for patients with severe cardiac failure. However, timing ECMO weaning remains challenging. We aimed to examine if an integrative weaning approach based on predefined haemodynamic, respiratory and echocardiographic criteria is associated with successful weaning.

A Descriptive Study of Perioperative Hemodynamics in Open Cardiac Surgery Patients.

Objectives: The purpose of the present study was to describe how the perioperative hemodynamic profile before and after cardiopulmonary bypass during cardiac surgery is influenced by age and to describe the association between postoperative hemodynamics and one-year mortality.

Design: A retrospective registry-based study.

Setting: University Hospital of Aarhus, Denmark.

[Extracorporeal membrane oxygenation therapy of acute respiratory distress syndrome in adults in Denmark].

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an established treatment option in critically ill patients with acute respiratory distress syndrome (ARDS). The overall mortality in patients with ARDS has fallen over the past 30 years. VV-ECMO for selected patients has contributed to this.

Fast-track cardiac anaesthesia protocols: Is quality pushed to the edge?

Background: The quest for methods expediting rapid postoperative patient turnover has triggered implementation of various fast-track cardiac anaesthesia protocols. Using three different fast-track protocols in randomized controlled studies (RCT) conducted 2010-2016 we found minimal achievements in ventilation time together with actual and eligible length of stay in cardiac recovery unit. The comparable control group patients were evaluated in this retrospective post hoc analysis, for an association between above mentioned parameters and quality parameters, to assess whether the marginal gains have been at the expense of quality of recovery and patient comfort.

Impact of minimally invasive extracorporeal circulation on coagulation-a randomized trial.

Objectives: Minimally invasive extracorporeal circulation (MiECC) is suggested to have favourable impact on blood loss compared to conventional extracorporeal circulation. We aimed to compare the impact of both systems on coagulation.

Methods: Randomized trial comparing endogenous thrombin-generating potential early after elective coronary surgery employing either MiECC group (n = 30) or conventional extracorporeal circulation group (n = 30).

What the anaesthesiologist needs to know about heart-lung interactions.

The impact of positive pressure ventilation extends the effect on lungs and gas exchange because the altered intra-thoracic pressure conditions influence determinants of cardiovascular function. These mechanisms are called heart-lung interactions, which conceptually can be divided into two components (1) The effect of positive airway pressure on the cardiovascular system, which may be more or less pronounced under various pathologic cardiac conditions, and (2) The effect of cyclic airway pressure swing on the cardiovascular system, which can be useful in the interpretation of the individual patient's current haemodynamic state. It is imperative for the anaesthesiologist to understand the fundamental mechanisms of heart-lung interactions, as they are a foundation for the understanding of optimal, personalised cardiovascular treatment of patients undergoing surgery in general anaesthesia.

To jump or not to jump? A multicentre propensity-matched study of sequential vein grafting of the heart†.

Objectives: In this propensity-matched study we investigated the outcome after grafting with either a single vein or a sequential vein grafting strategy. Outcomes were primarily risk of reintervention and death in the short, intermediate and long term (10 years).

Materials: In the period from 2000 to 2016, data from 24 742 patients undergoing coronary artery bypass grafting were extracted from the Western Denmark Heart Registry, where data are registered perioperatively.

Blood cardioplegia benefits only patients with a long cross-clamp time.

Introduction: A clear advantage of blood versus crystalloid cardioplegia has not yet been observed in smaller population studies. The purpose of this article was to further investigate the clinical outcomes of blood versus crystalloid cardioplegia in a large propensity-matched cohort of patients who underwent cardiac surgery.

Methods: The study was a single-centre study.

Lower Dose of Sufentanil Does Not Enhance Fast Track Significantly-A Randomized Study.

Objective: Adjustment in the doses of opioids has been a focus of interest for achieving better fast-track conditions in cardiac anesthesia, but relatively sparse information exists on the potential effect of psychologic and behavioral factors, such as stress, anxiety, and type of personality, on anesthesia requirements and patient turnover in the cardiac recovery unit (CRU); to the authors' knowledge, this particular focus has not been systematically investigated. In this randomized study, the authors tested the hypothesis that low-dose sufentanil, compared with a standard dose, can improve fast-track parameters and the overall quality of recovery. Opioid requirements related to personality type, pain sensitivity, and preoperative stress and anxiety also were assessed.

High-pressure balloon fracturing of small dysfunctional Mitroflow bioprostheses facilitates transcatheter aortic valve-in-valve implantation.

Aims: Transcatheter valve-in-valve (VIV) implantation is usually discouraged in small surgical tissue valves. We report our first ten cases of fracturing small dysfunctional Mitroflow bioprostheses by high-pressure balloon dilatation to increase the internal diameter of the surgical valve before VIV (BF-VIV).

Methods And Results: BF-VIV was performed in 10 patients (mean age 84±4 years) with failing Mitroflow valves size 19 mm (n=3, threshold of fracture 15 atm) and 21 mm (n=7, threshold of fracture 13 atm).

Rational and timely haemostatic interventions following cardiac surgery - coagulation factor concentrates or blood bank products.

Background: Cardiac surgery may cause a serious coagulopathy leading to increased risk of bleeding and transfusion demands. Blood bank products are commonly first line haemostatic intervention, but has been associated with hazardous side effect. Coagulation factor concentrates may be a more efficient, predictable, and potentially a safer treatment, although prospective clinical trials are needed to further explore these hypotheses.

Colloids in Cardiac Surgery-Friend or Foe?

Objective: The right choice of fluid replacement still is a matter of debate. Recently, two large-scale studies on the use of hydroxyethyl starches (HES) in the intensive care setting have been published, which have caused a huge shift in the daily practice of volume therapy. These results have been applied to patients outside intensive care.

Ultrashort acting remifentanil is not superior to long-acting sufentanil in preserving cognitive function-a randomized study.

Study Objective: Postoperative cognitive dysfunction (POCD) is a well-known complication after cardiac surgery and may cause permanent disabilities with severe consequences for quality of life. The objectives of this study were, first, to estimate the frequency of POCD after on-pump cardiac surgery in patients randomized to remifentanil- or sufentanil-based anesthesia and, second, to evaluate the association between POCD and quality of recovery and perioperative hemodynamics, respectively.

Design: Randomized study.

Remifentanil Compared With Sufentanil Does Not Enhance Fast-Track Possibilities in Cardiac Surgery-A Randomized Study.

Objective: Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the intensive care unit (ICU) are important factors in patient turnover, a more efficient use of resources, and early patient mobilization. However, LOS in ICU is not an objective measure because, in addition to medical factors, patient discharge may be guided by logistics and policy, and thus more objective measures are warranted.

[High-risk pregnancy in a woman with Marfan syndrome, a bicuspid aortic valve, and a dilated aortic sinus].

A 29-year-old woman with Marfan syndrome, a bicuspid aortic valve, and a dilated aortic sinus (5.2 cm) presented herself in clinic 14 weeks pregnant. She was advised to discontinue the pregnancy due to risk of dissection; however, she decided to continue.

[Airway obstruction and massive subcutaneous emphysema].

Airway obstruction caused by massive subcutaneous emphysema (MSE) in the chest and neck region is a rare complication to tension pneumothorax. We describe the condition in a 91-year-old male in whom rapidly progressing MSE caused airway obstruction. As a result of progressing airway obstruction acute intubation was performed prior to completion of tube thoracostomy resulting in immediate improvement of the condition.

[Extracorporeal membrane oxygenation treatment for a patient with life-threatening asthma].

This is a case report of a young male with life-threatening asthma presenting hypercapnia and respiratory acidosis despite mechanical ventilation and intense broncholytic medication. He was treated with venovenous extracorporeal membrane oxygenation (VV-ECMO) through a double-lumen catheter placed in the right jugular vein. This patient, as well as two other comparable patients, improved respiratory and circulatory within 3 h of VV-ECMO treatment.

High thoracic epidural analgesia as an adjunct to general anesthesia is associated with better outcome in low-to-moderate risk cardiac surgery patients.

Objective: The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome.

Design: Retrospective cohort study of prospectively registered data using population-based healthcare databases.

Participants: One thousand seven hundred thirteen consecutive patients scheduled for elective coronary artery bypass grafting, aortic valve replacement, mitral valve surgery, and combinations eligible for supplementation with epidural analgesia.