Abnormal Iron Status and Adverse Outcome After Elective Cardiac Surgery: A Prospective, Observational Multicenter Study.

Objectives: To investigate the incidence of preoperative abnormal iron status and its association with packed red blood cell (PRBC) transfusion, postoperative major complications, and new onset of clinically significant disability in patients undergoing elective cardiac surgery.

Design: A prospective, observational multicenter cohort study.

Setting: Three cardiac surgical centers in the Netherlands between 2019 and 2021.

Cardiac Surgery in Jehovah's Witnesses: 329 Consecutive Cases.

Objectives: This study aimed to describe the outcome of Jehovah's Witnesses (JWs) undergoing cardiac surgery at the authors' center.

Design: A single-center retrospective cohort study.

Setting: At a cardiovascular center with a tertiary intensive care unit (ICU) and specific experience with cardiac surgery in JWs.

Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis.

Background: Previous studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery.

Measures to Prevent Neurologic Deficits in Urgent CABG Surgery With Bilateral Carotid Occlusion.

Patients with bilateral high-degree carotid stenosis or occlusion impose high risk for neurologic complications during coronary artery bypass graft surgery (CABG). Former articles have described successful CABG in patients with bilateral carotid artery occlusion with uneventful recovery, with perioperative cerebral blood flow monitoring consisting of electroencephalography or near-infrared spectroscopy. In this case report, we describe the use of pulsatile flow on cardiopulmonary bypass and transcranial Doppler monitoring during successful CABG in a patient with bilateral carotid occlusion, leading to a safe approach where changes in cerebral blood flow were seen and analyzed with no lag between event and monitoring.

A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products.

Objectives: In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown.

Effects of Liraglutide on Myocardial Function After Cardiac Surgery: A Secondary Analysis of the Randomised Controlled GLOBE Trial.

Introduction: Previous studies demonstrated the cardioprotective properties of glucagon-like peptide-1 receptor agonists in patients with diabetes or cardiac disease. We investigated whether preoperative subcutaneous liraglutide improves myocardial function after cardiac surgery.

Methods: We performed a pre-planned secondary analysis of adult patients undergoing cardiac surgery included in the GLOBE trial.

Liraglutide for perioperative management of hyperglycaemia in cardiac surgery patients: a multicentre randomized superiority trial.

Aims: Most cardiac surgery patients, with or without diabetes, develop perioperative hyperglycaemia, for which intravenous insulin is the only therapeutic option. This is labour-intensive and carries a risk of hypoglycaemia. We hypothesized that preoperative administration of the glucagon-like peptide-1 receptor agonist liraglutide reduces the number of patients requiring insulin for glycaemic control during cardiac surgery.

Study protocol of the randomised placebo-controlled GLOBE trial: P-1 fr ridging of hyperglycamia during cardiac surgery.

Introduction: Perioperative hyperglycaemia is common during cardiac surgery and associated with postoperative complications. Although intensive insulin therapy for glycaemic control can reduce complications, it carries the risk of hypoglycaemia. GLP-1 therapy has the potential to lower glucose without causing hypoglycaemia.

Minimally Invasive Mitral Valve Surgery With Endoaortic Balloon Requires Cerebral Monitoring.

After induction of anesthesia, an extra right radial artery catheter and cerebral oximetry were placed for minimally invasive mitral valve surgery. An anterolateral minithoracotomy, endoaortic balloon, and left atriotomy allowed visualization of the mitral valve. During the procedure, we observed a drop of the right cerebral oximetry saturation without a drop in right radial artery pressure.

Effectiveness of pericardial lavage with or without tranexamic acid in cardiac surgery patients receiving intravenous tranexamic acid: a randomized controlled trial.

Objectives: Pericardial lavage with saline, with or without tranexamic acid (TA), is still not evidence-based within current clinical practice as a part of a blood conservation strategy in cardiac surgery patients receiving intravenous TA administration. The objective was to determine whether intravenous TA combined with pericardial lavage with saline, with or without TA, reduces blood loss by 25% after cardiac surgery measured in the first 12 h postoperatively.

Methods: In this single-centre, randomized controlled, multiple-armed, parallel study, individual patients were randomly assigned to receive either topical administration of 2 g TA diluted in 200 ml of saline (TA group), 200 ml of saline (placebo group) or no topical administration at all (control group).

Comparing the endo-aortic balloon and the external aortic clamp in minimally invasive mitral valve surgery.

Objectives: The aim of this study was to assess the differences in perioperative outcomes and complications between the endo-aortic balloon (EAB) and the external aortic clamp (EAC) during primary elective minimally invasive mitral valve surgery (MIMVS) in a single referral centre by one surgeon. Primary outcomes were cardiopulmonary bypass time (CPB), cross-clamp time (CX) and occurrence of postoperative cerebrovascular accidents (CVAs). Secondary outcomes were other perioperative parameters and complications.

Defining indications for selective chest radiography in the first 24 hours after cardiac surgery.

Objective: In the intensive-care unit (ICU), chest radiographs (CXRs) are frequently obtained routinely for postoperative cardiac surgery patients, despite the fact that the efficacy of routine CXRs is known to be low. We investigated the efficacy and safety of CXRs performed after cardiac surgery for specified indications only.

Methods: In this observational cohort study, we prospectively included all patients who underwent conventional major cardiac surgery by median sternotomy in the year 2012.

Intraoperative glycemic control without insulin infusion during pediatric cardiac surgery for congenital heart disease.

Background: Many studies are reporting that the occurrence of hyperglycemia in the postoperative period is associated with increased morbidity and mortality rates in children after cardiac surgery for congenital heart disease. This study sought to determine blood glucose levels in standard pediatric cardiac anesthesiological management without insulin infusions.

Methods: The study population consisted of 204 consecutive pediatric patients aged from 3 days to 15.

Three-dimensional transesophageal echocardiography: diagnosing intraoperative pulmonary artery thrombus.

A 61-year-old patient with the diagnosis of acute heart failure based on severe mitral valve insufficiency due to chordae rupture was scheduled for surgery. Intraoperatively, a standard two-dimensional transesophageal echocardiogram (2D-TEE) examination, revealed severe mitral valve regurgitation due to a prolaps with chordal rupture and an echo dense structure in the pulmonary artery (PA). Because it was not possible to visualize this echo dense structure fully with 2D-TEE we performed a three-dimensional transesophageal echocardiogram (3D-TEE).

Relevance of colloid oncotic pressure regulation during neonatal and infant cardiopulmonary bypass: a prospective randomized study.

Objective: In neonatal and infant cardiac surgery with cardiopulmonary bypass (CPB), hemodilution with reduction of plasma albumin concentration and low colloid oncotic pressure (COP) are the main factors associated with tissue edema and postoperative weight gain. The aim of our study was to evaluate the influence of two different COP regulatory strategies on post-bypass body weight gain, fluid balance, and clinical outcomes.

Methods: Seventy elective patients with body weight<10 kg underwent first-time cardiac surgery with CPB and were randomized into two groups.

Feasibility of real-time three-dimensional transesophageal echocardiography in type A aortic dissection.

Transesophageal echocardiography (TEE) is the fastest method for diagnosing aortic dissection type A and allows 3D TEE, even in hemodynamically instable patients. 3D TEE may provide additional information on aortic morphology, the involvement of coronary arteries by the dissection and aortic valve function. In this regard 2D and 3D TEE might become the diagnostic method of choice in hemodynamically instable patients.

Three-dimensional transesophageal echocardiography in Ebstein's anomaly.

Three-dimensional (3D) transthoracic echocardiography has advantages over traditional two-dimensional (2D) echocardiography in visualizing tricuspid valve morphology in Ebstein's anomaly. We describe the application of intra-operative 3D transesophageal echocardiography during a tricuspid valve repair procedure in a patient with Ebstein's anomaly. Intra-operatively three-dimensional transesophageal echocardiographic (3D TEE) data sets revealed morphology and function of the tricuspid valve, right ventricle outflow tract (RVOT) and pulmonary valve before and after repair.

Alveolar recruitment strategy and PEEP improve oxygenation, dynamic compliance of respiratory system and end-expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease.

Objective: Optimizing alveolar recruitment by alveolar recruitment strategy (ARS) and maintaining lung volume with adequate positive end-expiratory pressure (PEEP) allow preventing ventilator-induced lung injury (VILI). Knowing that PEEP has its most beneficial effects when dynamic compliance of respiratory system (Crs) is maximized, we hypothesize that the use of 8 cm H(2)O PEEP with ARS results in an increase in Crs and end-expiratory lung volume (EELV) compared to 8 cm H(2)O PEEP without ARS and to zero PEEP in pediatric patients undergoing cardiac surgery for congenital heart disease.

Methods: Twenty consecutive children were studied.

Rapid method for intraoperative assessment of aortic coarctation using three-dimensional echocardiography.

Aims: The availability of three-dimensional (3D) echography with its multiplanar review analysis software on board now allows detailed examination in assessing morphological details. We evaluated the feasibility of 3D echography in assessing intraoperative morphological details of aortic coarctation (CoA) and its repair.

Methods And Results: Nine consecutive children scheduled for surgery of CoA were intraoperatively evaluated.

A new transesophageal probe for newborns.

Current transesophageal probes are designed for adults and are used both in the operating theatre for monitoring as well as in the outpatient clinic for patients with specific indications, like obesity, artificial valves, etc. For newborns (<5 kg), transesophageal echocardiography (TEE) is not possible because the current probes are too big for introducing them into the esophagus. There is a clear need for a small probe in newborns that are scheduled for complicated cardiac surgery and catheterization.

Measurement of end-expiratory lung volume in intubated children without interruption of mechanical ventilation.

Purpose: Monitoring end-expiratory lung volume (EELV) is a valuable tool to optimize respiratory settings that could be of particular importance in mechanically ventilated pediatric patients. We evaluated the feasibility and precision of an intensive care unit (ICU) ventilator with an in-built nitrogen washout/washin technique in mechanically ventilated pediatric patients.

Methods: Duplicate EELV measurements were performed in 30 patients between 5 kg and 43 kg after cardiac surgery (age, median + range: 26, 3-141 months).