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Across observational and RCTs that included more than 2,800 patients, hemolysis occurred in three patients (out of four with known glucose-6-phosphate-dehydrogenase [G6PD] deficiency) (0.1%), oxalate nephropathy occurred in five patients (0.2%), and falsely elevated glucose was reported in one patient (0.03%) ([3]). We thank Honore et al ([1]) for their interest and careful attention to our Systematic Review and Meta-Analysis (SR-MA) on IV vitamin C (IVVC) in critically ill patients ([2]). In five trials that did not exclude patients with G6PD deficiency or oxalate nephropathy, adverse effects related to these disorders were not reported in patients who received IVVC ([2]). [Extracted from the article]

Background: Minimally invasive surgery for left ventricular assist device implantation may have advantages over conventional sternotomy (CS). Additionally, ultra-fast-track anesthesia has been linked to better outcomes after cardiac surgery. This study summarizes our early experience of combining minimally invasive surgery with ultra-fast-track anesthesia (MIFTA) in patients receiving HeartMate 3 devices and compares the outcomes between MIFTA and CS. Methods: From October 2015 to January 2019, 18 of 49 patients with Interagency Registry for Mechanically Assisted Circulatory Support profiles >1 underwent MIFTA for HeartMate 3 implantation. For bias reduction, propensity scores were calculated and used as a covariate in a regression model to analyze outcomes. Weighted parametric survival analysis was performed. Results: In the MIFTA group, intensive care unit stays were shorter (mean difference, 8 days [95% CI, 4–13]; P <0.001), and the incidences of pneumonia and right heart failure were lower than those in the CS group (odds ratio, 1.36 [95% CI, 1.01–1.75]; P =0.016, respectively). At 6 and 12 hours postoperatively, MIFTA patients had a better hemodynamic performance with lower pulmonary wedge pressure (mean difference, 2.23 mm Hg [95% CI, 0.41–4.06]; P =0.028) and a higher right ventricular stroke work index (mean difference, −1.49 g·m/m2 per beat [95% CI, −2.95 to −0.02]; P =0.031). CS patients had a worse right heart failure–free survival rate (hazard ratio, 2.35 [95% CI, 0.96–5.72]; P <0.01). Conclusions: Compared with CS, MIFTA is a beneficial approach for non–Interagency Registry for Mechanically Assisted Circulatory Support 1 HeartMate 3 patients with lower adverse event incidences, better hemodynamic performance, and preserved right heart function. Future large multicentric investigations are required to verify MIFTA's effects on outcomes. [ABSTRACT FROM AUTHOR]

The article presents a research that studied connection of intraoperative decrease of selenium to the postoperative development of multiorgan dysfunction in cardiac surgical patients. The study was carried out on 60 patients who had a cardiopulmonary bypass in university cardiothoracic operation theaters and intensive care units. It was concluded that low selenium concentrations were an independent factor for the postoperative development of multiorgan failure.

Introduction: An increasing number of patients require implantation of left ventricular assist device (LVAD) for the management of their end-stage heart failure. Organ dysfunctions and infectious complications belong to the most common adverse events, resulting from inflammation and oxidative stress. The essential trace element selenium is considered as cornerstone of the antioxidant defense mechanisms, which may offer therapeutic benefits. Hypothesis: Selenium supplementation provides beneficial effects after LVAD implantation. Methods: Adult patients scheduled to undergo LVAD implantation (destination therapy) were randomized to receive 300μg of sodium-selenite the evening before surgery, followed by high dose IV selenium supplementation (3000μg after induction, 1000μg on ICU admission, and 1000μg daily in ICU) or placebo. Patients with known severe renal dysfunction & chronic liver disease were excluded. The main outcomes of the pilot study were to determine its efficacy, feasibility (recruitment rates) and monitoring of adherence to the protocol. In an explorative approach, we evaluated major clinical endpoints, for the following confirmatory study. Results: In total, 20 patients met the inclusion criteria. The average recruitment rate was 1.5 patients/month (0-3). The average duration of the study intervention was 12.6 days (7-14) and there was a 97.7% compliance with dose administration. During the postoperative course, the inflammatory response, assessed by IL6 was similar between the groups. The number and duration of organ dysfunctions, requiring the need for ICU support was comparable. The placebo group showed a no significant faster recovery in this small cohort 12.5h (0.1-29.4) vs 20.5h (0.2-28.2). The intervention group presented a higher cardiac output, higher systolic and mean blood pressures, as well as lower pulmonary and central venous blood pressures on the 1. day of surgery. Conclusions: Selenium supplementation in patients receiving LVAD implantation was feasible and showed efficacy on patients' outcomes. A larger, more definitive trial is currently being planed. [ABSTRACT FROM AUTHOR]

Purpose of Review: No specific guidelines on medical nutrition therapy (MNT) in patients on different types of mechanical circulatory support (MCS) devices yet exist and overall evidence is limited. The purpose of this narrative review is to provide an overview about current existing evidence, which might be of underrecognized importance for the patients' short-term and long-term clinical and functional outcomes., Recent Findings: Patients on MCS inherit substantial metabolic, endocrinologic, inflammatory, and immunologic alterations, and together with the specificities of MCS therapy, technical modalities of respective devices, and concomitant medication, the consideration of individualized MNT approaches is indicated in routine clinical practice. Exemplarily, the evaluation of the patients' individual nutrition status, determination of nutrition targets, progressive increase of energy and protein supply throughout the different phases of disease, prevention of micronutrient deficiencies, implementation of nutrition protocols, appropriate monitoring strategies, and continuous quality improvement are essential elements of MNT in patients on MCS., Summary: The importance of MNT for patients on MCS still often remains underrecognized, which might be of particular relevance in view of the significant metabolic alterations, the long treatment period, and severity of illness in these patients. Further research on more targeted MNT approaches in those patients is urgently needed for the generation of evidence-based guidelines for this specific cohort of critically ill patients., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been reported for animal ischemia models., Methods: In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive xenon, sevoflurane, or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups was less than 0.15 ng/ml. Secondary outcomes were the safety and feasibility of xenon anesthesia., Results: The first patient included at each center received xenon anesthesia for practical reasons. For all other patients, anesthesia maintenance was randomized (intention-to-treat: n = 492; per-protocol/without major protocol deviation: n = 446). Median 24-h postoperative cardiac troponin I concentrations (ng/ml [interquartile range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia [per-protocol]). The mean difference in cardiac troponin I release between xenon and sevoflurane was -0.09 ng/ml (95% CI, -0.30 to 0.11; per-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 0.02). Perioperative variables and postoperative outcomes were comparable across all groups, with no safety concerns., Conclusions: In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous anesthesia. Xenon anesthesia appeared safe and feasible.

Rationale: We hypothesized that cluster of differentiation 74 (CD74) downregulation on placental macrophages, leading to altered macrophage-trophoblast interaction, is involved in preeclampsia., Objective: Preeclamptic pregnancies feature hypertension, proteinuria, and placental anomalies. Feto-placental macrophages regulate villous trophoblast differentiation during placental development. Disturbance of this well-balanced regulation can lead to pathological pregnancies., Methods and Results: We performed whole-genome expression analysis of placental tissue. CD74 was one of the most downregulated genes in placentas from preeclamptic women. By reverse transcriptase-polymerase chain reaction, we confirmed this finding in early-onset (<34 gestational week, n=26) and late-onset (≥34 gestational week, n=24) samples from preeclamptic women, compared with healthy pregnant controls (n=28). CD74 protein levels were analyzed by Western blot and flow cytometry. We identified placental macrophages to express CD74 by immunofluorescence, flow cytometry, and RT-PCR. CD74-positive macrophages were significantly reduced in preeclamptic placentas compared with controls. CD74-silenced macrophages showed that the adhesion molecules ALCAM, ICAM4, and Syndecan-2, as well as macrophage adhesion to trophoblasts were diminished. Naive and activated macrophages lacking CD74 showed a shift toward a proinflammatory signature with an increased secretion of tumor necrosis factor-α, chemokine (C-C motif) ligand 5, and monocyte chemotactic protein-1, when cocultured with trophoblasts compared with control macrophages. Trophoblasts stimulated by these factors express more CYP2J2, sFlt1, TNFα, and IL-8. CD74-knockout mice showed disturbed placental morphology, reduced junctional zone, smaller placentas, and impaired spiral artery remodeling with fetal growth restriction., Conclusions: CD74 downregulation in placental macrophages is present in preeclampsia. CD74 downregulation leads to altered macrophage activation toward a proinflammatory signature and a disturbed crosstalk with trophoblasts., (© 2016 American Heart Association, Inc.)