Search

Background Nucleic acid-targeted pathogen inactivation technology using amustaline (S-303) and glutathione (GSH) was developed to reduce the risk of transfusion-transmitted infectious disease and transfusion-associated graft-versus-host disease with red blood cell (RBC) transfusion. Study design and methods A randomized, double-blind, controlled study was performed to assess the in vitro characteristics of amustaline-treated RBCs (test) compared with conventional (control) RBCs and to evaluate safety and efficacy of transfusion during and after cardiac surgery. The primary device efficacy endpoint was the postproduction hemoglobin (Hb) content of RBCs. Exploratory clinical outcomes included renal and hepatic failure, the 6-minute walk test (a surrogate for cardiopulmonary function), adverse events (AEs), and the immune response to amustaline-treated RBCs. Results A total of 774 RBC unis were produced. Mean treatment difference in Hb content was -2.27 g/unit (95% confidence interval, -2.61 to -1.92 g/unit), within the prespecified equivalence margins (±5 g/unit) to declare noninferiority. Amustaline-treated RBCs met European guidelines for Hb content, hematocrit, and hemolysis. Fifty-one (25 test and 26 control) patients received study RBCs. There were no significant differences in RBC usage or other clinical outcomes. Observed AEs were within the spectrum expected for patients of similar age undergoing cardiovascular surgery requiring RBCs transfusion. No patients exhibited an immune response specific to amustaline-treated RBCs. Conclusion Amustaline-treated RBCs demonstrated equivalence to control RBCs for Hb content, have appropriate characteristics for transfusion, and were well tolerated when transfused in support of acute anemia. Renal impairment was characterized as a potential efficacy endpoint for pivotal studies of RBC transfusion in cardiac surgery.

Patients undergoing cardiac surgery presenting with chronic obstructive pulmonary disease (COPD) have a higher 30-day mortality risk. In these patients, pulmonary dysfunction linked to an inflammatory response is frequent after cardiac operations using cardiopulmonary bypass (CPB), which causes pulmonary hypoperfusion. We hypothesize that selective pulmonary perfusion (sPP) of the lungs leads to a reduction of pulmonary inflammation and a better clinical outcome.Fifty-nine COPD patients (forced expiratory volume in 1 s/vital capacity70%) undergoing cardiac surgery procedures (coronary artery bypass grafting 64%, valve 14%) were block-randomized to sPP (venous blood, temperature 2°C, 4 l) or standard CPB (28/28). The primary end-point of the study was to evaluate the effect of pulmonary perfusion on gas exchange by measuring alveolar-arterial oxygen gradient. The surrogate end-points were inflammatory response, intensive care unit (ICU) stay, time on respirator (TOR) and major adverse cardiac and cerebrovascular events. A cytokine assay for interleukin-1β, IL-6, IL-10, tumour necrosis factor-α (TNF-α) and polymorphonuclear elastase was performed with peripheral blood at different time-points [(t1) pre-CPB, (t2) end of CPB, (t3) 3 h, (t4) 24 h, (t5) 48 h postoperatively]. Repeated-measure analysis of variance and non-parametric statistics were used to assess the between-group and during time differences.The two groups proved comparable for perioperative variables. Serum cytokines were not different in the two groups throughout the study (P0.05 at single time-points), but as a function of time, the markers of the inflammatory response increased after CBP (P0.05 pre-CPB to 24 h). Clinical end-points were statistically comparable in both groups, but with a trend towards a shorter TOR (72 ± 159 h/106 ± 193 h) and ICU stay (3.9 ± 7.2 days/5.5 ± 9.2 days) in the sPP group despite a slightly longer time on extracorporeal circulation (120 vs 158 min).These results indicate a non-significant trend that repeated hypothermic lung perfusion with venous blood during CPB may have a protective effect on the lungs. A multicentre study design and larger cohort seem necessary to demonstrate the benefits of sPP more clearly.

Background: Papaverine (Paveron N™ Linden Arzneimittel Vertrieb GmbH, Germany) is a widely used agent for preventing spasm in mammary artery preparations. The question addressed in this study is whether the intraluminal administration of papaverine can result in detectable absorption of the drug into the systemic arterial circulation.Methods: In 15 patients (age 65 ± 6 years; body mass index 28.9 ± 3.7), an internal mammary artery (IMA) was prepared during coronary artery bypass grafting (CABG). A maximum of 3 mL of a 1 mg/1 mL diluted papaverine solution was injected intravascularly (intraluminally) for spasm prophylaxis. The IMA was closed proximally and distally with bulldog clamps. Blood samples were taken immediately after administration (T1), after 20 minutes (T2), and at the end of the operation (T3). Samples were measured in a liquid chromatography--tandem mass spectrometry (LC-MS/MS) system consisting of a binary pump from Agilent (Waldbronn, Germany) coupled to a high-throughput screening (HTS) PAL injection system (CTC, Zwingen, Switzerland) and a tandem mass spectrometer (API 4000, AB Sciex, Darmstadt, Germany). Papaverine was analyzed in positive mode using an electrospray ion source. Quantitation was performed using Analyst 1.5 software (AB Sciex, Darmstadt, Germany).Results: The newly developed LC-MS/MS method was successfully established for the detection of papaverine in plasma samples. The highest plasma papaverine levels were determined at time point T1 (mean 54.7 ± 39 ng/mL, range 16.6-179 ng/mL). The concentration was already halved 20 minutes after administration (T2) (mean 23.3 ± 2 ng/mL, range 4.6-118 ng/mL). Because of the short half-life and the hemodilution in the extracorporeal circulation, at the end of the operation papaverine (T3) had already fallen to just above the limit of detection (mean 4.1 ± 3.9 ng/mL, range 1.3-16.9 ng/mL). At time point T1, a significant negative correlation was determined between plasma levels and systemic diastolic, but not systolic, blood pressure.Conclusion: Papaverine was successfully determined systemically in plasma by LC-MS/MS after intraluminal administration in the IMA. Systemic circulatory effects are dependent on the detected quantity. Group size and the absence of a control group are considerable limitations.

Objectives: Haemodilution resulting from crystalloid priming of the cardiopulmonary bypass circuit represents a major risk factor for blood transfusions in high-risk cardiac surgery patients. We designed this study to evaluate the effects of antegrade autologous priming (AAP) on reducing perioperative blood transfusion and markers of the inflammatory response in older patients (>75 years). Methods: Seventy-two patients undergoing first-time coronary bypass and/or aortic valve replacement were prospectively randomised to a cardiopulmonary bypass (CPB) with or without AAP. AAP was performed by adding the patient’s own blood to the prime solution (mean 280ml). Perfusion and anaesthetic techniques were as usual. The haematocrit was maintained at a minimum of 21% during CPB. Patients were well matched for all preoperative variables, including established transfusion risk factors. The primary endpoint was the requirement of red cell transfusion. The surrogate endpoints were renal function, inflammatory response and ischaemic parameters. Blood samples were drawn pre- and intraoperatively and at intervals of 6 hours till POD 6. Results: Current analysis shows no differences in patients receiving homologous packed red cell transfusions. Also, markers of the inflammatory response (IL6, IL8), renal function (cystatin C, creatinine) and myocardial ischaemia (troponin T, CK-MB) were comparable in both groups (p>0.05). Clinical outcomes were similar with respect to pulmonary, renal and hepatic function, length of ICU stay and hospital stay. Conclusion: These data suggest that antegrade autologous priming is a safe procedure, but an ineffective way for improving biocompatibility and reducing the need for blood transfusion in older patients.

BACKGROUND Atrial fibrillation (AFIB) following cardiac surgery is a frequent complication. The purpose of this study was to evaluate the efficacy of a potassium-magnesium-aspartate solution (Inzolen) for the prevention of AFIB. METHODS In a randomised, prospective, double-blinded study, we studied 88 patients undergoing elective coronary artery bypass graft surgery (CABG). After surgery, patients were allocated randomly to one of two groups. Group A (n = 43) received a potassium-magnesium-aspartate solution (Inzolen), group B (n = 45) received potassium chloride; both solutions were administered continuously for 48 hours to keep the potassium serum levels between 4.5 and 5.5 mmol/l. Patients were observed for 5 days postoperatively and the incidence of atrial fibrillation was noted. At the end of surgery (T0), 4 h (T1), 24 h (T2), 48 h (T3), and 120 h (T4) postoperatively, magnesium and potassium serum levels were measured. RESULTS The two groups did not differ significantly with regard to demographics and perioperative data. No significant difference in the incidence of postoperative atrial fibrillation was seen (group A: 41.9 % vs. group B 31.1 %; P = 0.53). In group A, the magnesium serum levels were significantly higher at T1 (1.15 +/- 0.18 vs. 0.87 +/- 0.11 mmol/l), T2 (1.24 +/- 0.22 vs. 0.82 +/- 0.10 mmol/l) and T3 (1.15 +/- 0.18 vs. 0.81 +/- 0.20 mmol/l) compared to group B, whereas potassium levels were similar in the two groups throughout the study period. CONCLUSIONS The use of a potassium-magnesium-aspartate solution (Inzolen) showed no significant difference in potassium chloride for the prophylaxis of postoperative atrial fibrillation secondary to CABG.

OBJECTIVE In this prospective, randomised study a double lumen tube (DLT) or an Arndt bronchial blocker (BB) was used for one lung ventilation (OLV). Intraoperative oxygenation, ventilation, haemodynamics, and ease of placement were compared. METHODS In 32 patients undergoing robotic harvesting of the left internal thoracic artery (ITA) a left-sided DLT or a BB controlled by bronchoscopy was used for OLV of the right lung. In 2 patients randomised for DLT, a single lumen tube and BB was used for difficult visualisation of the larynx. These 2 patients were excluded from the study. RESULTS Correct placement of DLT (8.8 +/- 5.4 min, 87.5 % of the patients) as well as BB (6.5 +/- 4.0 min; n. s.; 100 % of the patients) was achieved rapidly. The Cormack-Lehane score for visualisation of the larynx was 2, 1 - 3 (median, range) in group DLT and 3, 1 - 4 (median, range) in group BB (p < 0.05). OLV lasted for 93 +/- 29 min in group DLT and 88 +/- 34 min in group BB (n. s.). Satisfactory conditions for harvesting ITA were achieved in all patients of both groups. There was no difference in any haemodynamic parameter at any time between the two groups. Mean pulmonary arterial pressure and pulmonary vascular resistance were increased without significant differences between the two groups during thoracoscopy for robotic preparation of left ITA. During OLV, index of paO (2)/FiO (2) was significantly (p < 0.05) lower in DLT patients compared to BB patients. Time to extubation did not differ between the two groups (DLT 14.3 +/- 4.6 h; BB 11.8 +/- 3.8 h). CONCLUSION OLV in patients undergoing robotic cardiac surgery was safely achieved either by BB or by left-sided DLT. Positioning of the BB was easier than that of a DLT when intubation was difficult and tube exchange at the end of surgery is avoided. Therefore, we prefer a BB in patients undergoing robotic harvesting of left ITA.

The aim of our study was to compare a systemic and a local aprotinin application in patients during coronary artery bypass graft (CABG) surgery. The advantage of a topical aprotinin application is seen in the fact that this may not lead to systemic side effects. A prospective, randomized study comprising 97 patients was conducted. A dose of 5 106KIU aprotinin was given systemically to 49 patients and four doses of 1.25 106KIU aprotinin were applied topically to 48 patients by spraying the substance on the target area (A. mammaria interna region and pericardium). We determined markers for the inflammatory response, coagulation system, standard haematological markers and postoperative complications. Exclusion criteria were defined as surgical bleeding, redo operations, neurological, haematological, liver and kidney disorders. Sex, age, perfusion times, mortality, renal failure and strokes were identical in both groups. Biochemical markers and clinical outcome demonstrated no significant differences between the systemic and local applications. Interleukin 6 and elastase were tendentially higher ( p= 0.1) in the local group, but with a high standard deviation in each patient. Our results suggest that there is no difference between the perioperative application of 5 106KIU systemically given aprotinin and 1.25 106KIU locally applied aprotinin.

Background: Bleeding after open heart surgery is a common but unintended problem, which is unequivocally related to platelet function. The target of our study was to correlate platelet activation levels and postoperative blood loss as well as the predictive power of measurements focusing on postoperative hemostasis. Materials and methods: The prospective trial comprised 100 patients (mean age: 64.3 years, 68% male) undergoing cardiac surgery. Platelet activation was measured by the new and modified HemoSTATUS™ test. Blood samples were drawn pre-, intra- and postoperatively. Standard hemostasis tests, including activated clotting time (ACT), partial thromboplastin time (PTT), hemoglobin, platelet count, antithrombin III (AT III) and fibrinogen, were measured according to the clinical routine. Blood loss and consumed blood products were documented up to the 24th hour after the operation. Results: Platelet activation showed a typical change, with lowest levels after the end of extracorporeal circulation and a restitution to preoperative levels after 24 h. Mean blood loss was 461 ml. Statistical analysis showed neither a correlation to the platelet activation measurements nor to low pre-, intra- or postoperative levels. Conclusion: The HemoSTATUS platelet function test is not suitable for a reliable monitoring of platelet pathophysiology and patient outcome after extracorporeal circulation. Furthermore, no correlation of preoperative platelet activation and blood loss could be shown.

Introduction Antithymocyte globulin (ATG)-Fresenius (Neovii-Biotech, Graefelfing, Germany), a highly purified rabbit polyclonal antihuman T-lymphocyte immunoglobulin resulting from immunization of rabbits with the Jurkat T-lymphoblast cell line, is currently used for the prevention of acute rejection in patients receiving solid organ transplants. Our aim was to investigate the in vitro activity of ATG-Fresenius regarding the proliferation of peripheral blood mononuclear cells (PBMCs), an important mechanism of rejection after solid organ transplantation. Methods PBMCs were isolated from 6 healthy donors. Proliferation was assayed using [ 3 H] thymidine incorporation. For analysis of mitogen-stimulated proliferation, the PBMCs were incubated at 37°C with various concentrations of ATG-Fresenius in the absence/presence of 40 μg/mL phytohemagglutinin. For analysis of the mixed lymphocyte reaction, PBMCs were incubated at 37°C with various concentrations of ATG-Fresenius for 3 days. On day 3, PBMCs (stimulator cells) from allogeneic donors were incubated with 25 μg/mL mitomycin C. The responder cells (preincubated with ATG-Fresenius) were then cultured at 37°C with the stimulator cells for 6 days. Groups were compared using ANOVA and the Tukey-Kramer multiple comparison test. Results Preincubation of PBMCs with ATG results in concentration-dependent inhibition of phytohemagglutinin-stimulated proliferation. The effect was more pronounced after 2 and 3 days of treatment with ATG compared with 1 day. There was a concentration-dependent decrease in the mixed lymphocyte reaction-induced proliferation (up to 80%) at ATG-Fresenius concentrations as low as 0.05 to 0.5 μg/mL. No further effect on proliferation at ATG-Fresenius concentrations of 0.5 to 50 μg/mL was seen, and higher concentrations (>100 μg/mL) totally inhibited proliferation. Conclusions Our in vitro results provide more evidence of the beneficial effect of ATGs in the early phase of solid organ transplantation, by reducing effector cell proliferation.

Objective: Acute kidney injury (AKI) after cardiac surgery procedures is associated with poor patient outcomes. Cystatin C as a marker for renal failure has been shown to be of prognostic value; however, a wide range of its predictive accuracy has been reported. The aim of the study was to evaluate whether the measurement of pre- and postoperative serum cystatin C improves the prediction of AKI. Methods: In a single-centre, prospective study of 70 patients (74 ± 9ys; range 47-85ys; 77% male), cystatin C was measured six times: (T1 = preoperative, T2 = start cardiopulmonary bypass (CPB), T3 = 20 min after CPB, T4 = end of operation; T5 = 24 h postoperatively; T6 = 7d postoperatively). Predictive property, in terms of the need for renal replacement therapy (RRT), was analysed by receiver operating characteristics (ROC) statistics and described by the area under the curve (AUC). Results: With respect to RRT (n = 8), serum cystatin C was significantly higher at the end of the operation (T4), 24 h postoperatively at T5 and at T6. The AUCs for preoperative T1 and intraoperative T2/3 cystatin C were

Female gender is an established risk factor for worse outcomes after cardiac surgery, and women are more likely to experience postoperative complications. Our aim was to analyze the influence of gender on outcome and postoperative complications after the use of intra-aortic balloon counter-pulsation (IABP) in cardiac surgery patients.Fifty-seven consecutive female patients (mean age: 73 ± 9 years) requiring an IABP at our department from January 2007 to January 2010 were retrospectively analyzed and compared with 182 male patients receiving IABP support within the same period. The collected data included patient demographics, preoperative state, operative details, postoperative pharmacological treatment, IABP-associated complications, and inhospital mortality. Preoperative mortality risk was calculated by logistic EuroSCORE.There were no differences regarding the type of operation, preoperative renal or hepatic failure, though the prevalence of peripheral artery occlusive disease was higher in men. Furthermore, female patients receiving an IABP were significantly older (73 ± 9 vs. 67 ± 10 years), had a higher ejection fraction (EF) (45% ± 24% vs. 36% ± 14%), and had a higher EuroSCORE (25% ± 20% vs. 19% ± 17%; p 0.05). Postoperative catecholamine support was significantly higher in the female patients. Women had a prolonged length of stay (LOS) at the ICU (10.64 ± 9.7 vs. 7.6 ± 7.6 days), higher incidence of renal replacement therapy, and a higher mortality (19 [19.4%] vs. 35 [33.9%]; p 0.05) after the use of IABP.Women have a worse outcome after the use of IABP, including LOS at the ICU, postoperative renal failure, and inhospital mortality, despite higher EF, when compared with men.

Objective: Aim of the study was the evaluation of the impact of lung recruitment maneuvers on the hemodynamics following cardiac surgery procedures. Methods: The prospective randomized study included 80 adult patients undergoing coronary artery bypass surgery from 01/2009 till 09/2009. Patients were randomized to two duration's of lung recruitment maneuvers (25 cmH2O airway pressure for 10s and 45cm H2O for 10s) immediately after arriving on ICU. Swan Ganz catheter measurement was used to calculate cardiac output, and arterial blood pressure were monitored continuously. Systemic and pulmonary arterial blood gases were sampled before and after each lung recruitment maneuver to determine the intrapulmonary shunt. Results: Left ventricular end-diastolic areas decreased significantly during both the 10-s and the 20-s lung recruitment maneuvers. Cardiac output was 5.6±0.8l/min at baseline, decreasing by 3.0±1.1l/min and 3.6±1.2l/min during lung recruitment maneuvers of 10 and 20s, respectively. Shunt decreased from 20±5% to 15±6% after the first lung recruitment maneuver and from 15±6% to 12±5% after the second. Conclusions: Lung recruitment maneuvers markedly reduced cardiac output and left ventricular end-diastolic areas in hemodynamically stable patients following cardiac surgery.

Objectives: In the postoperative course after conventional open removal of the greater saphenous vein, wound healing disturbances are common and often painful. Therefore the primary goal of this investigation was to prove the safety and practicability of this new less invasive technique for saphenous vein harvesting and the effect on complications and morbidity. Methods: The study comprised 103 coronary artery bypass grafting (CABG) patients with an endoscopic approach to harvest the saphenous vein (MIVH). We used the VasoView II system developed by Origin, and compared the intraoperative procedure time and the clinical results with 105 equivalent patients in which a conventional open technique was used. Results: In 101 patients endoscopic vein harvesting was successful; a conversion into open technique was necessary in two patients. On average 2.6 vein segments could be harvested in the endogroup versus 2.9 segments in the opengroup. The mean procedure time was 13.2 min per segment in the endogroup compared to 12.2 min per segment in the opengroup. Relevant hematoma were found in 29 patients (27.6%) of the opengroup, whereas only nine patients (8.7%) of the endogroup revealed severe hematoma. Infection was apparent in nine patients (8.5%) after conventional vein harvesting. Two infections were found after endoscopic intervention. Conclusions: Endoscopic saphenous vein harvesting as part of a less invasive concept in cardiac surgery is a safe and after the learning curve, fast alternative to harvest the saphenous graft. The cosmetic result is excellent and the complication rate seems to be lower. It must be noted however, that the cost effectiveness of the method has to be proved and that further histological and functional studies are needed in order to check the intimal structure of the vein. q 1999 Elsevier Science B.V. All rights reserved.

Objective: Gene polymorphisms of thrombolytic, lipoprotein and immological pathways are supposed to play a role in the pathogenesis of CAD (coronary artery disease). CAD accumulates in families, but does not segregate like a Mendelial single-gene disorder, indicating that atherosclerosis is basically a multifactorial disease. Method: We determined and compared 10 genetic mutations in homocygote or heterocygote occurrence in two cohorts: 314 patients with CAD following CABG operation and 500 healthy Caucasian. Factor V Leiden and Prothrombin are sensitive markers for venous thrombosis; Plasminogen-Activator-Inhibitor-1, Angiotensin Converting Enzyme, Methylentetrahydrofolatreductase, Cholesterinester-Transferprotein and Apolipoprotein E express risk for atherosclerosis; Glycoproteins (three polymorphisms) represent the risk for platelet induced thrombosis. Results: The analysis shows significant differences in two pathways. We found increased occurrence of FV Leiden (p=0.0034, OR 2.33) and PAI-1 (p=0.004, OR=1.34) in CABG patients compared to the control. There was also a higher mutation rate of GP Ia 807 in the CABG group. Discussion: With the identification of two polymorphisms involved in the metabolic path-ways of thrombus aggregation in CABG patients, there might be a future possibility in the screening, prediction and prevention of CAD in the population.

The aim of this study was to compare the systemic blood activation with open and closed perfusion management during cardiopulmonary bypass. In 30 patients undergoing coronary artery bypass grafting, we prospectively studied systemic blood activation, blood loss and the need for donor blood. In 15 patients we used an open venous reservoir consisting of a hard shell venous reservoir with an integrated cardiotomy filter. In another 15 patients we used a totally closed venous reservoir consisting of a collapsible venous reservoir, no coronary suction, modified vent and cell saver. Venous blood samples were collected pre, post and 24 hours postoperatively. Sex, age and perfusion times were identical in both groups. There were no statistically significant differences in concentrations of FXIIa and C3a, amount of blood loss and need for donor blood. Interleukin-6 and Elastase levels showed trends toward a lesser inflammatory reaction in closed venous reservoir patients. Modification of perfusion management with optimized air management does not seem to be an effective strategy in reducing the inflammatory response and influencing the coagulation system in this small cohort.

Sternal dehiscence is a frequent complication after cardiac surgical procedures. The objective was to evaluate a novel method for advanced sternal closure compared with standard techniques for preventing sternal dehiscence. Our investigation comprised 100 patients with a body mass index above 32. Patients were randomly assigned to receive either advanced sternal closure with three stainless steel double wires or standard techniques with stainless steel single wires. The incidence of sternal refixation was 6 of 50 patients in the standard techniques group and 1 of 50 in the advanced sternal closure group during a follow-up period of 6 months.

Background About 80 % of patients receiving an implantable cardioverter-defibrillator (ICD) due to life-threatening episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) have structural heart disease. ICD implantation reduces the risk of sudden cardiac death to less than 2 %. However, the major obstacle in these patients is chronic heart failure (CHF). Biventricular stimulation (BIV) has shown its efficiency as an alternative therapy in drug refractory CHF. Methods According to the InSync registry, we predefined possible indications for BIV as follows: complete branch bundle block (> 120 ms), left-ventricular ejection fraction (EF) II. We evaluated the number of patients presenting this indication at time of implant and during follow-up (FU) at our ICD clinic. Results Between 1992 and 1998, 360 patients were provided with an ICD (mean age 64.6 +/- 5.4 yrs, mean EF 37 +/- 14 % at implant, 82 % of patients with organic heart disease). Mean FU was 34 +/- 21 months. During FU 46 patients (13 %) died, 15 of these (33 %) presenting criteria for BIV. 33 patients died of heart failure, there was 1 sudden death and 12 patients died for non-cardiac reasons. 35 % of the patients who died of heart failure had an indication for BIV. Conclusions About 10 % of ICD patients had an indication for BIV at time of implant. Over a mean FU period of 34 months, 16% of all patients presented an indication for BIV. Patients with an indication for BIV had a higher mortality rate and more frequent atrial fibrillation compared to patients without. With this data and the good clinical results after BIV-ICD implantation, we consider the implantation of a BIV-ICD system in every patient with appropriate indications.

Background: The introduction of fast-track treatment procedures following cardiac surgery has significantly shortened hospitalisation times in intensive care units (ICU). Readmission to intensive care units is generally considered a negative quality criterion. The aim of this retrospective study is to statistically analyse risk factors and predictors for re-admission to the ICU after a fast-track patient management program. Methods: 229 operated patients (67 ± 11 years, 75% male, BMI 27 ± 3, 6/2010-5/2011) with use of extracorporeal circulation (70 ± 31 min aortic crossclamping, CABG 62%) were selected for a preoperative fast-track procedure (transfer on the day of surgery to an intermediate care (IMC) unit, stable circulatory conditions, extubated). A uni- and multivariate analysis were performed to identify independent predictors for re-admission to the ICU. Results: Over the 11-month study period, 36% of all preoperatively declared fast-track patients could not be transferred to an IMC unit on the day of surgery (n = 77) or had to be readmitted to the ICU after the first postoperative day (n = 4). Readmission or ICU stay signifies a dramatic worsening of the patient outcome (mortality 0/10%, mean hospital stay 10.3 ± 2.5/16.5 ± 16.3, mean transfusion rate 1.4 ± 1,7/5.3 ± 9.1). Predicators for failure of the fast-track procedure are a preoperative ASA class > 3, NYHA class > III and an operation time >267 min ± 74. The significant risk factors for a major postoperative event (= low cardiac output and/or mortality and/or renal failure and/or re-thoracotomy and/or septic shock and/or wound healing disturbances and/or stroke) are a poor EF (OR 2.7 CI 95% 0.98-7.6) and the described ICU readmission (OR 0.14 CI95% 0.05-0.36). Conclusion: Re-admission to the ICU or failure to transfer patients to the IMC is associated with a high loss of patient outcome. The ASA > 3, NYHA class > 3 and operation time >267 minutes are independent predictors of fast track protocol failure.