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Objective Delayed neurocognitive recovery (dNCR) remains a common complication after surgery and the incidence of it is determined 30–80% after cardiac surgery with cardiac bypass (CPB) in eldery patients. Many researchers have identified that neuropsychological complications emerge from insufficient cerebral perfusion. Relative cerebral hyperperfusion also disrupts cerebral autoregulation and might play a significant role in dNCR development. The aim of this study is to determine hyperperfusion in the middle cerebral artery during CPB influence to dNCR development and brain biomarker glial fibrillary acidic protein (GFAP) impact in diagnosing dNCR. Designs and methods This prospective - case control study included patients undergoing elective coronary artery bypass grafting or/and valve surgery with CPB. For cognitive evaluation 101 patients completed Addenbrooke’s cognitive examination - ACE-III. To determine mild cognitive dysfunction, cut - off 88 was chosen. Mean BFV was monitored with transcranial Doppler ultrasonography (TCD) and performed before surgery, after induction of anaesthesia, during CPB and after surgery. Preoperative BFV was converted to 100% and used as a baseline. The percentage change of cerebral blood flow velocity during CPB was calculated from baseline. Patients with decreased blood flow velocity were included for further investigation. To measure glial fibrillary acidic protein, blood samples were collected after anaesthesia induction, 24 and 48 h after the surgery. According to the ACE-III test results, patients with relative hyperperfusion were divided into two groups: with Delayed neurocognitive recovery and without dNCR (non‐dNCR group). Results 101 patients were examined, 67 (69.1%) men and 29 (29.9%) women, age 67.9 (SD 9.2) Increased percentage of BFV was determined for 40 (39.60%) patients. There were no differences in sex, haematocrit, paCO2, aortic cross-clamping or CPB time between the two groups. Percentage change of BFV was 105.60% in the non-dNCR group and 132.29% in the dNCR group, p = .033. Patients who developed dNCR in the early post-surgical period were significantly older, p < .001 and had a lower baseline of BFV, p = .004. GFAP concentration significantly increased in the dNCR group 48 hours after surgery, compared to the non-dNCR group, p = .01. Conclusions Relative hyperperfusion during CPB may cause dNCR. Elderly patients are sensitive to blood flow velocity acceleration during CPB. GFAP concentration increased 48 h after surgery in dNCR group but did not have any connection with risk factors.

Aim: we choose to evaluate, whether type of cardioplegia is an important predictor to determine biventricular function changes after CABG. Methods: 81 patients who underwent CABG surgery and matched inclusion criteria were enrolled in this study. The exclusion criteria were acute MI within 30 days, impaired systolic left ventricle function (LVEF ⩽35%), atrial fibrillation.TTE was performed for all patients and echocardiographic parameters of biventricular geometry and function were assessed before CABG surgery, first postoperative day and 6 months after surgery. Cardioplegia type was randomly chosen. First group consisted of 49 patients (60.5%) when CC was performed and the others 32 patients (39.5%) formed the second - BC group. Results: Patients’ demographic characteristics were similar in both groups, except the lower rates of AH and BSA in BC group ( p = 0.015, p = 0.001 respectively). Longer duration of XCT and CBP time was observed in BC group (p = 0.019 and p = 0.028). BC group patients showed more efficient right heart chambers size reduction ( p = 0.001 for RV diameter; p = 0.015 for RA diameter) and better improvement of longitudinal RV function ( p = 0.02 for TAPSE; p = 0.001 for RV S’) 6 months after surgery when compared with CC group patients. RV global systolic function diminished in both groups postoperatively, but the reduction was higher in CC group, although the difference was significant in comparing early postoperative measurements with the late after CABG surgery ( p = 0.03). Changes of LV systolic function as well as diameter of LA did not differ between groups ( p = 0.165 and p = 0.279, respectively), while diastolic function improved significantly in BC group patients at the late follow-up period: E/e’ decreased (p Conclusion: BC is associated with better RV reverse remodelling and improvement of longitudinal RV function, as well as LV diastolic function improvement after CABG surgery.

Background: Cardiovascular diseases remain one of the leading causes of morbidity and mortality worldwide, however its surgical treatment remains risky with possible complications. There is increasing evidence that the month of birth (MOB) has been related to different health problems during life. The aim of this study was to identify the effect of MOB on the risk of deep sternal wound infections (DSWI) in patients after open-heart surgery. Methods: The follow-up retrospective research was performed at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. We analyzed the MOB of 201 patients, who underwent open-heart surgery between January 2017 and December 2018. The case group consisted of 46 patients, who suffered from DSWI. Multivariate logistic regression for the association between MOB and risk of DSWI was used. Results: The results showed that the risk of DSWI was by four times higher for patients born in June-September months. The risk of developing DSWI in the case group was even higher for women, patients aged 70 years and younger, those overweight or obese, and patients who underwent only CABG surgery. Conclusion: Due to the growing evidence that the month of birth affects the onset of diseases, it is important to assess MOB as the potential risk factor for developing DSWI.

Background: Despite improvements over time with regard to morbidity, mortality, and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after open-heart surgery. This is why it is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting and valve replacement. The aim of this study was to identify the risk factors for postoperative development of deep sternal wound infection in patients after coronary artery bypass grafting and heart defect surgery at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. Methods: This retrospective study analyzed 201 patients, who underwent coronary artery bypass grafting and heart defect surgery between January 2017 and December 2018. The case group contained 45 patients, who had to be reoperated because of deep sternal wound infection, and the control group consisted of 156 randomly selected patients. For descriptive statistics, we used means, median values, ranges, standard deviations, and 95% confidence intervals, where appropriate. Categorical data were analyzed using the chi-square or Fisher’s exact test. Student T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age and gender was used to compare the risk of infection. A P-value of

Background: Patients may experience a variety of neurological complications after heart surgery. The most common complication observed in clinical practice is delayed neurocognitive recovery (dNCR). The role of the anesthesiologist is very important, as the risk of dNCR may be reduced, depending on the anesthesia tactic chosen. Although the possibility that neuropsychological complications are less common in patients undergoing combined anesthesia (general + epidural) than in patients undergoing general anesthesia is not yet confirmed, the results are being discussed. The aim of this study was to determine impact of combined anesthesia (general + epidural) on cognitive functions of patients after cardiac surgery. Methods: The prospective, case-controlled study included 80 patients undergoing cardiac surgery from 2015 to 2017 at the Department of Cardiothoracic and Vascular Surgery in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. After approval from the local bioethics center, informed consent was obtained from all study participants. Inclusion criteria were age 51 to 80 years, elective cardiac surgery, left ventricular ejection fraction > 35%, anamnesis of not using agents affecting the central nervous system, absence of neuropathology, and sufficient renal function. Exclusion criteria were patients suffering from diseases causing cognitive function or using agents affecting the central nervous system, emergency or re-surgery, carotid artery atherosclerosis with artery diameter 50 or more percent reduction, and a patient’s disagreement. MMSE test and 6-CIT test were used for a cognitive function assessment, Trail making test and WAIS Digital Symbol Substitution test were used for psychomotor function assessment. All tests were used a day before surgery and seven days after surgery. According to the planned anesthesia, patients were assigned into two groups: 1 – combined general + epidural anesthesia and 2 – general anesthesia. Standardized protocol of anesthesia was followed for all patients. Preoperative patients and surgery factors, preoperative and postoperative neuropsychological test results were recorded. Results: Eighty patients were enrolled in the study. Both groups did not differ in demographic, perioperative values, and baseline (preoperative) test results. Postoperative (7th day) WAIS (P = .042) and 6-item cognitive impairment (P = .016) test results were statistically different when comparing the GA and CA groups. Comparing preoperative and postoperative test results, there was a significant decline in the WAIS test score in the GA group (P = .013).

Background and Objectives: The aim of this study is to identify risk factors for the development of delayed neurocognitive recovery (dNCR). Methods: 140 patients underwent neurocognitive evaluations (Adenbrooke, MoCa, trial making, and CAM test) and middle cerebral artery (MCA) blood flow velocity (BFV) measurements, one day before cardiac surgery. BFV was re-evaluated after anesthesia induction, before the beginning, middle, end, and after cardiopulmonary bypass (CPB) and postsurgery. To measure glial fibrillary acidic protein (GFAP) and neurofilament heavy chain (Nf-H), blood samples were collected after anesthesia induction, 24 and 48 h after the surgery. Neurocognitive evaluation was repeated 7&ndash, 10 days after surgery. According to the results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non-dNCR group). Results: 101 patients completed participation in this research. GFAP increased in both the non-dNCR group (p &lt, 0.01) and in the dNCR group (p &lt, 0.01), but there was no difference between the groups (after 24 h, p 0.342, after 48 h, p 0.273). Nf-H increased in both groups (p &lt, 0.01), but there was no difference between them (after 24 h, p = 0.240, after 48 h, p = 0.597). MCA BFV was significantly lower in the dNCR group during the bypass (37.13 cm/s SD 7.70 versus 43.40 cm/s SD 9.56, p = 0.001) and after surgery (40.54 cm/s SD 11.21 versus 47.6 cm/s SD 12.01, p = 0.003). Results of neurocognitive tests correlated with CO2 concentration (Pearson&rsquo, s r 0.40, p &lt, 0.01), hematocrit (r 0.42, p &lt, 0.01), MCA BFV during bypass (r 0.41, p &lt, 0.01), and age (r &minus, 0.533, p &lt, 0.01). The probability of developing dNCR increases 1.21 times with every one year of increased age (p &lt, 0.01). The probability of developing dNCR increases 1.07 times with a decrease of BFV within 1 cm/s during bypass (p = 0.02). Conclusion: Risk factors contributing to dNCR among the tested patients were older age and middle cerebral artery blood flow velocity decrease during bypass.

Background: The aim of this study was to compare blood flow velocity changes in the middle cerebral artery before, during and after heart surgery with cardiopulmonary bypass for patients with and without postoperative cognitive dysfunction. Materials and methods: A total of 100 patients, undergoing elective coronary artery bypass grafting or/and valve surgery enrolled in the study. A neurocognitive test evaluation included Adenbrooke, Mini-Mental State Examination and Trial Making test before and 7-10 days after surgery. Middle cerebral artery mean blood flow velocity was evaluated 1 day before the surgery, after anaesthesia induction, before cardiopulmonary bypass, at the beginning, ending and after cardiopulmonary bypass, and post surgery in intensive care unit. Blood samples for glial fibrillary acidic protein were measured after anaesthesia induction, 24 hours and 48 hours after surgery. According to neurocognitive tests results patients were divided in to two groups: patients with and without postoperative cognitive dysfunction. Results: Of the 100, 86 patients completed investigation. After induction, blood flow velocity of the middle cerebral artery was lower in postoperative cognitive dysfunction group (41.2; min 27.91, max 49.47) than in the H group (41.2, min 21.9, max 84.3) p = 0.034, and during cardiopulmonary bypass, blood flow velocity of the middle cerebral artery was lower in the postoperative cognitive dysfunction group (37.35, min 26.6, max 44.02) than the H group (42.3, min 20.1, max 86.5), p = 0.001. After the surgery, blood flow velocity of the middle cerebral artery was lower in the postoperative cognitive dysfunction group (40.7, min 29.7, max 50.4) than in the H group (45.3, min 34.12, max 59.88), p = 0.05. Results of cognitive tests had weak correlation (rho, 0.391) with middle cerebral artery’s blood flow velocity after anaesthesia induction (p = 0.001) and during bypass (p = 0.018). The receiver operating characteristic analysis showed that the blood flow velocity of the middle cerebral artery during bypass (area under the curve = 0.735) was a fair predictor for postoperative cognitive dysfunction (p = 0.001). No significant correlations were found among glial fibrillary acidic protein, middle cerebral artery blood flow velocity, and cognitive tests results. Conclusion: Middle cerebral artery’s blood flow velocity was decreased after anaesthesia induction and during cardiopulmonary bypass for patients with postoperative cognitive dysfunction comparing with their blood flow velocity preoperatively. Blood flow velocity during bypass has diagnostic value for postoperative cognitive dysfunction. Brain biomarker glial fibrillary acidic protein is not helpful in diagnosing postoperative cognitive dysfunction.

As of now the relationship between glycocalyx degradation and microcirculatory perfusion abnormalities in non-septic critical ill patients is unclear. In addition, conjunctival sidestream dark field-imaging for the purpose of glycocalyx thickness estimation has never been performed. We aimed to investigate whether changes in glycocalyx thickness in non-septic patients are associated with microcirculatory alterations in conjunctival and sublingual mucosa. In this single-centre prospective observational study, using techniques for direct in-vivo observation of the microcirculation, we performed a single measurement of microcirculatory perfusion parameters and visualized glycocalyx thickness in both ocular conjunctiva and sublingual mucosa in mixed cardio surgical (n = 18) and neurocritical patients (n = 27) and compared these data with age-matched healthy controls (n = 20). In addition we measured systemic syndecan-1 levels. In the sublingual and conjunctival region we observed a significant increase of the perfused boundary region (PBR) in both neuro-critical and cardiac surgical ICU patients, compared to controls. There was a significant increase of syndecan-1 in ICU patients comparing with controls and in cardiac patients comparing with neurological (120.0[71.0–189.6] vs. 18.0[7.2–40.7], p < 0.05). We detected a weak correlation between syndecan-1 and sublingual PBR but no correlations between global glycocalyx damage and conjuctival glycocalyx thickness. We found significantly lower perfused vessel density (PVD) of small vessels in sublingual mucosa in patients after cardiac surgery in comparison with healthy subjects. In neuro-critical, but not cardiac surgery patients conjunctival TVD and PVD of small vessels were found to be significantly lower in comparison with controls.

Burnout is a syndrome of depersonalization, emotional exhaustion, and low personal accomplishment. Little is known about burnout in physicians. Our objective was to determine the prevalence of burnout among anesthetists and intensive care physicians, and associations between burnout and personal, as well as professional, characteristics. Methods In total, 220 anesthetists and intensive care physicians were contacted by email, asking them to participate in the study. For depression screening the PHQ-2 questionnaire, for problem drinking, CAGE items were used. Burnout was measured by the Maslach Burnout Inventory. Results Overall, 34% anesthetists and intensive care physicians indicated high levels of emotional exhaustion, 25% indicated high levels of depersonalization, and 38% showed low personal accomplishment. Burnout was found more frequent among subjects with problem drinking (OR 3.2, 95% CI 1.5–6.8), depressiveness (OR 10.2, 95% CI 4.6–22.6), cardiovascular disorders (OR 3.4, 95% CI 1.7-7.1), and digestive disorders (OR 2.2, 95% CI 1.2–4.0). Some favorite after-work activities positively correlated with burnout, such as sedative medications abuse (OR 4.8, 95% CI 1.8–12.5), alcohol abuse (OR 2.4, 95% CI 1.3–4.5), eating more than usual (OR 1.9, 95% CI 1.1–3.5), and transferring the accumulated stress to relatives (OR 2.8, 95% CI 1.4-5.5). In contrast, reading of non-medical literature seemed to have a protective effect (OR 0.5, 95% CI 0.2–0.9). Conclusions Burnout was highly prevalent among anesthetists and intensive care physicians with two fifths of them meeting diagnostic criteria. It was strongly correlated with problem drinking, depressiveness, cardiovascular and digestive disorders, use of sedatives and overeating.

Background. In cardiac surgery, patients face an increased risk of developing postoperative delirium (POD) that is associated with poor outcomes. Neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) have shown some promising results as potential tools for POD risk stratification, diagnosis, monitoring, and prognosis. Methods. Prospective single-centre study enrolled 44 patients undergoing elective coronary artery bypass grafting (CABG) and/ or valve procedures using cardiopulmonary bypass (CPB). The patients were assessed and monitored preoperatively, during surgery, and in the early postoperative period. The blood levels of NSE and GFAP were measured before and after surgery. The early POD was assessed by CAM-ICU criteria and patients were assigned to the POD group (with POD) or to the NPOD group (without POD) retrospectively. Results. The incidence of POD was 18.2%. After surgery, NSE significantly increased in the whole sample (p = 0.002). Comparing between groups, NSE significantly increased in the POD group after surgery (p = 0.042). ΔGFAP (before/after operation) for the whole sample was statistically significant (p = 0.022). There was a significant correlation between ΔGFAP and the lowest MAP during surgery in the POD group (p = 0.033). Conclusions. Our study demonstrated that NSE and GFAP are associated with early POD. An increase in NSE level during the perioperative period may be associated with subclinical neuronal damage. Serum GFAP levels show the damage of glial cells. Further studies are needed to find the factors influencing the individual limits of optimal MAP during surgery.

Summary. Objective. The aim of this study was to determine the prevalence of burnout among anesthesiology and intensive care residents, and associations between burnout and the personal and professional characteristics of residents. Material and Methods. All of 52 anesthesiology and intensive care residents employed in hospital of Lithuanian University of Health Sciences, internet based questionnaire was sent to their personal email accounts. 39 of them filled the questionnaire correctly. Data on personal characteristics (age, gender, marital status, number of children, sleeping hours, and addictions), professional characteristics (residency semester, years in residency, work in other hospitals and workload). Burnout was measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Results. One-fifth (20,5%) of residents reported of being burned out. As much as 79,5% of residents reported high emotional exhaustion, 79,5% had high depersonalization, and 20,5% demonstrated low personal accomplishment at work. Only female residents were burned out. 75% of burned out residents studied intensive care residency semester, rest 25% studied anesthesiology semester. Respondents living in marriage have heavily increased high emotional exhaustion (93,1%) and high depersonalisation (93,1%) scores. Conclusions. Burnout was found to be prevalent among anesthesiology and intensive care residents. Some personal and professional characteristics were significantly related to burnout. Burnout relief measures should be developed in order to prevent a further increase of burnout syndrome among anesthesiology and intensive care residents.

BACKGROUND Postoperative cognitive dysfunction (POCD) occurs in approximately 33-83% of patients after cardiac surgery with cardiopulmonary bypass (CPB). Recent clinical data suggest that real-time, intraoperative monitoring of patient-specific cerebrovascular autoregulation (CA) may help to prevent POCD by detecting individual critical limits for mean arterial pressure (MAP) outside which CA is impaired. Objectives of the study were to detect the episodes of impaired CA during cardiac surgery with CPB, and to investigate the association between CA impairment and POCD. METHODS The observational study of non-invasive ultrasonic volumetric CA monitoring included 59 patients undergoing elective coronary artery bypass graft surgery with CPB. All patients underwent series of neuropsychological tests the day before and ten days after the surgery in order to evaluate cognitive function. RESULTS Twenty-two patients (37%) experienced POCD, 37 patients (63%) showed no cognitive deterioration. The duration of the single longest CA impairment event was found reliably associated with occurrence of POCD (P

Background and objective. Acute kidney injury (AKI) following cardiac surgery with cardiopulmonary bypass (CPB) is polyethiological clinical syndrome. During CPB haemodilution develops, which is useful in reducing the risk of thrombosis; however, haemodilutional anaemia decreases oxygen transfer and provokes tissue hypoxia, which can lead to acute organ damage. The aim of the study was to find out the impact of perioperative anaemia on AKI after cardiac surgery with CPB. Materials and methods. This prospective study included 58 adult patients undergoing elective cardiac surgery with CPB, without any preoperative chronic renal disease or any systemic autoimmune disease. Serum concentrations of NGAL had been tested before the surgery, 2 hours, 6 hours, and one day after the surgery. Perioperative anaemia was assessed according to the Ht value before the surgery, the Ht value during CPB, and immediately after the surgery. Results. The rate of haemodilutional anaemia is 77.59% in this study. The average of serum NGAL concentration before CPB was 63.95 ± 33.25 ng/mL and it was significantly lower than the average concentration 2 hours after the surgery, 6 hours after the surgery and one day after the surgery (respectively 148.51 ± 62.39, 119.44 ± 55, 128.70 ± 59.04 ng/mL, p < 0.05). AKI developed in 46.55% of the patients. A significant positive reasonable correlation between the development of perioperative anaemia and AKI was determined (r = 0.50, p < 0.05). Conclusions. Post-operative AKI after cardiac surgery with CPB has a moderate positive correlation with perioperative haemodilutional anaemia. A longer CPB time and aortic cross-clamping time were found to be the risk factors for the development of AKI.

Tyrimo tiklas išsiaiškinti bendrinės anestezijos su aukšta epidūrine analgezija (TEA) ir bendrinės anestezijos (BA) poveikį inkstų funkcijai po vainikinių jungčių suformavimo (VAJO) operacijos, dirbtinės kraujo apytakos (DKA) sąlygomis. Medžiaga ir metodai. Į tyrimą įtraukti pacientai (49 - 82 metų), kuriems nuo 2014 m. spalio iki 2015 m. spalio LSMUL KK Širdies, krūtinės ir kraujagyslių chirurgijos klinikoje buvo atliekamos VAJO DKA sąlygomis. Pacientai buvo suskirstyti į dvi grupes: BA, jai priklausė pacientai, kuriems taikyta tik bendrinė anestezija (inhaliuojamieji anestetikai ir i/v opiatai); ir TEA (vietinis anestetikas ir BA inhaliuojamieji anestetikai su i/v opiatais) grupę, jai priklausė pacientai, kuriems operacijos metu taikyta aukšta krūtininė epidūrinė anestezija, kombinuota su bendrine anestezija. Tiriamiesiems pacientams tris kartus buvo daromas biocheminis kraujo tyrimas – prieš operaciją, pirmą parą po operacijos, penktą parą po operacijos. Vertintos kreatinino ir šlapalo koncentracijos kraujo serume perioperaciniu laikotarpiu, kurios atspindi inkstų funkcijos sutrikimą [2]. Atlikto tyrimo rezultatai. Įvertinus prieš operaciją kreatinino koncentraciją TEA grupėje vidurkis buvo 93,3 ±16 mmol/l, BA grupėje - 95,3 ±23,5 mmol/l (p>0,05). Pirmą parą po operacijos kreatinino vidurkis TEA grupėje buvo 101,3 ±19,3 mmol/l , BA grupėje - 104,81 ±37 mmol/l.(p0,05). Pirmą parą po operacijos šlapalo vidurkis TEA grupėje 5,6±1,8 mmol/l,BA grupėje 6,2 ±2,0 mmol/l.(p>0,05). Penktąją parą TEA 4,7 ±1,3 mmol/l , o BA 5,8 ±3 mmol/l (p

Objective This study was performed to investigate the correlation among decreased regional cerebral oxygen saturation (rSO2), blood levels of brain injury biomarkers, and postoperative cognitive disorder (POCD) after cardiac surgery with cardiopulmonary bypass (CPB). Methods This prospective observational study included 59 patients undergoing coronary artery bypass graft surgery with CPB. All patients underwent neuropsychological tests (Mini Mental State Evaluation, Rey Auditory Verbal Learning Test, digit span test, digit symbol substitution test, and Schulte table) the day before and 10 days after the surgery. The blood levels of two brain injury biomarkers, neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP), were measured before and 1 day after the surgery. Results The rSO2 decreased during surgery in 21 (35%) patients. POCD was detected in 22 (37%) patients. After the surgery, no significant changes in the GFAP blood level occurred in any patients. No significant correlations were found among the decreased rSO2, increased NSE blood level, and rate of POCD. Conclusion These results suggest that a decrease in rSO2 during cardiac surgery is not necessarily related to the development of POCD or an increased blood level of the brain injury biomarker NSE.

Enhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques.

Introduction Postoperative cognitive dysfunction (POCD) occurs in 30-80% patients. Cerebral blood flow changes during surgery, especially via cardiopulmonary bypass (CPB), when it becomes nonpulsate. This is one of the factors, which may lead to various neurological complications. The aim of this study was to compare a. cerebri media (ACM) blood flow changes before, during and after heart surgery with CPB for patients with and without POCD based on Addenbrookes cognitive examination (ACE-III). Methods This prospective- case control study included patients undergoing elective coronary artery bypass grafting (CABG) or/and valve surgery with cardiopulmonary bypass (CPB). 110 patient completed ACE-III for cognitive evaluation. For determine mild cognitive dysfunction cut-off 88 was chosen. Mean flow velocity was monitored with transcranial doplerography device and evaluated 1 day before surgery, after anaesthesia induction, before CPB, at the beginning, ending and after of CPB, and post-surgery in ICU unit. Results 97 patients without preoperative cognitive dysfunction were examined, 67 (69.1%) male and 29 (29.9%) female; age 70± 9.2. According to ACE-III results patients were enrolled in to 2 groups: healthy patients without cognitive dysfunction after surgery were included into the first (H)group, patients with postoperative cognitive dysfunction (POCD) were included into the second (POCD) group. Groups did not differ according to age, comorbidities, amount of narcotic analgesia, duration of bypass and cross-clamping, ejection fraction. POCD was established for 29 patients. ACM blood flow velocity (BFV) was significantly higher after anaesthesia induction (mean 39.9 SE 2.2) comparing to velocity during CPB (mean 36.5; SE 2.4); p = 0.029 and lower after bypass (mean 36.5 SE 2.3) comparing to velocity after surgery (mean 38.7; SE 2.1) in POCD group; p = 0.000 ACM BFV was significantly lower before surgery (median 44.7) comparing to velocity after surgery (median 45.9); p = 0.001 and BFV after bypass (median 44.5) was lower comparing to BFV after surgery, (median 45.9); p = 0.018 in H group. ACM BFV during CPB was significantly lower in POCD group (median 36.12), comparing H group (median 54.9), p = 0.03. ACM BFV after surgery (median 34.43) was lower in POCD group comparing to H group (median 55.21),p = 0.01. Spearman correlation analysis revealed that ACM blood flow velocity during bypass was week positively correlated (Spearman Ro 0.339, p = 0.01) and moderate positively correlated (Sprearman Ro 0.428, p = 0.00) with ACE-III test result after surgery. Discussion Comparing ACM blood changes during heart surgery revealed that patients with mild cognitive dysfunction ACM velocity was lower than in patients without POCD, and correlation was found between lower ACE-III test results ant reduced blood flow.

We report a unique clinical case about an 18-year-old woman, immediately post-partum after an urgent C-section, who survived severe sepsis, acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) and was successfully treated with 11 different antibiotics, massive blood transfusions and repetitive surgeries and was on extracorporeal membrane oxygenation (ECMO) support for 22 days. Although, ECMO is a time-limited procedure and most manufacturers do not advise more than 14 days of use,1 the situation for this patient was life-threatening and ECMO, despite the dangerous risks listed above, was the only way to win time for the lungs to recover and for treatment of the underlying disease, while maintaining adequate oxygenation and circulation. Fortunately, the condition of this woman was stabilized and she achieved complete physical recovery, despite minor neurological deficit in the fingers of her right hand.

Coronary artery blood flow restoration is necessary in order to preserve the myocardial viability. Often reperfusion of ischemic area can cause cardiomyocytes dysfunction and the phenomenon known as reperfusion injury. Reperfusion can induced myocardial stunning, microvascular and endothelial injury, and cell death of apoptosis and necrosis. Ischemia/reperfusion injury is a complex of molecular and cellular processes in which interlaced different biological mechanisms. Number of studies published that after ischemia/reperfusion period are significantly elevated myocardial damage markers, impaired myocardial contractility, worse clinical parameters. In animal studies, there is increasing evidence, that during ischemia/reperfusion injury the dysfunction of heart mitochondria plays a critical role. Cardioplegia during surgery is one of the prevention methods of ischemic injury. Cardioplegia reduces myocardial metabolic activity and oxygen demand during ischemia. Another way of determining a lower ischemic / reperfusion injury is ischemic preconditioning. It is noted that cardiac function from ischemic damage can preserve not only ischemic preconditioning, but also pharmacologic agents. The studies showed that volatile anesthetics may exert profound cardioprotection against myocardial ischemia and reperfusion injury.

Increasing numbers of patients with diabetes mellitus are referred to cardiac surgery. Biguanides are still first-line treatment for type 2 diabetes in all over the world. According preoperative guidelines, oral diabetes medications should be held on the day of surgery because of increased risk of lactic acidosis, induced by Metformin in patients after heart surgery. However, not well described in medical literature mechanism of biguanides is its influence to coagulation. We observed patients, who were scheduled for an elective coronary artery bypass graft surgery (CABG). Eighteen were diabetics, fourteen were Metformin users, where medication was stopped 72 to 24 hours before surgery. Prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen measurement were performed at the baseline, 2 hours and 6 hours after weaning from CPB. Chest tube drainage was checked at 2, 6 and 24 hours after weaning from CPB at the ICU. Presence of fibrinolysis was checked with rotational thromboelastometry testing (Rotem, Tem Innovation, Germany). Statistical analysis showed weak negative correlation between chest tube output in 24 hours and Metformin use (r=-0.255, p=0.03). Patients with Metformin preoperatively had less chest tube drainage (457.1 ± 143.9ml) compared to patients without Metformin (622.2 ± 269.9ml). Here was no significant fibrinolysis in ROTEM tests registered (ML 3.5 ± 2.5%) and apTEM didn`t show improved maximal cloth firmness (MCF) nor shor- ter clothing time (CF).

The aim of the study was to evaluate the effects of sevoflurane and propofol on the activity of mitochondrial function related to ischemia-reperfusion injury, myocardial damage biomarkers release and clinical parameters in the postoperative period. Seventy-two patients scheduled for elective coronary artery bypass graft surgery with cardiopulmonary bypass were randomized into two groups: 36 patients received sevoflurane during anesthesia (Group S) and 36 patients received propofol (Group P). To investigate the functional activity of mitochondria, we used skinned fibers prepared from biopsies of right atrial tissue before cardioplegia and after the aorta cross-clamp removal (within 10-15 minutes after reperfusion). Patients’ clinical data (length of stay in ICU, hemodynamic parameters, duration of mechanical ventilation (MV) and the amount of lactate and troponin I in the blood serum) were evaluated postoperatively. The results showed that, before cardioplegia and after reperfusion, there was no significant difference in the mitochondrial routine and State 3 respiration rates between the groups. The effect of cytochrome c was higher in Group P. Troponin I concentration at the 12th hour after the surgery was 2.2 ± 0.8 ng/mL in Group S and 3.5 ± 1.1 ng/mL in Group P (p

Background and objective: Cardiac surgery is associated with systemic inflammatory response, which is triggered by cardiopulmonary bypass (CPB) and possibly with underlying magnesium deficiency. Animal studies have shown that magnesium deficiency intensifies oxidative stress and inflammatory processes. We aimed to find a link between serum, erythrocyte, cardiac tissue magnesium concentration and C-reactive protein (CRP) as an inflammatory marker in patients undergoing elective cardiac surgery with CPB. Materials and methods: The data of 27 patients undergoing elective cardiac surgery with CPB for ischemic heart disease were analyzed. Measurements were taken at the baseline, i.e., 24 h before surgery (serum magnesium, CRP), time point 1, before CPB (serum, erythrocyte and cardiac tissue magnesium), time point 2, after CPB (serum, erythrocyte and cardiac tissue magnesium), and time point 3, 15–17 h after surgery (serum, erythrocyte magnesium, CRP). Results: There was a negative correlation between baseline serum magnesium and baseline CRP (P = 0.009, r = 0.492), negative correlation between cardiac tissue magne- sium at the time point 1 and baseline CRP (P = 0.021, r = 0.443), and positive correlation between CRP at time point 3 and erythrocyte magnesium at time point 2 (P &lt, 0.001, r = 0.637). Conclusions: The data of our study verify that inflammatory marker CRP and magnesium concentration in serum and cardiac tissue before the surgery are inversely related in patients undergoing elective cardiac surgery with CPB. Well-planned further studies are needed to evaluate the importance of underlying magnesium deficiency on the severity of systemic inflammatory response and postoperative complications after surgery with CPB.

Auksta krūtininė epiduralinė anestezija (angl. high thoracic epidural anesthesia, HTEA) sirdies operacijųmetu pacientams teikia įvairialype naudą: mažinasirdies isemijos riziką, aritmijų dažnį, pooperacinesplaucių komplikacijas bei efektyviai malsinaskausmą. Dauguma pacientų sirdies chirurgijoje yra vyresnio amžiaus, turi gretutinių ligų ir būklių, todėl pastaruoju metu yra tiriama, kokį poveikį si metodika turi didesnės rizikos pacientams. Mūsų tyrimo tikslas buvo nustatyti perioperacinių rizikos veiksnių (vyresnio amžiaus, lėtinių plaucių ligų bei priesirdžių virpėjimo epizodo anamnezėje) įtaką pooperacinėmskvėpavimo sistemos komplikacijoms, priesirdžių virpėjimui (PV) bei delyrui issivystyti. Retrospektyviai istirti 82 pacientai, operuoti Lietuvossveikatos mokslų universiteto ligoninės Kauno klinikų Sirdies, krūtinės ir kraujagyslių chirurgijos klinikoje. Jiems buvo atlikta sirdies operacija su dirbtine kraujo apytaka, taikant bendrine anesteziją, kombinuotą su HTEA.Rezultatai. 24,4% pacientų sirgo lėtinėmis plaucių ligomis. Pooperacinės kvėpavimo komplikacijos issivystė15,9% pacientų, is jų 46,2% taip pat pasireiskėpooperacinis priesirdžių virpėjimas, o 15,4% issivystė delyras. Pacientams be pooperacinių kvėpavimokomplikacijų PV ir delyro dažnis buvo atitinkamai36,2% ir 15,9%. Pooperacinio priesirdžių virpėjimo dažnis tirtoje populiacijoje buvo 38,6%, riziką jam atsirasti reiksmingai didino PV epizodas anamnezėje: pacientų, patyrusių PV iki operacijos, pooperacinio PV dažnis buvo 60,7%, lyginant su 27,3% tarp pacientų, anksciau niekada nepatyrusių priesirdžių virpėjimo (p < 0,05). Pirminio pooperacinioPV dažnis buvo 18,1%. Is jų pooperacinės kvėpavimo komplikacijos issivystė 13,3% (lyginantsu 16,2% tarp pacientų be pooperacinio PV), delyras atsirado 20% (lyginant su 14,7%) pacientų. Pooperacinio delyro dažnis buvo 15,9%. Pacientų,kuriems issivystė si komplikacija, amžius buvo reiksmingai didesnis (72,5 ± 5,9 vs. 62,3 ± 9,2 m., p < 0,01). Pacientams, vyresniems nei 70 m., su kiekvienaismetais delyro issivystymo po operacijos sansas padidėja (sansų santykis 1,21 (1,1 – 1,4), p < 0,01).Isvados. Lėtinės plaucių ligos nebuvo susijusios su didesniu pooperacinių kvėpavimo komplikacijų dažniu. Anksciau įvykes priesirdžių virpėjimo epizodasreiksmingai didina pooperacinio priesirdžių virpėjimo dažnį. Vyresnis amžius yra reiksmingas rizikos veiksnys pooperacinio delyrui issivystyti. Auksta krūtininė epiduralinė anestezija, kombinuotasu bendrine anestezija, nelemia didesnio pooperaciniųkomplikacijų dažnio rizikos grupių pacientams.

Coronary artery bypass graft (CABG) surgery on cardiopulmonarybypass (CPB) is frequently a useful method in the treatment of progressive coronary insufficiency today. According to the data of literature the most common lethal complications after this type of operations are myocardial infarct and arrhythmias associated with ischemic-reperfusion injury. The aim of this study was to evaluate the influence of volatile anaesthetic sevoflurane on clinical parametersof perioperative period and to compare it with intravenous anaesthetic propofol. A prospective randomized clinical trial has been completed. In this study we have evaluated postoperative clinical parameters: hemodynamic stability, time of mechanical ventilation, stay in the intensive care unit, the amount of lactate in the blood serum. For the assessment of myocardial damage, associated with reperfusion injury, we evaluated the amount of troponin I (TnI). The samples for TnI were made immediately after induction of anaesthesia and 12 hours after the operation. In this study 72 patients undergoing elective first time CABG surgery on CPB were included. In group I, 36 patients undergoing anaesthesia with volatile anaesthetic sevoflurane and in group II, 36 patients undergoing anaesthesia with intravenous anaesthetic propofol. Demographic, surgical and clinical data were similar and without any statistical differences in both groups. In the blood sample 12 hours after the operation in all patients the amount of TnI was elevated and there was a statistically significant difference between the both groups. It was significantly higher in propofol group if compared with sevoflurane group - 3.5 ± 1.1 ng/ml vs. 2.2 ± 0.8 ng/ml (p

Tikslas: įvertinti kylančiosios aortos, aortos lanko, nusileidžiančiosios krūtininės aortos protezavimo anesteziologinius ypatumus, baigtis ir komplikaci- jas. Metodika. Retrospektyvios analizės metu analizuo- ti 47 operacijų protokolai atrinkti iš 2006-2012 m. laikotarpio. Į analizę įtraukti duomenys: amžius, premedikacijos pasirinkimas, hemodinaminiai rodi- kliai, smegenų perfuzijos laikas, reoperacijų dažnis, baigtys. Rezultatai. Vidutinis vyrų amžius 60,8±13,87, vidutinis moterų amžius 70,1±8,08 (p=0.052). Dirbtinės kraujo apytakos(DKA) laikai: vyrams 172,03 min.±83,27, moterims 188,4 min.±85,157 (p=0.651). Įvertinus lovadienių skaičių moterys sta- tistiškai patikimai ilgiau būna ligoninėje po krūti- ninės aortos protezavimo operacijų (p=0.017). Am- žiaus vidurkis buvo statistiškai mažesnis išgyvenu- siųjų (p=0.05). Įvertinus smegenų perfuzijos panau- dojimą, smegenų perfuzija statistiškai patikimai ne- pagerino baigčių (p=0.4). Ilgesnis DKA laikas sie- jasi su blogesnėmis baigtimis p0.05. Dažniausiai premedikacijai naudojami: benzodiazepinai 59, 6% (n=28), opioidai 53,2% (n=25), rečiau betablokato- riai 23,4% (n=11) ir nitratai 4,3% (n=2). Arterinė hi- pertenzija ir išeminė širdies liga buvo dažniausios predisponuojančios ligos tarp pacientų, kuriems at- liktos krūtininės aortos srities protezavimo operaci- jos. Širdies išmetimo frakcija statistiškai nesiskyrė tarp pacientų su skirtingomis baigtimis ir komplika- cijomis. Aortos vožtuvo nesandarumo laipsnis kore- liavo su komplikacijų dažniu. Nenustatytos statistiš- kai skirtingos baigtys priklausomai nuo krūtininės aortos protezavimo lokalizacijų( kylančioji aorta, aortos lankas, nusileidžiančioji aorta). Ilgesnis kar- dioplegijos laikas ir DKA laikas sąlygoja didesnį re- operacijų dažnį p=0.02. ASA funkcinės klasės sta- tistiškai patikimai koreliuoja su komplikacijų skai- čiumi (p=0.04) ir ilgesniu DKA laiku (p=0.02). Išvados. Ilgesnis DKA laikas gali būti siejamas su didesniu komplikacijų dažniu. Dažniausiai preme- dikacijoje pasirenkami benzodiazepinų ir opiatų grupės medikamentai. Smegenų perfuzija statistiš- kai patikimai nesąlygojo operacijos baigčių. Širdies išmetimo frakcija nesąlygoja operacijos rezultatų. Aortos vožtuvo nesandarumo laipsniai siejami su didesniu komplikacijų dažniu.. Operacijos baigtys nepriklausė nuo protezavimo lokalizacijos.

INTRODUCTION: It is well documented that older age, chronic concomitant diseases (such as diabetes mellitus, chronic obstructive lung disease, etc.), and poor left ventricular function can increase the postoperative complication rate and worsen the general outcomes of coronary artery bypass (CABG) and concomitant repair of ischemic mitral regurgitation (MR). MATERIAL AND METHODS: Retrospective data of 394 patients after CABG and mitral valve (MV) repair (mainly annuloplasty) were analyzed. Patients were grouped according to age, diabetes mellitus (DM), and left ventricular ejection fraction (LVEF). Echocardiography data, the rate of postoperative complications (cardiogenic shock, preoperative myocardial infarction, bleeding from the gastrointestinal tract, cognitive disorders, stroke, sepsis, deep wound infection), and early and late mortality were compared between paired groups. RESULTS: There were no differences between age groups in reverse positive remodeling of LV. A significantly higher incidence of sepsis and deep wound infection in younger patients was observed. Patients with DM had no change in the pre-postoperative NYHA class and a higher rate of perioperative MI (10.3% vs. 3.1% respectively, p < 0.05) in comparison to patients with no DM. In all LVEF groups, MR was significantly decreased, but reverse positive remodeling of LV was pronounced only in those with "poor" and "moderately lowered" LVEF. Postoperative complications did not differ among these three groups. CONCLUSIONS: Elderly age, concomitant DM and lowered LVEF do not influence either early or late mortality, including early postoperative outcomes after MV repair for ischemic MR following CABG. Concomitant DM increases the rate of perioperative MI and impairs reverse remodeling of LV.

Bleeding remains a global problem in cardiac surgery. Patients have significant risk of bleeding after cardiac surgery with cardiopulmonary bypass. The amount of blood loss after such operations is directly related to the increased need of blood transfusion, prolonged hospital stay, worse outcome. The aim: to identify factors which lead to the increased chest tube drainage during the first postoperative day after aortocoronary bypass grafting; the volume of blood component transfusion, complications and outcomes; evaluate characteristics of postoperative course in patients over 65 years old. Methodology: a prospective randomized study included 51 patients undergoing isolated aortocoronary bypass grafting surgery in our hospital. Results. During the postoperative period two patients died (3.9%). Complicated course was identified in 16 patients (31.3%). Pneumonia (10 cases, 9.8%), sternal wound infection (5 cases, 4.9%), mediastinitis (2 cases, 3.9%) were the most common complications. One patient was re-explored because of bleeding. Blood component transfusion was performed in three patients at the intensive care unit (5.9%) and in eight patients after the discharge from the intensive care unit. Mechanical ventilation time, intensive care unit stay and hospitalization time was significantly higher in older patients group, however there was no increased requirement for transfusions of blood components. Patients, who preoperatively received clopidogrel (n=21), had higher risk of significant blood loss during the first postoperative day (>500ml) (odds ratio 3.692 [1059-12874], p = 0.036) than the patients without clopidogrel preoperatively (n = 28) (odds ratio, OR 0.271 [0078-0944]). Chest tube drainage did not exceed 500 ml per 16 hours, if clopidogrel was stopped for 6 days or more, but it was 500 ml and higher if clopidogrel was stopped 1 to 5 days preoperatively. Aspirin had no statistically significant influence on chest tube drainage as well as to blood transfusion. Conclusions. Patients who were treated with clopidogrel before the surgery, had a higher risk of bleeding more than 500 ml first postoperative day, than clopidogrel untreated patients. Chest tube drainage was inversely proportional to the stop time of clopidogrel. Aspirin did not affect the volume, excreted through the drains and the rate of blood components transfusion. The study did not show us, that preoperative fibrinogen level is independent factor to assess bleeding. Patients over 65 years had increased risk for a longer mechanical ventilation, longer intensive care unit stay, hospitalization and higher frequency of complications during postoperative period, but this was not related to increased chest tube drainage or blood components transfusion. doi:10.5200/sm-hs.2013.093

The aim of study was to assess the effects of an intraoperative external head-cooling technique on cognitive dysfunction in the early postoperative period (at the 10th day) in patients after coronary artery bypass graft (CABG) surgery. Patients in Group H (n=25) were cooled with CPB and the intraoperative, external head-cooling technique, patients in Group C (n=25) were cooled only with cardiopulmonary bypass (CPB) to achieve mild hypothermia (33 – 34°C). Cognitive function was analyzed before the operation and after the surgery using the Mini Mental State Examination (MMSE), the Modified Visual Reproduction Test from the Wechsler Memory Scale, Trail Making (A/B), WAIS - Digit Span (WDS) and WAIS Digit Symbol Substitution Test (WDSST). The incidence of cognitive impairment at the 10th day after the surgery was 36% (n=9) in Group H and 64% (n=16) in Group C (p=0.048). The temperature during the aortic cross-clamp period was associated with a lower rate of cognitive dysfunction (p=0.05, r2=0.09). The intraoperative, external head-cooling technique during the aortic cross-clamp period has a neuroprotective effect and leads to less short-term cognitive function impairment after CABG surgery.

Background The aim of this study was to identify predictors of repeated admission to the intensive care unit (ICU) of patients who underwent cardiac surgery procedures. Material and Methods This retrospective study analyzed 169 patients who underwent isolated coronary artery bypass grafting (CABG) between January 2009 and December 2010. The case group contained 54 patients who were readmitted to the ICU during the same hospitalization and the control group comprised 115 randomly selected patients. Results Logistic regression analysis revealed that independent predictors for readmission to the ICU after CABG were: older age of patients (odds ratio [OR] 1.04; CI 1.004-1.08); body mass index (BMI) >30 kg/m2 (OR 2.55; CI 1.31-4.97); EuroSCORE II >3.9% (OR 3.56; CI 1.59-7.98); non-elective surgery (OR 2.85; CI 1.37-5.95); duration of operation >4 h (OR 3.44; CI 1.54-7.69); bypass time >103 min (OR 2.5; CI 1.37-4.57); mechanical ventilation >530 min (OR 3.98; CI 1.82-8.7); and postoperative central nervous system (CNS) disorders (OR 3.95; CI 1.44-10.85). The hospital mortality of patients who were readmitted to the ICU was significantly higher compared to the patients who did not require readmission (17% vs. 3.8%, p=0.025). Conclusions Identification of patients at risk of ICU readmission should focus on older patients, those who have higher BMI, who underwent non-elective surgery, whose operation time was more than 4 hours, and who have postoperative CNS disorders. Careful optimization of these high-risk patients and caution before discharging them from the ICU may help reduce the rate of ICU readmission, mortality, length of stay, and cost.

Background and Goal: The incidence of postoperative cognitive dysfunction (POCD) occurs in 30-65% of patients after cardiac surgery. The aim of our study was to investigate the impact of general anaesthesia with thoracic epidural anaesthesia on cognitive functions after cardiac anaesthesia with CPB. Methods: 80 patients were enrolled into two groups: general anaesthesia (GA, n ¼ 42) and general anaesthesia with thoracic epidural anaesthesia (TEA, n ¼ 38). Neurocognitive tests were accomplished 1 day before surgery and 7 days postoperatively: MMSE, Six – item cognitive impairment test, WAIS Digit symbol substitution test. Results: All preoperative (baseline) test results did not differ significantly among TEA and GA groups. 7th-day WAIS test results did not differ much comparing TEA (20,03; SD 5,97) and GA (17,14; SD 6,48) groups. Comparing preoperative and postoperative WAIS test results there was a relevant decline in GA (preoperatively: 19 (SD 7,11); postoperatively 17,14 (SD 5,97) group. WAIS score change was significantly higher in GA groups, compared to TEA. There was no significant difference in 7th-day MMSE test results comparing TEA (median 28, min 23, max 30) and GA (median 28, min 18, max 30) groups. Patients in TEA group demonstrated better Six-item test results than in GA group at the 7th day after surgery (p¼ 0,16). Less points demonstrate better cognitive function, more points - cognitive dysfunction: GA median 2 (min 0, max 16) vs TEA median 2 (min 0, max 16) before surgery and GA median 4 (min 0, max 18) vs TEA median 2 (min 0, max 18) after surgery. Conclusions: Combined anaesthesia is not associated with POCD, compared to general anaesthesia. Memory and processing speed capabilities decrease after general anaesthesia.

The purpose of this study was to identify the post-cardiac surgery delirium risk factors and to evaluate clinical outcomes. Data on 90 patients with postoperative delirium after cardiac surgery on cardiopulmonary bypass (CPB) were analyzed retrospectively. The patients were divided into two groups by evaluating the severity of the delirium: light and moderate delirium group (n=74) and severe delirium group (n=16). We found that the rate of early post-cardiac surgery delirium was low (4.17%). We have determined that post-cardiac surgery delirium prolonged the length of stay in the Intensive Care Unit (ICU) by (8.4 (8.6)) and the hospital stay by (23.6 (13.0)) days. The patients had higher preoperative risk scores, their age was 71.5 (8.9) years, the body mass index was 28.8 (4.4) kg/m2, the majority were male (72.2%), and the left ventricular ejection fraction was 46.1(11.9) %. Statistical analysis by multivariable logistic regression has indicated that increasing the dose of fentanyl administered during surgery over 1.4 mg also increased the possibility of developing a severe delirium (OR=29.4, CI 4.1-210.3) and longer aortic clamping time could be independently associated with severe postoperative delirium (OR=8.0, CI 1.7-37.2). After surgery, new atrial fibrillation (AF) episodes amounted to 53.3% and, after distinguishing the delirium severity groups, AF developed in the patients belonging to the severe delirium groups statistically significantly more frequently, 81.8 vs 47.3, where p=0.01. Our data suggest that early post-cardiac surgery delirium is not a common complication, but it prolonged the length of stay at the ICU and in the hospital. The delirium risk factors, such as longer aortic clamping time, the dose of fentanyl and new atrial fibrillation episodes occurring after cardiac surgery, are associated statistically significantly with the development of severe post-cardiac surgery delirium.

Autotransfusion of the residual blood from the cardio-pulmonary bypass (CPB) circuit is considered to be one of the methods enabling reduction in the need for transfusion, the possible adverse effects of which are well known and documented. The aim of the study was to evaluate the effectiveness of the autologous autotrans-fusion of centrifuged red blood cells from the residual blood of the CPB circuit in patients following heart surgery. Three groups of patients who underwent heart surgery were examined. The first group (Group 1) consisted of 37 patients who received all of the residual blood in the bypass circuit after CPB (collected into sterile plastic bags) during the early postoperative period. The second group (Group 2) consisted of 45 patients who did not receive the residual blood following CPB. The third group (Group 3) consisted of 42 patients who underwent re-infusion of centrifuged red blood cells from the residual blood remaining in the CPB circuit during the early postoperative period. Hematocrit (Hct) values 12 hours after the operation were found to be higher in Group 3 compared with those of the first and the second groups (by 13.2% and 11.1%, respectively). Blood loss during the first 12 hours after the operation and during the time spent in the intensive care unit did not differ between the groups. The number of transfusions was significantly lower in Group 3 (28.57%) in comparison with that of Groups 1 and 2 (37.83% and 38.10%, respectively). The rate of infective complications in Group 3 was lower in comparison with both Group 1 and Group 2 (9.2% and 18.1%, respectively). The duration of in-hospital stay in Group 3 was 25.8% shorter than Group 1. We conclude that autotransfusion of centrifuged red blood cells processed from the residual blood of the CPB circuit after CPB was effective in increasing Hct values 12 hours postoperatively, reducing the need for donor blood product transfusions, the rate of infective complications and lenght of stay in hospital.

To define the mechanisms of ischemic mitral regurgitation (MR) and its correlation with left ventricular (LV) function prior to and 1 year following mitral valve (MV) repair.Fifty-three patients (pts) underwent echocardiographic evaluation of the MR mechanism according to Carpentier's classification; quantification of MR and LV function.Forty-one, 5% of pts had Type I (annulus dilation), 20, 5% had Type II (commissural prolapse) and 38% had Type IIIb MR (predominant posterior leaflet restriction). Preoperative LV function was slightly better preserved in pts with Type II and IIIb MR. Despite similar MV repair efficiency intraoperatively, after 1 year Type I MR progressed vs the remaining types. LV function, including dimensions, ejection fraction and pulmonary artery pressure had a tendency to worsen in pts with Type I and markedly improved in Type II and IIIb MR.Ischemic MR of Type I is associated with more marked LV dysfunction preoperatively, its further deterioration and MR progression after MV repair. Type II and IIIb MR correlates with better preserved LV function preoperatively and its incremental improvement late after surgery.