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Background: Postoperative anaemia is common in older cardiac surgery patients and often caused by iron deficiency. Anaemia may negatively affect recovery after cardiac surgery. This study aims to determine the efficacy of treatment of postoperative iron deficiency anaemia (IDA) with intravenous iron (IVI) on disability 90 days after cardiac surgery in older patients. Methods: This is a randomized placebo-controlled double blind multi-centre trial. In total, 310 patients aged ≥70 years with moderate IDA on postoperative day 1 (haemoglobin 85 - 110 g/L and ferritin concentration < 100 μg/L or iron saturation Discussion: The results of this study will demonstrate whether early treatment of postoperative IDA with IVI improves disability at 90 days in older cardiac surgery patients. Trial registration: Registered at ClinicalTrials.gov as NCT04913649 at June 4th, 2021.

OBJECTIVES Older patients have a higher cardiac surgery-associated acute kidney injury (CSA-AKI) related mortality. Low oxygen delivery (DO2) during cardiopulmonary bypass (CPB) is a risk factor for CSA-AKI, but critical DO2 thresholds for older patients are unknown. This study investigated critical DO2 thresholds for CSA-AKI in patients ≥70 years undergoing on-pump cardiac surgery. METHODS Patients were enrolled from July 2015 until August 2017. CPB data from 432 patients were collected, and DO2 values were calculated per minute. The primary outcome was CSA-AKI. The association between DO2 and CSA-AKI was analysed with multivariable regression analysis. Multiple DO2 thresholds were analysed. The association between CSA-AKI and the area below the DO2 thresholds (DO2 deficit) was evaluated, as was the association between frailty and CSA-AKI. RESULTS CSA-AKI occurred in 63 (14.6%) patients. Mean and nadir (lowest) DO2 values were lower in patients with CSA-AKI (283 vs 312 ml/min/m2; P-value CONCLUSIONS Low DO2 increased the risk for CSA-AKI in older patients who had cardiac surgery. A critical DO2 threshold of 270 ml/min/m2 was applicable for frail and non-frail patients. The efficacy of a DO2 >270 ml/min/m2 to reduce CSA-AKI in older patients needs further evaluation.

Background: Advanced glycation end products (AGEs) are a potential biomarker of biological age. Skin Auto Fluorescence (SAF) can assess AGEs non-invasively. We evaluated the association of SAF levels with frailty and its predictive ability for adverse outcomes in elderly cardiac surgery patients. Methods & Results: We measured SAF level in cardiac surgery patients aged ≥70 and analyzed the correlation with frailty diagnosed with geriatric assessment. A decision algorithm for frailty screening was developed using Conditional Interference Tree analysis and compared with the Frailty Phenotype (FP), a validated frailty assessment tool. We evaluated the association of SAF level with severe postoperative complications and a composite endpoint of one-year disability (defined by WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire) and mortality with Poisson regression analyses. Among 555 enrolled patients, 122 (22%) were classified as frail. Of all frailty characteristics, SAF level was most strongly associated with dependent living status (aRR 2.61 (95% CI 1.23-5.53) and handgrip strength (aRR 1.72 (95% CI 1.28-2.32). A decision algorithm including SAF level, sex, prescription drugs, preoperative hemoglobin and EuroSCORE II resulted in a C-statistic of 0.72 (95% CI 0.67-0.77) vs 0.66 (95% CI 0.61-0.71) for the FP. SAF level was also associated with disability/death after one year (aRR 1.18 (95% CI 1.06-1.30). The RR for severe complications was 1.32 (95% CI 0.99-1.75). Conclusion: Higher SAF level is associated with frailty in elderly cardiac surgery patients, as well as an increased risk of death and disability. This biomarker could potentially optimize preoperative screening for cardiac surgery.