Anesthetic Consideration in Case of Large Lymphangioma in Right Atrioventricular Groove: A Case Report

Background Cardiac tumor is a rare disease but it causes various hemodynamic changes depending on location and size. Compression of the right sided heart can lead to impaired venous return and consequent systemic and coronary vascular collapse. Case A 62-year-old male who had cardiac lymphangioma on right atrio-ventricular groove. Upon entering the operating room, he was admitted to the tamponade physiology with tachycardia and hypotension. Opioid based anesthesia was performed to minimize myocardial depression, and myocardial function was continuously monitored through Transesophageal echocardiography and pulmonary artery catheter to safely wean the cardio pulmonary bypass (CPB) machine. Conclusion Anesthesiologists should be able to predict and respond appropriately to physiological hemodynamic changes according to the location and size of cardiac tumor.

Prognostic Value of GDF-15 in Predicting Prolonged Intensive Care Stay following Cardiac Surgery: A Retrospective Case-Control Study

Background: Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters. Novel biomarkers could be employed to improve the prediction models. Methods: We performed a qualitative cytokine screening array to identify highly expressed biomarkers in preoperative blood samples of cardiac surgery patients. After identification of one highly expressed biomarker, growth differentiation factor 15 (GDF-15), a quantitative ELISA was undertaken. Preoperative levels of GDF-15 were compared in regard to duration of intensive care stay, cardio-pulmonary bypass time and indicators of organ dysfunction.Results: Preoperatively, GDF-15 was highly expressed in addition to several less highly expressed other biomarkers. After qualitative analysis we could show that preoperatively raised levels of GDF-15 was positively associated with prolonged ICU stay exceeding 48 h (median 713 versus 1041 pg/ml, p = 0.003). It was also associated with prolonged mechanical ventilation and rates of severe sepsis but not with dialysis rates or cardio-pulmonary bypass time. In univariate regression, raised GDF-15 levels were predictive of a prolonged ICU stay (OR 1.01, 95% Confidence Interval 1 – 1.02, p= 0.029). On ROC curves, GDF-15 was found to predict prolonged ICU stay (AUC= 0.86, 95% Confidence Interval 0.71 – 0.99, p= 0.003).Conclusion: GDF-15 showed potential as predictor of prolonged intensive care stay following cardiac surgery, which might be valuable for risk stratification models.

Cytosorb® hemoadsorption of apixaban during emergent cardio-pulmonary bypass: a case report

Background: Peri-operative coagulation management of patients receiving apixaban, a new oral anticoagulant, is difficult. The CytoSorb® hemoadsorption device might represent a therapeutic option to reduce apixaban’s pharmacological and inflammatory effects during high-risk surgery. Case presentation: An 83-year-old woman treated with Apixaban underwent emergent redo mitral valve replacement for prosthetic valve endocarditis. A CytoSorb® cartridge was added to the cardio-pulmonary bypass (CPB) circuit. Apixaban-specific anti-factor Xa activity (AFXaA) were measured peri-operatively. After 100 minutes of CPB, a 50% AFXaA rate decrease was observed as compared to pre-CPB values. Furthermore, we noticed 39% and 44% reductions of AFXaA levels in comparison to the expected levels in patients with normal or altered renal function, respectively. Conclusion: Insertion of a CytoSorb® cartridge in the CPB was safe and associated with rapid correction of Apixaban-associated anticoagulation.

Numerical Investigation of Blood Flow Characteristics through Cannulated Aorta

Cannulation of the aorta is done in order to provide oxygenation and circulatory function through the use of the heart lung machine during cardio-pulmonary bypass (CPB). The nature of the blood flow through the aorta and its ramifications during CPB is mostly linear as compared to the physiological flow, which is pulsatile in nature. This leads to the development of multiple morbidities caused by the development of emboli and atheromas. Perioperative postoperative care is necessitated by these conditions. As such the understanding of the blood flow characteristics is necessitated in order to effectively prevent the formation of emboli and to prevent the "Sandblasting" effect. The authors in this work seek to investigate the nature of blood flow through the aorta under such circumstances. The results obtained show the nature of blood flow in the cannulated aorta as well as the optimum angle of placement of the cannula with respect to the aortic wall.

Results of Surgical Treatment of Infective Endocarditis Complicated with Lung Impairment

The initial lung impairment in patients with infective endocarditis (IE) has a negative impact on the results of surgical treatment and rate of postoperative respiratory failure (RF). Mechanisms of development of RF are quite complicated, but the leading role is played by the initial septic lesion of pulmonary tissue in IE and surgical treatment with the use of cardio-pulmonary bypass. The aim of the study was to analyze results of surgical treatment of patients with IE, operated with the use of cardio-pulmonary bypass, implementing the method of intraoperative lung protection. Materials and methods. The basis of the study was clinical data of 663 patients with IE who were examined and treated at the SE “Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine” from 01.01.2016 to 01.01.2018. Diagnosis of IE was established according to the Duke University criteria Anesthetic support was carried out in accordance with standard techniques. For intraoperative lung protection, together with perfusion of the pulmonary artery with arterial blood, the mechanical ventilation was maintained for the period of bypass circulation. For determination of pathomorphological changes of lungs in patients with IE, histological analysis of intraoperative lung biopsy was performed. Results. In the surgical treatment of patients with IE with the use of standard method of anesthesia support, the rate of RF in the early postoperative period was 52 (7.8%) cases. The use of the modified method of intraoperative management led to the decrease of the signs of adults respiratory distress syndrome during the postperfusion period: decrease in the edema liquid in the alveolar lumen (p = 0.027), decrease in protein precipitate in the alveolar lumen (p = 0.031), decrease in the incidence of signs of alveoli collapse (p = 0.002). The use of the lung protection method offset the negative impact of intraoperative volume of blood transfusion on the lung function after surgery and the duration of mechanical ventilation (r = 0.121, p = 0.522). The introduction of lung protective in patients with IE, operated with the use of cardio-pulmonary bypass, contributed to decrease in the rate of RF in the early postoperative period from 7.9% to 2.8% of cases in the study groups. Conclusions. Implementation of the new protocol allowed to conduct long-term surgical interventions with the use of cardio-pulmonary bypass without increasing duration of mechanical ventilation and reducing the oxygenation index in the postoperative period, and contributed to the decrease in the frequency of postoperative RF.