Search Results (147)

Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional coronary artery bypass grafting (CABG) posed an unacceptable perioperative risk, patients were scheduled for minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive multivessel coronary artery bypass grafting (MICS-CABG). We called this approach “palliative revascularization.” This study assesses the safety and impact of palliative revascularization on clinical outcomes and overall survival. Methods: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in heart team after carefully assessing each case. The patients underwent single or double-vessel revascularization using the left internal thoracic artery and rarely radial artery/saphenous vein segments, both endoscopically harvested. Inpatient data could be completed for all 57 patients. The mean follow-up interval was 4.2 ± 3.7 years, with a follow-up rate of 91.2%. Results: Mean patient age was 79.7 ± 7.4 years. Overall, 46 patients (80.7%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. In total, 13 patients exhibited a moderate EuroSCORE II, while 27 were classified as high risk, with a EuroSCORE II exceeding 5%. Additionally, 40 patients (70.2%) presented with three-vessel disease, 17 (29.8%) suffered an acute myocardial infarction within three weeks prior to surgery and 50.9% presented an impaired ejection fraction. There were 48 MIDCAB and nine MICS CABG with no conversions either to sternotomy or to CPB. Eight cases were planned as hybrid procedures and only 15 patients (26.3%) were completely revascularized. During the first 30 days, four patients (7%) died. A myocardial infarction occurred in only one case, no patient necessitated immediate reoperation. The one-, three- and five-year survival rates were 83%, 67% and 61%, respectively. Conclusions: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases. Full article

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article

Cardiopulmonary bypass (CPB) is associated with significant neurological complications, yet the mechanisms underlying brain injury remain unclear. This study investigated the role of interleukin-17A (IL-17A) in exacerbating CPB-induced neuronal apoptosis and identified vulnerable brain regions. Utilizing a rat CPB model and an oxygen–glucose deprivation/reoxygenation (OGD/R) cellular model, we demonstrated that IL-17A levels were markedly elevated in the hippocampus post-CPB, correlating with endoplasmic reticulum stress (ERS)-mediated apoptosis. Transcriptomic analysis revealed the enrichment of IL-17 signaling and apoptosis-related pathways. IL-17A-Neutralizing monoclonal antibody (mAb) and the ERS inhibitor 4-phenylbutyric acid (4-PBA) significantly attenuated neurological deficits and hippocampal neuronal damage. Mechanistically, IL-17A activated the Act1-IRE1-JNK1 axis, wherein heat shock protein 90 (Hsp90) competitively regulated Act1-IRE1 interactions. Co-immunoprecipitation confirmed the enhanced Hsp90-Act1 binding post-CPB, promoting IRE1 phosphorylation and downstream caspase-12 activation. In vitro, IL-17A exacerbated OGD/R-induced apoptosis via IRE1-JNK1 signaling, reversible by IRE1 inhibition. These findings identify the hippocampus as a key vulnerable region and delineate a novel IL-17A/Act1-IRE1-JNK1 pathway driving ERS-dependent apoptosis. Targeting IL-17A or Hsp90-mediated chaperone switching represents a promising therapeutic strategy for CPB-associated neuroprotection. This study provides critical insights into the molecular crosstalk between systemic inflammation and neuronal stress responses during cardiac surgery. Full article

Cardiac surgery, particularly procedures involving cardiopulmonary bypass (CPB), is associated with a high risk of postoperative complications, including systemic inflammatory response syndrome (SIRS), postoperative atrial fibrillation (POAF), and infection. Growing evidence suggests that the gut–heart axis, through mechanisms involving intestinal barrier integrity and gut microbiota homeostasis, may influence these outcomes. This review summarizes the relationship between gut microbiota composition and the inflammatory response in patients undergoing cardiac surgery and the extent to which these alterations impact clinical outcomes. The reviewed studies consistently show that cardiac surgery induces notable alterations in microbial diversity and composition during the perioperative period. These changes, indicative of dysbiosis, are characterized by a reduction in health-associated bacteria such as Blautia, Faecalibacterium, and Bifidobacterium and an increase in opportunistic pathogens. Inflammatory biomarkers were frequently elevated postoperatively, even in patients without evident complications. Key microbial metabolites and biomarkers, including short-chain fatty acids (SCFAs), trimethylamine N-oxide (TMAO), and bile acids (BAs), were implicated in modulating inflammation and clinical outcomes. Additionally, vitamin D deficiency emerged as a contributing factor, correlating with increased systemic inflammation and a higher incidence of POAF. The findings suggest that gut microbiota composition prior to surgery may influence the severity of the postoperative inflammatory response and that perioperative modulation of the gut microbiota could represent a novel approach to improving surgical outcomes. However, the relationship between dysbiosis and acute illness in surgical patients is confounded by factors such as antibiotic use and other perioperative interventions. Large-scale, standardized clinical studies are needed to better define these interactions and guide future therapeutic strategies in cardiac surgery. Full article

Background: Postoperative delirium (POD) is a neurocognitive syndrome affecting patients undergoing surgery. It is a frequent complication of coronary artery bypass grafting (CABG) and is associated with higher morbidity, mortality and treatment costs. This study aimed to investigate the relationship between gaseous microemboli (GME) load during cardiopulmonary bypass (CPB) and subsequent POD in patients undergoing CABG. Methods: In total, 102 patients undergoing elective on-pump CABG were evaluated in this observational study. An ultrasonic microbubble counter, with probes placed on the arterial and venous lines, was used during CPB to evaluate the GME load for each patient. During the first postoperative week, the patients were examined for the presence of POD. Results: Patients diagnosed with POD had higher number of bubbles in the arterial CPB line (5382.8 (4127.8–6637.8) vs. 2389.4 (2033.9–2745.0), p < 0.001), higher volume of bubbles in both the venous (24.2 µL (16.8–31.6) vs. 12.4 µL (9.7–15.1), p = 0.004) and arterial lines (1.82 µL (1.43–2.21) vs. 0.29 µL (0.22–0.36), p < 0.001), lower quality factor (QF) values (p = 0.039), a lower venoarterial reduction in bubble number (83.0% (77.8–88.1) vs. 92.4% (90.9–93.8), p = 0.001) and a lower venoarterial reduction in bubble volume (88.8% (85.4–92.2) vs. 96.3% (95.2–97.3), p < 0.001) compared to the patients without POD. Older age (p = 0.005), a lower reduction in bubble volume (p < 0.001) and lower QF values (p = 0.004) were significant independent predictors of POD. Conclusions: Our findings indicate a strong association between GME and the occurrence of POD, which entails that all available actions should be implemented to prevent their generation and facilitate the elimination of GME from the CPB circuit. Full article

Background: Minimized extracorporeal circulation (miECC) was developed to mitigate the adverse effects of cardiopulmonary bypass (CPB), yet its impact on soluble urokinase plasminogen activator receptor (suPAR) is unclear. SuPAR has been linked to adverse outcomes, including acute kidney injury (AKI). This study investigated perioperative suPAR kinetics in patients undergoing cardiac surgery with miECC or conventional CPB (cCPB) and explored its association with AKI, postoperative delirium (POD), and infections. Methods: This study is a secondary analysis of an observational cohort of 79 cardiac surgical patients. It evaluates perioperative suPAR levels and their association with the type of CPB used (miECC vs. cCPB) and postoperative adverse outcomes, including POD, AKI, and infections. Statistical analyses included repeated measures ANOVA, Wilcoxon tests, logistic regression, and ROC curve analysis to assess the predictive value of suPAR for these outcomes. Results: During surgery, suPAR significantly increased to higher levels with the use of cCPB compared to miECC (p = 0.027; odds ratio of 0.69 [0.57–0.84], p < 0.001). The use of miECC was an independent influencing factor on suPAR (−0.41 ± 0.1; p < 0.001). Regardless of the type of CPB, suPAR levels differed significantly between patients with and without kidney damage (n = 25; no AKI: 1.6 [1.1–2.0], AKI: 1.7 [1.3–2.4], p < 0.001). Multivariate regression analysis showed that AKI was an independent influencing factor on suPAR (−0.49 ± 0.1; p < 0.001). SuPAR demonstrated only low predictive value for AKI and could not predict POD. Conclusions: This study provides evidence that miECC is associated with lower intraoperative suPAR levels, suggesting a reduced inflammatory response compared to cCPB. While suPAR levels were significantly higher in patients with AKI, their predictive value for AKI remains limited. Furthermore, suPAR did not predict POD but was elevated in patients with pneumonia. Full article

Background: In recent decades, aortic valve surgery has transitioned from conventional median sternotomy (MS) to minimally invasive techniques, including partial upper mini-sternotomy (PUMS) and right anterolateral mini-thoracotomy (RAMT). This study retrospectively compares the outcomes of aortic valve replacement (AVR) using PUMS during the learning phase with those of standard MS. Methods: A retrospective analysis was conducted on patients (n = 211) who underwent AVR for aortic stenosis. They were divided into MS (n = 119) and PUMS (n = 92) groups. Various preoperative, surgical and postoperative parameters, including survival, were examined. Results: Preoperatively, the main difference was age, with PUMS patients being older (67.5 ± 7 vs. 66.5 ± 9.6; p = 0.010). PUMS patients also had longer cardiopulmonary bypass (CPB) and cross-clamping times (99 ± 25 vs. 80 ± 16 min; p < 0.002; 79 ± 18 vs. 65 ± 13 min; p < 0.024). There were no significant differences in body mass index, prosthesis size, indexed effective orifice area, hospitalisation duration or any other monitored parameter. Echocardiographic follow-up found no differences in prosthetic pressure gradients, flow velocity or paravalvular leak between the PUMS and MS groups. Survival rates were similar over 1000 days. Conclusions: The data suggest that PUMS offers comparable surgical outcomes to MS for AVR with additional cosmetic benefits, undeterred by a learning curve. Full article

Introduction: Postoperative delirium (POD) remains a major complication in geriatric surgical care, with poorly understood molecular mechanisms. Emerging evidence links cardiac surgery to elevated markers of neurologic injury, even in cognitively intact individuals. While neuroinflammation is the prevailing model, a more detailed characterization of the systemic inflammatory and metabolic response to surgery may offer deeper insights into POD pathogenesis. Methods: We used the 7K SomaLogic proteomic platform to analyze preoperative and postoperative day-one serum samples from 78 patients undergoing cardiac surgery with cardiopulmonary bypass. We compared proteomic profiles within individuals (pre- vs. post-surgery) and between those who developed POD and those who did not. Functional analyses were performed to identify relevant biological pathways. A composite metabo-inflammatory score (MIF) was derived to quantify systemic derangement. We modeled the association between POD and age, sex, baseline cognition, and MIF score. Results: Cardiac surgery with CPB was associated with marked inflammatory responses across all subjects, including increased IL-6, CRP, and serum amyloid A. Compared to controls, POD cases showed greater metabo-inflammatory shifts from baseline (average logFC = 2.56, p < 0.001). Lower baseline cognitive scores (OR = 0.74, p = 0.019) and higher MIF scores (OR = 1.03, p = 0.013) were independently associated with increased POD risk. Conclusions: Cardiac surgery with CPB elicits a significant metabo-inflammatory response in all patients. However, those who develop POD exhibit disproportionately greater dysregulation. Full article

Minimally invasive coronary artery bypass grafting (MI-CABG) has emerged as a transformative approach to coronary revascularization, offering reduced morbidity, faster recovery and improved cosmesis compared to conventional coronary artery bypass grafting (CABG). Performed without full sternotomy and commonly without cardiopulmonary bypass (CPB), MI-CABG encompasses a variety of techniques. These procedures present unique challenges for the anesthesiologist, necessitating a tailored perioperative strategy. This review explores the anesthetic management of MI-CABG, focusing on preoperative assessment, intraoperative techniques, and postoperative care. Preoperative evaluation emphasizes cardiac, respiratory, and vascular considerations, including suitability for one-lung ventilation (OLV) and the impact of comorbidities. Intraoperatively, anesthesiologists must manage hemodynamic instability, ensure effective OLV, and maintain normothermia. Postoperative strategies prioritize multimodal analgesia, early extubation, and rapid mobilization to leverage the benefits of a minimally invasive approach. By integrating surgical and anesthetic perspectives, this review underscores the anesthesiologist’s pivotal role in navigating the physiological demands of MI-CABG. As techniques evolve and experience grows, a comprehensive understanding of these principles will enhance the safety and efficacy of MI-CABG, making it a viable option for an expanding patient population. Full article

Background: Red cell distribution width (RDW) has emerged as a prognostic biomarker in various clinical contexts. This retrospective study evaluated the predictive utility of RDW for cardiopulmonary bypass-associated acute lung injury (CPB-ALI) in pediatric patients undergoing cardiac surgery. Methods: A total of 166 children were enrolled and classified into CPB-ALI and non-ALI groups. Preoperative and postoperative RDW values were analyzed. Results: Postoperative RDW was significantly higher in the CPB-ALI group (15.40% vs. 13.78%, p < 0.001). Multivariate logistic regression identified postoperative RDW as an independent predictor of CPB-ALI (OR: 1.35, 95% CI: 1.10–1.64, p = 0.003). Receiver operating characteristic analyses yielded an AUC of 0.732, and restricted cubic spline analyses revealed a nonlinear association between RDW and CPB-ALI risks (p < 0.001). Higher postoperative RDW levels were positively correlated with prolonged mechanical ventilation duration, ICU stay, and total hospital stay (p < 0.001 for all). Conclusions: These findings suggest that postoperative RDW is a cost-effective and accessible biomarker for the early identification of CPB-ALI and may inform individualized perioperative management in pediatric cardiac surgery. Full article

Background: Antegrade root cardioplegia remains the most popular strategy for myocardial protection during coronary artery bypass graft (CABG) performed with cardiopulmonary bypass (CPB) and aortic cross clamp. In patients with depressed left ventricular function, however, especially if associated with severe multiple coronary stenosis, increased pharmacological and/or mechanical support in the early post-CPB period is often required to support left ventricular recovery. In this study, we analyzed the results of a myocardial protection strategy that includes selective infusion of cardioplegia through each venous graft followed by warm reperfusion distal to each coronary anastomosis until complete removal of the aortic clamp (total antegrade cardioplegia infusion and warm reperfusion = TAWR) to improve early postoperative recovery in patients with depressed left ventricular function undergoing multi-vessel CABG. Methods: Out of 97 patients undergoing CABG using the TAWR strategy for myocardial protection, 32 patients presented with depressed left ventricle function (EF < 40%) and multi-vessel coronary diseases requiring ≥2 vein grafts and were enrolled as Group A. Combined primary outcomes and postoperative early and late left ventricle recovery (including spontaneous rhythm recovery, inotropic support and postoperative troponin release) were analyzed and compared with those of 32 matched patients operated on using standard antegrade root cardioplegia and limited warm reperfusion through LIMA graft (SAWR) enrolled as Group B. Results: Two patient died in hospital (in-hospital mortality 3.1%) with no statistical differences between the two groups. In Group A 27 patients (90%) had spontaneous recovery of idiopathic rhythm compared to 17 (53%) in group B (p = 0.001). Early inotropic support was required in nine patients (28%) of group A and seventeen patients (53%) of group B (p = 0.041). Furthermore, in eight patients (25%) of group A and seventeen (53%) of group B (p = 0.039) inotropic support was continued for >48 h. Conclusions: The TAWR strategy seems to significantly improve early postoperative cardiac recovery in patients with left ventricle depression undergoing multi-vessel CABG, when compared with SAWR strategy and could therefore be considered the strategy of choice in this subset of patients. Full article

Introduction: Among aortic diseases in children, congenital defects such as coarctation of the aorta (CoA), interrupted aortic arch (IAA), hypoplastic aortic arch (HAA), and hypoplastic left heart syndrome (HLHS) predominate. Tissue patches are applied in pediatric cardiovascular surgery for the repair of congenital aortic defects as a filling material to replenish missing tissue or as a substitute material for the complete reconstruction of the vascular wall along the course of the vessel. This retrospective single-center study aimed to present the safety and feasibility of extracellular matrix (ECM) biological scaffolds in pediatric aortic surgery. Patients and methods: There were 26 patients (17 newborns and nine children), who underwent surgical procedures in the Department of Pediatric Cardiac Surgery (Poznań, Poland) between 2023 and 2024. The patients’ population was divided into two subgroups according to the hemodynamic nature of the primary diagnosis of the congenital heart defect and the performed pediatric cardiovascular surgery. The first group included 18 (72%) patients after aortic arch repair for interrupted aortic arch and/or hypoplastic aortic arch, while the second group included seven (28%) patients after aortopulmonary anastomosis. In the first group, patches were used to reconstruct the aortic arch by forming an artificial arch with three separate patches sewn together, primarily addressing the hypoplastic or interrupted segments. In the second group, patches were applied to augment the anastomosis site between the pulmonary trunk and the aortic arch, specifically at the connection points in procedures, such as the Damus–Kaye–Stansel or Norwood procedures. The analysis was based on data acquired from the national cardiac surgery registry. Results: The overall mortality in the presented group was 15%. All procedures were performed using median sternotomy with a cardiopulmonary bypass. The cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) median times were 144 (107–176) and 53 (33–79) min, respectively. There were two (8%) cases performed in deep hypothermic circulatory arrest (DHCA). The median postoperative stay in the intensive care unit (ICU) was 284 (208–542) h. The median mechanical ventilation time was 226 (103–344) h, including 31% requiring prolonged mechanical ventilation support. Postoperative acute kidney failure requiring hemodiafiltration (HDF) was noticed in 12% of cases. Follow-up data, collected via routine transthoracic echocardiography (TTE) and clinical assessments over a median of 418 (242.3–596.3) days, showed no evidence of patch-related complications such as restenosis, aneurysmal dilation, or calcification in surviving patients. One patient required reintervention on the same day due to a significantly narrow ascending aorta, unrelated to patch failure. No histological data from explanted patches were available, as no patches were removed during the study period. The median (Q1–Q3) hospitalization time was 21 (16–43) days. Conclusions: ProxiCor^® biological patches derived from the extracellular matrix can be safely used in pediatric patients with congenital aortic arch disease. Long-term follow-up is necessary to confirm the durability and growth potential of these patches, particularly regarding their resistance to calcification and dilation. Full article

Background and Objectives: The aim of this study was to compare the effects of sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA) on intraocular pressure (IOP) during coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). Materials and Methods: This prospective observational monocentric study included 68 patients scheduled for CABG with CPB, divided into two groups of propofol-based TIVA (Group P) and sevoflurane-based anesthesia (Group S). Intraocular pressure was measured and recorded at eight predefined time points using a tonometer: before anesthesia induction (T1), 10 min after induction (T2), immediately before the beginning of CPB (T3), 3 min after the beginning of CPB (T4), 3 min after cross-clamping (T5), 3 min after cross-clamp removal (T6), immediately before the weaning of CPB (T7), and at the end of the surgery (immediately after skin closure) (T8). The primary endpoint was to examine the effects of propofol-based TIVA and sevoflurane-based anesthesia methods on IOP during CABG operation. The secondary endpoints included a comparison of hemodynamic variables, blood gas values, and intensive care unit (ICU) and hospital stays. Results: Intraocular pressure values were similar for both groups at all time points. A statistically significant decrease was found in IOP in all measurements after induction compared to pre-induction values in both Group P and Group S (p < 0.05). Compared to IOP measured at 10 min after induction, no statistically significant difference was found at all subsequent time points in both groups. When the right and left IOP values were compared, no statistically significant difference was detected at all time points in both Group P and Group S. Conclusions: The results of the study indicated that propofol-based TIVA and sevoflurane-based anesthesia had similar effects on IOP in patients undergoing CABG with CPB. Full article

Background: Aortic valve stenosis remains the most prevalent valvular pathology in Western countries. Rapid deployment bioprosthesis (RD) has emerged as a promising alternative to conventional valves for surgical aortic valve replacement (SAVR), particularly in elderly and high-risk patients. This study reports the short- and long-term outcomes of RD in patients with isolated aortic stenosis. Methods: A retrospective single-center analysis was conducted on 382 patients who underwent RD-AVR between 2014 and 2020. Data were collected from clinical files and national electronic databases. Primary outcomes included cardiopulmonary bypass (CPB) and cross-clamping (XC) times, postoperative complications, and long-term survival. Results: The mean age was 75.6 ± 5.9 years, with 29.8% of patients over 80 years old and a mean EuroSCORE II of 2.3 ± 1.5%. CPB and XC times were 36.7 ± 10.8 and 27.4 ± 8.1 min, respectively. Postoperative complications included acute kidney injury (AKI, 53.4%), de novo atrial fibrillation (31.9%), and high-grade/complete atrioventricular block with permanent pacemaker implantation (9.8%). In-hospital and 30-day mortality was 1.02% and 2.3%, respectively. The 5-year survival rate was 77%. At 6 months postoperatively, the mean transvalvular gradient was 11.1 ± 4.7 mmHg. At a median follow-up of 6.7 years, no cases of structural valve deterioration and only one case of endocarditis were reported. Conclusion: In this single-center study, RD in isolated AVR demonstrated favorable short- and long-term outcomes, including no structural valve deterioration at mid-term follow-up. These devices offer a safe and effective alternative to conventional SAVR, particularly in high-risk populations. Full article

Background and Objectives: In coronary artery bypass grafting (CABG) surgeries, monitoring intracranial pressure (ICP) is crucial due to neurological risks. Although pulsatile flow (PF) during cardiopulmonary bypass (CPB) is considered more physiological than non-pulsatile flow (NPF), its impact on ICP remains unclear. This study aimed to compare preoperative and postoperative optic nerve sheath diameter (ONSD) measurements between PF and NPF techniques to evaluate their effect on ICP changes. Materials and Methods: Sixty patients undergoing elective CABG (aged 45–75 years, ASA II-III-IV) were enrolled and divided into two groups depending on the cardiopulmonary bypass technique determined by the surgeon: PF (Group P, n = 30) and NPF (Group NP, n = 30). ONSD measurements were performed with ultrasound before surgery (Tpreop) and after surgery (Tpostop). Hemodynamic parameters and jugular and carotid vessel diameters were also recorded. Statistical analysis included t-tests, Mann–Whitney U-tests, chi-square tests, and Pearson correlation. Results: Both groups demonstrated significant increases in ONSD postoperatively compared to preoperative values (p < 0.001). However, no statistically significant difference in the magnitude of ONSD change was observed between the PF and NPF groups (p > 0.05). Group P showed lower ejection fractions and higher total inotrope requirements compared to Group NP (p < 0.01), but these factors did not translate into differences in postoperative ICP dynamics. Conclusions: ONSD measurements increased significantly after CABG surgery, regardless of perfusion type. PF and NPF strategies were comparable in terms of their effects on ICP as reflected by ONSD changes. ONSD ultrasonography appears to be a simple, rapid, and non-invasive tool for perioperative ICP monitoring in cardiac surgery. Further studies are needed to confirm these findings with dynamic intraoperative monitoring and neurocognitive assessments. Full article