Introduction: The implementation of Patient Blood Management (PBM) in cardiac surgery has been shown to be effective in reducing blood transfusions and associated complications, as well as improving patient outcomes. Despite the potential benefits of PBM in cardiac surgery, there are several barriers to its successful implementation. Objectives: The main objectives of this study were to ascertain the impact of the national Romanian PBM recommendations on allogeneic blood product transfusion in cardiac surgery and identify predictors of perioperative packed red blood cell transfusion. Methods: As part of the Romanian national pilot programme of PBM, we performed a single-centre, retrospective study in a tertiary centre of cardiovascular surgery, including patients from two time periods, before and after the implementation of the national recommendations. Using coarsened exact matching, from a total of 1174 patients, 157 patients from the before group were matched to 169 patients in the after group. Finally, we built a multivariate regression model from the entire cohort to analyse independent predictors of PRBC transfusion in the perioperative period. Results: Although there was a trend towards a lower proportion of patients requiring PRBC transfusion in the “after” group compared to the “before” group (44.9%vs. 50.3%), it was not statistically significant. There was a significant difference between the “after” group and the “before” group in terms of fresh-frozen plasma (FFP) transfusion rates, with a lower percentage of patients requiring FFP transfusion in the “after” group compared to “before” (14.2%, vs. 22.9%, p = 0.04). This difference was also seen in the total perioperative FFP transfusion (mean transfusion 0.7 units in the “before” group, SD 1.73 vs. 0.38 units in the “after” group, SD 1.05, p = 0.04). In the multivariate regression analysis, age > 64 years (OR 1.652, 95% CI 1.17–2.331, p = 0.004), female sex (OR 2.404, 95% CI 1.655–3.492, p < 0.001), surgery time (OR 1.295, 95% CI 1.126–1.488, p < 0.001), Hb < 13 g/dl (OR 3.611, 95% CI 2.528–5.158, p < 0.001), re-exploration for bleeding (OR 3.988, 95% CI 1.248–12.738, p = 0.020), viscoelastic test use (OR 2.18, 95% CI 1.34–3.544, p < 0.001), FFP transfusion (OR 4.023, 95% CI 2.426–6.671, p < 0.001), and use of a standardized pretransfusion checklist (OR 8.875, 95% CI 5.496–14.332, p < 0.001) remained significantly associated with PRBC transfusion. The use of a preoperative standardized haemostasis questionnaire was independently associated with a decreased risk of perioperative PRBC transfusion (0.565, 95% CI 0.371–0.861, p = 0.008). Conclusions: Implementation of national PBM recommendations led to a reduction in FFP transfusion in a cardiac surgery centre. The use of a preoperative standardized haemostasis questionnaire is an independent predictor of a lower risk for PRBC transfusion in this setting.

Recent research has contested the previously accepted paradigm that volatile anaesthetics improve outcomes in cardiac surgery patients when compared to intravenous anaesthesia. In this review we summarise the mechanisms of myocardial ischaemia/reperfusion injury and cardioprotection in cardiac surgery. In addition, we make a comprehensive analysis of evidence comparing outcomes in patients undergoing cardiac surgery under volatile or intravenous anaesthesia, in terms of mortality and morbidity (cardiac, neurological, renal, pulmonary).

Background: Elective surgery soon after SARS-CoV-2 infection is linked to high morbidity, but the risk > 7 weeks post-infection is uncertain. Methods: A PROSPERO-registered systematic review (CRD42023416842) following PRISMA 2020 searched PubMed, Web of Science, WHO COVID Database, Wiley, Google Scholar, and Scopus (Jane 2020–July 2025) for studies reporting postoperative outcomes in patients with confirmed COVID-19 ≥ 7 weeks before elective surgery. Primary endpoints were cardiopulmonary, neurological, renal and thrombotic complications, ICU/hospital stay and 30-day mortality. Results: Thirteen observational studies (38,055 patients) met inclusion criteria. In patients operated ≥7 weeks after mild or asymptomatic infection, overall mortality rate was 2.27% (607/26,688), with no significant excess versus uninfected controls. Pneumonia (1.66%), pulmonary embolism (1.47%), arrhythmias (2.57%) and myocardial injury (1.06%)—did not exceed baseline surgical rates. Thrombosis occurred in 2.8% but lacked a clear association with prior infection. Conversely, individuals with previous moderate-to-severe disease or recent COVID-19-related hospitalization showed higher complication rates, especially in complex procedures such as coronary bypass. Conclusions: Evidence to date indicates that COVID-19 history beyond seven weeks does not independently raise perioperative morbidity or mortality for most elective procedures.

Background and Clinical Significance: Ventricular septal defect (VSD) is a rare but serious complication following myocardial infarction (MI) that can lead to cardiogenic shock and carries a high mortality rate. Acute mitral regurgitation (MR) is another severe complication of MI with additional risks of mortality. The optimal timing of surgical intervention for VSD with MR is still being debated, and delaying surgery in medically manageable patients has been associated with improved survival. However, managing these patients in the intensive care unit (ICU) presents unique challenges. Case Presentation: In this paper, we present the case of a 52-year-old male with comorbidities who developed post-MI VSD with severe MR and underwent successful delayed surgical repair and mitral valve replacement. Our aim is to highlight the clinical characteristics, diagnostic approach, and management strategies of this rare complication in the critical care setting. The patient presented in cardiogenic shock and acute pulmonary edema. After stabilization using an intra-aortic balloon pump, pre- and afterload reducing pharmacotherapy and non-invasive mechanical ventilation, a watchful waiting strategy was employed, and surgery was performed on day 21 after hospital admission. Surgery was performed under general anesthesia, and the patient did not develop any complications related to the intra-aortic balloon pump or novel organ dysfunction. Conclusions: This case highlights the importance of a multidisciplinary approach to managing post-MI VSD with MR and emphasizes the need for careful patient selection and timing of surgical intervention in the critical care setting. Clinicians should be aware of the potential benefits of delaying surgical intervention in medically manageable patients, while also considering the unique challenges of managing these patients in the ICU.

Haemostasis is a critical physiological process that ensures blood loss is minimised following vascular injury. Understanding the mechanisms of normal haemostasis is essential for managing patients with inherited bleeding disorders, particularly in the surgical setting. Inherited bleeding disorders, such as haemophilia and von Willebrand disease (vWD), pose unique challenges for anaesthesiologists and surgeons due to the increased risk of excessive bleeding during and after surgery. This state-of-the-art review outlines the essential knowledge for anaesthesiologists regarding normal haemostasis, the pathophysiology of inherited bleeding disorders, and the perioperative management strategies required for these patients. It draws on existing literature and current clinical guidelines to offer practical approaches for assessing and managing bleeding risks in surgical settings.

Background/Objectives: Whether a remote history of SARS-CoV-2 infection independently affects early haemodynamic stability after elective cardiopulmonary bypass (CPB) remains uncertain. We evaluated whether prior COVID-19 (>7 weeks before surgery) was associated with postoperative vasopressor requirements or early complications in adults undergoing elective CPB. Methods: We conducted a single-centre prospective cohort study including adults (≥18 years) scheduled for elective on-pump coronary, valve, or combined cardiac surgery between 1 August 2022 and 30 October 2023. Patients undergoing emergency procedures or surgery < 7 weeks after infection were excluded. The exposure was a documented history of COVID-19 for >7 weeks preoperatively. The primary outcome was postoperative vasopressor use within 24 h of ICU admission; secondary outcomes included inotrope use, arrhythmias, acute cardiac or respiratory failure, pneumonia, acute kidney injury (KDIGO), delirium, stroke, length of stay, and mortality. Multivariable logistic regression adjusted for age, CPB duration, obesity, anaemia, chronic kidney disease, sex, EuroSCORE I, left ventricular ejection fraction, and procedure type. Results: Of 351 screened patients, 280 elective CPB cases were analyzed; 101 (36.1%) had prior COVID-19. Vasopressor use occurred in 151/280 (53.9%) patients, with no difference between COVID and non-COVID groups (53.5% vs. 54.2%; p = 1.00). Prior COVID-19 was not associated with vasopressor requirement (adjusted OR 0.94, 95% CI 0.56–1.59). Independent predictors were longer CPB duration (aOR 2.80 per hour; p < 0.001) and older age (aOR 1.028 per year; p = 0.02). Secondary outcomes, including organ dysfunction and mortality, did not differ between groups. Conclusions: In adults undergoing elective CPB ≥ 7 weeks after SARS-CoV-2 infection, prior COVID-19 did not increase early vasopressor needs or short-term postoperative complications. Haemodynamic requirements were primarily driven by CPB duration and age. Further research using dose-standardized vasoactive metrics and formal COVID-19 severity stratification is warranted.