Postoperative bleeding is still one of the most common complications of cardiac surgery. Antifibrinolytic agents successfully reduce bleeding, but there are controversies concerning adverse effects after their systemic use. By topical application of antifibrinolytic agents in pericardial cavity, most of these effects are avoided. We compared the effects of topically applied aprotinin, tranexamic acid and placebo on postoperative bleeding and transfusion requirements. In this single-center prospective, randomized, double-blind trial, 300 adult cardiac patients were randomized into three groups to receive one million IU of aprotinin (AP group), 2.5g of tranexamic acid (TA group) or placebo (PL group) topically before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. Postoperative bleeding within first 12-h period (AP group 433+/-294 [350; 360]ml, TA group 391+/-255 [350; 305]ml, PL group 613+/-505 [525; 348]ml), as well as cumulative blood loss within 24h (AP group 726+/-432 [640; 525]ml, TA group 633+/-343 [545; 335]ml, PL group 903+/-733 [800; 445]ml), showed statistically significant inter-group differences (both p<0.001). Bleeding rates values were significantly higher in placebo group compared to the groups treated with antifibrinolytic agents (AP and TA groups) concerning both variables. Although TA group showed the lowest values, no statistical differences between TA and AP groups were found. Inter-group difference of blood product requirements was not statistically significant. Topical use of either tranexamic acid or aprotinin efficiently reduces postoperative bleeding. TA seems to be at least as potent as aprotinin, but potentially safer and with better cost-effectiveness ratio.

Continuous-flow left ventricular assist devices (LVAD) have become standard therapy option for patients with advanced heart failure. They offer several advantages over previously used pulsatile-flow LVADs, including improved durability, less surgical ...

Objective: To compare the intraoperative quality of coronary anastomoses performed with or without cardiopulmonary bypass using transit time flow measurement (TTFM) parameters. Methods: We collected data from 588 consecutive patients who underwent surgical revascularization. We retrospectively reviewed data from two groups: 411 with cardiopulmonary bypass (CABG group) and 177 off-pump (OPCABG group). Transit time flow measurement parameters: mean graft flow (MGF), pulsatile index (PI), and diastolic filing (DF) were measured for each graft and patient. Results: Patients in the OPCABG group had higher EuroSCORE compared with the CABG group (3.53 ± 2.32 versus 2.84 ± 2.15, P = .002). Overall comparison of TTFM parameters showed no statistical difference between the two surgical techniques except for PI in circumflex artery territory, which was higher in the OPCABG group for all types of grafts 3.0 ± 4.9 versus 2.4 ± 2.0 in, P = .026. Conclusion: The comparison between OPCABG and CABG in this study showed comparable results with both surgical techniques. PI was higher in the OPCABG group in harder-to-reach vessel territories. Measurement of transit time may improve the quality, safety, and efficacy of coronary artery bypass grafting and should be considered as a routine procedure.

Omentum flap as a salvage procedure in deep sternal wound infection Franjo Rudman,1 Davor BariÄ?,2 Daniel UniÄ?2 1Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital â??Dubravaâ??, 2Department of Cardiac and Transplant Surgery, University Hospital â??Dubravaâ??, Zagreb, CroatiaWe read with great interest the report by Dr Spindler and coworkers about the utilization of omentoplasty as salvage procedure in deep sternal wound infection.1 First of all, we congratulate the authors on the excellent results. Mortality rates in this high-risk cohort of patients can be attributed to advanced age, comorbidities, and other complications, but neither the timing nor the type of reconstruction performed.View the original paper by Spindler and colleagues.

Surgical aortic valve replacement (SAVR) remains an essential treatment option for patients with aortic stenosis (AS). Open-heart surgery requires the use of cardiopulmonary bypass (CPB), which triggers an inflammatory response that can lead to end-organ dysfunction and severe complications. Dexmedetomidine, a highly selective α2-adrenergic agonist, is widely used in anesthesia and intensive care medicine for its sedative, analgesic, and sympatholytic properties. This study aimed to investigate whether dexmedetomidine exerts a clinically relevant anti-inflammatory effect in patients undergoing open-heart surgery and to determine the optimal dose. A prospective, double-blind, placebo-controlled study was conducted, including 60 patients randomized into three groups according to dexmedetomidine dose. Inflammatory markers (IL-6, TNF-α), renal function, and other clinical parameters were analyzed at multiple time points. Statistical analyses were performed to assess differences between the groups. Dexmedetomidine administration significantly affected TNF-α levels 12 h after CPB (p = 0.033), while previously reported suppression of IL-6 was not observed. Dexmedetomidine was associated with lower opioid consumption before extubation and showed a tendency to reduce postoperative delirium. Diuresis was significantly increased on the first postoperative day in dexmedetomidine-treated patients (p = 0.003), with no significant changes in other renal parameters. The incidence of atrial fibrillation was highest in the control group and lowest in the high-dose dexmedetomidine group, though this difference was not statistically significant. These results suggest that dexmedetomidine influences inflammatory and clinical outcomes; however, further research is needed to confirm its long-term benefits and optimal dosing strategies.