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Background: Even minor postoperative reductions in renal function influence the outcome of cardiac surgery. The mechanisms of postoperative renal injury in cardiac surgery are multifactorial and include ischemia-reperfusion injury. The study investigates the effect of the antioxidant ascorbic acid on the postoperative acute kidney injury after elective CABG surgery.Methods: A prospective randomized single-center trial was conducted in on-pump coronary artery bypass patients. The patients in the ascorbic acid group received 2 grams of ascorbic acid 24 hours and 2 hours preoperatively and 1 gram twice daily five days after the surgery. Postoperatively, the subjects were monitored for renal dysfunction and other complications.Results: 100 patients were included, with 50 patients in each study group. The groups were well matched for baseline demographics, preoperative medications, comorbidities, and had similar intraoperative characteristics. The incidence of postoperative acute kidney injury in the ascorbic acid group was 16% and 14% in the control group (P = .779). The groups also did not differ in peak postoperative serum creatinine (83 [33] µmol/L versus 83 [39] µmol/L; P = .434), the lowest postoperative creatinine clearance (96.40 ± 35.78 mL/min versus 90.89 ± 36.18 mL/min; P = .766), and time from surgery to the onset of peak postoperative serum creatinine (1.64 ± 1.34 days versus 1.92 ± 1.54 days; P = .393). There was no dialysis required in any patient. Conclusion: The results of this study did not demonstrate a significant protective effect of ascorbic acid on the incidence of postoperative acute renal injury in elective on-pump CABG patients.

Left ventricular pseudoaneurysm is a partial cardiac rupture, contained by the surrounding pericardium that maintains communication with the left ventricular lumen. Whereas most cases of left ventricular pseudoaneurysms are related to myocardial infarction (loss of myocardial integrity), only a handful are associated with valve surgery. We present a female patient, who was admitted for elective mitral valve replacement. After the implantation of the mechanical valve, we encountered a rupture of the atrioventricular groove. After 3 months, a left ventricular pseudoaneurysm was found and the patient was reoperated. The valve was explanted and the inspection of the annulus and previously implanted pericardial patch revealed a loosened stitch on the inferior (ventricular) side. The defect was reinforced with additional stitches and the valve was reimplanted. In conclusion, we report an unusual case with two serious complications after mitral valve replacement – atrioventricular groove rupture and left ventricular pseudoaneurysm.

Although there has been a trend towards minimally invasive and sternum-sparing procedures, median sternotomy is still a standard surgical approach in cardiac surgery. Many techniques and innovations for closure of sternal osteotomy have been develo...

Purpose: Atrial fibrillation is the most common arrhythmia following cardiac surgery. An association between preoperative kidney dysfunction and postoperative atrial fibrillation has been previously reported; however, no study has so far investigated the impact of kidney function during cardiopulmonary bypass on the incidence of atrial fibrillation. The aim of this study was to investigate the value of preoperative renal function and urine output during cardiopulmonary bypass as predictors of postoperative atrial fibrillation in patients undergoing elective coronary artery bypass. Methods: This observational retrospective study included 409 patients who underwent elective coronary artery bypass surgery. According to whether or not atrial fibrillation developed postoperatively, the patients were divided into a sinus rhythm group (n = 340) and a new-onset atrial fibrillation group (n = 69). The impact of preoperative (serum creatinine and estimated glomerular filtration rate) and intraoperative (urine output during cardiopulmonary bypass) kidney function on the incidence of new-onset postoperative atrial fibrillation was assessed using univariable and multivariable analyses. Results:Patients with atrial fibrillation were older, and had higher EuroSCORE II and higher preoperative B-type natriuretic peptide levels than patients with sinus rhythm. Preoperative renal function was worse (higher serum creatinine level and lower estimated glomerular filtration rate) in the atrial fibrillation group than in the sinus rhythm group. However, there were no differences between the groups in urine output during cardiopulmonary bypass. Multivariable analysis identified older age, left ventricular ejection fraction ≤30%, and lower preoperative estimated glomerular filtration rate as independent risk factors for new-onset postoperative atrial fibrillation. Conclusion: Preoperative renal function—but not urine output during cardiopulmonary bypass—is a predictor of new-onset postoperative atrial fibrillation in patients undergoing elective coronary artery bypass surgery.