Background: Acute kidney injury (AKI) is one of the more serious complications following cardiac surgery, consistently linked to prolonged mechanical ventilation and higher in-hospital mortality. This study examined whether preoperative anaemia and impaired renal function are associated with AKI and death in a high-risk cardiac-surgery cohort requiring extended postoperative ICU monitoring and how these associations behave after adjustment for procedure type and intraoperative variables. Methods: In this single-centre retrospective cohort study, we screened 950 patients admitted to a cardiothoracic ICU between January 2018 and January 2024. After standard exclusion criteria and an audit of operative records, 553 cardiac-surgery patients formed the principal analysis cohort. AKI was defined by KDIGO criteria using serial postoperative serum-creatinine measurements during the first 7 days. Multivariable logistic regression for AKI and in-hospital mortality was built sequentially: Model A (baseline only); Model B (+procedure type); and Model C (+intraoperative variables: aortic cross-clamp time, intraoperative RBC units, and intraoperative inotrope use). Calibration was assessed by the Hosmer–Lemeshow test. Total cardiopulmonary bypass duration was not separately captured in the institutional database and is disclosed as a limitation. Results: AKI occurred in 174 of 553 patients (31.5%), and in-hospital mortality was 16.6% (92/553). Patients with AKI were older (median 77 vs. 68 years, p < 0.001), with lower preoperative haemoglobin (11.4 vs. 12.3 g/dL, p < 0.001) and lower eGFR (38.1 vs. 63.7 mL/min/1.73 m², p < 0.001). The aortic cross-clamp time was shorter in AKI patients (56 vs. 70 min, p = 0.043), a counterintuitive finding likely reflecting residual confounding by case-mix and procedure selection rather than a protective operative effect. In the fully adjusted multivariable model, the haemoglobin–AKI association attenuated and was no longer independently significant (OR 0.89 per 1 g/dL, 95% CI 0.73–1.08, p = 0.24), while intraoperative RBC transfusion emerged as an independent predictor (OR 1.12 per unit, p = 0.046). For mortality, AKI remained an independent predictor after full adjustment for procedure type and intraoperative variables (OR 7.14, 95% CI 1.45–35.13, p = 0.016), with cross-clamp time (OR 1.30 per 10 min, p = 0.010) and intraoperative RBC units (OR 1.48 per unit, p < 0.001) also independently associated. Both fully adjusted models showed acceptable calibration (Hosmer–Lemeshow p = 0.48 for AKI, p = 0.56 for mortality). Conclusions: In cardiac-surgery patients with a prolonged ICU stay, AKI is independently associated with in-hospital mortality even after adjustment for operative variables. The univariable association between preoperative haemoglobin and AKI is attenuated after adjustment for procedure type and intraoperative transfusion exposure, suggesting confounding or mediation by operative and case-mix factors rather than an independent direct association. The contribution of this analysis is aetiological/analytical rather than predictive (modest discrimination, AUROC 0.67 for AKI), and findings should be interpreted within the selected high-risk ICU ≥ 72 h population.

Background: Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients' quality of life after aortic valve replacement. Methods: A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of 0.85 cm2/m2). Mean EQ-5D-5L scores were compared among the groups statistically. Results: Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 ± 0.18, Group 2: 0.83 ± 0.20, and Group 3: 0.86 ± 0.9, p = 0.044 and p = 0.014). The EQ-5D-5L score was significantly lower in patients with a ≥20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 ± 0.25 vs. 0.84 ± 0.18, p = 0.014). Conclusions: Our results show that an iEOA <0.65 cm2/m2 is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.

Introduction: With the increase in life expectancy and developments in surgical and anesthetic techniques, intensive care follow-up, and treatment methods, the number of patients undergoing open-heart surgery has increased. Methods: The clinical files of 220 patients who underwent cardiovascular surgery were retrospectively reviewed. The patients were divided into two groups: group 1 (those who stayed for one day or less) and group 2 (those who stayed for more than one day). In addition, the reason for hospitalization for five days or more was investigated. The effect of patient variables on the length of stay in the intensive care unit was investigated by logistic regression analysis. Results: Hemoglobin values, ejection fraction values, and intensive care unit hospitalizations were significantly lower (p<0.05) than those in the group with intensive care unit hospitalizations of <24 h. The sodium value was significantly higher (p24 h than in the group with intensive care unit hospitalizations 24 h was significantly (p<0.05) higher than the group with intensive care unit hospitalizations < 24 h. The sinus rhythm in the group with intensive care unit hospitalizations >24 h was significantly lower (p<0.05) than that in the group with intensive care unit hospitalizations <24 h. Intensive care transfusion of erythrocyte suspension, fresh frozen plasma, and platelet suspension were significantly higher (p24 h than in the group with intensive care unit hospitalizations <24 h. Conclusion: In our study; We found that factors such as preoperative low ejection fraction (EF), hypernatremia, female gender, inotrope requirement, delirium, extubation time, intraoperative-postoperative transfusion, drainage revision affect the length of stay in the intensive care unit In the intraoperative period, methods to protect myocardial and kidney functions and provide hemostasis bleeding control reduce the duration of intensive care hospitalization Keywords: Thoracic Surgery; Length of Stay; Critical Care; Aging.

High-flow nasal cannula in a patient with prolonged air leak following cardiothoracic surgery: A case-based observation - Turkish Journal of Thoracic and Cardiovascular Surgery