- Email: [email protected]
Leipzig-Basel experiences with EACTA fellowship program
S73
POSTER PRESENTATIONS
II, cardiopulmonary bypass time, as well as BNP and TNT on postoperative day 1, continued to show a hazard ratio (HR) of 0.39 (95%CI 0.20 – 0.76) for increasing delta BNP. Stratification of BNP values on the first postop. day above and below 682 ng/L revealed increased mortality in the high BNP group (4682ng/L) for increasing delta BNP (log-rank p¼0.010), but decreased mortality in the low BNP group (o682ng/L) for increasing delta BNP (logrank p ¼0.001), albeit with a low event rate (21). Discussion. This preliminary analysis suggests that routine serial BNP measurements may be difficult to interpret. However, for patients with initially high postoperative BNP, a second measurement may contain additional prognostic information P-23 Changes in the psychsocial status after cardiac surgery in a 10-years follow-up study Enikő Holndonner-Kirst1, Lili Varga2, Andrea Szekely1 1
Semmelweis University, Dept of Anaesthesiology and Intensive Therapy, 2Semmelweis University
Background & Aim. Since the mortality after cardiac surgery has radically decreased in the last decades, the researchers take much interest in the postoperative psychosocial status and quality of life. On the other hand, psychosocial factors have been identified as risk factors for adverse long-time outcome after cardiac procedures. Methods. 180 patients, having undergone elective coronary artery bypass graft or valve surgery in Gottsegen György Hungarian Institute of Cardiology between July 2000 and May 2001, were enrolled in our prospective study. Anamnestic medical and psychosocial factors, a wide range of intra- and postoperative clinical factors and complications were recorded. The Beck depression inventory (BDI), state and trait anxiety subscale in Spielberger State–Trait Anxiety Inventory (STAI-S, -T) tests were recorded preoperatively, half, one, two, three, four, five, seven and ten years postoperatively. The social support, negative affectivity (NA), social inhibition (SI) tests were sent in the postoperative second, fifth, seventh and tenth year. Medical status and hospitalisation history were also asked at each interview. We used all-cause mortality and major adverse cardiac and cerebrovascular event (MACCE) as clinical end-points. Results. Age, the value of preoperative risk assessment scores, length of postoperative ICU stay and early complications, preoperative STAI-T, STAI-S, BDI as well as mean postoperative SI, STAI-T and BDI scores had significant adverse effect on both endpoints, while educational level were significantly protective in both. In a multivariable model with Euroscore the reoperation, circulatory failure were significant risk factors for both, while educational level was found to be protective for survival. Significant elevation was observed in STAI-S, STAI-T, BDI, NA, SI during the follow-up, but it was independent from the occurrence of MACCE. Conclusion. Psychosocial factors have a significant impact on survival and occurrence of MACCE after cardiac surgery, while higher educational level might be protective factor. P-24 The influence of dexmedetomidine on the quantity of postoperative cognitive disorders after cardiac surgery Piotr Jakubow Cardiosurgery Department
Background & Aim. Despite the progress of technology, the cognitive dysfunction and delirium in the postoperative period after cardiac operations still exist.(1,3) Dexmedetomidine, a selective alpha 2 adrenal receptor agonist, revealed anesthesia and a brain protective role.(2) Methods. The study evaluated a group of 150 patients staying in the postoperative department after different cardiac surgery operations. Patients were divided into 5 groups in terms of different kinds of sedative drug used and its connection to opioid drugs. Patients were assessed a battery of cognitive tests a week before and within 10 days, after surgery, in some patients a lab study S-100, NSE, BDNF was performed. In the course of sedation, handling and recovery from the infusion of the drug were assessed by the nursing staff. Results. In the study group, the total quantity of cognitive disorders, including delirium within 10 days after the operation, has occurred in 12% of propofol group, 10.6% in the midanium and 9.7% in the Dexmedetomidine group. Steering sedation was best assessed in a group of Propofol, but in this group there was the most unexpected reaction to the stimulation after discontinuation of the infusion. The amount of uncontrolled psychomotor agitation after the end of sedation was the smallest in the group of Sufentanil and Midanium or Dexmedetomidine. In the study, neuropsychological tests in Dexmedetomidine and Sufentanil group showed better results in the long-term memory in a recall subtest. Conclusion. The application of Dexmedetomidine does not adversely affect cognitive function observed in the postoperative period. This is probably a protective effect of hippocampal neuronal inflammatory response. REFERENCES 1. Monk TG: Postoperative cognitive disorders. Curr Opin Crit Care. 4:376-378, 2011. 2. Qian,Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice. Eur J Pharmacol. 746:206-212, 2015. 3. Krzych LJ: Detailed insight into the impact of postoperative neuropsychiatric complications on mortality in a cohort of cardiac surgery subjects: a 23,000-patient-year analysis. J Cardiothorac Vasc Anesth. 28(3):448-457, 2014. P-25 Leipzig-Basel experiences with EACTA fellowship program V. Protsyk1, J. Fassl2, M. Maurer2 J. Ender1 1 Department of Anaesthesiology and Intensive Care Medicine, Heartcentre, University Leipzig, Germany, 2Department of Anaesthesiology and Intensive Care Medicine, University Hospital Basel, Switzerland
Introduction. Since 2009 some European centres offer EACTAaccredited 2-year Fellowship program in cardiothoracic and vascular anaesthesia. To ensure a high quality in the education of the fellows we evaluated the workload of each fellow in two centres: University Hospital Basel (USB), Switzerland and Heartcenter University Leipzig (HCL), Germany. Methods. In this retrospective study the numbers of anaesthesia, where each fellow was involved, the numbers of performed transoesophageal ultrasound examinations (TEE) and the completion of the EACVI examination/certification were evaluated based on the individual database in each centre.
S74
POSTER PRESENTATIONS
Results. In total 7 fellows in Leipzig and 1 fellow in Basel have completed their fellowship since accreditation. Actually 3 fellows in Leipzig and 1 in Basel are in the program. For details of individual workload see Table 1. The numbers of performed anaesthesia by types of operations are shown in Table 2. Transplants are only performed in Leipzig, therefore the fellows from Basel visit HCL for one month. Table 1. Workload of individual fellows
Fellow/
Anaesthesia
Anaesthesia
numbers
numbers
EACVI
EACVI
Centre
Country
Year 1
Year 2
TEE
Exam
Certificate
1/HCL
Ireland
383
313
410
2/HCL
India
250
286
323
3/HCL 4/HCL
India India
228 273
307 180
215 250
5/HCL
Egypt
167
303
186
6/HCL
Egypt
312
291
298
7/HCL 8/HCL
Egypt Ukraine
268 290
146 40*
197 141*
9/HCL
India
200*
71*
10/HCL
Saudi
50*
18*
11/USB
Arabia Germany
206
12/USB
Germany
165*
150
Parameter DO2, mlmin-1m-2
Group 1
Group 2
P 0.004
445⫾12
386⫾15
VO2, mlmin-1m-2
146⫾48
109⫾41
0.001
ERO2, %
32.9⫾9
28.4⫾9
0.048
4.9⫾1.7 68⫾9
3.97⫾1. 5 73⫾10
0.011 0.037
1.99⫾1.03
3.21⫾2.1
0.004
12.9⫾4.9
16.9⫾7.3
0.010
A-V O2, ml% SvO2, % Lactate, mmolL-1
Leucocytes, L-1109
359 110*
Conclusion. Observed unfavorable combination of parameters in group 2 paradoxically includes the featers of low flow state and arterio-venous shunting [1] probably due to the inflammation accompanied by leukocytosis. This can create difficulties for the clinical interpretation.
*
In progress.
Table 2. Types of operations, mean value per fellow/year Operations
Methods. We evaluated 78 pts aged more than 74 years old undergoing cardiac surgery. Mixed venous saturation (SvO2), oxygen delivery (DO2), oxygen consuption (VO2), O2 extraction rate (ERO2), arterio-venous O2 difference (A-V O2), lactate level after CPB, postoperative leukocytosis, intensive care unit (ICU) stay were registered. Data are given as mean ⫾ SD. Student’s t-test was used with Po0.05 as significant. Results. Fifty two pts were discharged from ICU within one day after surgery (group 1). The rest 26 pts (group 2) had ICU staing 5⫾2 days, characterized by lover post-CPB DO2, VO2, ERO2, AV O2, higher SvO2, lactate (table). Leucocytes number had the significant (po0,05) dirrect correlation (r¼0.58) with SvO2, and inverse (r0.64) – with A-V O2.
HCL
USB
CABG
62
66
Single valve
91
30
Combined Aortic operations in circulatory arrest
23 4
31 10
Emergency Type A dissection
5
6
Transapical and transcatheter aortic valves
20
14
Heart/Lung transplantation
2
—
Discussion. Both centres offer a good clinical workload reflecting the guidelines for a centre that offers an EACTA fellowship program. To ensure high quality and comparable education for the European cardiac fellows there is a need for quality assurance among the accredited European centres.
Poster Session 5 Friday, June 26, 2015 1:00 p.m.–2:00 p.m., Poster Exhibition Area P-26 Oxygen balance and systemic inflammation after cardiopulmonary bypass in elderly patients with different intensive care duration Lev Krichevskiy2, Eugeniy Baliner1, Alexandr Urbanov1, Alla Laptiy1, Nikolay Semenychev1 1
Filatov Hospital 15, 2Negovskiy Research Institution of the General Reanimathology Background & Aim. The aim was to investigate the prognostic significance of oxygen balance and systemic inflammation after cardio-pulmonary bypass (CPB) in elderly patients (pts).
REFERENCE 1. Koning NG, Simon LE, Asfar P, et al: Systemic microvascular shunting through hyperdynamic capillaries after acute physiological disturbances following cardiopulmonary bypass. AJP Heart and Circulatory Physiology 307:H967-H975, 2014. P-27 Pulmonary and lobar isolation in a patient with aspergilloma within a tuberculous cavity M. Granell1,3, A. Arnau2,3, E. García del Olmo2, L. González1, R. Guijarro2,3, J.A. de Andrés1,3 1
Anesthesiology, Critical Care and Pain Relief Department, Thoracic Surgery Department (University General Hospital of Valencia)., 3University of Valencia, Spain (Medicine. Surgery Department. Anesthesiology). 2
Introduction. Thoracic surgery in lung abscesses always need healthy lungs or lobes isolation to prevent its infection. Case Report. A 22-years old patient had a surgical history of right pneumothorax and a major pulmonary tuberculosis treated with antibiotic treatment. Two years later of this disease he presented an aspergilloma within the residual tuberculous cavity in the upper left lobe (Fig.1. Tuberculous cavity (TAC).). This patient underwent a surgery of resection of the upper left lobe. The anesthesia was performed by a thoracic epidural block, an anesthetic induction by propofol and rocuronium, and finaly anesthetic maintenance by sevofluorane, remifentanyl and rocuronium. Airway management was performed by the insertion of a 39 French left double lumen tube (DLT) and a Cohen bronchial blocker (BB) insertion into the left lower bronchus throught the endobronchial lumen of DLT guided by a flexible fiberscope. This method tried to isolate the lower left lobe (LLL) of the upper left
POSTER PRESENTATIONS
II, cardiopulmonary bypass time, as well as BNP and TNT on postoperative day 1, continued to show a hazard ratio (HR) of 0.39 (95%CI 0.20 – 0.76) for increasing delta BNP. Stratification of BNP values on the first postop. day above and below 682 ng/L revealed increased mortality in the high BNP group (4682ng/L) for increasing delta BNP (log-rank p¼0.010), but decreased mortality in the low BNP group (o682ng/L) for increasing delta BNP (logrank p ¼0.001), albeit with a low event rate (21). Discussion. This preliminary analysis suggests that routine serial BNP measurements may be difficult to interpret. However, for patients with initially high postoperative BNP, a second measurement may contain additional prognostic information P-23 Changes in the psychsocial status after cardiac surgery in a 10-years follow-up study Enikő Holndonner-Kirst1, Lili Varga2, Andrea Szekely1 1
Semmelweis University, Dept of Anaesthesiology and Intensive Therapy, 2Semmelweis University
Background & Aim. Since the mortality after cardiac surgery has radically decreased in the last decades, the researchers take much interest in the postoperative psychosocial status and quality of life. On the other hand, psychosocial factors have been identified as risk factors for adverse long-time outcome after cardiac procedures. Methods. 180 patients, having undergone elective coronary artery bypass graft or valve surgery in Gottsegen György Hungarian Institute of Cardiology between July 2000 and May 2001, were enrolled in our prospective study. Anamnestic medical and psychosocial factors, a wide range of intra- and postoperative clinical factors and complications were recorded. The Beck depression inventory (BDI), state and trait anxiety subscale in Spielberger State–Trait Anxiety Inventory (STAI-S, -T) tests were recorded preoperatively, half, one, two, three, four, five, seven and ten years postoperatively. The social support, negative affectivity (NA), social inhibition (SI) tests were sent in the postoperative second, fifth, seventh and tenth year. Medical status and hospitalisation history were also asked at each interview. We used all-cause mortality and major adverse cardiac and cerebrovascular event (MACCE) as clinical end-points. Results. Age, the value of preoperative risk assessment scores, length of postoperative ICU stay and early complications, preoperative STAI-T, STAI-S, BDI as well as mean postoperative SI, STAI-T and BDI scores had significant adverse effect on both endpoints, while educational level were significantly protective in both. In a multivariable model with Euroscore the reoperation, circulatory failure were significant risk factors for both, while educational level was found to be protective for survival. Significant elevation was observed in STAI-S, STAI-T, BDI, NA, SI during the follow-up, but it was independent from the occurrence of MACCE. Conclusion. Psychosocial factors have a significant impact on survival and occurrence of MACCE after cardiac surgery, while higher educational level might be protective factor. P-24 The influence of dexmedetomidine on the quantity of postoperative cognitive disorders after cardiac surgery Piotr Jakubow Cardiosurgery Department
Background & Aim. Despite the progress of technology, the cognitive dysfunction and delirium in the postoperative period after cardiac operations still exist.(1,3) Dexmedetomidine, a selective alpha 2 adrenal receptor agonist, revealed anesthesia and a brain protective role.(2) Methods. The study evaluated a group of 150 patients staying in the postoperative department after different cardiac surgery operations. Patients were divided into 5 groups in terms of different kinds of sedative drug used and its connection to opioid drugs. Patients were assessed a battery of cognitive tests a week before and within 10 days, after surgery, in some patients a lab study S-100, NSE, BDNF was performed. In the course of sedation, handling and recovery from the infusion of the drug were assessed by the nursing staff. Results. In the study group, the total quantity of cognitive disorders, including delirium within 10 days after the operation, has occurred in 12% of propofol group, 10.6% in the midanium and 9.7% in the Dexmedetomidine group. Steering sedation was best assessed in a group of Propofol, but in this group there was the most unexpected reaction to the stimulation after discontinuation of the infusion. The amount of uncontrolled psychomotor agitation after the end of sedation was the smallest in the group of Sufentanil and Midanium or Dexmedetomidine. In the study, neuropsychological tests in Dexmedetomidine and Sufentanil group showed better results in the long-term memory in a recall subtest. Conclusion. The application of Dexmedetomidine does not adversely affect cognitive function observed in the postoperative period. This is probably a protective effect of hippocampal neuronal inflammatory response. REFERENCES 1. Monk TG: Postoperative cognitive disorders. Curr Opin Crit Care. 4:376-378, 2011. 2. Qian,Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice. Eur J Pharmacol. 746:206-212, 2015. 3. Krzych LJ: Detailed insight into the impact of postoperative neuropsychiatric complications on mortality in a cohort of cardiac surgery subjects: a 23,000-patient-year analysis. J Cardiothorac Vasc Anesth. 28(3):448-457, 2014. P-25 Leipzig-Basel experiences with EACTA fellowship program V. Protsyk1, J. Fassl2, M. Maurer2 J. Ender1 1 Department of Anaesthesiology and Intensive Care Medicine, Heartcentre, University Leipzig, Germany, 2Department of Anaesthesiology and Intensive Care Medicine, University Hospital Basel, Switzerland
Introduction. Since 2009 some European centres offer EACTAaccredited 2-year Fellowship program in cardiothoracic and vascular anaesthesia. To ensure a high quality in the education of the fellows we evaluated the workload of each fellow in two centres: University Hospital Basel (USB), Switzerland and Heartcenter University Leipzig (HCL), Germany. Methods. In this retrospective study the numbers of anaesthesia, where each fellow was involved, the numbers of performed transoesophageal ultrasound examinations (TEE) and the completion of the EACVI examination/certification were evaluated based on the individual database in each centre.
S74
POSTER PRESENTATIONS
Results. In total 7 fellows in Leipzig and 1 fellow in Basel have completed their fellowship since accreditation. Actually 3 fellows in Leipzig and 1 in Basel are in the program. For details of individual workload see Table 1. The numbers of performed anaesthesia by types of operations are shown in Table 2. Transplants are only performed in Leipzig, therefore the fellows from Basel visit HCL for one month. Table 1. Workload of individual fellows
Fellow/
Anaesthesia
Anaesthesia
numbers
numbers
EACVI
EACVI
Centre
Country
Year 1
Year 2
TEE
Exam
Certificate
1/HCL
Ireland
383
313
410
2/HCL
India
250
286
323
3/HCL 4/HCL
India India
228 273
307 180
215 250
5/HCL
Egypt
167
303
186
6/HCL
Egypt
312
291
298
7/HCL 8/HCL
Egypt Ukraine
268 290
146 40*
197 141*
9/HCL
India
200*
71*
10/HCL
Saudi
50*
18*
11/USB
Arabia Germany
206
12/USB
Germany
165*
150
Parameter DO2, mlmin-1m-2
Group 1
Group 2
P 0.004
445⫾12
386⫾15
VO2, mlmin-1m-2
146⫾48
109⫾41
0.001
ERO2, %
32.9⫾9
28.4⫾9
0.048
4.9⫾1.7 68⫾9
3.97⫾1. 5 73⫾10
0.011 0.037
1.99⫾1.03
3.21⫾2.1
0.004
12.9⫾4.9
16.9⫾7.3
0.010
A-V O2, ml% SvO2, % Lactate, mmolL-1
Leucocytes, L-1109
359 110*
Conclusion. Observed unfavorable combination of parameters in group 2 paradoxically includes the featers of low flow state and arterio-venous shunting [1] probably due to the inflammation accompanied by leukocytosis. This can create difficulties for the clinical interpretation.
*
In progress.
Table 2. Types of operations, mean value per fellow/year Operations
Methods. We evaluated 78 pts aged more than 74 years old undergoing cardiac surgery. Mixed venous saturation (SvO2), oxygen delivery (DO2), oxygen consuption (VO2), O2 extraction rate (ERO2), arterio-venous O2 difference (A-V O2), lactate level after CPB, postoperative leukocytosis, intensive care unit (ICU) stay were registered. Data are given as mean ⫾ SD. Student’s t-test was used with Po0.05 as significant. Results. Fifty two pts were discharged from ICU within one day after surgery (group 1). The rest 26 pts (group 2) had ICU staing 5⫾2 days, characterized by lover post-CPB DO2, VO2, ERO2, AV O2, higher SvO2, lactate (table). Leucocytes number had the significant (po0,05) dirrect correlation (r¼0.58) with SvO2, and inverse (r0.64) – with A-V O2.
HCL
USB
CABG
62
66
Single valve
91
30
Combined Aortic operations in circulatory arrest
23 4
31 10
Emergency Type A dissection
5
6
Transapical and transcatheter aortic valves
20
14
Heart/Lung transplantation
2
—
Discussion. Both centres offer a good clinical workload reflecting the guidelines for a centre that offers an EACTA fellowship program. To ensure high quality and comparable education for the European cardiac fellows there is a need for quality assurance among the accredited European centres.
Poster Session 5 Friday, June 26, 2015 1:00 p.m.–2:00 p.m., Poster Exhibition Area P-26 Oxygen balance and systemic inflammation after cardiopulmonary bypass in elderly patients with different intensive care duration Lev Krichevskiy2, Eugeniy Baliner1, Alexandr Urbanov1, Alla Laptiy1, Nikolay Semenychev1 1
Filatov Hospital 15, 2Negovskiy Research Institution of the General Reanimathology Background & Aim. The aim was to investigate the prognostic significance of oxygen balance and systemic inflammation after cardio-pulmonary bypass (CPB) in elderly patients (pts).
REFERENCE 1. Koning NG, Simon LE, Asfar P, et al: Systemic microvascular shunting through hyperdynamic capillaries after acute physiological disturbances following cardiopulmonary bypass. AJP Heart and Circulatory Physiology 307:H967-H975, 2014. P-27 Pulmonary and lobar isolation in a patient with aspergilloma within a tuberculous cavity M. Granell1,3, A. Arnau2,3, E. García del Olmo2, L. González1, R. Guijarro2,3, J.A. de Andrés1,3 1
Anesthesiology, Critical Care and Pain Relief Department, Thoracic Surgery Department (University General Hospital of Valencia)., 3University of Valencia, Spain (Medicine. Surgery Department. Anesthesiology). 2
Introduction. Thoracic surgery in lung abscesses always need healthy lungs or lobes isolation to prevent its infection. Case Report. A 22-years old patient had a surgical history of right pneumothorax and a major pulmonary tuberculosis treated with antibiotic treatment. Two years later of this disease he presented an aspergilloma within the residual tuberculous cavity in the upper left lobe (Fig.1. Tuberculous cavity (TAC).). This patient underwent a surgery of resection of the upper left lobe. The anesthesia was performed by a thoracic epidural block, an anesthetic induction by propofol and rocuronium, and finaly anesthetic maintenance by sevofluorane, remifentanyl and rocuronium. Airway management was performed by the insertion of a 39 French left double lumen tube (DLT) and a Cohen bronchial blocker (BB) insertion into the left lower bronchus throught the endobronchial lumen of DLT guided by a flexible fiberscope. This method tried to isolate the lower left lobe (LLL) of the upper left