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  • 1.
    Claesson Lingehall, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Svenmarker, Staffan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Appelblad, Micael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Davidsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Holmner, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wahba, Alexander
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Norwegian University of Circulation and Medical Imagining, Trondheim, Norway.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Is a hyperosmolar pump prime for cardiopulmonary bypass a risk factor for postoperative delirium?: A double blinded randomised controlled trial2023In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 57, no 1, article id 2186326Article in journal (Refereed)
    Abstract [en]

    Objective: Postoperative delirium (POD) is common after cardiac surgery. We have previously identified plasma sodium concentration and the volume of infused fluids during surgery as possible risk factors. Both are linked to the selection and composition of the pump prime used for cardiopulmonary bypass (CPB). Present study aims to examine whether hyperosmolality increases the risk for POD.

    Design: Patients ≥65 years (n = 195) scheduled for cardiac surgery were prospectively enrolled into this double blinded randomised clinical trial. Study group received a pump prime containing mannitol and ringer-acetate (966 mOsmol) (n = 98) vs. ringer-acetate (388 mOsmol) (n = 97) in the control group. Postoperative delirium was defined according to DSM-5 criteria based on a test-battery pre- and postoperatively (days 1–3). Plasma osmolality was measured on five occasions and coordinated with the POD assessments. The primary outcome was the POD incidence related to hyperosmolality as the secondary outcome.

    Results: The incidence of POD was 36% in the study group and 34% in the control group, without intergroup difference (p=.59). The plasma osmolality was significantly higher in the study group, both on days 1 and 3 and after CPB (p<.001). Post hoc analysis indicated that high osmolality levels increased the risk for delirium on day 1 by 9% (odds ratio (OR) 1.09, 95% CI 1.03–1.15) and by 10% on day 3 (OR 1.10, 95% CI 1.04–1.16).

    Conclusions: Use of a prime solution with high osmolality did not increase the incidence of POD. However, the influence of hyperosmolality as a risk factor for POD warrants further investigation.

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  • 2.
    Holmgren, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Heart Centre, Umeå University, Umeå, Sweden..
    Enger, Tone Bull
    Clinic of Medicine, St. Olavs University Hospital, Trondheim, Norway.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Videm, Vibeke
    Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway; Department of Immunology and Transfusion Medicine, St. Olavs University Hospital, Trondheim, Norway.
    Valle, Solveig
    Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
    Evjemo, Karen Julie Dybvad
    Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
    Wahba, Alexander
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiothoracic Surgery, St. Olavs University Hospital, Trondheim, Norway.
    Long-term results after aortic valve replacement for bicuspid or tricuspid valve morphology in a Swedish population2021In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 59, no 3, p. 570-576Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Our goal was to study long-term observed and relative survival after first-time aortic valve replacement surgery with or without concomitant coronary artery bypass surgery with reference to valve morphology (i.e. bicuspid vs tricuspid).

    METHODS: Consecutive patients (n = 5086) from 3 Swedish hospitals, operated on between 1 January 2005 and 31 December 2016, were included. The 30-day mortality (n = 116, 2.3%) was excluded from the analysis of long-term observed and relative survival (n = 4970). Observed survival was analysed using Cox regression. Relative survival was calculated as the ratio between observed and expected survival based on data from the general Swedish population, matched for age, sex and calendar year. Risk factors for death were explored using multivariable analysis.

    RESULTS: During the follow-up (median 4.7 years) period, 1157 (23%) patients died. Observed survival excluding 30-day mortality was 96.6%, 82.7% and 57.6% after 1, 5 and 10 years. Compared with the general Swedish population, the relative 1-, 5- and 10-year survival rates were 99.0%, 97.5% and 89.0%. Bicuspid morphology was independently associated with higher observed and relative long-term survival. Renal dysfunction, diabetes, chronic obstructive pulmonary disease, heart failure, smoking and atrial fibrillation were associated with higher long-term mortality. Combined surgery was not associated with higher observed or relative mortality.

    CONCLUSIONS: Patients with a bicuspid morphology had better prognosis, matching that of the general population. With increased age, long-term relative survival compared favourably with survival in the general Swedish population. Adding coronary artery bypass surgery to an aortic valve replacement procedure did not affect long-term outcome.

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