Background/Objectives: Postoperative body temperature abnormalities are common yet underrecognized, and their association with acute kidney injury (AKI) remains unclear. In this study, we aimed to identify early postoperative temperature trajectories and evaluate their associations with AKI. Methods: This retrospective cohort study included 3274 adults undergoing valvular heart surgery with cardiopulmonary bypass. The patients' temperatures were continuously measured using a pulmonary artery catheter for 12 postoperative hours, and temperature trajectories were identified using data-driven latrend class modeling. The primary outcome was severe AKI (KDIGO stage ≥ 2), and the secondary outcome was non-recovery AKI (≥72 h). Multivariable logistic regression and E-value sensitivity analysis were performed. Results: Four distinct temperature trajectories were identified: Class 1 (32.8%), initial normothermia progressing to mild hyperthermia (37.5-38.0 °C); Class 2 (27.4%), mild hypothermia (36.0-36.5 °C) with rapid normalization; Class 3 (24.4%), stable normothermia; and Class 4 (15.4%), lower-range mild hypothermia (35.5-36.0 °C) with delayed recovery. Severe AKI and non-recovery AKI occurred most frequently in Class 4 patients (15.1% vs. 2.9%, 3.9%, and 4.8% in Classes 1-3, p < 0.001; 15.1% vs. 1.7%, 4.0%, and 4.4%, p < 0.001, respectively). After adjusting for key clinical variables, Class 4 remained independently associated with severe AKI (OR 2.44, 95% CI: 1.69-3.57; E-value 4.33) and non-recovery AKI (OR 2.78, 95% CI: 1.89-4.00; E-value 4.97). Conclusions: Early postoperative temperature trajectories were significantly associated with severe AKI, with the highest risks in patients exhibiting lower-range mild hypothermia with delayed recovery. These findings suggest that early postoperative temperature patterns may be useful for risk stratification for severe AKI after cardiac surgery.

PURPOSE:Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions. MATERIALS AND METHODS:Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg). RESULTS:Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve). CONCLUSION:Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

Patients undergoing cardiac surgery are at high risk of severe immediate postoperative complications. Predicting immediate postoperative adverse events remains challenging owing to the complex and nonlinear interplay of numerous risk factors. This study aimed to develop and externally validate a machine-learning (ML) model to predict critical outcomes during the immediate postoperative period after cardiac surgery. Adult patients who underwent cardiac surgery at Seoul National University Hospital (SNUH) between October 2004 and October 2021 were included for model development and internal validation. Thirty-seven preoperative and intraoperative variables were used as model inputs. The primary outcome was a composite of reoperation for bleeding, death, cardiac arrest, and initiation of mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump (IABP) within 24 h after surgery. An extreme gradient boosting (XGBoost) model was developed as the primary model and compared with a least absolute shrinkage and selection operator (LASSO) regularized logistic regression model. An equal-weighted ensemble of the two models was additionally constructed. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC) with 95

OBJECTIVES:Patients undergoing cardiac surgery are at a high risk of developing postoperative delirium (POD), which is associated with increased morbidity and mortality. Neurofilament light chain (NFL), a neuronal cytoplasmic protein, is a marker of axonal injury. We investigated the association between perioperative plasma NFL concentration and POD. DESIGN:A prospective observational study. SETTING:A single institution of a tertiary university hospital PARTICIPANTS: A total of 151 patients aged ≥65 years scheduled for elective cardiac surgery with cardiopulmonary bypass. INTERVENTION:Plasma NFL levels were measured at induction and 6 hours postoperatively. POD was assessed twice daily for 7 days using the Confusion Assessment Method for the ICU or 3-Minute Diagnostic Interview for CAM-defined Delirium depending on intubation. The NFL values were log-transformed. Logistic regression was used to evaluate their associations with POD. Multivariable models were adjusted for preoperative and intraoperative variables. MEASUREMENTS AND MAIN RESULTS:Delirium occurred in 60 (40%) patients. Compared with those without POD, affected patients had higher rates of congestive heart failure, a lower educational status, and a higher incidence of erythrocyte transfusion. Delirium was also associated with complex procedures, prolonged deep anesthesia, and intraoperative burst suppression. Both baseline and postoperative log(NFL) were significantly associated with delirium, whereas perioperative changes in NFL were not. In the multivariable analysis, baseline log(NFL) remained an independent predictor of POD. CONCLUSIONS:Preoperative plasma NFL concentration was associated with POD, whereas changes in NFL were not. Baseline NFL may serve as a clinically useful biomarker for risk stratification in older patients undergoing cardiac surgery.

Background Non-anemic iron deficiency (ID) may be harmful during cardiac surgery with cardiopulmonary bypass. However, its impact on off-pump coronary artery bypass (OPCAB) remains unclear. This study examined the association between non-anemic ID and outcomes following OPCAB. Methods This single-center retrospective study included non-anemic patients who underwent OPCAB between November 2016 and May 2023. Patients were classified by preoperative ID status, defined as serum ferritin < 100 μg/L or 100–300 μg/L with C-reactive protein > 5 mg/L or transferrin saturation < 20%. The risk of primary outcome, defined as the composite of acute kidney injury, permanent stroke, deep sternal wound infection, hemostatic reoperation, prolonged mechanical ventilation, delirium, myocardial infarction, and 30-day mortality, was compared using multivariable logistic regression. Mediation analysis was performed to determine the indirect effects of non-anemic ID via perioperative red blood cell (RBC) transfusion. Results Of the 433 non-anemic patients, 229 (52.9%) had ID. The incidence of composite outcome was similar between patients with and without ID (30.1% vs. 22.5%, P = 0.075). ID was not significantly associated with the composite outcome, whereas perioperative transfusion (odds ratio: 2.10, 95% CI [1.17–3.78], P = 0.013) showed significant associations. Perioperative RBC transfusion was more common in patients with ID (25.8% vs. 10.8%, P < 0.001). Mediation analysis suggested that RBC transfusion partially mediated the effect of ID on the composite outcome. Conclusions Preoperative ID was not associated with adverse outcomes in non-anemic patients who had undergone OPCAB. However, its indirect impact via RBC transfusion warrants further investigation.

BACKGROUND:Increased thrombogenicity prohibits favorable ischemic outcomes in coronary artery disease. This study investigated the association between increased maximal amplitude (MA) on thromboelastography (TEG), which reflects high platelet-fibrin clot strength, and 1-year major adverse cardiovascular events (MACE) in patients who underwent isolated multi-vessel off-pump coronary artery bypass surgery (OPCAB). PATIENTS AND METHODS:Data from 657 patients were retrospectively analyzed. TEG was performed post-anesthesia induction. MACE was defined as cardiovascular death, repeat revascularization, myocardial infarction, stroke, or rehospitalization due to heart failure. Patients were analyzed by tertiles of MA (mm). Logistic regression analyzed the association between 1-year MACE and MA. RESULTS:The incidence of MACE increased with MA tertiles (1st: [<65.0]: 4.6%; 2nd [65.0-70.3]: 9.3%; 3rd [≥70.3]: 13%; p = 0.013). Logistic regression adjusted for known risk factors for MACE revealed an increased risk of MACE with higher MA tertiles (odds ratio [OR]: 1.99 [95% confidence interval {CI}: 0.92-4.55], p = 0.089 for the 2nd tertile; OR 2.78 [95% CI: 1.32-6.28], p = 0.010 for the 3rd tertile). A restricted cubic spline model revealed a linear relationship between MA and 1-year MACE. A 10-mm increase in MA was associated with a two-fold increase in the risk of 1-year MACE. The optimal MA cutoff for predicting MACE was 69.6 (normal range: 50.6-69.4). CONCLUSIONS:Increased thrombogenicity, reflected by elevated MA values, was linearly associated with the occurrence of 1-year MACE, highlighting the need for TEG screening and more aggressive, individualized perioperative anticoagulation management in selected patients with increased MA requiring OPCAB.

Background:The prognostic nutritional index (PNI) has been widely used as a nutritional metric in patients undergoing cardiac surgery because of its ability to incorporate both nutritional and inflammatory statuses. However, while preoperative PNI is well-known for its predictability of outcomes after coronary artery bypass grafting (CABG), the prognostic value of postoperative PNI has rarely been evaluated. This study investigated the changes in postoperative PNI values following off-pump coronary artery bypass (OPCAB) surgery using a trajectory analysis method and analyzed its influence on mortality outcomes. Methods:We retrospectively analyzed the data of 983 patients who underwent OPCAB surgery. PNI values from postoperative days 1, 2, 3, and 1 month was analyzed using the trajectory method, and patients were grouped based on the patterns of change in PNI values. The 1-year and overall mortality rates were compared between PNI trajectory groups. Additionally, multivariable logistic regression analysis was performed to identify independent risk factors for 1-year all-cause mortality, and multivariable Cox regression analysis was conducted for overall mortality. Results:The trajectory analysis categorized patients into two groups: the "PNI-improved group," characterized by a sharp increase in PNI values after surgery, and the "PNI-fixed group," which exhibited minimal changes in PNI values. The PNI-improved group had significantly lower 1-year mortality (1.1% vs. 9.5%, p < 0.001) and overall mortality (16.9% vs. 42.4%, p < 0.001) compared to the PNI-fixed group. Furthermore, the multivariable regression analysis indicated that the PNI trajectory pattern was an independent predictor of 1-year mortality (odds ratio: 7.931, 95% confidence interval [CI]: 3.117-20.180, p < 0.001) and overall mortality (hazard ratio: 2.120, 95% CI: 1.579-2.845, p < 0.001). Conclusions:Patients who exhibited a significant increase in PNI values during the month following OPCAB surgery experienced significantly lower 1-year and overall mortality rates than those with minimal changes in postoperative PNI values. The PNI recovery pattern was identified as an independent predictor of both 1-year and overall mortality after adjusting confounding factors. Recognizing the recovery patterns of postoperative PNI values after OPCAB surgery may be valuable for screening patients at high risk for mortality.

INTRODUCTION:Peri-operative anaemia is a common problem in patients undergoing cardiac surgery. Postoperative anaemia is not well understood relative to pre-operative anaemia; limited data exist on haemoglobin recovery and mortality after discharge, especially in the era of restrictive transfusion practice. We aimed to investigate the associations of pre-operative and persistent postoperative anaemia with 1-year mortality in patients undergoing valvular heart surgery. METHODS:We identified patients who had undergone valvular heart surgery and allocated them to one of four groups based on their pre-operative (haemoglobin ≥ 130 g.l-1 and < 130 g.l-1 in men and ≥ 120 g.l-1 and < 120 g.l-1 in women) and postoperative (measured 2 months after surgery; haemoglobin ≥ 100 g.l-1 and < 100 g.l-1 in both men and women) anaemia status. The four groups were: pre- and postoperative non-anaemia (non-anaemia-non-anaemia); pre-operative anaemia-postoperative non-anaemia (anaemia-non-anaemia); pre- and postoperative anaemia (anaemia-anaemia); and pre-operative non-anaemia-postoperative anaemia (non-anaemia-anaemia). The primary outcome was 1-year mortality. RESULTS:Data from 2486 patients were included. Pre-operative anaemia was diagnosed in 1107 patients (44.5%) and 279 (11.9%) met the diagnostic criteria for persistent anaemia 2 months postoperatively. The overall 1-year mortality rate was 3.3%. The highest rate was observed in the anaemia-anaemia group (17.8%), followed by the non-anaemia-anaemia (13.1%), anaemia-non-anaemia (2.9%) and non-anaemia-non-anaemia (0.5%) groups. Multivariable Cox regression analysis showed that the non-anaemia-anaemia group had the highest risk of 1-year mortality (adjusted hazard ratio 14.44, 95%CI 4.88-42.69), followed by the anaemia-anaemia group (adjusted hazard ratio 10.94, 95%CI 4.41-27.16). DISCUSSION:Our study highlights the high prevalence of persistent anaemia following valvular heart surgery. Persistent anaemia 2 months postoperatively is associated with an increased risk of 1-year mortality.

Objectives: To investigate the association of comprehensive geriatric assessment (related to diverse aspects of frailty) with postoperative recovery as measured by days alive and out of the hospital at 30 days (DAOH30) in older patients undergoing cardiac surgery. Design: Retrospective observational study using data retrieved from a prospective registry. Setting: Single tertiary hospital in South Korea. Participants: A total of 437 patients aged >65 years who underwent cardiac surgery between March 2021 and October 2022 were included. Measurements: Comprehensive geriatric assessment included subjective evaluations of functional frailty (cognitive, emotional, and physical aspects) and objective measurements of malnutrition and anaemia. DAOH30 was analysed using multivariable quantile regression to evaluate its association with these three domains. Results: In the entire cohort (median age 72 years; median DAOH30, 19 days), 85.1% of participants had functional frailty, 9.8% had malnutrition, and 45.8% had anaemia. Older age, cognitive dysfunction, emotional dysregulation, physical decline, malnutrition, and anaemia were associated with shorter DAOH30 (all p < 0.05). In multivariable analysis, malnutrition had the strongest impact, reducing DAOH30 by 6.0 days (95% confidence interval [CI]:-11.103 to-0.263), followed by anaemia (1.2 days, 95% CI:-2.199 to-0.148) and functional frailty (1.0 days, 95% CI:-1.677 to-0.171). Individual components of functional frailty did not retain an independently significant relationship with DAOH30 after adjustment for confounders. Conclusion: Comprehensive geriatric assessment, incorporating functional frailty, malnutrition, and anaemia, demonstrated a significant association with DAOH30 in older patients undergoing cardiac surgery. Among the assessed aspects, malnutrition showed the strongest association, which may underscore the importance of targeted nutritional interventions to improve outcomes in this patient population. (c) 2025 Published by Elsevier Masson SAS on behalf of SERDI Publisher. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Acute kidney injury frequently occurs after cardiac surgery, and is primarily attributed to renal ischemia-reperfusion (I/R) injury and inflammation from surgery and cardiopulmonary bypass. Vitamin C, an antioxidant that is often depleted in critically ill patients, could potentially mitigate I/R-induced oxidative stress at high doses. We investigated the effectiveness of high-dose vitamin C in preventing I/R-induced renal injury. The ideal time and optimal dosage for administration were determined in a two-phase experiment on Sprague–Dawley rats. The rats were assigned to four groups: sham, IRC (I/R + saline), and pre- and post-vitC (vitamin C before and after I/R, respectively), with vitamin C administered at 200 mg/kg. Additional groups were examined for dose modification based on the optimal timing determined: V100, V200, and V300 (100, 200, and 300 mg/kg, respectively). Renal I/R was achieved through 45 min of ischemia followed by 24 h of reperfusion. Vitamin C administration during reperfusion significantly reduced renal dysfunction and tubular damage, more than pre-ischemic administration. Doses of 100 and 200 mg/kg during reperfusion reduced oxidative stress markers, including myeloperoxidase and inflammatory responses by decreasing high mobility group box 1 release and nucleotide-binding and oligomerization domain-like receptor 3 inflammasome. Overall beneficial effect was most prominent with 200 mg/kg. The 300 mg/kg dose, however, showed no additional benefits over the IRC group regarding serum blood urea nitrogen and creatinine levels and histological evaluation. During reperfusion, high-dose vitamin C administration (200 mg/kg) significantly decreased renal I/R injury by effectively attenuating the major triggers of oxidative stress and inflammation.

Introduction: Existing risk-scoring systems for cardiac surgery include only standard preoperative factors without considering nutritional and inflammatory status or intraoperative factors. The objective of this study was to develop a comprehensive prediction model for mortality incorporating nutritional, inflammatory, and perioperative factors in patients undergoing valvular heart surgery.Materials and methods: In this retrospective review of 2046 patients who underwent valvular heart surgery, Cox and LASSO regression analyses were performed to identify independent prognostic factors for 1-year postoperative mortality among various perioperative factors known to affect prognosis, including objective nutritional and inflammatory indices. A novel nomogram model incorporating selected prognostic factors was developed, and its discrimination ability was evaluated using the C-index. The model was validated in internal and external cohorts.Results: The 1-year mortality rate after valvular heart surgery was 5.1% (105 of 2046 patients) and was significantly associated with several preoperative objective inflammatory and nutritional indices. Cox and LASSO analyses identified the following five independent prognostic factors for mortality: monocyte-to-lymphocyte ratio (an objective inflammatory index), EuroSCORE II, Controlling Nutritional Status score, cardiopulmonary bypass time, and number of erythrocyte units transfused intraoperatively. The nomogram model incorporating these five factors had a C-index of 0.834 (95% CI: 0.791-0.877), which was higher than that of EuroSCORE II alone (0.744, 95% CI: 0.697-0.791) (P<0.001). The nomogram achieved good discrimination ability, with C-indices of 0.836 (95% CI: 0.790-0.878) and 0.727 (95% CI: 0.651-0.803) in the internal and external validation cohorts, respectively, and showed well-fitted calibration curves.Conclusions: A nomogram model incorporating five inflammatory, nutritional, and perioperative factors, as well as EuroSCORE II, was a better predictor of 1-year mortality after valvular heart surgery than EuroSCORE II alone, with good discrimination and calibration power for predicting mortality in both internal and external validation cohorts.

This study aimed to investigate the association between acute kidney injury (AKI) recovery subtypes and days alive out of hospital within the first 3 months (DAOH-90) in patients undergoing lung transplantation. Patients who underwent lung transplantation from January 2012 to December 2021 were retrospectively analyzed and stratified into three groups: no-AKI, early recovery AKI (within 7 days), and non-early recovery AKI group. AKI occurred in 86 (35%) of patients, of which 40 (16%) achieved early recovery, and the remaining 46 (19%) did not. The median DAOH-90 was 21 days shorter in the AKI than in the no-AKI (P = 0.002), and 29 days shorter in the non-early recovery AKI group than in the no-AKI group (P < 0.001). Non-early recovery AKI and preoperative tracheostomy status were independently associated with shorter DAOH-90. The prevalence of CKD (76%), and 1-year mortality (48%) were highest in the non-early recovery AKI group. Postoperative AKI was associated with an adverse patient-centered quality measure for perioperative care, and shorter DAOH-90. The non-early recovery AKI group exhibited the worst prognosis in terms of DAOH-90, CKD progression, and 1-year mortality, highlighting the important role of AKI and early-recovery AKI on both the quality of life and clinical outcomes after lung transplantation.

Purpose The integrity of the endothelial glycocalyx (EG), a critical player in vascular homeostasis, reportedly influences the outcomes of critically ill patients. We investigated the effect of 5% albumin, which preserved EG integrity in preclinical studies, vs balanced crystalloid solution on EG degradation in patients undergoing off-pump coronary surgery. Methods Patients were randomized to receive either 5% albumin ( N = 51) or balanced crystalloid solution (Plasma-Lyte [Baxter Incorporated, Seoul, Republic of Korea]; N = 53) for intravenous volume replacement during surgery (double-blinded). The primary outcome was plasma syndecan-1 concentration, a marker of EG degradation, measured after anesthetic induction (baseline), completion of grafting, and sternal closure. Secondary outcomes were atrial natriuretic peptide (ANP), tumour necrosis factor (TNF)-α, soluble thrombomodulin, and perioperative fluid balance. Results The mean (standard deviation) fluid requirements were 833 (270) mL and 1,323 (492) mL in the albumin and Plasma-Lyte group, respectively (mean difference, −489 mL; 95% confidence interval [CI], −643 to −335; P < 0.001). Plasma syndecan-1 concentration increased after completion of grafting (median difference, 116 ng·mL −1 ; 95% CI, 67 to 184; P < 0.001) and sternal closure (median difference, 57 ng·mL −1 ; 95% CI, 36 to 80; P < 0.001) compared with those at baseline, without any intergroup differences. Atrial natriuretic peptide, TNF-α, and soluble thrombomodulin concentrations were similar between the two groups. The amount of chest tube drainage was greater in the albumin group than that in the Plasma-Lyte group (median difference, 190 mL; 95% CI, 18 to 276; P = 0.03). Conclusion Off-pump coronary surgery was associated with significant EG degradation. Yet, intraoperative fluid therapy with 5% albumin could not ameliorate EG degradation when compared with balanced crystalloid solution. Trial registration ClinicalTrials.gov (NCT03699462); first posted 9 October 2018.

BACKGROUND:Acute renal dysfunction is defined by the maximum increase in serum creatinine (sCr) without considering the pattern of change in sCr. We aimed to identify longitudinal patterns (trajectories) of postoperative sCr concentrations and investigate their association with long-term outcomes in patients undergoing valvular heart surgery. MATERIALS AND METHODS:In this retrospective review of 3436 patients who underwent valvular heart surgery, we applied trajectory projection cluster analysis to identify the trajectories of sCr changes from baseline during the 7 postoperative days. Primary and secondary endpoints were to investigate the associations of sCr trajectories with mortality using Kaplan-Meier curves and Cox proportional hazards regression analysis and a composite of major adverse kidney events (MAKEs) at 1 year after surgery, respectively. RESULTS:Four clusters were identified: Clusters 1 and 2, a minimal change in sCr (90.1% of patients); Cluster 3, a significant and persistent increase in sCr (4.1% of patients); and Cluster 4, a significant but transient increase in sCr (5.8% of patients). The 1-year postoperative mortality rate was higher in Cluster 3 (18.4%) and Cluster 4 (11.6%) than in Cluster 1+2 (2.7%). The Kaplan-Meier survival curve demonstrated significant differences in mortality rates among the clusters (log-rank test, P <0.001). In the multivariable Cox analysis, the sCr trajectory cluster was an independent prognostic factor for mortality. Cluster 3 had a higher prevalence of MAKEs (37.6%) compared with Cluster 1+2 (6.8%, P <0.001) and Cluster 4 (24.1%, P =0.045). The cluster was an independent prognostic factor for MAKEs. CONCLUSION:The sCr trajectory clusters exhibited significantly different risks of mortality and MAKEs 1 year after surgery. Through these sCr trajectories, we confirmed that both the extent of sCr increase and its sustainability during the first 7 postoperative days were closely associated with the long-term prognosis after valvular heart surgery.

Background: Patients undergoing cardiac surgery for infective endocarditis (IE) are at a high risk of postoperative acute kidney injury (AKI) owing to heightened systemic inflammation. Therefore, we aimed to investigate the effect of dexmedetomidine on postoperative AKI in patients who underwent cardiac surgery for IE. Methods: A total of 63 patients who underwent cardiac surgery for IE were randomly assigned to receive either intravenous dexmedetomidine infusion of 0.4 m g kg(-1) h(-1) (DEX group) or normal saline infusion (control group) for 24 h after induction of anesthesia. The occurrence of AKI within seven days post- operation, epinephrine, norepinephrine, and interleukin-6 levels, as well as postoperative morbidities, were assessed. An intertrim analysis was conducted using Pocock's alpha spending function at a = 0.05 and b = 0.2. Results: This trial was early terminated according to the results of interim analysis performed when 60 % of the pre-set number of patients have been collected. The incidence of AKI was significantly lower in the DEX group than in the control group (32.3 % vs. 9.4 %, p = 0.025). Patients in the DEX group had significantly lower epinephrine levels than those in the control group, whereas norepinephrine and interleukin-6 levels were similar. Perioperative mean arterial pressure or heart rate did not differ between the groups. Conclusions: Dexmedetomidine administration for 24 h starting from induction of anesthesia significantly reduced the incidence of postoperative AKI after cardiac surgery for IE (by 29 % vs. control) without hemodynamic side effects. This was accompanied by a significant attenuation of postoperative increase in serum epinephrine levels.

The perioperative milieu following curative lung cancer surgery is accompanied by a stress response. Inflammasomes mediate inflammation resulting in the unfavorable immunomodulation of natural killer (NK) cell activity, thus promoting cancer progression. This study aimed to investigate the effects of dexmedetomidine (DEX) on the innate immune system, chronic inflammation, and lung cancer progression in a clinically relevant human-to-mouse xenograft model. The human lung cancer cell line A549-luc was subcutaneously injected into BALB/c nude mice. Saline or dexmedetomidine was administered for 2 weeks via an implanted osmotic minipump. After 4 weeks, the tumor size and weight were measured. NK cell activity, serum interferon-γ, interleukin (IL)-1β and tumor necrosis factor (TNF)-α levels were also measured. IL-10, IL-18, and inflammasome expression levels were assessed in the tumor tissues. DEX caused a decrease in tumor size, tumor weight, and IL-1β and TNF-α levels and an increase in NK cell activity and IFN-γ level. IL-10 and IL-18 expression was significantly decreased in the DEX-treated group. NLRP3, CTP1A, TXNIP, ASC, IL-1β, and caspase-1 protein levels were decreased in the DEX-treated group. In conclusion, the use of DEX for 2 weeks inhibited lung cancer progression by suppressing inflammasome- and IL-1β signaling-induced inflammation and enhancing NK cell activity.