Extracorporeal circulation (ECC) constitutes a supreme tool for heart surgery allowing the surgeon to work on a secure surgical field by bypassing the cardiopulmonary system. However, pathophysiological hemodynamic changes occur from the use of the heart-lung device that regulates the venous return, cardiac output and oxygenation of blood. This condition is well described as 'surgical hypothermic controlled shock', or in cases of severe hypothermia, the term 'total arrest' is used to denote the lowest level of preservation that the body tolerates with respect to its metabolic needs. Hemodynamic Changes During ECCSignificant changes in homoeostasis occur at the very beginning of ECC as systemic vasodilatation prevails in order to maintain proper blood flow within vital organs. Additionally, the administration of heparin potentiates this vasodilatory effect. Following the establishment of hypothermia (moderate hypothermia, down to 25°C, or severe hypothermia, down to 18°C), the peripheral resistance increases because of severe vasoconstriction. During this phase, the metabolic profile changes because of the decreased metabolic demands of the organism. In general, it is believed that at a temperature of 29-30°C within approximately 130 min of ECC, the energy loss is approximately 330 KJ in a 75-to 90-kg patient (Pacifico et al. 1970 ABSTRACT. The aim of this article was to provide a comprehensive review of current knowledge regarding ocular hemodynamic alterations affecting the retinal neuroglial cells and optic nerve head (ONH) function during cardiac surgery. Literature indicates that visual loss after heart surgery is a rare but devastating complication provoked by two main causes of optic ischaemia and infarction during on-pump cardiac procedures: microembolism and ⁄ or hypoperfusion.Retinal ischaemia and ischaemic optic neuropathy are two possible major consequences of extracorporeal circulation in cardiac surgery. The hemodynamic modifications within the vascular beds of retina and ONH during cardiovascular operations have been incompletely studied. Consequently, it is of great interest to investigate the hemodynamic changes during cardiopulmonary bypass within the choroidal, retinal and optic nerve microcirculations as well as other potential causes of vaso-occlusion. Maintaining stable hemodynamic parameters during cardiovascular surgery seems to be the key to prevent visual impairment.

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Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atrium. We report an unusual case of cor triatriatum in a 33 - year old woman presented with congestive heart failure caused by left ventricular systolic dysfunction.

The prediction of intensive care unit length of stay (ICU-LOS) could contribute to more efficient ICU resources' allocation and better planning of care among cardiac surgery patients. The aim of this study was to identify the preoperative and intraoperative predictors for prolonged cardiac surgery ICU-LOS. An observational cohort study was conducted among 150 consecutive patients, who were admitted to the cardiac surgery ICU of a tertiary hospital of Athens, Greece from September 2010 to January 2011. Multivariate regression analysis revealed that patients with increased creatinine levels preoperatively (odds ratio (OR) 3.0, P = 0.049), history of atrial fibrillation (AF) (OR 6.3, P = 0.012) and high EuroSCORE values (OR 2.6, P = 0.017) had a significant greater probability to stay in the ICU for more than 2 days. In addition, intraoperative hyperglycemia (OR 3.0, P = 0.004) was strongly associated with longer ICU-LOS. In conclusion, the high perioperative risk, the history of AF and renal dysfunction, and the intraoperative hyperglycemia are significant predictors of prolonged ICU stay. The early identification of patients at risk could allow the efficient ICU resources' allocation and the reduction of healthcare costs. This would contribute to nursing care planning depending on the availability of healthcare personnel and ICU bed capacity.

Increased level of NWL, patient perioperative risk and ICU-LOS are closely associated with increased in-hospital mortality of cardiac surgery patients. The correlation between NWL and mortality represents the strong link of the nursing profession with the improvement of the effectiveness and quality of care.