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Seppelt PC, Mas-Peiro S, Van Linden A, Iken S, Zacharowski K, Walther T, Fichtlscherer S, Vasa-Nicotera M. Cerebral oxygen saturation as outcome predictor after transfemoral transcatheter aortic valve implantation. Clin Res Cardiol 2022; 111:955-965. [PMID: 35505123 PMCID: PMC9334442 DOI: 10.1007/s00392-022-02019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/31/2022] [Indexed: 12/24/2022]
Abstract
Background Cerebral oxygen saturation (ScO2) can be measured non-invasively by near-infrared spectroscopy (NIRS) and correlates with cerebral perfusion. We investigated cerebral saturation during transfemoral transcatheter aortic valve implantation (TAVI) and its impact on outcome. Methods and results Cerebral oxygenation was measured continuously by NIRS in 173 analgo-sedated patients during transfemoral TAVI (female 47%, mean age 81 years) with self-expanding (39%) and balloon-expanding valves (61%). We investigated the periprocedural dynamics of cerebral oxygenation. Mean ScO2 at baseline without oxygen supply was 60%. During rapid ventricular pacing, ScO2 dropped significantly (before 64% vs. after 55%, p < 0.001). ScO2 at baseline correlated positively with baseline left-ventricular ejection fraction (0.230, p < 0.006) and hemoglobin (0.327, p < 0.001), and inversely with EuroSCORE-II ( − 0.285, p < 0.001) and length of in-hospital stay ( − 0.229, p < 0.01). Patients with ScO2 < 56% despite oxygen supply at baseline had impaired 1 year survival (log-rank test p < 0.01) and prolonged in-hospital stay (p = 0.03). Furthermore, baseline ScO2 was found to be a predictor for 1 year survival independent of age and sex (multivariable adjusted Cox regression, p = 0.020, hazard ratio (HR 0.94, 95% CI 0.90–0.99) and independent of overall perioperative risk estimated by EuroSCORE-II and hemoglobin (p = 0.03, HR 0.95, 95% CI 0.91–0.99). Conclusions Low baseline ScO2 not responding to oxygen supply might act as a surrogate for impaired cardiopulmonary function and is associated with worse 1 year survival and prolonged in-hospital stay after transfemoral TAVI. ScO2 monitoring is an easy to implement diagnostic tool to screen patients at risk with a potential preserved recovery and worse outcome after TAVI. Graphical abstract ![]()
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Affiliation(s)
- Philipp C Seppelt
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany. .,DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany.
| | - Silvia Mas-Peiro
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
| | - Arnaud Van Linden
- DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany.,Department of Cardiothoracic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Sonja Iken
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Thomas Walther
- DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany.,Department of Cardiothoracic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
| | - Mariuca Vasa-Nicotera
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,DZHK Partner Site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
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Bérubé B, Boidin M, Gayda M, Vincent T, Tremblay J, Juneau M, Nigam A, Bherer L. Acute effects of exercise on cerebrovascular response and cognitive performance in individuals with stable coronary heart disease. Brain Res 2021; 1772:147671. [PMID: 34606749 DOI: 10.1016/j.brainres.2021.147671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Individuals with coronary heart disease (CHD) exhibit cognitive deficits and cerebrovascular dysfunctions, and are at higher risk of developing dementia. Cognitive function in individuals with CHD has never been studied during acute aerobic exercise. Given the increasing popularity of training at high peak power output (PPO), its impact on cerebrovascular and cognitive functions in individuals with CHD should be further studied. METHOD Thirty-eight individuals with CHD and 16 healthy controls completed two exercise bouts at 30% and 70% of their individualized PPO on an ergocycle while performing a cognitive task including non-executive and executive conditions. Variations of oxy- deoxy-hemoglobin, and total hemoglobin concentrations were measured on left prefrontal cortex at both PPO using near-infrared spectroscopy. RESULTS Cognitive task performances were equivalent between groups at all intensity levels. Individuals with CHD exhibited larger variation of deoxyhemoglobin in the executive condition and larger variation in total hemoglobin concentration in all task conditions compared to healthy controls at 70% of PPO. CONCLUSION Exercising at high intensity seems to have a larger impact on cerebral blood volume in CHD patients compared to healthy age-matched controls. Higher exercise intensity has negative impacts on cerebral blood volume variations during a cognitive task in CHD patients and could potentially lead to other neurocognitive dysfunctions. Other studies are needed to determine if a cognitive task administered during an exercise test could help identify individuals with CHD at higher risk of developing cognitive decline.
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Affiliation(s)
- B Bérubé
- Research Center and Preventive Medicine and Physical Activity Center (EPIC), Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Department of Psychology, Université de Montréal, Montréal, Québec, Canada.
| | - M Boidin
- Research Center and Preventive Medicine and Physical Activity Center (EPIC), Montreal Heart Institute, Montréal, Québec, Canada; School of Kinesiology and Exercise Science, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - M Gayda
- Research Center and Preventive Medicine and Physical Activity Center (EPIC), Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - T Vincent
- Research Center and Preventive Medicine and Physical Activity Center (EPIC), Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - J Tremblay
- School of Kinesiology and Exercise Science, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - M Juneau
- Research Center and Preventive Medicine and Physical Activity Center (EPIC), Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - A Nigam
- Research Center and Preventive Medicine and Physical Activity Center (EPIC), Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - L Bherer
- Research Center and Preventive Medicine and Physical Activity Center (EPIC), Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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Vretzakis G, Georgopoulou S, Stamoulis K, Stamatiou G, Tsakiridis K, Zarogoulidis P, Katsikogianis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Mpakas A, Beleveslis T, Koletas A, Siminelakis SN, Zarogoulidis K. Cerebral oximetry in cardiac anesthesia. J Thorac Dis 2014; 6 Suppl 1:S60-9. [PMID: 24672700 DOI: 10.3978/j.issn.2072-1439.2013.10.22] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 01/27/2023]
Abstract
Cerebral oximetry based on near-infrared spectroscopy (NIRS) is increasingly used during the perioperative period of cardiovascular operations. It is a noninvasive technology that can monitor the regional oxygen saturation of the frontal cortex. Current literature indicates that it can stratify patients preoperatively according their risk. Intraoperatively, it provides continuous information about brain oxygenation and allows the use of brain as sentinel organ indexing overall organ perfusion and injury. This review focuses on the clinical validity and applicability of this monitor for cardiac surgical patients.
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Affiliation(s)
- George Vretzakis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Stauroula Georgopoulou
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Stamoulis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Georgia Stamatiou
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Kosmas Tsakiridis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Paul Zarogoulidis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Katsikogianis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Ioanna Kougioumtzi
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Machairiotis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Theodora Tsiouda
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas Mpakas
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Thomas Beleveslis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Alexander Koletas
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Stavros N Siminelakis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Zarogoulidis
- 1 Anesthesiology Clinic, University Hospital of Larissa, Greece ; 2 Anesthesiology Department, University Hospital of Larisa, Greece ; 3 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece
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