In the division of cardiovascular anaesthesia we provide peri-operative care for adult and paediatric patients undergoing a broad range of cardiovascular procedures. It is a rapidly expanding field as an increasing number of patients with a compromised cardiovascular system are undergoing surgery. Cardiovascular anaesthesiology can involve complex and demanding situations including, high-risk pathologies, long durations of general anesthesia, interventional procedures, open heart surgery and mechanical circulatory support. In addition, we aid our colleagues in managing these patients for anaesthesia for non-cardiac procedures and surgery.

We apply clinical and novel techniques to monitor these patients including peri-operative cardiac imaging, cerebral perfusion and coagulation monitoring. Using up-to-date monitoring devices allows us to protect the heart and the rest of the body during the complex scenario of anaesthesia and related procedures.

We have a growing research team composed of a collaboration of medical professionals, scientists, study nurses, research management and students. We are actively involved in translational and clinical research with the goal of understanding the impact of cardiovascular anaesthesia, reduce the risk of related interventional and surgical procedures and to improve anaesthesia regimens with a high focus on organ protection for a safer and more efficient anaesthesia for the patient.

Transfusion and haemostasis in cardiovascular surgery

Our group’s research focuses on monitoring of perioperative haemostasis with conventional and point-of-care viscoelastic devices. We also aim to identify factors and circumstances that lead to a disturbance of perioperative haemostasis (e.g. plasma fibrinogen deficiency) in the high risk population undergoing different types of cardiovascular interventions and surgeries. Another focus is the reduction of the transfusion rate and early optimization of perioperative coagulation. In this context, we are investigating procedures for supply and delivery of blood and coagulation products. This in in cooperation with Inselspital, Departments of Cardiovascular Surgery, University Institute of Clinical Chemistry, ARTORG Center, University of Bern, and Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.

Perioperative Imaging

Myocardial injury is increasingly recognized as a frequent perioperative complication even in non-cardiac surgery. It is clearly associated with increased postoperative mortality, even though most patients do not experience ischemic symptoms. Anaesthesia in combination with surgical trauma establishes a complex perioperative scenario, which increases cardiovascular risk especially in multimorbid patients. Our group investigates the prevalence of peri-operative myocardial injury and its possible triggers. We have a large focus on the role of hyperoxia as a possible negative trigger. We investigate the association of these triggers not only with long-term post-operative outcomes, but we also research how these potential triggers directly impact cardiac function during general anaesthesia. By applying perioperative transesophageal echocardiographic imaging techniques, including 3D assessments and strain analysis, actual cardiac dysfunction can be monitored and be used to guide anaesthesia management in the hope of avoiding significant adverse outcomes. For these studies we collaborate with clinicians and scientists from the departments of cardiology, cardiac surgery and vascular surgery.

Cardiovascular Magnetic Resonance Imaging (CMR)

MRI is a useful imaging modality for performing an in-depth analysis of the cardiovascular system, and can measure a range of factors including, function, scar, edema, ischemia, and intraventricular haemodynamics using exciting 4D blood flow techniques. We utilize CMR as a diagnostic tool to detect cardiovascular features that may increase a patient’s risk to anaesthesia and to measure cardiovascular responses to anaesthetic stimuli in order to detect if and when the heart is compromised. Specifically, our group optimizes and validates CMR techniques to assess the myocardial oxygenation reserve and translates these techniques to a peri-operative environment to answer anaesthesia related research conundrums. These studies have ranged from in-vitro studies, fundamental assessments, development to translation and application into human studies. This includes undertaking novel research projects involving the induction of general anaesthesia in an MRI for a comprehensive non-invasive imaging assessment of peri-operative cardiovascular responses during this procedure. For these studies we collaborate with the departments of cardiology, radiology as well as multiple national and international research centers.

Blood Glucose Homeostasis during Cardiopulmonary Bypass

Hyperglycemia is a risk factor during surgery that leads to increased patient morbidity. The complex physiology during cardiopulmonary bypass for open heart surgery poses a risk for hyperglycemia not only for patients with diabetes but also for non-diabetic patients. Our group tries to better understand the pathophysiology of glucose homeostasis during cardiopulmonary bypass and to improve glycemic control during cardiac surgery. Our collaborators include clinicians, scientists and perfusionists of the division of visceral surgery and the departments of endocrinology, cardiac- and vascular surgery

Research Group Leaders

Gabor Erdös, Prof. Dr. med. et Dr. phil.
E-Mail: gabor.erdoes@insel.ch
PubMed

Dominik Günsch, PD. Dr. med.
E-Mail: dominik.guensch@insel.ch

 PubMed

Research Group Members

Kady Fischer, PD. Dr. phil.
E-Mail: kady.fischer@STOP-SPAM.insel.ch
PubMed

Sandra Terbeck, Dr. med.
E-Mail: sandra.terbeck@STOP-SPAM.insel.ch

Jan-Oliver Friess, Dr. med.
E-Mail: jan-oliver.friess@STOP-SPAM.insel.ch

PubMed

Daniel Gerber, Dr. med.
E-Mail: daniel.gerber@STOP-SPAM.insel.ch

PubMed

Anja Levis, Dr. med.
E-Mail: anja.levis@insel.ch

PubMed

Catherine Reid, Dr. med.
E-Mail: daniel.gerber@STOP-SPAM.insel.ch

Thilo Schweizer
E-Mail: thilo.schweizer@insel.ch

• NCT02621749: Cerebral Microembolism in the Critically Ill With Acute Kidney Injury (COMET-AKI)
• NCT03802760: Cerebral Microembolism in Cardiology (ZEMEK)
• NCT0480840: Influence of Oxygen on Perioperative Outcome in Patients Undergoing General Anaesthesia for Elective Non-cardiac Surgery (Promise-O2)
• NCT04585854: Effect of Caffeine on Myocardial Oxygenation (Coffee-O2)
• NCT04424433: Myocardial Strain Analysis in Anaesthetized Coronary Artery Disease Patients During Hyperoxia and Normoxaemia (Strecho-O₂)
• NCT04395846: Heart Failure and Preserved Ejection Fraction: Observation of Its Progression and Prognosis (HOPP-BERN)
• NCT04373122: REBOA in Out-of-hospital Cardiac Arrest
• Oxygenation-Sensitive Cardiovascular Magnetic Resonance as a Measure of Microvascular Dysfunction in Coronary Artery Disease (CADOS-II)
• Measuring the Impact of General Anaesthesia Induction on Myocardial Oxygenation in an Intra-Operative MRI-Suite (CADOS-III)
• Study of Heart Injury Observable after Elective External Electrical Cardioversion (SHOCC)

• Fischer K, Kauert-Willms K, Heinisch PP, Kadner A, Jenni H, Eberle B, Gabor E, Guensch DP. Resolution of strain abnormalities during extracorporeal rewarming from accidental hypothermic cardiac arrest following avalanche burial. J Am Coll Cardiol Case Rep. 2021. 3(1), 99-103.
• Guensch DP, Michel MC, Huettenmoser SP, Jung B, Gulac P, Segiser A, Longnus SL, Fischer K. The blood oxygen level dependent (BOLD) effect of in-vitro myoglobin and hemoglobin. Sci Rep. 2021 Jun 1;11(1):11464.

• Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, Rylander C, Wise MP, Oddo M, Cariou A, Bělohlávek J, Hovdenes J, Saxena M, Kirkegaard H, Young PJ, Pelosi P, Storm C, Taccone FS, Joannidis M, Callaway C, Eastwood GM, Morgan MPG, Nordberg P, Erlinge D, Nichol AD, Chew MS, Hollenberg J, Thomas M, Bewley J, Sweet K, Grejs AM, Christensen S, Haenggi M, Levis A, Lundin A, Düring J, Schmidbauer S, Keeble TR, Karamasis GV, Schrag C, Faessler E, Smid O, Otáhal M, Maggiorini M, Wendel Garcia PD, Jaubert P, Cole JM, Solar M, Borgquist O, Leithner C, Abed-Maillard S, Navarra L, Annborn M, Undén J, Brunetti I, Awad A, McGuigan P, Bjørkholt Olsen R, Cassina T, Vignon P, Langeland H, Lange T, Friberg H, Nielsen N; TTM2 Trial Investigators. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2021 Jun 17;384(24):2283-2294. doi: 10.1056/NEJMoa2100591. PMID: 34133859.

• Guensch DP, Tripyla A Fischer K, Vogt A, Bally L. First insights into the performance of the Dexcom G6 Continuous Glucose Monitoring (CGM) system during cardiac surgery using hypothermic extracorporal circulation. Diabetes Obes Metab. 2021. 23(1), 294.

• Fischer K, Neuenschwander MD, Jung C, Hurni S, Winkler BM, Huettenmoser SP, Jung B, Vogt AP, Eberle B, Guensch DP. Assessment of Myocardial Function During Blood Pressure Manipulations Using Feature Tracking Cardiovascular Magnetic Resonance. Frontiers in Cardiovascular Medicine. 2021;8:1353.

• Fischer K, Ranjan R, Friess J-O, Erdoes G, Mikasi J, Baumann R, Schoenhoff FS, Carrel TP, Brugger N, Eberle B, Guensch DP. Study design for a randomized crossover study investigating myocardial strain analysis in patients with coronary artery disease at hyperoxia and normoxemia prior to coronary artery bypass graft surgery (StrECHO-O2). Contemporary Clinical Trials. 2021 Nov 1;110:106567.

• Levis A, Egli N, Jenni H, Hautz WE, Daley JI, Haenggi M. Use of a disposable vascular pressure device to guide balloon inflation of resuscitative endovascular balloon occlusion of the aorta: a bench study. Sci Rep. 2021 Dec 15;11(1):24055. doi: 10.1038/s41598-021-03502-6. PMID: 34912008; PMCID: PMC8674295.

• Fischer K, Guensch DP, Jung B, King I, Von Tengg-Kobligk H, Giannetti N, Eberle B, Friedrich MF. Insights into Myocardial Oxygenation and Cardiovascular Magnetic Resonance Tissue Biomarkers in Heart Failure With Preserved Ejection Fraction. Circ Heart Failure. 2022 ;15:e008903. DOI:10.1161/CIRCHEARTFAILURE.121.008903.

• Spicher B, Fischer K, Zimmerli ZA, Yamaji K, Ueki Y, Bertschinger CN, Jung B, Otsuka T, Bigler MR, Gräni C, von Tengg-Kobligk H, Räber L, Eberle B and Guensch DP. Combined Analysis of Myocardial Deformation and Oxygenation Detects Inducible Ischemia Unmasked by Breathing Maneuvers in Chronic Coronary Syndrome. Front. Cardiovasc. Med. 2022. 9:800720. doi: 10.3389/fcvm.2022.800720