P-34 Intraoperative intracardiac echocardiography (ICE) during CABG surgery – A case report Sascha Treskatsch 1 , Torsten Geyer 1 , Herko Grubitzsch 2 , Pascal Dohmen 2 , Michael Sander 1 1 Charité - Universitätsmedizin Berlin, Department of Anesthesiol- ogy and Intensive Care Medicine, 2 Charité - Universitätsmedizin, Department of Cardiovascular Surgery Introduction. Today, in case of severe perioperative hemody- namic instability a multiplane transeosophageal echocardiogra- phy (TOE) is recommended to determine underlying pathophysiological causes, e.g. hypovolaemia, reduced myocar- dial contractility [1, 2]. However, there exist some contraindica- tions to TEE insertion, e.g. eosophageal pathology, and an intraoperative transthoracic approach (TTE) is mostly impossible. Therefore, we here present our first experience of intraoperative ICE usage. Methods & Results. A 72-year old man suffering a 2-vessel coronary artery disease was schedulded for elective CABG surgery. He presented with a reduced left ventricular ejection fraction (LVEF 45%) and had previous eosophageal surgery due to cancer. After uncomplicated induction of general anaesthesia a 9 French introducer was inserted in the right internal jugular vein. The ICE probe (AccuNavs, 8 French) was covered with a sterile plastic sheet, which is normally used for pulmonary artery catheter, and then inserted via the introducer. The plastic sheet was connected to the retainer of the introducer. It was thus possible to advance, withdraw or rotate the probe in an absolute sterile manner. Finally, the probe was connected to a standard echocardiographic hardware system. With this approach we were able to qualitatively estimate a) filling and global contrac- tility of both ventricles, b) the mitral valve, c) the aortic valve [3], d) the tricuspid valve and e) the pulmonary valve. Self-limitating rhythm disturbances when advancing the probe into the right ventricle for evaluation of the left ventricle and the subvalvular apparatus of the mitral valve were the only recognised ICE related side effects. Conclusion. Intraoperative ICE was feasible during CABG sur- gery. Biventricular function and all valves could be qualitatively examined. ICE thus seems to be an useful alternative in situations where TOE and TTE are impractical. REFERENCES 1. Cheitlin et al: JASE 16(10):1091-1110, 2003 2. Kristensen et al: Eur J Anaesthesiol 2014 3. Bartel at al: JASE 24(9):966-975, 2011. P-35 The effects of epicardial high-intensity focused ultrasound and conventional cryoablation for maze -procedures on the postoperative time course of high sensitive troponin T Matthias Heringlake 1 , Johann Bremer 1 , Astrid Berggreen 1 , Efstratios Charitos 2 , Thorsten Hanke 2 , Hauke Paarmann 1 1 Departments of Anesthesiology, University of Luebeck, Lue- beck, Germany., 2 Thoracic Vascular and Cardiac Surgery, Uni- versity of Luebeck, Luebeck, Germany. Background & Aim. Previous work has shown increased myo- cardial necrosis markers after cryoablation MAZE procedures (CRYO) [1]. Sparse data are available about the time course of troponin following surgical treatment of atrial fibrillation by epicardial high-intensity focused ultrasound (HIFU) [2]. Methods. Sixty-two patients were analyzed retrospectively (CRYO: n¼17; HIFU: n¼11; matched controls (CON): n¼34). Plasma levels of high-sensitive troponin (hsTNT) were deter- mined preoperatively, immediately after surgery, and on the morning of the first to third postoperative day. Data were analyzed non-parametrically. Results. Demographics and surgical core data (duration of surgery, cardiopulmonary bypass, and crossclamp time) revealed no significant differences between groups. Patients treated with CRYO more frequently underwent mitral surgery in comparison with the HIFU group that more often received aortic valve replacement. Additionally, CRYO-patients had a lower preoperative estimated glomerular filtration rate than HIFU and CON patients. Postoperative HsTNT levels showed a peak on the morning after surgery, decreased thereafter and were always significantly higher in the CRYO- in comparison with the CON-group. Immediately after surgery, hsTNT levels in the HIFU-group were also higher than in the CON-group. No further differences in hsTNT levels were observed between the HFU and the CON-group. Conclusions. Taking into account the small sample size, differences in surgical procedures, and preoperative renal function, the present study suggests that HIFU is associated with lower troponin levels than conventional CRYO in patients undergoing MAZE procedures. However, also HIFU may lead to higher than normal troponin levels immediately after surgery. REFERENCES 1. Martinez-Comendador J et al: Cryoablation of atrial fibrilla- tion in cardiac surgery: outcomes and myocardial injury biomar- kers. J Cardiothorac Vasc Anesth 25:1030-1035, 2011. 2. Groh MA et al: Epicardial ultrasonic ablation of atrial fibrillation during concomitant cardiac surgery is a valid option in patients with ischemic heart disease. Circulation. 118(14 Suppl):S78-S82, 2008. P-36 Evidence of staphylococcal exposure following angiography being responsible for increased anti-staphylococcal antibo- dies in cardiac surgical patients Sarka Moravcova 1 , Bonnie Kyle 2 , Thomas Treibel 2 , Andrew Smith 2 , Patricia Colques-Navarro 3 , Roland Molby 3 , Colin Hamilton-Davies 2 1 Royal Brompton & Harefield NHS Trust, London, UK, 2 UCL Hospitals, London, UK, 3 Karolinska Institute, Stockholm, Sweden Background & Aim. Cardiac surgery patients have greater levels of anti-staphylococcal antibodies compared with healthy volunteers (1).This study examines if staphylococcal exposure occurs during angiography. Method. Following institutional consent, patients scheduled for coronary angiography had blood (7ml) taken and serum stored. A sample was taken at four weeks to allow measurement of response to antigenic stimulation. Serum was analysed by ELISA assays for IgG class of endotoxin core antibodies (EndoCab) and staphylococcal antibodies. POSTER PRESENTATIONS S78