Perioperative Management
All procedures were conducted under general anesthesia, according to standard practice, using Midazolam, Propofol or Etomidate, plus Fentanyl, Sufentanil or Remifentanil for induction. Neuromuscular block was achieved with induction bolus and continuous infusion of Cisatracurium. Anesthesia was maintained by total intravenous infusion of Propofol and Sufentanil tailored to achieve a BIS value index between 30-50. Intraoperative care, including Cardio-Pulmonary Bypass (CPB), was managed within standard practice, thus including One Lung Ventilation techniques as needed during surgery, ultrasound-guided vascular cannulation, mild hypothermic with indirect anterograde cardioplegia, and glycemic control and blood transfusions as needed by the patient.Upon completion of surgery, all patients were transferred to cardio-surgical intensive care unit (ICU) for monitoring, respiratory weaning, and standard post-operative management. Sedation was maintained by Propofol infusion as deemed necessary by on-duty intensivist.