Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Comparative StudyAnesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of general versus local/regional anesthesia in 125 consecutive patients.
To describe differences in intra- and postoperative care between general (GA) and local/regional anesthesia (LRA) in consecutive high-risk patients with aortic stenosis who underwent transfemoral transcatheter aortic valve implantation (TAVI). ⋯ This observational study suggests that LRA was associated with less intraoperative hemodynamic instability and significant shortening of the procedure and hospital stay. Changes in the anesthetic technique adapted to changes in TAVI interventional techniques and did not increase the rate of postoperative complications.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Clinical TrialAre the point-of-care diagnostics MULTIPLATE and ROTEM valid in the setting of high concentrations of heparin and its reversal with protamine?
To evaluate the in vitro effects of high concentrations of heparin and its reversal with protamine on routine laboratory parameters as well as on modified thromboelastogram (ROTEM; TEM International, Munich, Germany) and impedance aggregometry (MULTIPLATE; Dynabyte, Munich, Germany). ⋯ Neither fibrinogen (Clauss) nor derived fibrinogen or FIBTEM testing is valid in the setting of high concentrations of heparin unless antagonized by heparinase. Reversal of heparin with protamine worsens platelet function at all ratios as detected by aggregometry (MULTIPLATE) and thromboelastography (ROTEM), starting at a 1:1 ratio. Therefore, appropriate coagulation testing under cardiopulmonary bypass conditions should be selected carefully according to heparin levels. In particular, fibrinogen values are falsely low at heparin levels of 2 IU/mL and above. Therefore, newer algorithms promoting the correction of fibrinogen levels on cardiopulmonary bypass should be based on appropriate testing.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Cryoablation of atrial fibrillation in cardiac surgery: outcomes and myocardial injury biomarkers.
Elevations of myocardial injury biomarkers after cardiac surgery without ablation of atrial fibrillation (AF) are related to perioperative myocardial ischemia and associated with an increased risk of mortality and cardiac events. However, there have not been any studies that examined the release of cardiac biomarkers after AF cryoablation procedures with concomitant cardiac surgery. The authors determined the levels of these biomarkers for 2 different procedures involving cryoablation and assessed their clinical implications. ⋯ Cryoablation in cardiac surgery causes the release of very high levels of myocardial injury biomarkers. The modified CM lesion causes a greater elevation of serum biomarker levels than the isolated LA maze procedure, but this increase does not seem to have an adverse effect on rhythm or overall outcome. Cryoablation is a safe and effective surgical treatment for AF.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Relationship between plethysmographic waveform changes and hemodynamic variables in anesthetized, mechanically ventilated patients undergoing continuous cardiac output monitoring.
To assess the relation between photoplethysmographically-derived parameters and invasively-determined hemodynamic variables. ⋯ This study was unable to reproduce the results of prior studies. Only stroke volume and photoplethysmographic width were correlated in this study; however, the correlation and concordance (based on analysis of a 4-quadrant plot) were too weak to be clinically useful. Future studies in patients undergoing low-to-moderate risk surgery may result in improved correlations and clinical utility.