Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Isolated High Lactate or Low Central Venous Oxygen Saturation After Cardiac Surgery and Association with Outcome.
To determine if isolated abnormally low central venous oxygen saturation (ScvO2) or elevated lactate levels on admission to an intensive care unit (ICU) are associated with increased morbidity and length of stay (LOS) after cardiac surgery. ⋯ Low ScvO2 with normal lactate or moderately elevated lactate with normal ScvO2 upon ICU admission after cardiac surgery was not associated with increased morbidity or length of stay. Markedly elevated lactate levels in the setting of a normal ScvO2 was associated with significantly higher incidence of major complications and prolonged length of stay. Additionally, a lactate level ≥ 4 mmol/L was an independent predictor of major complications.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Randomized Controlled Trial Comparative StudyReversal of Decreases in Cerebral Saturation in High-risk Cardiac Surgery.
To measure the incidence of cerebral desaturation during high-risk cardiac surgery and to evaluate strategies to reverse cerebral desaturation. ⋯ Cerebral desaturation in high-risk cardiac surgery is frequent but can be reversed most of the time resulting in a smaller desaturation load. A large randomized study will be needed to measure the impact of reversing cerebral desaturation on patient's outcome.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
ReviewPerioperative Conduction Disturbances after Transcatheter Aortic Valve Replacement.
Cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) are common and important. The risk factors and outcome effects of atrial fibrillation after TAVR recently have been appreciated. The paucity of clinical trials has resulted in the absence of clinical guidelines for the management of this important arrhythmia in this high-risk patient population. ⋯ The current evidence base has described the incidence, risk factors, and current outcomes of this conduction disturbance in detail. As the practice of TAVR evolves and novel valve prostheses are developed, a focus on minimizing damage to the cardiac conductive system remains paramount. It remains to be seen how the next generation of TAVR prostheses will affect the incidence, risk factors, and clinical outcomes of associated conduction disturbances.
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J. Cardiothorac. Vasc. Anesth. · Dec 2013
Ability of the Third-Generation FloTrac/Vigileo Software to Track Changes in Cardiac Output in Cardiac Surgery Patients: A Polar Plot Approach.
To evaluate the ability of the third-generation (3.01) of FloTrac/Vigileo monitor (Edwards Lifesciences, Irvine, CA) to follow variations in cardiac output (∆CO) using the new polar plot approach. ⋯ Third-generation FloTrac/Vigileo software still lacks the accuracy to reliably detect changes in cardiac output (∆CO) in cardiac surgery. Improvements to FloTrac/Vigileo CO algorithm and software still are needed in this particular setting.