Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2013
Meta AnalysisThe effect of isoflurane on survival and myocardial infarction: a meta-analysis of randomized controlled studies.
The aim of this meta-analysis was to investigate the cardioprotective properties of isoflurane versus any comparator in terms of the rate of myocardial infarction and all-cause mortality. ⋯ Isoflurane reduced mortality in high-quality studies and showed a trend toward a reduction in mortality when it was compared with propofol. No differences in the rates of overall mortality and myocardial infarction were noted.
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J. Cardiothorac. Vasc. Anesth. · Feb 2013
Randomized Controlled TrialLow target sufentanil effect-site concentrations allow early extubation after valve surgery.
To test the ability of low sufentanil effect-site concentrations (Ce) to shorten the time to tracheal extubation after valve surgery. ⋯ Compared with sufentanil Ce of 0.4 ng/mL, lower concentrations (0.2 and 0.3 ng/mL) promoted faster recovery and shorter times to extubation after valve surgery performed under target-controlled propofol infusion.
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J. Cardiothorac. Vasc. Anesth. · Feb 2013
ReviewChallenges after the first decade of transcatheter aortic valve replacement: focus on vascular complications, stroke, and paravalvular leak.
Transcatheter aortic valve replacement (TAVR) is entering its second decade. Three major clinical challenges have emerged from the first decade of experience: vascular complications, stroke, and paravalvular leak (PVL). Major vascular complications remain common and independently predict major bleeding, transfusion, renal failure, and mortality. ⋯ Further emerging management strategies for PVL include a repositionable valve prosthesis and transcatheter plugging. The first decade of TAVR has ushered in a new paradigm for the multidisciplinary management of valvular heart disease. The second decade likely will build on this wave of initial success with further significant innovations.
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J. Cardiothorac. Vasc. Anesth. · Feb 2013
Fibrinogen concentrate therapy in complex cardiac surgery.
Fibrinogen concentrate increasingly is used to treat coagulopathic bleeding in cardiac surgery although its effectiveness and safety have not been shown. The authors conducted a cohort study to quantify the effects of fibrinogen concentrate on postoperative blood loss and transfusion and the occurrence of adverse clinical events in complex cardiac surgery patients. ⋯ Fibrinogen concentrate infusion during surgery did not reduce postoperative blood loss and transfusion, and no increased risk for clinical adverse events was measured. The lower doses and the relatively late intervention with fibrinogen concentrate might have attenuated its hemostatic effect. This study reports the initial clinical use of fibrinogen concentrate in complex cardiac surgery. A randomized clinical trial has been initiated to investigate the hemostatic role of fibrinogen concentrate in cardiac surgery.