Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2013
Multicenter Study Comparative StudyAnesthesia for transfemoral aortic valve replacement in North America and Europe.
The purpose of this study was to determine how the anesthestic approach to transcatheter aortic valve replacement (TAVR) differs in North America and Europe. ⋯ General anesthesia is the predominant practice in North America and only 5% use sedation for TAVR cases, whereas sedation is more common in Europe.
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J. Cardiothorac. Vasc. Anesth. · Feb 2013
ReviewThe year in cardiothoracic and vascular anesthesia: selected highlights from 2012.
Cardiothoracic and vascular critical care has emerged as a subspecialty due to procedural breakthroughs, an aging population, and a multidisciplinary collaboration. This subspecialty now has a dedicated professional society, recently published guidelines, and plans for standardized certification. This paradigm shift represents a major collaboration opportunity for our specialty. ⋯ Major recent trials in comparative effectiveness have challenged the advantages of percutaneous coronary intervention, off-pump coronary artery bypass surgery, and intra-aortic balloon counterpulsation. The year 2012 has witnessed the emergence of new paradigms of care in our specialty with the emphasis on teamwork, safety, and quality. These processes will further improve perioperative outcome.
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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
Comparative StudyFibrinogen concentration significantly decreases after on-pump versus off-pump coronary artery bypass surgery: a systematic point-of-care ROTEM analysis.
Studies have emphasized the importance of normal fibrinogen concentrations in surgical patients. The primary hypothesis of this study was that fibrinogen levels significantly decrease in on-pump coronary artery bypass graft (CABG) surgery versus off-pump coronary artery bypass graft (OPCAB) surgery. The second objective was to show that ROTEM (TEM International, GmbH, Munich, Germany) rapidly detects these abnormalities compared with standard tests. ⋯ Fibrinogen concentration significantly decreases after cardiopulmonary bypass. ROTEM helps in its fast detection.