Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Case ReportsEarly Prosthetic Valve Malfunction Leading to Cardiogenic Shock and Emergency Redo Mitral Valve Replacement.
Early onset prosthetic valve stenosis is an uncommon complication after valve replacement surgery and is often caused by thrombus formation. Frequently it can be diagnosed by echocardiography and managed with optimizing anticoagulation and/or thrombolysis. ⋯ This case demonstrates how the leaflet orientation of a BMHV affects transmitral flow and fluid dynamics. Furthermore, we also discuss left atrial vortex formation in the setting of atrial fibrillation, kinetic energy transfer through an anatomically implanted mechanical mitral valve, and their roles in contributing to early prosthetic valve thrombosis despite adequate anticoagulation.
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Predictors of Increased Length of Hospital Stay in Patients with Severe Cardiomyopathy Undergoing Coronary Artery Bypass Grafting.
Predictors of operative outcome in patients with severely depressed left ventricular ejection fraction (LVEF) undergoing coronary artery bypass grafting (CABG) remain poorly defined. This study aims to identify preoperative variables that are associated with increased postoperative length of hospital stay or operative mortality in this patient population. ⋯ More than half of patients with severely depressed LVEF undergoing isolated CABG are able to be discharged within 7 days postoperatively. The absence of preoperative beta-blockers, low preoperative albumin levels, and higher Society of Thoracic Surgeons Predicted Risk of Mortality score are associated with more complicated or slower postoperative recovery after CABG in this patient population.
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Validation Study of the Transfusion Risk and Clinical Knowledge (TRACK) Tool in Cardiac Surgery Patients: A Retrospective Analysis.
The Transfusion Risk and Clinical Knowledge (TRACK) scoring system has been developed for predicting perioperative blood transfusions. However, the TRACK score needs to be validated externally in the US population. The primary objective of this study is to validate TRACK at the authors' institution. ⋯ This study demonstrates the validity of the TRACK score in predicting blood perioperative transfusions in cardiac surgery patients at the authors' institution. This study supports the external validity of TRACK and adds to its clinical utility by establishing cutoff scores for identifying patients at high risk of transfusion.
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Predicting the Number of Edge-to-Edge Repair Devices Needed to Adequately Treat Mitral Regurgitation Using Transesophageal Echocardiography.
Increased utilization and highly variable costs seen with percutaneous mitral valve edge-to-edge repair have made cost cutting strategies of significant interest. Mitral regurgitation etiology, the number of devices used, and experience all play a role in variability. Currently a paucity of data exists in predicting the number of devices. Any associations found between echocardiography parameters and the number of devices used could help with pre-procedure planning and device placement strategies, ultimately reducing variability and costs. ⋯ The 3D parameters of interest were not associated with the use of multiple devices, but the mitral valve area was associated. Further studies are needed to determine if this relationship is predictive.
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Echocardiographic Predictors of Tricuspid Ring Annuloplasty Repair Failure for Functional Tricuspid Regurgitation.
Significant tricuspid regurgitation (TR) recurs after tricuspid valve repair of functional TR in 15% to 20% within the first year, and 30% to 70% within 5 years. Prior investigations report leaflet tethering, and not tricuspid valve annular diameter (TVAD), as predictive of recurrent TR. The authors hypothesize that pre-repair TVAD is predictive of repair failure for functional TR. ⋯ For patients with functional TR undergoing primary left heart surgery, preoperative TVAD (systole and diastole), RV width, and postoperative RV function were predictors of repair outcome. Earlier TV repair and optimizing right heart function may improve repair outcome.