Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2019
ReviewSociety of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.
Postoperative atrial fibrillation (poAF) is the most common adverse event after cardiac surgery and is associated with increased morbidity, mortality, and increased hospital and intensive care unit length of stay. Despite progressive improvements in overall cardiac surgical operative mortality and postoperative morbidity, the incidence of poAF has remained unchanged at 30% to 50%. A number of evidence-based recommendations regarding the perioperative management of atrial fibrillation (AF) have been released from leading cardiovascular societies in recent years; however, it is unknown how closely these guidelines are being followed by medical practitioners. ⋯ Finally, given that no evidence-based threshold currently exists to differentiate patients at normal risk of developing poAF from those at elevated risk, the SCA/EACTA AF working group created a list of poAF risk factors using expert opinion, based on published risk score models for poAF. This allows stratification of patients into risk groups and facilitates adherence to the evidence-based recommendations summarized in the graphical advisory tool. It is the working group's hope that these new additions to the clinical toolkit for management of perioperative AF will improve the evidence-based care and outcomes of cardiac surgical patients worldwide.
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J. Cardiothorac. Vasc. Anesth. · Jan 2019
Observational StudyExtracorporeal Membrane Oxygenation in Pulmonary Endarterectomy Patients.
To investigate short-term outcomes in patients with chronic thromboembolic pulmonary hypertension (CTEPH) presenting for pulmonary endarterectomy (PEA) and requiring extracorporeal membrane oxygenation (ECMO) during the perioperative period. ⋯ Although still associated with high morbidity and mortality, ECMO appears to be an important treatment adjunct providing additional time for healing and recovery of cardiopulmonary function in patients who develop severe hypoxemia or right ventricular failure after PEA.
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J. Cardiothorac. Vasc. Anesth. · Jan 2019
Observational StudyThe Evolution of Echocardiographic Type and Anesthetic Technique for Transcatheter Aortic Valve Replacement at a High-Volume Transcatheter Aortic Valve Replacement Center.
Describe the change in intraoperative transcatheter aortic valve replacement (TAVR) care by examining the utilization of transesophageal echocardiography (TEE) versus transthoracic echocardiography (TTE) and general anesthesia (GA) versus conscious sedation (CS) over time. ⋯ Although TAVR initially was conducted exclusively under GA with TEE, nearly two-thirds of TAVR procedures now are performed using CS and TTE at the authors' institution. STS scores were significantly lower in patients having CS and TTE.
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J. Cardiothorac. Vasc. Anesth. · Jan 2019
Open Surgical Access for Transfemoral TAVR Should Not Be a Contraindication for Conscious Sedation.
The use of monitored anesthesia care (MAC) for transcatheter aortic valve replacement (TAVR) is gaining favor in the United States, although general anesthesia (GA) continues to be common for these procedures. Open surgical cutdown for transfemoral TAVR has been a relative contraindication for TAVR with MAC at most centers. The objective of this study was to review the authors' results of transfemoral TAVR performed in patients with open surgical cutdown with the use of MAC. ⋯ Open surgical cutdown for transfemoral TAVR can be performed safely using MAC and ilioinguinal block with low rates of conversion to general anesthesia and acceptable postoperative outcomes and pain scores.
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J. Cardiothorac. Vasc. Anesth. · Jan 2019
Comparative Study Observational StudyEarly Versus Late Tracheostomy in Cardiac Surgical Patients: A 12-Year Single Center Experience.
To evaluate whether early tracheostomy is associated with better outcomes in mechanical ventilation-dependent patients after cardiac surgery compared with a late tracheostomy. ⋯ In this study, early tracheostomy after cardiac surgery in patients requiring prolonged mechanical ventilation was associated with a shorter ventilation time and ICU and hospital stay, but did not result in a lower in-hospital and long-term mortality rate.