Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2019
Perioperative Acute Ischemic Stroke Increases Mortality After Noncardiac, Nonvascular, and Non-Neurologic Surgery: A Retrospective Case Series.
To identify the predictors of in-hospital mortality in patients who develop perioperative acute ischemic stroke (PAIS) associated with noncardiac, nonvascular, and non-neurologic surgery. ⋯ The risk of PAIS after noncardiac, nonvascular, and non-neurologic surgery significantly increased with age, and development of PAIS increased the mortality rate. Among these patients, the independent predictors of in-hospital mortality were preoperative atrial fibrillation, disturbance of consciousness as the first PAIS symptom, no anticoagulant/antiplatelet therapy after PAIS, diuretic treatment, and pulmonary infection.
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J. Cardiothorac. Vasc. Anesth. · Aug 2019
Randomized Controlled TrialEffects of Autologous Platelet Rich Plasma on Intraoperative Transfusion and Short-Term Outcomes in Total Arch Replacement (Sun's Procedure): A Prospective, Randomized Trial.
To observe the effect of collecting and retransfusing autologous platelet rich plasma (aPRP) on the amount of allogeneic blood usage in total arch replacement (Sun's surgery) and the outcomes 30 days after surgery. ⋯ In total arch replacement (Sun's surgery), collecting and retransfusing aPRP reduced intraoperative transfusions of erythrocyte, plasma, and cryoprecipitate and decreased the duration of postoperative mechanical ventilation and hospitalization. This technique had no significant effect on the incidence of complications and mortality 30 days postoperatively.
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This is a narrative review of recent articles (mainly published in 2017 and 2018) related to the conduct of cardiopulmonary bypass (CPB) that should be of interest to the cardiac anesthesiologist. Some of the topics covered include recent guidelines on temperature management, anticoagulation, perfusion practice, use of transesophageal echocardiography during CPB, optimal mean arterial pressure, vasoplegia, bleeding, perioperative anemia, post-cardiac surgery transfusion, acute kidney injury, delirium and cognitive decline, CPB during pregnancy, lung management, radial-to-femoral artery pressure gradients during CPB, prophylactic perioperative intra-aortic balloon pump, del Nido cardioplegia, antibiotic prophylaxis, and use of levosimendan in cardiac surgery. The review concludes with a perspective on the effect of these development on the practice of cardiac anesthesia.
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J. Cardiothorac. Vasc. Anesth. · Aug 2019
Meta Analysis Comparative StudyTranscatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease: A Meta-Analysis.
The aim of this meta-analysis was to compare the clinical outcomes of transcatheter aortic valve replacement (TAVR) with those of surgical aortic valve replacement (SAVR) in patients with chronic kidney disease (CKD). ⋯ Transcatheter aortic valve replacement might be a preferable approach to SAVR in patients with CKD. A large, prospective, randomized controlled trial is warranted.