Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
ReviewArtificial Intelligence for Dynamic Echocardiographic Tricuspid Valve Analysis: A New Tool in Echocardiography.
There has been a resurgence of interest in the structure and function of the tricuspid valve (TV) with the established prognostic impact of functional tricuspid regurgitation. Current 3-dimensional transesophageal echocardiography prototype software is limited to exploration of the mitral and aortic valves exclusively. Thus, newer analytical software is required for dynamic geometric analysis of the TV morphology for remodeling. ⋯ The software offers high correlation to surgical inspection by its ability to analyze morphology and dynamics of the valve throughout the cardiac cycle. In addition, it allows higher reproducibility of data analysis and reduces interobserver variability with minimal need for manual intervention. Integration of interactivity through preprocedural placement of specific devices of different sizes and shapes in the mitral and aortic positions facilitates prognostic evaluation of surgical and interventional procedures.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
ReviewClinical Management of Venoarterial Extracorporeal Membrane Oxygenation.
Venoarterial extracorporeal membrane oxygenation (ECMO) is a well-established technique to rescue patients experiencing cardiogenic shock. As a form of temporary mechanical circulatory support, venoarterial ECMO can be life-saving, but it is resource intensive and associated with substantial morbidity and mortality. Optimal clinical outcomes require specific expertise in the principles and nuances of ECMO physiology and management. Key considerations discussed in this review include hemodynamic assessment and goals; pharmacologic anticoagulation; ECMO weaning strategies; and the prevention, evaluation, and treatment of common complications.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
ReviewMonitoring of the Sublingual Microcirculation During Cardiac Surgery: Current Knowledge and Future Directions.
Handheld vital microscopes allow for direct observation of the sublingual microcirculatory perfusion during cardiac surgery. Through the use of handheld vital microscopes, it has been shown that cardiac surgery with cardiopulmonary bypass is associated with reduced and heterogenous microcirculatory perfusion. Microcirculatory impairment can result in inadequate tissue perfusion, leading to perioperative complications and poor outcome. ⋯ The implementation of microcirculatory variables into personalized treatment concepts has the potential to improve hemodynamic management during cardiac surgery and thereby improve patient outcomes. Therefore, specific treatment strategies need to be developed to prevent or treat alterations of the microcirculatory perfusion. In the future, the use of handheld vital microscopes for microcirculatory monitoring may help to improve hemodynamic management and outcomes for patients undergoing cardiac surgical procedures.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
Predicting 1-Year Mortality After Cardiac Surgery Complicated by Prolonged Critical Illness: Derivation and Validation of a Population-Based Risk Model.
Patients experiencing prolonged critical illness after cardiac surgery represent a resource- intensive group with a high risk of mortality. The authors sought to derive and validate a multivariate model that accurately predicts 1-year mortality in people who have been critically ill for at least 1 week after cardiac surgery. ⋯ A prespecified multivariate model using clinically relevant, routinely available variables was able to accurately predict death among those with prolonged critical illness after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
The Impact of Intraoperative Patient Blood Management on Quality Development in Cardiac Surgery.
Patient blood management (PBM) is increasingly introduced into clinical practice. Minimizing effects on transfusion have been proven, but relevance for clinical outcome has been sparsely examined. In regard to this, the authors analyzed the impact of introducing intraoperative PBM to cardiac surgery. ⋯ Real-time laboratory recommendations achieved a high acceptance rate early after initiation. Improvement of clinical outcome by intraoperative PBM adds to the optimized surgical care. However, the corridor between hemostatic optimization and thromboembolic risk may be narrow.