Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2020
ReviewManagement of Challenging Cardiopulmonary Bypass Separation.
SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery. ⋯ Unfortunately, no specific criteria defining complex separation from CPB and no management guidelines for these patients currently exist. Taking into account the above considerations, the aim of the present review is to describe the most common scenarios associated with a complex CPB separation and to suggest strategies, pharmacologic agents, and para-corporeal mechanical devices that can be adopted to manage patients with complex separation from CPB. The routine management strategies of complex CPB separation of 17 large cardiac centers from 14 countries in 5 continents will also be described.
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J. Cardiothorac. Vasc. Anesth. · Jun 2020
Acute Aortic Dissection Surgery: Hybrid Debranching Versus Total Arch Replacement.
It is unclear whether the hybrid debranching or total arch replacement (TAR) technique is preferential in treatment of acute Stanford type A aortic dissection (AAAD) among different age groups. The aim was to compare the clinical outcomes for the two therapeutic strategies. ⋯ In the treatment of AAAD, patients older than 60 years undergoing hybrid debranching surgery had shorter hospital lengths of stay, lower rates of neurologic events and renal insufficiency, and a higher mid-term survival rate compared with the TAR procedure, whereas there was no statistical difference in hybrid debranching versus TAR in patients younger than age 60. Irrespective of reintervention, hybrid debranching can be a promising surgical option for patients with AAAD older than 60 years.