Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2020
Outcomes After Noncardiac Surgery for Patients with Pulmonary Hypertension: A Historical Cohort Study.
Pulmonary hypertension (PH) is a substantial preoperative risk factor. For this study, morbidity and mortality were examined after noncardiac surgery in patients with precapillary PH. ⋯ PH patients undergoing noncardiac surgery have a high frequency of complications. Worse functional status, elevated serum NT-proBNP, and higher-risk surgery are predictive of worse outcome.
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J. Cardiothorac. Vasc. Anesth. · Jun 2020
Case ReportsAnesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome Coronavirus-2 Infection.
Severe acute respiratory syndrome coronavirus-2 is still active in Wuhan, China, and is spreading to the rest of the world. Recently, perioperative anesthetic management in patients with suspected or confirmed coronavirus-2 has been reported. ⋯ During the outbreak in Wuhan, the authors' team completed 4 cases of aortic dissection repair successfully in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. The purpose of the present report is to summarize current knowledge and experiences on anesthetic management in this patient population and to provide clinical practice guidelines on anesthetic management and infection prevention and control in these critically ill patients.
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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.
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J. Cardiothorac. Vasc. Anesth. · Jun 2020
The Year in Electrophysiology: Selected Highlights from 2019.
This article is the second in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the Editor-in-Chief, Dr. ⋯ Augoustides, and the editorial board for the opportunity to continue this series, namely the highlights of the year that pertain to electrophysiology in relation to cardiothoracic and vascular anesthesia. This second article focuses on cardiac sympathetic denervation, the management of patients with atrial fibrillation, cerebral oximetry for catheter ablation procedures, advancements in leadless pacemaker and subcutaneous implantable cardioverter defibrillator technology, and the emergence of pulsed field ablation for pulmonary vein isolation.
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J. Cardiothorac. Vasc. Anesth. · Jun 2020
Right Ventricular Hypertrophy in Refractory Acute Respiratory Distress Syndrome Treated With Venovenous Extracorporeal Membrane Oxygenation Support.
In severe acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO), right ventricular (RV failure) and dilation have been investigated with the use of echocardiography, whereas RV hypertrophy has not been addressed in the literature. The present study assessed the incidence of RV hypertrophy using echocardiography before ECMO treatment and at intensive care unit (ICU) discharge in severe ARDS patients. ⋯ In severe ARDS treated with ECMO support, RV hypertrophy is a common finding and patients with normal RV wall thickness developed RV hypertrophy after ECMO support. The latter finding may suggest that during ECMO support, the right ventricle still may be subjected to increased afterload. However, additional research should be performed to elucidate the spectrum of mechanism(s) involved in the genesis of RV hypertrophy.