Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Jul 2020
Socioeconomic Disparities in Carotid Revascularization Procedures.
Several studies have demonstrated healthcare disparities in postoperative outcomes after carotid endarterectomy and carotid artery stenting, including increased hospital mortality, postoperative stroke, and readmission rates. The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures. ⋯ These results suggest that disparities in postoperative outcomes after carotid artery procedures are associated with race but not with primary insurance status. Multiple contributing factors exist, including racial inequities in prevalence of comorbidities, health literacy, and procedure type performed.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2020
Standards and Best Practice for Acute Normovolemic Hemodilution: Evidence-based Consensus Recommendations.
To develop a standardized approach to the implementation and performance of acute normovolemic hemodilution (ANH) in order to reduce the incidence of bleeding and allogeneic blood transfusion in high-risk surgical bleeding-related cardiac surgery with cardiopulmonary bypass (CPB). ⋯ Consensus was reached on 6 conditions in which ANH would or would not be acceptable, showing that development of a standardized approach for the use of ANH in high-risk surgical bleeding and allogeneic blood transfusion is clearly possible. The recommendations developed by this expert panel may help guide the management and inclusion of ANH as an evidence and consensus-based blood conservation modality.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2020
Observational StudyAcute Kidney Injury and Postoperative Atrial Fibrillation In Patients Undergoing Cardiac Surgery.
To test the hypothesis that acute kidney injury (AKI) in the postoperative period could be an additional risk factor for the development of atrial fibrillation (AF) and to examine the risk factors for postoperative AF in the authors' cohort of patients. ⋯ This analysis of a large, contemporary cohort of patients identifies postoperative AKI as an associated risk factor for postoperative AF, along with other perioperative variables. Early identification of this patient cohort would allow targeted preventative treatment to reduce the incidence of postoperative AF.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2020
Case ReportsPulmonary Venous Flow After Lung Transplantation: Turbulence and High Velocities.
Lung transplantation is the definitive treatment for end-stage lung disease. The pulmonary venous anastomosis has the potential for significant obstructive complications that can lead to considerable morbidity and mortality. The use of intraoperative transesophageal echocardiography, including color-flow and spectral Doppler, is instrumental in evaluating the pulmonary veins after lung transplantation. In this E-challenge, a case of intraoperative pulmonary venous obstruction after bilateral lung transplantation is described, the echocardiographic principles required to evaluate the pulmonary veins and screen for complications are reviewed, and when intervention may be required is discussed.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2020
A Focused Transesophageal Echocardiography Protocol for Intraoperative Management During Orthotopic Liver Transplantation.
The value of a simplified, focused intraoperative transesophageal echocardiography (TEE) protocol in patients undergoing liver transplantation (LT) is unknown. We sought to create and assess a 5-view LT TEE examination focused on 5 prespecified common causes of hypotension during LT. ⋯ In a retrospective cohort study, a simplified LT TEE protocol would have detected 92% of prespecified TEE findings. Management changes occurred in 94% of those patients, while changes rarely occurred in patients with other TEE findings. A focused LT TEE protocol may diagnose critical pathology adequately and guide management during LT when standard monitors are insufficient.