Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2021
Case ReportsBivalirudin for Maintenance Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation for COVID-19.
In its severe manifestation, coronavirus disease 2019 (COVID-19) compromises oxygenation in a manner that is refractory to maximal conventional support and requires escalation to extracorporeal membrane oxygenation (ECMO). Maintaining ECMO support for extended durations requires a delicately balanced anticoagulation strategy to maintain circuit viability by preventing thrombus deposition while avoiding excessive anticoagulation yielding hemorrhage-a task that is complicated in COVID-19 secondary to an inherent hypercoagulable state. ⋯ Importantly, therapeutic anticoagulation intensity was achieved rapidly with stable pharmacokinetics, and there was no need for any circuit interventions throughout the patient's 27-day ECMO course. In COVID-19, bivalirudin offers a potential option for maintaining systemic anticoagulation during ECMO in a manner that may mitigate the prothrombotic nature of the underlying pathophysiologic state.
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J. Cardiothorac. Vasc. Anesth. · Apr 2021
Multicenter StudyMulticenter International Survey on Cardiopulmonary Bypass Perfusion Practices in Adult Cardiac Surgery.
To assess current practice in adult cardiac surgery during cardiopulmonary bypass (CPB) across European and non-European countries. ⋯ This international CPB survey revealed that techniques for optimization of pump flow and oxygenation during CPB usually were applied. Furthermore, cerebral and hemodynamic monitoring devices were frequently used during CPB. However, most CPB-related anesthetic techniques and medications were more variable. More high-quality randomized controlled trials are needed to assess anesthetic techniques and organ protection.
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J. Cardiothorac. Vasc. Anesth. · Apr 2021
Randomized Controlled TrialEsmolol in Cardiac Surgery: A Randomized Controlled Trial.
To assess whether the administration of the ultra-short-acting β-blocker esmolol in cardiac surgery could have a cardioprotective effect that translates into improved postoperative outcomes. ⋯ In the present trial, esmolol as a cardioplegia adjuvant enhanced postoperative cardiac performance but did not reduce a composite endpoint of prolonged intensive care unit stay and/or mortality.
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J. Cardiothorac. Vasc. Anesth. · Apr 2021
Case ReportsAcute Intramyocardial Right Ventricular Hematoma After Coronary Artery Bypass Graft.
A 50-year-old woman underwent coronary artery bypass graft (CABG) for multivessel coronary artery disease. Due to hemodynamic instability, the patient could not be weaned from cardiopulmonary bypass without mechanical support, even after multiple attempts. Subsequently, a right ventricular intramyocardial hematoma (IH) was found during postoperative coronary angiography. ⋯ It should be suspected when there is hemodynamic instability intraoperatively or postoperatively in the intensive care unit that cannot be explained easily. There currently is no standard treatment. Treatment often is based on the individual patient and degree of hemodynamic instability.
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J. Cardiothorac. Vasc. Anesth. · Apr 2021
Gradually Progressive Dyspnea and Exercise Intolerance in an Otherwise Active Middle-Aged Woman: Why Was the Presentation of Congenital Heart Disease Delayed?
Patients with congenital heart disease (CHD) increasingly are surviving into adulthood. In the United States alone, there are more than one million adult patients living with CHD with the number increasing about 5% each year. ⋯ The authors present an adult patient with uncorrected CHD presenting with late onset of heart failure symptoms. The authors also review the patient's complex congenital heart lesion, transesophageal echocardiography findings, and intraoperative management.