Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
ReviewHeart Failure With Preserved Ejection Fraction: A Comprehensive Review and Update of Diagnosis, Pathophysiology, Treatment, and Perioperative Implications.
Almost three-quarters of all heart failure patients who are older than 65 have heart failure with preserved ejection fraction (HFpEF). The proportion and hospitalization rate of patients with HFpEF are increasing steadily relative to patients in whom heart failure occurs as result of reduced ejection fraction. The predominance of the HFpEF phenotype most likely is explained by the prevalence of medical conditions associated with an aging population. ⋯ With the exception of symptom mitigation, lifestyle modifications, and rigorous control of comorbid conditions, few long-term treatment options exist for these unfortunate individuals. Patients with HFpEF present for surgery on a regular basis, and anesthesiologists need to be familiar with this heterogeneous and complex clinical syndrome to provide successful care. In this article, the authors review the diagnosis, pathophysiology, and treatment of HFpEF and also discuss its perioperative implications.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Observational StudyEffect of Systemic Vascular Resistance on the Reliability of Noninvasive Hemodynamic Monitoring in Cardiac Surgery.
To assess the effect of systemic vascular resistance (SVR) on the reliability of the ClearSight system (Edwards Lifesciences, Irvine, CA) for measuring blood pressure (BP) and cardiac output (CO). ⋯ The ClearSight system showed an acceptable accuracy in measuring BP and tracking BP changes in various SVR states; however, the accuracy of CO measurement and its trending ability in various SVR states was poor.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
ReviewMitral Regurgitation in 2020: The 2020 Focused Update of the 2017 American College of Cardiology Expert Consensus Decision Pathway on the Management of Mitral Regurgitation.
The recently published "2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation" provides a framework for the clinical and echocardiographic assessment of mitral regurgitation and describes considerations for the medical, surgical, and transcatheter treatment of mitral regurgitation. The Update provides guidance for clinicians in light of the significant interim developments since the 2017 recommendations, particularly in the areas of secondary mitral regurgitation and transcatheter mitral valve repair. The present review focuses on the aspects of the Update that are most relevant to the cardiac anesthesiologist, with emphasis on the integrated assessment of mitral regurgitation with echocardiography and the indications and considerations for the surgical and transcatheter management of mitral regurgitation.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Observational StudyComparison of Thoracic Epidural Analgesia and Traditional Intravenous Analgesia With Respect to Postoperative Respiratory Effects in Cardiac Surgery.
Surgical stress and pain affect the respiratory condition of patients and can cause complications that affect morbidity and mortality in cardiac surgeries. The authors studied the effect of thoracic epidural analgesia (TEA) versus traditional intravenous analgesia on postoperative respiratory mechanics in cardiac surgery. ⋯ TEA provided better postoperative respiratory condition via better sedative analgesia in cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Extubation in the Operating Room After Transapical Transcatheter Aortic Valve Implantation Safely Improves Time-Related Outcomes and Lowers Costs: A Propensity Score-Matched Analysis.
The experience of safe extubation in the operating room (OR) after transcatheter aortic valve implantation (TAVI) procedure remains not well established. The authors conducted this study to assess the effect of OR extubation in comparison with extubation in the intensive care unit (ICU) on the outcomes and cost in patients undergoing transapical-TAVI. ⋯ The current study provided evidence that extubation in the OR could be performed safely without increases in morbidity, mortality, or reintubation rate and could provide cost-effective outcome benefits in patients undergoing transapical-TAVI.