Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2023
Meta AnalysisGeneral Anesthesia Versus Local Anesthesia in Patients Undergoing Transcatheter Aortic Valve Replacement: An Updated Meta-Analysis and Systematic Review.
For patients with aortic stenosis, transcatheter aortic valve replacement (TAVR) offers a less invasive treatment modality than conventional surgical valve replacement. Although the surgery is performed traditionally under general anesthesia (GA), recent studies have described success with TAVR using local anesthesia (LA) and/or conscious sedation. The study authors performed a pairwise meta-analysis to compare the clinical outcomes of TAVR based on operative anesthesia management. ⋯ Transcatheter aortic valve replacement performed using LA is associated with lower rates of adverse clinical outcomes, including 30-day mortality and stroke. No difference was seen between the 2 groups for a 30-day paravalvular leak. These results support the use of minimally invasive forms of TAVR without GA.
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J. Cardiothorac. Vasc. Anesth. · Aug 2023
Randomized Controlled TrialEffect of Dexmedetomidine on Postoperative Renal Function in Patients Undergoing Cardiac Valve Surgery Under Cardiopulmonary Bypass: A Randomized Clinical Trial.
The effect of dexmedetomidine on postoperative renal function was investigated in patients undergoing cardiac valve surgery under cardiopulmonary bypass (CPB). ⋯ Dexmedetomidine may be considered as a way to reduce the incidence and severity of postoperative AKI in patients undergoing cardiac valve surgery under cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Aug 2023
Observational StudyProspective Evaluation of a Multibeat Analysis Cardiac Index Estimation in Patients With Cardiogenic Shock.
The decision algorithm for managing patients in cardiogenic shock depends on cardiac index (CI) estimates. Cardiac index estimation via thermodilution (CI-TD) using a pulmonary artery catheter is used commonly for obtaining CI in these patients. Minimally invasive methods of estimating CI, such as multibeat analysis (CI-MBA), may be an alternative in this population. ⋯ Cardiac index-MBA is not interchangeable with CI-TD. However, CI-MBA provides reasonable correlation and clinically acceptable trending ability compared with CI-TD. Cardiac output-MBA may be useful in trending changes in CI in patients with cardiogenic shock, especially in those whose pulmonary artery catheterization placement carries a high risk or is unobtainable.
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J. Cardiothorac. Vasc. Anesth. · Aug 2023
Observational StudyComparison of Tools for Postoperative Pulmonary Complications After Cardiac Surgery.
To review the efficacy of 2 score tools for identifying pulmonary complications after cardiac surgery. ⋯ The incidence of PPCs after cardiac surgery was highly prevalent. Both the Kroenke Score and the Melbourne Group Scale are effective in identifying patients with PPCs. Kroenke Score can identify patients with mild pulmonary adverse events, whereas the Melbourne Group Scale is more dominant in identifying moderate-to-severe pulmonary complications.