Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2014
Randomized Controlled Trial Comparative StudyHypothermic Versus Normothermic Cardiopulmonary Bypass in Patients With Valvular Heart Disease.
The aim of this study was to test the hypothesis that normothermic cardiopulmonary bypass (CPB) is as effective as hypothermic CPB in terms of cardiac protection (cTnI level) and outcome in patients with valvular heart disease. ⋯ Normothermic CPB in patients with valvular heart disease was as effective as hypothermic perfusion in terms of myocardial protection after the surgery assessed by cTnI release. The short ventilation duration in patients who underwent hypothermic CPB needs to be confirmed in a future investigation.
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J. Cardiothorac. Vasc. Anesth. · Apr 2014
Randomized Controlled TrialIndividualized Heparin and Protamine Management Improves Rotational Thromboelastometric Parameters and Postoperative Hemostasis in Valve Surgery.
This study investigated whether a tailored approach to heparin and protamine management improved thromboelastometric parameters after cardiopulmonary bypass and reduced postoperative blood loss compared with activated coagulation time (ACT)-based fixed target heparin and protamine management. ⋯ Individualized heparin and protamine management decreased the protamine-to-heparin ratio, improved postbypass thromboelastometric hemostatic parameters, and reduced the incidence of severe blood loss compared with an ACT-based strategy, supporting the added value of this approach for hemostatic optimization during cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2014
ReviewIncidental Moderate Mitral Regurgitation in Patients Undergoing Aortic Valve Replacement for Aortic Stenosis: Review of Guidelines and Current Evidence.
Recent evidence has shown that moderate mitral regurgitation is common and clinically relevant in patients presenting for surgical and transcatheter aortic valve replacement for aortic stenosis. Prospective multicenter clinical trials are now indicated to resolve the clinical equipoise about whether or not mitral valve intervention also is indicated at the time of aortic valve intervention. Advances in three-dimensional transesophageal echocardiography, transcatheter mitral interventions, and surgical aortic valve replacement, including the advent of sutureless valves, likely will expand the therapeutic possibilities for moderate mitral regurgitation in the setting of aortic valve interventions for severe aortic stenosis.
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J. Cardiothorac. Vasc. Anesth. · Apr 2014
Randomized Controlled Trial Comparative StudyHeparinase Thromboelastography Compared with Activated coagulation Time for Protamine Titration after Cardiopulmonary Bypass.
The present study is a comparison of two point-of-care (POC) tests as endpoints of protamine titration after CPB. The authors hypothesized that using the heparinase-kaolin thromboelastography (TEG-HK) R-time difference would more readily identify residual heparin necessitating additional protamine than when using activated coagulation time (ACT). The primary endpoint was the between-group difference in protamine dose. Whether this approach would lessen postoperative bleeding and sequelae also was investigated. ⋯ No difference was identified in protamine dosing using either ACT or TEG-HK R-time difference as endpoints. Heparinase TEG may be useful for monitoring heparin reversal.
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J. Cardiothorac. Vasc. Anesth. · Apr 2014
Comparative Study Observational StudyGeneral Anesthesia Versus Sedation for Implantation of a Biventricular Pacing Device for Cardiac Resynchronization Therapy.
Heart failure carries significant risk for major noncardiac surgery. Whether this risk is transferable to minor surgery is less well-documented. Thus, the aim of this study was to assess the outcome of a contemporary cohort of heart failure patients undergoing cardiac resynchronization therapy (CRT) device insertion under general anesthesia or sedation. ⋯ The authors found that patients with heart failure undergoing CRT insertion with concurrent general anesthesia or sedation had minimal immediate perioperative risk and that there was no difference in postoperative outcome between general anesthesia and sedation.