Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
Echocardiography for Intraoperative Decision Making in Mitral Valve Surgery-A Pilot Simulation-Based Training Module.
Echocardiographic assessment of the repaired or replaced mitral valve intraoperatively involves making a high-impact joint decision with the surgeon, in a time-sensitive manner, in a dynamic clinical situation. These decisions have to take into account the degree of imperfection if any, the likelihood of obtaining a better result, the underlying condition of the patient, and the impact of a longer cardiopulmonary bypass period if the decision is made to reintervene. Traditional echocardiography teaching is limited in its ability to provide this training. The authors report the development and implementation of a training module simulating the dynamic clinical environment of a mitral valve surgery in progress and the critical echo-based intraoperative decision making involved in the assessment of the acceptability of the surgical result.
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
Randomized Controlled Trial Comparative StudyUltrasound Guided Out-of-Plane Versus In-Plane Transpectoral Left Axillary Vein Cannulation.
The primary objective was to compare the frequency of first-attempt successful axillary vein cannulation by the Seldinger technique using out-of-plane ultrasound guidance versus in-plane imaging. Between the two ultrasound imaging planes, this study also compared the number of attempts that were necessary for the cannulation of the left axillary vein along with the number of needle redirections that had to be done for final cannulation of the vein. Incidence of complications and the number of times the procedure was abandoned also were compared between the two imaging planes. ⋯ Out-of-plane ultrasound imaging during axillary vein cannulation increased the chance of first-attempt successful cannulation. Axillary vein cannulation under out-of-plane ultrasound imaging also appeared to be quicker and was preferable in terms of the fewer number of attempts that were necessary for a successful vein cannulation.
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
Fluid Management in Cardiac Surgery: Results of a Survey in European Cardiac Anesthesia Departments.
To evaluate the current practice of perioperative fluid management in cardiac surgery patients. ⋯ Perioperative fluid management in cardiac surgery patients may have changed in the last few years in European centers. Balanced crystalloids now seem to be the preferred solutions, followed by synthetic colloids (mainly gelatins) and albumin.
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
ReviewPerioperative Management of Dual-Antiplatelet Therapy in Patients With New-Generation Drug-Eluting Metallic Stents and Bioresorbable Vascular Scaffolds Undergoing Elective Noncardiac Surgery.
Dual-antiplatelet therapy (DAPT) is considered mandatory after new-generation drug-eluting coronary stent implantation to reduce ischemic complications such as stent thrombosis, but the need for DAPT makes the timing of elective surgery difficult. Interrupting DAPT places patients at risk for stent thrombosis, and surgery in the setting of DAPT may lead to bleeding. The 2016 American College of Cardiology/American Heart Association guideline recommends delaying elective noncardiac surgery for a minimum 6-month period to reduce ischemic risks after the implantation of a second-generation metallic drug-eluting stent (DES). ⋯ The Absorb bioresorbable vascular scaffold (Abbott Vascular, Abbott Park, IL), which has a higher propensity for stent thrombosis compared with second-generation metallic DES, also produces DAPT management challenges in patients presenting for elective noncardiac surgery. Due to the novelty of bioresorbable vascular scaffold therapy, there are no guidelines available for the management of patients undergoing elective noncardiac surgery. This review addresses DAPT management in patients undergoing noncardiac surgery less than 12 months after new-generation metallic DES or bioresorbable vascular scaffold implantation and provides further guidance for anesthesiologists who encounter these challenging cases.
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J. Cardiothorac. Vasc. Anesth. · Oct 2017
Preoperative Aspirin Does Not Increase Transfusion or Reoperation in Isolated Valve Surgery.
Preoperative aspirin has been studied in patients undergoing isolated coronary artery bypass graft surgery. However, there is a paucity of clinical data available evaluating perioperative aspirin in other cardiac surgical procedures. This study was designed to investigate the effects of aspirin on bleeding and transfusion in patients undergoing non-emergent, isolated, heart valve repair or replacement. ⋯ Preoperative aspirin therapy in elective, isolated, valve surgery did not result in an increase in transfusion or reoperation for bleeding and was not associated with reduced readmission rate, MACE, or 30-day mortality.