Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Case ReportsEarly Prosthetic Valve Malfunction Leading to Cardiogenic Shock and Emergency Redo Mitral Valve Replacement.
Early onset prosthetic valve stenosis is an uncommon complication after valve replacement surgery and is often caused by thrombus formation. Frequently it can be diagnosed by echocardiography and managed with optimizing anticoagulation and/or thrombolysis. ⋯ This case demonstrates how the leaflet orientation of a BMHV affects transmitral flow and fluid dynamics. Furthermore, we also discuss left atrial vortex formation in the setting of atrial fibrillation, kinetic energy transfer through an anatomically implanted mechanical mitral valve, and their roles in contributing to early prosthetic valve thrombosis despite adequate anticoagulation.
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Predictors of Increased Length of Hospital Stay in Patients with Severe Cardiomyopathy Undergoing Coronary Artery Bypass Grafting.
Predictors of operative outcome in patients with severely depressed left ventricular ejection fraction (LVEF) undergoing coronary artery bypass grafting (CABG) remain poorly defined. This study aims to identify preoperative variables that are associated with increased postoperative length of hospital stay or operative mortality in this patient population. ⋯ More than half of patients with severely depressed LVEF undergoing isolated CABG are able to be discharged within 7 days postoperatively. The absence of preoperative beta-blockers, low preoperative albumin levels, and higher Society of Thoracic Surgeons Predicted Risk of Mortality score are associated with more complicated or slower postoperative recovery after CABG in this patient population.
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Observational StudyThe Coagulopathy of Acute Type A Aortic Dissection: A Prospective, Observational Study.
To evaluate the hemostatic system in patients undergoing surgery for acute type A aortic dissection (ATAAD) compared with those undergoing elective aortic procedures. ⋯ This study demonstrates that ATAAD is associated with a coagulopathic state. Surgery causes additional damage to the hemostatic system in ATAAD patients, but also in patients undergoing elective surgery of the ascending aorta or the aortic root.
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J. Cardiothorac. Vasc. Anesth. · Oct 2019
Editorial CommentBileaflet Prosthesis Design and Orientation Affect Fluid Shear, Residence Time, and Thrombus Formation.
The orientation and design of bileaflet valve prosthesis in the mitral position affects the intraventricular blood flow and exposure to shear. The combination of the anatomic orientation and a small gap size of the St. Jude Medical valve produces an increase in shear exposure and blood residence time, which both predispose the formation of thrombus in the high shear gaps of the valve hinges.