Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
ReviewRight Ventricular Failure After Left Ventricular Assist Device Placement-The Beginning of the End or Just Another Challenge?
Left ventricular assist device (LVAD) therapy has greatly improved outcomes in patients with end-stage heart failure. However, development of right ventricular failure (RVF) in LVAD recipients is associated with increased long- and short-term morbidity and mortality. The incidence of RVF after LVAD placement is difficult to assess due to the lack of a common definition. ⋯ As long-term RVADs are unavailable, currently approved treatment of prolonged RVF is limited to heart transplantation or the placement of a total artificial heart as bridge-to-transplant. Strategies to improve outcome in this patient population should include better risk stratification for RVF prior to LVAD placement as well as frank discussions about LVAD candidacy in patients ineligible for transplantation. The development of durable right-sided mechanical support would improve the scope of care of LVAD patients developing persistent RVF.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
ReviewAcute Kidney Injury After Cardiac Surgery: A Narrative Review of the Literature.
Acute kidney injury (AKI) is a common and serious complication of cardiac surgery. It is associated with increased morbidity and mortality. On a population level, the financial impact and overall incremental annual index hospitalization costs associated with AKI exceed $1 billion in the United States alone. ⋯ Prevention of AKI is still key to the management of AKI, and strategies include maintenance of renal perfusion and avoidance of nephrotoxins and blood transfusion-related insults. Dialysis in severe AKI is established, but the optimal modality and dose remains an area of ongoing research. This narrative review assesses the pathophysiology of AKI, role of biomarkers, risk assessment, and management in cardiac surgical patients.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
Extracorporeal Membrane Oxygenation Is a Team Sport: Institutional Survival Benefits of a Formalized ECMO Team.
At the authors' institution, prior to 2014, patients requiring care in the peri-extracorporeal membrane oxygenation (ECMO) period were treated by intensivists with specific training in ECMO but worked independently. This isolated form of care was addressed in late 2013 with the formal initiation of an ECMO team. The authors wanted to assess the difference in overall mortality for ECMO patients cared for prior to the initiation of a multidisciplinary team compared to after its establishment. ⋯ Patients cared for after the initiation of an ECMO team showed improved survival compared to patients cared for prior to the creation of the ECMO team.
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J. Cardiothorac. Vasc. Anesth. · Apr 2019
Observational StudyThe Edmonton Frail Scale Improves the Prediction of 30-Day Mortality in Elderly Patients Undergoing Cardiac Surgery: A Prospective Observational Study.
To investigate whether the Edmonton Frail Scale (EFS), a multidimensional frailty assessment tool, improves the prediction of 30-day or in-hospital mortality over the use of the European System for Cardiac Outcome Risk Evaluation (EuroSCORE) II alone. ⋯ The EFS has a good predictive ability for 30-day mortality after cardiac surgery in elderly patients and improves the prediction of 30-day mortality over the use of the EuroSCORE II.