Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
Randomized Controlled TrialIntraoperative Use of Nondepolarizing Neuromuscular Blocking Agents During Cardiac Surgery and Postoperative Pulmonary Complications: A Prospective Randomized Trial.
Nondepolarizing neuromuscular blocking agents (NMBAs) are associated with perioperative complications in noncardiac surgery; however, little is known about their effect on cardiac surgery. This study assessed the effect of neuromuscular blockade (NMB) on the incidence of postoperative pulmonary complications (PPCs) after cardiac surgery and operating conditions. ⋯ Although avoiding nondepolarizing NMBA is feasible, doing so worsened operating conditions and did not reduce the incidence of postoperative pulmonary complications.
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
ReviewOperational and Institutional Recommendations and Requirements for TAVR: A Review of Expert Consensus and the Impact on Health Care Policy.
When transcatheter aortic valve replacement (TAVR) was first approved for use in the United States in 2012, multiple leading surgical and cardiology societies were tasked with creating recommendations and requirements for operators and institutions starting and maintaining TAVR programs. Creation of this consensus document was challenging due to limited experience with this new technology, and a lack of robust centralized data that could be used to validate outcome measures and create benchmarks for self-assessment and improvement. ⋯ The new recommendations include suggested personnel, facilities, training, and assessment of outcomes and competencies required to run a safe and efficient TAVR program. This article seeks to detail the changes from the original consensus document with a particular focus on issues relevant to cardiac anesthesiologists as well as important healthcare policy ramifications for patients and providers in the United States.
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
Prevalence and Clinical Impact of Systemic Inflammatory Reaction After Cardiac Surgery.
Cardiac surgery induces a systemic inflammatory reaction that has been associated with postoperative mortality and morbidity. Many studies have characterized this reaction through laboratory biomarkers while clinical studies generally are lacking. This study aimed to assess the incidence of postoperative systemic inflammation after cardiac surgery, and the association of postoperative systemic inflammation with preoperative patients' characteristics and postoperative outcomes. ⋯ In this retrospective study, the clinical signs of SIRS were detected in a substantial percentage of patients who underwent cardiac surgery. The postoperative SIRS criteria were associated with a more complicated postoperative course and higher postoperative morbidity.
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
ReviewLeft Atrial Appendage Occlusion: A Narrative Review.
Left atrial appendage occlusion (LAAO) is a proposed alternative to oral anticoagulation in reducing stroke in patients with atrial fibrillation. It is suggested that LAAO is most suitable in patients at increased risk of stroke or bleeding or with contraindication to pharmacologic intervention. ⋯ Presently, several ongoing randomized trials are comparing various devices to each other and to pharmacologic anticoagulation. The objectives of this narrative review were to present the evidence on percutaneous and surgical LAAO devices, review current guidelines, and summarize landmark trials.
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
Comparative Study Observational StudyComparison of Left Atrial Measurements Using 2- and 3-Dimensional Transesophageal Echocardiography.
To assess the correlation between left atrial measurements using 2- and 3-dimensional transesophageal echocardiography. ⋯ Two- and 3-dimensional measurements of the left atrium correlated well. Measurements made using 3-dimensional transesophageal echocardiography were subject to similar limitations as those made using 2-dimensional echocardiography. The benefits of 3-dimensional transesophageal echocardiography and multiplanar reconstruction could be expanded by improvements in ultrasound technology and software.