Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
Association of Primary Anesthesia Type with Postoperative Adverse Events After Transcarotid Artery Revascularization.
The literature remains sparse regarding the influence of primary anesthesia type (monitored anesthesia care [MAC] v general anesthesia) on 30-day adverse events after transcarotid artery revascularization (TCAR). The objective of this study was to report the association of primary anesthesia type with 30-day adverse events after TCAR. ⋯ The majority of studies on this topic pertain to carotid endarterectomy patients, and this retrospective analysis sheds light on outcomes after TCAR. Overall, the authors urge additional risk stratification and preprocedural optimization to carefully select patients who may undergo MAC.
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
Quantitative Transthoracic Echocardiography of the Response to Dobutamine in Cardiac Surgery Patients With Low Cardiac Output Syndrome.
To quantify the acute effects of dobutamine in postoperative low cardiac output syndrome (LCOS) using transthoracic echocardiographic, hemodynamic, and blood biomarker monitoring and to assess its association with clinical outcomes. ⋯ Early transthoracic echocardiographic assessment and the acute response to inotropic therapy may provide rapid and highly valuable information in the diagnostic workup and risk evaluation of patients with suspected LCOS after cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
The Association Between Pulsatile Cardiopulmonary Bypass and Acute Kidney Injury After Cardiac Surgery: A Before-and-After Study.
To investigate the association between pulsatile perfusion and cardiac surgery-associated acute kidney injury. ⋯ There was no association found between kidney injury and pulsatile perfusion. It is likely that there is either no association between pulsatile perfusion and reduced kidney injury or that the difference is extremely small.
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
CYP2D6 Genotype-guided Metoprolol Therapy in Cardiac Surgery Patients: Rationale and Design of the Pharmacogenetic-guided Metoprolol Management for Postoperative Atrial Fibrillation in Cardiac Surgery (PREEMPTIVE) Pilot Study.
The Preemptive Pharmacogenetic-guided Metoprolol Management for Atrial Fibrillation in Cardiac Surgery (PREEMPTIVE) pilot trial aims to use existing institutional resources to develop a process for integrating CYP2D6 pharmacogenetic test results into the patient electronic health record, to develop an evidence-based clinical decision support tool to facilitate CYP2D6 genotype-guided metoprolol administration in the cardiac surgery setting, and to determine the impact of implementing this CYP2D6 genotype-guided integrated approach on the incidence of postoperative atrial fibrillation (AF), provider, and cost outcomes. ⋯ The PREEMPTIVE pilot study is the first perioperative pilot trial to provide essential information for the design of a future, large-scale trial comparing CYP2D6 genotype-guided metoprolol management with a nontailored strategy in terms of managing AF. In addition, secondary outcomes regarding implementation, clinical benefit, safety, and cost-effectiveness in patients undergoing cardiac surgery will be examined.
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J. Cardiothorac. Vasc. Anesth. · Jan 2020
Transesophageal Echocardiographic Estimation of Coronary Sinus Blood Flow for Predicting Favorable Postoperative Transit Time Coronary Graft Flow Measurements: A Pilot Study.
Augmentation of coronary artery flow by surgical grafting increases coronary sinus blood flow (CSBF), which can be quantified on transesophageal echocardiography (TEE). However, transit time flowmetry (TTF) technology remains the most used intraoperative technique for coronary artery graft assessment. The purpose of the present pilot study was to evaluate the predictive value of TEE-based CSBF estimation for identifying favorable TTF graft measurements. ⋯ TEE-based demonstration of an augmented CSBF can ensure favorable TTF graft parameters, guiding the adequacy of surgical revascularization.