Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
A Modified 4Ts Score for Heparin-Induced Thrombocytopenia in the Mechanical Circulatory Support Population.
To identify risk factors and develop a pretest scoring system to differentiate patients with heparin-induced thrombocytopenia (HIT) in the mechanical circulatory support (MCS) population. The authors present a modified "4TMCS" scoring system, which considers the "type of mechanical circulatory support" that may help identify patients at risk for developing postoperative HIT. ⋯ Heparin-induced thrombocytopenia is associated with worse outcomes and increased morbidity and mortality in the MCS population. Awareness of patient risk factors and the application of a modified 4TMCS probability score may allow for more accurate screening and treatment of HIT in the MCS population.
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
CommentCon: Can We Influence Postoperative Outcomes of Frail Patients After Cardiac Surgery?
Frail patients are scheduled routinely for elective cardiovascular surgery. Despite the proven association between frailty and postoperative outcomes, currently, there is no consistent evidence that the preoperative optimization of frail patients with preoperative nutrition support and exercise programs can alter postoperative mortality. Established frailty diagnostic tools are not sufficient to grasp the multidimensional nature of frailty in cardiovascular patients. Prehabilitation programs and preoperative nutritional support are time- and resource-consuming and, therefore, are hard to implement in routine clinical practice.
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
Pro: Can we influence postoperative outcomes of frail patients after cardiac surgery?
A significant proportion of cardiac surgery patients are frail. The first step to improve outcomes is recognizing that despite reduced postoperative mortality in cardiac surgery, postoperative morbidity remains high, most likely due to more frail patients undergoing surgeries. ⋯ Frailty recognition can prompt preoperative and postoperative interventions. Exercise programs and nutrition optimization support frail patients in the perioperative period and positively alter outcomes.