Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2024
ReviewPrognostic Impact of Anemia and Blood Transfusions on Cardiovascular Outcomes in Patients Undergoing Vascular Surgery: A Scoping Review.
Prior studies suggest an association of anemia and blood transfusion with increased morbidity and mortality in patients undergoing cardiac surgery. However, the impact of perioperative anemia and blood transfusion on clinical outcomes in patients undergoing major vascular surgery has been poorly defined yet. The primary objectives of this scoping review were to determine the extent of the evidence base that links anemia and blood transfusions to mortality and cardiovascular outcomes in patients undergoing major vascular surgery, and identify recurring themes or gaps in the literature to guide future research. ⋯ The weight of the evidence suggests that anemia carries a substantial burden of cardiovascular complications, mortality, and multiorgan complications, resulting in increased health care costs. Peripheral and endovascular aortic surgery are affected deeply by the impact of anemia. Anemia itself stands out as a crucial predictor for requiring transfusions. In turn, the effect of transfusion of blood products is associated with worse outcomes and complications.
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J. Cardiothorac. Vasc. Anesth. · Oct 2024
ReviewOutcomes in Women Undergoing Coronary Artery Bypass Grafting: Analysis of New Data and Operative Trends.
In 2019, coronary artery bypass grafting (CABG) made up more than one-half of all adult cardiac surgical procedures in the United States, with an estimated 301,077 procedures performed, of which 161,816 were isolated CABG, and approximately 25% of which were performed in women. Women undergoing CABG are statistically more likely to present for surgery at an older age, with a greater burden of comorbidities such as diabetes and hypertension, and in decompensated clinical states (eg, acute myocardial infarction or cardiogenic shock) versus their male counterparts. However, sex has been shown to be an independent risk factor for worse outcomes even when controlling for these differences. ⋯ Despite this, the recent evidence from Gaudino et al5 suggests that the outcomes gap between men and women has not improved. In their cohort study examining 1,297,204 patients undergoing isolated CABG from 2011 to 2020 in the US, women had a higher unadjusted risk of operative (30-day) morbidity and mortality, with no signs of improvement in this gap over the study period, suggesting that a greater understanding of and attention to sex-based outcomes in CABG operations are warranted. A thorough understanding of this discrepancy and the possible contributing factors is essential to improving outcomes for women undergoing CABG.
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J. Cardiothorac. Vasc. Anesth. · Oct 2024
The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part II: Cardiac Transplantation.
These highlights focus on research published in the year 2022 and is divided into preoperative, intraoperative, and postoperative sections. The preoperative section includes research on the assessment and optimization of candidates for heart transplantation; donor optimization and the use of extended donors; organ protection systems; donation after circulatory death allografts; recipient factors including cannabis use, sex, race, and comorbidities such as obesity, diabetes mellitus, and peripartum cardiomyopathy; the effects of the 2018 heart allocation policy change on waitlist and postoperative mortality; updates on heart transplantation in patients with coronavirus disease 2019; in pediatric patients; and those who require a bridge to transplant. The intraoperative section includes the use of a multidisciplinary team, a proposed transfusion algorithm, bench surgery on the allograft, and size matching. The postoperative section focuses on the research on the development and management of tricuspid regurgitation, echocardiography, arrhythmia management, and, finally, xenotransplantation.