Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2024
Right Ventricular Function Following Sternotomy Versus a Less-Invasive Approach for Left Ventricular Assist Device Implant: Retrospective Cohort Study.
Durable left ventricular assist device (LVAD) implantation is traditionally performed via median sternotomy (MS). Less-invasive implantation may lower the incidence of postimplant right ventricular failure (RVF). Our primary objective was to determine whether less-invasive implantation reduces the odds of severe RVF compared to MS. ⋯ There was no reduction in the odds of severe RVF following LVAD implantation using less-invasive approaches versus MS. However, we found improved odds of 30-day survival in the less-invasive group. The underlying mechanism requires further investigation.
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J. Cardiothorac. Vasc. Anesth. · Apr 2024
Observational StudyAssociation of Sarcopenia, as Defined Based on the Skeletal Muscle Index, With Mortality and Morbidity After Cardiac Surgery: A Retrospective Cohort Study.
To investigate whether "sarcopenia," defined based on the preoperative skeletal muscle index (SMI), can predict major postoperative morbidity and all-cause mortality. ⋯ Sarcopenia, defined by the skeletal muscle index, is associated with all-cause mortality and major morbidity after cardiac surgery, thereby suggesting the need for perioperative sarcopenia risk assessment for patients undergoing cardiac surgery to guide the prevention and management of adverse outcomes.
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J. Cardiothorac. Vasc. Anesth. · Apr 2024
Multicenter StudyApnea Testing Practice to Increase Baseline PaCO2 and Frequency of Blood Gas Analyses.
To study the influence of the initial partial pressure of carbon dioxide (PaCO2) and frequency of blood gas analyses on the positivity rate and safety of apnea testing (AT). ⋯ Increasing the baseline PaCO2 and doing more blood gas analyses can significantly shorten the time needed for AT and improve the AT positivity rate.
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J. Cardiothorac. Vasc. Anesth. · Apr 2024
Randomized Controlled TrialEffect of Retrograde Autologous Priming on Coagulation Assessed by Rotation Thromboelastometry in Patients Undergoing Valvular Cardiac Surgery.
To investigate the effect of retrograde autologous priming (RAP) on coagulation function using rotation thromboelastometry (ROTEM) in patients undergoing valvular cardiac surgery. ⋯ Cardiopulmonary bypass induced impaired coagulation function on ROTEM. However, RAP did not improve coagulation function when compared with conventional priming in patients undergoing valvular cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 2024
How Would I Treat My Own Chronic Thromboembolic Pulmonary Hypertension in the Perioperative Period?
Chronic thromboembolic pulmonary hypertension (CTEPH) results from an incomplete resolution of acute pulmonary embolism, leading to occlusive organized thrombi, vascular remodeling, and associated microvasculopathy with pulmonary hypertension (PH). A definitive CTEPH diagnosis requires PH confirmation by right-heart catheterization and evidence of chronic thromboembolic pulmonary disease on imaging studies. Surgical removal of the organized fibrotic material by pulmonary endarterectomy (PEA) under deep hypothermic circulatory arrest represents the treatment of choice. ⋯ Despite adequate pulmonary artery clearance, patients might be prone to perioperative complications, such as right ventricular maladaptation, airway bleeding, or pulmonary reperfusion injury. These complications can be treated conventionally, but extracorporeal membrane oxygenation has been included in their management recently. Patients with residual PH post-PEA should be considered for medical or percutaneous interventional therapy.