Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Perioperative Stroke Following Implantation of Left Ventricular Assist Device: A Retrospective Cohort Study.
Stroke is common following left ventricular assist device (LVAD) implantation, although comprehensive data on perioperative strokes in this uncommon population is lacking. The current study aim was to characterize the presentation, features, and outcomes of perioperative cerebrovascular ischemia post-LVAD implantation at the authors' institution. ⋯ LVAD patients carry a high risk of perioperative stroke. They experience delayed recognition and diagnosis, limited intervention, and poor outcomes. Frequent neurological assessment and a low threshold for neuroimaging are prudent.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
ReviewThe 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.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Observational StudyPredicting Extent of Opioid Use Following Cardiac Surgery: A Pilot Study.
This study was designed to test whether a negative affect phenotype reflecting depression, anxiety, anger, and pain catastrophizing predicts inpatient and outpatient opioid use outcomes following cardiac surgery. ⋯ Patients with higher preoperative levels of negative affect (depression, anxiety, anger, and pain catastrophizing) use more inpatient and outpatient opioid analgesics following cardiac surgery, a pattern similar to noncardiac surgery populations. Results support further study of patient-specific approaches to opioid prescribing to reduce the risk for opioid use disorder post-cardiac surgery.