Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
ReviewPostcardiotomy Shock Syndrome: A Narrative Review of Perioperative Diagnosis and Management.
Postcardiotomy shock (PCS) is generally described as the inability to separate from cardiopulmonary bypass due to ineffective cardiac output after cardiotomy, which is caused by a primary cardiac disorder, resulting in inadequate tissue perfusion. Postcardiotomy shock occurs in 0.5% to 1.5% of contemporary cardiac surgery cases, and is accompanied by an in-hospital mortality of approximately 67%. In the last 2 decades, the incidence of PCS has increased, likely due to the increased age and baseline morbidity of patients requiring cardiac surgery. In this narrative review, the authors discuss the epidemiology and pathophysiology of PCS, the rationale and evidence behind the initiation, continuation, escalation, and discontinuation of mechanical support devices in PCS, and the anesthetic implications.
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
ReviewScreening Modalities for Coronary Artery Disease in Liver Transplant Candidates: A Review of the Literature.
Patients with cirrhosis undergoing liver transplant (LT) are at high risk of postoperative cardiopulmonary complications. It is known that patients with coronary artery disease (CAD) have greater rates of post-LT morbidity and mortality than patients without CAD. Thus, identifying significant CAD in LT candidates is of the utmost importance to optimize survival posttransplant. ⋯ Traditional exercise and many pharmacologic stress tests are impractical and inaccurate in patients with cirrhosis due to their unique physiology. The purpose of this review is to describe different screening modalities for CAD among LT candidates. The background, diagnostic accuracy, and limitations of each screening modality are described to achieve this goal.
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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
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.
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J. Cardiothorac. Vasc. Anesth. · Dec 2023
Intraoperative FoCUS: Training Practices and Views on Feasibility.
To investigate whether resident anesthesiologists perceive intraoperative focused cardiac ultrasonography (FoCUS) as feasible, the self-reported confidence of residents performing intraoperative FoCUS, and United States graduate medical education resident ultrasound training practices. ⋯ The misconception that intraoperative FoCUS is infeasible appears prevalent, and most of the authors' respondents expressed a lack of comfort independently performing intraoperative FoCUS. Alterations of training practices, including increasing faculty usage of bedside ultrasonography, increasing trainee time performing FoCUS, and incorporating specific intraoperative ultrasound into the ultrasound curriculum, may address these deficiencies.