Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Nov 2024
ReviewAnalysis of The 2024 ESC/EACTS Guidelines For The Management Of Atrial Fibrillation.
The 2024 European Society of Cardiology guidelines for atrial fibrillation (AF) emphasize a patient-centered approach to management, structured around the AF-CARE pathway: Comorbidity and risk factor management (C), Avoiding stroke and thromboembolism (A), Reducing symptoms through rate and rhythm control (R), and Evaluation and dynamic reassessment (E). This framework ensures that comorbidities such as hypertension, heart failure, diabetes, and obesity are effectively managed to prevent disease progression and improve outcomes. A key principle of the guidelines is shared decision making involving patients, families, caregivers, and healthcare teams to ensure individualized care that reflects patient preferences. ⋯ For those with persistent symptoms despite medications, catheter ablation is recommended. Rate control strategies, including beta-blockers, digoxin, and calcium channel blockers, are used to manage heart rate and symptoms. Ongoing education for patients, families, and providers supports informed decision making and dynamic reassessment, optimizing patient outcomes and quality of life.
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J. Cardiothorac. Vasc. Anesth. · Nov 2024
Early Prone Positioning As a Rescue Therapy for Moderate-to-severe Primary Graft Dysfunction After Bilateral Lung Transplant.
Primary graft dysfunction (PGD) affects survival after lung transplant (LT). The current hypothesis was that prone positioning (PP), proposed as a rescue maneuver to treat refractory hypoxemia due to PGD, may improve LT outcomes, especially when applied early. ⋯ Early PP in LT recipients with moderate-to-severe PGD seems to be associated with better 28-day ventilator-free days, oxygenation, and driving pressure than late PP.
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J. Cardiothorac. Vasc. Anesth. · Nov 2024
ReviewPractical Considerations for Extracorporeal Membrane Oxygenation Use During Orthotopic Liver Transplantation.
Patients undergoing liver transplantation infrequently require extracorporeal membrane oxygenation (ECMO) support. However, when ECMO is required in the peritransplant period, several key considerations are required to maximize the efficacy of its support and minimize the risks of complications. This review seeks to briefly summarize the existing data supporting the use of ECMO in liver transplant patients and offers expert technical and practical advice from the authors' high-volume liver transplant center and ECMO program.
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J. Cardiothorac. Vasc. Anesth. · Nov 2024
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. · Nov 2024
Introduction of a Vendor-Independent Application for Clinical Generation of Pressure-Volume Loops from Routine Hemodynamic Data: A Methodological Exploration.
In the dynamic perioperative setting, changing fluid states complicate determination of ventricular function. This study evaluated the feasibility of clinical ventricular pressure-volume loop (PVL) construction using routine monitoring (echocardiography and invasive pressure monitoring). An application was developed and tested with biventricular simulated data and right ventricular (RV) clinical data. ⋯ This study introduces a vendor-independent application to generate PVLs from routinely available clinical data. The results highlight the potential application of the pressure-volume framework in cardiovascular research and patient care. A lack of external validation must be taken into account. Further research is warranted to validate the application. The app can be accessed at https://michael-vandenheuvel.shinyapps.io/eMv_Looper/.