Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
ReviewAnalysis of the 2020 European Society of Cardiology (ESC) Guidelines for the Management of Adults With Congenital Heart Disease (ACHD).
Adult congenital heart disease (ACHD) continues to rapidly increase worldwide. With an estimated 1.5 million adults with ACHD in the USA alone, there is a growing need for better education in the management of these complex patients and multiple knowledge gaps exist. This manuscript comprehensively reviewed the recent (2020) updated European Society of Cardiology Guidelines for the management of ACHD created by the Task Force for the management of adult congenital heart disease of the European Society of Cardiology, with perioperative implications for the adult cardiac anesthesiologist and intensivist who may be called upon to manage these complex patients.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
ReviewEchocardiography and Management for Cardiac Trauma.
Trauma is the number one cause of death among Americans between the ages of 1 and 46, costing >$670 billion a year. Blunt and penetrating trauma can lead to cardiac and aortic injuries, with the incidence of death varying upon the location of the damage. ⋯ This review article aims to analyze the pathophysiology of cardiac injuries in patients with trauma and the role of echocardiography for the accurate diagnosis of cardiac injury in trauma. This review, additionally, will offer a patient-centered, team-based, early management plan with a treatment algorithm to help improve the quality of care among these patients with cardiac trauma.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
Randomized Controlled TrialEffect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial.
To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). ⋯ An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
ReviewIntraoperative Renal Replacement Therapy: Practical Information for Anesthesiologists.
Previous publications regarding perioperative renal replacement therapy (RRT) have focused on the general care of the RRT-dependent patient and provided a broad overview of the various RRT modalities. The goal of this review article is to provide anesthesiologists with specific practical information regarding the possible intraoperative advantages and limitations of each modality, mandatory equipment to institute intraoperative therapy, and background knowledge necessary to communicate effectively with nephrologists and/or support staff regarding the intraoperative RRT goals.
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J. Cardiothorac. Vasc. Anesth. · Aug 2022
ReviewA Sequential Approach for Echocardiographic Guidance of Transseptal Puncture: The PITLOC Protocol.
With advancements in technology and progress in interventional procedures, left-sided structural heart disease (SHD) interventions have become part of everyday clinical practice. One of the most important steps for a successful left-sided structural heart intervention is the transseptal puncture (TSP). Appropriate transesophageal echocardiographic (TEE) guidance of TSP requires extensive supervised hands-on experience prior to attaining proficiency. ⋯ Several studies have emphasized the value of advanced training in imaging for SHD interventions; however, the pathways and advanced training to ensure proficiency in interventional echocardiography have not yet been clearly established. In an effort to achieve a uniform and consistent approach to TSP imaging that is homogeneous and complementary to the component steps of the TSP procedure from an interventional point-of-view, the authors have developed a protocol for providing image guidance for TSP - the PITLOC protocol (Practice, Identification of septal puncture needle, Tracking of needle tip, Localization of needle tip in fossa ovalis, Optimizing septal indentation, and, finally, Crossing the interatrial septum under direct vision). This protocol aims to standarize image guidance for TSP while complementing the the steps of the procedure as performed and described by interventionalists.