Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2022
How Should ECMO Be Used Under Conditions of Severe Scarcity? A Population Study of Public Perception.
To assess societal preferences regarding allocation of extracorporeal membrane oxygenation (ECMO) as a rescue option for select patients with coronavirus disease 2019 (COVID-19). ⋯ Even though participants expressed hesitation regarding ECMO in personal circumstances, they were uniformly in support of using ECMO to treat COVID patients at a policy level for others who might need it, even in the setting of severe scarcity.
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J. Cardiothorac. Vasc. Anesth. · Jun 2022
Anesthetic Considerations for Minimally Invasive, Off-Pump, HeartMate III Implantation.
The authors developed and utilized an anesthetic protocol for the management of an off-pump approach for minimally invasive Heartmate III (HM3) implantation. Their goal was to determine if this method was safe and feasible for patients with in-situ mechanical support. ⋯ In this single-center study, the authors have described the anesthetic consideration for the implantation of the HM3 left ventricular assist device using a complete sternal-sparing technique without the use of cardiopulmonary bypass. Their results have shown, in a case series of 8 patients, that this is a safe and feasible alternative to traditional techniques in patients with existing mechanical support.
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J. Cardiothorac. Vasc. Anesth. · Jun 2022
Case ReportsA Case of Transient Mitral Regurgitation: Not Everything Is Always What It Seems.
Mitral regurgitation (MR) is a common form of valvular heart disease that is associated with significant morbidity and mortality. MR can be broadly classified into 2 different categories: primary and secondary MR. ⋯ Without acute changes in loading conditions, myocardial blood flow, or rhythm disturbances, functional MR typically is not transient. In this E-Challenge, the authors show a transient and completely reversible acute and severe form of functional MR with the use of multimodal echocardiography.
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J. Cardiothorac. Vasc. Anesth. · Jun 2022
Case ReportsCoagulopathy Management of an Acute Type A Aortic Dissection in a Patient Taking Apixaban.
This paper reports the successful management of a patient with acute type A Penn B thoracic aortic dissection who was on apixaban therapy for atrial fibrillation. Emergency surgery was performed due to the patient's clinical deterioration, with innominate artery compromise and severe aortic valve regurgitation. ⋯ No additional blood products were required. The patient recovered fully and was discharged home.
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J. Cardiothorac. Vasc. Anesth. · Jun 2022
In Vitro Apixaban Removal By CytoSorb Whole Blood Adsorber: An Experimental Study.
The use of unopposed oral anticoagulants while undergoing cardiothoracic surgery is associated with severe bleeding and increased morbidity. The aim of this experimental study was to examine if the apixaban concentration in reconstituted blood could be reduced in an in vitro setup by the use of CytoSorb whole blood adsorber, and to study how this affected global coagulation assays. ⋯ In this in vitro study, apixaban concentrations were effectively reduced, and the clotting time and thrombin generation assays were normalized by the use of CytoSorb whole blood adsorber.