Artificial Intelligence in Echocardiography for Anesthesiologists
Echocardiography is a unique diagnostic tool for intraoperative monitoring and assessment of patients with cardiovascular diseases. However, there are high levels of interoperator variations in echocardiography interpretations that could lead to inaccurate diagnosis and incorrect treatment. Furthermore, anesthesiologists are faced with the additional challenge to interpret echocardiography and make decisions in a limited timeframe from these complex data. The need for an automated, less operator-dependent process that enhances speed and accuracy of echocardiography analysis is crucial for anesthesiologists. (Source: Journa...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 20, 2020 Category: Anesthesiology Authors: Xia Chen, Cindy A. Owen, Emma C. Huang, Brittany D. Maggard, Rana K. Latif, Sean P. Clifford, Jinbao Li, Jiapeng Huang Tags: Emerging Technology Review Source Type: research

Pericardial Effusions in Patients With Cancer: Anesthetic Management and Survival Outcomes
The objective of this study was to describe practice patterns of anesthetic management during pericardial window creation. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 20, 2020 Category: Anesthesiology Authors: Casey M. Chai, Kenneth Seier, Kay See Tan, Iris Chu, James M. Isbell, Gregory W. Fischer, Anoushka M. Afonso Tags: Original Article Source Type: research

Intraoperative Remifentanil Infusion and Postoperative Pain Outcomes After Cardiac Surgery —Results from Secondary Analysis of a Randomized, Open-Label Clinical Trial
Design: Report of secondary pain outcomes from a prospective, randomized, open-label clinical trial that compared remifentanil and fentanyl on perioperative hyperglycemic response in cardiac surgery.Setting: Single institution, tertiary university hospital.Participants: The study comprised 116 adult elective cardiac surgical patients.Interventions: Participants were randomly assigned to receive either intermittent fentanyl boluses (F) or continuous remifentanil infusion (R) intraoperatively.Measurements and Main Results: Postoperative pain was evaluated with pain scores every 6 hours for 48 hours. (Source: Journal of Cardi...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 20, 2020 Category: Anesthesiology Authors: Kathirvel Subramaniam, Andrea Ibarra, Kristine Ruppert, Kushi Mallikarjun, Steve Orebaugh Tags: Original Article Source Type: research

Testing the Asymptomatic Pre-Surgical Population for Severe Acute Respiratory Syndrome Coronavirus 2
IN RESPONSE to the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities deferred all but emergency surgeries for ≥12 weeks to minimize/reduce risk to patients and healthcare workers.1-6 However, by April 2020, increased mortality for delaying necessary cardiac and thoracic procedures prompted multidisciplinary teams to determine how to restart surgical cases safely, balancing the urgent needs of patients, th e reported increased morbidity and mortality of COVID-19–positive patients undergoing surgical procedures,2,3,7,8 and the risk of spreading COVID-19 infection among healthcare workers. (Source: ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 19, 2020 Category: Anesthesiology Authors: April M. Bobenchik, Andrew D. Maslow, Aimee B. Angus, John Murphy, Jonathan D. Kurtis, Kimberle C. Chapin Tags: Letter to the Editor Source Type: research

The C-Sept Space: Another Step Forward in the Superiority of 3-Dimensional Echocardiography-Based Measurements
Systolic anterior motion of the mitral valve (SAM) first was described in the 1960s in patients with hypertrophic cardiomyopathy, and later following mitral valve (MV) annuloplasty, in the 1970s.1,2 Since then, it has been shown that left ventricular outflow tract obstruction (LVOTO) from SAM has a plethora of other predisposing risk factors. These risk factors include, but are not limited to, hypertrophic cardiomyopathy, anterior and medial displacement of the left ventricular papillary muscles, redundant MV leaflet tissue, and after mitral valve repair (MVR) and aortic valve replacement (AVR) surgeries. (Source: Journal ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 19, 2020 Category: Anesthesiology Authors: Quoc-Sy Nguyen, Timothy Maus Tags: Editorial Source Type: research

Role of Tissue Plasminogen Activator for Diffuse Pulmonary Microemboli in Coronavirus Disease 2019 Patient
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) –related hypercoagulability has been of great interest in the pathophysiology of coronavirus disease 2019 (COVID-19). Many patients have clinical findings of dead-space ventilation, similar to pulmonary embolism. Herein, a patient who presented with COVID-19 pneumonia and whose condition rapidly d eteriorated to respiratory failure requiring intubation is described. Tissue plasminogen activator (tPA) was administered because of concern of pulmonary microemboli, with improvement of respiratory status and extubation within 24 hours. (Source: Journal of Cardio...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 19, 2020 Category: Anesthesiology Authors: Samit Ghia, Himani Bhatt, Michael Lazar Tags: Case Report Source Type: research

The Effect of Pulmonary Disease on the Intraoperative Management of Lung Transplant Patients
Compared to other solid organ transplants, despite significant advances in preservation, anti-rejection, and anesthetic and surgical management, the morbidity and mortality of patients undergoing lung transplantation (LTX) remains high. This is complicated by a shortage of available organs, leading to the use of extended and marginal donors and reconditioning with ex vivo lung perfusion, by the heterogenicity of lung pathologies that are treated with LTX, and by the high incidence of chronic allograft rejection. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 19, 2020 Category: Anesthesiology Authors: Theresa A. Gelzinis Tags: Editorial Source Type: research

Sugammadex for Fast-Track Surgery in Children Undergoing Cardiac Surgery: A Randomized Controlled Study
Objective: The purpose of this study was to evaluate the safety and efficacy of  sugammadex for fast-track surgery in children undergoing cardiac surgery.Design: This was a prospective, randomized, controlled clinical study.Setting: University hospital.Participants: The study comprised 60 children undergoing cardiac surgery.Interventions: The children in group S received sugam madex, 4 mg/kg, for reversal of neuromuscular block, and the children in group N received neostigmine, 30 µg/kg, and atropine, 15 µg/kg. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 19, 2020 Category: Anesthesiology Authors: L. Li, Y. Jiang, W. Zhang Tags: Original Article Source Type: research

To Every Nerve There Is a Needle —The Threat of a Pygmalion Effect
The outcome of pediatric cardiac surgery has improved progressively over the past several decades, in which the risk of mortality has decreased significantly for even the most complex of congenital heart defects.1 Along with the improved survival, the impetus and focus have shifted to limiting morbidities and enhancing recovery after cardiac surgery (ERACS).2 Similar to the adult drive for ERACS, one of the most important and effective tools is postoperative multimodal pain control, with its potential impact on early extubation, early mobilization, and shorter length of stay. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 18, 2020 Category: Anesthesiology Authors: Emad B. Mossad Tags: Editorial Source Type: research

Sublingual Sufentanil Tablet System Versus Continuous Morphine Infusion for Postoperative Analgesia in Cardiac Surgery Patients
To assess the effectiveness and side effects of a patient-controlled sublingual sufentanil tablet system for postoperative analgesia after cardiac surgery and to compare it to a nurse-controlled continuous morphine infusion. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 17, 2020 Category: Anesthesiology Authors: Vincent Van Tittelboom, Ruben Poelaert, Manu L.N.G. Malbrain, Mark La Meir, Kurt Staessens, Jan Poelaert Tags: Original Research Source Type: research

Regional Anesthesia in Pediatric Cardiac Surgery: A Road to Enhanced Recovery
Enhanced recovery after surgery (ERAS) initiatives, involving a multimodal approach to treating surgical patients, have been linked to major improvements in clinical outcomes and cost.1 At its core, ERAS revolves around the concept that patient outcomes can be improved through multiple incremental steps acting synergistically throughout the entire perioperative period to modulate the physiologic response to surgical stress.2 Although most initial ERAS efforts focused on adult surgical patients, the practice increasingly has become embraced within pediatric surgical subspecialties to optimize care. (Source: Journal of Cardi...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 17, 2020 Category: Anesthesiology Authors: Matthew M. Townsley Tags: Editorial Source Type: research

Combined Cardiothoracic Surgery and Liver Transplantation Versus Isolated Liver Transplantation
Objective: Combined cardiothoracic surgery and liver transplantation (cCSLT) recently increasingly has been used. Despite that, liver transplant immediately after cardiothoracic surgery has not been well-characterized. The authors aimed to compare perioperative management and postoperative outcomes between patients undergoing cCSLT and isolated liver transplantation (iLT).Design: A retrospective study.Setting: University tertiary medical center.Participants: Twenty-five cCSLT patients and 1091 iLT patients at a single institution from 2010 to 2017. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 17, 2020 Category: Anesthesiology Authors: Christine C. Myo Bui, Colby Tanner, Christine Nguyen-Buckley, Jennifer Scovotti, Christopher Wray, Victor W. Xia Tags: Original Article Source Type: research

Intravenous Fluids and Hyperchloremia in Cardiac Surgery: Not the End of the Story?
THE CHLORIDE ion often has been treated like the middle child, receiving far less attention compared with its sodium and calcium counterparts; thus, it sometimes is referred to as the “forgotten” electrolyte.1 The recognition of saline-induced hyperchloremic metabolic acidosis,2 followed by the development of the Stewart approach to acid-base analysis,3 has yielded substantial research in the role of chloride as a strong ion. Recent evidence has identified hyperchloremia as a common biochemical finding in critically ill patients4 and as being associated with adverse outcomes such as renal dysfunction,5 coagulat...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 17, 2020 Category: Anesthesiology Authors: Priscilla Hui Yi Phoon, Nian Chih Hwang Tags: Editorial Source Type: research

Angiotensin II and Vasoplegia in Cardiac Surgery: Paradigm Changer or Costly Contender?
VASOPLEGIA, or loss of vascular tone with normal cardiac output, is a serious problem after cardiopulmonary bypass (CPB). Its reported incidence depends on the type of surgery performed, the definition used, and the patient population. In a recent meta-analysis that included more than 30,000 cardiac surgery patients from 10 studies, the incidence of vasoplegia after CPB was 5.1%.1 In the same study, patients with vasoplegia had a 3-fold increase in mortality.1 (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 17, 2020 Category: Anesthesiology Authors: Jonathan H. Chow, Erik Strauss, Michael A. Mazzeffi Tags: Editorial Source Type: research

Minimally Invasive Cardiac Surgery —Identifying Opportunities for Further Improvement in the Quality of Postoperative Patient Recovery
According to the American Heart Association, more than 1.5 million patients worldwide undergo cardiac surgery every year.1 Traditional approaches to these cardiac surgeries include incisions, such as median sternotomy or thoracotomy, which provide excellent surgical exposure. Unfortunately, each of these traditional incisions produces its own pattern of postoperative pain that may become chronic.2,3 Furthermore, patients often may have additional incisions to facilitate vascular access and/or vascular conduit harvesting, as well as chest tubes that may exacerbate an already painful procedure. (Source: Journal of Cardiothor...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 16, 2020 Category: Anesthesiology Authors: Bao Ha, Asad Ali Usman, John G. Augoustides Tags: Editorial Source Type: research

Is That a Paper Clip in the Aorta?
Foreign body ingestion, with subsequent esophageal complications, commonly is encountered.1 Possible complications include impaction, ulceration, erosion, perforation, tracheoesophageal fistulas, aortoesophageal fistulas, and, in the rare event, direct vascular injury. Most of these cases can be managed conservatively. However, 10% to 20% of cases require invasive intervention and less than 1% of cases require surgery.2 The following case highlighted a rare example of a foreign body ingestion causing direct aortic injury and the multidisciplinary approach required for safe removal. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 16, 2020 Category: Anesthesiology Authors: Meena Bhatia, Candy Ezimora, Yaroslav Yatsky, Priya Kumar Tags: Case Report Source Type: research

Chasing the Cardiogenic Shock Unicorn
Cardiogenic shock (CS) in the setting of acute myocardial infarction (MI) is a deadly condition, and there has been a search for the optimal treatment strategy for years. However, in-hospital survival with CS has plateaued at 60% to 70%. Several reports in the literature emphasized the need for more scientific evidence on the optimal management of CS complicating MI. The recently published position statement by the Acute Cardiovascular Care Association of the European Society of Cardiology has summarized the recent evidence and provided expert consensus. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 16, 2020 Category: Anesthesiology Authors: Chak-yu So, Guson Kang, Pedro A. Villablanca, Iv án J. Núñez Gil, Harish Ramakrishna Tags: Editorial Source Type: research

Mitral Regurgitation in 2020: The 2020 Focused Update of the 2017 American College of Cardiology Expert Consensus Decision Pathway on the Management of Mitral Regurgitation
The recently published “2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation” provides a framework for the clinical and echocardiographic assessment of mitral regurgitation and describes considerations for the medical, surgical, and transcatheter treatment of mitral regurgitation. The Update provides guidance for clinicians in light of the significant interim developments since the 2017 recommendations, particularly in the areas of secondary mitral regurgitation and transcatheter mitral valve repair. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 16, 2020 Category: Anesthesiology Authors: Polydoros N. Kampaktsis, Mark Lebehn, Isaac Y. Wu Tags: Review Article Source Type: research

The Challenges of Venoarterial ECMO for Postcardiotomy Shock
Venoarterial extracorporeal membrane oxygenation (VA ECMO) commonly is used to manage cardiogenic shock after cardiac surgery, transcatheter aortic valve replacement,1,2 cardiac catheterization procedures, and cardiac arrest.3,4 Anesthesiologists often are involved in the management of these patients both in the operating room and in critical care settings. However, its use raises many medical, ethical, and economic challenges.5,6 Several articles,7-14 editorials,15,16 and a pro/con debate17,18 related to ECMO after cardiac surgery have appeared this year in this Journal of Cardiothoracic and Vascular Anesthesia. (Source: ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 16, 2020 Category: Anesthesiology Authors: Eugene A. Hessel, Adam C. Betz Tags: Editorial Source Type: research

Ultrasound-Guided Intermediate Cervical Plexus Block for Transcarotid Transcatheter Aortic Valve Replacement
To report the authors ’ initial experience of transcarotid transcatheter aortic valve replacement (TAVR) managed with ultrasound-guided intermediate cervical plexus block. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 15, 2020 Category: Anesthesiology Authors: Nora Colegrave, Paola Mascitti, Konstandinos Zannis, PierLuigi Miceli, Aur élie Veugeois, Christophe Caussin, Ivan Philip Tags: Original Article Source Type: research

Using CSEPT as a New Echocardiographic Approach for Identifying Risk of Left Ventricular Outflow Obstruction After Cardiopulmonary Bypass
WE READ with great interest the recent retrospective review “The Mitral Coaptation to Ventricular Septal Space: Two- and Three-Dimensional Transesophageal Echocardiographic Assessment” by Maslow et al.1 In their study, the authors suggested that substantial reductions in CSEPT distance (the coaptation point of the mitral leaflets to the left ventricular basal septum) and CSEPT area ensued after cardiopulmonary bypass (CPB) with or without valvular intervention. The researchers did an outstanding job bringing attention to what we believe is an important and often overlooked aspect of the echocardiographic examin...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 15, 2020 Category: Anesthesiology Authors: Thomas Graul, Joseph Cody, Nasir Hussain, Michael Essandoh Tags: Letter to the Editor Source Type: research

On-Table Verification of Aortopulmonary Shunt Patency Through Ipsilateral Pulmonary Venous Blood Flow Assessment by Transesophageal Echocardiography
Intraoperative transesophageal echocardiography is a well-established modality for the evaluation of the adequacy of the surgical repair of complex congenital heart lesions. This case report highlights the important role played by real-time transesophageal echocardiography during the evaluation of the patency of a left modified Blalock –Taussig shunt in a child with pulmonary atresia, nonconfluent pulmonary arteries, and borderline hemodynamic/ventilator parameters. Changes observed in the pulmonary venous blood flow pattern provided reassurance to the surgical team about the patency of the shunt and thereby avoided ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 11, 2020 Category: Anesthesiology Authors: Madan Mohan Maddali, Amr Mohamed Abolwafa, Andrew Campbell Tags: Case Report Source Type: research

Left Ventricular Mechanical Circulatory Support —Assessing Outcomes With New Data
Ventricular assist devices continue to play a significant role in the surgical management of advanced heart failure. Left ventricular assist devices in particular have seen a rapid evolution in design, technology, implantation, and outcomes. This concise review focuses on the key data that have been published in the past 5 years that have demonstrated this rapid evolution in left-sided mechanical circulatory support from principally bridge to transplantation to destination therapy, with an increasing emphasis on quality-of-life measures and durability. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 11, 2020 Category: Anesthesiology Authors: Kristin Stawiarski, Harish Ramakrishna Tags: Expert Review Source Type: research

Aortic Dissection During Cardiac Surgery
ACCORDING to the Stanford classification, acute type A aortic dissection involves the ascending aorta and is considered a surgical emergency in order to minimize the significant mortality risk from proximal aortic complications.1 In contrast, acute type B dissections involve the descending thoracic aorta and may extend more distally.1,2 The Penn classification defines aortic dissection by clinical presentation rather than location because ischemic burden on presentation significantly defines mortality. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 11, 2020 Category: Anesthesiology Authors: Ronak Shah, Danielle Pulton, Robert K. Wenger, Bao Ha, Jared W. Feinman, Saumil Patel, Christopher Lau, Lisa Q. Rong, Stuart J. Weiss, John G. Augoustides, Danisa Daubenspeck, Mark A. Chaney Tags: Case Conference Source Type: research

Balancing the Blood Component Transfusion Ratio for High- and Ultra High –Dose Cell Salvage Cases
To assess the ratio of non-red blood cell to red blood cell components required to avoid coagulopathy when transfusing large amounts of salvaged blood using laboratory test –guided therapy. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 11, 2020 Category: Anesthesiology Authors: Kevin R. Merkel, Sophia D. Lin, Steven M. Frank, Tymoteusz J. Kajstura, Nicolas C. Cruz, Brian D. Lo, James H. Black, Eric A. Gehrie, Nadia B. Hensley, Brian C. Cho, Laeben C. Lester Tags: Original Article Source Type: research

Transaxillary Intra-aortic Balloon Pump Promotes Physical Rehabilitation in Patients Requiring Long-term Mechanical Circulatory Support
Intra-aortic balloon pumps (IABPs) most commonly are used for temporary mechanical circulatory support in patients with advanced heart failure. They typically are inserted via the percutaneous femoral artery approach and remain in place until mechanical support is discontinued. This approach has the limitation of requiring patients to remain in bed during the period of support due to the femoral arteriotomy, thereby preventing ambulation and promoting deconditioning in the intensive care unit (ICU). (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 11, 2020 Category: Anesthesiology Authors: Aneel Deshmukh, Edward McGough, Mustafa Ahmed Tags: Letter to the Editor Source Type: research

Activated Coagulation Time and Hepcon Protamine Titration Device to Manage Unfractionated Heparin During Cardiopulmonary Bypass in a Hemophilia A Patient on Emicizumab
In the perioperative management of patients with hemophilia A, emicizumab prevents the accurate measurement of common clotting assays, including the activated clotting time (ACT), which is essential for high-dose heparin monitoring during cardiopulmonary bypass surgery. The authors describe the successful perioperative management of a hemophilia A patient on maintenance emicizumab who, following a non-ST myocardial infarction, underwent cardiopulmonary bypass grafting surgery with heparin monitoring using both the ACT and heparin levels from the Hepcon protamine titration device. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 11, 2020 Category: Anesthesiology Authors: James Isaacs, Ian J. Welsby, Jacob N. Schroder, Oluwatoyosi A. Onwuemene Tags: Case Report Source Type: research

Zebras at the Derby?
IN MEDICAL training, the saying goes that when hoofbeats are heard, one should think of horses rather than zebras. This idiom often proves useful in the clinical setting, but one must also take into account where the hoofbeats are heard. For example, hoofbeats heard at Churchill Downs are far more likely to come from horses as compared with those heard in the Serengeti. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Wendy L. Pabich Tags: Editorial Source Type: research

Biased Agonism: The Future (and Present) of Inotropic Support
Biased agonism, which is the concept that different ligands activate different downstream signalling partners in different ratios to cause different functional effects, is yet to gain appropriate appreciation in the field of inotropic pharmacology. Biased agonism has already proven to be a clinically translatable technology in analgesic pharmacology, but this development is yet to be translated into inotropes. A better appreciation of bias in clinically used inotropes and a focus on bias when developing novel inotropes has the potential to lead to more targeted, personalized, and cleaner inotropes. (Source: Journal of Card...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Huw Garland, Alain Vuylsteke Tags: Emerging Technology Source Type: research

Comparison of Hemodynamic Responses to Administration of Vasopressin and Norepinephrine Under General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis
Objective: The authors performed a meta-analysis to determine if vasopressin improves hypotension more than norepinephrine under general anesthesia.Design: Meta-analysis.Setting: Operating room.Patients: Patients who underwent surgery, with general anesthesia.Interventions: Administration of vasopressin or norepinephrine in order to increase blood pressure.Measurements and Main Results: The primary outcome of this study was to determine if vasopressin increased mean blood pressure more effectively compared with norepinephrine for patients under general anesthesia. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Hiroshi Hoshijima, Takahiro Mihara, Yohei Denawa, Toshiya Shiga, Kentaro Mizuta Tags: Original Research Source Type: research

A Retrospective Evaluation of Airway Anatomy in Young Children and Implications for One-Lung Ventilation
ONE-LUNG ventilation (OLV) in young children remains technically challenging. With the advancement of less-invasive thoracoscopic techniques, there continues to be an escalating need for OLV via endobronchial intubation or bronchial blocker placement.1 Given this, it is important the clinician have some understanding of the anatomic constraints of the lower pediatric airway to safely and efficiently administer OLV. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Martina G. Downard, Amy J. Lee, Christopher J. Heald, Evelyn Y. Anthony, Jasmeet Singh, T. Wesley Templeton Tags: Original Article Source Type: research

Severe Intraoperative Hypertension Associated With AngioJet Rheolytic Thrombectomy for Lower Extremity Deep Venous Thrombosis
RHEOLYTIC thrombectomy (AngioJet; Boston Scientific, Marlborough, MA) is an emerging endovascular therapy for arterial and venous thrombosis.1,2 It has been studied best in extremity vessel procedures, including deep venous thrombosis (DVT).2-5 Previous studies have focused on bleeding complications; hemodynamic complications have been documented but not quantified further.2,6,7 We noticed frequent severe hypertension during these procedures and sought to estimate its incidence and describe associated patient and case characteristics given the current gap in the literature. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Sameer Lakha, Lucia Qian, Scott Lipson, Daniel Katz Tags: Letter to the Editor Source Type: research

Oxygen Management During Cardiopulmonary Bypass: A Single-Center, 8-Year Retrospective Cohort Study
To characterize the institutional oxygen management practices during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery, including any potential changes during an 8-year study period. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Bronwen B. Grocott, Hessam H. Kashani, Hendrick Maakamedi, Vikas Dutta, Brett Hiebert, Martin Rakar, Hilary P. Grocott Tags: Original Research Source Type: research

Regional Cerebral Oxygen Saturation: Does the Baseline Matter?
DESPITE IMPROVEMENTS in surgical and anesthesia techniques, neurocognitive complications continue to be a major concern after cardiac surgery. Two of the most significant risk factors for the development of postoperative neurocognitive disorders are advanced age and pre-existing cognitive impairment.1 One of the preventive strategies to alleviate or minimize neurocognitive sequelae is the application of brain monitoring during cardiac surgery. This may involve adjusting the depth of anesthesia using processed electroencephalography devices,2 or detecting real-time cerebral ischemia with the application of near-infrared spe...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Karla Pungsornruk, George Djaiani Tags: Editorial Source Type: research

Myocardial Preconditioning With Volatile Anesthetics: Goodbye to All That?
IN THE CURRENT issue, Oh et al. presented a large retrospective database review comparing total intravenous anesthesia (TIVA) with volatile maintenance on adverse outcomes after primary coronary bypass graft (CABG) surgery.1 The authors found a 3% absolute risk reduction in mortality that persisted up to 3 years after surgery favoring TIVA, the first time such a result has been reported. The current study suggested the exact opposite to all that have gone before —that not only are volatile anesthetics providing no protection against adverse outcomes after CABG, but that they are associated with an increase in mortali...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Daniel Sellers, Ludwik Fedorko, George Djaiani Tags: Editorial Source Type: research

Individualized Perioperative Antifibrinolytic Therapy: The Next Goal in Cardiac Surgery?
Antifibrinolytic therapy is a pharmacologic cornerstone of a multimodal blood conservation program in cardiac surgery with or without cardiopulmonary bypass (CPB).1 The administration of antifibrinolytic agents during CPB lowers both perioperative blood loss and requirements for transfusion of allogeneic blood products. It is a 1A recommendation for adult cardiac surgical procedures with CPB2-5 and a 1B recommendation for pediatric cardiac surgery.6 Since the withdrawal of aprotinin from the market in 2008 because of safety concerns,7,8 tranexamic acid (TXA) and Ɛ-aminocaproic acid (EACA) have become the 2 most extensivel...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Daniel Bolliger, Joachim M. Erb Tags: Editorial Source Type: research

Individualizing Care for a Vulnerable Population: A Look at the AHA Scientific Statement on Older Adults in the Cardiac Intensive Care Unit
As the US population ages, approximately one-fourth will be older than age 65 in 2060.1 With these changing demographics, elderly patients increasingly are presenting for medical and surgical interventions. Cardiac interventions have become more frequent, as approximately 85% of people older than 80 have cardiovascular disease.2 Addressing factors that can affect intensive care unit and hospital length of stay, in addition to long-term functional outcome, may decrease long-term morbidity and improve quality of life in these patients. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Megan N. Manento, Erica D. Wittwer, Bhargavi Gali Tags: Editorial Source Type: research

A Survey of the Practice of Thoracic Anesthesia in India
The aim of the survey was to understand the contemporary thoracic anesthesia practice in India. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Swapnil Y. Parab, Abinash Patro, Priya Ranganathan, Madhavi Shetmahajan Tags: Original Article Source Type: research

Arterial Stiffness Predicts General Anesthesia –Induced Vasopressor-Resistant Hypotension in Patients Taking Angiotensin-Converting Enzyme Inhibitors
HYPERTENSION remains a persistent worldwide problem for patients and healthcare providers. With recent changes in American Heart Association guidelines for hypertension management, it is likely that a greater percentage of patients will be prescribed antihypertensive medication.1 Among the various pharmacologic options used to treat hypertension, angiotensin-converting enzyme inhibitors (ACEIs) are first-line agents.2 (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Kenichi Ueda, David M. Janiczek, Darren P. Casey Tags: Original Article Source Type: research

Acute Severe Functional Mitral Regurgitation After Non-Mitral Valve Cardiac Surgery —Left Ventricular Dyssynchrony as a Potential Mechanism
Functional mitral regurgitation (MR) describes valve leakage in the absence of disease or damage to the mitral leaflets or subvalvular apparatus. Significant, new functional MR after cardiopulmonary bypass (CPB) may result from a number of intraoperative processes, including left ventricular (LV) ischemia and enlargement, left atrial enlargement secondary to increased filling pressure, and systolic anterior motion of the mitral valve after mitral repair. Assessment of new MR after CPB is important because it may direct hemodynamic maneuvers or prompt reinitiation of CPB if surgical intervention is deemed necessary. (Source...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: James A. Nelson, Raul Espinosa, Hector Michelena, Kent Rehfeldt Tags: Review Article Source Type: research

Ruptured Sinus of Valsalva Aneurysms: Does Transesophageal Echocardiography Have a Role in the Era of Sophisticated Cardiac Imaging?
SINUS OF Valsalva aneurysms (SVAs) may remain asymptomatic or present with complications such as aneurysm rupture, aortic insufficiency, disruption of the cardiac conduction system, compression of a coronary artery, or thrombus formation with subsequent embolization.1 Their most feared complication, SVA rupture, carries a high mortality unless managed with early surgical intervention. Given its rarity, varied presentations, and proximity to multiple critical structures, a ruptured SVA poses a diagnostic challenge even among experts. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 10, 2020 Category: Anesthesiology Authors: Harendra Arora, Priya A. Arora Tags: Editorial Source Type: research

Acute Intramyocardial Right Ventricular Hematoma After Coronary Artery Bypass Graft
A 50-year-old woman underwent coronary artery bypass graft (CABG) for multivessel coronary artery disease. Due to hemodynamic instability, the patient could not be weaned from cardiopulmonary bypass without mechanical support, even after multiple attempts. Subsequently, a right ventricular intramyocardial hematoma (IH) was found during postoperative coronary angiography. The IH was felt to be the main contributing factor leading to right ventricular failure and cardiogenic shock, which, to the authors ’ knowledge, has not been previously reported after CABG. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 5, 2020 Category: Anesthesiology Authors: Michael Johnson, Arun Kumar, Bradford L. Cardonell Tags: Case Report Source Type: research

Development of an Instrument for Preoperative Prediction  of Adverse Discharge in Patients Scheduled for Cardiac Surgery
Inability of home discharge occurs in nearly a third of patients undergoing cardiac surgery and is associated with increased mortality. The authors aimed to evaluate the incidence and risk factors for adverse discharge disposition (ADD) after cardiac surgery and develop a prediction tool for preoperative risk assessment. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 5, 2020 Category: Anesthesiology Authors: Andre F. Gosling, Maximilian Hammer, Stephanie Grabitz, Luca J. Wachtendorf, Anastasia Katsiampoura, Kadhiresan R. Murugappan, Sankalp Sehgal, Kamal R. Khabbaz, Feroze Mahmood, Matthias Eikermann Tags: Original Research Source Type: research

A New Tool for Timely Rescue of Heart Transplant Patients with Severe Primary Graft Dysfunction
ADVANCEMENTS IN heart transplantation have come a long way since Barnard, Shumway, and other pioneers first performed the revolutionary procedure more than 50 years ago.1 Progress in appropriate donor and recipient selection, organ protection, surgical and anesthetic techniques, and postoperative management have significantly reduced the initial mortality rates once seen with heart transplant. Indeed, the early years of 1968-to-1970 saw worldwide 1-year survival at 18% and 2-year survival at only 11%. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 3, 2020 Category: Anesthesiology Authors: Prakash A. Patel Tags: Editorial Source Type: research

Preoperative Evaluation and Anesthetic Management of Patients With Liver Cirrhosis Undergoing Cardiac Surgery
Preoperative evaluation and anesthetic management of patients with liver cirrhosis undergoing cardiac surgery remain a clinical challenge because of its high risk for perioperative complications. This narrative review article summarizes the pathophysiology and anesthetic implication of liver cirrhosis on each organ system. It will help physicians to evaluate surgical candidates, to optimize intraoperative management, and to anticipate complications in liver cirrhosis patients undergoing cardiac surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 3, 2020 Category: Anesthesiology Authors: Uzung Yoon, James Topper, Jordan Goldhammer Tags: Review Article Source Type: research

Thoracotomy Versus Sternotomy: Is it a Matter of Scar?
A STANDARD median sternotomy has been the preferred approach for cardiac surgical procedures and is considered the gold standard in children and adults. Despite medical and surgical advancement, a sternotomy scar is there to stay as a reminder that a cardiac defect had to be repaired. Alternative approaches to a median sternotomy have been proposed, including mini-sternotomy; thoracotomy (anterolateral, posterolateral, axillary); and endoscopic surgical procedures with or without robotic assistance. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 3, 2020 Category: Anesthesiology Authors: Dima G. Daaboul, Viviane G. Nasr Tags: Editorial Source Type: research

Sodium Abnormalities in Cardiac Surgery With Cardiopulmonary Bypass in Adults: A Narrative Review
Perioperative sodium abnormalities or dysnatremia is not uncommon in patients presenting for cardiac surgery and is associated with increased morbidity and mortality. Both the disease process of heart failure and its treatment may contribute to abnormalities in serum sodium concentration. Serum sodium is the main determinant of serum osmolality, which in turn affects cell volume. Brain cells are particularly vulnerable to changes in serum osmolality because of the nondistensible cranium. The potentially catastrophic neurologic sequelae of rapidly correcting chronic dysnatremia and the time-sensitive nature of cardiac surge...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 2, 2020 Category: Anesthesiology Authors: Xin Fang Leong, Maureen Cheng, Bronte Jong, Nian Chih Hwang, Andrew Roscoe Tags: Review Article Source Type: research

Use of ECMO in Patients With Coronavirus Disease 2019: Does the Evidence Suffice?
CORONAVIRUS DISEASE 2019 (COVID-19) is a contagious infection precipitated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2. It is a novel virus of which transmissability, incidence and mortality rates have made it a global emergency. While the clinical manifestations of the virus may vary in severity, it is widely known that the cardiorespiratory system is the principle infection point of the virus, with acute respiratory distress syndrome (ARDS) and shock being possibilities.1 (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 2, 2020 Category: Anesthesiology Authors: Samiha Alom, Ana Alina Haiduc, Naomi Melamed, Ariana Axiaq, Amer Harky Tags: Letter to the Editor Source Type: research

Use of a High-Flow Nasal Cannula in a Child With a Functional Single Ventricle and Difficult Airway
Inducing anesthesia and securing the airway without disrupting the patient's hemodynamic state are challenging in pediatric patients with a functional single ventricle (FSV). Here, the authors report effective use of a high-flow nasal cannula (HFNC) as a tool in providing oxygen supplementation for airway management in pediatric FSV patients with a history of a difficult airway. A female patient, aged 5 years 7 months, was admitted for extracardiac conduit Fontan procedure. The patient had a history of multiple failed attempts at endotracheal intubation and was diagnosed with retrognathia and severe oral trismus of less th...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 2, 2020 Category: Anesthesiology Authors: Byungdoo Andrew Lee, Won-Jung Shin, DaUn Jeong, Jae Moon Choi, Mijeung Gwak, In-Kyung Song Tags: Case Report Source Type: research

Assessing Diaphragmatic Dysfunction After Elective Cardiac Surgery: Expanding the Role of Critical Care Ultrasound
DIAPHRAGMATIC dysfunction occurs in mechanically ventilated patients as a result of both atrophy and contractile dysfunction.1 Other etiologies associated with cardiothoracic surgery include phrenic nerve injury, ligation of the diaphragmatic blood supply during internal mammary dissection, high mitochondrial oxidative stress, and multiorgan dysfunction in critically ill patients. Assessment and monitoring of diaphragmatic dysfunction are essential for the diagnosis and early identification of patients who are going to be challenging to wean from mechanical ventilation. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 2, 2020 Category: Anesthesiology Authors: Archit Sharma, Harish Ramakrishna Tags: Editorial Source Type: research