The aha/acc consensus conference: a roadmap for success or just a long road?
At no time in our modern-day history have institutions of higher learning and professional organizations been under more scrutiny to demonstrate team diversity, a battle cry for social justice, outrage at a flawed social system, care for all ranks of caregivers, and policing of those “dangerous liaisons” with “big pharma” and industry. The stakes have never been higher. Today, breathe the wrong word, and incomplete sound bites will land you in the unemployment line. Between a global pandemic, civil unrest, political division, and a multi-generational society with diverge nt opinions, discord has bec...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 3, 2021 Category: Anesthesiology Authors: Aaron Douglas, Michelle Capdeville Tags: Editorial Source Type: research

Masthead
(Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Source Type: research

Editorial Board
(Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Source Type: research

Contents
(Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Source Type: research

Articles to Appear in Future Issues
(Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Source Type: research

Guide for Authors
(Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Source Type: research

Cardiac Calendar 2021-2022
(Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Source Type: research

Prevalence, characteristics and preoperative predictors of chronic pain after double-lung transplantation: a prospective cohort study
Over the years, striking changes have transformed anesthesia, leading to new challenges. Because of the improved survival of lung transplant patients, which reaches about 70% at 5 years, 1 their anesthetic management must take into consideration the risk of development of chronic pain and its consequences, notably an impaired quality of life. Pain is a common problem in patients who are candidates for, or have undergone, lung transplantation. Accordingly, nearly half of the patients awaiting lung transplantation had pain 2 and post-transplant pain prevalence has been evaluated in up to 20% to 80% of patients. (Source: Jour...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Authors: Quentin Laurent, Mireille Michel-Cherqui, Barbara Szekely, Matthieu Glorion, Edouard Sage, Julie Trichereau, Marc Fischler, Julien Fessler, Morgan Le Guen Tags: Original Article Source Type: research

Successful Left Phrenic Nerve Block for Intractable Hiccups in a Patient with LVAD Induced Diaphragmatic Irritation
We report the first case of intractable hiccups caused by mechanical irritation of the LVAD that resolved after two left sided phrenic nerve blocks performed in succession within 1 month. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Authors: Daneel Patoli, Ronny Cheuk-Kit Chan, Avery Tung, Maunak Rana Source Type: research

The Lymphatic System in the Fontan Patient; Pathophysiology, Imaging, and Interventions: What the Anesthesiologist Should Know
The Fontan operation was developed as a palliative intervention for congenital heart disease (CHD) patients with single ventricle physiology who are not candidates for a biventricular repair. Improvements in the operation and medical management of these patients has increased survival, yet this population remains at risk for complications and end-organ dysfunction due to Fontan failure.Lymphatic vessels maintain a fluid balance within the extracellular space, participate in fat reabsorption from the small intestines and play an important role in the body's immune response. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Authors: Maricarmen Roch é Rodríguez, James A. DiNardo Source Type: research

Euglycemic Diabetic Ketoacidosis After Cardiac Surgery In A Patient Treated With Empagliflozin For Type 2 Diabetes Mellitus: A Case Report
We report a patient that developed severe euglycemic diabetic ketoacidosis (EDKA) after cardiac surgery. The patient was preoperatively treated with Empagliflozin and postoperatively presented with critical metabolic acidosis with increased anion gap. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2021 Category: Anesthesiology Authors: Peter Wohlrab, Matthias Kainz, Arno Schiferer, Bernhard Zapletal, Edda Tschernko Source Type: research

Paraplegia after open surgical repair vs thoracic endovascular aortic repair for thoracic aortic disease: a retrospective analysis of Japanese administrative data
To comparatively examine the risk of postoperative paraplegia between open surgical descending aortic repair and thoracic endovascular aortic repair (TEVAR) among patients with thoracic aortic disease. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 30, 2021 Category: Anesthesiology Authors: Takeshi Umegaki, Susumu Kunisawa, Kota Nishimoto, Yasufumi Nakajima, Takahiko Kamibayashi, Yuichi Imanaka Source Type: research

Prone positioning in postoperative cardiac surgery patients: a narrative review
Limited data are available on the use of prone position in cardiac surgery. Concerns in performing this maneuver in open-heart surgery due to the risk of post-sternotomy wound infections and hemodynamic instability do not seem to be supported by existing evidence. Indeed, available data show that prone positioning may improve gas exchange in cardiac surgery patients as well. However, previous studies of prone positioning in this setting were heterogeneous in terms of patient characteristics and outcomes evaluated. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 29, 2021 Category: Anesthesiology Authors: Giuseppe Santarpino, Raffaele Bonifazi, Marco Albanese, Anna Nicoletti, Flavio Fiore, Giuseppe Nasso, Giuseppe Speziale Tags: Review Article Source Type: research

Spontaneous ventilation video-assisted thoracoscopic surgery for geriatric patients with non-small-cell lung cancer
: The aim of the present study was to compare the short-term outcomes between spontaneous ventilation video-assisted thoracic surgery (SV-VATS) and mechanical ventilation video-assisted thoracic surgery (MV-VATS) in the elderly. All the patients included in the present study underwent lobectomy, segmentectomy, or wedge resection and lymph node dissection. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 29, 2021 Category: Anesthesiology Authors: Chuqiao Wang, Donghong Wu, Peilin Pang, Han Kong, Jieyi Zhao, Xiaoying Chen, Jingyi Ye, Zhe Pan, Wenhua Liang, Jun Liu, Jianxing He Source Type: research

Ultrasound hepatic vein ratios are associated with the development of acute kidney injury post cardiac surgery
The contemporary definition of the diagnosis of acute kidney injury (AKI) is neither time-sensitive, nor specific. AKI is notoriously multifactorial in origin and found to occur more commonly in cardiac surgery patients when compared to non-cardiac surgery patients. Cardiac surgery associated acute kidney injury (CSA AKI) carries substantial morbidity and mortality. Pursuits to timeously diagnose CSA AKI have, to date, not been actualized. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 27, 2021 Category: Anesthesiology Authors: Gabriela Pettey, Johan Lyngklip Hermansen, Samantha Nel, Hlamatsi Jacob Moutlana, Michel Muteba, Peter Juhl-Olsen, Nqoba Tsabedze, Palesa Motshabi Chakane Tags: Original Article Source Type: research

The optimal cell salvage settings to maximize hematocrit and minimize potassium using the Cobe BRAT2 Autologous Blood Recovery Unit
The objective was to determine the optimal cell saver device settings (infusion rate and wash rate) at which hematocrit is preserved and potassium and lactate are removed from banked red blood cells.Design: Red cells were washed using the Cobe BRAT 2 Autologous Blood Recovery Unit and sampled for electrolyte composition and hematocrit pre and post-wash.Setting: This was a single-center study.Interventions: Red cells were washed using at six infusion rates (100 to 1000 mL/min) and six wash rates (100 to 1000 mL/min) for a total of 36 combinations. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 27, 2021 Category: Anesthesiology Authors: Natalie K. Smith, Sang Kim, Qasim Simmons, Hung-Mo Lin, Diana Romano, Elaine Boydston, Samuel DeMaria, Jeron Zerillo Tags: Original Article Source Type: research

JCVA-D-21-00741R1: A left atrial mass after COVID-19 and cardiac surgery
When a new left atrial mass is encountered following open-heart surgery, it is important to be aware of the possibility of a left atrial invagination prior to resorting to drastic measures especially in the critical period after separation from cardiopulmonary bypass. Intraoperative transesophageal echocardiography is of immense value and the mass has to be evaluated in multiple views before arriving at a definitive diagnosis. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 27, 2021 Category: Anesthesiology Authors: Dr. Madan Mohan Maddali, Dr. Thushara Dharshana Munasinghe Tags: Diagnostic Dilemma Source Type: research

A rare complication in a child undergoing resection of a huge thoracic lipoma: Pediatric reexpansion pulmonary edema
The parents of a 19-month-old, 11 kg, 86 cm girl brought their otherwise healthy daughter to their primary care physician for evaluation of a persistent dry cough of three weeks duration. They reported that the child's cough seemed to be worse at night, but it did not prevent her from sleeping comfortably on her back. The parents denied that she had a fever, chills, malaise, weight loss, night sweats, dyspnea at rest or on exertion, orthopnea, paroxysmal nocturnal dyspnea, or a change in appetite. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 27, 2021 Category: Anesthesiology Authors: Barbara J. Meinecke, William R. Clarke, Paul S. Pagel Tags: Diagnostic Dilemma Source Type: research

Thoracic Anesthesia during the 2019 Novel Coronavirus Infection Pandemic: 2021 Updated Recommendations for Airway Management by the EACTAIC Thoracic Subspecialty Committee
The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority and there is an increasing need to fully define the optimal oncological management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Health care providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer: an imminent spike due to mortality from acute COVID-19 infection and a secondary peak reflecting an excess of cancer-relate...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 26, 2021 Category: Anesthesiology Authors: Mert Şentürk, Mohamed R. El Tahan, Ben Shelley, Laszlo L. SZEGEDI, Federico Piccioni, Marc-Joseph Licker, Waheedullah Karzai, Manuel Granell Gil, Vojislava Neskovic, Caroline Vanpeteghem, Paolo Pelosi, Edmond Cohen, Massimiliano Sorbello, Johan Bence, R Tags: SPECIAL ARTICLE Source Type: research

Motion Tracking Machines and Sensors: Advancing Education Technology
Graduate medical education is  predominantly based on a time-based apprenticeship model, with implied acquisition of proficiency after a pre-set amount of clinical exposure. While motion metrics have been used previously to measure skill performance indicators, these assessments have largely been performed on a summative scale to describe the performance of complete tasks or procedures. By segmenting performances of interest and assessing the essential elements individually, a more comprehensive understanding of the aspects in need of improvement for a learner can be obtained. (Source: Journal of Cardiothoracic a...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 25, 2021 Category: Anesthesiology Authors: Vincent Baribeau, Jeffrey Weinstein, Vanessa T. Wong, Aidan Sharkey, Derek N. Lodico, Robina Matyal, Feroze Mahmood, John D Mitchell Source Type: research

Association Between Preoperative Statin Exposure and Acute Kidney Injury in Adult Patients Undergoing Cardiac Surgery
: The existing literature has shown conflicting results regarding the association between preoperative statin exposure and the risk of postoperative cardiac surgery-associated acute kidney injury(CSA-AKI). (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 23, 2021 Category: Anesthesiology Authors: Yu Tian, Xiuyuan Li, Yuefu Wang, Wei Zhao, Chunrong Wang, Yuchen Gao, Sudena Wang, Jia Liu Source Type: research

Dopamine reverses lung function deterioration after cardiopulmonary bypass without affecting gas exchange
To investigate the effects of dopamine on the adverse pulmonary changes following cardiopulmonary bypass (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 23, 2021 Category: Anesthesiology Authors: Ferenc Pet ák, Ádám L. Balogh, Péter Hankovszky, Gergely H. Fodor, József Tolnai, Roberta Südy, Barbara N. Kovács, Andrea Molnár, Barna Babik Tags: Original Article Source Type: research

Perioperative changes in global myocardial work indices in a patient with severe aortic stenosis with severe left ventricular dysfunction undergoing surgical aortic valve replacement
The severity of aortic stenosis (AS) is assessed by aortic valve gradients and aortic valve area. The American Heart Association guidelines for indication of aortic valve replacement (AVR) for severe AS are based on either presence of symptoms (angina, syncope) or left ventricular (LV) systolic dysfunction as measured by LV ejection fraction (LV EF)1. But both these conditions represent late stage of the disease. The LV global longitudinal strain (GLS) in contrast is reduced early in majority of patients with AS and associated with all-cause mortality independent of LVEF2. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 23, 2021 Category: Anesthesiology Authors: Deepak Borde, Pooja Joshi, Balaji Asegaonkar, Ashish Agrawal Tags: Case Report Source Type: research

Associations between expiratory flow limitation and postoperative pulmonary complications in cardiac surgery patients
To determine whether driving pressure and expiratory flow limitation are associated with the development of postoperative pulmonary complications (PPCs) in cardiac surgery patients. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 23, 2021 Category: Anesthesiology Authors: Lorenzo Ball, Carlo Alberto Volta, Francesco Saglietti, Savino Spadaro, Antonio Di Lullo, Giulio de Simone, Marcello Guarnieri, Francesca Della Corte, Ary Serpa Neto, Marcelo Gama de Abreu, Marcus J. Schultz, Alberto Zangrillo, Paolo Pelosi, Elena Bignami Tags: Original Article Source Type: research

2021 Update in the Diagnosis and Management of Acute Coronary Syndromes For the Perioperative Clinician
In this review, recent key publications related to acute coronary syndrome (ACS) are summarized and placed into context of contemporary practice. Landmark trials examining vascular access in STEMI (ST elevation myocardial infarction), the management of multivessel disease, acute myocardial infarction and cardiac arrest are discussed. An update in pharmacology for ACS provides updates in major trials relating to P2Y12 inhibitor initiation, de-escalation, and use in special populations. Additional updates in the use of lipid lowering agents and adjunctive medications in ACS are reviewed. (Source: Journal of Cardiothoracic an...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 22, 2021 Category: Anesthesiology Authors: Katherine J. Kunkel, Alejandro Lemor, Shazil Mahmood, Pedro Villablanca, Harish Ramakrishna Tags: Expert Review Source Type: research

Neuromonitoring and Neurocognitive Outcomes In Cardiac Surgery: A Narrative Review
Neurocognitive dysfunction following cardiac surgery can present with diverse clinical phenotypes, which include postoperative delirium, postoperative cognitive dysfunction, and stroke, and it presents a significant healthcare burden for both patients and providers. Neurological monitoring during cardiac surgery includes several modalities assessing cerebral perfusion and oxygenation (near-infrared spectroscopy, transcranial doppler and jugular venous bulb saturation monitoring) and those that measure cerebral function (processed and unprocessed electroencephalogram), reflecting an absence of a single, definitive neuromoni...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 20, 2021 Category: Anesthesiology Authors: Ben Milne, Thomas Gilbey, Livia Gautel, Gudrun Kunst Tags: Review Article Source Type: research

Early Thromboembolic Stroke Risk of Postoperative Atrial Fibrillation Following Cardiac Surgery
We aimed to study the association between postoperative atrial fibrillation (POAF) and thromboembolic stroke and to determine risk factors for thromboembolic stroke following cardiac surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 20, 2021 Category: Anesthesiology Authors: Ramon Pierik, Miriam Zeillemaker-Hoekstra, Thomas W.L. Scheeren, Michiel E. Erasmus, Gert-Jan R. Luijckx, Michiel Rienstra, Maarten Uyttenboogaart, Maarten Nijsten, Walter M. van den Bergh Source Type: research

Postoperative tracheal compression requiring transposition of the brachiocephalic artery after Bentall operation combined with total arch replacement in a patient with Loeys-Dietz syndrome
Loeys –Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder similar to Marfan syndrome (MFS), which mainly consists of vascular lesions (aneurysm and dissection), skeletal abnormalities, head and facial abnormalities, and skin lesions [1, 2]. Compared to MFS, LDS has more severe vasc ular symptoms and lesions are found in a wide range of arteries; hence, surgical interventions for aortic dissection and cerebral hemorrhage are often required from a young age [3]. Despite this, there are only a handful of reports on perioperative management of LDS and points of caution in airway m anagement have yet...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 17, 2021 Category: Anesthesiology Authors: Tsukamoto Marumi, Kondo Takashi, Miyoshi Hirotsugu, Toyota Yukari, Yokomi Hiroshi, Sumii Ayako, Shorin Daiki, Takahashi Shinya, M Tsutsumi Yasuo Tags: CASE REPORT Source Type: research

Utility of the CHA2DS2-VASc Score in Prediction of Postoperative Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery
We aimed to investigate the role of CHA2DS2-VASc score and its components in prediction of postoperative atrial fibrillation (POAF) after isolated coronary artery bypass graft (CABG) surgery. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 17, 2021 Category: Anesthesiology Authors: Seyedeh Hamideh Mortazavi, Alireza Oraii, Hamidreza Goodarzynejad, Peyvand Bina, Arash Jalali, Seyed Hossein Ahmadi Tafti, Jamshid Bagheri, Saeed Sadeghian Tags: Original Article Source Type: research

Angiotensin II: A Review of Current Literature
Up to one-third of all patients admitted to intensive care units carry a diagnosis of shock. The use of angiotensin II is becoming widespread in all forms of shock, including cardiogenic, after the Food and Drug Administration initial approval for vasoplegic shock in 2017. We review the literature on angiotensin II's mechanism of action, benefits, and future therapeutic opportunities. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 16, 2021 Category: Anesthesiology Authors: Amit Alam, William Sovic, Jasmeet Gill, Nikolaus Ragula, Mahmoud Salem, GregoryJ. Hughes, Gates B. Colbert, Jennifer L. Mooney Source Type: research

Perioperative Implications of the 2020 American Heart Association/American College of Cardiology Guideline for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy: A Focused Review
Hypertrophic cardiomyopathy (HCM) is a complex disease with significant implications for patients and the physicians called upon to care for them during the perioperative period. In this article, the 2020 American Heart Association and American College of Cardiology clinical practice guidelines for the evaluation and management of pediatric and adult patients with HCM is reviewed, with a particular focus on perioperative considerations for the anesthesiologist. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 16, 2021 Category: Anesthesiology Authors: Dylan R. Addis, Matthew M. Townsley Tags: Review Article Source Type: research

Pro: 24/7 In-House Intensivist Coverage in CTICU
Perspective guides much of our daily lives, perhaps especially how we view our professional careers. The notable American writer, Edmund Wilson, once said, “No two persons have ever read the same book”. This phrase can be applied to numerous aspects of life, including work in a cardiothoracic intensive care unit (CTICU). Restated for intensivists, it could be written, “No two intensivists working in a CTICU will feel the same way about their jobs ”. This is due to the multitude of encounters with high acuity or deteriorating patients, along with the incessant environment of a critical care unit. (So...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 15, 2021 Category: Anesthesiology Authors: Brent Kidd, Brigid C. Flynn Source Type: research

To be removed or not? Intraoperative transesophageal echocardiography evaluation of coronary ostial stent protruding into the aorta
We report the details of two patients undergoing cardiac surgery where a perioperative decision was required regarding a coronary ostial stent protruding into the aorta. In the absence of guidelines on perioperative management of such situations, we highlight the specific aspects of intraoperative TEE evaluation along with the perioperative factors and their possible long-term implications that could influence management. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 15, 2021 Category: Anesthesiology Authors: Dr. Bhargava V Devarakonda, Dr. Sandeep Garre, Dr. Puthuvassery Raman Suneel, Dr. Saravana Babu, Dr. Thomas Koshy Source Type: research

Management of Patients with Non-alcoholic Steatohepatitis Undergoing Liver Transplantation: Considerations for the Anesthesiologist
Non-alcoholic fatty liver disease currently affects more than 25% of the world population and is rising. Non-alcoholic fatty liver disease can progress to non-alcoholic steatohepatitis that is associated with hepatic inflammation and fibrosis and can result in cirrhosis with subsequent liver failure. Non-alcoholic steatohepatitis has now emerged as one of the leading etiologies for a liver transplant among adults in the United States. Given the rising incidence of liver transplants in patients with non-alcoholic steatohepatitis related cirrhosis, it is essential for anesthesiologists to be familiar with this condition as w...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 15, 2021 Category: Anesthesiology Authors: Sonal Sharma, Jonathan G. Stine, Thomas Verbeek, Dmitri Bezinover Source Type: research

An novel 3D printing based simulation device for transcatheter edge-to-edge mitral repair
Transcatheter edge-to-edge mitral valve repair technique has now been recommended as a standard treatment option for patients severe symptomatic mitral regurgitation who are at high or prohibitive surgical risk.1-2 However this procedure requires complex technical skills to navigate the clip device within the heart thorough a sophisticated multi-arm steerable delivery system under guidance of transesophageal echocardiography (TEE). Studies have revealed that operator experience is directly associated with procedural outcomes and at least 50 procedures are needed until outcomes improve. (Source: Journal of Cardiothoracic an...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 15, 2021 Category: Anesthesiology Authors: Da Zhu, Shouzheng Wang, Xiangbin Pan Tags: Letter to editor: Source Type: research

Con: 24/7 In-House Intensivist Coverage is NOT required for CTICU Management
The 24/7 ICU coverage model is increasingly prevalent, with a recent survey of critical care fellowship programs suggesting that one-third of programs have an attending intensivist who is physically present in the hospital at night to oversee the care of ICU patients1. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 15, 2021 Category: Anesthesiology Authors: Junaid Nizamuddin, Avery Tung Tags: Pro and Con Source Type: research

Contemporary Practice of Echocardiography in Transcatheter Aortic Valve Replacement
The contemporary practice of perioperative imaging and procedural guidance for transcatheter aortic valve replacement (TAVR) has evolved greatly in recent years. This has been both a cause and an effect of changes in the way we provide anesthesia for these procedures. While valve sizing with multidetector computed tomography (MDCT) has decreased the use of general anesthesia (GA) chosen solely to facilitate intraprocedural transesophageal echocardiography (TEE), a shift towards greater use of monitored anesthesia care (MAC) and transthoracic echocardiography (TTE) was already underway. (Source: Journal of Cardiothoracic an...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 14, 2021 Category: Anesthesiology Authors: Liliya Pospishil, Robert G. Nampi, Peter J. Neuburger Source Type: research

Ultrasound-Enhancing Agent Safety: Understanding the New Food and Drug Administration Warning on Polyethylene Glycol
IN APRIL 2021, the Food and Drug Administration (FDA) issued an alert stating ultrasound-enhancing agents (UEA) should not be administered to patients with known hypersensitivity reactions to polyethylene glycol (PEG). In response, several societies, including the International Contrast Ultrasound Society and the American Society of Echocardiography, have issued and published statements providing education and guidance on this topic.1 (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 13, 2021 Category: Anesthesiology Authors: Tiffany M. Williams, Reed Harvey, Wolf B. Kratzert, Matthew A. Fischer, Jacques Neelankavil Tags: Editorial Source Type: research

Left Atrial Appendage Occlusion Device Placement and the Integration of Echocardiography-Fluoroscopy Fusion Imaging
Integration of innovative technology and new procedures have often moved forward in a parallel fashion. One example is the advent of fluoroscopy leading to successes in transcatheter procedures and subsequent improvements in both. The addition of transesophageal echocardiography during transcatheter procedures with simultaneous fluoroscopy has been synergistic, giving the proceduralist data from both modalities. It is not surprising that finding technological means to combine these modalities is a natural step, such as is seen in Echocardiography-Fluoroscopic Fusion Imaging (EFFI) systems. (Source: Journal of Cardiothoraci...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 13, 2021 Category: Anesthesiology Authors: Andrew C. Maresch, M. Megan Chacon, Nicholas W. Markin Source Type: research

Ultrasound Enhancing Agent Safety: Understanding the New FDA Warning on Polyethylene Glycol
In April 2021, the Food and Drug Administration (FDA) issued an alert stating ultrasound enhancing agents (UEA) should not be administered to patients with known hypersensitivity reactions to polyethylene glycol (PEG). In response, several societies including the International Contrast Ultrasound Society and the American Society of Echocardiography have issued and published statements providing education and guidance on this topic1. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 13, 2021 Category: Anesthesiology Authors: Tiffany M. Williams, Reed Harvey, Wolf B. Kratzert, Matthew A. Fischer, Jacques Neelankavil Source Type: research

Acute Myocardial Infarction with Cardiogenic Shock – navigating the invasive options in clinical management
A multidisciplinary working group from the American Heart Association recently published a perspective about the mechanical circulatory support options for acute myocardial infarction complicated by cardiogenic shock.1 This scientific statement has high impact, given the complex patient population addressed, the noted variability in practice across regions, and the inherent value of this topic.1-2 Cardiogenic shock is a common cause for mortality in patients with acute myocardial infarction not only during the acute phase but up to one year from hospital discharge, representing a contrast to the improved outcomes for acute...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 13, 2021 Category: Anesthesiology Authors: Jesse J. Kiefer, John G. Augoustides Source Type: research

Cardiac Surgery in a Patient With Antiphospholipid Syndrome and Heparin-Induced Thrombocytopenia
ANTIPHOSPHOLIPID SYNDROME (APS) and heparin-induced thrombocytopenia (HIT) are separate disease processes that are both characterized by a prothrombotic state and an increased risk of perioperative complications. APS is a rare, noninflammatory, autoimmune disease, resulting in arterial and/or venous thrombosis, thrombocytopenia, fetal loss, and the presence of antiphospholipid (APL) antibodies.1 The incidence of APS is approximately 2% in the general population.2 Irregular thickening of heart valves from immune-complex deposition leads to valvular disease in 35% to 82% of patients with APS, and 4% to 6% of these patients r...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 12, 2021 Category: Anesthesiology Authors: Eric R. Simon, Milap Rakholia, Marie LaPenta McHenry, Pankaj Kumar Mishra, Rajendra Singh, Kalyana Javangula, Mohammed M. Minhaj, Mark A. Chaney Tags: Case Conference Source Type: research

Hhhhhhggggcardiac surgery in a patient with antiphospholipid syndrome and heparin-induced thrombocytopenia
Antiphospholipid syndrome (APS) and heparin-induced thrombocytopenia (HIT) are separate disease processes that are both characterized by a prothrombotic state and an increased risk of perioperative complications. APS is a rare, noninflammatory, autoimmune disease resulting in arterial and/or venous thrombosis, thrombocytopenia, fetal loss, and the presence of antiphospholipid (APL) antibodies.1 The incidence of APS is approximately 2% in the general population.2 Irregular thickening of heart valves from immune complex deposition leads to valvular disease in 35-82% of patients with APS and 4-6% of these patients require sur...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 12, 2021 Category: Anesthesiology Authors: Eric R. Simon, Milap Rakholia, Marie LaPenta McHenry, Pankaj Kumar Mishra, Rajendra Singh, Kalyana Javangula, Mohammed M. Minhaj, Mark A. Chaney Source Type: research

Near-Infrared Spectroscopy (NIRS) for Cerebral and Tissue Oximetry: Analysis of Evolving Applications
THE USE OF NEAR-INFRARED SPECTROSCOPY (NIRS) has increased significantly worldwide in the past decade. This technology, first described more than 40 years ago, is based on the fact that near-infrared light is able to penetrate biologic tissue and can obtain real-time, noninvasive information on tissue oxygenation and metabolism. In the clinical setting, NIRS has been able to provide clinicians potentially valuable information in patients with impaired microcirculations (systemic and cerebral). Near-infrared spectroscopy has progressed beyond assessment of brain oxygenation to monitor local tissue and muscle oxygenation and...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2021 Category: Anesthesiology Authors: Jafer Ali, Joseph Cody, Yasdet Maldonado, Harish Ramakrishna Tags: Expert Review Source Type: research

Incidence of Difficult Laryngoscopy in Adult Congenital Heart Disease Patients: A Retrospective Cohort Study
To identify the incidence of difficult intubation in patients with adult congenital heart disease (ACHD) undergoing cardiac surgery or catheterization. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2021 Category: Anesthesiology Authors: Zuhair A. Siddiqui, Arvind Chandrakantan, Emma E. Hills, Christopher N. Nguyen, Benjamin M. Todd, Adam C. Adler Tags: Original Article Source Type: research

Normative Transesophageal Echocardiographic Values of Cardiac Structures in the Indian Population —Indian Normative TEE Measurements (INTEEM) Study
Information on normative reference values for cardiac structures is critical for the accurate application of echocardiography for guiding clinical decision-making. Many studies using transthoracic echocardiography (TTE) have shown that Indians have smaller diameters of various cardiac structures. There are no normative studies for transesophageal echocardiography (TEE). The authors observed dimensions of various cardiac structures in healthy Indian patients under general anesthesia using TEE and compared them with existing guidelines from non-Indian data. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2021 Category: Anesthesiology Authors: Deepak Borde, Kumar Chidambaram, Ayya Syama Sundar, Venugopal Kulkarni, Amish Jasapara, Vijay Shetty, Ramachandra Gopinath, Archana Pathy, V.V. Raja Viswanath, Balaji Asegaonkar, Pramod Apsingkar, Unmesh Takalkar, Shreedhar Joshi, Murali Chakravarthy Tags: Original Article Source Type: research

Early albumin exposure after cardiac surgery
To determine whether the early use of albumin after cardiac surgery in the first 24 hours in the intensive care unit is associated with reduced mortality. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2021 Category: Anesthesiology Authors: Dr Christopher Thang, Dr Prashanti Marella, Dr Aashish Kumar, Dr Mbakise Matebele, Dr Mahesh Ramanan Source Type: research

Development and validation of a predictive score for prolonged mechanical ventilation after cardiac surgery
Despite the steady improvement in surgical techniques and perioperative anesthetic management, cardiac surgery still has a high rate of major complications compared to non-cardiac surgery. Prolonged mechanical ventilation (PMV), like acute renal failure requiring renal remplacement therapy or post-operative stroke, is one of these major complications1. After cardiac surgery, mechanical ventilation weaning is usually achieved within 10 hours of surgery. However, 2.6% to 22.7% of patients require prolonged mechanical ventilation (PMV) depending on depending on the threshold for the definition of PMV2 –6 . (Source: Jour...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2021 Category: Anesthesiology Authors: Ludovic Michaud, Pauline Dureau, Basile Kerleroux, Ahmed Charfeddine, Mary Regan, Jean-Michel Constantin, Pascal Leprince, Adrien Bougl é Source Type: research

Incidence of difficult laryngoscopy in adult congenital heart disease patients; a retrospective cohort study
To identify the incidence of difficult intubation in patients with adult congenital heart disease (ACHD) undergoing cardiac surgery or catheterization. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2021 Category: Anesthesiology Authors: Zuhair A. Siddiqui, Arvind Chandrakantan, Emma E. Hills, Christopher N. Nguyen, Benjamin M. Todd, Adam C. Adler Source Type: research

Normative Trans esophageal Echocardiographic Values Of Cardiac Structures in Indian Population; Indian Normative TEE Measurements (INTEEM) Study
Information on normative reference values for cardiac structures is critical for the accurate application of echocardiography for guiding clinical decision-making. Many studies using trans thoracic echocardiography (TTE) have shown that Indians have smaller diameters of various cardiac structures. There are no normative studies for trans esophageal echocardiography (TEE). The authors observed dimensions of various cardiac structures in normal Indian patients under general anaesthesia using TEE and compared them to existing guidelines from non-Indian data. (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2021 Category: Anesthesiology Authors: Deepak Borde, Kumar Chidambaram, Ayya Syama Sundar, Venugopal Kulkarni, Amish Jasapara, Vijay Shetty, Ramachandra Gopinath, Archana, V.V. Raja Viswanath, Balaji Asegaonkar, Pramod Apsingkar, Unmesh Takalkar, Shreedhar Joshi, Murali Chakravarthy Source Type: research