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The Price of Keeping the Rhythm: Increased Bleeding Risk in Patients with Atrial Fibrillation Concurrently Prescribed Amiodarone and Factor Xa Inhibitors
Atrial fibrillation is the most common sustained cardiac arrhythmia affecting nearly 2% of the population of the United States.1 Patients with atrial fibrillation are twice as likely to have a myocardial infarction and five-times as likely to have a stroke.1 Current guidelines recommend antiarrhythmic pharmacotherapy in patients with symptomatic atrial fibrillation as first-line management.2-4 Amiodarone is a very effective, and therefore, a commonly prescribed agent for this purpose.5 Anticoagulation is a key tenet in the management of atrial fibrillation due to the increased tendency of left atrial appendage clot formati...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 10, 2023 Category: Anesthesiology Authors: Nicolas Kumar, Manoj H. Iyer, Adam Dalia, Amit Bardia Tags: Editorial Source Type: research

Single Versus Multiarterial Grafts for Coronary Artery Bypass Graft Surgery: Analysis of Recent Data
ACCORDING TO THE Centers for Disease Control and Prevention, there are 37.3 million people with diabetes mellitus (DM) in the United States.1 The main cause of death for patients with DM, types 1 and 2, is coronary artery disease (CAD), with a 2- to 4-fold increased risk of mortality for heart disease.2 The trend of increased morbidity and mortality in patients with DM is likely due to its more complex and diffuse CAD pattern.3 Coronary artery bypass grafting (CABG) remains the gold standard compared to percutaneous coronary intervention for CAD in patients with DM, with reductions in mortality, myocardial infarction, and ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 12, 2023 Category: Anesthesiology Authors: Kenneth R. Hassler, Harish Ramakrishna Tags: Expert Review Source Type: research

Single vs Multi-Arterial Grafts for CABG - Analysis of Recent Data
According to the Center for Disease Control and Prevention (CDC) there are 37.3 million people with diabetes mellitus (DM) in the United States.1 The main cause of death for DM patients, type 1 and 2, is coronary artery disease (CAD), with a 2 to 4-fold increased risk of mortality for heart disease.2 The trend of increased morbidity and mortality in DM patients is likely due to its more complex and diffuse CAD pattern.3 Coronary artery bypass grafting (CABG) remains the gold standard when compared to percutaneous coronary intervention (PCI) for CAD in DM with a reduction in mortality, myocardial infarction, and stroke as d...
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 12, 2023 Category: Anesthesiology Authors: Kenneth R. Hassler, Harish Ramakrishna Tags: Expert Review Source Type: research

Predicting Post –Liver Transplant Outcomes—Rise of the Machines or a Foggy Crystal Ball?
ALTHOUGH LIVER transplantation (LT) provides a life-saving therapy to thousands of patients per year, many more die while awaiting transplantation resulting from critical organ shortages. Due to these shortages, patient selection is of paramount importance. Liver transplant programs strive to select recipients with high expected gains in life expectancy and low risks of complications. Major adverse cardiovascular events (MACE), such as myocardial infarction, heart failure, and stroke, may occur in approximately 23% of LT recipients within six months of transplantation.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 12, 2021 Category: Anesthesiology Authors: Matthew W. Vanneman, Vikram Fielding-Singh, Nima Aghaeepour Tags: Editorial Source Type: research

Predicting post-liver transplant outcomes —rise of the machines or a foggy crystal ball?
Although liver transplantation (LT) provides a life-saving therapy to thousands of patients per year, many more die while awaiting transplantation due to critical organ shortages. Due to these shortages, patient selection is of paramount importance. Liver transplant programs strive to select recipients with high expected gains in life expectancy and low risks of complications. Major adverse cardiovascular events (MACE), such as myocardial infarction, heart failure, and stroke, may occur in approximately 23% of LT recipients within 6 months of transplantation.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 12, 2021 Category: Anesthesiology Authors: Matthew W. Vanneman, Vikram Fielding-Singh, Nima Aghaeepour Tags: Editorial Source Type: research

A figure of eight and a circle within a circle: is this left ventricular geometry responsible for multiple embolic strokes two years after inferior wall myocardial infarction?
An 83-year-old, 165 cm, 67 kg man with hypertension, hyperlipidemia, and stage III chronic kidney disease presented for evaluation after several strokes. The patient suffered an inferior wall myocardial infarction two years before the current admission and more recently, underwent placement of a stent in the left circumflex coronary artery at a community hospital for treatment of a hemodynamically significant stenosis. The patient reported he was physically active after his most recent stroke with improved strength in his right upper and lower extremities.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 23, 2020 Category: Anesthesiology Authors: Ryan M. Davidovich, Benjamin M. Mathews, Zafar Iqbal, Xavier V. Jean, Heather A. Sutter, G. Hossein Almassi, Paul S. Pagel Source Type: research

Incorporating Indices of Postoperative Glycemic Variability in Postoperative Outcome Prediction Modeling: How Accurate Can it Get?
PERIOPERATIVE hyperglycemia, as well as the amplitude and frequency of glycemic variation are associated with increased morbidity and mortality after cardiac surgery, regardless of diabetic state.1,2 In patients undergoing coronary artery bypass grafting surgery, early postoperative hyperglycemia (blood glucose concentration [BGC]>250 mg/dL) significantly increases the risks of postoperative complications (nonfatal stroke, myocardial infarction, sepsis, death).3
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 29, 2020 Category: Anesthesiology Authors: Kai Yin Hwang, Nian Chih Hwang Tags: Editorial Source Type: research

Con: Adult Cardiac Surgery Should Not Proceed in the Event of Cardiac Arrest After Induction of Anesthesia
IT IS ESTIMATED that in-hospital cardiac arrest occurs in greater than 290,000 adults each year in the United States.1 In-hospital cardiac arrest has received significantly less attention than other cardiovascular conditions with high risks of morbidity and mortality, such as myocardial infarction, stroke, and out-of-hospital cardiac arrest. Survival to discharge has been estimated at around only 25%. The etiology of in-hospital cardiac arrest is most often owing to cardiac causes (50%-60%), followed by respiratory insufficiency (15%-40%).
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 2, 2020 Category: Anesthesiology Authors: Hamdy Awad, Scott Smith, Islam Shehata, Samiya Saklayen Tags: Pro and Con Source Type: research

Xenon Anesthesia: Is it in Due Course for a Mainstream Comeback?
HISTORICALLY, carotid endarterectomy (CEA) surgery has generated several disputes regarding the choice of anesthesia provided and intraoperative neuromonitoring. The landmark General Anesthesia versus Local Anesthesia trial,1 which included 3,526 patients, showed no difference in the occurrence of stroke, myocardial infarction, or death at 30 days after surgery with respect to either local or general anesthesia. Harky et al.2 conducted a systematic review and meta-analysis of general versus local anesthesia in CEA surgery and concluded that each of the anesthetic techniques was noninferior to one another.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 2, 2019 Category: Anesthesiology Authors: V. Melnyk, L. Fedorko, G. Djaiani Tags: Editorial Source Type: research

The Effect of Steroids in Patients Undergoing Cardiopulmonary Bypass: An Individual Patient Meta-Analysis of Two Randomized Trials
Steroids suppress the inflammatory response to cardiopulmonary bypass, but the impact on death at 30 days, myocardial infarction or injury, stroke, renal failure, respiratory failure, new atrial fibrillation, transfusion requirement, infection, and length of intensive care unit (ICU) and hospital stays are uncertain.
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 6, 2019 Category: Anesthesiology Authors: Richard P. Whitlock, Jan M. Dieleman, Emilie Belley-Cote, Jessica Vincent, Michelle Zhang, P.J. Devereaux, Cor J. Kalkman, Diederik van Dijk, Salim Yusuf Tags: Original Article Source Type: research

Perioperative Management of Pheochromocytoma Resection in a Patient With Severe Aortic Stenosis
PHEOCHROMOCYTOMA IS A rare catecholamine-secreting tumor composed of chromaffin tissue arising from the adrenal medulla. Surgical resection is a high-risk procedure and remains a clinical challenge for anesthesiologists and surgeons. There is potential for massive and sudden changes in catecholamine release resulting in significant hemodynamic effects, which in turn can lead to devastating cardiac and neurologic complications such as myocardial infarction, stroke, or death. Advances in medical management and anesthetic and surgical techniques have led to improved surgical outcomes.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 21, 2017 Category: Anesthesiology Authors: Jagroop Singh Saran, Jacob Moalem, Luke Schoeniger, Konstantine Tzimas Tags: Case Report Source Type: research

Statins Losing Their Luster?
STATINS HAVE NUMEROUS intriguing and potentially desirable pleiotropic anti-inflammatory effects that may clinically benefit patients undergoing cardiac surgery with/without cardiopulmonary bypass.1,2 Suggested clinical benefits include decreased postoperative morbidity (renal dysfunction, atrial fibrillation, myocardial infarction, stroke, infection) as well as decreased in-hospital mortality. While suppressing perioperative inflammation in patients undergoing cardiac surgery appears to make sense, nothing is ever as simple as it seems.
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 19, 2017 Category: Anesthesiology Authors: Richa Dhawan, Mark A. Chaney Tags: Editorial Source Type: research

Inefficacy of Platelet Transfusion in a Heart Transplant Patient Under Continuous Ticagrelor
Antiplatelet agents have a predominant role in the therapeutic treatment of acute coronary syndrome (ACS) and myocardial infarction. Recently, ticagrelor has been incorporated in the European Society of Cardiology guidelines for the management of ACS with ST elevation and non-ST elevation.1 The AHA/ACC guidelines further advocate the choice of ticagrelor over clopidogrel in patients with ACS with non-ST elevation treated with an early invasive strategy.2 In fact, major studies have proven the benefits of ticagrelor on cardiovascular death, myocardial infarction, and stroke without an increase in major bleeding risk.
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 15, 2017 Category: Anesthesiology Authors: Laura Filaire, Dat T. Pham, Nicolas d ’Ostrevy, Huyen T. Tran, Lionel Camilleri, Kasra Azarnoush Tags: Case Report Source Type: research

The AngioVac Device and Its Anesthetic Implications
ALTHOUGH THE EXACT incidence of venous thromboembolism (VTE) is not known, about 1 million cases are reported in the United States each year,1 and VTE is the third most frequent cardiovascular disease after myocardial infarction and stroke.2 The term VTE encompasses both deep venous thrombosis (DVT) and pulmonary embolism (PE).3 DVT may be found in any location, with the lower extremities being the most common site. Once formed, venous thrombi either remain in the peripheral veins, undergo endogenous fibrinolysis and recanalization, or embolize to the pulmonary arteries and cause PE.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 18, 2017 Category: Anesthesiology Authors: Harish Ram, Rebecca M. Gerlach, Antonio Hernandez Conte, Danny Ramzy, Ashley R. Jaramillo-Huff, Neal S. Gerstein Tags: Emerging Technology Review Source Type: research

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