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Combined coronary and carotid artery disease: what to operate on first? or both at the same time?
Heart disease and stroke rank amongst the top four leading causes of death in the United States.1 Studies have demonstrated a positive correlation between the two, even suggesting that carotid artery disease may predict the presence of coronary artery disease (CAD).2,3 In fact, some have found that the prevalence of carotid artery stenosis (CAS) in those undergoing coronary artery bypass grafting (CABG) may be as high as 8-14%.4 Despite such co-existence, there remains no clear consensus Guidelines for revascularization in patients with co-existing CAD and CAS.
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 20, 2023 Category: Anesthesiology Authors: Sherman Yu, Mark A. Chaney Tags: Case Conference Source Type: research

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

The PARTNER 3 Trial at 2 Years: What We've Learned and What Time Will Tell
Based on data from large, industry-sponsored randomized prospective studies, the United States Food and Drug Administration (FDA) has approved both balloon-expandable and self-expanding transcatheter aortic valve replacement (TAVR) devices for use in aortic stenosis patients at low, intermediate and high-risk for surgical aortic valve replacement (SAVR).1-6 High-risk device approval was based on 1-year data, which was reasonable due to the actuarial life expectancies of the cohort.1, 2 Intermediate-risk approval for the balloon-expandable Sapien XT (Edwards Lifesciences, Irvine, California) system was largely based on data...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 28, 2021 Category: Anesthesiology Authors: Peter J. Neuburger, Kinjal M. Patel, Prakash A. Patel Source Type: research

Analysis of the ESC/EACTS 2020 Atrial Fibrillation Guidelines with Perioperative Implications
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide with an individual lifetime risk of approximately 37% in the United States. Broadly defined as a supraventricular tachyarrhythmia with disorganized atrial activation, AF results in an increased risk of stroke, heart failure (HF), valvular heart disease (VHD), impaired quality of life and confers a significant burden to the health of individuals and society. AF in the perioperative setting is common and a significant source of perioperative morbidity and mortality worldwide.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 15, 2021 Category: Anesthesiology Authors: James A. Nelson, Ying X. Gue, Jon M. Christensen, Gregory Y.H. Lip, Harish Ramakrishna Tags: Expert Review Source Type: research

Cardiac disease in pregnancy: hypertrophic obstructive cardiomyopathy and pulmonic stenosis
The prevalence of cardiovascular disease in pregnancy is increasing and cardiovascular disease is the leading cause of pregnancy-related death in the United States.1 The physiologic adaptations to pregnancy include an increased heart rate, stroke volume, and substantial expansion in circulatory volume, which may pose significant cardiac stress to patients with cardiac disease. During labor, cardiac output increases further and maternal expulsive efforts during the second stage of labor, with the decreased preload and increased afterload that accompany the Valsalva maneuver, may provoke decompensation in vulnerable patients.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 26, 2021 Category: Anesthesiology Authors: David E. Arnolds, Chad Dean, Mohammed Minhaj, William T. Schnettler, Jennifer Banayan, Mark A. Chaney Tags: Case Conference 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

Efficacy and Efficiency of Perioperative Stellate Ganglion Blocks in Cardiac Surgery: A Pilot Study
Nationally, postoperative atrial fibrillation (POAF) occurs in up to 40% of patients after coronary artery bypass grafting (CABG), 50% of patients after valve surgery, 64% of patients after mitral valve and CABG, and 49% after aortic valve replacement.1 Atrial fibrillation worsens a patient ’s hemodynamic status and increases the risk of congestive heart failure, embolic events, and longer intensive care unit stays, leading to increased patient morbidity and strain on financial resources. In the United States, POAF carries a higher risk of stroke, worsened survival, and an additional 4.9 days and $10,000 to $11,500 in hospital stay costs.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 20, 2017 Category: Anesthesiology Authors: Christopher W. Connors, Wendy Y. Craig, Scott A. Buchanan, Justin M. Poltak, James B. Gagnon, Craig S. Curry Tags: Letter to the Editor Source Type: research