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Cognitive function deterioration after cardiopulmonary bypass: Can intraoperative optimal cerebral regional tissue oxygen saturation predict postoperative cognitive function?
Neurologic complications from cardiac surgeries with cardiopulmonary bypass (CPB) affect further outcomes, including length of hospital stay, survival, health care costs, and quality of life. Stroke is the most obvious manifestation among neurologic complications, reported in 1% –3% of cases1. Although not as clinically significant as stroke, cognitive impairment occurs in about 50% of patients2 and carries important social and financial implications3.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 30, 2023 Category: Anesthesiology Authors: Yu-Ning Hu, Tsung-Hao Hsieh, Meng-Ta Tsai, Chung-Yao Chien, Jun-Neng Roan, Yu-Ching Huang, Sheng-Fu Liang Tags: Original Article Source Type: research

Predicting Postoperative Atrial Fibrillation: The Search Continues
Atrial fibrillation (AF) has an incredibly large burden on the American health system with approximately 454,000 annual hospital admissions as the primary diagnosis.1 Unfortunately, AF is not a benign entity, with a reported underlying primary cause of death in 26,535 people in 2019 according to the CDC.2 AF is the cause of 1 in 7 strokes,3 and increases the risk of ischemic stroke five-fold.4 These statistics are alarming when it is considered that the incidence of postoperative atrial fibrillation (POAF) has been reported to be as high as 65% after cardiac surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 12, 2022 Category: Anesthesiology Authors: Kenneth R. Hassler, Harish Ramakrishna Tags: Editorial Source Type: research

Utility of the Hypotension Prediction Index During Cardiac Surgery
Intraoperative hypotension is common despite the monitors and pharmacologic interventions currently available.1 Intraoperative hypotension is associated with adverse outcomes. Studies have established a correlation between the degree of intraoperative hypotension and the incidence of post-operative myocardial ischemia (MI), acute kidney injury (AKI) and overall mortality following non-cardiac surgeries.2-4 Similar correlations are also observed following cardiac surgeries with respect to stroke, renal injury, and prolonged hospital stay.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 21, 2020 Category: Anesthesiology Authors: Brian Shin, Steven A. Maler, Keerthi Reddy, Neal W. Fleming Tags: Original Research Article 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

Doing Simple Things Well: Practice Advisory Implementation Reduces Atrial Fibrillation After Cardiac Surgery
Atrial Fibrillation After Cardiac Surgery (AFACS) is associated with increased morbidity, including thromboembolic stroke, renal failure, gastrointestinal complications, infections, and prolonged ventilation, and a significant increase in the risk of subsequent chronic atrial fibrillation.1-4 Furthermore, it is associated with an increase in mortality and hospital and intensive care unit length of stay.1,3 It has a persistently high incidence, ranging from 30% to more than 50%, depending on the type of surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 29, 2020 Category: Anesthesiology Authors: Martina Buerge, Rosalie Magboo, Dylan Wills, Ioannis Karpouzis, Damian Balmforth, Paul Cooper, Neil Roberts, Ben O'Brien Tags: Special Article 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

Socioeconomic Disparities in Carotid Revascularization Procedures
The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 12, 2020 Category: Anesthesiology Authors: Latha Panchap, Seyed A. Safavynia, Virginia Tangel, Robert S. White Tags: Original Article Source Type: research

CHA2DS2-VASc Score and In-Hospital Mortality in Critically Ill Patients With New-Onset Atrial Fibrillation
To examine the role of the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years [doubled]; Diabetes; previous Stroke, transient ischemic attack, or thromboembolism [doubled]; Vascular disease; Age 65-75 years; and Sex category) score as a prognostic marker of in-hospital mortality in critically ill patients who develop new-onset atrial fibrillation (NOAF).
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 29, 2019 Category: Anesthesiology Authors: Kunal Karamchandani, Robert S. Schoaps, Thomas Abendroth, Zyad J. Carr, Tonya S. King, Anthony Bonavia Tags: Original Article Source Type: research

A Case of Successful Treatment of Cerebral Embolism Using Endovascular Thrombectomy Immediately After Transcatheter Aortic Valve Implantation
TRANSCATHETER aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement in high-risk patients with severe aortic stenosis. However, there are increasing concerns about the potential complications of TAVI now that its indications have been expanded to include patients with low-to-intermediate surgical risk.1,2 One of the serious complications of TAVI is stroke. It is known that there is an increase in 30-day mortality, rates of respiratory insufficiency and postprocedural delirium, and duration of hospital stay if stroke occurs.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 17, 2019 Category: Anesthesiology Authors: Shunichi Murakami, Kazuyoshi Ishida, Hideyuki Ishihara, Takayuki Okamura, Tetsuro Oda, Ryo Suzuki, Atsuo Yamashita, Satoshi Yamashita, Hiroshi Kurazumi, Michiyasu Suzuki, Mishiya Matsumoto Tags: Case Report Source Type: research

Intraoperative Stroke During Robotic Totally Endoscopic Coronary Artery Bypass
THE INCIDENCE OF stroke after coronary artery bypass graft (CABG) surgery is between 1% and 5% and is one of the most detrimental complications.1 Off-pump CABG is associated with a lower stroke rate than traditional on-pump CABG (0.7% v 1.4%).2 Stroke after CABG is associated with increased morbidity and mortality and increased cost secondary to longer hospital stays and rehabilitation. The authors ’ presented case demonstrates the complexity of perioperative management of a patient scheduled for elective off-pump total endoscopic coronary artery bypass (TECAB) grafting with recent transient ischemic attack (TIA), stroke...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 7, 2019 Category: Anesthesiology Authors: Jennette D. Hansen, Mark A. Chaney, Michael Essandoh, Jean Starr, BobbieJean Sweitzer Tags: Case Conference 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

Left Atrial Thrombus Formation in a Patient With Severe Non-rheumatic Mitral Stenosis After Mitral Valve Repair Receiving Dual Antiplatelet Therapy: A Clinical Challenge
A 60-YEAR-OLD, 88-kg, 165-cm woman presented to a community hospital with heart failure 5 years after mitral valve repair for mitral regurgitation. The patient previously suffered an ischemic stroke and was currently treated with dual antiplatelet therapy. Transesophageal echocardiography revealed severe mitral stenosis with a mean transmitral gradient of 10 mmHg and thickening of the posterior left atrial wall. The patient was then transferred to the authors ’ institution for mitral valve replacement.
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 10, 2019 Category: Anesthesiology Authors: Michael Essandoh, Amir Elhassan, Thomas J. Papadimos, Brandon Pruett, Gregory D. Rushing Tags: Diagnostic Dilemma Source Type: research

Perioperative Acute Ischemic Stroke Increases Mortality After Noncardiac, Nonvascular, and Non-Neurologic Surgery: A Retrospective Case Series
To identify the predictors of in-hospital mortality in patients who develop perioperative acute ischemic stroke (PAIS) associated with noncardiac, nonvascular, and non-neurologic surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 3, 2019 Category: Anesthesiology Authors: Hong Wang, Shuang-ling Li, Jing Bai, Dong-xin Wang Tags: Original Article Source Type: research

Short-Term Outcomes After Off-Pump or On-Pump Coronary Artery Bypass Grafting in the Octogenarian Patients
Despite large randomized controlled trials demonstrating similar outcomes for of-pump or on-pump coronary artery bypass grafting, the debate between proponents of each technique remains current.1 On-pump technique improves surgical exposure on a nonbeating heart but exposes the patient to a powerful inflammatory response and to ischemic stroke owing to cross clamping and cannulation. Off-pump coronary artery bypass (OPCAB) may reduce blood transfusion, postoperative length of hospital stay, postoperative neurocognitive decline, and systemic anticoagulation, but heart repositioning may be associated with hemodynamic instabi...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 2, 2019 Category: Anesthesiology Authors: B érénice Tiquet, Jean David Blossier, Isabelle Orsel, Frank Pihan, Alessandro Piccardo, Jean Phillippe Marsaud, David Vandroux Tags: Letter to the Editor Source Type: research

Carotid Revascularization Procedures and Perioperative Outcomes: A Multistate Analysis, 2007-2014
To compare in-hospital mortality, postoperative stroke, and combined stroke/mortality in carotid artery stenting (CAS) patients and carotid endarterectomy (CEA) patients.
Source: Journal of Cardiothoracic and Vascular Anesthesia - February 15, 2019 Category: Anesthesiology Authors: Abdullah S. Rasheed, Robert S. White, Virginia Tangel, Bess M. Storch, Kane O. Pryor Tags: Original Article Source Type: research

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