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Source: Journal of Cardiothoracic and Vascular Anesthesia
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Total 207 results found since Jan 2013.
Unexpected Findings in a Man with a Repaired Type A Aortic Dissection and a New Stroke
A 67-YEAR-OLD, 82-kg, 175cm man presented to the authors ’ institution for evaluation of new right-sided facial droop, dysarthria, and expressive aphasia. The patient reported that he had been in his usual state of health the previous evening, but awoke the morning of admission with slurred speech. He called his daughter who confirmed his symptoms and t ransported him to the emergency department. He denied fever, chills, malaise, weight loss, confusion, memory deficits, and other neurological symptoms.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 10, 2018 Category: Anesthesiology Authors: Paul S. Pagel, Wayne A. Hendrix, Michael T. Cain, Ahmed K.Y. Ali, Gina Muscato, Charan Mungara, Chris Rokkas Tags: Diagnostic Dilemma 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
Pharmacokinetics of Magnesium in Cardiac Surgery: Implications for Prophylaxis Against Atrial Fibrillation
Postoperative atrial fibrillation (POAF) is the most common cardiovascular complication in patients undergoing cardiac surgery. The risk of POAF depends on the type of procedure, and ranges from 30% in patients undergoing coronary artery bypass surgery to 50% in those undergoing combined procedures. Patients who develop POAF have an increased risk of a number of other complications, including stroke and a prolonged hospital stay, and have a higher risk of death during long-term follow-up.1 The precise mechanism of POAF is unknown, but it is obvious that numerous preoperative, intraoperative, and postoperative factors might...
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 4, 2017 Category: Anesthesiology Authors: Vladimir V. Lomivorotov, Sergey M. Efremov, Alexander M. Karaskov Tags: Editorial Source Type: research
Off-Pump Versus On-Pump Coronary Artery Bypass Grafting —A Systematic Review and Analysis of Clinical Outcomes
Surgical coronary artery bypass grafting (CABG) is the standard of care for revascularization of left main or three-vessel coronary artery disease. The off-pump coronary artery bypass graft (OPCAB) procedure avoids the use of cardiopulmonary bypass. Theoretically, OPCAB may improve long-term outcomes by reducing the rates of perioperative myocardial injury, stroke, neurocognitive impairment, and cardiac-related mortality. Several high-quality clinical trials have been conducted since OPCAB became popular in the 1990s and have demonstrated no benefit of OPCAB over traditional CABG with respect to these outcomes despite favo...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 9, 2018 Category: Anesthesiology Authors: Shahzad Shaefi, Aaron Mittel, Dan Loberman, Harish Ramakrishna Tags: Expert Review Source Type: research
Decannulation of a Ventricular Assist Device
BECAUSE OF the donor organ shortage, an increasing number of patients with advanced heart failure are receiving ventricular assist devices (VADs) as a bridge to transplantation or as a destination therapy.1 Patients with advanced heart failure who receive a VAD have significantly greater survival rates compared with those who are treated with only medication.2 However, short- and long-term complications of VADs still are a major concern.3 There are perioperative risks attributed to patient comorbidities; risks of surgery and anesthesia; and postoperative risks such as bleeding, thrombosis, stroke, infection, right ventricu...
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 4, 2018 Category: Anesthesiology Authors: Tuan-Yen Wu Tags: Case Report Source Type: research
A Rare Cause of Stroke FourWeeks After Ascending Aortic Aneurysm Repair
A 71-YEAR-OLD, 97 kg, 178 cm man with a history of a slowly expanding 5.4 cm ascending aortic aneurysm, bicuspid aortic valve disease without stenosis, hypertension, hyperlipidemia, type II diabetes mellitus, and hemodynamically insignificant coronary artery disease underwent ascending aortic replacement using a woven synthetic graft. The patient's postoperative course was complicated by persistent sternal drainage that required exploration, evacuation of pericardial fluid, and antibiotic treatment, but he otherwise made an uneventful recovery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 4, 2018 Category: Anesthesiology Authors: Graham E.D. Hill, Patrick S. Aranda, Julie F. Harvey, Timothy J. Olund, G. Hossein Almassi, Lyle D. Joyce, Paul S. Pagel Tags: Diagnostic Dilemma Source Type: research
The HAS-BLED Score is Associated With Major Bleeding in Patients After Cardiac Surgery
The Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol (HAS-BLED) score has been developed to predict the risk of potential bleeding in anticoagulated patients affected by atrial fibrillation. The aim of this study was to test the hypothesis that the HAS-BLED score is associated with major bleeding also in patients after cardiac surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - February 4, 2019 Category: Anesthesiology Authors: Gianluca Santise, Saverio Nardella, Francesco Migliano, Alessandro Testa, Daniele Maselli Tags: Original Article Source Type: research
Percutaneous Coronary Artery Revascularization and Transcatheter Aortic Valve Replacement: Is There a Who, Why, and When?
WITH A PREVALENCE in aortic stenosis (AS) patients of 25% to 50%, concomitant coronary artery disease (CAD) has proven to be an independent risk factor for patients undergoing transcatheter aortic valve replacement (TAVR).1 Currently there is no standard- or guideline-driven approach for these patients, and many new challenges have emerged in this population. In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Bacigalupo et al.2 report a case of a patient with recent percutaneous coronary intervention (PCI) for obstructive CAD who underwent TAVR complicated by in-stent thrombosis and an ischemic stroke ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - February 20, 2019 Category: Anesthesiology Authors: Oscar D. Aljure, Michael Fabbro Tags: Editorial Source Type: research
Myocardial Protection During Minimally Invasive Mitral Valve Surgery: Is Retrograde Cardioplegia Alone Enough?
Minimally invasive mitral valve surgery is a commonly performed procedure in contemporary cardiac surgery.1-3 The surgical exposure for minimally invasive mitral valve surgery (right anterolateral minithoracotomy) provides very limited access to the aorta and makes myocardial protection with antegrade cardioplegia challenging.1,3 Early experiences used an endo-aortic balloon to administer antegrade cardioplegia, and retrograde cardioplegia was administered through a coronary sinus catheter.3 The endo-aortic balloon approach was associated with complications such as aortic dissection and stroke and has fallen out of favor in some centers.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 17, 2019 Category: Anesthesiology Authors: Michael Essandoh Tags: Letter to the Editor Source Type: research
Hypertension in Post-Bypass Acute Kidney Injury: Not Just About Systolic and Diastolic Blood Pressures?
Pulse pressure (PP), defined as the difference between the systolic and diastolic blood pressure, is proportional to volume change in the aorta (or stroke volume) and inversely proportional to arterial compliance.1 The main contributory factor to poor vascular compliance is aging of the vasculature, leading to central vasculature stiffness.2 In the cardiac surgical patient, common cardiovascular comorbidities such as hypertension, hyperlipidemia, and impaired glucose tolerance also contribute to stiffness by altering the extracellular matrix in the arterial wall.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 26, 2019 Category: Anesthesiology Authors: Li Ying Koh, Nian Chih Hwang Tags: Editorial Source Type: research
Anesthetic Management of Total Thoracoscopic Left Atrial Maze Procedure for Chronic Atrial Fibrillation —A Single-Institution Experience
ATRIAL FIBRILLATION (AF) is an increasingly common health problem with a prevalence of 1% to 2% that is expected to double within 20 years.1,2 As an independent risk factor for death and stroke, patients with AF have a 5-fold higher risk for those adverse outcomes compared to the general population.3 The goal of treatment is to interrupt the re-entrant circuits causing AF. Pharmacologic cardioversion is successful in only 35% to 75% of cases,4 leaving many to rely on transcatheter radiofrequency (RF) ablation or surgical treatment.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 27, 2019 Category: Anesthesiology Authors: Zhuo Sun, Ping Fu, Nadine Odo, Vijay Patel, Gyanendra Sharma, Shvetank Agarwal Tags: Special Article Source Type: research
A New Approach to Detect Nonconvulsive Seizures in Patients in a Cardiac Surgery Intensive Care Unit by Monitoring Heart Rate Variability
CORONARY ARTERY BYPASS GRAFTING (CABG) surgery has been associated with different neurologic complications such as intracerebral hemorrhage, seizures, delirium, cognitive impairment, and peripheral neuropathy.1,2 Specifically, the incidence of seizures after cardiac surgery varies between 0.5% and 7.6%.3 Seizures are due mainly to thromboembolic ischemic stroke, cerebral air embolism, or specific drugs.4 When seizures occur, recurrence rates range between 40% and 66%, and an association with an abnormal outcome has been reported.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 27, 2019 Category: Anesthesiology Authors: Alessandro Forti, Marika Falla, Tommaso Scquizzato, Giacomo Strapazzon Tags: Case Report Source Type: research
A Rare Cause of Stroke Four Weeks After Ascending Aortic Aneurysm Repair
A 71-YEAR-OLD, 97 kg, 178 cm man with a history of a slowly expanding 5.4 cm ascending aortic aneurysm, bicuspid aortic valve disease without stenosis, hypertension, hyperlipidemia, type II diabetes mellitus, and hemodynamically insignificant coronary artery disease underwent ascending aortic replacement using a woven synthetic graft. The patient's postoperative course was complicated by persistent sternal drainage that required exploration, evacuation of pericardial fluid, and antibiotic treatment, but he otherwise made an uneventful recovery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 3, 2018 Category: Anesthesiology Authors: Graham E.D. Hill, Patrick S. Aranda, Julie F. Harvey, Timothy J. Olund, G. Hossein Almassi, Lyle D. Joyce, Paul S. Pagel Tags: Diagnostic Dilemma 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
Patent Foramen Ovale and Risk of Cryptogenic Stroke – Analysis of Outcomes and Perioperative Implications
PATENT FORAMEN OVALE (PFO) is the most common congenital defect of the atrial septum, with reported incidences ranging between 27% and 34% in autopsy studies.1 During embryonic life, the PFO is a physiological discontinuity of the septum secundum that allows the oxygenated placental blood to bypass the non-functional lungs of the fetus. There are 2 overlapping components of the developing atrial septum. On the right, the septum secundum stems from an infolding of the atrial walls and contains a posteroinferior oval-shaped opening, the foramen ovale.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 14, 2019 Category: Anesthesiology Authors: Pablo Michel, Pedro A. Villablanca, Sagar Ranka, Alejandro Lemor, Tarun Jain, Harish Ramakrishna Tags: Expert Review Source Type: research
