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Stroke After Transcatheter Aortic Valve Replacement: Incidence, Definitions, Etiologies and Management Options
Neurologic complications after transcatheter aortic valve replacement are devastating. The etiologies of stroke in this setting are best addressed in an integrated fashion during each phase of the perioperative pathway. The conduct of this triphasic approach will continue to be refined to reduce the stroke risks even further, given the major focus on aspects such as embolic protection devices and valve thrombosis. This neurologic focus in transcatheter aortic valve replacement has transformed the investigational approach to neurologic events in cardiovascular clinical trials, resulting in novel guidelines for the diagnosis...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 22, 2017 Category: Anesthesiology Authors: Prakash A. Patel, Saumil Patel, Jared W. Feinman, Jacob T. Gutsche, Prashanth Vallabhajosyula, Ronak Shah, Jay Giri, Nimesh D. Desai, Elizabeth Zhou, Stuart J. Weiss, John G. Augoustides Tags: Review Article Source Type: research

Code Stroke After Cardiac Surgery: Can We Make a Difference?
IN AN editorial in the Journal of Cardiovascular and Thoracic Anesthesia, Kashani et al. reported their systematic review on intraarterial thrombolytic (IAT) and endovascular mechanical treatment (EMT) for stroke after cardiac surgery.1 Unfortunately, few conclusions about the efficacy of either approach could be drawn because of the sparsity of data —a total of 33 patients were reported in case series or case reports. Complete reperfusion was possible in 26% of the IAT group, with 42% of patients also receiving EMT due to poor initial results.
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 24, 2020 Category: Anesthesiology Authors: Daniel Bainbridge Tags: Editorial Source Type: research

Arterial Closure Devices for Treatment of Inadvertent Large-Caliber Catheter Insertion Into the Subclavian or Carotid Artery: A Case Series of Five Patients
CENTRAL VENOUS CATHETERIZATION is a common procedure in today`s medicine. Iatrogenic complications occur in up to 34% of catheter placements including 5% of arterial puncture. A variety of complications by arterial puncture have recently been described, including airway obstruction, pseudoaneurysms, arteriovenous fistulas, and even stroke caused by arterial thrombosis or embolization. Although 2-D ultrasound assisted insertion of large central venous catheters may reduce adverse events, it might not be available in an emergency setting, and the use of ultrasound guidance requires training. Depending on anatomic localizatio...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 9, 2013 Category: Anesthesiology Authors: Arno Stellmes, Nicolas Diehm, Malte Book, Jürg Schmidli, Dai-Do Do, Jan Gralla Tags: Case Reports Source Type: research

Postoperative Stroke Following Administration of Intraoperative Recombinant Tissue Plasminogen Activator for the Treatment of Intracardiac Thrombus During Liver Transplantation: A Report of Two Cases
MASSIVE INTRACARDIAC AND PULMONARY thromboembolism have an extremely high mortality during liver transplantation.1,2 The authors describe 2 cases in which intraoperative use of tissue plasminogen activator was able to reduce the thrombus size and improve hemodynamics during liver transplantation. Although both patients survived the surgery, they suffered neurologic sequelae postoperatively. The authors discuss the current understanding of the pathophysiology, diagnosis, and management of intracardiac thromboembolism during liver transplantation.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 22, 2014 Category: Anesthesiology Authors: Stephen Aniskevich, Beth L. Ladlie, Sher-Lu Pai, Dana K. Perry, Juan M. Canabal, C. Burcin Taner Tags: Case Report Source Type: research

Old Drug, New Route: A Systematic Review of Intravenous Acetaminophen After Adult Cardiac Surgery
THE MANAGEMENT OF postoperative pain after cardiac surgery remains clinically challenging. Well-controlled pain is critical to maintaining the physical and psychologic well-being of each patient and can help facilitate timely extubation, comfortable breathing, and early postoperative ambulation. On the other hand, left poorly managed, postoperative pain can lead to rising catecholamine levels, ultimately triggering myocardial ischemia, stroke, or bleeding complications.1-3 Insufficient pain control also can limit patient mobility, increasing the risk of deep vein thrombosis and pneumonia, in addition to the harmful psychol...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2016 Category: Anesthesiology Authors: Daniel J. Douzjian, Alexander Kulik Tags: Review ArticleGiovanni Landoni, MDSection Editors? > 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

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

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

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

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

NobleStitch ™ EL PFO Closure Guided by Transesophageal Echocardiography
Paradoxical embolism secondary to a persistent patent foramen ovale (PFO) is a significant source of embolic stroke and has been increasingly targeted by percutaneous interventional techniques. Both implanted devices and more recently, “deviceless” closure methods (i.e. suturing) have been developed. While device closure methods have historically been the predominant approach, issues related to the implanted devices such as migration, embolization, need for anticoagulation, device related thrombosis (DRT), erosion into adjacen t cardiovascular structures, and endocarditis are well documented.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 5, 2020 Category: Anesthesiology Authors: Sridhar R. Musuku, Adithya Srikanthan, Divya Cherukupalli, Jaqueline Donovan, Alexander D. Shapeton, Brion Winston Tags: Case Report Source Type: research

NobleStitch EL PFO Closure Guided by Transesophageal Echocardiography
Paradoxical embolism secondary to a persistent patent foramen ovale (PFO) is a significant source of embolic stroke and increasingly has been targeted by percutaneous interventional techniques. Both implanted devices and, more recently, deviceless closure methods (ie, suturing) have been developed. Although device closure methods historically have been the predominant approach, issues related to the implanted devices, such as migration, embolization, need for anticoagulation, device-related thrombosis, erosion into adjacent cardiovascular structures, and endocarditis are well-documented.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 5, 2020 Category: Anesthesiology Authors: Sridhar R. Musuku, Adithya Srikanthan, Divya Cherukupalli, Jaqueline Donovan, Alexander D. Shapeton, Brion Winston Tags: Case Report Source Type: research

How to Manage the Perioperative Patient on Combined Anticoagulant and Antiplatelet Therapy: Comments on the 2020 ACC Consensus Decision Pathway
Antithrombotic drugs are frequently used to prevent or treat various common cardiovascular disorders like acute coronary syndrome (ACS), stroke, atrial fibrillation (AF), and venous thromboembolism (VTE). Mainly, two classes of oral antithrombotic drugs are on market: anticoagulants, which slow down clot formation by reduced thrombin generation and fibrin formation; and antiplatelet drugs, which prevent platelet activation and formation of stable clots. Combined anticoagulant and antiplatelet therapy might be indicated in some patients, but it is associated with increased risk of critical bleeding.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 28, 2021 Category: Anesthesiology Authors: Daniel Bolliger, Jens Fassl, Gabor Erdoes Tags: Editorial Commentary Source Type: research

Impact of Early, Low-Dose Factor VIIa on Subsequent Transfusions and Length of Stay in Cardiac Surgery
OFF-LABEL USE of recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) for perioperative cardiac surgical bleeding has been shown to reduce bleeding,1-4 blood product administration,1,5,6 and the rate of reoperations.4,6,7 However, there also has been an association with increased mortality,8 thrombosis,9-11 stroke,7,11,12 and renal morbidity.8,9 These inconsistent outcomes may be a function of variations in both timing and dosing of rFVIIa.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 6, 2021 Category: Anesthesiology Authors: Lauren Sutherland, Abigail Houchin, Tian Wang, Shuang Wang, Vivek Moitra, Akshit Sharma, Trip Zorn, Brigid C. Flynn Tags: Original Article Source Type: research

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