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Early Thromboembolic Stroke Risk of Postoperative Atrial Fibrillation Following Cardiac Surgery
We aimed to study the association between postoperative atrial fibrillation (POAF) and thromboembolic stroke and to determine risk factors for thromboembolic stroke following cardiac surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 20, 2021 Category: Anesthesiology Authors: Ramon Pierik, Miriam Zeillemaker-Hoekstra, Thomas W.L. Scheeren, Michiel E. Erasmus, Gert-Jan R. Luijckx, Michiel Rienstra, Maarten Uyttenboogaart, Maarten Nijsten, Walter M. van den Bergh Source Type: research

Neuromonitoring and Neurocognitive Outcomes In Cardiac Surgery: A Narrative Review
Neurocognitive dysfunction following cardiac surgery can present with diverse clinical phenotypes, which include postoperative delirium, postoperative cognitive dysfunction, and stroke, and it presents a significant healthcare burden for both patients and providers. Neurological monitoring during cardiac surgery includes several modalities assessing cerebral perfusion and oxygenation (near-infrared spectroscopy, transcranial doppler and jugular venous bulb saturation monitoring) and those that measure cerebral function (processed and unprocessed electroencephalogram), reflecting an absence of a single, definitive neuromonitor.
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 20, 2021 Category: Anesthesiology Authors: Ben Milne, Thomas Gilbey, Livia Gautel, Gudrun Kunst Tags: Review Article Source Type: research

Development and validation of a predictive score for prolonged mechanical ventilation after cardiac surgery
Despite the steady improvement in surgical techniques and perioperative anesthetic management, cardiac surgery still has a high rate of major complications compared to non-cardiac surgery. Prolonged mechanical ventilation (PMV), like acute renal failure requiring renal remplacement therapy or post-operative stroke, is one of these major complications1. After cardiac surgery, mechanical ventilation weaning is usually achieved within 10 hours of surgery. However, 2.6% to 22.7% of patients require prolonged mechanical ventilation (PMV) depending on depending on the threshold for the definition of PMV2 –6 .
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 10, 2021 Category: Anesthesiology Authors: Ludovic Michaud, Pauline Dureau, Basile Kerleroux, Ahmed Charfeddine, Mary Regan, Jean-Michel Constantin, Pascal Leprince, Adrien Bougl é Source Type: research

New-onset Atrial Fibrillation after Cardiac Surgery is a Significant Risk Factor for Long-term Stroke: An 8-Year Prospective Cohort Study
This study sought to determine the incidence and significance of new-onset atrial fibrillation as a risk factor for long-term stroke and mortality after cardiac surgery.Design: A prospective cohort study.Setting: 2 large tertiary public hospitalsParticipants: The study comprised 3008 patients who underwent coronary artery bypass grafting and/or valve surgery from 2008 to 2012.Interventions: None.Measurements and Main Results: new-onset atrial fibrillation was analysed as a risk factor for postoperative stroke using a multivariable logistic regression model following adjustment for potential confounders.
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 8, 2021 Category: Anesthesiology Authors: Kevin K.P. Wang, Weiling Liu, Sophia T.H. Chew, Lian Kah Ti, Liang Shen Source Type: research

The PARTNER 3 Trial at Two Years: What We Have Learned and What Time Will Tell
Based on data from large, industry-sponsored randomized prospective studies, the US 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 one-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, CA) system was based largely on data from the Placeme...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 28, 2021 Category: Anesthesiology Authors: Peter J. Neuburger, Kinjal M. Patel, Prakash A. Patel Tags: Editorial 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

A mass in the left ventricular outflow tract after mitral valve replacement
A 34-yr-old woman presented with a 4-yr history of shortness of breath and dyspnea on exertion that had worsened over the preceding 6 months. The patient suffered a stroke two years before her current presentation but had no residual neurologic deficits. Transthoracic 2-dimensional (2D) echocardiography revealed severe mitral stenosis (peak/mean gradients= 21/14 mm Hg) with a mitral valve area of 0.7 cm2 by the pressure-half time method and calcific thickened mitral valve leaflets with commissural fusion and subvalvular thickening.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 21, 2021 Category: Anesthesiology Authors: Satyajeet Misra, Priyank Tapuria, Siddhartha Sathia, Rudra Pratap Mahapatra 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

Neurological Injury in COVID-19 Patients Who Receive VV-ECMO Therapy: A Cohort Study
Both thrombotic and bleeding events have been implicated in the progression of Coronavirus disease 2019 (COVID-19).1,2 Such dysregulation of coagulation has been associated with poor prognosis.3,4 Neurologic sequelae, such as ischemic stroke and intracranial hemorrhage (ICH), have been reported in COVID-19 patients at rates of 0.9%-2.3% and 0.9%, respectively.5,6,7,8 Limited data exists on neurological events in COVID-19 patients in the intensive care unit (ICU) who require extracorporeal membrane oxygenation (ECMO) due to severe acute respiratory distress syndrome (ARDS).
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 13, 2021 Category: Anesthesiology Authors: Nivedha V. Kannapadi, Meghana Jami, Lavienraj Premraj, Eric W. Etchill, Katherine Giuliano, Errol L. Bush, Bo Soo Kim, Stella Seal, Glenn Whitman, Sung-Min Cho Tags: Letter to the Editor Source Type: research

Neurologic Injury in Patients With COVID-19 Who Receive VV-ECMO Therapy: A Cohort Study
THROMBOTIC AND BLEEDING events have been implicated in the progression of coronavirus disease 2019 (COVID-19).1,2 This dysregulation of coagulation has been associated with poor prognoses.3,4 Neurologic sequelae, such as ischemic stroke and intracranial hemorrhage (ICH), have been reported in patients with COVID-19 at rates of 0.9%-to-2.3% and 0.9%, respectively.5,6,7,8 Limited data exist on neurologic events in patients with COVID-19 in the intensive care unit who require extracorporeal membrane oxygenation (ECMO) due to severe acute respiratory distress syndrome (ARDS).
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 13, 2021 Category: Anesthesiology Authors: Nivedha V. Kannapadi, Meghana Jami, Lavienraj Premraj, Eric W. Etchill, Katherine Giuliano, Errol L. Bush, Bo Soo Kim, Stella Seal, Glenn Whitman, Sung-Min Cho Tags: Letters to the Editor 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

Independent Predictors of Postoperative Stroke With Cardiopulmonary Bypass
To assess predictive factors of postoperative stroke in cardiac surgery using cardiopulmonary bypass (CPB).
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 31, 2021 Category: Anesthesiology Authors: Eric Yu Wei Lo, Rebecca Dignan, Bruce French Tags: Original Article Source Type: research

Independent predictors of post-operative stroke with cardiopulmonary bypass
To assess predictive factors of post-operative stroke in cardiac surgery utilising cardiopulmonary bypass (CPB).
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 31, 2021 Category: Anesthesiology Authors: Eric Yu Wei Lo, Rebecca Dignan, Bruce French 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

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

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