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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

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

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

Left Atrial Appendage Occlusion: A Narrative Review
Left atrial appendage occlusion (LAAO) is a proposed alternative to oral anticoagulation in reducing stroke in patients with atrial fibrillation. It is suggested that LAAO is most suitable in patients at increased risk of stroke or bleeding or with contraindication to pharmacologic intervention. Despite the increase in evidence evaluating LAAO, the relative safety and efficacy of the procedure remains uncertain. Presently, several ongoing randomized trials are comparing various devices to each other and to pharmacologic anticoagulation.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 8, 2019 Category: Anesthesiology Authors: Ali Alsagheir, Alex Koziarz, Emilie P. Belley-C ôté, Richard P. Whitlock Tags: Review 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

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

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

Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement
Ove the last decade, transcatheter aortic valve replacement (TAVR) has emerged as the recommended approach over surgical aortic valve replacement (SAVR) for many patients with aortic stenosis. While initial trials demonstrated a higher incidence of stroke with TAVR compared to SAVR, the incidence of stroke appears to have improved over time. With the increasing number of patients expected to undergo TAVR in the coming decades, it is important to review the incidence and etiology of stroke after SAVR and TAVR.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 27, 2018 Category: Anesthesiology Authors: Sundar Krishnan, Archit Sharma, Sudhakar Subramani, Lovkesh Arora, Divyanshu Mohananey, Pedro Villablanca, 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

Regional Versus General Anesthesia for Carotid Endarterectomy: Do We Need Another Randomized Trial?
STROKE CURRENTLY remains the second cause of death among all patients with cardiovascular disease.1 Carotid endarterectomy (CEA) is a safe and effective surgical technique that lowers the risk of ischemic stroke in patients with carotid artery stenosis secondary to atherosclerotic disease.2 CEA is associated with improved neurologic and cognitive function and quality of life.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 4, 2018 Category: Anesthesiology Authors: Vladimir V. Lomivorotov, Vladimir A. Shmyrev, Valery A. Nepomniashchikh Tags: Editorial 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

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

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

Anesthesia Matters: In Pursuit of the Interventions that Affect Outcomes in Transcatheter Aortic Valve Replacement
FOR THE LAST 15 years, clinical research into transcatheter aortic valve replacement (TAVR) was focused chiefly on device technology, periprocedural imaging, and patient selection.1 –3 Early challenges included vascular access, valve positioning, and valve performace.4,5 The time and resources dedicated to the study of these areas have led to a better understanding of which patient should get which procedure and prosthesis, resulting in improvements in outcomes including deat h, stroke, and recovery that now match or exceed surgical aortic valve replacement.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 2, 2018 Category: Anesthesiology Authors: Peter J. Neuburger, Prakash A. Patel Tags: Editorial Source Type: research

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