Acute Kidney Injury and Renal Replacement Therapy: A Review and Update for the Perioperative Physician.

Post-operative acute kidney injury is a devastating complication with significant morbidity and mortality associated with it. The perioperative anesthesiologist is in a unique position to potentially mitigate the risk of postoperative AKI, however, understanding the pathophysiology, risk factors and preventative strategies is paramount. There are also certain clinical scenarios, where renal replacement therapy may be indicated intraoperatively including severe electrolyte abnormalities, metabolic acidosis and massive volume overload.

Loss of Independent Living in Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Retrospective Cohort Study.

Background: The recommendation for transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) in patients 65 to 80 years of age is equivocal, leaving patients with a difficult decision. We evaluated whether TAVR compared to SAVR is associated with reduced odds for loss of independent living in patients ≤65, 66 to 79, and ≥80 years of age. Further, we explored mechanisms of the association of TAVR and adverse discharge.

Mechanical Circulatory Support: Primer for Consultant Specialists.

Mechanical life support therapies exist in many forms to temporarily replace the function of vital organs. Generally speaking, these tools are supportive therapy to allow for organ recovery but, at times, require transition to long-term mechanical support. This review will examine nonrenal extracorporeal life support for cardiac and pulmonary support as well as other mechanical circulatory support options.

Social determinants of health affect unplanned readmissions following acute myocardial infarction.

Low socioeconomic status predicts inferior clinical outcomes in many patient populations. The effects of patient insurance status and hospital safety-net status on readmission rates following acute myocardial infarction are unclear. A retrospective review of State Inpatient Databases for New York, California, Florida and Maryland, 2007-2014.

To Swan or Not to Swan: Indications, Alternatives, and Future Directions.

The pulmonary artery catheter (PAC) has revolutionized bedside assessment of preload, afterload, and contractility using measured pulmonary capillary wedge pressure, calculated systemic vascular resistance, and estimated cardiac output. It is placed percutaneously by a flow-directed balloon-tipped technique through the venous system and the right heart to the pulmonary artery. Interest in the hemodynamic variables obtained from PACs paved the way for the development of numerous less-invasive hemodynamic monitors over the past 3 decades.

Preoperative Opioid Use Disorder Is Associated With Poorer Outcomes After Coronary Bypass and Valve Surgery: A Multistate Analysis, 2007-2014.

Objective: To determine the effect of preoperative opioid use disorder (OUD) on postoperative outcomes in patients undergoing coronary artery bypass grafting (CABG) and heart valve surgery.

Design: Retrospective, observational study using data from the State Inpatient Database and the Healthcare Cost and Utilization Project.

Setting: Inpatient data from Florida, California, New York, Maryland, and Kentucky between 2007 and 2014.

The impact of hospital safety-net burden on mortality and readmission after CABG surgery.

Background And Aim: Safety-net hospitals (SNHs) serve high proportions of uninsured and Medicaid patients. Data conflict as to the impact of hospital safety-net status on perioperative complications. Our goal was to assess the effect of hospital safety-net burden on mortality and readmission following coronary artery bypass graft (CABG) surgery.

Insurance Status and Socioeconomic Factors Affect Early Mortality After Cardiac Valve Surgery.

Objective: To characterize the effects markers of socioeconomic status (SES), including race and ethnicity, health insurance status, and median household income by zip code on in-patient mortality after cardiac valve surgery.

Design: Retrospective cohort study of adult valve surgery patients included in the State Inpatient Databases and Healthcare Cost and Utilization Project. The primary outcome was mortality during the index admission.

Noteworthy Literature From 2019 for Cardiothoracic Critical Care.

This annual article summarizes key findings from notable studies published in 2019 relevant to the practice of cardiothoracic critical care medicine. This year's article encompasses updates to the literature on enhanced recovery after cardiac surgery, extracorporeal membranous oxygenation, delirium, and primary graft dysfunction after heart transplant.