Pragmatic Evaluation of a Deep-Learning Algorithm to Automate Ejection Fraction on Hand-Held, Point-of-Care Echocardiography in a Cardiac Surgical Operating Room.

Objective: To test the correlation of ejection fraction (EF) estimated by a deep-learning-based, automated algorithm (Auto EF) versus an EF estimated by Simpson's method.

Design: A prospective observational study.

Setting: A single-center study at the Hospital of the University of Pennsylvania.

Airway trauma in a high patient volume academic cardiac electrophysiology laboratory center.

Background: Providing anesthesia and managing airways in the electrophysiology suite can be challenging because of its unique setting outside of the conventional operating room. We report our experience of several cases of reported airway trauma including tongue and pharyngeal hematoma and vocal cord paralysis in this setting.

Methods: We analyzed all of the reported airway trauma cases between December 2009 and January 2011 in our cardiac electrophysiology laboratories and compared these cases with those without airway trauma.

Classification of acute type A dissection: focus on clinical presentation and extent.

Recent advances in the management of acute Stanford type A dissection have highlighted the clinical importance of clinical presentation and extent of dissection. The Penn classification of type A clinical presentations is based on ischemic profiles that not only determine mortality but also influence management options. The extent of type A dissection as summarized by the DeBakey classification significantly determines the role of endovascular intervention in this important disease.

Bleeding and blood product utilization in adults undergoing elective aortic root replacement: the impact of antifibrinolytic exposure and aortic root prosthesis.

A retrospective observational study was carried out to test the hypothesis that bleeding and blood component utilization are significantly associated with aortic root replacement (ARR). The aims of the study were as follows. (1) To determine antifibrinolytic exposure (AFE) in ARR; (2) To determine mediastinal drainage within the first 24 hours after ARR; (3) To determine blood component transfusion within the first 24 hours after ARR; (4) To determine whether AFE affects bleeding and blood component transfusion for ARR; and, (5) To determine whether type of aortic root prosthesis affects bleeding and/or blood component transfusion after ARR.

Perioperative outcome in adults undergoing elective deep hypothermic circulatory arrest with retrograde cerebral perfusion in proximal aortic arch repair: evaluation of protocol-based care.

Objective: The purpose of this study was to describe perioperative outcome in adults undergoing elective proximal aortic arch repair with protocol-based deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP).

Design: Retrospective and observational.

Setting: Cardiothoracic operating rooms and intensive care unit.

A randomized controlled clinical trial of real-time needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department.

Objective: The purpose of this study was to evaluate needle-guided ultrasound for internal jugular venous cannulation in a large university anesthesia department, to determine cumulative cannulation success by method, to determine first-pass cannulation success by method and operator, and to determine arterial puncture by method and operator.

Study Design: Prospective, observational, and randomized. Blinding was not possible.

Major clinical outcomes in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest: quantification of organ-based perioperative outcome and detection of opportunities for perioperative intervention.

Objective: The purpose of this study was to describe clinical outcome after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA), to determine mortality and length of stay, neurologic outcome, cardiorespiratory outcome, and hemostatic and renal outcome after DHCA.

Design: Retrospective and observational.

Setting: Cardiothoracic operating rooms and intensive care unit (ICU).

Analysis of the interatrial septum by transesophageal echocardiography in adult cardiac surgical patients: anatomic variants and correlation with patent foramen ovale.

Objectives: The purpose of this study was to document the perioperative prevalence of anatomic variants of the interatrial septum (IAS), to classify atrial septal aneurysm based on mobility pattern, and to correlate anatomic variants of IAS with patent foramen ovale (PFO).

Design: A prospective observational study.

Setting: University hospital (single institution).

Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography in adult cardiac surgical patients.

Objective: To evaluate multiplane transesophageal echocardiography (TEE) for detection of patent foramen ovale (PFO) and to compare multiplane TEE with visual inspection (VI) for PFO detection.

Design: A prospective observational study.

Setting: University hospital (single institution).

Prevalence of risk factors, and not gender per se, determines short- and long-term survival after coronary artery bypass surgery.

Objective: Much attention has been directed towards female gender as an independent risk factor for in-hospital mortality after coronary artery bypass grafting surgery; however, the effects of surgery are known to persist for 6 months or more. Studies that have compared postoperative survival in women and men beyond hospital discharge report disparate results with regard to the independent effect of gender per se on ultimate survival.

Design: This investigation was a prospective, observational study.

What does transesophageal echocardiography add to valvular heart surgery?

No single monitoring tool in the last decade has had more of an effect on intraoperative decision making and surgical management of cardiac valvular pathologies than has TEE. It has become the standard of care for evaluating reparative valvular procedures, thus providing an immediate gauge of the surgical results and helping to avoid suboptimal surgical outcomes. As the technology of TEE and its application advance, so too should the ability to diagnose and manage valvular pathologies, broaden the range of surgical options, and ultimately improve patient outcomes.

Acute circulatory actions of intravenous amiodarone loading in cardiac surgical patients.

Background: The duration, severity, and cause of hypotension after intravenous amiodarone has not been well characterized in anesthetized cardiac surgical patients. Because amiodarone is tolerated in patients with advanced cardiac disease, we hypothesized that left ventricular systolic performance is preserved despite hypotension during amiodarone loading.

Methods: In a prospective double-blind trial, 30 patients undergoing coronary artery bypass graft (CABG) surgery were randomly assigned to receive intravenous amiodarone (n = 15) or placebo (n = 15).

Practice pattern variability for myocardial revascularization: impact on resource use across 24 centers.

Objective: To determine the predictors of hospital length of stay (LOS) after elective uncomplicated coronary artery bypass graft surgery.

Design: Retrospective analysis of the EPI-1 database, 1991-1993.

Setting: Multicenter; 24 academic, private, federal, and health maintenance institutions.