Results of open thoracoabdominal aortic replacement in patients unsuitable for or after endovascular repair with remaining disease components.

Objectives: Our goal was to evaluate outcomes in all-comer patients undergoing open thoracoabdominal aortic replacement either unsuitable for or after failed endovascular aortic repair.

Methods: Within a 4-year period, we analysed a consecutive series of 80 patients undergoing elective, urgent and emergency thoracoabdominal aortic replacement. Preoperative data, intraoperative data and outcomes were evaluated.

Management of acute and chronic aortic disease during the COVID-19 pandemic-Results from a web-based ad hoc platform.

Background: To share the results of a web-based expert panel discussion focusing on the management of acute and chronic aortic disease during the coronavirus (COVID-19) pandemic.

Methods: A web-based expert panel discussion on April 18, 2020, where eight experts were invited to share their experience with COVID-19 disease touching several aspects of aortic medicine. After each talk, specific questions were asked by the online audience, and results were immediately evaluated and shared with faculty and participants.

Evaluation of myocardial injury, the need for vasopressors and inotropic support in beating-heart aortic arch surgery.

Background: In contrast to the standard cardioplegic cardiac arrest (CA), some centers prefer the beating-heart technique using selective normothermic myocardial perfusion (SMP) during aortic arch repair. The aim of this study was to evaluate myocardial injury and the need for inotropic and vasopressor support in patients undergoing total aortic arch replacement using SMP or CA during arch repair.

Methods: Total arch replacement was performed in 127 patients (65 years [IQR: 56-73 years] years) between March 2013 and May 2018 via the frozen elephant trunk technique.

Unilateral pulmonary oedema after minimally invasive cardiac surgery via right anterolateral minithoracotomy.

Objectives: To investigate the incidence of unilateral pulmonary oedema after minimally invasive cardiac surgery (MICS) requiring unilateral lung collapse has been unknown until now.

Methods: We analysed the data of 484 consecutive patients undergoing minimally invasive cardiac surgery with unilateral lung collapse between January 2008 and December 2013. The clinical regimen was changed in 2010 to a single dose of dexamethasone (approximately 1 mg/kg body weight) administered after anaesthesia induction.

Pulmonary artery vs. transpulmonary thermodilution for the assessment of cardiac output in mitral regurgitation: a prospective observational study.

Context: With increasing prevalence of mitral regurgitation, even noncardiac anaesthesiologists will be confronted by this disorder and will need to be familiar with the extended haemodynamic monitoring required. The assessment of cardiac output (CO) measured by transpulmonary thermodilution (COTP) has become an accepted alternative to the CO measured by thermodilution via pulmonary artery catheter (COPAC). However, the integrity of COTP in severe mitral regurgitation requires systematic evaluation.

Acute hemodynamic effects of right and left ventricular lead positions during the implantation of cardiac resynchronization therapy defibrillators.

Background: To evaluate the acute hemodynamic effects of different right (RV) and left ventricular (LV) pacing sites in patients undergoing the implantation of a cardiac resynchronization therapy defibrillator (CRT-D).

Methods: Stroke volume index (SVI), assessed via pulse contour analysis, and dp/dt max, obtained in the abdominal aorta, were analyzed in 21 patients with New York Heart Association class III heart failure and left bundle branch block (mean ejection fraction of 24 ± 6%), scheduled for CRT-D implantation under general anesthesia. We compared the hemodynamic effects of RV apical (A), RV septal (B), and biventricular pacing using the worst (lowest SVI; C) and best (highest SVI; D) coronary sinus lead positions.

Predicted and measured plasma propofol concentration and bispectral index during deep sedation in patients with impaired left ventricular function.

Objective: To evaluate the ability of the Schnider pharmacokinetic model to predict plasma propofol concentration during target-controlled propofol infusion in patients with impaired left ventricular function and to investigate the predictive value of the bispectral index (BIS) to indicate deep sedation in this patient group.

Design: Prospective, observational study.

Participants: Thirty-four patients (mean left ventricular ejection fraction 31% +/- 9%) undergoing the implantation of a cardioverter-defibrillator during deep sedation.

Cardiac output determination by thermodilution and arterial pulse waveform analysis in patients undergoing aortic valve replacement.

Purpose: To compare the accuracy of cardiac output (CO) measurement by arterial pulse waveform analysis (CO(PW)) to thermodilution assessments in patients with aortic stenosis, a high-risk patient group who may benefit from extended hemodynamic monitoring.

Methods: In 30 patients with aortic stenosis, CO was assessed in triplicate by thermodilution via pulmonary artery catheterization (CO(PAC)), and by arterial pulse waveform analysis (CO(PW)), before and after valve replacement. The techniques were compared by assessing the repeatability coefficient of each method and by calculating the percentage error, bias, and the limits of agreement between methods.

Changes in pulse pressure variability during cardiac resynchronization therapy in mechanically ventilated patients.

Introduction: The respiratory variation in pulse pressure (PP) has been established as a dynamic variable of cardiac preload which indicates fluid responsiveness in mechanically ventilated patients. The impact of acute changes in cardiac performance on respiratory fluctuations in PP has not been evaluated until now. We used cardiac resynchronization therapy as a model to assess the acute effects of changes in left ventricular performance on respiratory PP variability without the need of pharmacological intervention.