Publications by authors named "Ortoleva J"

The 2024 European Society of Cardiology guidelines for atrial fibrillation (AF) emphasize a patient-centered approach to management, structured around the AF-CARE pathway: Comorbidity and risk factor management (C), Avoiding stroke and thromboembolism (A), Reducing symptoms through rate and rhythm control (R), and Evaluation and dynamic reassessment (E). This framework ensures that comorbidities such as hypertension, heart failure, diabetes, and obesity are effectively managed to prevent disease progression and improve outcomes. A key principle of the guidelines is shared decision making involving patients, families, caregivers, and healthcare teams to ensure individualized care that reflects patient preferences.

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Purpose: Following esophagectomy, annually several thousand patients in the United States (US) reach a stable post-esophagectomy status. Such patients may require general anesthesia (GA) for elective procedures, but no generally accepted guidelines exist for the induction of GA in post-esophagectomy patients.

Methods: A national survey describing a post-esophagectomy patient was emailed to 23,524 attending anesthesiologists who were members of the American Society of Anesthesiologists.

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Article Synopsis
  • The study investigates the potential impact of cannulation timing (daytime vs. nighttime/weekend) on patient outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO).
  • It was conducted as a retrospective cohort study at a large academic medical center, examining 468 patients who underwent VA-ECMO cannulation from 2011 to 2021.
  • The findings suggest that cannulating VA-ECMO at night or on weekends does not significantly affect one-year mortality rates or the need for renal replacement therapy, indicating that such procedures can be safely performed during these times.
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Heart failure (HF) remains a public health concern affecting millions of individuals worldwide. Despite recent advances in device-related therapies, the prognosis for patients with chronic HF remains poor with significant long-term risk of morbidity and mortality. Left ventricular assist devices (LVADs) have transformed the landscape of advanced HF management, offering circulatory support as destination therapy or as a bridge for heart transplantation.

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Regardless of the type, extracorporeal membrane oxygenation (ECMO) requires the use of large intravascular cannulas and results in multiple abnormalities including non-physiologic blood flow, hemodynamic perturbation, rapid changes in blood oxygen and carbon dioxide levels, coagulation abnormalities, and a significant systemic inflammatory response. Among other sequelae, neurologic complications are an important source of mortality and long-term morbidity. The frequency of neurologic complications varies and is likely underreported due to the high mortality rate.

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Article Synopsis
  • This study aimed to assess how adjusting for pressure recovery (PR) affects the severity classification of aortic stenosis in patients who underwent transcatheter aortic valve implantation (TAVI).
  • The research included 342 adult patients and found that after accounting for PR, 24% of patients were reclassified from severe to moderate aortic stenosis based on adjusted aortic valve area (AVA).
  • The findings emphasize the importance of considering PR in echocardiographic evaluations, as it significantly influences disease severity grading and clinical decisions.
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Refractory vasodilatory shock, or vasoplegia, is a pathophysiologic state observed in the intensive care unit and operating room in patients with a variety of primary diagnoses. Definitions of vasoplegia vary by source but are qualitatively defined clinically as a normal or high cardiac index and low systemic vascular resistance causing hypotension despite high-dose vasopressors in the setting of euvolemia. This definition can be difficult to apply to patients undergoing mechanical circulatory support (MCS).

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