Transcatheter aortic valve replacement with or without anesthesiologist: results from a high-volume single center.

Aims: Local instead of general anesthesia has become the standard approach in many centers for transfemoral transcatheter aortic valve replacement (TAVR). New generation devices and an increase in operator skills had led to a drastic reduction in periprocedural complications, bringing in the adoption of a minimalist approach. In our study, we aimed to compare patients treated with TAVR under local anesthesia with or without the presence of an anesthesiologist on site (AOS).

Balloon aortic valvuloplasty before noncardiac surgery in severe aortic stenosis: a single-center experience.

Objectives: The aim of this study is to investigate the role and short-term results of balloon aortic valvuloplasty (BAV) before noncardiac surgery in a high selected cohort of patients.

Background: Aortic stenosis is one of the most common valvular heart diseases and a well recognized risk factor for perioperative mortality.

Methods: Between May 2012 and July 2013 we enrolled 15 consecutive patients with severe aortic stenosis to allow urgent major noncardiac surgery.

The Anesthetic Management of Transcatheter Aortic Valve Implantation.

An increasing number of patients with a high risk for surgery because of advanced age and associated comorbidities that significantly increase the perioperative risk successfully undergo transcatheter aortic valve implantation (TAVI). TAVI is commonly performed under general or local anesthesia or local anesthesia plus mild sedation to achieve a conscious sedation. The anesthetic regimen generally depends on the patient's clinical profile and the procedural technical characteristics, but the center's experience and internal organization likely play an important role in anesthetic decision making.

Effect of fenoldopam on use of renal replacement therapy among patients with acute kidney injury after cardiac surgery: a randomized clinical trial.

Importance: No effective pharmaceutical agents have yet been identified to treat acute kidney injury after cardiac surgery.

Objective: To determine whether fenoldopam reduces the need for renal replacement therapy in critically ill cardiac surgery patients with acute kidney injury.

Design, Setting, And Participants: Multicenter, randomized, double-blind, placebo-controlled, parallel-group study from March 2008 to April 2013 in 19 cardiovascular intensive care units in Italy.

Transesophageal echocardiography during MitraClip® procedure.

The percutaneous mitral valve (MV) repair procedure performed with the MitraClip delivery system is increasingly used to treat severe mitral regurgitation in high-risk patients. The treatment involves percutaneous insertion and positioning of a clip between the MV leaflets. Transesophageal echocardiography (TEE) plays a key role in the procedure by providing information regarding clip navigation, clip alignment to the MV coaptation line, transmitral advancement of the system, leaflet grasping, confirmation of valve tissue catching, and assessment of the final result.

Ventriculoarterial decoupling in human septic shock.

Introduction: Septic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive cardiovascular state associated with multiorgan dysfunction and metabolic disturbances. Management of septic shock is targeted at preserving adequate organ perfusion pressure without precipitating pulmonary edema or massive volume overload.

Non invasive evaluation of cardiomechanics in patients undergoing MitrClip procedure.

Background: In the last recent years a new percutaneous procedure, the MitraClip, has been validated for the treatment of mitral regurgitation. MitraClip procedure is a promising alternative for patients unsuitable for surgery as it reduces the risk of death related to surgery ensuring a similar result. Few data are present in literature about the variation of hemodynamic parameters and ventricular coupling after Mitraclip implantation.

Beta-adrenergic antagonists improve oxygen saturation in acute pulmonary edema: a case series in the prehospital setting.

The use of beta-adrenergic antagonists in acute heart failure is controversial. In this case series, we report the use of intravenous atenolol, a short-acting cardioselective beta-adrenergic antagonist, to treat acute pulmonary edema in the prehospital setting. Four patients with a documented history of cardiac disease and one patient with unknown cardiac issues experienced severe respiratory distress and presented with pulmonary edema; the local emergency medical service was utilized.

Anesthetic management of transcatheter aortic valve implantation with transaxillary approach.

Objective: To describe the anesthetic management of transcatheter aortic valve implantation (TAVI) with the transaxillary approach.

Design: An observational cohort study.

Setting: Two university hospitals.

Surgical and transcatheter aortic valve procedures. The limits of risk scores.

Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in very high-risk patients with severe aortic stenosis. The present multicenter, retrospective study investigates the accuracy and calibration properties of the EuroSCORE and the age, serum creatinine, and ejection fraction (ACEF) score in selecting a population of patients to be referred to TAVI. The study includes 1053 surgical and 211 transcatheter procedures.

Non-invasive ventilation-aided transoesophageal echocardiography in high-risk patients: a pilot study.

Aims: Transoesophageal echocardiography (TEE) may require patient sedation, eventually leading to respiratory depression, a risky condition in severe cardiac disease. Non-invasive ventilation (NIV) has been applied during diagnostic manoeuvres, but its use during TEE has not been reported. We describe NIV-aided continuous TEE monitoring under sedation in the supine position in three consecutive orthopnoeic patients with severe aortic valve stenosis: two of them underwent percutaneous aortic valve implantation, and one underwent aortic valvuloplasty.

Radiofrequency ablation of lung malignancies: where do we stand?

Percutaneous radiofrequency (RF) ablation is a minimally invasive technique used to treat solid tumors. Because of its ability to produce large volumes of coagulation necrosis in a controlled fashion, this technique has gained acceptance as a viable therapeutic option for unresectable liver malignancies. Recently, investigation has been focused on the clinical application of RF ablation in the treatment of lung malignancies.

Antifungal prophylaxis in liver transplant recipients: a randomized placebo-controlled study.

The aim of this study was to evaluate the efficacy of two antifungal prophylaxis regimens in liver transplant recipients. One hundred and twenty-nine consecutive recipients were randomized to receive sequential treatment with intravenous liposomal amphotericin B + oral itraconazole, intravenous fluconazole + oral itraconazole, or intravenous and oral placebo. Frequency and incidence of mycotic colonization, local and systemic infection of mycotic origin, causes of death, and possible risk factors for mycotic infection were evaluated.