Cardiac Surgery During Pregnancy.

The need for cardiovascular surgery during pregnancy is infrequent but is expected to increase as more patients with congenital heart disease live into childbearing years. Care for women considering pregnancy with residual, recurrent, or newly identified lesions related to congenital heart disease disease must address therapeutic options that maximize the mother's health while acknowledging concerns for procedural effects on fetal development and risks associated with preterm delivery. This report summarizes the current knowledge regarding optimal intraoperative techniques for the pregnant patient and provides recommendations to optimize maternal and fetal outcomes.

Deep Parasternal Intercostal Plane Block for Postoperative Analgesia After Sternotomy for Cardiac Surgery-A Retrospective Cohort Study.

Objective: To examine the analgesic efficacy of postoperative deep parasternal intercostal plane (DPIP) blocks for patients having cardiac surgery via median sternotomy.

Design: This single-center retrospective study compared patients receiving bilateral DPIP blocks with a matched cohort of patients not receiving DPIP blocks.

Setting: Large quaternary referral center.

Impact of ketamine versus propofol for anesthetic induction on cognitive dysfunction, delirium, and acute kidney injury following cardiac surgery in elderly, high-risk patients.

Objective: Evaluate the effects of ketamine versus propofol when used for induction of anesthesia in elderly, high-risk cardiac surgical patients on postoperative complications including cognitive dysfunction, delirium, and acute kidney injury.

Methods: Prospective, randomized study performed at a tertiary medical center. A total of 52 patients aged ≥70 and older presenting for complex cardiac surgery were randomized to receive either ketamine or propofol for induction of anesthesia.

Perioperative management of aortic stenosis in patients undergoing non-cardiac surgery.

Aortic stenosis is one of the most common cardiac valve pathologies in the world and its prevalence increases with age. Although previously associated with increased perioperative mortality, more recent studies suggest that mortality rates may be decreasing. Recent guidelines suggest that major non-cardiac surgery can be performed safely in asymptomatic severe aortic stenosis patients with close hemodynamic monitoring.

Pectoral Fascial Plane Versus Paravertebral Blocks for Minimally Invasive Mitral Valve Surgery Analgesia.

Objectives: This study examined the postoperative analgesic efficacy of single-injection pectoral fascial plane (PECS) II blocks compared to paravertebral blocks for elective robotic mitral valve surgery.

Design: A single-center retrospective study that reported patient and procedural characteristics, postoperative pain scores, and postoperative opioid use for patients undergoing robotic mitral valve surgery.

Setting: This investigation was performed at a large quaternary referral center.

Coagulation Tests and Bleeding Classification After Cardiopulmonary Bypass: A Prospective Study.

Objective: No recent prospective studies have analyzed the accuracy of standard coagulation tests and thromboelastography (TEG) to identify patients with excessive microvascular bleeding following cardiopulmonary bypass (CPB). The aim of this study was to assess the value of coagulation profile tests, as well as TEG, for the classification of microvascular bleeding after CPB.

Design: A prospective observational study.

Prothrombin Complex Concentrate vs Plasma for Post-Cardiopulmonary Bypass Coagulopathy and Bleeding: A Randomized Clinical Trial.

Importance: Post-cardiopulmonary bypass (CPB) coagulopathy and bleeding are among the most common reasons for blood product transfusion in surgical practices. Current retrospective data suggest lower transfusion rates and blood loss in patients receiving prothrombin complex concentrate (PCC) compared with plasma after cardiac surgery.

Objective: To analyze perioperative bleeding and transfusion outcomes in patients undergoing cardiac surgery who develop microvascular bleeding and receive treatment with either PCC or plasma.

Perioperative Outcomes for Radical Nephrectomy and Level III-IV Inferior Vena Cava Tumor Thrombectomy in Patients with Renal Cell Carcinoma.

Objectives: This study examined the characteristics, intraoperative, and postoperative course of patients undergoing inferior vena cava tumor thrombectomy for metastatic renal cell carcinoma.

Design: A single-center case series that reported demographic data and intraoperative and postoperative outcomes for patients with renal cell carcinoma undergoing inferior vena cava thrombectomy.

Setting: This investigation was performed at a large quaternary referral center.

Emergent pulmonary thromboembolectomy and atrial septal aneurysmectomy for intracardiac impending paradoxical embolism: An en bloc approach to prevent clot embolism and facilitate repair.

Although a patent foramen ovale (PFO) is relatively common, confirmed reports of thrombus entrapped within a PFO are uncommon. Management of impending paradoxical embolism (IPE), also called a thrombus in transit, lacks consensus but includes systemic anticoagulation (e.g.

Use of plasma late on cardiopulmonary bypass in patients undergoing left ventricular assist device implantation.

Coagulopathy is common during left ventricular assist device (LVAD) implantation, treatment of which can be challenging given the often-limited ability for the right ventricle to accommodate volume transfusion after device initiation with 20% to 40% of patients developing right ventricular failure (RVF). Transfusion of plasma late on cardiopulmonary bypass (CPB) combined with ultrafiltration may replace clotting factors while reducing volume administration. We compared outcomes in patients undergoing LVAD implantation receiving plasma on CPB and ultrafiltration with traditional transfusion practices.

MELD and MELD XI Scores as Predictors of Mortality After Pericardiectomy for Constrictive Pericarditis.

Objective: To assess the association between the preoperative model for end-stage liver disease (MELD) and MELD-XI (exclude international normalized ratio) score and outcomes in patients undergoing pericardiectomy for constrictive pericarditis.

Patients And Methods: Patients >18 years of age undergoing pericardiectomy for constrictive pericarditis between January 1, 2007, and October 12, 2017, were analyzed with data for MELD and MELD-XI score calculation within 30 days preoperatively. The association between the MELD and MELD-XI scoring systems and risk of postoperative outcomes was assessed in regression models adjusting for relevant covariates.

Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove Cytokines, Chemokines, and Cell-derived Microvesicles.

Background: Removal of cytokines, chemokines, and microvesicles from the supernatant of allogeneic erythrocytes may help mitigate adverse transfusion reactions. Blood bank-based washing procedures present logistical difficulties; therefore, we tested the hypothesis that on-demand bedside washing of allogeneic erythrocyte units is capable of removing soluble factors and is feasible in a clinical setting.

Methods: There were in vitro and prospective, observation cohort components to this a priori planned substudy evaluating bedside allogeneic erythrocyte washing, with a cell saver, during cardiac surgery.

Coagulation test changes associated with acute normovolemic hemodilution in cardiac surgery.

Background: Patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) are at risk for coagulopathy and bleeding requiring blood product transfusion. Acute normovolemic hemodilution (ANH) is a blood conservation technique shown to reduce transfusion and bleeding associated with cardiac surgery. Despite numerous advantages, little is known about the effect of ANH on coagulation testing.

Intraoperative Fluid Balance and Perioperative Outcomes After Aortic Valve Surgery.

Background: The effect of intraoperative fluid balance on postoperative acute kidney injury (AKI) in cardiac surgical patients is poorly defined.

Methods: In this retrospective study of patients undergoing aortic valve replacement for aortic stenosis, the primary outcome of interest was postoperative AKI. Secondary outcomes were postoperative fluid balance, cardiac index, vasopressor use, hospital-free days, stroke, myocardial infarction, hospital readmission, and 30- and 90-day mortality.

The Safety and Feasibility of Transesophageal Echocardiography in Patients With Esophageal Stricture.

Objectives: Expert guidelines consistently list esophageal stricture (ES) as a contraindication to the performance of transesophageal echocardiography (TEE), although anecdotally the authors are aware of patients with ES undergoing TEE without apparent complication. Therefore the authors sought to determine the outcomes of patients with ES who had undergone TEE at their institution.

Design: Single-center, retrospective review.

Robotic Mitral Valve Repair: Indication for Surgery Does Not Influence Early Outcomes.

Objective: To evaluate the outcomes of robotic mitral valve repair (MVr) by primary indication per American Heart Association guidelines for surgery: class I vs class IIa.

Patients And Methods: From January 1, 2008, through September 30, 2016, 603 patients underwent robotic MVr for severe primary mitral regurgitation. Medical records of 576 consenting patients were retrospectively reviewed to determine the primary indication for surgery.

Cerebrospinal fluid drainage complications during first stage and completion fenestrated-branched endovascular aortic repair.

Objective: To determine the rates and risk factors of complications related to cerebrospinal fluid drainage (CSFD) during first stage and completion fenestrated-branched endovascular aortic repair (F-BEVAR) of pararenal and thoracoabdominal aortic aneurysms.

Methods: We reviewed the outcomes of 293 consecutive patients enrolled in a prospective, nonrandomized study to investigate outcomes of F-BEVAR between 2013 and 2018. Patients who received CSFD during first-stage thoracic endovascular aortic repair, index F-BEVAR, or completion of temporary aneurysm sac perfusion procedures were included in the analysis.

Same-Day Cancellation in Vascular Surgery: 10-Year Review at a Large Tertiary Care Center.

Background: Same-day cancellation of vascular surgical procedures is an undesirable occurrence with multifaceted implications into the patient's health care. Numerous factors play a role in same-day cancellations, ranging from medical causes, patient factors, or administrative and scheduling conflicts.

Methods: A retrospective review of the medical records database at our large tertiary academic referral center from 2007 to 2017 was performed to identify patients scheduled for vascular surgical procedures who experienced same-day cancellation.

Intensive Care Unit Readmission After Left Ventricular Assist Device Implantation: Causes, Associated Factors, and Association With Patient Mortality.

Background: Previous studies on readmissions after left ventricular assist device (LVAD) implantation have focused on hospital readmissions after dismissal from the index hospitalization. Because few data exist, the purpose of this study was to examine intensive care unit (ICU) readmissions in patients during their initial hospitalization for LVAD implantation to determine reasons for, factors associated with, and incidence of mortality after ICU readmission.

Methods: A retrospective analysis was performed from February 2007 to March 2015 of patients at our institution receiving first-time LVAD implantation.

Small bowel bleeding in patients with left ventricular assist device: outcomes of conservative therapy versus balloon-assisted enteroscopy.

Background: Small bowel bleeding (SBB) accounts for 30% of gastrointestinal bleeding (GIB) episodes in patients with a left ventricular assist device (LVAD). The aim of this study was to determine the outcomes of conservative therapy (CT) compared to balloon-assisted enteroscopy (BAE) in the management of SBB in LVAD patients.

Methods: A retrospective review was performed of a prospectively maintained LVAD database from January 2003 to July 2015.