Primary graft dysfunction after heart transplantation: Incidence, trends, and associated risk factors.

Changes in heart transplantation (HT) donor and recipient demographics may influence the incidence of primary graft dysfunction (PGD). We conducted a retrospective study to evaluate PGD incidence, trends, and associated risk factors by analyzing consecutive adult patients who underwent HT between January 2009 and December 2014 at our institution. Patients were categorized as having PGD using the International Society for Heart & Lung Transplantation (ISHLT)-defined criteria. Variables, including clinical and demographic characteristics of donors and recipients, were selected to assess their independent association with PGD. A time-trend analysis was performed over the study period. Three-hundred seventeen patients met inclusion criteria. Left ventricular PGD, right ventricular PGD, or both, were observed in 99 patients (31%). Risk factors independently associated with PGD included ischemic time, recipient African American race, and recipient amiodarone treatment. Over the study period, there was no change in the PGD incidence; however, there was an increase in the recipient pretransplantation use of amiodarone. The rate of 30-day mortality was significantly elevated in those with PGD versus those without PGD (6.06% vs 0.92%, P = .01). Despite recent advancements, incidence of PGD remains high. Understanding associated risk factors may allow for implementation of targeted therapeutic interventions.

Anesthesiology Fellowships in the Military Health System: An Education Analysis of the Supply and Demand.

INTRODUCTION: Evidence indicates that desire for fellowship training is most influenced by personal interest, enhancement of career options, and a specific interest in an academic medicine career. The overall objective of this study is to evaluate anesthesiology fellowship interest and its potential impact on military retention and other outcomes. We hypothesized that current fellowship training accessibility is outpaced by the interest for fellowship training and that additional factors will be associated with the desire for fellowship training. METHODS: This prospective cross-sectional survey study was approved as Exempt Research by the Brooke Army Medical Center Institutional Review Board in November 2020. Participants were eligible to complete the online voluntary survey if they were active duty anesthesiologists. Anonymous surveys were administered via the Research Electronic Data Capture System from December 2020 to January 2021. Aggregated data were evaluated using univariate statistics, bivariate analyses, and a generalized linear model. RESULTS: Seventy-four percent of general anesthesiologists (those without fellowship training) were interested in pursuing future fellowship training versus 23% of subspecialist anesthesiologists (those currently in fellowship training or have completed fellowship training), odd ratio 9.71 (95% CI, 4.3-21.7). Of subspecialist anesthesiologists, 75% indicated serving in a nongraduate medical education (GME) leadership position (e.g., service/department chief), with 38% serving in a GME leadership position (e.g., program or associate program director). Almost half (46%) of subspecialist anesthesiologists reported being "extremely likely" to serve ≥20 years, versus 28% of general anesthesiologists. CONCLUSIONS: There is a high demand among active duty anesthesiologists for fellowship training, which in turn, may improve military retention. The demand for fellowship training is outpaced by what the Services currently offer, including training in Trauma Anesthesiology. Leveraging this interest in subspecialty fellowship training, particularly when the skills align with combat casualty care-related requirements, would greatly benefit the Services.

A profound case of neurally mediated syncope with asystole after septoplasty.

Vasovagal syncope (VVS) is an alarming yet benign condition that may present postoperatively for the first time in otherwise healthy patients. Although VVS is associated anecdotally with nasal manipulation, no data have been found to quantify this incidence with otolaryngology surgeries. We present a case of profound, recurrent syncope and documented asystole with an initial diagnosis of glossopharyngeal neuralgia. We conclude with a discussion of neurally mediated syncope particular to the perioperative setting. It is essential to recognize neurocardiogenic etiology to differentiate it from other more concerning causes of syncope and asystole.