New frontiers in aortic therapy: focus on deep hypothermic circulatory arrest.

There is currently a paradigm shift in the conduct of adult aortic arch repair. Although deep hypothermic circulatory arrest has been the classic perfusion platform for adult aortic arch repair, recent developments have challenged this aortic arch paradigm. There has been a gradual clinical drift towards moderate, and even mild, hypothermic circulatory arrest combined with antegrade cerebral perfusion. This paradigm shift appears to be associated with equivalent clinical outcomes, and in certain settings, with improved outcomes. The advent of endovascular therapy has challenged even further the concept that circulatory arrest is required for adult aortic arch repair. These dramatic advances have resulted in the emergence of an international aortic arch surgery study group that aims to advance this dynamic field through consensus statements, meta-analysis, clinical database analysis, prospective registries, and randomized controlled trials.

The year in cardiothoracic and vascular anesthesia: selected highlights from 2012.

Cardiothoracic and vascular critical care has emerged as a subspecialty due to procedural breakthroughs, an aging population, and a multidisciplinary collaboration. This subspecialty now has a dedicated professional society, recently published guidelines, and plans for standardized certification. This paradigm shift represents a major collaboration opportunity for our specialty. The rise of evidence-based perioperative practice has produced a culture of large trials in our specialty to search for solutions to the challenging outcome questions. Besides the growth in the development of evidence, the consensus conference format and postpublication peer review have both emerged as effective processes for identifying the most relevant high-quality evidence. The quest for best perioperative practice has highlighted the importance of teamwork at all phases of care with respect to transitions in care, blood component transfusion, and research misconduct. The emergence of ultrasound as a standard for central vascular access also has been emphasized in recent multisociety guidelines. There also has been a paradigm shift in the management of patients with coronary artery disease. Recent guidelines have emphasized the roles of the cardiac anesthesiologist and the interventional cardiologist as part of the heart team approach. Major recent trials in comparative effectiveness have challenged the advantages of percutaneous coronary intervention, off-pump coronary artery bypass surgery, and intra-aortic balloon counterpulsation. The year 2012 has witnessed the emergence of new paradigms of care in our specialty with the emphasis on teamwork, safety, and quality. These processes will further improve perioperative outcome.