RESUMO
This article reviews the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist published in 2023. After a search of the US National Library of Medicine PubMed database, several topics emerged where significant contributions were made in 2023. The authors of this article considered the following topics noteworthy to be included in this review: (1) advancements in percutaneous mechanical support in children with congenital heart disease, (2) children with pulmonary hypertension undergoing surgery for congenital heart disease, (3) dexmedetomidine in pediatric cardiac surgery, and (4) recommendations for pediatric heart surgery in the United States: Implications for pediatric cardiac anesthesia.
Assuntos
Anestesia em Procedimentos Cardíacos , Cardiopatias Congênitas , Humanos , Cardiopatias Congênitas/cirurgia , Anestesia em Procedimentos Cardíacos/métodos , Anestesia em Procedimentos Cardíacos/tendências , Procedimentos Cirúrgicos Cardíacos/métodos , Dexmedetomidina , Criança , Hipertensão PulmonarRESUMO
This article is a review of the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist, and was published in 2022. After a search of the United States National Library of Medicine PubMed database, several topics emerged in which significant contributions were made in 2022. The authors of this manuscript considered the following topics noteworthy to be included in this review-intensive care unit admission after congenital cardiac catheterization interventions, antifibrinolytics in pediatric cardiac surgery, the current status of the pediatric cardiac anesthesia workforce in the United States, and kidney injury and renal protection during congenital heart surgery.
Assuntos
Anestesia em Procedimentos Cardíacos , Anestesia , Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Cirurgia Torácica , Criança , Humanos , Estados Unidos , Cardiopatias Congênitas/cirurgiaRESUMO
Acute pulmonary embolism is the third leading cause of cardiovascular death, with most pulmonary embolism-related mortality associated with acute right ventricular failure. Although there has recently been increased clinical attention to acute pulmonary embolism with the adoption of multidisciplinary pulmonary embolism response teams, mortality of patients with pulmonary embolism who present with hemodynamic compromise remains high when current guideline-directed therapy is followed. Because historical data and practice patterns affect current consensus treatment recommendations, surgical embolectomy has largely been relegated to patients who have contraindications to other treatments or when other treatment modalities fail. Despite a selection bias toward patients with greater illness, a growing body of literature describes the safety and efficacy of the surgical management of acute pulmonary embolism, especially in the hemodynamically compromised population. The purpose of this document is to describe modern techniques, strategies, and outcomes of surgical embolectomy and venoarterial extracorporeal membrane oxygenation and to suggest strategies to better understand the role of surgery in the management of pulmonary embolisms.
Assuntos
Sistema Cardiovascular , Embolia Pulmonar , Humanos , American Heart Association , Resultado do Tratamento , Embolia Pulmonar/cirurgia , Embolia Pulmonar/complicações , Pulmão , Embolectomia/efeitos adversosRESUMO
This article is a review of the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist and was published in 2021. After a search of the United States National Library of Medicine PubMed database, several topics emerged where significant contributions were made in 2021. The authors of this manuscript considered the following topics noteworthy to be included in this review: risk stratification in adult congenital heart disease surgery, physician burnout in pediatric cardiac anesthesia, transfusion practice in pediatric congenital heart surgery, and racial disparity and outcomes in pediatric patients with congenital heart disease.
Assuntos
Anestesia em Procedimentos Cardíacos , Anestesia , Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Adulto , Criança , Bases de Dados Factuais , Cardiopatias Congênitas/cirurgia , HumanosRESUMO
This article is a review of the highlights of pertinent literature published during the 12 months of 2020 that are of interest to the congenital cardiac anesthesiologist. After a search of the US National Library of Medicine's PubMed database, several topics emerged for which significant contributions were made in 2020. The authors of the present article considered the following topics noteworthy to be included in this review: pediatric cardiac care in the coronavirus disease 2019 era, the use of mechanical circulatory support in coronavirus disease 2019-related multisystem inflammatory syndrome in children, transfusion and coagulation management in children undergoing congenital heart surgery, and pulmonary vein stenosis.
Assuntos
Anestesia em Procedimentos Cardíacos , COVID-19 , Cardiopatias Congênitas , Criança , Cardiopatias Congênitas/cirurgia , Humanos , SARS-CoV-2 , Síndrome de Resposta Inflamatória SistêmicaRESUMO
BACKGROUND: Intra-operative hypothermia has been extensively investigated. However, the incidence of intra-operative hyperthermia has not been investigated in detail. OBJECTIVE: The main objective of this study was to assess the incidence and risk factors of new-onset intra-operative hyperthermia in a large surgical patient population. DESIGN: Retrospective database review. SETTING: Tertiary-care teaching hospital. PATIENTS: Patients undergoing surgery with general anaesthesia between 1 January 2002 and 31 December 2017 were included. MAIN OUTCOME MEASURES: The primary outcome measurement was new-onset intra-operative hyperthermia (>37.5â°C). A logistic regression model was fitted to identify risk factors for intra-operative hyperthermia. RESULTS: A total of 103â648 patients were included in the final analyses. The incidence of new-onset hyperthermia in the overall patient cohort was 6.45%, reaching 20 to 30% after prolonged (>8âh) surgery, and was up to 26.5% in paediatric patients. The use of forced air active patient warming, larger amounts of fluid administration, longer surgery, younger age and smaller body size were all independently associated with intra-operative hyperthermia. The adoption of the Surgical Care Improvement Project (SCIP) temperature measures was associated with an increased incidence of intra-operative hyperthermia. CONCLUSION: Mild intra-operative hyperthermia is not uncommon particularly in longer procedures and small children.
Assuntos
Hipertermia , Hipotermia , Anestesia Geral/efeitos adversos , Criança , Estudos de Coortes , Humanos , Hipotermia/diagnóstico , Hipotermia/epidemiologia , Hipotermia/etiologia , Estudos RetrospectivosRESUMO
This article is a review of the highlights of pertinent literature published in 2019, which is of interest to the pediatric cardiac anesthesiologist. After a search of the United States National Library of Medicine PubMed database, several topics emerged in which significant contributions were made in 2019. The authors of this manuscript considered the following topics noteworthy and were included in this review: advances in pediatric heart transplantation, blood management in pediatric cardiac surgery, the impact of nutrition on outcomes in congenital heart surgery, and the use of vasopressin in patients after Fontan palliation.
Assuntos
Anestesia em Procedimentos Cardíacos , Técnica de Fontan , Cardiopatias Congênitas , Transplante de Coração , Cirurgia Torácica , Criança , Cardiopatias Congênitas/cirurgia , HumanosRESUMO
AIMS: During atrial fibrillation ablation, oesophageal heating typically prompts reduction or termination of radiofrequency energy delivery. We previously demonstrated oesophageal temperature rises are associated with posterior left atrial pulmonary vein reconnection (PVR) during redo procedures. In this study, we assessed whether mechanical oesophageal deviation (MED) during an index procedure minimizes posterior wall PVRs during redo procedures. METHODS AND RESULTS: Patients in whom we performed a first-ever procedure followed by a clinically driven redo procedure were divided based on both the use of MED for oesophageal protection and the ablation catheter employed (force or non-force sensing) in the first procedure. The PVR sites were compared between MED using a force-sensing catheter (MEDForce), or no MED with a non-force (ControlNoForce) or force (ControlForce) sensing catheter. Despite similar clinical characteristics, the MEDForce redo procedure rate (9.2%, 26/282 patients) was significantly less than the ControlNoForce (17.2%, 126/734 patients; P = 0.002) and ControlForce (17.5%, 20/114 patients; P = 0.024) groups. During the redo procedure, the posterior PVR rate with MEDForce (2%, 1/50 PV pairs) was significantly less than with either ControlNoForce (17.7%, 44/249 PV pairs; P = 0.004) or ControlForce (22.5%, 9/40 PV pairs; P = 0.003), or aggregate Controls (18.3%, 53/289 PV pairs; P = 0.006). However, the anterior PVR rate with MEDForce (8%, 4/50 PV pairs) was not significantly different than Controls (aggregate Controls-3.5%, 10/289 PV pairs, P = 0.136; ControlNoForce-2.4%, 6/249 PV pairs, P = 0.067; ControlForce-10%, 4/40 PV pairs, P = 1.0). CONCLUSION: Oesophageal deviation improves the durability of the posterior wall ablation lesion set during AF ablation.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Recidiva , Resultado do TratamentoRESUMO
THIS ARTICLE IS a review of the highlights of pertinent literature published during the 12 months of 2018 that is of interest to the congenital cardiac anesthesiologist. During a search of the US National Library of Medicine PubMed database, several topics that displayed significant contributions to the field in 2018 emerged. The authors of the present review consider the following topics noteworthy: the patient with high-risk congenital heart disease (CHD) presenting for noncardiac surgery, cardiopulmonary resuscitation in infants and children with CHD, dexmedetomidine use in pediatric patients, point-of-care lung ultrasound, and regional anesthesia in pediatric cardiac surgery.
Assuntos
Anestesia em Procedimentos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Reanimação Cardiopulmonar/métodos , Cardiopatias Congênitas/cirurgia , Anestesia em Procedimentos Cardíacos/tendências , Procedimentos Cirúrgicos Cardíacos/tendências , Reanimação Cardiopulmonar/tendências , Criança , Pré-Escolar , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Recém-NascidoAssuntos
Cordas Tendinosas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Músculos Intercostais/inervação , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Bloqueio Nervoso/métodos , Anestésicos Locais/farmacologia , Humanos , Nervos Intercostais , Pessoa de Meia-Idade , Desenho de PróteseAssuntos
Nervos Intercostais , Toracotomia , Criança , Fáscia , Humanos , Dor Pós-Operatória , Nervos TorácicosRESUMO
OBJECTIVES: The goal of this study was to determine the safety and feasibility of a novel esophageal balloon retractor (DV8) for MED during PVI. BACKGROUND: The authors previously showed that mechanical esophageal deviation (MED) is feasible using an off-the-shelf metal stylet to allow uninterrupted ablation along the posterior left atrium during pulmonary vein isolation (PVI). Although it is an attractive strategy to avoid esophageal thermal injury, this technique was hampered by both the propensity for oropharyngeal trauma from the stiff stylet and the limited lateral esophageal displacement. METHODS: In 200 consecutive patients undergoing atrial fibrillation ablation, the DV8 balloon retractor was used for MED; contrast was instilled into the esophagus to accurately delineate the trailing esophageal edge. Deviation was performed to maximize the distance from the trailing esophageal edge to the closest point of the ablation line (MEDEffective) and correlated to occurrences of luminal esophageal temperature elevation. RESULTS: In patients undergoing MED during a first-ever PVI of 304 vein pairs, the MEDEffective during right and left PVI were 21.2 ± 8.7 mm and 15.5 ± 6.8 mm, respectively. Deviation of at least 5 mm of MEDEffective was achievable in 97.7%. Luminal esophageal temperature increases universally occurred (100%) at MEDEffective <5 mm, less often (28%) at MEDEffective 5 to 20 mm, and rarely (1.9%) at MEDEffective >20 mm. There were no esophageal complications, but 2 patients experienced oropharyngeal bleeding due to trauma related to device placement. CONCLUSIONS: MED with the balloon retractor safely moved the esophagus away from the site of energy delivery during atrial fibrillation ablation.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Doenças do Esôfago/prevenção & controle , Esôfago/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Idoso , Ablação por Cateter/efeitos adversos , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Anestesia em Procedimentos Cardíacos/métodos , Cardiopatias Congênitas/cirurgia , Pediatria/métodos , Anestesia em Procedimentos Cardíacos/tendências , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/tendências , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Pediatria/tendênciasRESUMO
Sutureless aortic valves are increasingly used for aortic valve replacement (AVR) with excellent outcomes. Implantation requires device expansion in a subannular position within the native aortic root. We report a patient with severe aortic stenosis who received a Perceval sutureless AVR (LivaNova, London, United Kingdom), resulting in a competent prosthesis with an absence of paravalvular leak and aortic regurgitation. However, this implantation resulted in the exacerbation of mitral regurgitation. The sutureless valve required explantation, and a traditional sutured valve was subsequently implanted, which returned the mitral regurgitation to baseline. We discuss a potential etiology of this sutureless AVR-specific complication.