The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement.

Background: There is an increasing number of patients undergoing transfemoral aortic valve replacement (TAVR) with sedation. There is limited data assessing the efficacy and safety of the different types of sedative drugs. The objective was to compare two sedation techniques with regard to the need for vasoactive support, respiratory support, rate of conversion to general anesthesia (GA), common perioperative morbidities, intensive care unit (ICU) stay, and in-hospital mortality. Methods: A retrospective chart review study conducted among patients who underwent TAVR at a specialized cardiac center between January 2016 and December 2019. Data collection included patient diagnosis, preoperative comorbidities, intraoperative outcomes, and postoperative outcomes. Results: A total of 289 patients received local anesthesia; 210 received propofol infusion and 79 received a mixed propofol-ketamine infusion (Ketofol). The average age was 75.5 ± 8.9 years and 58.1% of the patients were females. Comparing propofol and ketofol groups, 31.2% and 34.2% of the patients required drug support, 7.6% and 6.3% required conversion to GA, 46.7% and 59.5% required respiratory support, respectively. These intraoperative outcomes were not significantly different between groups, P = 0.540, P = 0.707, and P = 0.105, respectively. In-hospital 30-day mortality in propofol and ketofol groups were 1.9% and 3.8%, respectively, P = 0.396. In both groups, the median post-procedure coronary care unit stay was 26 hours while post-procedure hospital stay was 3 days. Conclusions: There were no significant differences in perioperative or postoperative outcomes in TAVR patients receiving either propofol or ketofol. Propofol infusion, either alone or with ketamine, is reliable and safe, with minimal side effects.

Late outcomes of surgical reconstruction of peripheral pulmonary arteries.

OBJECTIVE: The ideal management of peripheral pulmonary artery stenosis is still controversial. We adopted a primary surgical approach to this complex lesion with excellent early outcomes. In this study, we analyzed our late outcomes. METHODS: We performed a retrospective review of 91 patients with biventricular anatomy who underwent peripheral pulmonary artery reconstruction from March 2008 to July 2020. Our surgical approach included either a single-stage complete repair through median sternotomy or a 2-stage repair through sternotomy/left thoracotomy, depending on the degree of distal involvement of the left pulmonary artery branches. RESULTS: Median age was 26 months. Syndromic etiology was established in 54 patients (59.3%) versus nonsyndromic etiology in 37 patients (40.7%). Single-stage repair was achieved in 68 patients (74.7%). There were 2 (2.2%) in-hospital mortalities. The mean right ventricular to aortic systolic pressure ratio decreased from 1.07 ± 0.20 preoperatively to 0.32 ± 0.07 immediately postoperatively (P < .001), representing a 70.1% reduction. At 1-year postoperative catheterization, the mean right ventricular to aortic systolic pressure ratio was 0.28 ± 0.05 (P < .001 compared with immediately postoperative value). With a median follow-up of 68 months (IQR, 39-117.5 months), there was no late mortality after discharge. All patients were active and asymptomatic on the most recent follow-up. There were no early or late reinterventions on pulmonary arteries. CONCLUSIONS: Late outcomes of surgical reconstruction of peripheral pulmonary arteries are excellent and durable in various pathologies (syndromic and nonsyndromic) with a significant reduction in right ventricular to aortic systolic pressure ratio, low mortality, and no reintervention.

Late Outcomes After Pulmonary Arterial Reconstruction in Patients With Arterial Tortuosity Syndrome.

BACKGROUND: Surgical pulmonary artery reconstruction in patients with arterial tortuosity syndrome has excellent outcomes. In this study, we report our late outcomes after more than a decade of experience with such complex interventions. METHODS: We conducted a retrospective review of 33 arterial tortuosity syndrome patients who underwent pulmonary artery reconstruction. The mean preoperative right ventricular to left ventricular pressure ratio was 1.19 ± 0.2. Our surgical approach included either a single-stage complete repair through a median sternotomy (17 patients) or a two-stage repair through sternotomy/left thoracotomy (16 patients), depending on the degree of distal involvement in the left pulmonary artery. RESULTS: Median age was 36 months. All patients had distal segmental peripheral pulmonary artery stenosis. Thirty patients (90.1%) were symptomatic before surgery. There was one hospital death due to viral pneumonia 78 days after the surgery (in-hospital mortality 3%). The mean right ventricular to left ventricular pressure ratio decreased to 0.31 ± 0.07 early postoperatively (P < 0.001), representing a 74% reduction compared with preoperative values. Follow-up was 100% complete for all hospital survivors (32 of 33) with a mean follow-up of 70.42 ± 43.32 months (range, 2 to 143). There was no late mortality or need for reintervention (surgical or catheter based) after hospital discharge. In late postoperative catheterization, the mean right ventricular to left ventricular pressure ratio was 0.27 ± 0.05 (P = .003 compared with early postoperative value). All patients were asymptomatic on their most recent follow-up. CONCLUSIONS: A strategy of complete surgical reconstruction of all stenotic pulmonary artery segments in patients with arterial tortuosity syndrome is recommended for sustainable successful outcomes more than a decade later.

Anesthetic management in tetralogy of fallot with pulmonary atresia and major aortopulmonary collateral arteries in pediatric patients: One year experience.

BACKGROUND: Unlike the typical tetralogy of fallot (TOF), the presence of pulmonary atresia and major aortopulmonary collaterals is recognized as a rare but severe variant of TOF. The objective was to describe the perioperative anesthetic management of pediatric patients who underwent unifocalization procedure and to describe their postoperative morbidity and mortality. METHODS: A retrospective observational study was conducted among pediatric patients who underwent unifocalization procedure at Prince Sultan Cardiac Center (PSCC) between October 2017 and October 2018. Unifocalization procedures were performed in a two-staged approach. Anesthetic management of both stages had similar concerns and challenges but with few peculiar issues. These included preoperative assessment, intraoperative management, vascular access, positioning, ventilation, optimizing hemodynamics, cardiopulmonary bypass monitoring, and postoperative management. RESULTS: A total of 19 unifocalization procedures were included. The average age was one year and 52.6% were females. Two patients (10.5%) arrived in theater already with intubated ventilation. Continuous mandatory ventilation was used in 11 (57.9%) patients while one-lung ventilation was used in the rest of patients. Approximately, 30% of patients encountered a stormy postoperative course, 52.6% underwent cardiopulmonary bypass with or without cross-clamping of the aorta, and 10.5% had reperfusion injury. CONCLUSIONS: Despite the major challenges of unifocalization, significantly low rates of morbidity and mortality were observed in our patients. A thorough familiarity of different airway and ventilation issues, besides meticulous hemodynamic and anesthetic management, is of paramount importance. The maintenance of hemodynamic stability, hemostasis, and proper ventilation is critical for the success of the operation.

RETRACTED: I do not even remember what I smoked! A case of marijuana-induced transient global amnesia.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the editor as it is a duplicate of a paper that has already been published in JSciMed Central, JSM Clinical Case Reports: Mansou G, Tantoush H, Abuzaid A, Al Ashry H, Bellamkonda P. Marijuana Induced Transient Global Amnesia: JSM Clin Case Rep 2(4): 1043. One of the conditions of submission of a paper for publication is that authors declare explicitly that the paper has not been previously published and is not under consideration for publication elsewhere. A longer version of this case report was published on March 10, 2014, by J Sci Med Central, 3 months before three of the original authors submitted it to AJM. As such this article represents a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and we apologize to readers of the journal that this was not detected during the submission process. Joseph S. Alpert, MD, Editor in Chief, The American Journal of Medicine