The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2009

Harish Ramakrishna, Jens Fassl, Ashish Sinha, Prakash Patel, Hynek Riha, Michael Andritsos, Insung Chung, John G.T. Augoustides

Research output: Contribution to journalReview article

9 Scopus citations

Abstract

The hybrid operating room is the venue for transcatheter therapy with the convergence of 3 specialties: cardiac surgery, cardiovascular anesthesiology, and interventional cardiology. Transcatheter aortic valve replacement is proof that cardiac specialists have embraced the endovascular revolution. Because pharmacologic conditioning and ischemic myocardial conditioning are safe and effective, they are currently the focus of multiple trials. Angiotensin blockade, anemia, and endoscopic saphenous vein harvesting worsen outcome after coronary artery bypass graft (CABG) surgery. Although off-pump CABG surgery is equivalent to on-pump CABG surgery, it may improve outcomes in high-risk groups. Although percutaneous coronary intervention (PCI) significantly decreases mortality after myocardial infarction, the evidence is less convincing for intra-aortic balloon counterpulsation. Even though prasugrel recently was approved for platelet blockade in PCI, it may be superseded by ticagrelor. Although PCI and CABG surgery appear equivalent for multivessel coronary disease, CABG surgery lowers revascularization rates and also has superior outcomes in diabetics and the elderly. Hetastarch and N-acetylcysteine both increase bleeding and transfusion in cardiac surgery. Factor VII can treat life-threatening bleeding, but its safety requires further evaluation. Because eltrombopag and romiplostim stimulate platelet production, they may have a future role in hemostasis after cardiac surgery. Even though fenoldopam, atrial natriuretic peptide, and sodium bicarbonate are nephroprotective, further trials must confirm these findings. Intensive insulin therapy offers no further outcome advantage and significantly increases hypoglycemic risk. The past year has witnessed the advent of a new clinical venue, new devices, and new drugs. The coming year will most likely advance these achievements.

Original languageEnglish (US)
Pages (from-to)7-17
Number of pages11
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume24
Issue number1
DOIs
StatePublished - Feb 1 2010

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Keywords

  • anemia
  • angiotensin-converting enzyme inhibitors
  • atrial natriuretic peptide
  • coronary artery bypass graft surgery
  • eltrombopag
  • endovascular saphenous vein graft harvesting
  • fenoldopam
  • hetastarch
  • hybrid operating room
  • intensive insulin therapy
  • intra-aortic balloon counterpulsation
  • ischemic preconditioning
  • levosimendan
  • percutaneous coronary intervention
  • pharmacologic conditioning
  • prasugrel
  • romiplostim
  • sodium bicarbonate
  • ticagrelor
  • transcatheter aortic valve replacement
  • transcatheter mitral valve repair
  • volatile anesthetics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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