Innovations in Cardiovascular Care: A Society of Cardiovascular Anesthesiologists’ Monograph

Abstract

Innovations in Cardiovascular Care: A Society of Cardiovascular Anesthesiologists’ Monograph Cook DJ, ed. Philadelphia: Lippincott Williams & Wilkins, 2006. ISBN 1-58255-529-X. DVD-ROM, $99.00. For the busy practitioner, it can be difficult to keep pace with rapidly advancing technical innovations and the expanding body of pertinent literature. For those still in training, getting “up to speed” may seem even more daunting. This monograph distills a vast body of literature and presents a focused and comprehensive update on selected aspects of cardiovascular medicine. Innovative technologies are approached in the context of pertinent pathology and evidence based practices. The organization of this disc is well thought out and executed. The presentation software utilizes HTML formatting to provide a cross-platform document that is compatible on both Windows and Macintosh computers. In the age of digital technology, it is tempting to overwhelm the reader with superfluous information or to frustrate them by making it cumbersome to scan or “flip through the pages” quickly. However, in this case, the organization of the information content is intuitive and navigation and exploration of this disk is facile. Each section is edited into a flowing, logical format. References for each section are current, with many seemingly available only months before the publication of this monograph. Accompanying photos and videos are generally relevant and informative. Images load refreshingly quickly and are of high quality and resolution. Although several industry-generated video animations and illustrations are included, they significantly enhance the reader’s understanding of current and developing technologies. The editor has assembled a number of well-qualified contributors to provide an up-to-date review of the literature and a structured approach to understanding a broad reach of cardiovascular interventions. As with any monograph written in this multiauthored format, there is significant variability in style and comprehensiveness. Regardless, each topic is reviewed from a historical perspective, giving the reader a context in which to place the current state of the art. The authors try to adhere to the principles of evidenced-based medicine, educating the reader to the “alphabet soup” of surgical and cardiology trials. In addition, the authors frequently discuss the anesthetic requirements for performance of a procedure, as well as the implications of our medications and anesthetic technique. The monograph includes 13 chapters that are divided into four sections; 12 of the chapters are devoted to several major issues in cardiac and vascular medicine and the final chapter addresses future challenges. Section I entitled “New Devices in Interventional Cardiology” reviews percutaneous valve replacement and nonsurgical treatment for mitral valve disease. A thorough review of research pertaining to drug eluting stents also appears in this section. Section II, “Innovations in Electrophysiology,” begins with the basics of cardiac pacing and goes on to detail implantable cardiac defibrillators and pacemakers. Electrical therapies, such as catheter ablation and cardiac resynchronization, are discussed here. Perioperative care of patients with these devices is also reviewed. Section III, “Cardiac Surgery,” examines the engineering innovations in ventricular assist devices, mechanical hearts, and intraaortic balloon pumps. After reading this section, one comes away with a detailed understanding of both short- and long-term assist devices as well as their effectiveness, complications, and anesthetic implications. Section IV, ”Vascular Surgery,” updates the reader on the materials, technical considerations, and anesthetic management of endovascular techniques for the aorta and carotid arteries. The chapter discussing carotid stenting presents the trials and literature starting with the studies comparing medical management versus carotid endarterectomy and continues on to endarterectomy versus stenting. The chapter concludes by introducing embolic protection devices. A particularly comprehensive chapter describes the unique physiology and technology of ventricular assist devices. Each of the currently available assist devices is discussed with regard to the history of its development, clinical use, and effectiveness. Accompanying diagrams and animations clearly illustrate in vivo function. An interesting discussion of ongoing innovation and development of total artificial heart technology also appears in this section. In summary, Innovations to Cardiovascular Care is a very readable introduction to a broad sweep of new technological interventions for the cardiac and vascular patient. It is useful as a reference because of its comprehensive discussion of the critical aspects of pathophysiology and evidenced approach to current medical trials and investigations. This monograph aids perioperative cardiovascular physician in integrating their knowledge base and facilitating discussions of overall management issues of cardiac disease with cardiology and surgical colleagues. Dr. Cook and his coauthors have produced a current, thorough, and readable reference that is indeed a “State of the Art Review” and a welcome addition to my library. John Fisher, MD Fellow in CT Anesthesia Stuart J. Weiss, MD, PhD Associate Professor Department of Anesthesia and Critical Care University of Pennsylvania Philadelphia, PA [email protected] [email protected]