Cardiothoracic Anesthesia Research Articles

Meeting Report: First Scottish Right Heart Symposium.

*Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Clydebank, United Kingdom †Anaesthesia, Perioperative Medicine and Critical Care Research Group, University of Glasgow School of Medicine, Glasgow, United Kingdom Accepted for publication January 12, 2023. Supported by grants from the UK Association of Cardiothoracic Anaesthesia and Critical Care and the British Heart Foundation. [email protected]

Cardiothoracic Transplant Anesthesia: Selected Highlights: Part I—Lung Transplantation

The Year in Cardiothoracic Transplant: Lung Transplantation in 2021 focuses on the recent research this year, including the assessment, optimization, and selection of candidates for lung transplantation (LTX), donor optimization, the use of organs from donation after circulatory death (DCD) donors, the use of ultrasound to assess donor lung function, and outcomes utilizing marginal donors, as well as recipient factors affecting LTX, including age, disease, the use of extracorporeal life support, and COVID-19. The remainder of the article focuses on the perioperative management of LTX, including antirejection strategies, as well as recent multi-organizational recommendations on the care of these patients.

Simulation in cardiac surgery: current evidence

Simulation permeated healthcare curricula and has become a powerful teaching tool to improve manual and cognitive skills in medicine today. Amongst other skill sets, cardiothoracic anaesthetists are expected to make safe life-saving decisions to improve patient outcome during rare critical events. These stressful situations require leadership and problem solving skills from all medical personnel, which traditional learning by “apprenticeship” may not cover. This narrative review looks at current simulation modalities used in cardiothoracic anaesthesia, which include critical scenarios for the placement of arterial and central venous lines, as well as the interpretation of the pulmonary artery catheter derived data. Simulation in transthoracic and transoesophageal echocardiography has proven to be very useful. Of particular importance in cardiothoracic clinical practice is simulation for cardiopulmonary bypass, veno-arterial and veno-venous extracorporeal membrane oxygenation. Trainees’ working hour regulations may affect patient safety, because of decreased exposure to real life patient-related scenarios. The complexity of patient interventions in a high-stakes discipline like cardiothoracic anaesthesia may necessitate the development of further simulation-enhanced educational processes.

Effectiveness of Simulation- Versus Didactic Video-Based Learning to Teach Advanced Lung Isolation Techniques

Mastery of lung isolation is crucial for optimal cardiothoracic anesthesia education. The authors tested the hypothesis that simulation- is more effective than didactic video-based learning (cognitive, affective, and psychomotor) to teach anesthesiology fellows advanced lung isolation techniques. A prospective randomized study. At a single academic heart center, simulation laboratory. Thirty anesthesiology fellows with equivalent prior experience in basic lung isolation techniques. Randomized participants received 1 of 2 structured educational interventions of equivalent duration designed to teach advanced lung isolation skills, a simulation workshop, or a video-based didactic session. To assess Bloom's taxonomy domains, performance measurements included pre- and postintervention cognitive tests and affective surveys and a postintervention psychomotor task (time to complete lung isolation). Changes in test and survey scores and time to completion were compared using the Mann-Whitney U test; p values < 0.05 were considered significant. Improvements in lung isolation learning assessments were greater in the simulation group, but significant differences only existed in the affective domain. Specifically, affective survey score increases were greater in the simulation group (simulation- versus video-based didactic: +19.0 v +4.0; p ≤ 0.001), whereas there was no significant difference in cognitive pre- to posttest scores (simulation- versus video-based: +28.6 v +19.1, p=0.23), and time to achieve lung isolation (simulation- versus video-based: 32 v 36 seconds, p=0.46). Although greater affective learning of advanced lung isolation skills occurred with simulation-based compared to didactic video-based education, the authors found no differences between the teaching approaches in cognitive and psychomotor learning among anesthesiology fellows.

Current Practice in Carcinoid Heart Disease and Burgeoning Opportunities.

Cardiac surgery with tricuspid valve and potentially pulmonic valve replacement at an experienced center is currently the most effective strategy available for the treatment of carcinoid heart disease. Cardiac surgery for carcinoid heart disease requires a multidisciplinary team including cardiology, medical oncology, cardiothoracic anesthesia, and cardiac surgery. Without cardiac surgery, morbidity and mortality from carcinoid heart disease is high. Aggressive management of carcinoid before and after cardiac surgery is critical. Over time, though, circulating carcinoid hormones can lead to destruction of prosthetic valves as well, resulting in recurrent right heart failure. Percutaneous options for valve repair may be on the horizon for management of carcinoid heart disease.

Association of CHA2DS2-VASc Score with Post Cardiac Surgery Atrial Fibrillation: A Single Centre Study

Objective: To find out the association of CHA2DS2-VASc score with postoperative atrial fibrillation in cardiac surgery patients.&#x0D; Study Design: Analytical Cross-Sectional study.&#x0D; Place and Duration of Study: Cardiothoracic Anaesthesia and Adult Cardiac Critical Care department, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi Pakistan, from Feb 2022 to Apr 2022.&#x0D; Methodology: After IERB approval, 186 adult patients of POAF with the prevalence of 9.7%undergoing CABG surgery were included in the study. Their demographic data and CHA2DS2-VASc score, originally used to find the risk of stroke in patients with atrial fibrillation, was calculated pre-operatively. They were followed for 48 hours postoperatively for any episode of post op atrial fibrillation (POAF). Data including pre op drugs, type of surgery, number of grafts, inotropic support and POAF timing after surgery was recorded and analysed by SPSS v 21.0.&#x0D; Results: Incidence of POAF in our study patients was 17.2 %( n=32). Mean time of onset of POAF was 24.75±16.05 hours.Patients who developed POAF had higher CHA2DS2-VASc score 3.06±1.21 compared with those who did not develop POAF 2.61±0.97. This association was statistically significant (p-value=0.023). Among the variables of CHA2DS2-VASc score, age had significant association with POAF (p-value= 0.001). No difference was found between on pump vs off pump surgery in terms of POAF (p-value=0.539).&#x0D; Conclusion: This study found that CHA2DS2-VASc score has significant association with POAF after CABG surgery. It is a simple and easy scoring system which can be calculated in preoperative period. Patients at increased risk of POAF can be identified and given prophylactic treatment to reduce morbidity and mortality.

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2022

This special article is the 15th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief Dr. Kaplan and the editorial board for the opportunity to continue this series, namely the research highlights of the past year in the specialties of cardiothoracic and vascular anesthesiology. The major themes selected for 2022 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights, in the specialties for 2022, begin with an update on COVID-19 therapies, with a focus on the temporal updates in a wide range of therapies, progressing from medical to the use of extracorporeal membrane oxygenation and, ultimately, with lung transplantation in this high-risk group. The second major theme is focused on medical cardiology, with the authors discussing new insights into the life cycle of coronary disease, heart failure treatments, and outcomes related to novel statin therapy. The third theme is focused on mechanical circulatory support, with discussions focusing on both right-sided and left-sided temporary support outcomes and the optimal timing of deployment. The fourth and final theme is an update on cardiac surgery, with a discussion of the diverse aspects of concomitant valvular surgery and the optimal approach to procedural treatment for coronary artery disease. The themes selected for this 15th special article are only a few of the diverse advances in the specialties during 2022. These highlights will inform the reader of key updates on a variety of topics, leading to the improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.

Perioperative management and outcomes of neonates undergoing anaesthesia for congenital tracheo-oesophageal fistula repair at Charlotte Maxeke Johannesburg academic hospital.

Congenital tracheo-oesophageal fistula (TOF) occurs in 1 in 3000 births. Perioperative management for TOF repair requires co-ordination with a multi-disciplinary team, support from critical care units, and expertise in neonatal and cardiothoracic anaesthesia. Charlotte Maxeke Johannesburg academic hospital (CMJAH) is a quaternary referral centre that serves the regional community of Johannesburg, in Gauteng, South Africa. The aim of this research was to describe the perioperative outcomes of neonates undergoing surgical TOF repair at CMJAH. Factors in the preoperative, intra-operative, and postoperative management were considered to find relationships with the perioperative outcomes. A retrospective single institution study was conducted with a population of 38 neonates who underwent congenital TOF repair from 1 January 2015 to 31 March 2020 at CMJAH. Descriptive statistics were used to describe the biodata using percentages, median, and inter-quartile ranges. An in-depth description of neonates that died was performed. A total of 38 neonates diagnosed with TOF/OA were operated on during the study period. The mortality rate was 15.8%. No deaths occurred intraoperatively. In addition, 52.6% of the neonates had a prolonged stay in ICU, 44% had a delay in the initiation of feeds, 65% developed sepsis, and 36.8% had surgical related complications. CPR was required in 1 neonate, hypoxia leading to bradycardia in 10, and hyperlactataemia in 9 neonates. Inotropic support was required in 6 neonates, and vasopressor support in 4. Blood product transfusion were necessary for 9 neonates. The in-hospital mortality of TOF repair was better than that reported in other African countries and worse than international findings. In-hospital morbidity was burdened by respiratory illness and sepsis. Areas where management could be improved include widespread foetal anomaly scanning, incorporation of bronchoscopy, and preoperative respiratory optimisation.

Enrolling patients in cardiogenic shock trials: are we missing someone? Insights from the Italian AltShock-2 registry.

European Journal of Heart FailureEarly View Viewpoint Enrolling patients in cardiogenic shock trials: are we missing someone? Insights from the Italian AltShock-2 registry Federico Pappalardo, Corresponding Author Federico Pappalardo fedepappa.71@gmail.com Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy Corresponding author. Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy. Email: fedepappa.71@gmail.comSearch for more papers by this authorGuido Tavazzi, Guido Tavazzi Anaesthesia and Intensive Care Unit, University of Pavia, Pavia, ItalySearch for more papers by this authorStefano Savonitto, Stefano Savonitto Division of Cardiology, Manzoni Hospital, Lecco, ItalySearch for more papers by this authorNuccia Morici, Nuccia Morici IRCCS S. Maria Nascente—Fondazione Don Carlo Gnocchi ONLUS, Milan, ItalySearch for more papers by this author Federico Pappalardo, Corresponding Author Federico Pappalardo fedepappa.71@gmail.com Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy Corresponding author. Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy. Email: fedepappa.71@gmail.comSearch for more papers by this authorGuido Tavazzi, Guido Tavazzi Anaesthesia and Intensive Care Unit, University of Pavia, Pavia, ItalySearch for more papers by this authorStefano Savonitto, Stefano Savonitto Division of Cardiology, Manzoni Hospital, Lecco, ItalySearch for more papers by this authorNuccia Morici, Nuccia Morici IRCCS S. Maria Nascente—Fondazione Don Carlo Gnocchi ONLUS, Milan, ItalySearch for more papers by this author First published: 06 August 2022 https://doi.org/10.1002/ejhf.2640Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

The Year in Thoracic Anesthesia: Selected Highlights From 2021

THIS SPECIAL ARTICLE is the fifth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors would like to thank the editor-in-chief, Dr. Kaplan; the associate editor-in-chief, Dr. Augoustides; and the editorial board for the opportunity to expand this series, the research highlights of the year that specifically pertain to the specialty of thoracic anesthesia. The highlights of this year include new developments in the preoperative assessment and prehabilitation of thoracic surgery patients, updates on the use of devices for one-lung ventilation (OLV) in adults and children, updates on the anesthetic management of these patients, including protective ventilation, regional anesthesia, and outcomes when enhanced recovery after thoracic surgery protocols are followed, as well as the use of expanding indications for extracorporeal membrane oxygenation (ECMO) and nonintubated video-assisted thoracic surgery (NIVATS).

How to disseminate clinical research.

AnaesthesiaVolume 77, Issue 9 p. 1051-1054 Reviewer Recommendations How to disseminate clinical research M. Charlesworth, Corresponding Author M. Charlesworth Consultant editor-charlesworth@anaesthetists.org Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK Correspondence to: M. Charlesworth Email: editor-charlesworth@anaesthetists.orgSearch for more papers by this authorT. Selak, T. Selak Consultant Department of Anaesthesia, Wollongong Hospital, Wollongong, NSW, AustraliaSearch for more papers by this author M. Charlesworth, Corresponding Author M. Charlesworth Consultant editor-charlesworth@anaesthetists.org Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK Correspondence to: M. Charlesworth Email: editor-charlesworth@anaesthetists.orgSearch for more papers by this authorT. Selak, T. Selak Consultant Department of Anaesthesia, Wollongong Hospital, Wollongong, NSW, AustraliaSearch for more papers by this author First published: 08 June 2022 https://doi.org/10.1111/anae.15781Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume77, Issue9September 2022Pages 1051-1054 This article also appears in:Reviewer Recommendations Collection RelatedInformation

European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) Fellowship Curriculum: Second Edition

This document represents the first update of the Cardiothoracic and Vascular Anaesthesia Fellowship Curriculum of the European Association of Cardiothoracic Anaesthesiology and Intensive Care. After obtaining feedback from exit interviews with fellows in training, graduate fellows, and program directors, 2 modified online Delphi procedures with questionnaires were conducted. A consensus was reached when two-thirds of responding committee members gave green or yellow ratings on a traffic light system, and >70% indicated strong agreement or agreement on a 5-point Likert scale.

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia.

In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: "cardiac anesthesiology and outcomes" (n = 177), "cardiothoracic anesthesiology" (n = 34), "cardiac anesthesia," and "clinical outcomes" (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.

The Year in Graduate Medical Education: Selected Highlights From 2021

This special article is the first in a planned annual series for the Journal of Cardiothoracic and Vascular Anesthesia that will highlight significant literature from the world of graduate medical education (GME) that was published over the past year. The major themes selected for this inaugural review are the educational value of simulation and training workshops, the expanding role of social media and other information technologies in GME and recruitment, the state of residency and fellowship training before the COVID-19 pandemic, and the inevitable effects COVID-19 has had on graduate medical education. The authors would like to thank the editorial board for allowing us to shine a light on a small subset of the writing and research produced in this field, so that educators may understand how best to educate and train the next generation of anesthesiologists.

The Year in Perioperative Echocardiography: Selected Highlights From 2021

This article is the sixth of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series. In most cases, these were research articles that were targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but, in some cases, these articles targeted the use of perioperative echocardiography in general.

Prospective national audit of major gastrointestinal complications of transesophageal echocardiography studies in children.

Background:Perioperative trans-esophageal echocardiography ('TEE') is widely used for the assessment of anatomy/repair of congenital cardiac defects. It is recognised that there are risks associated with its use.Aims:We wished, by means of a contemporaneous prospective national audit over a six-month period, to establish what proportion of TEE studies in children are complicated by major upper gastrointestinal or upper aerodigestive tract trauma.Methods:After obtaining appropriate local institutional ethics committee approval, a national prospective audit of the rate and severity of gastrointestinal complications of trans-esophageal echocardiography studies in anaesthetised adult cardiology and cardiac surgical patients was conducted by the Association of Cardiothoracic Anaesthesia and Critical Care in the United Kingdom and Ireland during the twelve months of 2017. During the second six months of the audit, the Congenital Cardiac Anaesthesia Network (an organisation including anaesthetists with a paediatric cardiac anaesthetic practice in all the United Kingdom cardiac surgical centres) prospectively audited the incidence of such complications of TEE studies in children.Results:A total of 1,059 studies were included in this six-month paediatric audit. There were no reports of the specified major complication.Statistical Analysis:The zero incidence of the major complication is consistent with a worst possible incidence of five per thousand TEE examinations.Conclusions:Such potentially reassuring information could be included in discussions with patients or families about the risk of trans-esophageal studies in children.

WITHDRAWN: Dealing With the Right Side: Carcinoid Heart Disease

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Journal of Cardiothoracic and Vascular Anesthesia, 36 (2022) 2793-2802, http://dx.doi.org/10.1053/j.jvca.2021.10.030. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

The Year in Electrophysiology: Selected Highlights from 2021

THIS SPECIAL ARTICLE is the fourth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the Editor-in-Chief, Dr. Kaplan, the Associate Editor-in-Chief, Dr. Augoustides, and the editorial board for the opportunity to author this series; namely, the research highlights of the year that pertain to electrophysiology (EP) in relation to cardiothoracic and vascular anesthesia. The selected topics for this year, “The Year in Electrophysiology: Selected Highlights from 2021,” were chosen to reflect the recent updates to EP practice and the potential future of where EP care will be for years to come. There were several advances in clinical operations for EP patients during the coronavirus disease 2019 (COVID-19) pandemic, new devices, updates in technology, and new procedural approaches to device implantation. Each of these components directly affects the anesthetic care of patients both in the cardiothoracic arena and in the noncardiothoracic perioperative environment.

Editorial introductions.

Editorial introductions.

Advances in training of the specialized human resources for health in Tanzania: the case of Muhimbili University of Health and Allied Sciences

BackgroundIncreasing the number of specialized human resources for health is paramount to attainment of the United Nations sustainable development goals. Higher learning institutions in low-and middle-income countries must address this necessity. Here, we describe the 5-years trends in accreditation of the clinical and non-clinical postgraduate (PG) programmes, student admission and graduation at the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, highlighting successes, challenges and opportunities for improvement.MethodsThis was a retrospective longitudinal study describing trends in PG training at MUHAS between 2015 and 2016 and 2019-2020. Major interventions in the reporting period included university-wide short course training programme to faculty on curricula development and initiation of online application system. Data were collected through a review of secondary data from various university records and was analyzed descriptively. Primary outcomes were the number of accredited PG programmes, number of PG applicants as well as proportions of applicants selected, applicants registered (enrolled) and students graduated, with a focus on gender and internationalization (students who are not from Tanzania).ResultsThe number of PG programmes increased from 60 in 2015-2016 to 77 in 2019-2020, including programmes in rare fields such as cardiothoracic surgery, cardiothoracic anesthesia and critical care. The number of PG applications, selected applicants, registered applicants and PG students graduating at the university over the past five academic years had steadily increased by 79, 81, 50 and 79%, respectively. The average proportions of PG students who applied, were selected and registered as well as graduated at the university over the past five years by gender and internationalization has remained stably at 60% vs. 40% (male vs. female) and 90% vs. 10% (Tanzanian vs. international), respectively. In total, the university graduated 1348 specialized healthcare workers in the five years period, including 45 super-specialists in critical fields, through a steady increase from 200 graduates in 2015-2016 to 357 graduates in 2019-2020. Major challenges encountered include inadequate sponsorship, limited number of academic staff and limited physical infrastructure for teaching.ConclusionDespite challenges encountered, MUHAS has made significant advances over the past five years in training of specialized and super-specialized healthcare workforce by increasing the number of programmes, enrollment and graduates whilst maintaining a narrow gender gap and international relevance. MUHAS will continue to be the pillar in training of the specialized human resources for health and is thus poised to contribute to timely attainment of the health-related United Nations sustainable development goals in Tanzania and beyond, particularly within the Sub-Saharan Africa region.