Elizabeth Zhou

Surgical Aortic Valve Replacement—Clinical Update on Recent Advances in the Contemporary Era

From the *Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ, †Department of Anesthesiology and Critical Care; and §Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Address reprint requests to John G. Augoustides, MD, Professor Anesthesiology and Critical Care, Dulles 680, HUP, 3400 Spruce Street, Philadelphia, PA, 191014. E-mail: yiandoc@hotmail.com

Stroke after Transcatheter Aortic Valve Replacement: incidence, definitions, etiologies and management options

Neurologic complications after transcatheter aortic valve replacement are devastating. The etiologies of stroke in this setting are best addressed in an integrated fashion during each phase of the perioperative pathway. The conduct of this triphasic approach will continue to be refined to reduce the stroke risks even further, given the major focus on aspects such as embolic protection devices and valve thrombosis. This neurologic focus in transcatheter aortic valve replacement has transformed the investigational approach to neurologic events in cardiovascular clinical trials, resulting in novel guidelines for the diagnosis and assessment of neurologic injury after cardiovascular interventions.

Moderate Aortic Stenosis and Coronary Artery Bypass Grafting: Clinical Update for the Perioperative Echocardiographer

Incidental aortic stenosis in the setting of coronary artery bypass surgery may be a perioperative challenge. The accurate assessment of the degree of aortic stenosis remains an important determinant. Although severe aortic stenosis is an indication for valve replacement, current guidelines advise a balanced approach to the management of moderate aortic stenosis in this setting. Multiple factors should be considered in a team discussion to balance risks versus benefits for the various management options in the given patient. The rapid progress in aortic valve technologies also offer alternatives for definitive management of moderate aortic stenosis in this setting that will likely become even safer in the near future.

Acute Type B Aortic Dissection in Pregnancy – Therapeutic Challenges in a Multidisciplinary Setting ☆ ☆☆

Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston-Salem, NC Cardiothoracic Anesthesiology, Department of Anesthesiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL

Simultaneous Right-Sided and Left-Sided Infective Endocarditis – Management Challenges in a Multidisciplinary Setting☆☆☆

Cardiothoracic Section, Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico, Albuquerque, NM

Catheterization Laboratory: Structural Heart Disease, Devices, and Transcatheter Aortic Valve Replacement

The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications. Left atrial occlusion and the endovascular edge-to-edge mitral valve repair devices were approved. Although these devices require general anesthesia, an invasive surgery and cardiopulmonary bypass machine are not necessary for deployment.

Cardioversions and Transthoracic Echocardiography

Patients with atrial fibrillation and flutter routinely require transesophageal echocardiography with cardioversion. It is not uncommon to encounter patients with reduced ejection fractions, coronary artery disease, prior cardiac surgery, or obstructive sleep apnea. The anesthesiologist must carefully evaluate the patient and any available laboratory and study findings to assess for potential complications after anesthesia. Appropriate anesthetics must be chosen based on the preoperative evaluation. Additionally, because most of these cases are done without a secured airway, emergency medications and airway equipment must be readily available.