Ronak Shah

Sudden Cardiac Death and Disorders of the QT Interval: Anesthetic Implications and Focus on Perioperative Management

ONG QT SYNDROME (LQTS) and short QT syndrome SODIUM CHANNEL PATHOPHYSIOLOGY AND LQTS/SQTS L(SQTS) are genetic cardiac ion channelopathies that occur in the general population and have a well-documented association with sudden cardiac death both in children and adults. Sudden cardiac death usually is caused by sustained ventricular tachycardia, including ventricular fibrillation. The published incidence averages about 5 to 10 deaths per 10,000 population. In the United States, sudden cardiac death is responsible for about 300,000 to 450,000 deaths per year. The ion channelopathies are a heterogenous group of inherited multisystem disorders that include Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and arrhythmogenic right ventricular cardiomyopathy. These conditions have 3 features in common: (1) a structurally normal heart, (2) genetic basis, and (3) predisposition to lethal arrhythmias. They are being recognized with increased frequency in the perioperative period, and guidelines for the management of patients with these complex arrhythmias are lacking. This review addresses the perioperative issues associated with LQTS and SQTS, with a focus on evidence-based management.

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.

CASE 6-2016Cardiopulmonary Bypass as a Bridge to Clinical Recovery From Cardiovascular Collapse During Graft Reperfusion in Liver Transplantation.

From the *Cardiovascular and Thoracic Section Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and †Liver Transplant Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Address reprint requests to John G.T. Augoustides, MD, FASE, FAHA, Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Dulles 680, HUP 3400 Spruce St., Philadelphia, PA 19104-4283. E-mail: yiandoc@hotmail.com

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.