Publications by authors named "Prakash Patel"

160 Publications

TAVR Valves in the Mitral Position: Forever Between a Ring and a Hard Place.

J Cardiothorac Vasc Anesth 2021 Jul 13;35(7):1917-1921. Epub 2021 Mar 13.

Department of Anesthesiology, Cardiothoracic Division, Yale University School of Medicine, New Haven, CT. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2021.03.015DOI Listing
July 2021

The Year in Coagulation: Selected Highlights from 2020.

J Cardiothorac Vasc Anesth 2021 Mar 2. Epub 2021 Mar 2.

Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Maryland School of Medicine, Baltimore, MD; Department of Anesthesiology, Division of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.

This is the second annual review in the Journal of Cardiothoracic and Vascular Anesthesia to cover highlights in coagulation for cardiac surgery. The goal of this article is to provide readers with a focused summary from the literature of the prior year's most important coagulation topics. In 2020, this included a discussion covering allogeneic transfusion, antiplatelet and anticoagulant therapy, factor concentrates, coagulation testing, mechanical circulatory support, and the effects of coronavirus disease 2019.
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http://dx.doi.org/10.1053/j.jvca.2021.02.057DOI Listing
March 2021

Role of demographic and clinical factors in survival of HIV patients on antiretroviral therapy.

Trop Doct 2021 Feb 8:49475520981257. Epub 2021 Feb 8.

Professor & Head, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India.

Our retrospective cohort study assesses the survival probability and identifies the demographic and clinical predictors of mortality in HIV patients taking antiretroviral therapy using an antiretroviral therapy centre data in Western India. Secondary data on 7532 registered HIV-infected individuals between September 2006 and January 2013 were analysed. The probability of survival at 75 months was 84.9%. Significant indicators of poor chances of survival were greater age, lower occupation class, lower CD4 count, poor functional status; higher stage of disease, lower weight, the presence and type of opportunistic infections, co-trimoxazole therapy and poor adherence to antiretroviral therapy. We thus find that, in addition to pre-ART, antiretroviral therapy clinical status and treatment adherence, socioeconomic status plays an important influence on ultimate survival of HIV patients on antiretroviral therapy.
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http://dx.doi.org/10.1177/0049475520981257DOI Listing
February 2021

Skeletal Muscle Characteristics May Inform Preprocedural Risk Stratification in Transcatheter Aortic Valve Replacement Patients.

J Cardiothorac Vasc Anesth 2020 Dec 21. Epub 2020 Dec 21.

Department of Anesthesiology, Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA. Electronic address:

Objectives: Low psoas muscle mass previously has been associated with mortality after transcatheter aortic valve replacement (TAVR). Evidence from other clinical disciplines suggests that psoas density (PD) may be a better predictor than psoas muscle cross-sectional area indexed to body surface area (PI). The authors hypothesized that PD would be more strongly correlated with patient discharge disposition and survival after TAVR than PI.

Design: The authors performed a single-center, retrospective study of TAVR patients from 2013 to 2016. PI and PD were assessed at the third lumbar spine level using computed tomography imaging. Propensity-score matching was used to investigate the association of PI and PD with discharge disposition and mortality.

Setting: Tertiary university hospital PARTICIPANTS: Cohort of 245 TAVR patients.

Interventions: None MEASUREMENTS AND MAIN RESULTS: A total of 245 patients met inclusion criteria. Following propensity score matching, patients with PI <4 cm/m and PD <25 Hounsfield units (HU) were less likely to survive and to be discharged home compared with patients with PI ≥4 cm/m or PD >25 HU. After repeating the propensity score matching with PI as a covariable, PD remained associated with mortality (90 days: odds ratio [OR] 4.59; 95% confidence interval [CI] 2.96-10.31, p < 0.001, 1 year: OR 6.14; 95% CI 3.45-28.57, p = 0.01, 3 years: OR 4.55; 95% CI 2.41-40.00, p = 0.03).

Conclusions: PD may be more relevant than PI in risk stratification for TAVR patients.
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http://dx.doi.org/10.1053/j.jvca.2020.12.024DOI Listing
December 2020

COVID-19 disease severity and mortality determinants: A large population-based analysis in Oman.

Travel Med Infect Dis 2021 Jan-Feb;39:101923. Epub 2020 Nov 20.

Directorate General for Disease Surveillance and Control, Ministry of Health, Oman. Electronic address:

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http://dx.doi.org/10.1016/j.tmaid.2020.101923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678429PMC
February 2021

Successful in vitro fertilization in women with Fontan physiology.

J Assist Reprod Genet 2020 Dec 10;37(12):3017-3023. Epub 2020 Oct 10.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Purpose: Patients with single ventricle anatomy palliated with Fontan operation are at risk for thromboembolism, arrhythmia, and heart failure rendering pregnancy high risk or even contraindicated. Infertility and high rates of first trimester miscarriage are not uncommon. In vitro fertilization (IVF) with or without gestational surrogacy can be an option, but poses risks during ovarian stimulation, oocyte retrieval, and the post-procedural period. We present six cases of women with complex congenital heart disease status post Fontan operation who underwent successful IVF.

Methods: Case series from a single-center tertiary care setting.

Results: Indications for referral were cardiac or fertility concerns for pregnancy of the congenital cardiologist. One woman had mild volume overload after oocyte retrieval requiring furosemide and one experienced post-operative colitis. There were no thrombotic complications.

Conclusions: A multidisciplinary team-based approach can result in successful oocyte retrieval and IVF in women with complex congenital heart disease and Fontan physiology.
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http://dx.doi.org/10.1007/s10815-020-01969-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714836PMC
December 2020

Dynamic volumetric assessment of the aortic root: The influence of bicuspid aortic valve competence.

Ann Thorac Surg 2020 Sep 25. Epub 2020 Sep 25.

Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA.

Background: Aortic root evaluation is conventionally based on two-dimensional measurements at a single phase of the cardiac cycle. This work presents an image analysis method for assessing dynamic three-dimensional changes in the aortic root of minimally calcified bicuspid aortic valves (BAVs) with and without moderate to severe aortic regurgitation.

Methods: The aortic root was segmented over the full cardiac cycle in three-dimensional transesophageal echocardiographic images acquired from 19 patients with minimally calcified BAVs and from 16 patients with physiologically normal tricuspid aortic valves (TAVs). The size and dynamics of the aortic root were assessed using the following image-derived measurements: absolute mean root volume and mean area at the level of the ventriculoaortic junction, sinuses of Valsalva, and sinotubular junction, as well as normalized root volume change and normalized area change of the ventriculoaortic junction, sinuses of Valsalva, and sinotubular junction over the cardiac cycle.

Results: Normalized volume change over the cardiac cycle was significantly greater in BAV roots with moderate to severe regurgitation than in normal TAV roots and in BAV roots with no or mild regurgitation. Aortic root dynamics were most significantly different at the mid-level of the sinuses of Valsalva in BAVs with moderate to severe regurgitation than in competent TAVs and BAVs.

Conclusions: Echocardiographic reconstruction of the aortic root demonstrates significant differences in dynamics of BAV roots with moderate to severe regurgitation relative to physiologically normal TAVs and competent BAVs. This finding may have implications for risk of future dilatation, dissection, or rupture, which warrant further investigation.
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http://dx.doi.org/10.1016/j.athoracsur.2020.07.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990744PMC
September 2020

Association of Clinical and Demographic Factors With the Severity of Palmoplantar Pustulosis.

JAMA Dermatol 2020 11;156(11):1216-1222

St John's Institute of Dermatology, King's College London, London, United Kingdom.

Importance: Although palmoplantar pustulosis (PPP) can significantly impact quality of life, the factors underlying disease severity have not been studied.

Objective: To examine the factors associated with PPP severity.

Design, Setting, And Participants: An observational, cross-sectional study of 2 cohorts was conducted. A UK data set including 203 patients was obtained through the Anakinra in Pustular Psoriasis, Response in a Controlled Trial (2016-2019) and its sister research study Pustular Psoriasis, Elucidating Underlying Mechanisms (2016-2020). A Northern European cohort including 193 patients was independently ascertained by the European Rare and Severe Psoriasis Expert Network (2014-2017). Patients had been recruited in secondary or tertiary dermatology referral centers. All patients were of European descent. The PPP diagnosis was established by dermatologists, based on clinical examination and/or published consensus criteria. The present study was conducted from October 1, 2014, to March 15, 2020.

Main Outcomes And Measures: Demographic characteristics, comorbidities, smoking status, Palmoplantar Pustulosis Psoriasis Area Severity Index (PPPASI), measuring severity from 0 (no sign of disease) to 72 (very severe disease), or Physician Global Assessment (PGA), measuring severity as 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), and 4 (severe).

Results: Among the 203 UK patients (43 men [21%], 160 women [79%]; median age at onset, 48 [interquartile range (IQR), 38-59] years), the PPPASI was inversely correlated with age of onset (r = -0.18, P = .01). Similarly, in the 159 Northern European patients who were eligible for inclusion in this analysis (25 men [16%], 134 women [84%]; median age at onset, 45 [IQR, 34-53.3] years), the median age at onset was lower in individuals with a moderate to severe PGA score (41 years [IQR, 30.5-52 years]) compared with those with a clear to mild PGA score (46.5 years [IQR, 35-55 years]) (P = .04). In the UK sample, the median PPPASI score was higher in women (9.6 [IQR, 3.0-16.2]) vs men (4.0 [IQR, 1.0-11.7]) (P = .01). Likewise, moderate to severe PPP was more prevalent among Northern European women (57 of 134 [43%]) compared with men (5 of 25 [20%]) (P = .03). In the UK cohort, the median PPPASI score was increased in current smokers (10.7 [IQR, 4.2-17.5]) compared with former smokers (7 [IQR, 2.0-14.4]) and nonsmokers (2.2 [IQR, 1-6]) (P = .003). Comparable differences were observed in the Northern European data set, as the prevalence of moderate to severe PPP was higher in former and current smokers (51 of 130 [39%]) compared with nonsmokers (6 of 24 [25%]) (P = .14).

Conclusions And Relevance: The findings of this study suggest that PPP severity is associated with early-onset disease, female sex, and smoking status. Thus, smoking cessation intervention might be beneficial.
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http://dx.doi.org/10.1001/jamadermatol.2020.3275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495329PMC
November 2020

A New Tool for Timely Rescue of Heart Transplant Patients with Severe Primary Graft Dysfunction.

Authors:
Prakash A Patel

J Cardiothorac Vasc Anesth 2021 02 11;35(2):404-405. Epub 2020 Aug 11.

Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2020.08.010DOI Listing
February 2021

Hematologic Consequences of the Coronavirus Crisis-Focus on Relevant Clues and Complications for the Perioperative Cardiothoracic and Vascular Community.

J Cardiothorac Vasc Anesth 2020 Dec 27;34(12):3189-3192. Epub 2020 May 27.

Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2020.05.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251401PMC
December 2020

Expanding the Utilization of Acute Normovolemic Hemodilution.

J Cardiothorac Vasc Anesth 2020 07 15;34(7):1761-1762. Epub 2020 Apr 15.

Department of Anesthesiology, Perioperative Care, and Pain Management Miller School of Medicine University of Miami Miami, FL.

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http://dx.doi.org/10.1053/j.jvca.2020.03.030DOI Listing
July 2020

Transesophageal Echocardiography, Mortality, and Length of Hospitalization after Cardiac Valve Surgery.

J Am Soc Echocardiogr 2020 06 26;33(6):756-762.e1. Epub 2020 Mar 26.

Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.

Background: Despite recommendations regarding the use of intraoperative transesophageal echocardiography (TEE), there is no randomized evidence to support its use in cardiac valve surgery. The purpose of this study was to compare the clinical outcomes of patients undergoing open cardiac valve repair or replacement surgery with and without transesophageal echocardiographic monitoring. The hypothesis was that transesophageal echocardiographic monitoring would be associated with lower 30-day mortality and shorter length of hospitalization.

Methods: In this observational retrospective cohort study, Medicare claims were used to test the association between perioperative TEE and 30-day all-cause mortality and length of hospitalization among patients undergoing open cardiac valve repair or replacement surgery between January 1, 2010, and October 1, 2015. Baseline characteristics were defined by inpatient and outpatient claims. Medicare death records were used to ascertain 30-day mortality. Statistical analyses included regression models and propensity score matching.

Results: A total of 219,238 patients underwent open cardiac valve surgery, of whom 85% underwent TEE. Patients who underwent TEE were significantly older and had greater comorbidities. After adjusting for patient demographics, clinical comorbidities, surgical characteristics, and hospital factors, including annual surgical volume, the TEE group had a lower adjusted odds of 30-day mortality (odds ratio, 0.77; 95% CI, 0.73 to 0.82; P < .001), with no difference in length of hospitalization (<0.01%; 95% CI, -0.61% to 0.62%; P = .99). Results were similar across all analyses, including a propensity score-matched cohort.

Conclusions: Transesophageal echocardiographic monitoring in cardiac valve repair or replacement surgery was associated with lower 30-day risk-adjusted mortality, without a significant increase in length of hospitalization. These findings support the use of TEE as routine practice in open cardiac valve repair or replacement surgery.
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http://dx.doi.org/10.1016/j.echo.2020.01.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276287PMC
June 2020

Callus culture and plantlet regeneration in date palm ( L.): an important horticultural cash crop for arid and semi-arid horticulture.

Physiol Mol Biol Plants 2020 Feb 3;26(2):391-398. Epub 2020 Jan 3.

Applied Phycology and Biotechnology Division, CSIR-Central Salt and Marine Chemicals Research Institute (CSIR-CSMCRI), Council of Scientific and Industrial Research (CSIR), G.B. Marg, Bhavnagar, Gujarat 364002 India.

L. commonly called date palm is a highly valuable horticultural cash crop for arid and semi-arid regions. The availability of offshoots and their survival during plantation are major concern. Being dioecious tree, seed propagation in date palm do not produce true-to-type offspring and tissue culture propagation is the only viable option to supply quality-planting propagules. Hereby, we report callus culture and plantlet regeneration in female date palm using in vitro-derived adventitious shoot bud tissues as explants. Explants (89.33 ± 2.67%) produced callus culture on 0.8% agar-gelled Murashige and Skoog's basal medium containing 100.0 mg l each polyvinylpyrrolidone, ascorbic acid and glutamine, 50.0 mg l each citric acid, adenine sulphate and l-arginine as additives, 0.1% activated charcoal (AC), 100 mg l 2,4-dichlorophenoxyacetic acid (2,4-D) and 3.0 mg l 2-isopentenyladenine (2-iP). Callus culture were amplified on medium containing 3.0 mg l 2-iP along with 50 mg l 2,4-D for 2 passages and 10 mg l 2,4-D for 2 passages. Cultures grew moderately, organized and subsequently regenerated into shoot bud like structures during gradual transfer from medium containing higher concentration of 2,4-D to lower concentration. Plantlets were developed by sub-culturing of differentiated buds on (1) hormone free medium supplied with 10.0% sucrose and (2) medium containing 100.0 mg l each ascorbic acid and glutamine, 50.0 mg l each citric acid, adenine sulphate and l-arginine as additives, 1.0 mg l each 6-benzylaminopurine, kinetin, 2-iP and α-naphthaleneacetic acid. Plantlets were developed on medium containing 0.1% AC, 1.0 mg l each indole-3-acetic acid and indole-3-butyric acid. Rooted plantlets were soil-transplanted and acclimatized through gradual exposure from in vitro to in vivo conditions. Simple adoption, higher culture regeneration and simultaneous production of rooted plantlets in a cyclic manner render the protocol useful for mass scale propagation of elite genotype of female date palm.
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http://dx.doi.org/10.1007/s12298-019-00733-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036384PMC
February 2020

Contemporary Challenges for Fellowship Training in Adult Cardiothoracic Anesthesiology: Perspectives From Program Directors Around the United States.

J Cardiothorac Vasc Anesth 2020 Aug 11;34(8):2047-2059. Epub 2020 Feb 11.

Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address:

The fellowship in adult cardiothoracic anesthesiology has matured as an accredited program. This special article addresses current challenges in this educational milieu. The first challenge relates to serving as a program director in the contemporary era. The second challenge deals with the accreditation process, including the site visit. The third challenge discusses the integration of structural heart disease and interventional echocardiography into daily practice. The fourth challenge deals with the issues that face fellowship education in the near future. Taken together, these perspectives provide a review of the contemporary challenges facing fellowship education in adult cardiothoracic anesthesiology.
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http://dx.doi.org/10.1053/j.jvca.2020.02.011DOI Listing
August 2020

Severe Vasoplegic Shock During Coronary Artery Bypass Surgery: Therapeutic challenges and Dilemmas in Hemodynamic Rescue.

J Cardiothorac Vasc Anesth 2020 May 10;34(5):1341-1347. Epub 2020 Feb 10.

Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2020.01.058DOI Listing
May 2020

Severe Vasoplegic Shock During Coronary Artery Bypass Surgery: Therapeutic challenges and Dilemmas in Hemodynamic Rescue.

J Cardiothorac Vasc Anesth 2020 May 10;34(5):1341-1347. Epub 2020 Feb 10.

Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2020.01.058DOI Listing
May 2020

The Year in Coagulation: Selected Highlights From 2019.

J Cardiothorac Vasc Anesth 2020 Jul 31;34(7):1745-1754. Epub 2020 Jan 31.

Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.

This is the first annual highlights in coagulation article to be published in the Journal of Cardiothoracic and Vascular Anesthesia. Its purpose is to review the most important coagulation literature from 2019. In the review, the authors discuss the recent Society of Cardiovascular Anesthesiologists clinical practice advisory on the management of perioperative bleeding and hemostasis, heparin monitoring, protamine dosing, antiplatelet therapy, factor concentrate therapy, and coagulopathy during mechanical circulatory support.
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http://dx.doi.org/10.1053/j.jvca.2020.01.045DOI Listing
July 2020

In Response.

Anesth Analg 2020 05;130(5):e154-e156

Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, Department of Anesthesiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell, Northshore University Hospital, Manhasset, New York Missoula Anesthesiology, Affiliate with International Heart Institute of Montana at Providence St Patrick Hospital, Missoula, Montana Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina Department of Anesthesiology, Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Tampa, Florida, AAA Anesthesia Associates, PhyMed Healthcare Group, Allentown, Pennsylvania.

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http://dx.doi.org/10.1213/ANE.0000000000004709DOI Listing
May 2020

A randomised placebo controlled trial of anakinra for treating pustular psoriasis: statistical analysis plan for stage two of the APRICOT trial.

Trials 2020 Feb 10;21(1):158. Epub 2020 Feb 10.

Imperial Clinical Trials Unit, Imperial College London, W12 7RH, London, UK.

Background: Current treatment options for Palmoplantar Pustulosis (PPP), a debilitating chronic skin disease which affects the hands and feet, are limited. The Anakinra for Pustular psoriasis: Response in a Controlled Trial (APRICOT) aims to determine the efficacy of anakinra in the treatment of PPP. This article describes the statistical analysis plan for the final analysis of this two-staged trial, which was determined prior to unblinding and database lock. This is an update to the published protocol and stage one analysis plan.

Methods: APRICOT is a randomised, double-blind, placebo-controlled trial of anakinra versus placebo, with two stages and an adaptive element. Stage one compared treatment arms to ensure proof-of-concept and determined the primary outcome for stage two of the trial. The primary outcome was selected to be the change in Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks. Secondary outcomes include other investigator-assessed efficacy measures of disease severity, participant-reported measures of efficacy and safety measures. This manuscript describes in detail the outcomes, sample size, general analysis principles, the pre-specified statistical analysis plan for each of the outcomes, the handling of missing outcome data and the planned sensitivity and supplementary analyses for the second stage of the APRICOT trial.

Discussion: This statistical analysis plan was developed in compliance with international trial guidelines and is published to increase transparency of the trial analysis. The results of the trial analysis will indicate whether anakinra has a role in the treatment of PPP.

Trial Registration: ISCRTN, ISCRTN13127147. Registered on 1 August 2016. EudraCT Number 2015-003600-23. Registered on 1 April 2016.
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http://dx.doi.org/10.1186/s13063-020-4103-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011285PMC
February 2020

Traumatic Rupture of the Left Atrial Appendage: Perioperative Management and Echocardiographic Challenges.

J Cardiothorac Vasc Anesth 2020 Apr 8;34(4):1074-1081. Epub 2020 Jan 8.

Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

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http://dx.doi.org/10.1053/j.jvca.2019.12.036DOI Listing
April 2020

Comparison of international normalized ratio determined by point-of-care to standard laboratory testing before and after reversal of heparin in cardiac surgery.

Blood Coagul Fibrinolysis 2020 Mar;31(2):140-144

Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Study Objective: To compare point-of-care (POC) of international normalized ratio to laboratory-derived values before and after cardiopulmonary bypass, with the primary aim of evaluating for any change in the relationship between the tests.

Methods: This is a prospective observational study with 50 patients undergoing cardiac surgery enrolled. The International normalized ratio measured at two time points, precardiopulmonary bypass and after heparin reversal with protamine using both POC i-STAT and standard laboratory analysis for both time points. A difference of 0.2 between tests at either time point was considered clinically significant based on previous literature. A paired t test was used to test for a changing or statistically significant mean difference between tests. At both time points values were categorized into absolute difference of more than 0.2 or less than 0.2, and a Fisher's exact test was used to determine if an association existed between heparin reversal and a difference more than 0.2. Bland-Altman plots were also evaluated for agreement.

Results: A statistically and clinically significant mean difference [0.09 vs. 0.25, difference -0.163 95% confidence interval (-0.25, -0.08), P = 0.003] was seen between the laboratory and POC tests when pre and postheparin reversal samples were compared. A significantly greater number of patients had a clinically relevant difference between the tests post compared with pre (four patients vs. 18 patients, P = 0.001). Linear regression analysis of the difference compared with the means, showed significant correlation suggesting the presence of a proportional bias (pre r = 0.488, P = <0.01, post r = 0.571, P = <0.01).

Conclusion: Clinically significant differences exist between POC and laboratory testing of international normalized ratio after heparin reversal during cardiac surgery. ClinicalTrials.gov Identifier NCT03267823.
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http://dx.doi.org/10.1097/MBC.0000000000000889DOI Listing
March 2020

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2019.

J Cardiothorac Vasc Anesth 2020 Jan 9;34(1):1-11. Epub 2019 Nov 9.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.

This highlights in our specialty for 2019 begin with the ongoing major developments in transcatheter valve interventions. Thereafter, the advances in left ventricular assist devices are reviewed. The recent focus on conduit selection and robotic options in coronary artery bypass surgery are then explored. Finally, this special articles closes with a discussion of pulmonary hypertension in noncardiac surgery, anesthetic technique in cardiac surgery, as well as postoperative pneumonia and its outcome consequences.
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http://dx.doi.org/10.1053/j.jvca.2019.10.057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398274PMC
January 2020

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients.

Anesth Analg 2019 11;129(5):1209-1221

Pacific Anesthesia, Honolulu, Hawaii.

Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point-of-care (POC) coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, have increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has only modestly declined over the last decade, remaining at ≥50% in high-risk patients. Given these limitations, and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists (SCA) has formed the Blood Conservation in Cardiac Surgery Working Group to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.
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http://dx.doi.org/10.1213/ANE.0000000000004355DOI Listing
November 2019

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients.

J Cardiothorac Vasc Anesth 2019 Nov 19;33(11):2887-2899. Epub 2019 Apr 19.

Pacific Anesthesia, Honolulu, HI.

Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point of care coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, has increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has declined only modestly over the last decade, remaining at 50% or greater in high-risk patients. Given these limitations and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists has formed the Blood Conservation in Cardiac Surgery Working Group in order to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.
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http://dx.doi.org/10.1053/j.jvca.2019.04.003DOI Listing
November 2019

The Program Evaluation Committee in the Adult Cardiothoracic Anesthesiology Fellowship - Harnessing Opportunities for Program Improvement.

J Cardiothorac Vasc Anesth 2020 Mar 12;34(3):797-804. Epub 2019 Aug 12.

Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address:

The Program Evaluation Committee has an essential role in the quality improvement process of the adult cardiothoracic anesthesiology fellowship. The annual program evaluation presents all stakeholders with an opportunity to evolve with the changing needs and opportunities of the fellowship milieu. The active engagement of the program in this process is a high-quality approach to successful planning, preparation and conduct of the self-study and site visit that are important extensions of the annual program evaluation and the program evaluation committee.
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http://dx.doi.org/10.1053/j.jvca.2019.08.011DOI Listing
March 2020

Analysis of the 2018 American Heart Association/American College of Cardiology Guidelines for the Management of Adults With Congenital Heart Disease: Implications for the Cardiovascular Anesthesiologist.

J Cardiothorac Vasc Anesth 2020 May 9;34(5):1348-1365. Epub 2019 Aug 9.

Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2019.08.004DOI Listing
May 2020

Anesthesiologists Can Add Value in Transcatheter Aortic Valve Replacement by Performing Transthoracic Echocardiography.

J Cardiothorac Vasc Anesth 2020 01 4;34(1):32-34. Epub 2019 Jul 4.

Department of Anesthesiology, Perioperative Care, and Pain Medicine, Division of Cardiothoracic Anesthesiology, New York University Langone Health, New York University School of Medicine, New York, NY.

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http://dx.doi.org/10.1053/j.jvca.2019.06.045DOI Listing
January 2020

Chronic postthoracotomy pain in transapical transcatheter aortic valve replacement.

Ann Card Anaesth 2019 Jul-Sep;22(3):239-245

Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA.

Objective: Chronic postthoracotomy pain (CPTP) is a persistent, occasionally debilitating pain lasting >2 months following thoracic surgery. This study investigates for the first time the prevalence and clinical impact of CPTP in patients who have undergone a transapical transcatheter aortic valve replacement (TA-TAVR).

Design: This was a single-institution, prospective observational survey and a retrospective chart review.

Setting: The study was conducted in the University Hospital.

Participants: Patients.

Materials And Methods: A survey of 131 participants with either a previous TA TAVR or transfemoral (TF) TAVR procedure was completed. A telephone interview was conducted at least 2 months following TAVR; participants were asked to describe their pain using the Short-Form McGill Pain Questionnaire.

Measurements And Main Results: Odds ratio (OR) was calculated using the proportions of questionnaire responders reporting "sensory" descriptors in the TA-TAVR versus the TF-TAVR groups. Results were then compared to individual Kansas City Cardiomyopathy Questionnaire (KCCQ12) scores and 5-min walk test (5MWT) distances. A total of 119 participants were reviewed (63 TF, 56 TA). Among TA-TAVR questionnaire responders (n = 16), CPTP was found in 64.3% of participants for an average duration of 20.5-month postprocedure (OR = 10, [confidence interval (CI) 95% 1.91-52.5];P = 0.003). TA-TAVR patients identified with CPTP had significant reductions in 5MWT distances (-2.22 m vs. 0.92 m [P = 0.04]) as well as trend toward significance in negative change of KCCQ12 scores OR = 18.82 (CI 95% 0.85-414.99;P = 0.06) compared to those without CPTP.

Conclusions: CPTP occurs in patients undergoing TA-TAVR and is possibly associated with a decline quality of life and overall function.
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http://dx.doi.org/10.4103/aca.ACA_77_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639875PMC
August 2020