ABSTRACT
BACKGROUND: Over the last decade, preoperative anemia has become recognized as a clinical condition in need of management. Although the etiology of preoperative anemia can be multifactorial, two thirds of anemic elective surgical patients have iron deficiency anemia. At the same time, one third of nonanemic elective surgical patients are also iron deficient. METHODS: Modified RAND Delphi methodology was used to identify areas of consensus among an expert panel regarding the management of iron deficiency in patients undergoing cardiac surgery. A list of statements was sent to panel members to respond to using a five-point Likert scale. All panel members subsequently attended a face-to-face meeting. The initial survey was presented and discussed, and panel members responded to each statement on the Likert scale again. Based on the second survey, the panel came to a consensus on recommendations. RESULTS: The panel recommended all patients undergoing cardiac surgery be evaluated for iron deficiency, whether or not anemia is present. Evaluation should include iron studies and reticulocyte hemoglobin content. If iron deficiency is present, with or without anemia, patients should receive parenteral iron. Erythropoietin-stimulating agents may be appropriate for some patients. CONCLUSIONS: Consensus of an expert panel resulted in a standardized approach to diagnosing and managing iron deficiency in patients undergoing cardiac surgery.
Subject(s)
Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/drug therapy , Cardiac Surgical Procedures , Heart Diseases/complications , Heart Diseases/surgery , Iron Deficiencies/complications , Iron Deficiencies/drug therapy , Delphi Technique , Humans , Preoperative PeriodSubject(s)
Aortic Valve Stenosis , Embolic Protection Devices , Intracranial Embolism , Stroke , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Humans , Intracranial Embolism/prevention & control , Risk Factors , Stroke/etiology , Stroke/prevention & control , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been performed for many elderly patients with severe aortic stenosis (AS). The SAPIEN 3 is one of the latest balloon-expandable prosthesis. This study aimed to investigate the early clinical outcomes after TAVR using the SAPIEN 3 in nonagenarians. METHODS: A total of 97 consecutive patients underwent TAVR for severe AS between December 2015 and December 2016. Of these, 85 consecutive patients who underwent TAVR using the SAPIEN 3 were included. According to the age, patients were classified into age ≥ 90 years group (17 patients) or age < 90 years group (68 patients). The clinical outcomes including all-cause mortality and composite endpoint of early safety at 30 days were evaluated. RESULTS: The Society of Thoracic Surgeons score in age ≥ 90 years group was higher than age < 90 years group (12.3 ± 6.1% vs. 8.5 ± 5.1%, P < 0.01). There was no significant difference in 30-day mortality between the two groups. However, the life-threatening bleeding and major vascular complications in age ≥ 90 years group were greater than age < 90 years group (11.8% vs. 1.5%, P = 0.04 and 11.8% vs. 1.5%, P = 0.04, respectively). The composite endpoint of early safety at 30 days was similar between the two groups. Multivariate logistic regression analysis showed that prior myocardial infarction was an independent predictor of the composite endpoint of early safety (odds ratio: 4.76, 95% confidence interval: 1.02-22.21, P = 0.047). CONCLUSIONS: The early mortality and safety after TAVR using the SAPIEN 3 in nonagenarians were similar and acceptable despite of higher operative risk.
ABSTRACT
A patient with traumatic thoracic injury and hypovolemic shock is presented to stress important differences in preoperative and postoperative aortic diameters. The patient had a blood pressure of 80/40 mm Hg. A diagnostic computed tomography angiography revealed a rupture of the thoracic aorta, and a thoracic endograft was sized based on these data. However, the postoperative computed tomography angiography (Riva-Rocci, 164/70 mm Hg) showed an increase in aortic diameters of about 30% at multiple levels. In this patient, with rupture of the thoracic aorta and hypovolemia, the aortic diameter was significantly decreased. This indicates that adequate preoperative sizing for endovascular repair of vascular pathology in patients in shock is complicated.
