Year in Review 2023: Noteworthy Literature in Cardiac Anesthesiology.

Notable clinical research published in 2023 related to cardiac anesthesia included studies focused on resuscitation and pharmacology, regional anesthesia, technological advances, and novel gene therapies. We reviewed 241 articles to identify 25 noteworthy studies that represent the most significant research related to cardiac anesthesia from the past year. Overall, improvements in clinical practice have enabled decreased morbidity and mortality with a renewed focus on mechanical circulatory support and transplantation.

PERSUADE Survey-PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States.

OBJECTIVE: To comprehensively assess relevant institutional variations in anesthesia and intensive care management during left ventricular assist device (LVAD) implantation. DESIGN: The authors used a prospective data analysis. SETTING: This was an online survey. PARTICIPANTS: Participants were from LVAD centers in Europe and the US. INTERVENTIONS: After investigating initial interest, 91 of 202 European and 93 of 195 US centers received a link to the survey targeting institutional organization and experience, perioperative hemodynamic monitoring, medical management, and postoperative intensive care aspects. MEASUREMENTS AND MAIN RESULTS: The survey was completed by 73 (36.1%) European and 60 (30.8%) US centers. Although most LVAD implantations were performed in university hospitals (>5 years of experience), significant differences were observed in the composition of the preoperative multidisciplinary team and provision of intraoperative care. No significant differences in monitoring or induction agents were observed. Propofol was used more often for maintenance in Europe (p < 0.001). The choice for inotropes changed significantly from preoperatively (more levosimendan in Europe) to intraoperatively (more use of epinephrine in both Europe and the US). The use of quantitative methods for defining right ventricular (RV) function was reported more often from European centers than from US centers (p < 0.05). Temporary mechanical circulatory support for the treatment of RV failure was more often used in Europe. Nitric oxide appeared to play a major role only intraoperatively. There were no significant differences in early postoperative complications reported from European versus US centers. CONCLUSIONS: Although the perioperative practice of care for patients undergoing LVAD implantation differs in several aspects between Europe and the US, there were no perceived differences in early postoperative complications.

Year in Review 2022: Noteworthy Literature in Cardiac Anesthesiology.

Last year researchers made substantial progress in work relevant to the practice of cardiac anesthesiology. We reviewed 389 articles published in 2022 focused on topics related to clinical practice to identify 16 that will impact the current and future practice of cardiac anesthesiology. We identified 4 broad themes including risk prediction, postoperative outcomes, clinical practice, and technological advances. These articles are representative of the best work in our field in 2022.

Electrical Dyssynchrony on Noninvasive Electrocardiographic Mapping correlates with SAI QRST on surface ECG.

AIM: The goal of this study was to compare associations between clinical and ECG predictors of cardiac resynchronization therapy (CRT) response with electrical dyssynchrony. METHODS: Body-surface potentials were recorded using a 120-lead system in 4 patients (age 62 ± 12 y, left ventricular ejection fraction (LVEF) 29 ± 5 %; QRS duration 154 ± 19 ms) with post-myocardial infarction scar and left bundle branch block before CRT implantation. A patient-specific heart-torso model derived from MRI with 291 heart-surface nodes was developed. Electrical dyssynchrony index (EDI) was computed as the standard deviation of activation times on the epicardium while uncoupling index (UI) was measured as the difference between the activation times. RESULTS: QRS duration correlated with mean activation time (r = 0.977; P = 0.023), but did not correlate with EDI or UI. LVEF inversely correlated with activation time at the lowest 20th percentile (r = -0.960; P = 0.040). Sum absolute QRST integral (SAI QRST), measured on orthogonal XYZ ECG, correlated with EDI (r = 0.955; P = 0.045), and characterized late-activated area of the left ventricle. CONCLUSION: SAI QRST is a measure of electrical dyssynchrony on ECG.