title: The year in cardiothoracic and vascular anesthesia: selected highlights from 2010.
abstract: The aortic valve treatment revolution continues with the maturation of aortic valve repair and the dissemination of transcatheter aortic valve implantation. The recent publication of comprehensive multidisciplinary guidelines for diseases of the thoracic aorta has assigned important roles for the cardiovascular anesthesiologist and perioperative echocardiographer. Although intense angiotensin blockade improves outcomes in heart failure, it might further complicate the maintenance of perioperative systemic vascular tone. Ultrafiltration as well as intensive medical management guided by the biomarker brain natriuretic peptide improves outcomes in heart failure. Continuous-flow left ventricular assist devices have further improved outcomes in the surgical management of heart failure. Major risk factors for bleeding in the setting of these devices include advanced liver disease and acquired von Willebrand syndrome. The metabolic modulator perhexiline improves myocardial diastolic energetics to achieve significant symptomatic improvement in hypertrophic cardiomyopathy. A landmark report was also published recently that outlines the major areas for future research and clinical innovation in this disease. Landmark trials have documented the outcome importance of perioperative cerebral oxygen saturation monitoring as well as the outcome advantages of the Sano shunt over the modified Blalock-Taussig shunt in the Norwood procedure. Furthermore, the development and evaluation of pediatric-specific ventricular assist devices likely will revolutionize the mechanical management of pediatric heart failure. A multidisciplinary review has highlighted the priorities for future perioperative trials in congenital heart disease. These pervasive developments likely will influence the future training models in pediatric cardiac anesthesia.
authors.affiliation: Department of Anesthesiology, The Ohio State University, Columbus, OH, USA. yiandoc@hotmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Andritsos
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Prakash
authors.initials: P
authors.lastname: Patel
authors.forename: Ashish
authors.initials: A
authors.lastname: Sinha
authors.forename: Jens
authors.initials: J
authors.lastname: Fassl
authors.forename: Tygh
authors.initials: T
authors.lastname: Wyckoff
authors.forename: Hynek
authors.initials: H
authors.lastname: Riha
authors.forename: Chris
authors.initials: C
authors.lastname: Roscher
authors.forename: Balachundar
authors.initials: B
authors.lastname: Subramaniam
authors.forename: Harish
authors.initials: H
authors.lastname: Ramakrishna
authors.forename: John G T
authors.initials: JG
authors.lastname: Augoustides
mesh_terms: D000776:Anesthesiology / Q000639:trends*; D001013:Aorta, Thoracic; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000639:trends; D006330:Heart Defects, Congenital / Q000601:surgery / Q000628:therapy; D006333:Heart Failure / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D006349:Heart Valve Diseases / Q000601:surgery / Q000628:therapy; D006801:Humans; D010506:Periodicals as Topic