title: Major themes for 2012 in cardiovascular anesthesia and intensive care.
abstract: There was major progress through 2012 in cardiovascular anesthesia and intensive care. Although recent meta-analysis has supported prophylactic steroid therapy in adult cardiac surgery, a large Dutch multicenter trial found no outcome advantage with dexamethasone. A second large randomized trial is currently testing the outcome effects of methyprednisolone in this setting. Due to calibration drift, the logistic EuroSCORE has recently been recalibrated. Despite this model revision, EuroSCORE II still overestimates mortality after transcatheter aortic valve implantation. It is likely that a specific perioperative risk model will be developed for this unique patient population. Recent global consensus has prioritized 12 non-surgical interventions that merit further study for reducing mortality after surgery. There is currently a paradigm shift in the conduct of adult aortic arch repair. Recent advances have facilitated aortic arch reconstruction with routine antegrade cerebral perfusion at mild-to-moderate hypothermia. Further integration of hybrid endovascular techniques may allow future aortic arch repair without hypothermia or circulatory arrest. These advances will likely further improve patient outcomes.
authors.affiliation: Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine Prague, Czech Republic.
authors.forename: H
authors.initials: H
authors.lastname: Riha
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.forename: L
authors.initials: L
authors.lastname: Al-Ghofaily
authors.forename: E
authors.initials: E
authors.lastname: Valentine
authors.forename: A
authors.initials: A
authors.lastname: Sophocles
authors.forename: J G T
authors.initials: JG
authors.lastname: Augoustides
keywords: EuroSCORE II; aortic arch repair; cardiopulmonary bypass; chlorhexidine; circulatory arrest; clonidine; consensus conference; dexamethasone; digestive tract; hemodynamic optimization; hybrid aortic arch repair; hypothermia; insulin; intra-aortic balloon counterpulsation; leukodepletion; levosimendan; logistic EuroSCORE; meta-analysis; methylprednisolone; mortality; neuraxial anesthesia; noninvasive ventilation; oxygen; perioperative risk; selective decontamination; steroids; transcatheter aortic valve implantation; volatile anesthetics