Department of Anesthesiology, The Ohio State University, Columbus, OH, USA.
J Cardiothorac Vasc Anesth. 2011 Feb;25(1):6-15. doi: 10.1053/j.jvca.2010.11.001.
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.
主动脉瓣治疗革命随着主动脉瓣修复的成熟和经导管主动脉瓣植入术的传播而继续。最近发布的胸主动脉疾病综合多学科指南为心血管麻醉师和围手术期超声心动图医师分配了重要角色。尽管强烈的血管紧张素阻断可改善心力衰竭的预后，但它可能进一步使围手术期全身血管张力的维持复杂化。超滤以及由生物标志物脑钠肽指导的强化药物治疗可改善心力衰竭的预后。连续流左心室辅助装置进一步改善了心力衰竭的手术治疗结果。这些设备出血的主要危险因素包括晚期肝病和获得性血管性血友病。代谢调节剂培高利特可改善心肌舒张能量学，从而在肥厚型心肌病中实现显著的症状改善。最近还发表了一份具有里程碑意义的报告，概述了该疾病未来研究和临床创新的主要领域。具有里程碑意义的试验记录了围手术期脑氧饱和度监测的结果重要性，以及 Sano 分流在 Norwood 手术中优于改良 Blalock-Taussig 分流的结果优势。此外，儿科专用心室辅助装置的开发和评估可能会彻底改变儿科心力衰竭的机械管理。多学科综述强调了先天性心脏病围手术期试验的未来优先事项。这些普遍的发展可能会影响儿科心脏麻醉的未来培训模式。
