Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Cardiothoracic Anesthesiology: Novel Milestone and Renewed Opportunities.","authors":"Nirvik Pal, Benjamin A Abrams, Miklos D Kertai","doi":"10.1177/10892532221121115","DOIUrl":"https://doi.org/10.1177/10892532221121115","url":null,"abstract":"As a journal focused on cardiothoracic anesthesia and solid organ transplantation, readers of SCVA are undoubtedly enthralled by recent advances in our ever-evolving fields. This year has been particularly momentous in this regard, including Griffith et al. reporting the first cardiac xenotransplantation with a genetically modified pig heart in January 2022, an incredible triumph across the fields of clinical transplantation, biotechnology, and genetic engineering. A multitude of other relevant advancements have been made recently, and this issue of SCVA is affluent in such scientific progress; 6 original research manuscripts are published in this issue, along with a review article describing the value of cardiothoracic anesthesiologists in clinical outcomes after cardiac surgery and a variety of informative clinical challenges. Ariyo et al. present a brief review of value-added care by the cardiothoracic anesthesiologist (CTA). Implementation science is defined as the complex field focusing on planning, influencing, and evaluating the adoption (or barriers) of evidence-based practices. This includes principles of bundled implementation strategies, fidelity interventions, and critical drivers of change. The authors have highlighted certain cardiac surgery areas within the purview of cardiothoracic anesthesiologists to bring a change or make a difference. Not only do we need to understand more about the inflammatory effects of cardiopulmonary bypass, cognitive effects after cardiac surgery, transfusion, and coagulation, we need to understand and eradicate the barriers, if any, to improve the overall outcomes. While scientific guidelines are the outcomes of scientific studies, catering to and addressing the local needs associated with incorporating the guidelines is the goal for implementation sciences. Cardiothoracic anesthesiologists hold that unique position, as opined by the authors. Similarly, Osman et al. present their initial experience establishing a specialized center in Lebanon for CTEPH therapy. The authors must be congratulated on their successful endeavor as CTEPH surgery remains localized to only a few highly specialized centers, even in the United States. However, diligence must be exercised to differentiate initiation vs the center of excellence status. The designation often tends to be self-proclaimed due to the high-volume center. Ideally, it should be broader and must meet specific established criteria, including but not limited to volume, outcomes, research, and services. Cardiac surgery-associated acute kidney injury (AKI) continues to be a vexing problem. Quests for reversible or modifiable risk factors persist to this day. Over time, as our understanding of AKI has improved, the definitions have evolved too—from the RIFLE criteria to the AKIN criteria to the KDIGO criteria. Per the consensus statement of the Acute Dialysis Quality initiative (www.adqi.org), the definitions for AKI, acute kidney disease (AKD), and chronic kidn","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"169-172"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40699935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiating a Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Endarterectomy Program Based on a Single Center Experience in Lebanon.","authors":"Bassam Osman,&nbsp;Imad Bou Akel,&nbsp;Tamam Tulimat,&nbsp;Pierre Sfeir,&nbsp;Jamil Borgi","doi":"10.1177/10892532211066645","DOIUrl":"https://doi.org/10.1177/10892532211066645","url":null,"abstract":"<p><strong>Purpose: </strong>In 2018, the American University of Beirut Medical Center established the first multidisciplinary Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Endarterectomy program in Lebanon. The study describes the challenges faced in establishing the program and in improving patient referral, evaluation, and perioperative care.</p><p><strong>Methods: </strong>The program establishment including the preparation phase, clinical evaluation, and team education is discussed. The implementation of the flow of patients referred to the program was established. Education regarding diagnosis and referral were provided to physicians in the community. The initial experience is described in a retrospective analysis of 4 consecutive patients who were diagnosed with CTEPH and underwent PEA.</p><p><strong>Results: </strong>Four patients were diagnosed with CTEPH had PEA performed. The mean age of patients was 64 years. The average CPB and total circulatory arrest times were 244 and 23.9 minutes per side, respectively. No mortalities were encountered perio-operatively. All patients reported significant improvement in functional capacity from NYHA III and IV to a NYHA class of I with an average PASP decrease of 59.5 ± 19.7 mmHg and mPAP drop by 30.2 ± 16.3 mmHg.</p><p><strong>Conclusion: </strong>The launch of the first CTEPH and PEA program in Lebanon, with a clear framework, coupled with good surgical outcomes is very encouraging. The program offers a curative solution for CTEPH patients in the region. A clear referral process and an increase in disease and treatment awareness in the community are crucial to the future success of the program, offering a definitive treatment, and avoiding delays to surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"187-194"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39851636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Value-Added Care by Cardiothoracic Anesthesiology and Impact on Outcomes After Cardiac Surgery.","authors":"Promise Ariyo,&nbsp;James H Abernathy,&nbsp;Nadia B Hensley","doi":"10.1177/10892532211048953","DOIUrl":"https://doi.org/10.1177/10892532211048953","url":null,"abstract":"<p><p>The medical community is increasingly aware of the need for high-quality and high-value patient care. Anesthesiologists in particular have long demonstrated leadership in the field of quality and safety. Cardiothoracic anesthesiologists can improve the quality of care delivered to cardiac patients both with anesthesia-specific practices and in a team-based approach with other perioperative care providers. Collecting large volumes of multicentered data to study, measure, and improve anesthesia care is one of the many commitments of cardiothoracic anesthesiologists to this cause. This article reviews this and other aspects of the work of cardiothoracic anesthesiologists to improve value-added care to cardiac patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"173-178"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39897265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Hemodynamic Index of Post-operative Right Heart Dysfunction Predicts Mortality in Cardiac Surgical Patients.","authors":"Ziyad O Knio,&nbsp;Robert H Thiele,&nbsp;W Zachary Wright,&nbsp;Sula Mazimba,&nbsp;Bhiken I Naik,&nbsp;Matthew C Hulse","doi":"10.1177/10892532221080382","DOIUrl":"https://doi.org/10.1177/10892532221080382","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate whether mortality following cardiac surgery was associated with the pulmonary artery pulsatility index (PAPi): pulmonary artery pulse pressure divided by central venous pressure (CVP), and a novel index: mean pulmonary artery pressure (mPAP) minus CVP.</p><p><strong>Methods: </strong>This retrospective analysis investigated all cardiac surgery patients in the Society of Thoracic Surgeons registry at a single academic medical center from January 2017 through March 2020 (n = 1510). The primary and secondary outcomes were mortality at 1 year and serum creatinine increase during index surgical admission, respectively. CVP, mPAP, PAPi, mPAP-CVP gradient, mean arterial pressure (MAP), and cardiac index (CI) were sampled continually from invasive hemodynamic monitors post-operatively. Associations with mortality were tested with univariate and multivariate analyses. The relationship with serum creatinine was investigated with Pearson's correlation at alpha = .05.</p><p><strong>Results: </strong>One-year mortality was observed in 44/1200 patients (3.7%). On univariate analysis, mortality was associated with minimums for mPAP, MAP, and CI and maximums for CVP, mPAP, PAPi, mPAP-CVP gradient, and CI (all <i>P</i> < .10). Model selection revealed that the only independently predictive parameters were minimum MAP (AOR = .880 [.819-.944]), maximum mPAP-CVP gradient (AOR = 1.082 [1.031-1.133]), and maximum CI (AOR = 1.421 [.928-2.068]), with model c-statistic = .770. A maximum mPAP-CVP gradient >20.5 predicted mortality with 54.5% sensitivity and 79.30% specificity, maintaining significance on survival analysis (<i>P</i> < .001). Peak increase in serum creatinine from baseline demonstrated a weak association with all parameters (max |r| = .33).</p><p><strong>Conclusions: </strong>Mortality was not predicted by the post-operative PAPi; rather, it was independently predicted by the mPAP-CVP gradient, MAP, and CI.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"200-208"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40327312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Mean Arterial Pressure During Cardiopulmonary Bypass and the Risk of Acute Kidney Injury: A Propensity Score Matched Observational Study.","authors":"Tiago R Velho,&nbsp;Rafael M Pereira,&nbsp;Nuno C Guerra,&nbsp;Hugo Ferreira,&nbsp;André Sena,&nbsp;Ricardo Ferreira,&nbsp;Ângelo Nobre","doi":"10.1177/10892532211045765","DOIUrl":"https://doi.org/10.1177/10892532211045765","url":null,"abstract":"<p><strong>Introduction: </strong>Low mean arterial pressure (MAP) periods occur frequently during cardiopulmonary bypass (CPB), and their management remains controversial. Our aim was to correlate MAP during CPB with the occurrence of post-operative acute kidney injury (AKI), considering two different parameters: consecutive and cumulative low MAP periods.</p><p><strong>Methods: </strong>Single-centre observational retrospective study including 250 patients submitted to non-emergent aortic valve replacement, with tepid to mild hypothermia (not below 32°C). The primary outcome was the occurrence of AKI. A propensity scored matching of 43 patients was used to adjust both populations (AKI and No AKI). MAP measures were automatically and continuously recorded during CPB. Low MAP periods were analysed employing two parameters: consecutive and the cumulative sum of time.</p><p><strong>Results: </strong>Patients who experienced at least 5 min with MAP <50 mmHg had an increased risk of post-operative AKI (OR infinity; 95% CI, 1.47 to infinity; <i>P</i> = .026). The risk is also significant with MAP <40 mmHg (OR 2.78; 95% CI 1.1-6.9; = .044) and <30 mmHg (OR 3.36; 95% CI 1.2-9.2; <i>P</i> = .029). Post-operative AKI was associated with cumulative and consecutive periods of low MAP. Patients with periods of low MAP had higher levels of post-operative creatinine and reduced glomerular filtration rate (GFR). Patients with AKI had prolonged endotracheal ventilation time, and ICU and ward lengths of stay.</p><p><strong>Conclusion: </strong>Low MAP periods during CPB are associated with an increased occurrence of post-operative AKI, leading to 1) higher creatinine levels; 2) decreased GFR and 3) longer ICU and ward lengths of stay. Both consecutive and cumulative periods of low MAP are associated with an increased risk of AKI. MAP appears to be an important contributor to post-operative AKI and should be carefully managed during CPB. Further studies must address if MAP variations lead to definitive and long-term consequences.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"179-186"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39578364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Management of an Adolescent Fontan Patient with Narrowing of the Aortopulmonary Space for Posterior Scoliosis Surgery.","authors":"Kim van Loon,&nbsp;Remco Minkhorst,&nbsp;Henriette Ter Heide,&nbsp;Hans M P Breur,&nbsp;Moyo C Kruyt,&nbsp;Tom P C Schlosser","doi":"10.1177/10892532221114285","DOIUrl":"https://doi.org/10.1177/10892532221114285","url":null,"abstract":"<p><p>Congenital cardiac patients who received neonatal reconstructive aortic arch surgery are at risk of aortopulmonary space narrowing with compression of the left pulmonary artery and left main bronchus (LMB) later in life. We discuss a challenging adolescent single ventricle patient who presented for surgical treatment of a non-idiopathic thoracic scoliosis (posterior spinal fusion) with severe stenosis of the LMB and left pulmonary artery due to a narrow aortopulmonary space. Careful preoperative imaging, evaluation, and decision making resulted in successful surgical treatment and uneventful perioperative course.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"221-225"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/c5/10.1177_10892532221114285.PMC9460710.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40604145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular Twist Mechanics Before and After Aortic Valve Replacement: A Feasibility Study and Exploratory Analysis.","authors":"Kan Zhang,&nbsp;Nikhil Kumar,&nbsp;Andrej Alfirevic,&nbsp;Shiva Sale,&nbsp;Jing You,&nbsp;Andrew Bauer,&nbsp;Andra E Duncan","doi":"10.1177/10892532221114791","DOIUrl":"https://doi.org/10.1177/10892532221114791","url":null,"abstract":"<p><p><i>Introduction.</i> We examined whether intraoperative assessment of left ventricular (LV) twist mechanics is feasible with transesophageal echocardiography (TEE). We then explored whether twist mechanics were altered by hemodynamic conditions or patient comorbidities. <i>Methods.</i> In this sub-analysis of clinical trial data, transgastric short-axis echocardiographic images of the LV base and apex were collected in patients having aortic valve replacement (AVR) at baseline and end of surgery. Transvalvular gradients and LV systolic and diastolic function were assessed using two-dimensional (2D) and Doppler echocardiography. 2D speckle-tracking echocardiography was used for off-line analysis of LV twist, twisting rate, and untwisting rate. We examined the intraoperative change in twist mechanics before and after AVR. LV twist mechanics were also explored by diabetic status, need for coronary artery bypass grafting (CABG), and use of epinephrine/norepinephrine. <i>Results.</i> Of 40 patients, 16 patients had acceptable TEE images for off-line LV twist analysis. Baseline median [Q1, Q3] LV twist was 12 [7, 16]°, twisting rate was 72 [41, 97]°/sec, and untwisting rate was -91 [-154, -56]°/s. Median [Q1, Q3] change in LV twist at end of surgery was -2 [-5, 3]°, twisting rate was 7 [-33, 31]°/s, and untwisting rate was 0 [-11, 43]°/s. No difference was noted between diabetic and non-diabetic patients or AVR and AVR-CABG patients. <i>Conclusion.</i> LV twist was augmented in patients with aortic stenosis, though twist indices were not affected by reduced afterload, diabetes, or coronary artery disease. Intraoperative assessment of twist mechanics may provide unique information on LV systolic and diastolic function, though fewer than 50% of TEE examinations successfully assessed twist. <i>Clinical Trial Registry.</i> This work is a sub-analysis of a clinical trial, registered on ClinicalTrials.gov on August 19, 2010 (NCT01187329), Andra Duncan, Principal Investigator.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 3","pages":"226-236"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10156174/pdf/nihms-1889862.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9407310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Simpson's Method to Determine Left Ventricular Ejection Fraction Using the Transgastric Two-Chamber View.","authors":"Logan Gray,&nbsp;Fei Chen,&nbsp;Emily G Teeter,&nbsp;Lavinia M Kolarczyk,&nbsp;Alan M Smeltz","doi":"10.1177/10892532211073240","DOIUrl":"https://doi.org/10.1177/10892532211073240","url":null,"abstract":"Introduction Left ventricular chamber size and functional assessment by transesophageal echocardiography can be difficult if visualization is poor in the mid-esophageal views. However, the accuracy of using the Simpson’s method in the transgastric 2-chamber (TG2C) as an alternative approach has not been assessed. Methods The Simpson’s method was performed by 2 independent reviewers using midesophageal 2-chamber (ME2C) and TG2C views. Echocardiographic images were retrieved retrospectively for 49 adult cardiac surgical patients. Results Two-way random effects intraclass correlation coefficients demonstrated no significant interobserver variability. Linear mixed effects models showed no significant differences in ME2C and TG2C measurements with regard to EDV (P=.4407), ESV (P=.5113), or EF (P=.0610). Compared to the ME2C view, the TG2C view had better image quality of the LV walls (image quality score median [interquartile range]: 2.00 [.00] vs 1.00 [1.00]; P<.0001), but worse image quality of the mitral annulus (1.00 [1.00] vs 2.00 [.00]; P<.0001) and LV apex (.00 [1.00] vs 2.00 [1.00]; P<.0001). Conclusions This study suggests the Simpson’s method can be applied to the TG2C view as an alternative to the standard midesophageal method to estimate chamber volumes and EF.","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"195-199"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39630723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia.","authors":"Aaron Smoroda,&nbsp;David Douin,&nbsp;Joseph Morabito,&nbsp;Matthew Lyman,&nbsp;Meghan Prin,&nbsp;Bryan Ahlgren,&nbsp;Andrew Young,&nbsp;Elijah Christensen,&nbsp;Benjamin A Abrams,&nbsp;Nathaen Weitzel,&nbsp;Nathan Clendenen","doi":"10.1177/10892532221100660","DOIUrl":"https://doi.org/10.1177/10892532221100660","url":null,"abstract":"<p><p>In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: \"cardiac anesthesiology and outcomes\" (n = 177), \"cardiothoracic anesthesiology\" (n = 34), \"cardiac anesthesia,\" and \"clinical outcomes\" (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 2","pages":"107-119"},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9588253/pdf/nihms-1841224.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9114468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2021––Forging Ahead Into the Endemic While Struggling Against the New Challenges Facing Health Care Providers","authors":"Cara E. Crouch, Benjamin A. Abrams, M. Kertai, N. Weitzel","doi":"10.1177/10892532221104162","DOIUrl":"https://doi.org/10.1177/10892532221104162","url":null,"abstract":"This issue of Seminars in Cardiothoracic and Vascular Anesthesia is our annual noteworthy review issue where we recruit experts in multiple perioperative fields to hand pick the key themes and articles from the previous publication year. This year’s authors have done fantastic work collating the best literature in their chosen fields with topics in transplant, Cardiac ICU, cardiac anesthesia topics of hyperoxia, transfusion, and of course cardiac surgery. We hope that you enjoy this issue. 2021 began for much of the medical community with hope for a conclusion to the unprecedented COVID-19 pandemic. Sadly, a shift was made to the endemic phase of this process and COVID-19 continues to have an impact on both clinical practice and ongoing research. The medical and scientific community is moving forward through this phase and advancing our understanding of the complex interaction between SARS-Cov-2 and host, and the underlying pathophysiology of long haul COVID-19 symptoms. Centers across Asia, Australia, Europe, North America, and South America experienced a 50–70% reduction in cardiac surgery volume with a 53% reduction in cardiac surgery cases in the United States during the last 2 years of the pandemic. Despite the ongoing pandemic, transplantations had a record year in the United States with 41,354 organ transplants performed in 2021, a 5.9% increase from 2020. This included new annual records for kidney transplants (24,669), liver transplants (9,236), and heart transplants (3,817); although, lung transplants decreased slightly (2,524) from the year prior (Figure 1). In this setting, the medical community also has faced its largest challenge providing care as the workforce numbers have been reduced nationwide, significantly impacting the medical system in all phases of perioperative care. Cardiothoracic Anesthesiology","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"101 - 106"},"PeriodicalIF":1.4,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45960286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}