2021––Forging Ahead Into the Endemic While Struggling Against the New Challenges Facing Health Care Providers

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