The year 2018 was marked by high-quality, impactful articles spanning the basic, translational, and clinical spectrum in the field of cardiothoracic anesthesia. In this article, we present several hand-picked articles from the past year that we feel were the most significant in shaping our specialty. Large multicenter, randomized controlled trials presenting clinical outcome data dominated the publishing arena: is a restrictive red blood cell transfusion strategy superior to a liberal red blood cell transfusion strategy during cardiopulmonary bypass? Does a low mean arterial blood pressure strategy during cardiopulmonary bypass increase stroke incidence? Does the obesity paradox apply to cardiac surgery? Advancing technology continues to revolutionize our field: can the MitraClip be used to effectively treat secondary mitral regurgitation? Can stem cells improve cardiac function in patients with left ventricular assist devices? These studies allow us to shape our practice in an evidence-based manner, so that we may evolve as a specialty and deliver the best care to our patients.
MazerCDWhitlockRPFergussonDAet al; TRICS Investigators and Perioperative Anesthesia Clinical Trials Group. Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med. 2017;377:2133-2144.
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VedelAGHolmgaardFRasmussenLSet al. High-target versus low-target blood pressure management during cardiopulmonary bypass to prevent cerebral injury in cardiac surgery patients: a randomized controlled trial. Circulation. 2018;137:1770-1780.
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MariscalcoGWozniakMJDawsonAGet al. Body mass index and mortality among adults undergoing cardiac surgery: a nationwide study with a systematic review and meta-analysis. Circulation. 2017;135:850-863.
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StoneGWLindenfeldJAbrahamWTet al; COAPT Investigators. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379:2307-2318.
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WangDSKaneshwaranKLeiGet al. Dexmedetomidine prevents excessive γ-aminobutyric acid type A receptor function after anesthesia. Anesthesiology. 2018;129:477-489.
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PaganiF.Intramyocardial injection of mesenchymal precursor cells in left ventricular assist device recipients: the LVAD MPC-II trial. Paper presented at: AHA 2018; November 11, 2018; Chicago, IL.
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SurgenorSDDeFoeGRFillingerMPet al. Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation. 2006;114(1 suppl):I43-I48.
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SurgenorSDKramerRSOlmsteadEMet al; Northern New England Cardiovascular Disease Study Group. The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg. 2009;108:1741-1746.
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MurphyGJPikeKRogersCAet al; TITRe2 Investigators. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med. 2015;372:997-1008.
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PatelNNAvlonitisVSJonesHEReevesBCSterneJAMurphyGJ.Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol. 2015;2:e543-e553.
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GottesmanRFShermanPMGregaMAet al. Watershed strokes after cardiac surgery: diagnosis, etiology, and outcome. Stroke. 2006;37:2306-2311.
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NewmanMFKirchnerJLPhillips-ButeBet al; Neurolog-ical Outcome Research Group and the Cardiothoracic Anesthe-siology Research Endeavors Investigators. Longitudinal as-sessment of neurocognitive function after coronary-artery by-pass surgery. N Engl J Med. 2001;344:395-402.
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FlegalKMKitBKOrpanaHGraubardBI.Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309:71-82.
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StamouSCNussbaumMStiegelRMet al. Effect of body mass index on outcomes after cardiac surgery: is there an obesity paradox?Ann Thorac Surg. 2011;91:42-47.
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AngerasOAlbertssonPKarasonKet al. Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J. 2013;34:345-353.
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OreopoulosAPadwalRKalantar-ZadehKFonarowGCNorrisCMMcAlisterFA.Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156:13-22.
SanninoASmithRL2ndSchiattarellaGGTrimarcoBEspositoGGrayburnPA.Survival and cardiovascular outcomes of patients with secondary mitral regurgitation: a systematic review and meta-analysis. JAMA Cardiol. 2017;2:1130-1139.
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FeldmanTFosterEGlowerDDet al; EVEREST II Investigators. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med. 2011;364:1395-1406.
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GlowerDDKarSTrentoAet al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol. 2014;64:172-181.
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DjaianiGSilvertonNFedorkoLet al. Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery: a randomized controlled trial. Anesthesiology. 2016;124:362-368.
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ZurekAAYuJWangDSet al. Sustained increase in α5GABAA receptor function impairs memory after anesthesia. J Clin Invest. 2014;124:5437-5441.
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AscheimDDGelijnsACGoldsteinDet al. Mesenchymal precursor cells as adjunctive therapy in recipients of contemporary left ventricular assist devices. Circulation. 2014;129:2287-2296.
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PatelSRMadanSSaeedOet al. Association of nasal mucosal vascular alterations, gastrointestinal arteriovenous malformations, and bleeding in patients with continuous-flow left ventricular assist devices. JACC Heart Fail. 2016;4:962-970.
