Faculty Bibliography

AIM/OBJECTIVE:The "2026 HRS Expert Consensus Statement Update on Cardiovascular Implantable Electronic Device Lead Management and Extraction" provides updated recommendations to guide clinicians in the management of cardiovascular implantable electronic device (CIED) leads. BACKGROUND:Since the publication of the "2017 HRS Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction," the field has evolved quickly. New evidence on CIED lead management and the blooming development of new CIED technologies, including leadless pacing and implantable cardioverter-defibrillator leads implanted outside the vascular system and new lumenless pacing leads and lead extraction tools, have contributed to the field's rapid evolution. METHODS AND RESULTS/RESULTS:A comprehensive literature search was conducted in accordance with the Institute of Medicine standards. The writing committee reviewed evidence gathered through electronic literature searches encompassing clinical trials, original studies, and meta-analyses conducted on human subjects published in English from MEDLINE, PubMed, Embase, and the Cochrane Library up to December 2024. The comprehensive literature review supports each evidence-based recommendation and is compiled in the evidence tables. A predefined threshold of >70% approval for each recommendation was required, with a quorum of two-thirds of the writing committee. The final mean consensus of 108 recommendations was 93.61%. DISCUSSION/CONCLUSIONS:The recommendations from the "2017 Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction" have been updated with new evidence to guide clinicians. The new recommendations address the latest CIED technologies with the advantages over transvenous leads; new evidence supporting diagnosis, treatment, and prevention for CIED infection; appropriate lead management in transcatheter tricuspid valve replacement for tricuspid regurgitation; and standardization of transvenous lead extraction approach, protocol, and facilities to improve the outcomes of CIED lead management and extraction.

Heart transplantation outcomes have tremendously improved over the nearly fifty years that the procedure has been performed. As demand continues to grow, there is a persistent shortage of organs. Compounding this is the potential for organs to deteriorate with increasing preservation and transport times. New technologies have been developed to address these issues. These include novel physiologic preservation solutions and preservation devices (which range from those that optimize temperature control to those that use machine perfusion or combinations of these facets) to minimize the risk of ischemic injury. Research is ongoing into these techniques and their potential to improve outcomes by protecting donor organs (particularly in cases of prolonged ischemic times) and expand the donor pool by better preserving grafts from marginal and/or donation after circulatory death donors. There is even research into utilizing these technologies to enable safe cardiac xenograft implantation as well as their role in beating heart transplantation.

Vasoplegic syndrome, a form of distributive shock that may manifest during or after cardiopulmonary bypass, is a serious complication that increases morbidity and mortality after cardiac surgery. No consensus definition exists, but vasoplegic syndrome is generally described as a state of pathologic vasodilation causing hypotension refractory to fluid resuscitation and vasopressor therapy, and resulting in organ malperfusion despite a normal or increased cardiac output. Diagnosis can be complex as there is a broad differential diagnosis for low systemic vascular resistance in the cardiac surgical patient. Interpretation of hemodynamic data can also be challenging in the setting of mixed shock states and mechanical support. This narrative review summarizes the pathophysiology of vasoplegic syndrome, the literature concerning its incidence and risk factors, the hemodynamic parameters important to the diagnosis of vasoplegic syndrome, a consensus definition of the syndrome, and a proposed goal-directed treatment framework.

The presence of underrepresented minorities (URMs) in cardiothoracic anesthesiology is underwhelming, and progress toward diversity has been slow at best. Despite decades of efforts, change seems hard to achieve. For example, it took more than 30 years for women to make up 50% of medical school matriculants. However, women continue to be underrepresented in our professional subspecialty and notably. This slow movement is not idiosyncratic to women but also applies to equity related to race and ethnicity. Given this current state, this article seeks to bring attention to the lack of diversity in cardiac anesthesiology and is a call to action to accelerate efforts and the pace of change toward greater equity both in our field and in medicine in general. This piece is the final part of a 4-part series exploring opportunities for improving diversity in cardiac anesthesiology. The authors focus specifically on the professional experience of URMs in medicine in our subspecialty and the opportunities for improving diversity. While many barriers for URM physicians reflect those of women, the experience of URM practicing physicians is unique and solutions need to incorporate.

OBJECTIVES/OBJECTIVE:This study aims to characterize the risks and benefits of in-OR extubation after cardiac surgery. DESIGN/METHODS:This is a retrospective chart review. SETTING/METHODS:Single tertiary care hospital. PARTICIPANTS/METHODS:Cardiac surgical patients >18 years. Exclusion criteria included patients extubated after 6 h in the ICU, those with a history of congenital heart disease (CHD), those intubated prior to arrival to the OR, procedures including circulatory arrest and/or selective cerebral perfusion, cardiothoracic transplantation, and intraoperative death. De-identified data was collected via the hospital's electronic medical record. INTERVENTIONS/METHODS:None. MEASUREMENTS AND MAIN RESULTS/RESULTS:Perioperative data was collected for 726 patients, of which 303 (42 %) were extubated in the OR. Multivariable regression models were derived with covariates based on expert clinical reasoning. When compared to fast track extubation, in-OR extubation was independently associated with decreased index hospitalization length of stay (-1.74, 95 % CI [-2.22, -1.08], p < 0.001) and decreased incidence of in-hospital new post-operative atrial fibrillation (OR 0.56 95 % CI [0.37, 0.86], p < 0.01). There were no differences in persistent vasoactive therapy requirement, postoperative mechanical circulatory support or extubation failure. CONCLUSIONS:In-OR extubation is associated with decreased index hospitalization length of stay and decreased new onset in-hospital atrial fibrillation.

The Society of Cardiovascular Anesthesiologists (SCA) is committed to improving the quality, safety, and value that cardiothoracic anesthesiologists bring to patient care. To fulfill this mission, the SCA supports the creation of peer-reviewed manuscripts that establish standards, produce guidelines, critically analyze the literature, interpret preexisting guidelines, and allow experts to engage in consensus opinion. The aim of this report, commissioned by the SCA President, is to summarize the distinctions among these publications and describe a novel SCA-supported framework that provides guidance to SCA members for the creation of these publications. The ultimate goal is that through a standardized and transparent process, the SCA will facilitate up-to-date education and implementation of best practices by cardiovascular and thoracic anesthesiologists to improve patient safety, quality of care, and outcomes.