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Preoperative Care Practice for Female Cardiac Patients: A Survey From the Society of Cardiovascular Anesthesiologists [Letter]

Nanegrungsunk, Danop; Patel, Shayna; Jan, Thomas; Ngai, Jennie Y
PMID: 34776353
ISSN: 1532-8422
CID: 5048912

A Call for Diversity: Underrepresented Minorities and Cardiothoracic Anesthesiology Fellowship Education

Sumler, Michele L; Capdeville, Michelle; Ngai, Jennie; Cormican, Daniel; Oakes, Daryl
This paper is the first of a four-part series that details the current barriers to diversity in the field of adult cardiothoracic anesthesiology and outlines actionable programs that can be implemented to create change. Part I and Part II address the training experience of women and underrepresented minorities (URMs) in adult cardiothoracic anesthesiology (ACTA), respectively, and explore concrete opportunities to promote positive change. Part III and Part IV examine the professional experience of URMs and women in ACTA, respectively, and discuss interventions that can facilitate a more equitable and inclusive environment for both groups. Although these problems are complex, the authors here offer a detailed analysis of the challenges faced by each group both in the training phase and the professional practice phase of their careers. The authors also present meaningful and concrete actions that can be implemented to create a more diverse, equitable, and inclusive professional environment in cardiovascular and thoracic anesthesiology.
PMID: 34696968
ISSN: 1532-8422
CID: 5042302

Sex Diversity in the Cardiothoracic Anesthesiology Fellowship: The Influence of Geographic Region

Patel, Shayna; Ngai, Jennie
OBJECTIVES/OBJECTIVE:To investigate if the lack of sex diversity in adult cardiothoracic anesthesiology fellowships is a result of few female applicants or low acceptance rate. DESIGN/METHODS:Retrospective review of adult cardiothoracic anesthesiology applicants and fellows by sex and geographic regions across the United States. SETTING/METHODS:Accreditation Council for Graduate Medical Education's adult cardiothoracic anesthesiology fellowship programs across the United States. PARTICIPANTS/METHODS:Applicants to adult cardiothoracic anesthesiology fellowship programs and fellows. INTERVENTIONS/METHODS:No intervention. MEASUREMENTS AND MAIN RESULTS/RESULTS:Numerical comparison of male and female applicants by percentage and acceptance rates into adult cardiothoracic anesthesiology fellowship programs in each geographic region. Women comprised between 27% and 35% of applicants from 2013 to 2018. Acceptance rates for men completing residency in the Midwest region ranged between 67% and 84%, and 67% and 87% for women from the Midwest (p = 0.1-0.9). Men from Northeast residencies had acceptance rate of 71% to 86% and women had rate of 69% to 83% (p = 0.2-0.8). Male and female residents from the Southeast had acceptance rates of 65% to 94% and 71% to 93%, respectively (p = 0.3-0.8). The male residents from the Southwest had acceptance rates of 73% to 85%, and female residents had rates between 44% and 100% (p = 0.02-0.8). The male residents from the West had rates of 59% to 88%, female residents had rates between 64% and 100% (p = 0.1-0.7). CONCLUSIONS:There is an absence of clear identification of the barriers preventing women from entering cardiac anesthesiology. The reasons leading to a male-dominated field of cardiac anesthesiologists stem from fewer female anesthesiology residents applying to cardiothoracic anesthesiology fellowships. No bias against acceptance of women into cardiothoracic anesthesiology fellowships was found.
PMID: 33573930
ISSN: 1532-8422
CID: 4799812

A Call for Diversity: Women and Cardiothoracic Anesthesiology Fellowship Education

Ngai, Jennie; Capdeville, Michelle; Sumler, Michele; Oakes, Daryl
SCOPUS:85111519191
ISSN: 1053-0770
CID: 5001052

Anesthetic Considerations During Heart Transplantation Using Donation After Circulatory Death [Case Report]

Ngai, Jennie; Masuno, Kiriko; Moazami, Nader
Worldwide, the majority of heart transplant organs are from donation after brain death. However, the shortage of suitable donors places severe limitations on this route. One option to increase the donor pool is to use organs from donation after circulatory death (DCD). Transplant centers for solid organs have been using DCD organs for years. At this time, 40% of solid organ transplantation in the United Kingdom uses organs from DCD. Use of DCD for solid organ transplants in Canada is also rising. Recently, there has been interest in using DCD organs for heart transplantation. The authors will discuss their experience of 4 heart transplants with organs from DCD donors after normothermic regional perfusion (NRP). The authors' first heart transplant using a DCD organ was in January 2020, and the fourth was in March 2020, just before the coronavirus disease 2019 (COVID-19) pandemic. The authors' protocol using NRP allows adequate evaluation of the donor heart to confidently determine organ acceptance. The co-location of the donor and the recipient in neighboring operating rooms limits ischemic times. Avoidance of an expensive ex vivo organ perfusion machine is an additional benefit for programs that may not have the resources required to purchase and maintain the machine. Some hospitals may not have the resources and space to be able to co-locate both the donor and recipient. Use of cold storage may be an option to transport the procured organ, similar to donation after brain death organs. The authors hope that this technique of NRP in DCD donors can help further increase the donor pool for heart transplantation in the United States.
PMCID:7313525
PMID: 32660929
ISSN: 1532-8422
CID: 4527982

Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

Muehlschlegel, J Daniel; Burrage, Peter S; Ngai, Jennie Yee; Prutkin, Jordan M; Huang, Chuan-Chin; Xu, Xinling; Chae, Sanders H; Bollen, Bruce A; Piccini, Jonathan P; Schwann, Nanette M; Mahajan, Aman; Ruel, Marc; Body, Simon C; Sellke, Frank W; Mathew, Joseph; O'Brien, Ben
Postoperative atrial fibrillation (poAF) is the most common adverse event after cardiac surgery and is associated with increased morbidity, mortality, and hospital and intensive care unit length of stay. Despite progressive improvements in overall cardiac surgical operative mortality and postoperative morbidity, the incidence of poAF has remained unchanged at 30%-50%. A number of evidence-based recommendations regarding the perioperative management of atrial fibrillation (AF) have been released from leading cardiovascular societies in recent years; however, it is unknown how closely these guidelines are being followed by medical practitioners. In addition, many of these society recommendations are based on patient stratification into "normal" and "elevated" risk groups for AF, but criteria for that stratification have not been clearly defined. In an effort to improve the perioperative management of AF, the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee developed a multidisciplinary Atrial Fibrillation Working Group that created a summary of current best practice based on a distillation of recent guidelines from professional societies involved in the care of cardiac surgical patients. An evidence-based set of survey questions was then generated to describe the current practice of perioperative AF management. Through collaboration with the European Association of Cardiothoracic Anaesthetists (EACTA), that survey was distributed to the combined memberships of both the SCA and EACTA, yielding 641 responses and resulting in the most comprehensive understanding to date of perioperative AF management in North America, Europe, and beyond. The survey data demonstrated the broad range of therapies utilized for the prevention and treatment of poAF, as well as a spectrum of adherence to published guidelines. With the goal of improving adherence, a graphical advisory tool was created with an easily accessible format that could be utilized for bedside management. Finally, given that no evidence-based threshold currently exists to differentiate patients at normal risk to develop poAF from those at elevated risk, the SCA/EACTA AF working group created a list of poAF risk factors using expert opinion and based on published risk score models for poAF. This approach allows stratification of patients into risk groups and facilitates adherence to the evidence-based recommendations summarized in the graphical advisory tool. It is our hope that these new additions to the clinical toolkit for the management of perioperative AF will improve the evidence-based care and outcomes of cardiac surgical patients worldwide.
PMID: 30550473
ISSN: 1526-7598
CID: 3556392

Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

O'Brien, Ben; Burrage, Peter S; Ngai, Jennie Yee; Prutkin, Jordan M; Huang, Chuan-Chin; Xu, Xinling; Chae, Sanders H; Bollen, Bruce A; Piccini, Jonathan P; Schwann, Nanette M; Mahajan, Aman; Ruel, Marc; Body, Simon C; Sellke, Frank W; Mathew, Joseph; Muehlschlegel, J Daniel
Postoperative atrial fibrillation (poAF) is the most common adverse event after cardiac surgery and is associated with increased morbidity, mortality, and increased hospital and intensive care unit length of stay. Despite progressive improvements in overall cardiac surgical operative mortality and postoperative morbidity, the incidence of poAF has remained unchanged at 30% to 50%. A number of evidence-based recommendations regarding the perioperative management of atrial fibrillation (AF) have been released from leading cardiovascular societies in recent years; however, it is unknown how closely these guidelines are being followed by medical practitioners. In addition, many of these society recommendations are based on patient stratification into "normal" and "elevated" risk groups for AF, but criteria for that stratification have not been defined clearly. In an effort to improve the perioperative management of AF, the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee developed a multidisciplinary Atrial Fibrillation Working Group that created a summary of current best practices based on distillation of recent guidelines from professional societies involved in the care of cardiac surgical patients. An evidence-based set of survey questions then was generated to describe the current practice of perioperative AF management. Through a collaboration with the European Association of Cardiothoracic Anaesthetists (EACTA), that survey was distributed to the combined memberships of both the SCA and the EACTA, yielding 641 responses and resulting in the most comprehensive understanding to date of perioperative AF management in North America and Europe and beyond. The survey data demonstrated the broad range of therapies used for prevention and treatment of poAF, as well as a spectrum of adherence to published guidelines. With the goal of improving adherence, a graphical advisory tool was created with an easily accessible format that could be used for bedside management. Finally, given that no evidence-based threshold currently exists to differentiate patients at normal risk of developing poAF from those at elevated risk, the SCA/EACTA AF working group created a list of poAF risk factors using expert opinion, based on published risk score models for poAF. This allows stratification of patients into risk groups and facilitates adherence to the evidence-based recommendations summarized in the graphical advisory tool. It is the working group's hope that these new additions to the clinical toolkit for management of perioperative AF will improve the evidence-based care and outcomes of cardiac surgical patients worldwide.
PMID: 30591178
ISSN: 1532-8422
CID: 3560182

Transcatheter Valve Procedures and the Anesthesiologist

Mader, Thomas; Ngai, Jennie
PMID: 30204609
ISSN: 1537-1913
CID: 3277722

Totally Endoscopic Robotic Left Atrial Appendage Closure Demonstrates High Success Rate

Ward, Alison F; Applebaum, Robert M; Toyoda, Nana; Fakiha, Ans; Neuburger, Peter J; Ngai, Jennie; Nampiaparampil, Robert G; Yaffee, David W; Loulmet, Didier F; Grossi, Eugene A
OBJECTIVE: In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates. METHODS: Before robotic mitral repair, patients underwent RLAAC; the base of the LAA was oversewn using a running 4-0 polytetrafluoroethylene suture in two layers. Postoperatively, the LAA was interrogated in multiple TEE views. Incomplete closure was defined as any flow across the LAA suture line or a residual stump of greater than 1 cm. RESULTS: Seventy-nine consecutive patients underwent RLAAC; no injuries occurred. On postrepair TEE, 73 of 79 patients had LAAs visualized well enough to thoroughly evaluate. Successful ligation was confirmed in 64 (87.7%) of 73 patients. Seven patients (9.6%) had small jet flow into the LAA; no residual stumps were noted. Two patients (2.7%) had undetermined flow. CONCLUSIONS: We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7%) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5%) and staple closure (72.7%). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients.
PMID: 28129320
ISSN: 1559-0879
CID: 2418792

Left Atrial Appendage Velocity as a Predictor of Atrial Fibrillation After Cardiac Surgery

Ngai, Jennie; Leonard, James; Echevarria, Ghislaine; Neuburger, Peter; Applebaum, Robert
OBJECTIVE: To determine if there is an association between left atrial appendage velocity and the development of postoperative atrial fibrillation (POAF). DESIGN: Single institution retrospective study performed between January 2013 and December 2013. SETTING: Single-institution, university hospital. PARTICIPANTS: Five hundred sixty-two adult patients undergoing cardiac surgery utilizing cardiopulmonary bypass. INTERVENTIONS: No interventions for the purpose of this study. MEASUREMENTS AND MAIN RESULTS: Left atrial appendage velocity, measured by transesophageal echocardiogram, ranged from 8 cm/sec to 126 cm/sec. The development of POAF within the first 3 days after cardiac surgery was 38.3%. The authors found that patients with a lower left atrial appendage velocity had a higher risk of developing POAF. In the adjusted logistic regression model, there was an 11% decrease in the odds of POAF for each 10-unit (cm/sec) increase in the left atrial appendage velocity (p = 0.044). CONCLUSIONS: Decreasing left atrial appendage velocity is an independent predictor of risk for the development of POAF following cardiac surgery with cardiopulmonary bypass.
PMID: 26706710
ISSN: 1532-8422
CID: 1884402