Browsing by Author "McCartney, Sharon L"

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Open Access
CASE 7---2015: Perioperative Considerations for a Cardiac Paraganglioma...Not Just Another Cardiac Mass.
(J Cardiothorac Vasc Anesth, 2015-08) Gerlach, Rebecca M; Barrus, Adam B; Ramzy, Danny; Hernandez Conte, Antonio; Khoche, Swapnil; McCartney, Sharon L; Swaminathan, Madhav
Open Access
Intraoperative vasoplegia: methylene blue to the rescue!
(Curr Opin Anaesthesiol, 2018-02) McCartney, Sharon L; Duce, Lorent; Ghadimi, Kamrouz
PURPOSE OF REVIEW: To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). RECENT FINDINGS: Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of nitric oxide, while inhibiting activation of soluble guanylyl cyclase and preventing vasodilation. MTB has been used in postgraft reperfusion during liver transplantation and anaphylaxis in a limited number of cases. Additionally, this medication has been used in septic shock with promising results, but similar to the cardiac surgical population, the effects of MTB administration on clinical outcomes has yet to be elucidated. SUMMARY: MTB should be considered during vasoplegic syndrome in cardiac surgery with cardiopulmonary bypass and usage may be more effective in an early critical window, prior to end-organ hypoperfusion. Other perioperative scenarios of MTB use show promise, but additional studies are required to develop formative conclusions.
Open Access
Long-term outcomes and management of the heart transplant recipient.
(Best Pract Res Clin Anaesthesiol, 2017-06) McCartney, Sharon L; Patel, Chetan; Del Rio, J Mauricio
Cardiac transplantation remains the gold standard in the treatment of advanced heart failure. With advances in immunosuppression, long-term outcomes continue to improve despite older and higher risk recipients. The median survival of the adult after heart transplantation is currently 10.7 years. While early graft failure and multiorgan system dysfunction are the most important causes of early mortality, malignancy, rejection, infection, and cardiac allograft vasculopathy contribute to late mortality. Chronic renal dysfunction is common after heart transplantation and occurs in up to 68% of patients by year 10, with 6.2% of patients requiring dialysis and 3.7% undergoing renal transplant. Functional outcomes after heart transplantation remain an area for improvement, with only 26% of patients working at 1-year post-transplantation, and are likely related to the high incidence of depression after cardiac transplantation. Areas of future research include understanding and managing primary graft dysfunction and reducing immunosuppression-related complications.
Open Access
Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes.
(J Cardiothorac Vasc Anesth, 2017-06) McCartney, Sharon L; Cooter, Mary; Samad, Zainab; Sivak, Joseph; Castleberry, Anthony; Gregory, Stephen; Haney, John; Hartwig, Matthew; Swaminathan, Madhav
OBJECTIVE: Progression of mitral regurgitation (MR) after orthotopic lung transplantation (OLT) may be an underrecognized phenomenon due to the overlapping symptomatology of pulmonary and valvular disease. Literature evaluating the progression of MR after OLT currently is limited to case reports. Therefore, the hypothesis that MR progresses after OLT was tested and the association of preprocedure MR with postoperative mortality was assessed. DESIGN: A retrospective cohort. SETTING: A tertiary-care hospital. PARTICIPANTS: Patients who underwent OLT between January 1, 2003 and February 4, 2012. INTERVENTIONS: After receiving institutional review board approval, a preprocedure transesophageal echocardiogram was compared with a postoperative transthoracic echocardiogram (TTE) to determine the progression of MR. Univariate and multivariate association between preprocedure MR grade and 1- and 5-year mortality was assessed. A p value of<0.05 was considered statistically significant. MEASUREMENTS AND MAIN RESULTS: From 715 patients who underwent OLT, 352 had a postoperative TTE and were included in the evaluation of progression of MR. Five patients had progression of MR postoperatively, and the mean change in MR score of -0.04 was found to be nonsignificant (p = 0.25). Mortality data were available for 634 of the 715 patients. After covariate adjustment, there was no significant association between MR grade and 1-year mortality (p = 0.20) or 5-year mortality (p = 0.46). CONCLUSIONS: This study rejected the hypothesis that primary and secondary MR progresses after OLT and found that preprocedure MR was not associated with increased postoperative mortality. Despite the findings that MR does not progress in all patients, there is a subset of patients for whom MR progression is clinically significant.
Open Access
Outcomes in Patients Undergoing Cardiac Surgery Who Decline Transfusion and Received Erythropoietin Compared to Patients Who Did Not: A Matched Cohort Study.
(Anesth Analg, 2017-08-29) Duce, Lorent; Cooter, Mary L; McCartney, Sharon L; Lombard, Frederick W; Guinn, Nicole R
BACKGROUND: Erythropoiesis-stimulating agents, such as erythropoietin (EPO), can be used to treat preoperative anemia. Some studies suggest an increased risk of mortality and thrombotic events, and use in cardiovascular surgery remains off-label. This study compares outcomes in cardiac surgery patients declining blood transfusion who received EPO with a matched cohort who did not. METHODS: After institutional review board approval, we conducted a retrospective review of all patients who decline blood transfusion who underwent cardiac surgery and received EPO between January 1, 2004, and June 15, 2015, at a single institution. Control patients who did not receive EPO and were not transfused allogeneic red blood cells perioperatively were identified during the same period. Two controls were matched to each EPO patient using an optimal matching algorithm based on age, date of surgery, gender, operative procedure, and surgeon. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and baseline characteristics remaining unbalanced in the matched cohorts were controlled for in assessing patient outcomes. The primary outcome was a composite of mortality and thrombotic events, and secondary outcomes included change in hemoglobin (Hb) from baseline to discharge, acute kidney injury (AKI), sternal wound infection, atrial fibrillation, time to extubation, intensive care unit, and hospital length of stay (LOS). RESULTS: Fifty-three patients who decline transfusion and received EPO were compared to 106 optimally matched control patients who did not receive EPO or red blood cell transfusion in the perioperative period. The median additive EuroSCORE was similar between the EPO and control group [6 (4, 9) vs 5 (3, 7), respectively; P = .39]. There was no difference in the primary outcome (P = .12) and mortality was zero in both groups. The EPO group had a higher mean preoperative Hb (13.91 g/dL vs 13.31; P = .02) and a smaller change in Hb from baseline (-2.65 vs -3.60; P = .001). The incidence of AKI (47.17% vs 41.51%; P = .49) was similar and there was no significant difference in all other outcomes, including time to extubation, hospital LOS, or intensive care unit LOS. CONCLUSIONS: In this retrospective matched cohort study of patients declining transfusion and receiving EPO matched to control patients, there were no clinically meaningful differences in the outcomes.
Open Access
Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension.
(J Cardiothorac Vasc Anesth, 2018-01-10) Gregory, Stephen H; Yalamuri, Suraj M; McCartney, Sharon L; Shah, Syed A; Sosa, Julie A; Roman, Sanziana; Colin, Brian J; Lentschener, Claude; Munroe, Ray; Patel, Saumil; Feinman, Jared W; Augoustides, John GT
Open Access
Pulmonary dysfunction after lung transplantation: the dilemma of coexisting mitral regurgitation.
(J Cardiothorac Vasc Anesth, 2014-12) McCartney, Sharon L; Colin, Brian J; Duane Davis, R; Del Rio, J Mauricio; Swaminathan, Madhav
A case of MR progression after single-lung transplant as a significant contributor to postoperative respiratory failure is reported. Pre-existing MR may progress due to the decompressive effects of lung transplantation on RV dimension and consequent alteration of MV geometry. This case highlights the importance of intraoperative TEE findings, especially pertaining to valvulopathies in the setting of lung transplantation. Postoperative surveillance of significant findings is imperative when any new symptoms are being investigated.
Open Access
Uncorrected Tetralogy of Fallot, Biventricular Dysfunction, and a Large Pericardial Effusion.
(J Cardiothorac Vasc Anesth, 2015-10) McCartney, Sharon L; Machovec, Kelly; Jooste, Edmund H