European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) Fellowship Curriculum: Second Edition.

International audienceThis document represents the first update of the Cardiothoracic and Vascular Anaesthesia Fellowship Curriculum of the European Association of Cardiothoracic Anaesthesiology and Intensive Care. After obtaining feedback from exit interviews with fellows in training, graduate fellows, and program directors, 2 modified online Delphi procedures with questionnaires were conducted. A consensus was reached when two-thirds of responding committee members gave green or yellow ratings on a traffic light system, and >70% indicated strong agreement or agreement on a 5-point Likert scale. The new regulations include the following: (1) more flexibility in the fellows` rotation, as long as the total number of days, rotations, and cases are completed during the training year; (2) recommendation for strict compliance with national working-time guidelines; (3) no extension of fellowship training to compensate for annual and/or sick leave, unless the required minimum number of cases and rotations are not reached; (4) interruption of fellowship training for >12 months is allowed for personal or medical reasons; (5) introduction of a checklist for quantitative assessment of standard clinical skills; (6) recommendations for a uniform structure of exit interviews; (7) possibility of a 1-month training rotation in a postanesthesia care unit instead of an intensive care unit; and (8) provided all other requirements have been met, the allowance of progression from the basic training year to the advanced fellowship training year without first passing the transesophageal echocardiography examination

Plasmatic microRNAs in advanced heart failure patients supported by left ventricular assist devices (LVAD)

Nowadays, heart failure remains a global problem responsible of a high mortality. Despite spectacular advances made in the past three decades in cardiovascular medicine and surgery, the prognosis of heart failure is worse than that of most cancers (1). The gold standard therapy for refractory end-stage heart failure is currently heart transplantation. However, the increasing shortage of donors has led to the development of mechanical assist devices to support and improve the organ function of patients while on waiting for transplantation. The good results of ventricular assist devices \u201cas a bridge to transplantation\u201d has expanded the application of VAD to be implanted \u201cas a bridge to decision\u201d, \u201cas a bridge to candidacy\u201d, \u201cas a bridge to recovery\u201d and, increasingly, \u201cas a destination therapy\u201d (DT) (2). In 2001 the REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment OF Congestive Heart Failure) study first demonstrated that long-term support with a left ventricular assist device resulted in substantial improvement in survival in patients with severe heart failure who were not candidates for cardiac transplantation compared with any known optimal medical therapy addressed to optimize organ perfusion and minimize symptoms of congestive heart failure (3). Several mechanisms have been advocated to contribute to pathophysiology of heart failure, including genetic mechanisms. In this 4 context, short non-coding RNAs called microRNA (miRNAs) block gene expression and protein translation. These molecules are crucial to calcium cycling and ventricular hypertrophy. The actions of miRNAs can be blocked by a new class of drugs, antagomirs, some of which have been shown to improve cardiac function in animal models. Moreover, the microRNAs have been proposed as biomarkers of heart failure or cardiac function recovery. For example, increased concentrations of miRNA34, 192 and 194 are predictive of development of heart failure in patients after acute myocardial infarction (4). Matkovich and coworkers (5) reported that the miRNA-499 levels of patients with heart failure were greatly increased and almost completely normalized after they had been placed on left ventricular assist device. In selected patients, LVAD can lead to myocardial recovery and explantation of the device. Maybe circulating miRNA could be useful prognostic biomarkers of cardiac reverse remodeling in LVAD patients but further investigations are warranted to understand the real role of miRNAs in this setting and their potential utility. The aim of this study is to evaluate the modification of some miRNAs related to myocardial fibrosis, ventricular remodelling and platelet function in patients with heart failure compare with healthy volunteers and in heart failure patients after LVAD positioning at short and long term periods (6-10 day, 2-3 months, 12-18 months). To analyze the modification of P-Selectin in patients supported by VAD and its correlation with thrombotic events

Role of Bivalirudin for Anticoagulation in Adult Perioperative Cardiothoracic Practice.

Bivalirudin, a direct thrombin inhibitor with a fast onset of action and short half-life, is often referred to as an alternative anticoagulant to a heparin/protamine regimen. Bivalirudin demonstrated promising results as an anticoagulant in cardiac surgery with and without cardiopulmonary bypass, postcardiotomy extracorporeal membrane oxygenation, interventional cardiology and endovascular procedures, and particularly in the treatment of patients with heparin-induced thrombocytopenia undergoing high-risk cardiac surgery. Currently, bivalirudin in cardiac surgery with cardiopulmonary bypass has a limited clinical spectrum, likely because the still obvious advantages of its competitor, heparin, outweigh it in terms of medical costs, established point-of-care monitoring systems, and availability of protamine as a reversal agent. The unique pharmacology of the drug also requires adjustment of surgical and perfusion strategy. In contrast, in off-pump coronary artery surgery, established protocols from interventional cardiology can be easily translated into the operating room. In this setting bivalirudin has the potential for a more important role in the future. Through a triple mechanism of action-inhibition of plasma thrombin, clot bound thrombin, and collagen-induced platelet activation-bivalirudin may perform better than heparin by attenuating the immediate postoperative prothrombotic state and thus positively impacting the early coronary graft patency after off-pump coronary artery bypass grafting. Further studies are necessary to better evaluate this niche field and discover further applications for this unique anticoagulant