William T. Costello

Bio: William T. Costello is an academic researcher from Vanderbilt University. The author has contributed to research in topics: Ventricular assist device & Thoracotomy. The author has an hindex of 2, co-authored 3 publications receiving 42 citations. Previous affiliations of William T. Costello include Vanderbilt University Medical Center.

2019 EACTS Expert Consensus on long-term mechanical circulatory support

Abstract: Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.

Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12

Abstract: A significant number of surgical patients are at risk of intra- or post-operative complications or both, which are associated with increased lengths of stay, costs, and mortality Reducing these risks is important for the individual patient but also for health-care planners and managers Insufficient tissue perfusion and cellular oxygenation due to hypovolemia, heart dysfunction or both is one of the leading causes of perioperative complications Adequate perioperative management guided by effective and timely hemodynamic monitoring can help reduce the risk of complications and thus potentially improve outcomes In this review, we describe the various available hemodynamic monitoring systems and how they can best be used to guide cardiovascular and fluid management in the perioperative period in high-risk surgical patients

Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part I: Routine Postoperative Care

Abstract: Objectives:Cardiac surgery, including coronary artery bypass, cardiac valve, and aortic procedures, is among the most common surgical procedures performed in the United States. Successful outcomes after cardiac surgery depend on optimum postoperative critical care. The cardiac intensivist must have

A review of echocardiography in anaesthetic and peri‐operative practice. Part 1: impact and utility

Abstract: Echocardiography is migrating rapidly across speciality boundaries and clinical demand is expanding. Echocardiography shows promise for evolving applications in the peri-operative assessment and therapeutic management of patients undergoing non-cardiac surgery, whether it be elective or emergency. Although evidence is limited with regard to significant impact on outcomes from anaesthesia and surgery, there is little doubt about the validity and power of two-dimensional real-time viewing of cardiac anatomy and function. Echocardiography can be used to assist in decision-making along the entire peri-operative pathway, and is increasingly delivered by the previously referring physicians. The discussion around more widespread incorporation of cardiac ultrasound into anaesthetic practice must take into account competency, training and governance. Failure to do so adequately may mean that the use of echocardiography is poorly applied and costly.

A review of echocardiography in anaesthetic and peri‐operative practice. Part 2: training and accreditation

Abstract: Echocardiography has been widely adopted as a diagnostic and monitoring tool in cardiac anaesthesia and critical care. There is considerable interest in how echocardiography could be used to benefit patients in other areas of anaesthesia and peri-operative practice. The first part of review examines the impact and utility of echocardiography, while this second part is concerned with the matter of training and accreditation. There are a number of existing clinical protocols for the use of transthoracic echocardiography with a focused approach. Some of these, such as Focused Intensive Care Echocardiography in the UK, have been developed into structured accreditation processes with embedded supervision. Learning opportunities are now emerging for anaesthetists who wish to acquire echocardiography skills--these encompass clinical, simulation and online resources. Whilst the roll-out of echocardiography for more widespread use in peri-operative management is a long-term project, it is now an appropriate time to consider how this may be achieved.