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Intravenous iron in heart failure

2024-04-16 - 2024-04

Individuals with heart failure (HF) and iron deficiency should be treated, but expert groups differ on the perceived benefits. In a new meta-analysis that included over 4500 patients participating in randomized trials, intravenous iron reduced the rate of cardiovascular hospitalizations compared with placebo; all-cause mortality was not reduced [12]. This supports our suggested approach of using intravenous iron, although oral iron may be reasonable. Iron supplementation should be stopped once stores are repleted, as excess iron deposition is cardiotoxic. (See "Evaluation and management of anemia and iron deficiency in adults with heart failure", section on 'Iron supplementation'.)

Moderate hypothermia during aortic arch surgery with antegrade cerebral perfusion

2024-04-09 - 2024-04

Observational data have supported a shift from deep to moderate hypothermia during circulatory arrest for aortic arch surgery, particularly with adjunctive antegrade cerebral perfusion (ACP). A recent trial has now compared outcomes for 251 patients undergoing aortic arch surgery with ACP and randomly assigned to deep (?20.0°C), low-moderate (20.1 to 24.0°C), or high-moderate (24.1 to 28.0°C) circulatory arrest temperature [1]. At one-month follow-up, the three groups had similar neurocognitive and neuroimaging outcomes and similar mortality, major morbidity, and quality of life. The volume of transfused blood products was higher in the deep group, but transfusion-related complications were not different. Based on this trial, moderate (20.1 to 28.0°C) rather than deep hypothermia is reasonable during aortic arch surgery when ACP is also used. Whether a low-moderate or high-moderate temperature is selected depends on the complexity of the arch intervention and the anticipated duration of hypothermia. (See "Overview of open surgical repair of the thoracic aorta", section on 'Hypothermic circulatory arrest'.)

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Intravenous iron in heart failure

Moderate hypothermia during aortic arch surgery with antegrade cerebral perfusion

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Intravenous iron in heart failure

Moderate hypothermia during aortic arch surgery with antegrade cerebral perfusion