Continuing Research in the Face of Adversity.

The COVID-19 pandemic has presented significant challenges to many forms of research and other scholarly activity. Patient enrollment has been hampered, collaboration among coinvestigators and coauthors has been difficult, and simply the allotted time to pursue research and academic projects during the strain of the pandemic on clinical and family life has been a significant hurdle. However, many groups have managed to overcome these obstacles and continued to produce important work across a broad range of subspecialties within the field of anesthesiology. This issue of Seminars in Cardiothoracic and Vascular Anesthesia highlights the impressive dedication and fortitude of those who have managed to overcome the pandemic in this regard. The work includes review articles on pulmonary artery aneurysm (PAA) and mitral regurgitation (MR) following surgical aortic valve replacement (SAVR), an original research article investigating the direct myocardial effects of propofol, as well as 2 separate forums in abdominal transplantation and congenital cardiac diseases. The first of 2 articles in the Reviews section of the journal offers a thorough discussion of PAA. Here, Drs Arain and Gilbride1 describe a unique case of a patient with PAA secondary to severe pulmonary hypertension presenting for double lung transplantation. They include impressive intraoperative transesophageal echocardiography images along with a description of the successful perioperative management of this patient. The authors then go on to provide a thorough description of the etiology, pathophysiology, and various imaging modalities for assessment of PAA. They provide a discussion of the various treatment options for PAA, including surgical repair and lung transplant, depending on the etiology. They also highlight the unique anesthetic considerations for these patients intraoperatively, including specific approaches to ventilator management as well as hemodynamic considerations in order to avoid catastrophic rupture of the PAA. Kumar et al2 produced the second article in the Reviews section, providing a thorough evaluation of the literature with regard to new or worsened MR following SAVR. The group identified 36 full-text citations describing this specific complication of SAVR, representing 207 patients. As the primary outcome of their work, they estimated the prevalence of new or worsened MR after SAVR to be 8.4%. They went on to classify unique subgroups by the specific mechanism of MR: extravalvular (prosthetic aortic valve components or sutures interfering with mitral valve function), intravalvular (Manouguian patch degeneration or iatrogenic injury), and various forms of functional MR. Interestingly, the vast majority of cases were not identified intraoperatively or even within the first 48 hours postoperatively. Functional MR was by far the most commonly reported mechanism, including both systolic anterior motion of the mitral valve and left ventricular dysfunction. Consistent with this trend in mechanism, only 16 of the patients required emergent surgical reintervention to treat MR related to SAVR; the remainder of patients were treated medically. Overall, these authors highlight a very important, yet often underappreciated, complication of SAVR. This issue of the journal also includes an Abdominal Transplantation Forum, which highlights a broad range of clinical challenges within this complex field. McGahan et al3 describe a patient with Alagille syndrome (ALGS) and moderate pulmonary hypertension who presented for combined liver-kidney transplantation. The authors provide a nice review of ALGS, as well as a discussion of the unique considerations of liver transplantation in a patient with bilateral branch pulmonary artery stenosis; the latter highlights the importance of a well-functioning multidisciplinary team of specialists to guide preoperative optimization, intraoperative support, and postoperative management in high-risk patients. To follow this work, Dr Cherchi and colleagues4 report on the potential utility of intraoperative 1038779 SCVXXX10.1177/10892532211038779Seminars in Cardiothoracic and Vascular AnesthesiaAbrams et al editorial2021