The aortic valve treatment revolution continues with the maturation of aortic valve repair and the dissemination of
transcatheter aortic valve implantation. The recent publication of comprehensive multidisciplinary guidelines for diseases of the thoracic aorta has assigned important roles for the cardiovascular anesthesiologist and perioperative echocardiographer. Although intense
angiotensin blockade improves outcomes in
heart failure, it might further complicate the maintenance of perioperative systemic vascular tone. Ultrafiltration as well as intensive medical management guided by the
biomarker brain natriuretic peptide improves outcomes in
heart failure. Continuous-flow left
ventricular assist devices have further improved outcomes in the surgical management of
heart failure. Major risk factors for
bleeding in the setting of these devices include advanced
liver disease and acquired von Willebrand syndrome. The metabolic modulator
perhexiline improves myocardial diastolic energetics to achieve significant symptomatic improvement in
hypertrophic cardiomyopathy. A landmark report was also published recently that outlines the major areas for future research and clinical innovation in this disease. Landmark trials have documented the outcome importance of perioperative cerebral oxygen saturation monitoring as well as the outcome advantages of the Sano shunt over the
modified Blalock-Taussig shunt in the
Norwood procedure. Furthermore, the development and evaluation of pediatric-specific
ventricular assist devices likely will revolutionize the mechanical management of pediatric
heart failure. A multidisciplinary review has highlighted the priorities for future perioperative trials in
congenital heart disease. These pervasive developments likely will influence the future training models in pediatric
cardiac anesthesia.