Allegheny General Hospital (AGH) is rated No. 1 in Western Pennsylvania for patient safety in overall Cardiac care, heart attack treatment, heart transplants, and many other specialties by CareChex, 2018. The cardiac Surgical Department began decades ago with Dr George Magovern Sr, who was a pioneer of clinical and scientific achievements in cardiac surgery. One of his many accomplishments was the development of the first sutureless valve (Magovern-Cromie Valve), which doubled the patient survival rate in the United States. Dr Magovern passed his legacy onto his 2 sons, Dr George Magovern Jr and late Dr James Magovern. Dr George Magovern performed the first United Network for Organ Sharing (UNOS)-approved heart transplant and established the left ventricular assist device with the introduction of venoarterial extracorporeal membrane oxygenation (ECMO) for the treatment of cardiogenic shock. In addition, he established multidisciplinary programs for the treatment of atrial fibrillation, percutaneous aortic value replacement, thoracic aortic endovascular surgery, minimally invasive and robotic-assisted open heart procedures, and MitraClip therapy. Many of these programs and procedures have been discussed throughout this issue.

The issue opens with an article, "When Transfusion is Not an Option: Challenges and Rewards," contributed by Schwab, Kosoglow, Philip, and Suydam. These authors discuss the importance of having support in developing a bloodless medicine program. The article reviews the parameters for blood products and outlines which ones should be used for various clinical scenarios and the need to manage these patients without blood products. The program has developed to the point that it can successfully meet the needs of complex surgical patients and their families without transfusions. The following contribution by Weatherby, "Coronary Artery Bypass Grafting: A Clinical Overview" explains the process of coronary artery bypass grafting. Even though there are many surgical treatment options for patients with heart attack, open heart surgery remains an option whether it is performed minimally invasive or by direct myocardial revascularization bypass. The American Heart Association's Fitness Seven are included as a reminder of the preventative measures that all patients need to be taught after having open heart surgery. Berger's article, "Evolution of a Transcatheter Aortic Valve Replacement (TAVR) Program" explains the nuts and bolts of program development, surgical criteria and the multidisciplinary team process. This procedure gives the older patient who is high or immediate risk an option for aortic valve replacement. Presently, the TAVRs that are done through the femoral artery are recovered in the postanesthesia recovery room and go to the telemetry unit for discharge by hospital day 2. "Managing Heart Failure Patients-All the Way to Heart Transplant" by Pirozzi focuses on patients who have had heart failure and are ready for heart transplant. The article describes the criterion that needs to be met to be on the transplant list and the importance of having a strong multidisciplinary team. The multidisciplinary team members' roles are described in detail because each piece of information about the patient will determine his or her success with a heart transplant. "The Use of the Left Ventricular Assist Devices in End-Stage Heart Failure" by Blair considers the next stage in the process of heart transplantation. One of the areas described is the care and teaching of the patient and significant others that must be completed before the patient is discharged.

There are certain lifestyle changes that are described to enable patients to live independently at home with the left ventricular assist device. Hoy and Frisbee have contributed an important article describing additional concerns after heart transplantation. "Common Postoperative Heart Transplant Complications" provides an overview of heart transplant immediate postoperative care and explains the clinical parameters that need to be monitored and managed to ensure optimal patient outcomes. The need to watch blood glucose levels and complications of immunosuppressive therapy can help to reduce infections. "The Role of Education in Heart Transplant Recipients" by Mohney describes the postoperative follow-up care and procedures that need to be systematically addressed after discharge. At frequent intervals the patient needs to return to the hospital for biopsies, laboratory tests, and other clinical studies. The nursing staff who care for the patient during the acute phase may fail to recognize and appreciate all the nuances of postdischarge care. Calhoun's "Extracorporeal Membrane Oxygenation" details the nursing care that is necessary for a patient requiring ECMO support temporarily or on a long-term basis. This article details the various types of ECMO, clinical applications and complications that may occur. Leininger's article "Blood Glucose Management for Reducing Cardiac Surgery Infections" discusses the importance of keeping the blood glucose below 180 mg/dL. Best practices for blood glucose management in cardiac surgical patients are emphasized. Evidence shows that even with the increase of acuity of care and surgical volume that surgical-site infections have not increased when closely controlling blood glucose. "Operational Excellence in the Cardiothoracic Surgical ICU" by Bartolowits details the work of a designated board used on the units at AGH. Daily issues in care delivery processes are promptly addressed each day, empowering the staff when they see results of their voices being heard.

"Transport of Critically Ill Cardiovascular Patients" by Ignatyeva and colleagues provides insights into the complexities of safely moving and transferring an individual who is unstable and dependent upon multiple attached lines, medical support devices, and monitors. Crimlisk, Krisciunas, Sipe, and Winter conclude the issue with their interesting study, "Emergency Airway Response Team Documentation: Criteria, Feasibility and Usability."

The staff from AGH who shared their knowledge and experiences in these articles hope they have provided inspiration to others who care for patients with cardiovascular surgery. This issue helps to confirm the values of practice innovation, clinical expertise, teamwork, and unrelenting searches for answers first ignited by Dr George Magovern Sr, who decades ago established this facility as an industry leader. This issue of Critical Care Nursing Quarterly is dedicated to the staff of the Cardiac Surgery Programs at AGH who perpetuate his legacy.

-Susan Leininger, RN, MSN

Co-Issue Editor

-Kim Bartolowits, RN, MSN, NE-BC

Co-Issue Editor