Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Low-Range Heparin and Protamine Detection: A Single-Center Prospective Diagnostic Study.","authors":"Michael Vandenheuvel, Laura Vierstraete, Filip De Somer, Katrien M J Devreese, Patrick F Wouters, Pieter M De Kesel","doi":"10.1053/j.jvca.2025.01.009","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.009","url":null,"abstract":"<p><strong>Objectives: </strong>The detection of low-range heparin activity is important to correctly assess heparin reversal and rebound, especially after cardiopulmonary bypass. Current parameters are either not available at point-of-care (anti-Xa activity [aXa] and activated partial thromboplastin time [aPTT]), insensitive (kaolin-activated clotting time [kACT]), or expensive (ROTEM viscoelastic test). We aimed to assess the performance of a recently proposed parameter from the Sonoclot viscoelastic test: the slope-45. We aimed to assess the effects of a range of low-dose heparin and protamine and their interaction on multiple proposed parameters.</p><p><strong>Design: </strong>Prospective in vitro volunteer study.</p><p><strong>Setting: </strong>Single-center university teaching hospital.</p><p><strong>Participants: </strong>Healthy volunteers.</p><p><strong>Interventions: </strong>Blood samples from healthy volunteers (n = 10) were treated ex vivo with incremental low doses of heparin, protamine, or their combination. In the combination cycle, theoretical reversal ratios were 25%, 62.5%, 100%, and 200% of the highest heparin dose, based on a unit-for-unit reversal. We compared the effects on aXa, aPTT, iSTAT kACT, ROTEM clotting time ratio, and the novel Sonoclot slope-45 parameter, and we performed receiver operating curve analysis.</p><p><strong>Measurements and main results: </strong>In heparin-spiked blood, all parameters except iSTAT kACT were able to reliably detect low heparin activity. Protamine, both in isolation and combined with heparin, showed no impact on aXa, aPTT, iSTAT kACT, ROTEM clotting time ratio, and the novel Sonoclot slope-45 parameter.</p><p><strong>Conclusions: </strong>We were able to confirm that the Sonoclot slope-45 has a high sensitivity for low-dose heparin, which is retained in the setting of interacting protamine. It was insensitive to protamine in itself.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-stratified Surgical Aortic Valve Replacement for Aortic Stenosis: What Does It Mean for Patients with Bicuspid Aortic Valve Disease?","authors":"Matthew M Townsley","doi":"10.1053/j.jvca.2025.01.015","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.015","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pro: Remimazolam: New Impetus for the Anesthesia of Critically Ill and High-risk Cardiovascular Patients.","authors":"Mark G Filipovic, Dominik P Guensch","doi":"10.1053/j.jvca.2025.01.010","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.010","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life Versus Clinical Outcomes: What Is the Proper Metric to Assess the Benefit of Transcatheter Tricuspid Valve Replacement?","authors":"Liliya Pospishil, Peter J Neuburger","doi":"10.1053/j.jvca.2025.01.016","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.016","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasoplegia in Heart, Lung, or Liver Transplantation: A Narrative Review.","authors":"Jamel Ortoleva, Adam Dalia, David Convissar, Dominic V Pisano, Edward Bittner, Lorenzo Berra","doi":"10.1053/j.jvca.2025.01.012","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.012","url":null,"abstract":"<p><p>Vasoplegia is a pathophysiologic state of hypotension in the setting of normal or high cardiac output and low systemic vascular resistance despite euvolemia and high-dose vasoconstrictors. Vasoplegia in heart, lung, or liver transplantation is of particular interest because it is common (approximately 29%, 28%, and 11%, respectively), is associated with adverse outcomes, and because the agents used to treat vasoplegia can affect immunosuppressive and other drug metabolism. This narrative review discusses the pathophysiology, risk factors, and treatment of vasoplegia in patients undergoing heart, lung, and liver transplantation. Vasoplegia in this patient population is associated with acute kidney injury, hospital length of stay, and even survival. The mechanisms of vasoplegia in this patient population likely involve multiple pathways, including nitric oxide synthase, cyclic guanylate cyclase, cytokine release, hydrogen sulfide, adrenal axis abnormalities, and vasopressin deficiency. Contributors to vasoplegia in this population include mechanical circulatory support such as extracorporeal membrane oxygenation and cardiopulmonary bypass, organ ischemia time, preexisting infection, and medications such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and excessive sedation. Treatment of vasoplegia in this population begins with conventional catecholamines and vasopressin analogs. Occasionally, agents, including methylene blue, hydroxocobalamin, and angiotensin II, are administered. Though retrospective literature suggests a hemodynamic response to these agents in the transplant population, minimal evidence is available to guide management. In what follows, we discuss the treatment of vasoplegia in the heart, lung, and liver transplant populations based on patient characteristics and potential risk factors associated with non-catecholamine agents.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Mortality in Venoarterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience.","authors":"Alaa Rahhal, Ousama Bilal, Ahmed M Salama, Praveen Sivadasan, Ammar Al Abdullah, Safae Abuyousef, Siddiha Shahulhameed, Khaled J Zaza, Abdulwahid Al Mulla, Abdulaziz Alkhulaifi, Ahmed Mahfouz, Sumaya Alyafei, Amr Omar","doi":"10.1053/j.jvca.2025.01.013","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.013","url":null,"abstract":"<p><strong>Objective: </strong>The use of an intra-aortic balloon pump (IABP) has been suggested to unload the left ventricle while on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS), leading to possibly improved in-hospital mortality. However, the predictors of mortality on dual mechanical circulatory support have not yet been evaluated, especially in real-world clinical settings. Therefore, a case-control study was conducted to determine the rate of all-cause mortality associated with VA-ECMO use regardless of left ventricular (LV) unloading, and with early LV unloading in the setting of CS, and to identify the predictors of mortality associated with VA-ECMO, with concurrent early LV unloading.</p><p><strong>Design: </strong>Retrospective observational case-control study.</p><p><strong>Setting: </strong>National tertiary cardiology center.</p><p><strong>Participants: </strong>All patients with CS requiring VA-ECMO cannulation during the index admission between January 06, 2016, and January 0, 2022.</p><p><strong>Intervention: </strong>VA-ECMO with or without IABP MEASUREMENTS AND MAIN RESULTS: Patient- and disease-related characteristics associated with in-hospital 30-day mortality following VA-ECMO with and without IABP support were assessed using multivariate logistic regression. Results are presented as odds ratio (OR), and a p-value < 0.05 indicates statistical significance. A total of 110 patients were included. Most were male (90%) with a mean age of 53 ± 11 years. Around 67% were Asian. The majority of patients were admitted with ST-elevation myocardial infarction (87%), with 26% presenting with left main disease. In-hospital 30-day mortality occurred in 42.7% of those who received VA-ECMO support regardless of IABP use, while it was 46.9% among those receiving early LV unloading with IABP. Significant positive predictors of mortality with VA-ECMO regardless of IABP in CS were cardiopulmonary resuscitation (CPR) >20 minutes (adjusted OR 14.74, 95% confidence interval 2.02-107.41, p-value = 0.008), older age (ie, >55 years) and left main disease of more than 50% stenosis were associated with a fourfold increase in the odds of mortality while on VA-ECMO. Conversely, CPR >20 minutes (adjusted OR 12.45, 95% confidence interval 1.79-86.36, p-value = 0.011) was the only significant positive predictor of mortality with VA-ECMO and IABP.</p><p><strong>Conclusion: </strong>The mortality rate in CS requiring VA-ECMO, regardless of IABP use, remains high. However, only one predictor (ie, prolonged CPR) was found to increase the likelihood of 30-day mortality with early LV unloading, suggesting that concomitant IABP use might minimize the effect of mortality predictors.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombotic Complications Associated With Right Atrial Lines in Neonates and Infants Undergoing Cardiac Surgery. Is Calcium Chloride a Culprit?","authors":"Vy A Tran, Evelyn M Griffin, Jehan D Elliott, Rebecca L Scholl, Robert B Hill, Kelbie Kerr, Hala Khan, Jonathan Bates, Xu Zhang, Sepideh Saroukhani, Jorge Salazar, Olga I Pawelek","doi":"10.1053/j.jvca.2025.01.008","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.008","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if a change from calcium chloride to calcium gluconate infusion resulted in a decreased incidence of atrial thrombi and thrombotic events in neonates undergoing cardiac surgery.</p><p><strong>Design: </strong>A single-center, retrospective cohort analysis.</p><p><strong>Setting: </strong>A single center in Houston, TX.</p><p><strong>Participants: </strong>135 neonates undergoing cardiac surgery who had either a central venous catheter or tunneled atrial catheter placed and received infusions of either calcium chloride or calcium gluconate in the perioperative period.</p><p><strong>Interventions: </strong>Patients either received a calcium chloride or calcium gluconate infusion in the perioperative period.</p><p><strong>Measurements and main results: </strong>The study cohort consisted of 93 procedures using calcium chloride and 88 procedures using calcium gluconate infusions. The 181 procedures were recorded on a total of 135 patients. The overall incidence of thrombosis was 9.9%. The association between calcium chloride or calcium gluconate infusion and thrombotic events was assessed using a generalized linear mixed model for binary data (proc Glimmix, SAS v.9.4, SAS Institute, Cary, NC), to account for within-subjects correlation in patients requiring more than one procedure. The odds of thrombotic events when receiving calcium chloride infusion was 3.45 times that with calcium gluconate infusion in the setting of neonatal cardiac surgery (15% v 4.6%, odds ratio = 3.46, 95% confidence interval = 1.02, 11.7, p = 0.047).</p><p><strong>Conclusions: </strong>In this single-center study, a significant decrease in the odds of an atrial catheter-related thrombus when a calcium gluconate infusion is used instead of calcium chloride was shown.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which Type of POCUS Do You Do? Echoing the American Society of Echocardiography's Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature.","authors":"Nikhil Chawla, Mario Montealegre-Gallegos, Andrew P Notarianni","doi":"10.1053/j.jvca.2025.01.006","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.006","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Levosimendan in Extracorporeal Membrane Oxygenation for Refractory Cardiac Arrest.","authors":"Rasha Kaddoura, Bassant Orabi, Amr S Omar, Mohamed Izham Mohamed Ibrahim, Sumaya Alsaadi Alyafei, Abdulaziz Alkhulaifi, Ahmed Labib Shehatta","doi":"10.1053/j.jvca.2025.01.004","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.004","url":null,"abstract":"<p><strong>Objectives: </strong>To examine whether levosimendan could improve survival in patients with cardiac arrest supported by extracorporeal cardiopulmonary resuscitation (ECPR).</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary academic center.</p><p><strong>Participants: </strong>Patients with refractory cardiac arrest.</p><p><strong>Interventions: </strong>Patients who were exposed to levosimendan and those who were not.</p><p><strong>Measurement and main results: </strong>There were 87 patients with a mean age of 45.4 ± 11.9 years, 86.2% of them were males with a mean body mass index of 26.8 ± 5.0 kg/m², and a mean Charlson Comorbidity Index score of 0.7 ± 1.3. Of the 87 patients, 18 (20.7%) were administered levosimendan. The 2 groups were similar in terms of baseline characteristics. Overall, 70% of patients in both groups suffered in-hospital cardiac arrest and the remaining suffered out of hospital cardiac arrest. Median cardiopulmonary resuscitation duration before extracorporeal membrane oxygenation initiation was 54.0 minutes (interquartile range, 35.0-84.0 minutes). The highest lactate levels after between the second and the fourth days after ECPR were significantly higher (8.1 mmol/L vs 3.4 mmol/L; p = 0.046) and the duration of extracorporeal membrane oxygenation support was significantly longer (4.2 days vs 1.9 days; p = 0.0019) with levosimendan. There was no difference between the groups in terms of survival to decannulation (27.8% vs 26.1%), survival to hospital discharge (27.8% vs 24.6%), length of intensive care unit stay (19.1 vs 18.2 days), length of hospital stay (51.1 days vs 53.4 days), or complications rates (eg, infection, bleeding, and arrhythmias).</p><p><strong>Conclusions: </strong>Levosimendan use in ECPR did not improve survival. Future well-designed randomized trials are warranted to investigate the potential benefit of levosimendan in the ECPR setting.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Analgesia in Pediatric Cardiothoracic Surgery: A Bayesian Network Meta-Analysis.","authors":"Yi Ren, Lijing Li, Jingchun Gao, Lei Hua, Tiehua Zheng, Fang Wang, Jianmin Zhang","doi":"10.1053/j.jvca.2024.12.043","DOIUrl":"https://doi.org/10.1053/j.jvca.2024.12.043","url":null,"abstract":"<p><p>Various regional analgesia techniques are used to reduce postoperative pain in pediatric patients undergoing cardiothoracic surgeries. This study aimed to determine the relative efficacy of regional analgesic interventions. PubMed, EMBASE, Web of Science, and Cochrane databases were searched to identify all randomized controlled studies evaluating the effects of regional block after cardiothoracic surgery. The primary endpoint was opioid consumption within 24 hours postoperatively, Pain scores, the time to first rescue analgesic, and the incidence of postoperative nausea and vomiting were also collected. A Bayesian NMA was performed to compare the outcomes of interest. A total of 24 studies involving 1602 patients and 13 regional blocks were included. All techniques reduced opioid consumption within 24 hours postoperatively. The largest decrease was in the thoracic retrolaminar block group, with a WMD of -0.97 (95% CrI -1.1, -0.84) mg/kg morphine equivalent. In terms of pain scores, there was no significant difference between any block and the control at any time point except for the thoracic retrolaminar block group at 0 hours postoperatively. In addition, all regional blocks prolonged the time to first rescue analgesic, which was the longest in the pectoral nerve block group. The incidence of postoperative nausea and vomiting was the lowest in the epidural anesthesia group, followed by the transversus thoracis muscle plane block group. Regional anesthesia revealed significant opioid-sparing effects following pediatric cardiothoracic surgery. However, indirect comparisons are limited because of the heterogeneity of previous studies, and direct comparisons are needed to establish the relative efficacies of different blocks.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}