Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Interpreting the Acute Kidney Injury Signal With Intraoperative Hemoadsorption During Cardiopulmonary Bypass: Methodological Considerations.","authors":"Gde Bagus Susila Pradnyana Nurcahyo Oka","doi":"10.1053/j.jvca.2026.09.048","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.048","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216339","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":"New Dialysis-Dependent Renal Failure After Durable LVAD Implantation: Risk Factors and Potential Targets for Improvement.","authors":"Nicholas D'Alonzo, Nola Darden, Paras Chand, Eric W Schaefer, Justin W Walker","doi":"10.1053/j.jvca.2026.09.049","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.049","url":null,"abstract":"<p><strong>Objectives: </strong>To identify preoperative predictors of postoperative renal replacement therapy (RRT) in patients undergoing left ventricular assist device (LVAD) implantation to help guide interventions that could decrease the incidence of new dialysis-dependent acute kidney injury (AKI).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A single-center, university hospital.</p><p><strong>Participants: </strong>There were 159 adult patients undergoing LVAD implantation between July 2012 to July 2024 INTERVENTIONS: Retrospective analysis of preoperative variables, including hemoglobin, creatinine, MELD score, and intraoperative RBC transfusion volume and their effect on the primary outcome of new dialysis-dependent AKI.</p><p><strong>Measurements and main results: </strong>New dialysis-dependent AKI occurred in 17% of patients. Preoperative hemoglobin was inversely associated with RRT risk; every 1-g/dL increase was associated with a 21% reduction in odds ratio (OR 0.79; CI 0.65-0.97, p = .023). Intraoperative red blood cell transfusion volume was a major predictor, with patients receiving 0 to 5 units having significantly lower OR than those receiving ≥11 units (OR 0.01; 95% CI 0.001-0.11; p < .001). MELD scores between 10 and 20 also increased the OR (OR 3.10; 95% CI 1.07-9.00; p = .038). Additionally, needing new dialysis was strongly associated with prolonged mechanical ventilation (OR 8.76; 95% CI 2.52-30.5; p = .001) and postoperative gastrointestinal bleeding (OR 3.73; 95% CI 1.48-9.40; p = .005).</p><p><strong>Conclusion: </strong>Preoperative hemoglobin and perioperative red blood cell transfusion volume are significant and potentially actionable, modifiable risk factors for postoperative RRT in LVAD recipients. Optimizing preoperative hemoglobin may offer a targeted strategy to reduce RRT rates in this high-risk population.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224212","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":"High-Flow Oxygen: Physiology, Intubation, and Survival After the Standard Oxygen Versus High-Flow Oxygen Therapy in Acute Hypoxemic Respiratory Failure (SOHO) Trial.","authors":"Lattawat Eauchai, Jacopo D'Andria Ursoleo, Patrick M Wieruszewski, Harish Ramakrishna, Omar Elmadhoun","doi":"10.1053/j.jvca.2026.09.039","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.039","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224197","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":"Competing Hemodynamic Goals During Hepatectomy in Patients with Fontan Circulation: A Systematic Review of Case Reports.","authors":"Takamune Minote, Hiroki Yonezawa, Michiko Kinoshita, Katsuya Tanaka","doi":"10.1053/j.jvca.2026.09.044","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.044","url":null,"abstract":"<p><strong>Objectives: </strong>To synthesize available evidence on perioperative management and clinical outcomes of hepatectomy in patients with Fontan circulation, focusing on hemodynamic strategies and surgical safety.</p><p><strong>Design: </strong>A systematic review of case reports and case series.</p><p><strong>Settings: </strong>Published studies were identified through databases (PubMed, Scopus, Cochrane Library, Google Scholar, ICHUSHI, and CiNii Research).</p><p><strong>Participants: </strong>Thirty-one patients from 28 studies underwent hepatectomy after the Fontan procedure.</p><p><strong>Interventions: </strong>Open or laparoscopic hepatectomy, primarily for hepatocellular carcinoma in the setting of Fontan-associated liver disease.</p><p><strong>Measurements and main results: </strong>All patients had stable Fontan physiology, and no perioperative mortality was reported. Preoperative baseline central venous pressure (CVP) ranged from 10 to 15 mmHg. Intraoperative management consistently favored a baseline-CVP strategy over conventional low-CVP targets. Laparoscopic approaches uniformly used low-pressure pneumoperitoneum below baseline-CVP levels. The Pringle maneuver was well tolerated; however, inferior vena cava clamping was associated with significant hypotension. The median blood loss was 1,106 mL (range 10-4,130 mL). Congestion-related complications, including ascites, pleural effusion, heart failure, and unspecified fluid retention, were most commonly reported postoperatively.</p><p><strong>Conclusion: </strong>Hepatectomy appears feasible in carefully selected patients with stable Fontan circulation. Practical perioperative considerations summarized from reported patterns include maintaining CVP near baseline, minimizing increases in pulmonary vascular resistance, and keeping pneumoperitoneum pressure below baseline CVP during laparoscopic surgery. However, hepatectomy-specific risk stratification has yet to be established, and optimal perioperative management of patients with impaired Fontan physiology remains uncertain. A critical knowledge gap remains regarding hemostatic approaches that optimize bleeding control while preserving the Fontan circulation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216327","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":"Perioperative Antithrombin Activity and Postoperative Outcomes in Adult Cardiac Surgery: A Prospective Cohort in Contemporary Plasma-Sparing Practice.","authors":"Nicholas Hua, Mosana Abraha, Ricardo Eli Guido Guerra, Victoria Barkley, Jeannie Callum, Darrin Payne, Lani Lieberman, Stuart A McCluskey, Keyvan Karkouti, Justyna Bartoszko","doi":"10.1053/j.jvca.2026.08.157","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.157","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether low pre- or post-bypass antithrombin (AT) activity identifies adult cardiac surgery patients at increased risk of adverse outcomes in settings where plasma transfusion is rare.</p><p><strong>Design: </strong>Prospective exploratory observational cohort.</p><p><strong>Setting: </strong>Two academic cardiac surgery centers using factor concentrate-based hemostatic algorithms without routine AT supplementation.</p><p><strong>Participants: </strong>One hundred three adults (≥18 years) undergoing cardiac surgery with cardiopulmonary bypass.</p><p><strong>Interventions: </strong>Fibrinogen concentrate and 4-factor prothrombin complex concentrate (4F-PCC) were first-line hemostatic agents. AT activity was measured immediately before and after cardiopulmonary bypass.</p><p><strong>Measurements and main results: </strong>Two patients (2%) received plasma, 23% received 4F-PCC, and 26% received fibrinogen concentrate. Prebypass AT activity was categorized, comparing the lowest quintile (Q1) with higher quintiles (Q2-Q5). Co-primary outcomes were hospital and intensive care unit length of stay to postoperative day 28. Secondary outcomes included acute kidney injury, composite major morbidity, and vasopressor or inotrope use beyond postoperative day 1. Q1 patients had lower postbypass AT levels and higher rates of acute kidney injury, vasopressor/inotrope use, and longer hospital stay, but prebypass AT status was not an independent predictor in multivariable models. A sensitivity analysis using a postbypass AT threshold level of 63.7% showed similar results.</p><p><strong>Conclusion: </strong>In cardiac surgery patients where plasma was avoided and no AT supplementation was used, low perioperative AT activity was associated with higher unadjusted complication rates but did not independently predict outcomes after accounting for patient and procedural factors. The routine use of factor concentrates over plasma as first-line hemostatic therapy, without additional routine AT supplementation, does not appear to increase risk.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038149","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":"Perioperative Management for Placement of Patent Ductus Arteriosus Stents in Infants With Ductal-Dependent Pulmonary Circulation.","authors":"A Rebecca L Hamilton, Koichi Yuki, Steven J Staffa, Kirsten C Odegard","doi":"10.1053/j.jvca.2026.09.042","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.042","url":null,"abstract":"<p><strong>Objectives: </strong>Stenting of the patent ductus arteriosus (PDA) offers a minimally invasive alternative to the modified Blalock-Thomas-Taussig shunt in infants with ductal-dependent pulmonary blood flow. This study reviews the periprocedural management of infants undergoing ductal stenting in the cardiac catheterization laboratory.</p><p><strong>Design: </strong>A retrospective single-center review.</p><p><strong>Setting: </strong>Quaternary children's hospital.</p><p><strong>Participants: </strong>Infants receiving PDA stents in the cardiac catheterization laboratory from 2018 to 2021 were included.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Sixty-eight patients were included; median age was 5 days [1-62]; 95.6% (65/68) were neonates and 23.5% (16/68) premature. Pulmonary atresia with intact ventricular septum was the most common cardiac diagnosis (n = 23, 33.8%); 22.1% (15/68) presented with a syndrome and 35.3% (24/68) with noncardiac comorbidities. In total, 39.7% (27/68) developed intraoperative events. Median time to extubation was 19.4 hours [3.2-372.5].</p><p><strong>Conclusions: </strong>Infants with ductal-dependent pulmonary blood flow undergoing ductal stenting may present with a wide range of challenges in the perioperative period. Meticulous care and interdisciplinary coordination are required to optimize the outcomes for this particularly vulnerable patient group.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223900","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 Association of the Systemic Oxygen Delivery to Oxygen Consumption Ratio With Mortality, Heart Transplantation, and Mechanical Circulatory Support.","authors":"Goyal Umadat, Kevin G Buda, Shahyar M Gharacholou, Katrina Augustin, Misty Radosevich, Kyle Bohman, Kenneth Seid, Nathan Peffley, Courtney Bennett, Nandan Anavekar, Bradley Ternus, Dustin Hillerson, Jennifer Lee","doi":"10.1053/j.jvca.2026.09.043","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.043","url":null,"abstract":"<p><strong>Objectives: </strong>To identify if the delivery of oxygen over consumption of oxygen (DO₂/VO₂) ratio is significantly associated with clinical outcomes such as mortality, need for heart transplantation, or need for a mechanical circulatory support device.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Medical and surgical cardiac intensive care units of the Mayo Clinic.</p><p><strong>Participants: </strong>Adult patients (≥18 years old) admitted to the cardiothoracic surgical or cardiac intensive care units between January 2012 and December 2025 were included if they underwent invasive hemodynamic assessment with simultaneous arterial blood gas, mixed venous blood gas, hemoglobin, and mean arterial pressure. Patients were excluded if they had their venous oxygen saturations drawn from a central line or a peripherally inserted central catheter, as well as those admitted for sepsis/septic shock.</p><p><strong>Interventions: </strong>No interventions were performed on patients.</p><p><strong>Measurements and main results: </strong>DO₂/VO₂ demonstrated a nonlinear association with mortality. Using the median value of 4.73 as a reference point, patients with a DO₂/VO₂ value of ∼2 had the highest likelihood of mortality. Kaplan-Meier analysis using a prespecified cut-point of 5 did not demonstrate any significant relationship with mortality, likely because of the underlying nonlinear relationship. There was no significant association between DO₂/VO₂ ratio and the need for mechanical circulatory support or heart transplantation.</p><p><strong>Conclusions: </strong>DO₂/VO₂ is a marker of systemic oxygen balance that complements conventional hemodynamic indices. A categorical threshold of 5 did not show an association with clinical outcomes, but continuous analyses did suggest that a low DO₂/VO₂ may identify a high-risk phenotype.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216334","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":"LETTER IN REPLY.","authors":"Vincenzo Verzeletti, Giovanni M Comacchio, Marco Mammana, Alessandro Rebusso, Marco Schiavon, Andrea Dell'Amore","doi":"10.1053/j.jvca.2026.09.037","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.037","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182184","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":"A Common Language for Acute Lung Allograft Dysfunction: A Major Step Forward for Lung Transplant Outcomes.","authors":"Harry Wanar, Menachem M Weiner","doi":"10.1053/j.jvca.2026.09.031","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.031","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193813","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":"Global Longitudinal Strain as a Predictor of Challenging Separation from Cardiopulmonary Bypass.","authors":"Giulia Franceschini, Andrea Farinaccio, Alessia Zingaro, Serena Buscaglia, Ilaria Scoglio, Mustafa Emre Gürcü, Laura De Felice, Marzia Flaminio, Manuela Moresco, Mattia Gatta, Paolo Nardi, Valentina Ajello","doi":"10.1053/j.jvca.2026.09.036","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.036","url":null,"abstract":"<p><strong>Objectives: </strong>Although reduced left ventricular ejection fraction is a risk factor for adverse postoperative outcomes, its ability to predict challenging cardiopulmonary bypass (CPB) separation remains limited. We aimed to determine whether preoperative left ventricular global longitudinal strain (GLS), measured with a fully automated speckle-tracking echocardiographic software (LV AutoStrain) before induction of general anesthesia, can predict challenging separation from CPB.</p><p><strong>Design: </strong>Single-center prospective observational study.</p><p><strong>Setting: </strong>Adult patients undergoing cardiac surgery with CPB.</p><p><strong>Participants: </strong>Fifty-two consecutive patients were scheduled for cardiac surgery requiring CPB, with adequate preoperative transthoracic echocardiographic windows. Patients with preoperative atrial fibrillation, inotropic and mechanical circulatory support, or mechanical ventilation were excluded.</p><p><strong>Interventions: </strong>GLS was obtained non-invasively by transthoracic echocardiography using LV AutoStrain.</p><p><strong>Measurements and main results: </strong>CPB separation was classified as easy or challenging. Compared with the easy-weaning group, patients in the challenging weaning group showed more impaired preoperative GLS values (-11.8% [IQR -14.0% to -10.3%] v -16.1% [IQR -18.6% to -15.4%]; p < .01) and longer CPB (132.5 minutes [94.0-164.0] v 100.0 minutes [69.2-132.5]; p = .036) and aortic cross-clamp times (89.0 [67.5-116.0] v 61.0 [40.0-79.0]; p = .004). On multivariable analysis adjusted for EuroSCORE II, left ventricular ejection fraction category, CPB duration, and type of surgical procedure, GLS remained the only independent predictor of challenging CPB separation (odds ratio 1.40, 95% confidence interval [CI] 1.09-1.79; p < .01). Receiver operating characteristic curve analysis showed good discrimination for challenging weaning (area under the curve 0.864, 95% CI 0.740-0.969; p < .001); the optimal threshold of -14.0% for preoperative GLS yielded 80.0% sensitivity and 90.9% specificity.</p><p><strong>Conclusion: </strong>Fully automated, operator-independent preoperative GLS was strongly and independently associated with challenging separation from CPB, with a clinically applicable threshold. GLS may represent a rapid, reproducible adjunct to perioperative risk stratification.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193834","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}