Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Pulmonary Hemorrhage During Pulmonary Artery Stenting Necessitating Venovenous Extracorporeal Membrane Oxygenation","authors":"Tyler E. Powell MD , Theodore O. Loftsgard APRN, CNP , Arnoley S. Abcejo MD , Omar Elmadhoun MD, MPH","doi":"10.1053/j.jvca.2024.11.007","DOIUrl":"10.1053/j.jvca.2024.11.007","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 489-491"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769198","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":"Inhaled Nitric Oxide Therapy Is Associated With a Low Prevalence of Postoperative Delirium Among Patients Who Undergo Aortic Arch Surgery: A Propensity Score Matching Analysis","authors":"Kimito Minami MD, PhD , Tatsutoshi Shimatani MD, PhD , Yosuke Inoue MD, PhD , Hitoshi Matsuda MD, PhD , Muneyuki Takeuchi MD, PhD","doi":"10.1053/j.jvca.2024.11.031","DOIUrl":"10.1053/j.jvca.2024.11.031","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 552-554"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791759","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":"Personalizing Permissive Hypercapnia in Acute Severe Respiratory Failure","authors":"Vasileios Zochios MD , Hakeem Yusuff MBBS , Matthieu Schmidt PhD","doi":"10.1053/j.jvca.2024.12.005","DOIUrl":"10.1053/j.jvca.2024.12.005","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 355-359"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894762","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 Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part II: Cardiac Transplantation","authors":"Elizabeth Ungerman MD, MS ,&nbsp;Oriana C. Hunter MD, PhD Procirca MCS ,&nbsp;Arun L. Jayaraman MD, PhD ,&nbsp;Swapnil Khoche MBBS ,&nbsp;Steven Bartels MD ,&nbsp;Robert M. Owen MD ,&nbsp;Klint Smart MD ,&nbsp;Heather K. Hayanga MD, MPH, FASE, FASA ,&nbsp;Bhoumesh Patel MD ,&nbsp;Alice M. Whyte MBBS ,&nbsp;Joshua Knight MD ,&nbsp;T. Everett Jones MD ,&nbsp;S. Michael Roberts DO, FASE ,&nbsp;Ryan Ball MD, MBA ,&nbsp;Marguerite Hoyler MD ,&nbsp;Theresa A. Gelzinis MD","doi":"10.1053/j.jvca.2024.10.026","DOIUrl":"10.1053/j.jvca.2024.10.026","url":null,"abstract":"<div><div>These highlights focus on research published in the year 2022 and is divided into preoperative, intraoperative, and postoperative sections. The preoperative section includes research on the assessment and optimization of candidates for heart transplantation; donor optimization and the use of extended donors; organ protection systems; donation after circulatory death allografts; recipient factors including cannabis use, sex, race, and comorbidities such as obesity, diabetes mellitus, and peripartum cardiomyopathy; the effects of the 2018 heart allocation policy change on waitlist and postoperative mortality; updates on heart transplantation in patients with coronavirus disease 2019; in pediatric patients; and those who require a bridge to transplant. The intraoperative section includes the use of a multidisciplinary team, a proposed transfusion algorithm, bench surgery on the allograft, and size matching. The postoperative section focuses on the research on the development and management of tricuspid regurgitation, echocardiography, arrhythmia management, and, finally, xenotransplantation.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 364-397"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prebypass Critical Closing Pressure Predicts Acute Kidney Injury After Cardiopulmonary Bypass","authors":"Brian C. Ayers MD, MBA ,&nbsp;Raimon Padrós-Valls MS ,&nbsp;Sarah Brownlee MD ,&nbsp;Benjamin S. Steinhorn MD, PhD ,&nbsp;Kenneth Shann CCP ,&nbsp;Asishana Osho MD ,&nbsp;Thoralf M. Sundt MD ,&nbsp;Aaron D. Aguirre MD, PhD","doi":"10.1053/j.jvca.2024.11.010","DOIUrl":"10.1053/j.jvca.2024.11.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Optimal blood pressure goals during cardiopulmonary bypass (CPB) remain uncertain and new metrics to individualize perfusion targets are needed. Critical closing pressure (Pcrit) is a fundamental property of the arterial circulation related to vascular tone and represents the outflow pressure impacting flow across the systemic circulation. We examined Pcrit as a prognostic marker of acute kidney injury (AKI).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Single tertiary care hospital</div></div><div><h3>Participants</h3><div>We included 1,038 adult cardiac surgery patients who underwent CPB.</div></div><div><h3>Interventions</h3><div>Pcrit was calculated using arterial waveform data before initiation of CPB. Pcrit was examined in relation to incidence of stage 2 or higher postoperative AKI according to standard Kidney Disease Improving Global Outcomes definitions.</div></div><div><h3>Measurements and Main Results</h3><div>Of the 1,038 patients included in the study, 50 (5%) experienced AKI. Patients who suffered AKI had significantly higher preoperative risk factors, including higher incidence of severe chronic kidney disease and higher Society of Thoracic Surgeons risk score (p &lt; 0.01). They also had longer operative times and longer cross-clamp times (p &lt; 0.01). All patients were maintained at similar mean arterial pressure while on CPB. Patients who suffered AKI had a significantly higher prebypass Pcrit than those who did not (49.0 mmHg vs 44.1 mmHg; p = 0.018). In a multivariate regression, Pcrit remained a significant predictor, representing a 16% increased risk of AKI for each 5 mmHg increase in prebypass Pcrit (p = 0.011).</div></div><div><h3>Conclusions</h3><div>A higher prebypass Pcrit is associated with a significantly higher incidence of postoperative AKI. Future study is warranted to investigate using intraoperative Pcrit to determine a personalized blood pressure goal during CPB.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 437-446"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791811","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":"Outcomes in Women Undergoing Coronary Artery Bypass Grafting: Analysis of New Data and Operative Trends","authors":"Sarvie Esmaeilzadeh MBBCh,&nbsp;Nathan Vinzant MD,&nbsp;Harish Ramakrishna MD, FACC, FESC","doi":"10.1053/j.jvca.2024.10.031","DOIUrl":"10.1053/j.jvca.2024.10.031","url":null,"abstract":"<div><div>In 2019, coronary artery bypass grafting (CABG) made up more than one-half of all adult cardiac surgical procedures in the United States, with an estimated 301,077 procedures performed, of which 161,816 were isolated CABG, and approximately 25% of which were performed in women. Women undergoing CABG are statistically more likely to present for surgery at an older age, with a greater burden of comorbidities such as diabetes and hypertension, and in decompensated clinical states (eg, acute myocardial infarction or cardiogenic shock) versus their male counterparts. However, sex has been shown to be an independent risk factor for worse outcomes even when controlling for these differences.</div><div>Although evidence has long suggested that women seem to be at significantly increased risk of adverse perioperative outcomes and worse long-term outcomes, overall trends for patients undergoing CABG in the United States (US) have improved over the last decades. Despite this, the recent evidence from Gaudino et al⁵ suggests that the outcomes gap between men and women has not improved. In their cohort study examining 1,297,204 patients undergoing isolated CABG from 2011 to 2020 in the US, women had a higher unadjusted risk of operative (30-day) morbidity and mortality, with no signs of improvement in this gap over the study period, suggesting that a greater understanding of and attention to sex-based outcomes in CABG operations are warranted. A thorough understanding of this discrepancy and the possible contributing factors is essential to improving outcomes for women undergoing CABG.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 532-537"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639178","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":"Termination of Ventricular Septal Defect Device Closure Due to an Insurmountable Obstruction","authors":"Madan Mohan Maddali MD ,&nbsp;Swaroopa Ghatnatti MD ,&nbsp;Salim Nasser Al-Maskari FRCPCH","doi":"10.1053/j.jvca.2024.11.011","DOIUrl":"10.1053/j.jvca.2024.11.011","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 546-548"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739764","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":"Association Between Pulmonary Artery Pulsatility Index and Radial Artery Pulse Pressure and Successful Separation from Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation: A French Single-Center Retrospective Study From 2017 to 2021","authors":"Viet-Dung Duong MD ,&nbsp;Chadi Aludaat MD ,&nbsp;Geoffrey Kouadri MD ,&nbsp;Vincent Scherrer MD ,&nbsp;Thomas Clavier MD, PhD ,&nbsp;Zoe Demailly MD ,&nbsp;Vincent Compère MD, PhD ,&nbsp;Nathalie Rey MD ,&nbsp;Jean Selim MD, PhD ,&nbsp;Emmanuel Besnier MD, PhD","doi":"10.1053/j.jvca.2024.11.013","DOIUrl":"10.1053/j.jvca.2024.11.013","url":null,"abstract":"<div><h3>Objective</h3><div>Few reliable tools exist to predict weaning patient outcomes from venoarterial extracorporeal membrane oxygenation (ECMO; VA-ECMO). Pulmonary artery pulse pressure indexed on right atrial pressure (PAPi) reflects the ventricle-pulmonary coupling and may be representative of right ventricular recovery. Radial artery pulse pressure (rPP) may be representative of left ventricular recovery. We intended to explore the usefulness of these indices in the weaning from VA-ECMO.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Single center in a tertiary university hospital.</div></div><div><h3>Participants</h3><div>Patients benefiting from a VA-ECMO for all-cause refractory cardiogenic shock between 2017 and 2021. Non-inclusion criteria were minor/pregnant patients and ECMO within 48 hours. Univariate and multivariate logistic regression analyses explored the relationship between PAPi and rPP with weaning success.</div></div><div><h3>Interventions</h3><div>We explored the association between the pulmonary artery pulse pressure indexed on PAPi, rPP, and the success of weaning from VA-ECMO.</div></div><div><h3>Measurements and Main Results</h3><div>We included 124 patients for rPP analysis and 82 patients for PAPi analysis. Higher rPP and PAPi (50.43 <em>v</em> 26.3 mmHg, p &lt; 0.001: 1.78 <em>v</em> 0.88, p &lt; 0.001, respectively) and shorter ECMO duration were associated with weaning success. Areas under ROC for rPP and PAPi were 0.85 and 0.88. The combination of rPP ≥ 40 mmHg and PAPi ≥ 1.09 predicted weaning with a sensitivity of 0.94, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of 0.84.</div></div><div><h3>Conclusion</h3><div>Higher PAPi and rPP were predictors of successful weaning from VA-ECMO in this retrospective study.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 429-436"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction of a Vendor-Independent Application for Clinical Generation of Pressure-Volume Loops from Routine Hemodynamic Data: A Methodological Exploration","authors":"Michael Vandenheuvel MD ,&nbsp;Stefaan Bouchez MD ,&nbsp;Jakob Labus MD ,&nbsp;Patrick Wouters MD, PhD ,&nbsp;Eckhard Mauermann MD, PhD","doi":"10.1053/j.jvca.2024.11.024","DOIUrl":"10.1053/j.jvca.2024.11.024","url":null,"abstract":"<div><h3>Objectives</h3><div>In the dynamic perioperative setting, changing fluid states complicate determination of ventricular function. This study evaluated the feasibility of clinical ventricular pressure-volume loop (PVL) construction using routine monitoring (echocardiography and invasive pressure monitoring). An application was developed and tested with biventricular simulated data and right ventricular (RV) clinical data.</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting</h3><div>Single center, university teaching hospital.</div></div><div><h3>Participants</h3><div>Adults requiring cardiac surgery.</div></div><div><h3>Interventions</h3><div>After code development, a simulated dataset (Harvi simulator) was used to test the application. Next, RV data from 12 consenting adult elective cardiac surgery patients were analyzed in 4 distinct physiologic settings, comparing supine baseline condition with a passive leg raise setting, during maintained elevated positive end-expiratory pressure (PEEP), and after chest wall opening.</div></div><div><h3>Measurements and Main Results</h3><div>Overall PVL feasibility combining 3 acquisitions was 97.6%. Derived PVL parameters followed expected patterns: during leg raise, end-diastolic volume (+36 ± 23%; p = 0.0054) and stroke volume (+32 ± 27%; p = 0.017) augmented with stable heart rate (HR), resulting in a trend toward increased cardiac output (+34 ± 33%; p = 0.06). PEEP resulted in a marked increase in arterial elastance (+126 ± 80%; p = 0.0000068) compared to the other conditions. Chest opening resulted in minor effects.</div></div><div><h3>Conclusions</h3><div>This study introduces a vendor-independent application to generate PVLs from routinely available clinical data. The results highlight the potential application of the pressure-volume framework in cardiovascular research and patient care. A lack of external validation must be taken into account. Further research is warranted to validate the application. The app can be accessed at <span><span>https://michael-vandenheuvel.shinyapps.io/eMv_Looper/</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 420-428"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824221","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":"Early Prone Positioning As a Rescue Therapy for Moderate-to-severe Primary Graft Dysfunction After Bilateral Lung Transplant","authors":"Nicolò Sella MD ,&nbsp;Tommaso Pettenuzzo MD ,&nbsp;Sabrina Congedi MD ,&nbsp;Maria Bisi MD ,&nbsp;Giulio Gianino MD ,&nbsp;Agnese De Carolis MD ,&nbsp;Carlo Alberto Bertoncello MD ,&nbsp;Mario Roccaforte MD ,&nbsp;Francesco Zarantonello MD ,&nbsp;Paolo Persona MD, PhD ,&nbsp;Enrico Petranzan MD ,&nbsp;Gabriella Roca MD ,&nbsp;Eugenio Biamonte MD ,&nbsp;Michele Carron MD ,&nbsp;Andrea Dell'Amore MD ,&nbsp;Federico Rea MD ,&nbsp;Annalisa Boscolo MD, PhD ,&nbsp;Paolo Navalesi MD, FERS","doi":"10.1053/j.jvca.2024.11.018","DOIUrl":"10.1053/j.jvca.2024.11.018","url":null,"abstract":"<div><h3>Objectives</h3><div>Primary graft dysfunction (PGD) affects survival after lung transplant (LT). The current hypothesis was that prone positioning (PP), proposed as a rescue maneuver to treat refractory hypoxemia due to PGD, may improve LT outcomes, especially when applied early.</div></div><div><h3>Design</h3><div>Bilateral LT recipients developing moderate-to-severe PGD within 24 hours from intensive care unit admission were enrolled. From January 2020 to November 2021, patients developing PGD after LT were turned prone between 24 and 48 hours after diagnosis, only in case of radiological or oxygenation worsening (“late PP” group). After November 2021, patients were routinely turned prone within 24 hours from PGD diagnosis (“early PP”). A propensity score–weighted analysis, adjusted for clinically relevant covariates, was applied.</div></div><div><h3>Setting</h3><div>Intensive care unit.</div></div><div><h3>Participants</h3><div>Bilateral LT recipients.</div></div><div><h3>Interventions</h3><div>Early PP, late PP, or supine position.</div></div><div><h3>Measurements and Main Results</h3><div>130 LT patients were screened and 67 were enrolled. A total of 25 (37%) recipients were treated in the supine position, 24 (36%) in early PP, and 18 (27%) in late PP. After propensity score weighting, both supine treatment (estimated effect for 1 ventilator-free day = 8.23, standard error: 2.97, p = 0.007) and early PP treatment (estimated effect = 9.42, standard error: 2.59, p &lt; 0.001) were associated with greater 28-day ventilator-free days than late PP treatment (reference). Compared with late PP, early PP was also associated with better oxygenation, driving pressure, and static respiratory system compliance. Compared with supine recipients, the early PP group showed better oxygenation at 72 hours after PGD diagnosis.</div></div><div><h3>Conclusions</h3><div>Early PP in LT recipients with moderate-to-severe PGD seems to be associated with better 28-day ventilator-free days, oxygenation, and driving pressure than late PP.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 479-488"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}