Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Where Is This New Murmur Coming From?","authors":"Yekaterina V Korol, Brent T Boettcher, Adam J Cambray, Paul S Pagel, Dustin Hang","doi":"10.1053/j.jvca.2026.04.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.026","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838376","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":"Artificial Intelligence in Perioperative Cardiothoracic and Vascular Practice: The Development and Deployment of Assisted and Autonomous Care Options.","authors":"John G Augoustides","doi":"10.1053/j.jvca.2026.04.019","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.019","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838297","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":"Postoperative Respiratory Support After Cardiac Surgery: The BREASE ARC International Survey.","authors":"Axel Hirwe, Nicolas Nesseler, Gudrun Kunst, Fabio Sangalli, Adrien Bouglé, Pauline Dureau","doi":"10.1053/j.jvca.2026.04.023","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.023","url":null,"abstract":"<p><strong>Objective: </strong>To describe current clinician-reported postextubation noninvasive respiratory strategies after cardiac surgery with a focus on variability across centers and emerging combined strategies.</p><p><strong>Design: </strong>Cross-sectional 25-item survey with descriptive analysis.</p><p><strong>Setting: </strong>Cardiac surgery units across Europe, North Africa, the Middle East, and South America.</p><p><strong>Participants: </strong>Ninety-two clinicians from European and French cardiothoracic anesthesia societies; 86% worked in cardiac-dedicated ICUs, 73% had >5 years of experience.</p><p><strong>Interventions: </strong>No clinical interventions were undertaken. Respondents reported institutional protocols and individual postextubation respiratory support practices.</p><p><strong>Measurements and main results: </strong>Institutional protocols were reported by 40% of respondents. Noninvasive respiratory support was used prophylactically by 77% of them, most often in high-risk patients (62%). Obesity (93%), severe chronic obstructive pulmonary disease (FEV₁ ≤50%, 93%), and obstructive sleep apnea (78%) were the main risk factors used for stratification. High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) were available in almost all units. Combination HFNO-NIV was the most frequently selected prophylactic strategy (37%) and the dominant option for established postextubation respiratory failure (54%). The duration of prophylaxis varied widely, reflecting marked heterogeneity in practice. Decisions were influenced by training and experience (63%), protocol availability, and equipment constraints.</p><p><strong>Conclusion: </strong>Postextubation respiratory practices after cardiac surgery are highly variable, with increasing adoption of combined HFNO-NIV strategies. The absence of standardized pathways contributes to inconsistency in patient selection, timing, and duration. These findings highlight the need for harmonized postoperative respiratory protocols and pragmatic multicenter trials to define optimal respiratory support strategies in cardiac surgical patients.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864105","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 of Dexmedetomidine Use With Complete Heart Block After Transcatheter Aortic Valve Replacement: A Retrospective Single-Center Cohort Study.","authors":"Eric A Fried, Yuxia Ouyang, Natalia N Egorova, Gilbert H L Tang, Matthew A Levin","doi":"10.1053/j.jvca.2026.04.012","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.012","url":null,"abstract":"<p><strong>Objectives: </strong>Complete heart block requiring permanent pacemaker (PPM) implantation is a known complication after transcatheter aortic valve replacement (TAVR). Dexmedetomidine (DEX) reduces postoperative delirium but is associated with hypotension, bradycardia, and conduction abnormalities. To date, DEX has not been implicated as an independent risk factor for PPM after TAVR. The authors hypothesized that intraoperative DEX use would increase PPM rates after TAVR.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single center from January 1, 2019, to July 1, 2025.</p><p><strong>Participants: </strong>Two thousand twenty-two TAVRs performed under monitored anesthesia care without pre-existing PPM were included.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>DEX use was categorized into 4 levels: no DEX (786 patients), low dose (<1 μg/kg, 354 patients), medium dose (1-2 μg/kg, 581 patents), and high dose (>2 μg/kg, 301 patients). DEX use was not associated with PPM at any dose: low dose, odds ratio (OR) of 0.98 (95% confidence interval [CI], 0.64-1.50; p = 0.92); medium dose, OR of 0.78 (95% CI, 0.50-1.22; p = 0.28), or high dose, OR of 1.05 (95% CI, 0.61-1.82; p = 0.85). Propensity-matched analysis demonstrated no difference in PPM rates between DEX and no-DEX (9.1% v 10.2%, p = 0.61). Higher PPM rates were observed in male patients (OR, 1.89; 95% CI, 1.36-2.64; p < 0.001), dialysis patients (OR, 2.32; 95% CI, 1.11-4.86; p = 0.025), patients with high-risk preoperative electrocardiograms (OR, 2.64; 95% CI, 1.75-3.99; p < 0.001), and patients receiving self-expanding valves (OR, 2.65; 95% CI, 1.77-3.96; p < 0.001). Larger self-expanding valves (OR, 1.25; 95% CI, 1.12-1.39; p < 0.001), post-balloon dilation (OR, 1.51; 95% CI, 1.05-2.18; p = 0.028), and ventricular valve deployment increased PPM risk, while aortic deployment reduced risk (OR, 0.96; 95% CI, 0.94-0.98; p < 0.001).</p><p><strong>Conclusions: </strong>DEX use during TAVR was not associated with increased risk of postprocedural PPM implantation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838326","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":"Impact of Restrictive Versus Liberal Oxygenation on Pulmonary Decline After Cardiac Surgery: A Substudy of the GLORIOUS Randomized Clinical Trial.","authors":"Astrid Duus Mikkelsen, Sebastian Wiberg, Hans Henrik Lawaetz Schultz, Peter Hasse Møller-Sørensen, Dan Høfsten, Lars Køber, Raphaelle Avigael Chemtob, P Cornelius Helbo Jakobsen, Jens Christian Nilsson, Christian Holdflod Møller, Christian Hassager, Jesper Kjærgaard","doi":"10.1053/j.jvca.2026.04.013","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.013","url":null,"abstract":"<p><strong>Objectives: </strong>Pulmonary dysfunction is a known complication of cardiac surgery. High fractions of inspired oxygen (FiO₂) during the critical pulmonary reperfusion phase of cardiopulmonary bypass (CPB) weaning is a proposed pathophysiological contributor yet remains sparsely investigated.</p><p><strong>Design: </strong>Predefined, exploratory substudy of the GLORIOUS randomized, clinical trial.</p><p><strong>Setting: </strong>Single tertiary center with cardiothoracic surgery expertise.</p><p><strong>Participants: </strong>Adult patients undergoing nonemergent coronary artery bypass grafting (CABG) and/or surgical aortic valve replacement.</p><p><strong>Interventions: </strong>Restrictive (FiO₂ 50%) versus liberal (FiO₂ 100%) oxygenation during CPB and the first hour after weaning or until patient transfer from the operating table. Pulmonary function (forced expired volume in 1 second [FEV₁], forced vital capacity [FVC], FEV₁/FVC, and diffusion capacity of carbon monoxide) was measured preoperatively and 3 months postoperatively.</p><p><strong>Measurements and main results: </strong>A total of 878 patients were included in the study. Postoperatively, at the 3-month mark, pulmonary function declined across all parameters in the overall study population (median FEV₁ [% predicted] by 8.3 percentage points [95% CI 6.6 to 8.3], FVC [% predicted] by 6.1 percentage points [95% CI 5.2 to 7.0], FEV₁/FVC by 1.6 percentage points [95% CI 1.0 to 2.1], and diffusion capacity of carbon monoxide [% predicted corrected] by 7.7 percentage points [95% CI 6.2 to 9.1], all p< 0.001). However, no significant between-group differences in decline were observed (all p > 0.3), including in subgroup analyses.</p><p><strong>Conclusions: </strong>While pulmonary function exhibited a mild-to-moderate decline 3 months after cardiac surgery, a restrictive (FiO₂ 50%) oxygenation strategy during CPB did not attenuate this decline compared with a liberal (FiO₂ 100%) strategy. Findings are hypothesis-generating.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838335","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":"Preoperative Iron-Deficiency Anemia and Survival After Cardiac Surgery: A Retrospective Cohort Study.","authors":"Jamal Alkadri, Maggie Chen, Keyvan Karkouti, Alexa Grudzinski, Maral Ouzounian, Fraser Rubens, Jacob Raphael, Jeannie Callum, Yulia Lin, Stuart A McCluskey, Daniel I McIsaac, Justyna Bartoszko","doi":"10.1053/j.jvca.2026.04.018","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.018","url":null,"abstract":"<p><strong>Objectives: </strong>To describe preoperative testing for iron-deficiency anemia in cardiac surgery, including its prevalence and impact on outcomes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single academic center.</p><p><strong>Participants: </strong>A total of 5,960 consecutive adults undergoing coronary artery bypass grafting (CABG), valve, or combined CABG/valve surgery, of whom 338 (5.7%) had iron-deficiency anemia, 1,918 (32.2%) had unspecified anemia, and 3,704 (62.1%) had no anemia.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Associations between preoperative iron-deficiency anemia (ferritin ≤100 µg/L or ferritin ≤300 µg/L and transferrin saturation ≤20%), survival at 30 and 365 days, and resource utilization were analyzed using Cox proportional hazards, quantile regression, and negative binomial regression. After adjustment, compared to nonanemic patients, those with iron-deficiency anemia had higher 30-day (hazard ratio [HR], 1.91; 95% confidence interval [CI], 1.22 to 2.98; p = 0.004) and 365-day mortality (HR, 2.78; 95% CI, 2.13 to 3.62; p < 0.001), longer intensive care unit (HR, 0.84; 95% CI, 0.76 to 0.94; p = 0.002) and hospital length of stay (HR, 0.75; 95% CI, 0.68 to 0.83; p < 0.001), decreased median days alive at home (-3.71; 95% CI, -7.16 to -0.27; p = 0.03), and higher risk of emergency department (ED) visits at 1 year (incident rate ratio [IRR], 1.36; 95% CI, 1.15 to 1.61; p < 0.001). Iron-deficiency anemia was also associated with higher 365-day mortality (HR, 1.48; 95% CI, 1.17 to 1.88; p = 0.001) and ED visits at 1 year (IRR, 1.26; 95% CI, 1.07 to 1.50; p = 0.007) compared to unspecified anemia.</p><p><strong>Conclusions: </strong>Among cardiac surgery patients, preoperative iron-deficiency anemia is associated with decreased survival and higher health care utilization compared to patients with no anemia and unspecified anemia.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838338","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":"How To Dose Prothrombin Complex Concentrates in Bleeding Patients After Cardiac Surgery.","authors":"Daniel Bolliger, Eckhard Mauermann, Kenichi A Tanaka","doi":"10.1053/j.jvca.2026.04.007","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.007","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815489","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":"Vasoactive-Inotropic Score in Orthotopic Liver Transplantation: A Retrospective Observational Study.","authors":"Cristian Ursella, Serena Tomasino, Francesco Meroi, Annarita Tullio, Simone Bressan, Sebastiano Di Maiolo, Davide Morgante, Riccardo Pravisani, Luca Peressoni, Andrea Saba, Manuela Lugano, Umberto Baccarani, Tiziana Bove","doi":"10.1053/j.jvca.2026.04.009","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.009","url":null,"abstract":"<p><strong>Objectives: </strong>The authors explored the potential role of the Vasoactive-Inotropic Score (VIS), calculated both intraoperatively and postoperatively, in patients undergoing orthotopic liver transplantation (OLTx). The primary outcome was the association between the VIS and the occurrence of acute kidney injury (AKI) in the first 7 postoperative days, while the secondary outcomes were the associations between the VIS and 30-day and 1-year mortality, cardiovascular events in the first 30 days after OLTx, length of mechanical ventilation, and intensive care unit (ICU) length of stay.</p><p><strong>Design: </strong>Single-center retrospective observational study.</p><p><strong>Setting: </strong>Transplant center at a tertiary referral university hospital.</p><p><strong>Participants: </strong>One hundred forty-four patients who underwent OLTx between January 2018 and November 2023.</p><p><strong>Interventions: </strong>VIS evaluation in patients undergoing OLTx.</p><p><strong>Measurements and main results: </strong>Analysis showed that postoperative VIS correlated with the incidence of AKI (odds ratio [OR], 1.06; p = 0.03). Patients with VIS > 10 had a higher risk than patients with VIS < 5 (OR, 3.63; p = 0.006). VIS correlated with 30-day mortality (intraoperative: OR, 1.06 [p = 0.001]; postoperative: OR, 1.11 [p < 0.001]) and 1-year mortality (intraoperative: OR, 1.04 [p < 0.001]; postoperative: OR, 1.08 [p < 0.001]). In addition, VIS correlated with length of mechanical ventilation (intraoperative: R = 0.27 [p = 0.001]; postoperative: R = 0.36 [p < 0.001]) and ICU length of stay (intraoperative: R = 0.18 [p = 0.03]; postoperative: R = 0.21 [p = 0.01]).</p><p><strong>Conclusions: </strong>VIS calculated in the first 24 hours after OLTx showed a significant correlation with AKI in the first 7 postoperative days. VIS, calculated either intraoperatively or postoperatively, correlated with 30-day and 1-year mortality, duration of mechanical ventilation, and ICU length of stay.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838387","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":"Comment on \"Preoperative Hematocrit Is Not Associated with Stroke After Surgery for Acute Type A Aortic Dissection\".","authors":"Ankur Sharma, Varshini Vadhithala, Arun Kumar, Sushma Verma, Sushma Narsing Katkuri","doi":"10.1053/j.jvca.2026.04.015","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.015","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838328","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":"Vasopressin and Major Adverse Kidney Events in Patients Requiring Vasopressor Support After Cardiac Surgery: A Multicenter Retrospective Cohort Study.","authors":"Kyle C White, Tim G Coulson, Ary Serpa-Neto, Mahesh Ramanan, Aidan Burrell, James McCullough, Kiran Shekar, Rahul Costa-Pinto, Stephen Whebell, Sebastiaan Blank, Andrew Udy","doi":"10.1053/j.jvca.2026.04.011","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.011","url":null,"abstract":"<p><strong>Objectives: </strong>To examine whether early vasopressin use was associated with major adverse kidney events in patients requiring vasopressor support after cardiac surgery.</p><p><strong>Design: </strong>A multicenter retrospective cohort study using inverse probability of treatment weighting with overlap weights.</p><p><strong>Setting: </strong>Four intensive care units in Queensland, Australia (2015-2021).</p><p><strong>Participants: </strong>A total of 3,753 adults admitted after cardiac surgery (coronary artery bypass grafting, valve surgery, or combined procedures) requiring 6 or more consecutive hours of vasopressor support within the first 24 hours. Patients receiving extracorporeal membrane oxygenation were excluded.</p><p><strong>Interventions: </strong>Vasopressin use within 24 hours of intensive care unit admission versus no vasopressin.</p><p><strong>Measurements and main results: </strong>The primary outcome was major adverse kidney events at 30 days, a composite of death, new renal replacement therapy, or creatinine doubling. Of 3,753 patients, 603 (16.1%) received vasopressin. After weighting, vasopressin was not associated with major adverse kidney events at 30 days (odds ratio [OR] 1.02, 95% confidence interval [CI] 0.76-1.38, p = 0.88). No differences were observed for 30-day mortality (OR 1.12, 95% CI 0.69-1.82), acute kidney injury within 7 days (OR 1.04, 95% CI 0.85-1.28), or new renal replacement therapy (OR 1.19, 95% CI 0.80-1.76). A significant interaction was observed for illness severity (p = 0.004), with a trend toward benefit in the highest-severity tertile.</p><p><strong>Conclusions: </strong>Adjunctive vasopressin use was not associated with major adverse kidney events or mortality in patients requiring vasopressors after cardiac surgery. Heterogeneity of treatment effect by illness severity warrants prospective evaluation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815514","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}