Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Articles to Appear in Future Issues","authors":"","doi":"10.1053/S1053-0770(25)00690-1","DOIUrl":"10.1053/S1053-0770(25)00690-1","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 10","pages":"Page xiv"},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097684","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 Phantom Mass in the Transverse Sinus.","authors":"Boran Katunaric, John R Shepherd, Lydia Duvall, Brent Boettcher","doi":"10.1053/j.jvca.2025.09.013","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.013","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206409","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":"Pain Management in Vascular Disease and Vascular Surgery.","authors":"Alan M Smeltz, James C Krakowski, Kenneth B Brown","doi":"10.1053/j.jvca.2025.09.011","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.011","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206400","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: Restrictive Transfusion Strategies Are Always Better Than Liberal Ones.","authors":"Sigismond Lasocki, Maeva Campfort, Tristan Perrault","doi":"10.1053/j.jvca.2025.09.012","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.012","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206327","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":"Peripheral Venoarterial Extracorporeal Membrane Oxygenation: A Better Pressor due to Impedance Effects.","authors":"Cameron P Upchurch, Ran Ran","doi":"10.1053/j.jvca.2025.09.018","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.018","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232671","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":"VExUS Score Is Associated with Right Ventricular-Pulmonary Arterial Coupling in Pediatric Patients Post Cardiac Surgery.","authors":"Matthew T Siuba, Philipe Rola, Korbin Haycock, Suchitra Ranjit, Rajeswari Natraj","doi":"10.1053/j.jvca.2025.09.014","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.014","url":null,"abstract":"<p><strong>Objectives: </strong>Right ventricular dysfunction occurs commonly post cardiac surgery and may be difficult to assess. The venous excess ultrasound (VExUS) score has demonstrated value in assessing solid organ congestion and prognostication in critically ill patients. We assessed the relationship between the venous excess ultrasound score and echocardiographic right ventricular-pulmonary arterial coupling, measured by the tricuspid annular plane systolic excursion-to-pulmonary artery systolic pressure ratio (TAPSE/PASP).</p><p><strong>Design: </strong>A secondary analysis of a single-center prospective observational cohort.</p><p><strong>Setting: </strong>Apollo Children's Hospital, Chennai, Tamil Nadu, India PARTICIPANTS: Patients 1 month to 17 years of age with right ventricular dysfunction admitted to the pediatric ICU immediately post cardiac surgery.</p><p><strong>Interventions: </strong>Serial echocardiographic and VExUS exams were performed on postoperative days 1-3.</p><p><strong>Measurements and main results: </strong>Forty-three patients were included in the study, with a median TAPSE/PASP of 0.17. VExUS score moderately correlated with TAPSE/PASP (r = -0.53). In a hierarchical linear regression model accounting for multiple measurements per patient, increasing the VExUS score worsened the expected TAPSE/PASP. Similar findings were demonstrated in a secondary analysis of the portal vein score to TAPSE/PASP, though the full VExUS score performed better.</p><p><strong>Conclusions: </strong>There was a moderately strong association of the VExUS score with TAPSE/PASP. This may be a useful hemodynamic monitoring modality in pediatric patients post cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206398","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":"Monitoring Oxygen Delivery During Cardiopulmonary Bypass: A Preliminary Multinational Practice Survey.","authors":"Salman Pervaiz Butt, Drisya Paul, Salman Abdulaziz, Laszlo Gobolos, Huda Alfoudri, Yusuf Bayrak, Mohamed Azzam, Ibrahim Fawzy Hassan, Arun Kumar, Fazil Ashiq, Arshad Ghori, Vivek Kakar, Umer Darr, Gopal Bhatnagar","doi":"10.1053/j.jvca.2025.09.010","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.010","url":null,"abstract":"<p><strong>Objectives: </strong>Oxygen delivery (DO₂) is a pivotal factor in maintaining adequate tissue protection during cardiopulmonary bypass (CPB). Despite its clinical significance, there is currently no global consensus regarding standardized DO₂ monitoring or threshold strategies during CPB. This study aimed to evaluate current global practices related to DO₂ monitoring during CPB and to assess awareness, implementation, and perceived clinical benefits, particularly in reducing acute kidney injury.</p><p><strong>Design: </strong>A cross-sectional international survey.</p><p><strong>Setting: </strong>Cardiac surgery centers globally, with distribution through platforms including the South West Asia and Africa Chapter of the Extracorporeal Life Support Organization.</p><p><strong>Participants: </strong>A total of 120 respondents including perfusionists, anesthesiologists, and cardiac surgeons.</p><p><strong>Interventions: </strong>Not applicable (survey-based observational study).</p><p><strong>Measurements and main results: </strong>The survey revealed 73.9% of centers actively practiced goal-directed perfusion (GDP), with significantly higher adoption in high-volume centers (>500 cases/year) (82% v 65% in low-volume centers). Monitoring methods varied, with 48.7% of respondents using continuous devices and 37.8% using intermittent calculations. For target parameters, more than 80% of respondents maintained specific DO₂ thresholds, whereas hemoglobin management most focused on 80 to 90 g/L (32.8%), and cardiac index typically ranged from 2.4 to 2.6 L/min/m² (65%). Clinical benefits include reduced acute kidney injury incidence reported by 55% of GDP users, although implementation barriers persisted, particularly financial constraints (45%) and limited resources (38%), preventing a wider adoption of continuous monitoring in resource-limited settings.</p><p><strong>Conclusions: </strong>These findings reveal significant global variability and underuse of DO₂ monitoring during CPB. Despite emerging evidence supporting the benefits of GDP strategies, widespread adoption remains limited. Cost and limited access to advanced monitoring in low-resource settings were considered the major barriers that prevented continuous monitoring of DO₂ during CPB. These insights highlight an urgent need for international guidelines and standardization to optimize patient outcomes in cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137798","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 Effect of Thoracic Paravertebral Block on Postoperative Pain After Coronary Artery Bypass Graft Surgery: A Retrospective Study.","authors":"Yilmaz Nezir, Güven Cengiz, Dağhan Abdurrahman","doi":"10.1053/j.jvca.2025.09.008","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.008","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effect of bilateral single-shot thoracic paravertebral block (PVB) on postoperative analgesia in patients undergoing coronary artery bypass grafting (CABG) surgery.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>A single tertiary university hospital.</p><p><strong>Participants: </strong>Patients who underwent elective CABG surgery.</p><p><strong>Interventions: </strong>Among 110 patients included in the study, 59 received general anesthesia alone (Group C: control group), while 51 received general anesthesia combined with a bilateral single-dose thoracic PVB (Group B: block group).</p><p><strong>Measurements and main results: </strong>Demographic characteristics, intraoperative fentanyl consumption, postoperative paracetamol requirements, and pain scores-documented in patient records using the visual analog scale at 2, 4, 16, and 24 hours-along with extubation time, intensive care unit and hospital length of stay, time to first mobilization, and time to chest drain removal were retrospectively collected and analyzed. Group B showed significantly lower intraoperative fentanyl and postoperative paracetamol use compared with Group C (p < 0.05). Visual analog scale scores were significantly lower in Group B (p < 0.05). Additionally, extubation time, intensive care unit length of stay, and time to mobilization were significantly shorter in Group B (p < 0.05). No significant differences were observed in total hospital length of stay or chest drain removal time (p > 0.05).</p><p><strong>Conclusions: </strong>Bilateral single-shot thoracic PVB may be a safe and effective adjunct to general anesthesia in patients undergoing CABG surgery. In this retrospective study, PVB was associated with superior analgesia, decreased opioid consumption, and improved early recovery parameters. These findings support the integration of PVB into multimodal analgesia protocols; however, prospective randomized controlled trials are needed to validate these results.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228571","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 Impact of Prothrombin Complex Concentrate Versus Fresh Frozen Plasma for Hemorrhage Management in Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Clinical Trials.","authors":"Iago T C Grillo, Eric Katsuyama, Carolina C Aguiar, Felipe S Passos, Bianca S Costa, Ricardo E Treml, Johannes Ehler, Hristo Kirov, Torsten Doenst, Tulio Caldonazo","doi":"10.1053/j.jvca.2025.09.009","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.009","url":null,"abstract":"<p><strong>Objective: </strong>To clarify the efficacy and safety endpoints, comparing prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) for hemorrhage management in cardiac surgery.</p><p><strong>Design: </strong>Systematic review and meta-analysis of randomized clinical trials (RCTs).</p><p><strong>Setting: </strong>Tertiary care.</p><p><strong>Participants: </strong>Adult patients who developed hemorrhage related to coagulation factor deficiency during cardiac surgery.</p><p><strong>Interventions: </strong>PCC or FFP for hemorrhage management in cardiac surgery.</p><p><strong>Measurements and main results: </strong>A systematic search was conducted in PubMed, Embase, and Cochrane Library and identified RCTs comparing PCC with FFP for hemorrhage management in cardiac surgery. The primary outcome was postintervention hemoglobin levels. Secondary outcomes included 30-day mortality, transfusion requirements, adverse events, postintervention international normalized ratio, and reoperation rates. Categorical values were analyzed using risk ratios with 95% confidence intervals (CIs), whereas continuous values were compared using the mean difference and standardized mean difference with 95% CIs. Statistical analyses were conducted using R software, version 4.4.2. Four RCTs (671 patients) were included, with 343 (51.1%) patients receiving PCC. PCC was associated with higher postintervention hemoglobin levels (mean difference 1.17 g/dL, 95% CI 0.93-1.41, p < 0.01). Compared with FFP, the PCC group required fewer red blood cell transfusions at 24 hours, had reduced use of recombinant factor VII, and demonstrated improved postintervention international normalized ratio.</p><p><strong>Conclusion: </strong>In patients undergoing cardiac surgery with significant bleeding, PCC was associated with higher postintervention hemoglobin levels and reduced transfusion needs compared with FFP, without an increase in adverse events.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199548","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":"Current State of Patient Blood Management in Cardiovascular Surgery: Insights from a Survey of Leading Centers.","authors":"Arthur W Bracey, Sean G Yates, Abe DeAnda, Pratik Kothary, Ravi Joshi, Matthew A Warner, Linda J Shore-Lesserson","doi":"10.1053/j.jvca.2025.08.061","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.061","url":null,"abstract":"<p><strong>Objective: </strong>To determine the state of patient blood management (PBM) practice in leading US cardiac surgery centers.</p><p><strong>Design: </strong>A survey tool addressing PBM program structure and PBM program operations was deployed. The survey also incorporated practice in managing certain case scenarios.</p><p><strong>Setting: </strong>Cardiac surgery centers.</p><p><strong>Intervention: </strong>None.</p><p><strong>Participants: </strong>The US News and World Reports 2024 top 25 cardiac surgery centers.</p><p><strong>Measurements and main results: </strong>Only 29% of sites had full-time equivalents committed to PBM. The approach to informed consent varied among sites. Most sites (54%) obtained informed consent to cover the entire hospital stay. Consent for non-emergent transfusion was obtained at 21% of sites. Preadmission anemia screening was deployed for longer than 2 weeks in 29% of sites. While many anesthesia techniques associated with blood conservation were used by the majority (e.g., acute normovolemic hemodilution 92%, retrograde autologous priming 95%), simple steps like adjusting cardiopulmonary (CPB) circuits for patient size were only offered at 43% of sites.</p><p><strong>Conclusions: </strong>Key features of well-designed PBM programs were not found in many of the surveyed programs. This audit suggests an opportunity for PBM growth across cardiovascular surgery programs.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199483","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}