Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"A Comprehensive Review of Left Atrial Venoarterial Extracorporeal Membrane Oxygenation.","authors":"Ahmad Jabri, Sant Kumar, Al Muthana Shadid, Harish Ramakrishna, Gennaro Giustino, Raef Ali Fadel, Brian O'Neill, Mohammad Alqarqaz, Mir Babar Basir, Pedro Engel-Gonzalez, Tiberio Frisoli, Philippe Genereux, Rodrigo Bagur, Gian Jimenez-Rodriguez, Ivan Hanson, Amr Abbas, Simon Dixon, William O'Neill, Pedro A Villablanca","doi":"10.1053/j.jvca.2025.04.036","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.036","url":null,"abstract":"<p><p>Cardiogenic shock (CS) in patients with structural heart disease (SHD) and severe valvular abnormalities poses unique challenges to traditional mechanical circulatory support (MCS) strategies, such as intra-aortic balloon pumps and ventricular assist devices. These devices may fail to address the complex interplay between ventricular unloading and systemic perfusion. Left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) incorporating left atrial (LA) drainage into the ECMO circuit to reduce left ventricular (LV) preload, mitigate pulmonary congestion, and maintain systemic perfusion. This review explores the pathophysiologic principles and clinical applications associated with LAVA-ECMO. Studies have demonstrated its efficacy in managing CS due to severe valvular disease, biventricular failure, and complex hemodynamic profiles, such as those complicated by aortic regurgitation or ventricular septal defect. Although traditional venoarterial ECMO can incorporate LA drainage, LAVA-ECMO offers distinct advantages by actively unloading the left ventricle, thereby preventing such complications as LV distension and pulmonary edema. Clinical evidence suggests its role as a bridge to definitive interventions, including transcatheter and surgical valve replacements. Despite these benefits, challenges remain, including high in-hospital mortality and complications such as bleeding. LAVA-ECMO represents a transformative advancement in MCS, offering superior hemodynamic stabilization and myocardial recovery for patients with refractory CS and severe valvular disease. Its ability to address LV unloading directly positions it as a pivotal tool in critical care and SHD management; however, significant gaps in evidence, particularly in long-term outcomes and optimal patient selection, underscore the need for further research.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127758","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":"Candidacy Decision Making for Extracorporeal Cardiopulmonary Resuscitation (ECPR): Lessons from a Single-Center Retrospective Analysis.","authors":"Jonah Rubin, Beatriz Rizkallah Alves, Eduardo M H Padrao, John Fountain, Caroline Jensen, James C Henderson, Eddy Fan, Eriberto Michel, Kamal Medlej, Jerome C Crowley","doi":"10.1053/j.jvca.2025.04.031","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.031","url":null,"abstract":"<p><strong>Objective: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used to rescue patients in cardiac arrest. However, minimal data guide candidacy decisions, and centers must develop their own initiation criteria, raising concern for inconsistent application between and even within centers. This single-center analysis of ECPR decisions was conducted to demonstrate an internal review process, identify patterns of inconsistency, and generate hypotheses for potential sources of inappropriate inconsistency and means of mitigation.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single quaternary academic center.</p><p><strong>Participants: </strong>Seventy-three patients for whom ECPR was considered between 2021 and 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Seventy-three consultations resulted in 14 candidates who underwent ECPR, 53 noncandidates, and 6 patients who achieved return of spontaneous circulation before a decision. Twenty unique contraindications were invoked across all noncandidates; the 5 most common were duration of CPR (n = 21), age (n = 17), nonshockable rhythm (n = 16), comorbidities (n = 15), and acidemia (n = 11). We identified 5 patterns of inconsistency: in (1) application of contraindications between candidates and noncandidates, (2) invoked contraindications between noncandidates, (3) application of contraindications in young and peri- and postoperative patients, (4) documentation, and (5) terminology use. We propose Domain-Based Decision-Making invoking contraindications to inform whether the patient belongs to 1 of 3 prognostic domains: (1) inability to achieve cardiovascular recovery/destination therapy or (2) meaningful neurologic recovery, or (3) ECPR technically/practically infeasible.</p><p><strong>Conclusions: </strong>We demonstrate an effective process for assessing internal candidacy decision making processes for centers performing ECPR. We identify 5 patterns of inconsistency, propose a Domain-Based Decision-Making model, and share lessons likely applicable to other centers.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078272","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 Electrophysiology: Selected Highlights from 2024.","authors":"Sophia P Poorsattar, Nicolas Kumar, Matthew W Vanneman, Daniel A Kinney, Jonathan Tang, Christina A Jelly, Natalie J Bodmer, John Bryant, Amit Bardia","doi":"10.1053/j.jvca.2025.04.032","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.032","url":null,"abstract":"<p><p>This special article marks the seventh installment in an annual series featured in the Journal of Cardiothoracic and Vascular Anesthesia. The authors extend their gratitude to Editor-in-Chief Dr. Kaplan, Associate Editor-in-Chief Dr. Augoustides, and the editorial board for the opportunity to contribute to this series, which highlights key research in electrophysiology (EP) relevant to cardiothoracic and vascular anesthesiologists. This collection of articles explores evolving perioperative EP practices, including updated guidelines and therapies for atrial and ventricular fibrillation management, innovations in cardiovascular implantable devices and wearable technologies, and the integration of artificial intelligence into EP. Implications of these advancements on anesthetic management for patients undergoing EP procedures are discussed.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293825","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":"Advances in Vascular Diseases-Translating the Latest Perspectives From Europe.","authors":"Jesse J Kiefer, John G Augoustides","doi":"10.1053/j.jvca.2025.04.027","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.027","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199227","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 to Evaluate Aortic Insufficiency: An Exercise in Machine Learning.","authors":"Alan M Smeltz, Bryant W Tran","doi":"10.1053/j.jvca.2025.04.021","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.021","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972526","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":"Concomitant Percutaneous Coronary Intervention During Transcatheter Aortic Valve Implantation: New Literature Supports Clinical Benefit.","authors":"Reed E Harvey, Andrew Disque, Sophia Poorsattar, Marisa Hernandez-Morgan, Jonathan K Ho, Jacques Neelankavil","doi":"10.1053/j.jvca.2025.04.023","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.023","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142720","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":"Cerebral Embolic Protection Devices: A Solution Searching for the Right Patient.","authors":"Peter Thomas Evans, Jamel Ortoleva, Alexander D Shapeton","doi":"10.1053/j.jvca.2025.04.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.026","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086239","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: Speckle-tracking Echocardiographic Strain Analysis of the Right Ventricle Should Be Incorporated into the Assessment of Right Ventricular Function After Left Ventricular Mechanical Support.","authors":"Ricardo Diaz Milian, Ross Renew","doi":"10.1053/j.jvca.2025.04.028","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.028","url":null,"abstract":"<p><p>Right ventricular (RV) dysfunction is a major concern in patients requiring left ventricular assist devices (LVADs). Speckle-tracking echocardiography offers superior sensitivity for RV function assessment compared with traditional methods. This article advocates for the routine integration of RV strain analysis in perioperative and intensive care unit settings to enhance early detection and management of RV dysfunction following LVAD placement.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007823","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":"Effect of Bicuspid or Tricuspid Aortic Valve on Preoperative Coagulation in Patients Scheduled for Thoracic Aortic Surgery.","authors":"Maite M T van Haeren, Caitlin Bozic, Susanne Eberl, Markus W Hollmann, Jennifer S Breel, Nimrat Grewal, Antoine H G Driessen, Alexander P J Vlaar, Marcella C A Müller, Henning Hermanns","doi":"10.1053/j.jvca.2025.04.029","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.029","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to analyze the impact of aortic valve morphology on preoperative coagulation status in patients undergoing elective thoracic aortic surgery. Preoperative ROTEM and conventional coagulation tests of patients with a bicuspid aortic valve (BAV) were compared to those with a tricuspid aortic valve (TAV).</p><p><strong>Design: </strong>An exploratory prospective observational study.</p><p><strong>Setting: </strong>Conducted in a single center.</p><p><strong>Participants: </strong>The study included 169 patients (63 BAV and 106 TAV).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Mann-Whitney U tests were conducted to compare the groups. Regression analysis was performed to evaluate the association between valve morphology and abnormal ROTEM profiles. BAV patients were on average 10 years younger and had a median aortic diameter 5 mm smaller. No significant differences were found in preoperative ROTEM values or coagulation tests between groups, except for higher D-dimers in TAV patients. Sex was a significant confounder, and aortic diameter was a significant mediator. TAV patients required more red blood cell and platelet transfusions, likely due to more preoperative antiplatelet therapy and longer cardiopulmonary bypass times. Mortality and postoperative complications were similar between groups.</p><p><strong>Conclusions: </strong>Patients with a BAV have similar preoperative coagulation profiles and postoperative outcomes as TAV patients, based on ROTEM and conventional coagulation tests. While TAV patients required more RBC and platelet transfusions, this is likely due to factors other than valve type. These findings suggest that BAV patients do not need altered coagulation management despite structural differences and endothelial dysfunction.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086243","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":"Mixed Venous Oxygen Saturation Has a Poor Association with Cardiac Index during Early Intensive Care Unit Stay after Cardiac Surgery.","authors":"Petteri Holm, Jaana M Karhu, Tiina M Erkinaro, Pasi P Ohtonen, Janne H Liisanantti, Panu Taskinen, Hanna Säkkinen, Tero I Ala-Kokko, Timo I Kaakinen","doi":"10.1053/j.jvca.2025.04.030","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.030","url":null,"abstract":"<p><strong>Objectives: </strong>Our aim was to assess the association between mixed venous oxygen saturation (SvO₂) and cardiac index (CI) among cardiac surgical patients during the initial 4 hours in the intensive care unit (ICU).</p><p><strong>Design: </strong>A single-center retrospective observational study.</p><p><strong>Setting: </strong>A tertiary-level university hospital.</p><p><strong>Participants: </strong>Adult cardiac surgical patients (N = 4,958) operated on during 2007 to 2020.</p><p><strong>Interventions: </strong>Pulmonary artery catheter (PAC) measurements of SvO₂ and CI were taken at ICU admission and 4 hours later. Linear regression was used to analyze the association between these variables.</p><p><strong>Measurements and main results: </strong>Paired CI and SvO₂ values were available from 4,958 patients. The median (interquartile range) SvO₂ was 68% (63-72%) at ICU admission and 66% (61-71%) 4 hours later. CI was 2.34 L/min/m² (2.03-2.79) at ICU admission and 2.48 L/min/m² (2.15-2.86) 4 hours later. In the entire cohort, a 10% change of SvO₂ coincided with a CI change of 0.36 L/min/m² (95% confidence interval 0.34-0.38) at ICU admission and a change of 0.33 L/min/m² (0.31-0.36) at 4 hours. In patients with SvO₂ less than 60%, the association between CI and SvO₂ weakened further.</p><p><strong>Conclusions: </strong>Factors affecting oxygen consumption and demand weaken the association between SvO₂ and CI values in the early ICU recovery phase after cardiac surgery. Therefore, SvO₂ and CI values should not be relied upon in clinical decision-making as reliable predictors of one another.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093611","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}