Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Advances in Cardiovascular Pharmacotherapy. I. Cardiac Myosin Inhibitors.","authors":"Paul S Pagel, Dustin Hang, Julie K Freed, George J Crystal","doi":"10.1053/j.jvca.2025.02.009","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.009","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy. The disease is characterized by asymmetric left ventricular (LV) remodeling with myocyte disarray and interstitial fibrosis, a hypercontractile state, dynamic subaortic obstruction of the LV outflow tract, impaired LV diastolic function, atrial and ventricular arrhythmias, and sudden cardiac death. HCM occurs as a result of pathological alterations in the cardiac myocyte's chemomechanical cycle, in which an enhanced rate of myosin-actin crossbridge formation and destabilization of the energy-conserving \"super-relaxed off-actin state\" of myosin play essential roles. For decades, management of HCM has been limited almost exclusively to medications (eg, beta-blockers, calcium channel blockers, disopyramide) and interventions (eg, septal reduction therapy, implanted cardioverter-defibrillator devices) that palliate symptoms, but do not address the disease's underlying causative mechanisms. A new class of cardiovascular medications, cardiac myosin inhibitors, has surged to the forefront of HCM treatment in recent years. These drugs, including mavacamten and aficamten, show great promise to profoundly affect the disease's clinical course. In this article, the authors review the molecular mechanisms of action of cardiac myosin inhibitors, discuss in detail the most recent data from mavacamten and aficamten clinical trials, describe future planned studies designed to address unanswered questions about their clinical utility in HCM phenotypes, and comment on their potential application to patients with other forms of heart failure with preserved ejection fraction. The possible anesthetic implications of mavacamten and aficamten are also discussed because it is highly likely that patients who are treated with these medications will begin to present for perioperative care with increasing regularity.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501268","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":"Transcatheter Repair or Surgery for Secondary Mitral Regurgitation? The MATTERHORN Question That Matters.","authors":"Asif Neil Mohammed, Miguel Abalo, Pankaj Jain","doi":"10.1053/j.jvca.2025.01.044","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.044","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663426","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":"Comparative Analysis of Percutaneous Dilatational Tracheotomy and Surgical Tracheotomy in Critically Ill Patients: Outcomes and Complications.","authors":"Şahin Temel, Hatice Metin, Mehmet Gökhan Gök, Recep Civan Yüksel, Murat Sungur, Emrah Gülmez, Gönül Sungur, Kürşat Gündoğan","doi":"10.1053/j.jvca.2025.02.008","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.008","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcomes of percutaneous dilatational tracheostomy (PDT) versus surgical tracheostomy (ST) in critically ill patients, focusing on complications, duration of mechanical ventilation (MV), intensive care unit (ICU) length of stay, and mortality.</p><p><strong>Design: </strong>Retrospective trial SETTING: Single tertiary center PARTICIPANTS: A total of 119 patients receiving invasive MV in a medical ICU INTERVENTIONS: PDT (n = 55) or ST (n = 64) methods MEASUREMENTS AND MAIN RESULTS: The 2 groups showed comparable outcomes in terms of MV duration (36 days for PDT vs 35 days for ST; p = 0.72), ICU stay (43 days for PDT vs 37 days for ST; p = 0.17), and all-cause mortality (71% for PDT vs 64% for ST; p = 0.42). PDT was associated with significantly lower rates of subcutaneous emphysema (0% vs 16%; p = 0.01). Multivariate analysis showed no statistically significant association between tracheostomy technique and ICU mortality or overall complication rates after adjustment for confounders.</p><p><strong>Conclusion: </strong>PDT and ST yield comparable outcomes in critically ill ICU patients, with no significant difference in overall complication rates or mortality. The fewer specific complications for PDT, such as subcutaneous emphysema, highlight its advantages in suitable cases. Individualized patient assessment remains crucial, and further studies are needed to refine tracheostomy practices.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483285","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":"Intraoperative Oxygenation and Microcirculatory Changes Following Off-pump Coronary Artery Bypass Grafting: An Exploratory Secondary Analysis of a Randomized Clinical Trial.","authors":"Karam Nam, Jaeyeon Chung, Jae-Woo Ju, Youn Joung Cho, Yunseok Jeon","doi":"10.1053/j.jvca.2025.01.045","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.045","url":null,"abstract":"<p><strong>Objectives: </strong>The effect of perioperative hyperoxia on microcirculation after cardiac surgery remains inconclusive. We evaluated the relationship between intraoperative fractional inspired oxygen and microcirculation after off-pump coronary artery bypass grafting (OPCAB).</p><p><strong>Design: </strong>Exploratory secondary analysis of a multicenter cluster-randomized trial.</p><p><strong>Setting: </strong>Three teaching hospitals.</p><p><strong>Participants: </strong>Adult patients who underwent OPCAB.</p><p><strong>Interventions: </strong>Seven postoperative microcirculatory parameters, including De Backer scores and the proportion of perfused vessels via sublingual microscopy (from all and small vessels), and thenar muscle tissue oxygenation, occlusion slope, and recovery slope via the vascular occlusion test, were compared between patients receiving 30% and 80% oxygen intraoperatively. Generalized estimating equations were used to account for intracluster correlation.</p><p><strong>Measurements and main results: </strong>The analysis included 52 and 51 patients from the 30% and 80% oxygen groups, respectively, for sublingual microscopy and 59 and 53 patients for the vascular occlusion test. Although all microcirculatory parameters were similar between groups, the 80% oxygen group had higher De Backer scores for all vessels (mean, 9.8 ± 2.9 mm^-1 vs. 8.7 ± 2.0 mm^-1; p = 0.011) and small vessels (4.0 ± 1.8 mm^-1 vs. 3.4 ± 1.1 mm^-1; p = 0.024) than the 30% oxygen group at the end of surgery. The 80% oxygen group also exhibited greater thenar muscle tissue oxygenation immediately before vascular occlusion (78.4% ± 10.5 vs. 74.0% ± 9.3; p = 0.031) and a higher recovery score (4.1%·s^-1 ± 1.7 vs. 3.2%·s^-1 ± 1.4; p = 0.001).</p><p><strong>Conclusions: </strong>Patients receiving 80% oxygen during OPCAB had significantly better postoperative microcirculatory profiles than those receiving 30% oxygen. These findings highlight the potential for optimizing perioperative oxygenation to improve or mitigate microcirculatory impairment, thereby reducing postoperative complications.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483286","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":"RESHAPE HF2 Trial for Mitral Valve Edge-to-Edge Repair for Mitral Regurgitation in Heart Failure: More Information Without More Clear Answers.","authors":"Walter E McGregor, Gabriele D'Orsi, Daniel S Cormican","doi":"10.1053/j.jvca.2025.02.005","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.005","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556972","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":"Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association.","authors":"Nicholas Houska, Megan Albertz, Richard J Ing","doi":"10.1053/j.jvca.2025.02.007","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.007","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458124","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 and Outcome of Catecholamine-Induced Takotsubo and Dilated Cardiomyopathy in Pheochromocytoma and Paraganglioma.","authors":"Manjiao Ma, Xiuhua Zhang, Xuerong Yu, Lulu Ma","doi":"10.1053/j.jvca.2025.02.004","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.004","url":null,"abstract":"<p><strong>Objectives: </strong>To outline and compare the clinical features, preoperative preparation, perioperative management, and outcome of Takotsubo cardiomyopathy (TCM) and dilated cardiomyopathy (DCM) associated with pheochromocytomas and paragangliomas (PPGLs).</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>A single tertiary hospital.</p><p><strong>Participants: </strong>All patients scheduled for elective surgery of PPGL resection with TCM and DCM between March 2005 and June 2023 were enrolled.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>This study enrolled 29 patients: 20 patients were in the TCM group and 9 patients were in the DCM group. The tumor size of the DCM group was bigger and the level of 24-hour urine norepinephrine was higher than those in the TCM group. After the preoperative medication preparation (111 median days) and anti-heart failure treatment (if necessary), the mean preoperative ejection fraction in the TCM group was significantly higher than that in the DCM group (66.8% ± 4.4% v 48.8% ± 7.8%, p<0.001), both elevated compared to ejection fraction at presentation (p<0.001). The intraoperative hemodynamic instability score was rather high in PPGL-TCM and PPGL-DCM patients (84.6 points), as well as in the hemodynamic variables section (13.7 points). Patients with DCM were more prone to present hemodynamic disturbances and to require a lower volume of fluids but a higher infusion of vasoactive agents than patients with TCM. The incidence of complications was 6.9% and there was no perioperative mortality.</p><p><strong>Conclusions: </strong>Following the preoperative medication preparation and anti-heart failure treatment, patients with TCM had better left ventricular recovery before surgery and fewer cardiovascular risks compared to patients with DCM. Optimal perioperative management and individualized anesthetic strategies are essential for this unique patient population.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482113","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":"Use of Hydroxycobolamin in the Prevention of Vasoplegic Syndrome in Adult Patients Undergoing Cardiopulmonary Bypass: A Controlled Prospective Trial.","authors":"Dina Salah, Sondos Ahmed, Dalia A Ibrahim","doi":"10.1053/j.jvca.2025.02.001","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We hypothesized that the prophylactic use of hydroxocobalamin in patients at high-risk patients to develop vasoplegia after cardiopulmonary bypass (CPB) may decrease its incidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This randomized placebo-controlled prospective single-center study was conducted on high-risk patients for vasoplegia who underwent coronary artery bypass grafting (CABG).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was conducted in Ain Shams University Hospitals from August 2019 to October 2023 in cardiothoracic operative rooms and its intensive care unit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Patients included in the study were 18 to 60 years old and undergoing CABG and/or valve surgery on CPB and had 2 or more preoperative risk factors for vasoplegia. They were receiving using preoperative β-blocker or angiotensin-converting enzyme inhibitor with a preoperative ejection fraction of less than 35% and a history of thyroid disease and preoperative diuretics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;At the end of CPB, the patients were assigned randomly into two groups: group I consisted of 30 patients who received hydroxocobalamin 5 g intravenously via the central venous catheter as a bolus over 15 minutes reconstituted in 200 mL of normal saline, and group II (control) consisted of 30 patients who received 200 mL of normal saline intravenously over 15 minutes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements and main results: &lt;/strong&gt;The primary outcome was the change in mean arterial pressure between baseline and all time points (30 and 60 minutes after CPB initiation and 30 and 60 minutes after CPB separation) between the two groups and within the same group. The comparison regarding the change in systemic venous resistance between baseline and all time points (30 and 60 minutes before CPB initiation and 30 and 60 minutes after CPB separation) between the two groups and within the same group is calculated. Cardiac index was calculated 30 min before CPB initiation and 30 min after CPB separation. Doses of norepinephrine and its equivalent, incidence of vasoplegic shock syndrome, serum lactate, number of ventilator days, intensive care unit length of stay, hospital length of stay, incidence of norepinephrine-resistant refractory vasoplegia, acute kidney injury, shock liver and mortality in 1 week were calculated. Results showed that mean arterial pressure and systemic venous resistance at minutes 30 and 60 after CPB separation was significantly higher in group I compared to group II. Cardiac index was significantly lower in group I compared to group II. Norepinephrine requirements (µg/kg/min) at minutes 30 and 60 after CPB separation as well as average total dose norepinephrine equivalent were significantly lower in group I. Serum lactate was also found to be significantly lower in group I. Incidence of vasoplegic shock syndrome, norepinephrine-resistant refractory vasoplegia, number of ventilator days, intensive care unit length of","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585696","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: The Patient With the Recent Intake of DOACs Problems Are Solved With the Approval of Reversal Agents.","authors":"Eleni Arnaoutoglou, Maria P Ntalouka","doi":"10.1053/j.jvca.2025.02.002","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.002","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472466","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":"CON: Quantitative Neuromuscular Monitoring Is Required When Sugammadex Is Used for Reversal of Neuromuscular Blockade.","authors":"Emily Lachmann, Kunal Karamchandani","doi":"10.1053/j.jvca.2025.02.003","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.003","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458079","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}