Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Highlights from the American College of Cardiology and American Heart Association 2024 Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery.","authors":"Perin Kothari, Matthew W Vanneman, Christine Choi, Rachel Diehl, Vikram Fielding-Singh","doi":"10.1053/j.jvca.2025.05.014","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.014","url":null,"abstract":"<p><p>Increasing noncardiac surgery volumes globally combined with the growing prevalence of cardiovascular risk factors continues to pose a challenge for anesthesiologists caring for patients in the perioperative period. Forty-five percent of all patients >45 years old have multiple cardiovascular risk factors, with cardiovascular complications reported in three percent of surgical admissions. In 2024, the American College of Cardiology and the American Heart Association, in collaboration with several subspecialty societies, updated the 2014 guidelines on the management of cardiovascular diseases in the perioperative period for patients undergoing noncardiac surgery. Some of the topics covered include perioperative risk calculators, guidelines for diagnostic testing, perioperative considerations for cardiovascular comorbidities, management of medical therapies, and anesthetic/intraoperative management strategies. Since the guidelines are broad and detailed, this article highlights essential recommendations that are especially relevant to the busy perioperative physician.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248007","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":"Unifying Weaning Success Criteria to Bridge the Extracorporeal Membrane Oxygenation Gap: Variations in Determinants Based on Definitions of Successful Weaning.","authors":"Hibiki Serizawa, Ginga Suzuki, Saria Nishioka, Toshimitsu Kobori, Yuka Masuyama, Saki Yamamoto, Yoshimi Nakamichi, Mitsuru Honda, Yosuke Sasaki","doi":"10.1053/j.jvca.2025.05.015","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.015","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the factors contributing to the \"ECMO gap,\" the discrepancy between successful weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) and survival to hospital discharge, using different definitions of successful weaning.</p><p><strong>Design: </strong>Single-center retrospective observational study.</p><p><strong>Setting: </strong>A tertiary academic medical center intensive care unit.</p><p><strong>Participants: </strong>Patients aged ≥18 years who underwent VA-ECMO between January 2018 and June 2023. Patients who died while on ECMO were excluded. Successful weaning from ECMO was defined using two criteria: survival for 48 hours (Definition 1) and independence from mechanical circulatory support (MCS) within 30 days (Definition 2).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Multivariate logistic regression analysis was performed to identify factors associated with the ECMO gap for each definition, with Bayesian logistic regression conducted as a sensitivity analysis. Of the 130 ECMO patients, 110 were included in the analysis. Acute myocardial infarction and sepsis-induced cardiogenic shock (SICS) were associated with the ECMO gap under Definition 1. Under Definition 2, age (p = 0.04) was significantly associated with the ECMO gap,\" while SICS showed a trend toward significance (p = 0.06). Bayesian analysis supported the association between age (odds ratio [95% confidence interval]: 0.08 [0.01-0.16]) and the ECMO gap. SICS showed a possible association (odds ratio [95% confidence interval]: 3.15 [0.26-6.33]); however, the wide credible interval suggests caution in interpretation.</p><p><strong>Conclusions: </strong>The factors associated with the ECMO gap vary depending on the definition of successful weaning from ECMO. Specifically, advanced age and sepsis (eg, SICS) may hinder long-term recovery and contribute to the ECMO gap. Standardizing the definition of successful ECMO weaning is essential to improving patient outcomes and refining treatment strategies.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225530","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":"FARES-II: Plasma vs. PCC - The Hemostatic Showdown.","authors":"Julian Hubrich, Jay Saggu, Christoph G S Nabzdyk, Jakob Wollborn","doi":"10.1053/j.jvca.2025.05.011","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.011","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275040","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":"A 2024 Update From the American Society of Echocardiography: Multimodality Imaging for Patients With Left Ventricular Assist Devices and Temporary Mechanical Circulatory Support.","authors":"Stuart Sacks, Jared Feinman","doi":"10.1053/j.jvca.2025.05.012","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.012","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248003","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":"Guidelines for Randomized Trials-A Spirited Journey for Clarity and Consistency.","authors":"John G Augoustides","doi":"10.1053/j.jvca.2025.05.013","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.013","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199229","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":"Predictive Factors of Mortality in Extracorporeal Membrane Oxygenation-Assisted Patients as a Bridge to Heart Transplantation.","authors":"Carlos Domínguez-Massa, Manuel Pérez-Guillén, Iratxe Zarragoikoetxea-Jauregui, Eduardo Tébar-Botí, Salvador Torregrosa-Puerta, María José Dalmau-Sorlí, Tomás Heredia-Cambra, Audelio Guevara-Bonilla, Alejandro Rincón-Almanza, Raquel López-Vilella, Ricardo Gimeno-Costa, Juan Bautista Martínez-León","doi":"10.1053/j.jvca.2025.05.007","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.007","url":null,"abstract":"<p><strong>Objectives: </strong>To identify predictors of in-hospital mortality in patients listed for urgent heart transplantation (HT) who are supported by extracorporeal membrane oxygenation (ECMO).</p><p><strong>Design: </strong>A retrospective, observational study of ECMO use as a bridge to HT from 2007 to 2024.</p><p><strong>Setting: </strong>A single-center tertiary hospital.</p><p><strong>Participants: </strong>110 patients were included, of whom 100 underwent HT (90.9%).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The overall in-hospital mortality rate for the entire cohort was 31.8% (75 out of 110 patients survived). Among the patients who underwent HT, the in-hospital mortality rate was 25% (75 out of 100 patients survived). Multivariate analysis identified the following predictive factors for in-hospital mortality in the overall cohort: obesity, age, infection, and need for hemodialysis. In patients who underwent HT, the predictors of hospital mortality included age, need for hemodialysis, donor body mass index (BMI) < 10% (relative decrease in donor BMI < 10% compared to recipient BMI) and the requirement for invasive mechanical ventilation at the time of transplantation. Long-term mortality in HT recipients was independently predicted by age and a donor BMI < 10%.</p><p><strong>Conclusions: </strong>Mechanical assist devices, such as ECMO, are frequently used as a bridge to heart transplantation HT. Morbidity and mortality remain high in this population. In this study, the duration of ECMO did not emerge as a predictor of mortality; however, the need for hemodialysis and older age were associated with higher mortality in both the overall cohort and the transplanted patients. Donor BMI was identified as a significant predictor of mortality in both the short term and long term.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199231","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 Cardiovascular Pharmacotherapy. III. Sodium-Glucose Cotransporter Type 2 Inhibitors, Part 1: Efficacy in Heart Failure and Myocardial Infarction.","authors":"Paul S Pagel, Dustin Hang, Julie K Freed, George J Crystal","doi":"10.1053/j.jvca.2025.05.010","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.010","url":null,"abstract":"<p><p>Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of oral hypoglycemic medications used for the treatment of type 2 diabetes mellitus. Cardiovascular safety testing of these drugs unexpectedly revealed that they improve outcomes in patients with heart failure, findings that were subsequently confirmed regardless of diabetes status in randomized clinical trials. The widespread application of SGLT2 inhibitors over the past 5 years is a groundbreaking advance in heart failure pharmacotherapy. This is especially the case in those with heart failure with preserved ejection fraction, whose treatment was previously limited to symptom mitigation and lifestyle modification. Encouraging results from additional clinical trials supporting the use of these drugs in myocardial infarction have also emerged. However, these data are not as robust as those related to heart failure. This two-part article provides an overview of SGLT2 inhibitor cardiovascular pharmacology. The first part briefly describes the physiology of SGLT2, including its role in glucose regulation and the impact of its inhibition in type 2 diabetes; discusses the safety trials indicating that these drugs had previously unrecognized advantages in patients with heart failure and atherosclerotic cardiovascular disease; and reviews the major clinical trials and their substudies demonstrating the efficacy of these medications across heart failure phenotypes and in myocardial infarction.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234230","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":"Comparison of the Effects of Combined Rhomboid Intercostal and Sub-Serratus Plane Block versus Rhomboid Intercostal Block on Postoperative Analgesia in Patients Undergoing Video-Assisted Thoracoscopic Surgery for Wedge Resection.","authors":"Ferhat Üstüner, Fatma Nur Kaya, Leman Gökçenur Aydın, Seda Cansabuncu","doi":"10.1053/j.jvca.2025.05.003","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.003","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the analgesic effects of rhomboid intercostal and subserratus plane block (RISS) and rhomboid intercostal block (RIB) on postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery (VATS) for wedge resection.</p><p><strong>Design: </strong>A prospective, randomized study.</p><p><strong>Setting: </strong>A single-center tertiary surgery center.</p><p><strong>Participants: </strong>Sixty patients with American Society of Anesthesiologists class I-III undergoing VATS wedge resection.</p><p><strong>Interventions: </strong>Ultrasound-guided RIB or RISS block implementation.</p><p><strong>Measurements and main results: </strong>Patients were assigned to the RIB group or the RISS group as part of a multimodal analgesia. In addition to the blocks, multimodal analgesia consisted of paracetamol, tenoxicam, intravenous morphine via patient-controlled analgesia (PCA), and tramadol as a rescue analgesic for both groups, in accordance with the medical literature. Pain scores assessed by the visual analog scale (VAS) at rest and coughing, morphine consumption, rescue analgesic requirements, and side effects were recorded postoperatively for 48 hours. The RISS group had lower VAS scores at rest and with coughing at all time points except 12 hours (for both variables, p < 0.05 at 0 hour and p < 0.01 at 0.5, 1, 2, 4, 8, 24, and 48 hours). The first PCA demand time was significantly longer in the RISS group (p = 0.001). Morphine consumption via PCA was lower in the RISS group at all time points (p < 0.05 at 0 hours and p < 0.01 at 12, 24, and 48 hours). Recovery room stay and mobilization times also were shorter in the RISS group (p < 0.05 for both). Other parameters were similar in the 2 groups.</p><p><strong>Conclusions: </strong>In this study with a multimodal analgesic approach, RISS provided superior analgesia compared to RIB in patients undergoing VATS for wedge resection.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199228","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":"Pregnancy Anticoagulation Management in a Patient With a Mechanical Heart Valve and Heparin-induced Thrombocytopenia.","authors":"Jerome J Federspiel, Virginia Y Watkins, Sarah C Snow, Cary C Ward, Toi N Spates, Oluwatoyosi A Onwuemene, Marie-Louise Meng, Thomas L Ortel","doi":"10.1053/j.jvca.2025.05.005","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.005","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142738","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":"Still Missing the Mark? Revisiting the Role of Landmark-Based Techniques in the Era of Ultrasound-Guided Vascular Access.","authors":"Nazia Siddiqui, Ronak G Desai, Kinjal M Patel","doi":"10.1053/j.jvca.2025.05.004","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.004","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248010","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}