Journal of cardiothoracic and vascular anesthesia最新文献

{"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}

{"title":"A Novel Simulation-Based Approach to Enhance Anesthesiologists' Electroencephalography Training and Education.","authors":"Federico Puerta-Martinez, David Benavides-Zora, Adil Al-Karim Manji, Dario Winterton, Claudia Friedrich, Robina Matyal","doi":"10.1053/j.jvca.2025.08.041","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.041","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Perioperative electroencephalography (EEG) has expanding clinical relevance in anesthesia; however, structured, real-time EEG education remains inconsistent, leading to incomplete understanding and underutilization in practice. This article reviews the educational gap, articulates why anesthesiologists should acquire foundational competence in interpreting raw EEG and spectrograms in addition to processed indices, and proposes a simulation-based strategy to deliver standardized, hands-on training. The rationale is grounded in current practice constraints and contrasted with the trainability and clinical utility of waveform interpretation. The proposed approach uses an EEG simulator integrated with a commercial monitor to create reproducible scenarios that progress from induction to emergence and burst suppression, allowing deliberate practice, artifact recognition, and discussion of index lag and clinical implications. As supportive evidence, a one-hour faculty development session using the SEDSIM-SedLine setup elicited uniformly positive evaluations from respondents, who rated usefulness, realism, and impact on EEG interpretation at the highest level and identified priority use cases such as TIVA, select neuroanesthesia, and frail/high-risk patients. These early impressions suggest simulation can feasibly address the documented training gap and provide a scalable pathway for competency-based EEG education, while future work should formalize curricula, assessment benchmarks, and longitudinal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This article synthesizes the need for perioperative EEG education in anesthesiology, delineate the current training gap, and propose a novel simulation-based strategy to standardize and accelerate competency in raw EEG and spectrogram interpretation; secondarily, to present early user feedback from a pilot faculty session as supportive evidence for feasibility and educational value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Narrative review with a descriptive pilot educational experience using an EEG simulator integrated with a commercial anesthesia EEG monitor; immediate post-session survey for formative evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Single-center academic anesthesiology faculty development session conducted in a controlled educational environment with real-time display on a SedLine monitor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Anesthesiology faculty; fourteen completed the post-session survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;A one-hour, highly interactive simulation comprising a concise didactic review (PSI, spectral edge frequency, suppression ratio, raw EEG and DSA interpretation) followed by four guided scenarios: induction, emergence, burst suppression, and anesthetic agent effects. The format emphasized real-time interpretation, artifact awareness, index lag during state transitions, and clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements and main results: &lt;/strong&gt;Post-session survey of sati","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199506","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 American Association for Thoracic Surgery 2025 Expert Consensus Document: Management of Ebstein Anomaly in Children and Adults.","authors":"R J Ing, B McElroy, E Downs","doi":"10.1053/j.jvca.2025.09.001","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.001","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175576","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":"Changes in the Relationship Between Plasma Fibrinogen Concentration and Functional Clot Strength After Cardiopulmonary Bypass: A Retrospective Observational Study.","authors":"Yusaku Terada, Kenji Yoshitani, Masahiro Morinaga, Akito Tsukinaga, Soshiro Ogata, Satsuki Fukushima","doi":"10.1053/j.jvca.2025.08.060","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.060","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether the relationship between plasma fibrinogen concentration (Clauss method) and functional fibrinogen activity as measured by viscoelastic hemostatic assays (VHAs)- thromboelastography-derived citrated functional fibrinogen (CFF) and Quantra-derived fibrinogen contribution to clot stiffness (FCS)-changes before and after cardiopulmonary bypass (CPB).</p><p><strong>Design: </strong>A single-center retrospective observational study.</p><p><strong>Setting: </strong>Cardiovascular surgery center in Japan.</p><p><strong>Participants: </strong>208 adult patients undergoing cardiovascular surgery with CPB.</p><p><strong>Interventions: </strong>No intervention.</p><p><strong>Measurements and main results: </strong>Fibrinogen function was assessed at 3 time points: before CPB (T1), immediately after protamine administration (T2), and 1 hour later (T3). CFF (n = 170) and FCS (n = 79) values, along with plasma fibrinogen concentrations, were collected. For CFF, the regression slope against Clauss fibrinogen increased from 6.12 at T1 to 8.69 at T2 (p < 0.05), then returned to 6.58 at T3. The intercept decreased significantly at T2 (from 0.29 to -8.39), indicating enhanced clot strength per unit of fibrinogen. For FCS, the slope decreased from 1.66 at T1 to 0.61 at T2 and 0.72 at T3, and the intercept increased from -3.55 to -0.32, suggesting persistently reduced fibrinogen contribution post-CPB. Conventional tests showed prolonged prothrombin time/activated partial thromboplastin time, decreased hemoglobin and platelet counts, and elevated thrombin antithrombin complex, fibrin/fibrinogen degradation products, and D-dimer levels, indicating coagulation factor consumption and thrombin generation.</p><p><strong>Conclusions: </strong>The association between fibrinogen concentration and functional clot strength changes significantly after CPB, with contrasting trends in TEG and Quantra. These findings highlight qualitative fibrinogen alterations post-CPB, suggesting that concentration alone might not reflect true coagulative function.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228535","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":"\"Right Ventricular Function and Echocardiographic Pressure-volume Loops\": There Is More to the Story.","authors":"Paul M Heerdt, Taro Kariya","doi":"10.1053/j.jvca.2025.08.057","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.057","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199478","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":"Extracorporeal Blood Purification with CytoSorb in Patients with Shock: A Secondary Analysis of Standalone Circuit Configuration Versus Integrated Use within Extracorporeal Membrane Oxygenation in 359 Critically Ill Patients.","authors":"Jacopo D'Andria Ursoleo, Marina Pieri, Domenico Pontillo, Alessandro Belletti, Claudia Francescon, Savino Altizio, Evgeny Fominskiy, Alberto Zangrillo, Silvia Ajello, Anna Mara Scandroglio","doi":"10.1053/j.jvca.2025.09.006","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.006","url":null,"abstract":"<p><strong>Objectives: </strong>CytoSorb, an extracorporeal blood purification device composed of biocompatible, highly porous polymer beads, is being increasingly adopted in different critically ill settings to allow for both enhanced organ protection and control of inflammation derangement. This investigation aimed to evaluate the characteristics and performances of two different CytoSorb circuit configurations to inform clinical practice.</p><p><strong>Design: </strong>We performed a secondary analysis of the largest available cohort of critically ill patients undergoing hemoadsorption with CytoSorb.</p><p><strong>Setting: </strong>Cardiac intensive care unit of a tertiary referral center university-hospital.</p><p><strong>Participants: </strong>Critically ill patients receiving CytoSorb.</p><p><strong>Interventions: </strong>CytoSorb as a standalone circuit was compared to the CytoSorb cartridge integrated within the extracorporeal membrane oxygenation (ECMO) circuit.</p><p><strong>Measurement and main results: </strong>Among the 359 patients included in the study, 148 (41%) received CytoSorb treatment with a standalone circuit and 211 (59%) had the CytoSorb cartridge integrated into the ECMO circuit. The reasons for ICU admission differed between the two groups, with patients in the ECMO group exhibiting higher inotropic load at baseline. Renal replacement therapy was administered in up to 34% of the overall population, with significantly greater use among those receiving ECMO support (p < 0.001). Across both groups, patients received a median of two CytoSorb cartridges within a single cycle, and the duration of each cartridge and CytoSorb efficacy, assessed by reduction in inotropic load and improvement in laboratory exams, were comparable in both groups. Both ICU and hospital survival were higher in patients treated with CytoSorb as a standalone circuit (54.1% v 34.1%, p < 0.001, and 49.3% v 30.8%, p < 0.001, respectively).</p><p><strong>Conclusions: </strong>CytoSorb treatment proved safe and effective in both configurations. Despite substantial intergroup diversity at baseline and in their clinical outcomes, the choice of CytoSorb configuration had no impact on cartridge performance and duration.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228603","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 Retrospective Observational Cohort Study of Ultrasound-guided Subclavian Central Venous Cannulation in Children Undergoing Cardiac Surgery.","authors":"Lior Shtayer, Jennifer M Lynch, Benjamin Kozyak, Febina Padiyath, Mark D Weber, Divya Madhusudhan, Manal Mirreh, J Nick Pratap, Matthew A Jolley, Allan F Simpao, Asif Padiyath","doi":"10.1053/j.jvca.2025.09.002","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.002","url":null,"abstract":"<p><strong>Objectives: </strong>There is currently limited data regarding the use of ultrasound (US)-guided subclavian (SC) central venous catheters (CVCs) in pediatric patients undergoing cardiac surgery. The primary aim of this study was to determine the incidence of complications associated with US-guided SC-CVC placement. The secondary aims were to identify risk factors for US-guided SC-CVC complications.</p><p><strong>Design: </strong>A retrospective, observational cohort study between 2021 and 2024.</p><p><strong>Setting: </strong>A single-center, quaternary pediatric cardiac program.</p><p><strong>Participants: </strong>A total of 93 children who underwent US-guided SC-CVC placement before cardiac surgery.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurement and main results: </strong>A total of 857 cases were screened for eligibility; 103 SC-CVCs were placed during cardiac surgery, and 93 patients met all inclusion criteria and were included in the final study cohort. No patients had documented hematoma, arterial puncture, pneumothorax, or central line-associated bloodstream infection. One patient (1.1%) had an SC-line-associated nonocclusive thrombus. Catheter malposition was noted in 8.6% (8/93) of patients, more commonly involving the catheter tip positioned in the ipsilateral internal jugular vein (5/93) or contralateral brachiocephalic vein (3/93). Multivariate logistic regression identified higher patient weight as a risk factor for catheter malposition (odds ratio: 1.09, 95% confidence interval: 1.02-1.17) while increased catheter length was a protective factor against catheter malposition (odds ratio: 0.47, 95% confidence interval: 0.27-0.82).</p><p><strong>Conclusions: </strong>In a large cohort of pediatric patients with US-guided SC-CVCs undergoing cardiac surgery, the most common complication was catheter malposition. This study suggests that US-guided SC-CVC cannulation is a feasible option for perioperative central venous access for pediatric cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244575","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":"Predicting post-cardiac surgery vasopressor use in a large, multicenter national cardiac surgical database.","authors":"Enya Martic, Mohammad Asghari-Jafarabadi, Jenni Williams-Spence, Julian A Smith, Christopher M Reid, Lavinia Tran, David Pilcher, Tim G Coulson","doi":"10.1053/j.jvca.2025.09.005","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.09.005","url":null,"abstract":"<p><strong>Objectives: </strong>To develop a model to predict post-cardiac surgery vasopressor administration and describe hospital variation in practice.</p><p><strong>Design: </strong>Retrospective analysis.</p><p><strong>Setting: </strong>Multi-institutional.</p><p><strong>Participants: </strong>All patients who underwent cardiac surgery with cardiopulmonary bypass between 2012 and 2021.</p><p><strong>Interventions: </strong>Observational.</p><p><strong>Measurements and main results: </strong>The study cohort was divided into a development set (80%) and a validation set (20%). Univariate logistic regression was used to identify variables associated with postoperative vasopressor administration. The least absolute shrinkage and selection operator was used to develop parsimonious models with variables known preoperatively only (preoperative model), as well as preoperative and immediate postoperative variables (postoperative model). Model discrimination and calibration were performed on both the development and validation sets. The study included 106,348 patients across 33 hospitals. The incidence of postoperative vasopressor administration was 29.3% (n = 31,157). Significant interhospital variability in the rate of the outcome was observed, ranging from 1.20% to 69.4% (median, 22.3%). Fixed effects models with patient and surgical variables were developed for postoperative vasopressor administration, with an area under the receiver operating curve of 0.56 and 0.60 preoperatively and postoperatively, respectively. Accounting for the hospital of admission through mixed effects multilevel modeling improved the area under the receiver operating curve to 0.75 and 0.76 preoperatively and postoperatively, respectively.</p><p><strong>Conclusions: </strong>Post-cardiac surgery vasopressor administration can only be predicted with poor to fair accuracy based on patient and surgical variables alone. Significant institutional variation in the rate of vasopressor administration exists, seemingly unrelated to measured patient and surgical factors, and predictive ability improves substantially when this is considered.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137750","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":"Obesity and Heart Failure: The (Fried) Chicken or the Egg?","authors":"Luke Foster, Kelly Byrne, Gwilym Rivett","doi":"10.1053/j.jvca.2025.08.046","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.046","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130901","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 Best to See What Needs to Be Seen? Imaging-guided Precision in Transcatheter Valve Failure.","authors":"Fabrizio Monaco, Jacopo D'Andria Ursoleo","doi":"10.1053/j.jvca.2025.08.054","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.054","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102799","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}