Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Venous Pulsation Artifact and BIS-CVP Waveform Mimicry in Cardiac Surgery.","authors":"Sudarshan Setty, Lauren Barta, Benjamin Gorbaty, Vanessa Moll","doi":"10.1053/j.jvca.2026.03.052","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.03.052","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815543","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":"SEER Sonorheometry and Rotational Thromboelastometry for Heparin Monitoring in ECMO: A Prospective Pilot Study.","authors":"Philip Patrick, Patricia Kim, Jesse Qiao, Joseph Rinehart, Sean Coeckelenbergh, Kei Togashi","doi":"10.1053/j.jvca.2026.03.060","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.03.060","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838426","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":"Atrial Functional Mitral Regurgitation: Contemporary Mechanisms, Imaging, and Perioperative Implications for Cardiothoracic Anesthesiologists and Intensivists.","authors":"Juan G Ripoll, Juan P Garcia-Mendez, Jon M Christensen, Edward A Bittner, Marvin G Chang, Jamel Ortoleva, Harrison R Herrera, Jacopo D'Andria Ursoleo, Patrick M Wieruszewski, Thomas B Comfere, Harish Ramakrishna","doi":"10.1053/j.jvca.2026.04.006","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.006","url":null,"abstract":"<p><p>Secondary mitral regurgitation (MR) is associated with substantial cardiovascular morbidity and mortality. Traditionally, secondary MR has been understood primarily as a ventricular disorder caused by structural and functional abnormalities of the left ventricle. However, atrial functional mitral regurgitation (AFMR) is increasingly recognized as a distinct pathophysiological entity characterized by left atrial and mitral annular dilatation despite relatively preserved left ventricular geometry and systolic function. AFMR is commonly encountered in older patients, particularly those with chronic atrial fibrillation, heart failure with preserved ejection fraction, or both, and presents unique perioperative diagnostic and management challenges. Contemporary data further suggest that AFMR is not a single rigid phenotype, but rather a spectrum of atrial and annular remodeling with variable degrees of leaflet tethering and, in some patients, early ventricular overlap. Recent work has also shown marked variability among published AFMR definitions, with important consequences for prevalence, morphology, and prognosis. For the cardiothoracic anesthesiologist and intensivist, differentiating AFMR from classical ventriculogenic functional MR is essential because this distinction influences hemodynamic goals, volume management, and procedural planning. This review summarizes the mechanisms underlying AFMR, emphasizes the pivotal role of multimodality imaging in diagnosis, reviews current and emerging interventional strategies, and outlines practical perioperative considerations.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772286","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 Storm Behind the Shock: Thyroid Storm Presenting With Postcardiotomy Vasoplegia.","authors":"Jake Rachiele, Oscar Aljure","doi":"10.1053/j.jvca.2026.04.008","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.008","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838397","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":"Hemodynamic Response to Intubation With 4 Different Laryngoscopes in Coronary Artery Bypass Graft Surgery: A Randomized Trial.","authors":"Hasan Alp Mermer, Munise Yildiz, Mahmut Sami Tutar, Mehmet Akif Yazar, Betul Kozanhan","doi":"10.1053/j.jvca.2026.03.050","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.03.050","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether different laryngoscope types influence the hemodynamic stress response to tracheal intubation in adult patients undergoing elective coronary artery bypass graft (CABG) surgery.</p><p><strong>Design: </strong>Prospective, randomized, controlled clinical trial.</p><p><strong>Setting: </strong>University-affiliated tertiary care hospital.</p><p><strong>Participants: </strong>A total of 112 adult patients scheduled for elective CABG surgery with no anticipated difficult airway.</p><p><strong>Interventions: </strong>Patients were randomly assigned to tracheal intubation using a Macintosh laryngoscope, C-MAC videolaryngoscope, EzVision videolaryngoscope, or McGrath videolaryngoscope under a standardized deep anesthesia protocol.</p><p><strong>Measurements and main results: </strong>Hemodynamic parameters were recorded at predefined time points. The primary outcome was the hemodynamic stress response as changes in mean arterial pressure (ΔMAP) and heart rate (ΔHR) between measurements obtained after anesthesia induction but before neuromuscular blockade (T2) and those obtained 1 minute after tracheal intubation (T4). Mean ΔMAP values were 20.8 ± 19.4 mmHg in the Macintosh group, 26.3 ± 13.6 mmHg in the C-MAC group, 21.8 ± 12.4 mmHg in the EzVision group, and 28.4 ± 11.9 mmHg in the McGrath group (p = 0.168). Corresponding ΔHR values were 7.4 ± 8.2 bpm, 6.1 ± 10.6 bpm, 8.6 ± 16.4 bpm, and 7.5 ± 7.7 bpm, respectively (p = 0.844). When hemodynamic stress response was defined as an increase of ≥10 mmHg in MAP and/or ≥10 beats per minute in heart rate, its incidence was 28.5%, 37.0%, 42.8%, and 42.8% in the Macintosh, C-MAC, EzVision, and McGrath groups, respectively (p = 0.653). Intubation time differed significantly among the groups (median [interquartile range]: 15 [11-18], 19 [12-22], 22 [15-28], and 16 [12-19] seconds, respectively; p < 0.001), whereas intubation success rates and complication profiles were similar across groups.</p><p><strong>Conclusions: </strong>Videolaryngoscopes conferred no hemodynamic advantage over direct laryngoscopy during intubation in deeply anesthetized patients undergoing CABG. Adequate anesthesia depth and pharmacologic modulation likely play a more prominent role than device type in blunting intubation stress.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838308","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":"Early Postoperative Cognitive Change After Carotid Endarterectomy: A Pilot Comparison of Cervical Plexus Block and General Anesthesia With Optic Nerve Sheath Diameter Monitoring.","authors":"Oğuz Gündoğdu, Aysun Akın","doi":"10.1053/j.jvca.2026.04.003","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.003","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838269","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":"Anesthetic Management of a Patient With a Single Ventricle and Fontan Circulation Presenting for an Emergency Cesarean Birth.","authors":"Samhati Mondal, Savannah Cofer, Michael Brush, Shobana Bharadwaj, Earl Wilson, John G Augoustides, Liliane R Ernst, Rohesh J Fernando, Afif Kraitem, Marie-Louise Meng","doi":"10.1053/j.jvca.2026.04.002","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.002","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815361","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":"Shallow Probe Position During Transesophageal Echocardiography for Assessment of the Aortic Arch Branches.","authors":"Kazumasa Orihashi","doi":"10.1053/j.jvca.2026.04.004","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.04.004","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815601","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":"Impact of an Autotransfusion Device on Platelet Count and Transfusion Requirements in Cardiac Surgery: An Observational Study.","authors":"Manon Desfour, Jean-Christophe Rigal, Elodie Boissier, Guillaume Guimbretiere, Fouzia Souab, Côme Gaillard, Julien Cadiet, Manon Guibot, Bertrand Rozec, Mickael Vourc'h","doi":"10.1053/j.jvca.2026.03.053","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.03.053","url":null,"abstract":"<p><strong>Objectives: </strong>To compare postoperative platelet counts in patients in whom intraoperative cell salvage (ICS) was performed using either a centrifugation-based device (ICS-centrifugation) or a filtration-based device (ICS-filtration; Same) for red blood cell recovery from shed blood, as well as to compare the transfusion requirements and outcomes of the patients in both groups.</p><p><strong>Design: </strong>Observational, retrospective, single-center study.</p><p><strong>Setting: </strong>Academic hospital, June 2021 to May 2024.</p><p><strong>Participants: </strong>All patients admitted for scheduled cardiac surgery who had an anticipated duration of cardiopulmonary bypass ≥ 2 hours or underwent aortic arch surgery, redo or combined surgery, or multiple aorto-coronary bypasses, who had expressed their non-opposition to the use of their personal data for research purposes and for whom data collection was performed.</p><p><strong>Interventions: </strong>Red blood cell recovery from shed blood with either the ICS-centrifugation device (n = 208) or the ICS-filtration device (n = 85) according to device availability.</p><p><strong>Measurements and main results: </strong>The primary outcome was the decrease in platelet count between the preoperative and postoperative assessments. Secondary outcomes included transfusion rate, postoperative morbidity, and length of hospital stay. A total of 293 patients were included, predominantly male (81.6%); the mean age was 66.2 years. Postoperatively, the platelet count decrease was greater in the ICS-centrifugation group than in the ICS-filtration group (74.9 × 10⁹/L v 65.0 × 10⁹/L; mean difference, 9.94 [95% confidence interval, 1.99-18.58]; p = 0.02). This difference was consistent in the multivariable analysis. The number of patients receiving intraoperative or postoperative transfusion by day 28 was higher in the ICS-centrifugation group than in the ICS-filtration group (49% v 34.1%, p = 0.03). Finally, the ICS-centrifugation group presented higher overall postoperative morbidity rates than the ICS-filtration group on day 28 (16.3% v 5.9%; odds ratio, 0.32 [95% confidence interval, 0.11-0.78]; p = 0.03).</p><p><strong>Conclusions: </strong>Compared with ICS-centrifugation, ICS-filtration may offer advantages in platelet salvage for shed blood, thereby reducing transfusion requirements and related morbidity in cardiac surgery patients. These results need to be confirmed by larger randomized studies with a special focus on clinical outcomes.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815470","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":"Percutaneous Decannulation Versus Open Surgical Decannulation in Patients Weaned From Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis.","authors":"Karam R Motawea, Maria Qadri, Momen Ibrahim, Merna Abouelenien, Mohammad El Diasty, Yasir Abu-Omar, Marc Pelletier","doi":"10.1053/j.jvca.2026.03.030","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.03.030","url":null,"abstract":"<p><strong>Objectives: </strong>To compare clinical outcomes between percutaneous decannulation and conventional open surgical decannulation in patients undergoing femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO).</p><p><strong>Design and setting: </strong>A systematic review and meta-analysis were conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Web of Science, and Scopus databases were searched through January 2025 for randomized controlled trials and/or cohort studies comparing the two techniques in patients undergoing femoral VA ECMO.</p><p><strong>Participants: </strong>Only studies comparing percutaneous decannulation and conventional open surgical decannulation in adult populations undergoing femoral VA ECMO were included. Thirteen cohort studies with 1,709 patients were included in this meta-analysis.</p><p><strong>Interventions: </strong>Percutaneous decannulation and conventional open surgical decannulation in patients undergoing femoral VA ECMO.</p><p><strong>Measurements and main results: </strong>Primary outcomes included mortality and procedural success. Secondary outcomes were vascular complications, wound complications, hospital and intensive care unit length of stay, and units of red blood cell transfusion. The pooled analysis revealed no significant difference between percutaneous decannulation and open surgical conventional approaches in terms of 30-day mortality (risk ratio [RR] = 0.78, 95% confidence interval [CI] [0.59-1.04], p-value = 0.09) or procedural success (RR = 0.98, 95% CI [0.93-1.04], p-value = 0.51). The pooled effect estimate showed a significant association between percutaneous decannulation and decreased wound infection rate (RR = 0.26, 95% CI [0.14-0.48], p-value < 0.0001), delayed wound healing (RR = 0.03, 95% CI [0.0-0.24], p-value = 0.0008), open revision (RR = 0.52, 95% CI [0.28-0.95], p-value = 0.03), and amount of red blood cell transfusion (MD = -0.34 [-0.60, -0.09], p-value = 0.008) compared with the open surgical conventional approach. However, the study revealed no significant differences between the percutaneous and conventional open surgical decannulation approaches in vascular and wound complications, or in the length of intensive care unit and hospital stays.</p><p><strong>Conclusion: </strong>The study suggests no significant difference between the percutaneous and open surgical decannulation approaches in patients undergoing femoral VA ECMO with respect to 30-day mortality and procedural success. However, the percutaneous approach is associated with better results than the conventional open surgical approach, given its potential to decrease infection rates, delayed wound healing, open revision, and blood transfusions. Multicenter randomized controlled trials are warranted to confirm these findings.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838277","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}