Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Preoperative C-Reactive Protein to Albumin Ratio Is Associated With Incremental Prognostic Information Beyond EuroSCORE II After Isolated Coronary Artery Bypass Surgery.","authors":"Yiğit Şahin, Dilek Yeniay","doi":"10.1053/j.jvca.2026.08.176","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.176","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the prognostic performance of the preoperative C-reactive protein to albumin ratio (CAR), systemic immune-inflammation index (SII), systemic inflammation response index, pan-immune-inflammation value (PIV), and hemoglobin-albumin-lymphocyte-platelet score for predicting mortality after isolated coronary artery bypass grafting (CABG) and to determine whether these biomarkers provide incremental prognostic value beyond European System for Cardiac Operative Risk Evaluation (EuroSCORE) II.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Setting: </strong>Single-center tertiary training and research hospital.</p><p><strong>Participants: </strong>Six hundred eighteen consecutive adults undergoing isolated CABG between January 1, 2022, and December 1, 2024, with complete 1-year follow-up.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcomes were intensive care unit mortality rate (11.8%) and 1-year all-cause mortality rate (16.2%). Among all evaluated biomarkers, CAR demonstrated the strongest prognostic performance for both outcomes and independently predicted in-hospital and 1-year mortality after adjustment for EuroSCORE II and base excess. Incorporating CAR into EuroSCORE II improved discrimination and showed favorable internally validated calibration and decision-curve net benefit within the proposed perioperative management framework, whereas the remaining inflammatory indices provided little or no incremental prognostic information. Cell count-based indices, including SII and PIV, did not demonstrate meaningful prognostic discrimination or independent associations with the evaluated mortality outcomes in the present cohort. The optimal CAR threshold was derived and evaluated within the same cohort and should therefore be considered exploratory pending external validation.</p><p><strong>Conclusions: </strong>Preoperative CAR was independently associated with both in-hospital and 1-year mortality after isolated CABG and provided incremental prognostic information beyond EuroSCORE II in the present cohort. Rather than replacing EuroSCORE II, it provides complementary prognostic information by capturing inflammatory and nutritional dimensions not represented in conventional surgical risk models. External multicenter validation is warranted before routine clinical implementation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182194","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":"Preoperative Mechanical Thrombectomy in Ischemic Stroke Complicating Acute Type A Aortic Dissection.","authors":"Charlotte Chabanol, Nicolas Chardon, Andrea Gambino, Thomas Varin, Mathilde Deblois, Rémi Schweizer, Matthias Jacquet-Lagrèze","doi":"10.1053/j.jvca.2026.09.015","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.015","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147700","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":"Postmarket Surveillance of ECMO Pump and Control Console Malfunctions: Insights from the MAUDE Database.","authors":"James C Henderson, Leon Fan, Ernesto Marin, Tony Zhu, Glenn J R Whitman, Sung-Min Cho","doi":"10.1053/j.jvca.2026.09.023","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.023","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169486","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":"Acute Kidney Injury After Cardiac Surgery: A Systematic Review of Pharmacological and Non-Pharmacological Interventions.","authors":"Filippo D'Amico, Matteo Aldo Bonizzoni, Rosario Losiggio, Niki Kaufman, Federico Mattia Oliva, Marc Vives, Tiziana Bove, Martina Baiardo Redaelli, Christian Stoppe, Alberto Zangrillo, Giacomo Monti, Giovanni Landoni","doi":"10.1053/j.jvca.2026.09.020","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.020","url":null,"abstract":"<p><strong>Objective: </strong>To identify and synthesize all randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions for the prevention of cardiac surgery‒associated acute kidney injury (CSA-AKI).</p><p><strong>Design: </strong>We performed a systematic review of RCTs evaluating pharmacological and non-pharmacological strategies. Interventions were qualitatively synthesized, and meta-analysis was performed when at least 4 RCTs were available.</p><p><strong>Setting: </strong>Hospitals.</p><p><strong>Participants: </strong>Adults undergoing cardiac surgery.</p><p><strong>Interventions: </strong>Pharmacological and non-pharmacological strategies to prevent CSA-AKI.</p><p><strong>Measurements and main results: </strong>A total of 207 RCTs, including 63,785 patients and evaluating 55 interventions, were identified. Most studies were small (median sample size 120) and single-center (76.7%) and reported neutral results (149/206), whereas 49 reported benefit and 8 reported harm. N-Acetylcysteine was the most frequently studied pharmacological intervention (19 RCTs), and remote ischemic preconditioning was the most frequently studied non-pharmacological intervention (34 RCTs). Among interventions evaluated in at least 4 RCTs were the use of dexmedetomidine (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.29-0.80), fenoldopam (OR 0.57, 95% CI 0.33-0.98), nitric oxide (OR 0.61, 95% CI 0.43-0.88), and remote ischemic preconditioning (OR 0.78, 95% CI 0.67-0.90) were associated with lower odds of CSA-AKI. Among interventions evaluated in fewer than 4 RCTs were signals of benefit reported for amino acids, atrial natriuretic peptide, goal-directed perfusion, and KDIGO-based care bundles.</p><p><strong>Conclusion: </strong>Only a limited number of interventions were associated with lower odds of CSA-AKI; these findings require cautious interpretation and confirmation in adequately powered RCTs.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167976","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":"Pseudo-Heparin Resistance in a Child on Extracorporeal Membrane Oxygenation.","authors":"Madan Mohan Maddali, Mohammed Hamed Al Ghafri, Khaled Mohamed Ali, Hajer Nasser Al Nasseri, Samiuddin Shaikh, Said Al Hanshi, Mohammed Ismail Al-Yamani","doi":"10.1053/j.jvca.2026.09.025","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.025","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147132","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":"Intravenous Immunoglobulin Administration in Cardiac Surgery, Heart Transplantation and Infective Endocarditis: A Scoping Review.","authors":"Eros Pilia, Kamil Derylo, Marcello Guarnieri, Sergej Marjanovic, Gianluca Paternoster, Gabriele Finco, Giovanni Landoni, Alessandro Belletti","doi":"10.1053/j.jvca.2026.09.021","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.021","url":null,"abstract":"<p><p>Perioperative infections are a common cause of morbidity in cardiac surgery. Intravenous immunoglobulin (IVIG) is increasingly used as a rescue treatment for septic shock. However, data on efficacy and safety in cardiac surgery patients are limited. A scoping review of available literature aimed at identifying studies investigating the use of IVIG in patients undergoing cardiac surgery or with infective endocarditis was performed. Studies reporting data on the use of IVIG in these populations were included, including case reports. Data on study design, population, control group, indications for IVIG therapy, and formulation and dose of IVIG were abstracted. Outcome data from randomized controlled trials (RCTs) were also abstracted. A total of 135 studies were identified, including 7 RCTs and 1 RCT study protocol. Most studies were performed in the setting of heart transplantation, followed by nontransplant cardiac surgery and infective endocarditis. The most common formulation was standard IVIG at a dose of 2 g/kg. Available data on the use of IVIG in cardiac surgery patients are mostly limited to the use of standard IVIG in heart transplantation recipients, and available evidence does not justify the routine use of IVIG in the cardiac surgery setting. However, in light of the strong scientific rationale supporting the use of IVIG, new high-quality RCTs enrolling a larger number of patients and following prospectively registered protocols are needed.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136670","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":"Transesophageal Echocardiography for Intraoperative Hemodynamic Assessment: A Physiology-Based, Phase-Oriented Practical Framework.","authors":"Aslıhan Aykut, Ümit Karadeniz, Muhammed Enes Aydın, Çağrı Özdemir, Burhan Dost, Gamze Talih, Zeliha Aslı Demir, Manu L N G Malbrain","doi":"10.1053/j.jvca.2026.09.014","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.014","url":null,"abstract":"<p><p>Intraoperative transesophageal echocardiography (TEE) has evolved from a diagnostic adjunct into a real-time tool supporting perioperative decision-making in cardiac surgery. Although the 2025 American Heart Association Scientific Statement and the 2025 American Society of Echocardiography updates on diastolic and right heart function introduce new parameters and severity grading relevant to intraoperative interpretation, an integrated framework linking these advances to perioperative fluid stewardship has been lacking. This review synthesizes contemporary guidelines and pertinent recent evidence into a physiology-based, phase-oriented practical framework for intraoperative TEE assessment in adult cardiac surgery. Preload assessment integrates left ventricular end-diastolic area, left ventricular outflow tract velocity-time integral dynamics, and diastolic indices and explicitly distinguishes fluid responsiveness from fluid tolerance. Afterload interpretation differentiates vascular load, mechanical obstruction, and vasoplegia. Contractility is assessed using ejection fraction and regional wall-motion analysis, with attention to discordance between global longitudinal strain and ejection fraction. Postpericardiotomy and post‒cardiopulmonary bypass physiology require phase-specific reinterpretation. Emerging measures-including left atrial reservoir strain, 3-dimensional right ventricular ejection fraction, tricuspid annular plane systolic excursion/pulmonary artery systolic pressure coupling, and end-systolic elastance-are discussed as adjuncts, though their intraoperative feasibility and validation remain limited. Many thresholds throughout are extrapolated from transthoracic or intensive care populations rather than validated for intraoperative cardiac surgical TEE. Rather than introducing new measurements, this review organizes established TEE findings into a phase-based decision structure. Each finding is linked to a specific management decision within the Resuscitation-Optimization-Stabilization-Evacuation framework, with particular attention to distinguishing fluid tolerance from fluid responsiveness. The proposed framework is conceptual and warrants prospective validation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168194","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 Preoperative Prediction Model for Acute Kidney Injury After Off-Pump Coronary Artery Bypass Grafting.","authors":"Tatsuya Kunigo, Masakiyo Hayashi, Yuta Ikeshima, Naoyuki Hirata, Shigeo Tsuchiya, Masaki Toriyabe, Kazutoshi Kasaba, Ryo Miyashita, Nao Yoshida, Masahito Omote, Sho Ohno, Yasuaki Sawashita, Tomoya Ito, Koki Nishikawa, Hitoshi Namba, Junichi Sato, Naoki Tsujiguchi, Yuji Neppu, Yusuke Yoshikawa, Shiro Hinotsu, Michiaki Yamakage","doi":"10.1053/j.jvca.2026.09.016","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.016","url":null,"abstract":"<p><strong>Objectives: </strong>Off-pump coronary artery bypass (OPCAB) is considered renal-protective; however, the incidence of acute kidney injury (AKI) remains high. Because AKI is associated with adverse outcomes, accurate prediction and prevention are essential. We developed and evaluated a preoperative prediction model for AKI after OPCAB. Model performance was also evaluated by applying the AKI model to predict renal replacement therapy (RRT).</p><p><strong>Design: </strong>Diagnostic/prognostic study.</p><p><strong>Setting: </strong>Two university hospitals and 10 tertiary care centers.</p><p><strong>Participants: </strong>A total of 1,640 OPCAB patients.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Model performance was evaluated in terms of discrimination, calibration, and net benefit. AKI occurred in 290 patients (17.7%), and RRT was required in 33 patients (2.0%). Preoperative predictors were male sex, obesity, contrast use within 7 days, diabetes, absence of aspirin therapy, anemia, and chronic kidney disease. Postoperative predictors included unplanned cardiopulmonary bypass, oliguria, and prolonged surgery. The area under the receiver operating characteristic curves (AUCs) were 0.715 for the preoperative model and 0.753 for the postoperative model (p < .001). For RRT prediction, the AUCs of the preoperative and postoperative models were 0.776 and 0.800 (p = .441), respectively. All calibration plots confirmed agreement between predicted and observed probabilities (all Hosmer-Lemeshow goodness-of-fit tests p > .05). The preoperative and postoperative models provided greater net benefit compared with previously reported models using decision curve analysis.</p><p><strong>Conclusion: </strong>We developed a preoperative AKI prediction model based solely on 7 simple variables, which demonstrated good performance comparable to models incorporating postoperative factors and was also applicable to RRT prediction.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136595","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":"Prognostic Value of Vasoactive-Inotropic Score and Inotropic Score for Mortality After Pediatric Congenital Heart Surgery:A Retrospective Cohort Study.","authors":"Selen Bozdemir, Nurgul Yurtseven","doi":"10.1053/j.jvca.2026.09.006","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.006","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the associations of admission vasoactive-inotropic score (VIS) and inotropic score (IS) with postoperative mortality and compare their incremental discrimination beyond baseline clinical and surgical risk.</p><p><strong>Design: </strong>Retrospective single-center cohort study.</p><p><strong>Setting: </strong>Pediatric intensive care unit of a tertiary referral center.</p><p><strong>Participants: </strong>Pediatric patients (<18 years) undergoing congenital heart surgery with cardiopulmonary bypass between January 2020 and September 2022. A total of 1,450 procedures in 1,324 patients were analyzed; 120 patients underwent more than 1 procedure.</p><p><strong>Interventions: </strong>No specific intervention was performed. VIS and IS were calculated from vasoactive and inotropic drug doses at the time of pediatric intensive care unit admission.</p><p><strong>Measurements and main results: </strong>Mortality occurred after 107 procedures (7.38%), representing 107 unique patients (8.1% patient-level mortality). Separate patient-clustered generalized estimating equation logistic models were adjusted for age, sex, weight, and STAT mortality category. Both VIS (odds ratio 1.126 per point, 95% confidence interval 1.101-1.151; p < .001) and IS (odds ratio 1.225, 95% confidence interval 1.177-1.274; p < .001) were independently associated with mortality. The baseline model area under the curve was 0.626 and increased to 0.869 with VIS and 0.852 with IS. The difference between the adjusted VIS and IS models was not statistically significant (Δ area under the curve = 0.017; p = .101).</p><p><strong>Conclusion: </strong>Admission VIS and IS were independently associated with postoperative mortality and improved discrimination beyond baseline risk factors. VIS was not statistically superior to IS. Both scores should be interpreted as objective measures of early postoperative cardiovascular support and illness severity rather than standalone predictive tools.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136684","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 Cardiopulmonary Bypass Duration on the Development of Postoperative Delirium in Cardiac Surgery: A Secondary Subgroup Analysis of an Observational Study.","authors":"Johanna Feggeler, Andrea Kunsorg, Markus Velten, Andreas Mayr, Maria Wittmann, Georg Baumgarten","doi":"10.1053/j.jvca.2026.08.163","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.163","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative delirium (POD) is an acute brain impairment linked to higher morbidity and mortality after surgery. This issue is especially prevalent in older cardiac surgery patients receiving cardiopulmonary bypass (CPB), who face unique pathophysiological risks and heightened POD susceptibility. Identifying risk factors is crucial for targeted prevention and therapy.</p><p><strong>Design: </strong>This investigation represents a subgroup analysis derived from a prospective observational study.</p><p><strong>Setting: </strong>In this subgroup analysis, 274 cardiac surgery patients from a prospective observational study were examined. Data collection was performed during the patients' postoperative hospital stay across 5 consecutive assessment days.</p><p><strong>Participants: </strong>A total of 274 adult patients were included in the analysis. POD was considered present if any of the following screening tools indicated delirium on at least 1 of the 5 evaluation days: Confusion Assessment Method for the ICU, Confusion Assessment Method, 4 'A's Test, or Delirium Observation Screening scale.</p><p><strong>Intervention: </strong>No intervention was performed; the study was purely observational.</p><p><strong>Measurement and main results: </strong>The incidence of POD was 50.4% in a cohort with a mean age of 70.7 years (standard deviation, 6.4 years). The regression model showed a significant effect of CPB duration category (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.12-1.75; p = 0.003) and preoperative troponin T level (OR, 1.64; 95% CI, 1.07-2.51; p = 0.024) on POD.</p><p><strong>Conclusions: </strong>This subgroup analysis examined several risk factors for POD in a cardiac surgery cohort. The duration of CPB has been shown to be a risk factor for the development of POD. This information can help identify patients at increased risk of POD during the perioperative period.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149084","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}