Journal of cardiothoracic and vascular anesthesia最新文献

{"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}

{"title":"Prediction of Postoperative Lung Graft Dysfunction During the Procedure: A Single-Center Cohort Study of Cystic Fibrosis Patients.","authors":"Pimnara Chuachao, Jérome Devaquet, Edouard Sage, Alexandre Vallée, Morgan Le Guen, Marc Fischler, Julien Fessler","doi":"10.1053/j.jvca.2025.04.033","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.033","url":null,"abstract":"<p><strong>Objectives: </strong>To predict severe primary graft dysfunction (PGD3) after double-lung transplantation in cystic fibrosis (CF) patients using intraoperative data.</p><p><strong>Design: </strong>A retrospective single-center cohort study.</p><p><strong>Setting: </strong>University Hospital, France.</p><p><strong>Participants: </strong>CF patients who underwent double-lung transplantation between 2012 and 2019. Patients younger than age 18 and those with multiorgan transplants, retransplantation, or intraoperative cardiopulmonary bypass were excluded.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Sixty-nine variables were recorded in real-time across the nine time-points. PGD3 occurred in 24 patients (15.5%). PGD3 WAS ASSESSED ON POSTOPERATIVE DAY 3: A logistic regression model to predict PGD3 was developed using data collected at nine predefined time-points during surgery, from start (recipient and donor variables) to finish. The model's area under the curve improved progressively during surgery, rising from 0.764 to 0.892. The optimal model incorporated five variables: three associated with reduced PGD3 risk (preoperative pulmonary hypertension, donor body mass index, and PaO₂/FiO₂ ratio at surgery's end) and two were linked to increased risk (lactate level at second pulmonary artery clamping and extracorporeal membrane oxygenation [ECMO] use at surgery's end). The risk of PGD3 increased by a factor of 11.48 (95% CI 4.48-29.39; p < 0.001) when ECMO was required at the end of surgery and by 1.29 (95% CI: 1.02-1.63; p = 0.035) for each 1 mEq/L rise in lactate concentration at time-point 7 (second pulmonary artery clamping).</p><p><strong>Conclusions: </strong>This predictive model underscores the adverse impact of sustained ECMO placed at the end of surgery and elevated intraoperative lactate levels on PGD3 risk.</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":"144142736","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":"Life-Threatening Iatrogenic Pulmonary Hemorrhage Managed with Salvage Anticoagulation-Free Venovenous Extracorporeal Membrane Oxygenation.","authors":"Aurélien Gonze, Thomas Neff, Sebahat Ocak, Benoit Robaye, Benoit Rondelet, Martial Gillet, Pierre Bulpa, Isabelle Michaux, Arnaud Robert","doi":"10.1053/j.jvca.2025.05.009","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.009","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":"144199230","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":"Left Ventricular Outpouchings Following Acute Anterior Myocardial Infarction: A Diagnostic Dilemma.","authors":"Cynthia Karam, Nancy Abou Nafeh, Marie T Aouad, Sahar Siddik-Sayyid, Roland Kaddoum, Kelly Merheb, Maher El Shami, Amro Khalili, Carine Zeeni","doi":"10.1053/j.jvca.2025.05.008","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.008","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":"144179977","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":"Articles to Appear in Future Issues","authors":"","doi":"10.1053/S1053-0770(25)00286-1","DOIUrl":"10.1053/S1053-0770(25)00286-1","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Page xiv"},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912885","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":"Rescue Transesophageal Echocardiography Matrix for In-hospital Hemodynamic Instability and Cardiac Arrest Imaging.","authors":"Andrew Peev, Alexander Fischman, Audrey Elizabeth Spelde, Emily Gordon, Samantha Stein, John G Augoustides, Stuart J Weiss, William J Vernick, Jacob T Gutsche, Asad Ali Usman","doi":"10.1053/j.jvca.2025.04.040","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.040","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248008","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}