Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Measure Twice, Clip Once: Real-Time Assessment of Transcatheter Mitral Valve Edge-to-Edge Repair Stability.","authors":"Maciej Czarnecki, Miranda Timonen, James M McCabe, Richard Sheu","doi":"10.1053/j.jvca.2025.03.005","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.005","url":null,"abstract":"<p><p>Transcatheter edge-to-edge repair of the mitral valve is a commonly accepted therapeutic alternative for a subset of patients with symptomatic mitral regurgitation. Societal guidelines focus on the screening of patients to identify suitable candidates and evaluation of postprocedural results, including residual regurgitation and transvalvular gradient. We present a case with excellent immediate reduction of mitral regurgitation by transcatheter edge-to-edge repair, but subsequent development of single leaflet detachment that may have been prevented by intraprocedural quantitative echocardiographic assessments.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742604","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 Membrane Oxygenation in Pulmonary Embolism: Current Evidence and Evolving Data","authors":"Omar Elmadhoun MD, MPH ,&nbsp;Sarvie Esmaeilzadeh MD ,&nbsp;Michael P. Merren MD, MS ,&nbsp;Juan G. Ripoll MD ,&nbsp;Patrick M. Wieruszewski PharmD, RPh ,&nbsp;Harish Ramakrishna MD, FACC, FESC, FASE","doi":"10.1053/j.jvca.2025.02.052","DOIUrl":"10.1053/j.jvca.2025.02.052","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1556-1563"},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691846","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":"Postoperative Pain Intensity After Single-port, Double-port, and Triple-port Video-assisted Lung Lobectomy: A Three-arm Parallel Randomized Clinical Trial.","authors":"Sylweriusz Kosiński, Zbigniew Putowski, Jakub Stachowicz, Wojciech Czajkowski, Michał Wiłkojć, Mirosław Ziętkiewicz, Marcin Zieliński","doi":"10.1053/j.jvca.2025.02.051","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.051","url":null,"abstract":"<p><strong>Objective: </strong>Video-assisted thoracic surgery (VATS) has evolved from a multiport approach to a one-port approach to reduce the degree of surgical trauma. However, there is no consensus on the number of incisions leading to less postoperative pain. Early postoperative pain was compared after three technical variants of VATS lobectomy under multimodal analgesia, including thoracic epidural analgesia.</p><p><strong>Design: </strong>This study was designed as a prospective, randomized, controlled clinical trial with three parallel arms.</p><p><strong>Setting: </strong>Single-center study.</p><p><strong>Participants: </strong>A total of 112 adult patients with ASA statuses I to III who were scheduled to undergo elective VATS lobectomy for early-stage non-small cell lung cancer were enrolled.</p><p><strong>Interventions: </strong>Patients were randomly assigned to one of three groups: single-port, double-port, and triple-port VATS lobectomy. The same postoperative analgesia protocol was used in each group.</p><p><strong>Measurements and main results: </strong>The primary outcome was postoperative pain intensity at rest and when coughing within the first 72 hours after surgery. The secondary outcomes were cumulative opioid consumption and the composite rate of postoperative complications. A total of 112 patients were enrolled in the study, 91 of whom completed the study protocol. There were no significant differences between the study groups in terms of pain intensity either at rest (p = 0.319) or when coughing (p = 0.202). There was no difference in the incidence of postoperative complications.</p><p><strong>Conclusions: </strong>This study revealed no differences in pain intensity in the early postoperative period between three different technical variants of VATS lobectomy when an analgesia protocol based on thoracic epidural anesthesia was used.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742844","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":"Advancing Inclusivity in Perioperative Cardiothoracic and Vascular Clinical Trials.","authors":"Nirvik Pal, Benu Makkad, Miklos D Kertai","doi":"10.1053/j.jvca.2025.03.004","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.004","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719258","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":"Vasoplegic Syndrome in Cardiac Surgery: A Narrative Review of Etiologic Mechanisms and Therapeutic Options.","authors":"Paul Polyak, Jenny Kwak, Miklos D Kertai, James M Anton, Sherif Assaad, Michelle E Dacosta, Galina Dimitrova, Wei Dong Gao, Reney A Henderson, McKenzie M Hollon, Nathan Jones, Donna Kucharski, Yinghui Low, Allison Moriarty, Peter Neuburger, Jennie Y Ngai, Sheela Pai Cole, Amanda Rhee, Ellen Richter, Alexander Shapeton, Lauren Sutherland, Katja Turner, Alycia M Wanat-Hawthorne, Isaac Y Wu, Linda Shore-Lesserson","doi":"10.1053/j.jvca.2025.02.047","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.047","url":null,"abstract":"<p><p>Vasoplegic syndrome, a form of distributive shock that may manifest during or after cardiopulmonary bypass, is a serious complication that increases morbidity and mortality after cardiac surgery. No consensus definition exists, but vasoplegic syndrome is generally described as a state of pathologic vasodilation causing hypotension refractory to fluid resuscitation and vasopressor therapy, and resulting in organ malperfusion despite a normal or increased cardiac output. Diagnosis can be complex as there is a broad differential diagnosis for low systemic vascular resistance in the cardiac surgical patient. Interpretation of hemodynamic data can also be challenging in the setting of mixed shock states and mechanical support. This narrative review summarizes the pathophysiology of vasoplegic syndrome, the literature concerning its incidence and risk factors, the hemodynamic parameters important to the diagnosis of vasoplegic syndrome, a consensus definition of the syndrome, and a proposed goal-directed treatment framework.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742849","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":"Perioperative Bleeding Is Not an Independent Risk Factor for Acute Kidney Injury in On-pump Cardiac Surgery-A Post-hoc Analysis of a Randomized Clinical Trial.","authors":"Hanna E Vlasov, Liisa M Petäjä, Erika M Wilkman, Akseli T Talvasto, Minna K Ilmakunnas, Peter M Raivio, Seppo T Hiippala, Raili T Suojaranta, Tatu S Juvonen, Eero J Pesonen","doi":"10.1053/j.jvca.2025.03.006","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.006","url":null,"abstract":"<p><strong>Objectives: </strong>To study the association between bleeding and acute kidney injury (AKI).</p><p><strong>Design: </strong>Post-hoc study of a randomized trial of 4% albumin versus Ringer's acetate for cardiopulmonary bypass priming and perioperative volume replacement.</p><p><strong>Setting: </strong>Single-center study.</p><p><strong>Patients: </strong>1,386 on-pump cardiac surgical patients.</p><p><strong>Measurements and results: </strong>AKI was defined by the Kidney Disease: Improving Global Outcomes creatinine criteria, and bleeding by the Universal Definition of Perioperative Bleeding (UDPB) classification. With univariably independent factors, two logistic regression analyses (Model 1: AKI Risk Score, EuroSCORE II, and UDPB class; Model 2: risk scores, components of the UDPB classification, and factor VIII/von Willebrand factor concentrate) and a mediation analysis (Model 3: risk scores, UDPB class, and perioperative factors) were performed. A total of 139 (10%) patients developed AKI. In Model 1, UDPB class \"severe\" (odds ratio: 2.16, 95% confidence interval: 1.19-3.89), \"massive\" bleeding (6.78, 1.8-25.33), and AKI Risk Score (1.51, 1.29-1.78) were associated with AKI. In Model 2, AKI Risk Score (1.55, 1.33-1.82) and fresh frozen plasma transfusion (1.29, 1.06-1.58) were associated with AKI. In Model 3, the combined UDPB classes \"severe\" and \"massive\" bleeding did not have a direct effect (regression coefficient: 0.32, 95% confidence interval: -0.26 to 0.91), while mean arterial pressure (0.08, 0.003-0.21) and fluid balance (0.12, 0.17-0.27) had indirect effects on AKI.</p><p><strong>Conclusions: </strong>In on-pump cardiac surgery, perioperative bleeding was not an independent risk factor for AKI but manifested as AKI via hypotension and higher fluid balance. Prevention of bleeding may reduce AKI in cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742623","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 We Would Use Enhanced Recovery After Cardiac Surgery: What We Would Do for Ourselves During the Perioperative Period.","authors":"Crosby Culp, Michael W Manning","doi":"10.1053/j.jvca.2025.02.040","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.040","url":null,"abstract":"<p><p>Enhanced Recovery After Cardiac Surgery (ERACS) programs have grown from their humble beginnings as a \"fast-track recovery\" pathway that was first described in 1994 and have now evolved into patient-centered, multidisciplinary, multimodal, comprehensive, evidence-based bundles that standardize care and minimize variability throughout the perioperative period. Here, we use a model case, one familiar to most cardiac anesthesiologists, to describe how we would like to be managed using ERACS pathways. These are the same pathways and interventions we use almost daily in our own practices. We highlight the key pathway elements that we would want and describe the rationale behind their use, across the perioperative period, beginning with the initial consultation for surgery to the day of surgery, and into the intensive care unit and floor recovery, onward to hospital discharge.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795529","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":"Cardiogenic Shock: A Cardiac Anesthesiologist Perspective on an Ever-evolving Clinical Challenge.","authors":"Ricardo Hideo Tachibana, Daniel Bainbridge","doi":"10.1053/j.jvca.2025.02.049","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.049","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788436","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":"Pan-Immune-Inflammation Value: A Novel Biomarker for Predicting Postoperative Atrial Fibrillation in Young Patients Undergoing Off-Pump CABG","authors":"Mustafa Selcuk Atasoy MD ,&nbsp;Hakan Guven MD","doi":"10.1053/j.jvca.2025.02.050","DOIUrl":"10.1053/j.jvca.2025.02.050","url":null,"abstract":"<div><h3>Objectives</h3><div>To the best of our knowledge, the possible predictive relationship between pan-immune-inflammation value (PIV) and new-onset atrial fibrillation (AF) following off-pump coronary artery bypass grafting (CABG) has not yet been examined in the literature. Therefore, we aimed to examine whether there was a predictive relationship of PIV with new-onset AF in young patients undergoing off-pump CABG.</div></div><div><h3>Design</h3><div>A retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Tertiary referral hospital in Turkey.</div></div><div><h3>Participants</h3><div>A total of 223 young patients (age ≤50 years) undergoing off-pump CABG.</div></div><div><h3>Interventions</h3><div>The patients were categorized into two groups as AF group (n = 31) and non-AF group (n = 192). The groups were compared with regard to preoperative basic clinical features, laboratory parameters, and operative and postoperative data of patients. Following univariate analyses, logistic regression analysis was conducted to identify independent predictors of postoperative new-onset AF, and receiver-operating characteristic curve analyses were conducted to determine the optimum cut-off values of identified independent predictors. PIV measurement was the primary outcome of the study.</div></div><div><h3>Measurements and Main Results</h3><div>No significant differences were found between the groups with regard to preoperative basic clinical features and operative and postoperative data, except for length of hospital stay. There were statistically significant differences between the groups in terms of platelet, neutrophil, lymphocyte, and monocyte counts as well as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and PIV. In logistic regression analysis, PIV and NLR were detected to be significant hematological variables, and thus these indices were considered independent predictors of postoperative new-onset AF (odds ratio 1.001, 95% CI 1.000-1.002 for PIV). Receiver-operating characteristic analysis revealed that for predicting postoperative AF, PIV of 307.9 constituted the optimum cut-off value with 93.5% sensitivity and 71.4% specificity rates.</div></div><div><h3>Conclusion</h3><div>Our study demonstrated for the first time in the literature that the PIV and the NLR significantly and independently predicted new-onset AF following off-pump CABG.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1464-1471"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709870","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 Femoral Extracorporeal Membrane Oxygenation Cannulation Using an Ilioinguinal Block for Lung Transplantation Recipients With Severe Pulmonary Hypertension","authors":"J.J. Duijghuisen MD ,&nbsp;M.E. Hellemons MD, PhD ,&nbsp;M. ter Horst MD, PhD","doi":"10.1053/j.jvca.2025.03.007","DOIUrl":"10.1053/j.jvca.2025.03.007","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 6","pages":"Pages 1522-1525"},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691851","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}