Journal of cardiothoracic and vascular anesthesia最新文献

{"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":"Perceptions, Definitions, and Preparedness Regarding Low-Performing and Impaired Colleagues in Cardiothoracic and Vascular Anesthesia: An International Survey.","authors":"Evangelia Samara, Mona Momeni, Agathi Karakosta, Anna Smyrli, Konstantina Kolonia, Petros Tzimas, Jiapeng Huang, Vojislava Neskovic, Manuel Granell Gil, Gianluca Paternoster, Abdelazeem Eldawlatly, Mikhail Kirov, Evgeny Grigoryev, Hushan Ao, Davy Cheng, Fawzia Aboulfetouh, Eric Benedet Lineburger, Jakob Wittenstein, Mert Senturk, Zerrin Sungur, Abdulaziz Ahmad, Xiaojie Liu, Carolina Baeta Neves Duarte Ferreira, Fabio Guarracino, Ueda Kenichi, Laszlo L Szegedi, Mina Tharwat Fouad Beshara, Marc Vives, Priya Ramachandran Menon, Mohamed R El Tahan","doi":"10.1053/j.jvca.2025.08.055","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.055","url":null,"abstract":"<p><strong>Objective: </strong>To define low-performing colleagues in cardiothoracic and vascular anesthesia (LPC-CTVA), evaluate institutional preparedness to identify and manage such individuals, and identify predictors of recognition, reporting, and response behaviors.</p><p><strong>Design: </strong>International cross-sectional survey.</p><p><strong>Setting: </strong>Web-based data collection from June to September 2024.</p><p><strong>Participants: </strong>Of 878 responses, 537 (61.2%) were complete and analyzed, representing 57 countries.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A 43-item questionnaire was developed by a multidisciplinary team and distributed via professional societies, social media, and email. It assessed definitions of LPC-CTVA, institutional protocols, and preparedness to address underperformance. Consensus was defined as ≥70% agreement. Thirteen of the 18 statements met consensus. Common indicators included non-compliance with infection control (80.0%), outdated knowledge (80.3%), repeated procedural failures (80.0%), and persistent negligence (79.1%). Institutional support was limited: among 464 respondents, 22.2% reported active supervision for underperformance, 15.3% reported the presence of identification mechanisms, and 11.7% indicated the existence of formal management processes. Although 39.9% of 434 had encountered a low-performing colleague, only 23.1% of 447 had reported one. Preparedness to manage impaired colleagues was reported by 46.2% of 418 respondents, and preparedness to manage underperforming colleagues by 44.1% of 416 respondents. Key barriers included the belief that others would act (33.7% of 265), perceived ineffectiveness (28.3%), and fear of retaliation (21.9%). Preparedness was more prevalent among older, more experienced clinicians, those in leadership roles, and those with prior experience in reporting.</p><p><strong>Conclusions: </strong>A consensus-based definition of LPC-CTVA has been established. However, institutional readiness and clinician confidence remain limited. Experience and structured systems enhance response capability.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251215","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}

{"title":"Perioperative Renal Perfusion Pressure Deficits and Risk of Acute Kidney Injury in Cardiac Surgery: A Pilot Study Using Right Heart Catheterization (PRO-AKI).","authors":"Ankur Srivastava, Ryan Price, Maria Fernandez, Mohit Aspal, Sanya Rastogi, Avika Kasubhai, Emily Eruysal, Sagar Navare, Berhane Worku, Christopher Lau, Brady Rippon, Stuart Saal, Natalia Girardi, James Osorio","doi":"10.1053/j.jvca.2025.08.043","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.043","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between postoperative renal perfusion pressure (RPP) deficit and acute kidney injury (AKI) after cardiac surgery.</p><p><strong>Design: </strong>A retrospective case-control pilot study.</p><p><strong>Setting: </strong>A single academic medical center.</p><p><strong>Participants: </strong>Data were collected from 486 patients who underwent cardiac surgery requiring cardiopulmonary bypass from July 2018 to March 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Preoperative hemodynamics, including (RPP = mean arterial pressure (MAP) - central venous pressure (CVP), which was obtained via right heart catheterization. Postoperative RPP, MAP, and CVP were tracked from postoperative days 0 to 4 and analyzed as percent deficits from preoperative baseline. The primary outcome was AKI progression using the Kidney Disease: Improving Global Outcomes score, and secondary outcomes included adverse events. Among 486 patients, 70 (14.4%) developed AKI. Compared with patients without AKI (416, 85.6%), patients with AKI had a higher percent deficit in RPP (23% v 16%, p < 0.001) and MAP (15% v 8%, p < 0.001). A 10% decrease in average RPP and MAP was associated with a 46% (odds ratio: 1.46, 95% confidence interval: 1.03-2.10, p < 0.036) and 42% (odds ratio: 1.42, 95% confidence interval: 1.16-1.75, p < 0.001) increase in odds of AKI, respectively, adjusted for preoperative hemodynamics and AKI risk factors.</p><p><strong>Conclusions: </strong>Greater postoperative decreases in RPP and MAP from preoperative baseline were independently associated with increased AKI risk after cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131027","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 Rotated Aortic Root: A Hidden Anatomical Variant Revealed by Three-dimensional Echocardiography.","authors":"Usman Ahmed, Fatima Noor, Siraj Ahmad, Aidan Sharkey, Mark Robitaille, Feroze Mahmood","doi":"10.1053/j.jvca.2025.08.056","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.056","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131047","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":"Pulsus Bisferiens as a Sign of Left Ventricular Outflow Tract Obstruction Due to Systolic Anterior Motion of the Mitral Valve Following Mitral Valve Repair.","authors":"Jordan Holloway, Cassidy Wernke, Courtney Vidovich, Michael Essandoh","doi":"10.1053/j.jvca.2025.08.059","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.059","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137746","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":"Efficacy and Safety of Pulmonary Vasodilator and Inodilator Drugs in Congenital Heart Disease Surgery: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Martina Ollosu, Vincenzo Francesco Tripodi, Carlotta Aresu, Giammarco Ledda, Francesca Manai, Chiara Marini, Mario Musu, Mariachiara Ippolito, Andrea Cortegiani, Gabriele Finco, Salvatore Sardo","doi":"10.1053/j.jvca.2025.08.053","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.053","url":null,"abstract":"<p><strong>Background: </strong>Perioperative management of congenital heart disease (CHD) surgery presents a unique challenge due to significant pathophysiological alterations, with pulmonary hypertension contributing substantially to morbidity and mortality. Although pulmonary vasodilators and inodilators are commonly used, evidence of their efficacy and safety remains limited.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and safety of vasodilators and inodilators in pediatric patients undergoing CHD surgery.</p><p><strong>Design: </strong>Systematic review with network meta-analysis.</p><p><strong>Data sources: </strong>PubMed, CENTRAL, and Embase.</p><p><strong>Eligibility criteria: </strong>We included single- or double-blind, parallel-group, randomized controlled trials comparing the perioperative use of vasodilators and inodilators in pediatric CHD surgery. We selected only English-language studies. We excluded crossover, non randomized trials and trials comparing the same drugs in all study arms.</p><p><strong>Results: </strong>We included 28 randomized controlled trials involving 3118 patients. Intravenous levosimendan ranked highest in decreasing postoperative mortality, although the effect was not statistically significant. Intravenous sildenafil and inhaled nitric oxide (NO) significantly reduced the duration of mechanical ventilation, and inhaled NO also significantly shortened the length of intensive care unit stay. Inhaled iloprost, NO, and enteral sildenafil reduced mean pulmonary artery pressure. No intervention significantly affected the incidence of acute kidney injury.</p><p><strong>Conclusions: </strong>Vasodilators and inodilators did not significantly decrease perioperative mortality in pediatric CHD. Some agents, such as intravenous sildenafil and inhaled NO, demonstrated modest benefits of questionable clinical significance regarding duration of mechanical ventilation, intensive care unit stay, and pulmonary pressure. The results are limited by small sample sizes, study heterogeneity, variability in standard care, and risk of bias, requiring cautious interpretation.</p><p><strong>Registration: </strong>CRD42024552531.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086076","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":"Evolving Management of Post-myocardial Infarction Ventricular Septal or Free Wall Rupture.","authors":"Angel Yu, Andrew Maslow, Neel Sodha, Shyamal Asher, Tzong Huei Chen, David A Rudnick, Richa Dhawan, Kelly Ural, Kimberly Rich","doi":"10.1053/j.jvca.2025.08.045","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.045","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102763","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 Hemodilution on the Coagulation Profile in the Cardiac Perioperative Period.","authors":"Yuji Hirasaki, Koichi Yoshinaga, Masataka Kuroda, Ko Ishikawa, Kentaro Fukano, Yusuke Iizuka","doi":"10.1053/j.jvca.2025.08.052","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.052","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130937","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}