Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Venoarterial Extracorporeal Membrane Oxygenation: A Better Pressor.","authors":"Edith Elianna Rodríguez Aparicio, Isabel Londono, Gabriel Sanchez, Camilo Pizarro, Leonardo Salazar, Marc Dickstein, Akram Zaaqoq, Michael Mazzeffi, Bryan E Marchant, Rohesh J Fernando","doi":"10.1053/j.jvca.2025.04.038","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.038","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":"144142690","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":"Enhancing Transesophageal Echocardiography Training in Cardiac Anesthesia Fellows Using Wearable Eye-Tracking Technology.","authors":"Benjamin Gorbaty, Enrique Vergara Escuardo, Alexander Gherciuc, Serjey Gherciuc, Tjorvi E Perry","doi":"10.1053/j.jvca.2025.04.039","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.039","url":null,"abstract":"<p><p>The training of Adult Cardiothoracic Anesthesiology (ACTA) fellows in transesophageal echocardiography (TEE) is essential for their development, but assessing technical proficiency remains challenging. While hands-on experience is the cornerstone of learning, traditional evaluation methods primarily focus on image interpretation, neglecting the assessment of image acquisition techniques and visual attention. We describe our experience using wearable eye-tracking technology to objectively assess the TEE skills of ACTA fellows. Since 2023, our ACTA fellows have been equipped with Tobii Pro Glasses 3 (Tobii Pro, Danderyd, Sweden) during weekly preoperative TEE examinations. These glasses record video and track gaze patterns in real-time, allowing for the analysis of fellows' focus and performance over time. The gaze data is processed using Tobii Pro Lab Analyzer, creating heat maps and measuring the time spent on specific TEE views. One attending physician, considered an expert, also participates to provide a benchmark for comparison. Our initial experience suggests that eye-tracking technology can provide valuable insights into the fellows' gaze patterns, enabling objective measurement of their focus during TEE procedures. While limitations such as scheduling conflicts, case type, and variable imaging windows were noted, our experience demonstrates the feasibility of this technology in evaluating technical skills. This approach offers a promising method for refining TEE education and feedback in cardiac anesthesia fellowship. Further research is needed to explore additional metrics such as gaze efficiency and time to image acquisition to enhance TEE training for fellows.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142724","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":"Organ Donation Potential from Patients Receiving Mechanical Circulatory Support in the United Kingdom: A Single-Center Experience.","authors":"Antonio Rubino, Aileen Tan, Thomas Edmiston, Marian Ryan, George Thundiyl Joseph, Antonella Cagnes, Corinna Dunzendorfer, Jo-Anne Fowles, Andrew Hadley-Brown, Kiran Salaunkey, Alex Manara","doi":"10.1053/j.jvca.2025.04.035","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.035","url":null,"abstract":"<p><p>Mechanical circulatory support (MCS), including extracorporeal membrane oxygenation and ventricular assist devices, is increasingly being used to manage critically ill patients with cardiac or respiratory failure. Despite advancements in MCS, many patients do not survive, raising the question of their potential contribution to deceased organ donation. This study evaluated the organ donation potential and outcomes of organ transplantation in patients receiving MCS at a UK regional cardiothoracic and transplant center. Data for all patients who died while receiving MCS in the ICU of a tertiary cardiothoracic referral center in the United Kingdom between January 2012 and November 2021 were analyzed retrospectively. These data included demographics, MCS type, cause of death, organ donation referrals, donation outcomes and recipient follow-up. Donors were categorized as a donor after brain death (DBD) or donor after circulatory determination of death (DCD). Reasons for nonreferral and nonacceptance were assessed, and outcomes of transplanted organs were followed. Of the 376 patients who died while on MCS, 208 were referred for organ donation. Sixteen patients became donors (14 DCD, 2 DBD), donating 30 organs. The most commonly donated organs are kidneys, followed by liver, pancreas, lungs, and heart. Recipients had excellent outcomes, with a median follow-up of 1,196 days and a 93% survival rate. Neurologic complications were the most frequent cause of death associated with donation. Despite concerns about donor organ quality, organ utilization rates and recipient outcomes were comparable to those of donors not on MCS. This study highlights that organ donation is feasible in patients receiving MCS, with outcomes similar to those not on MCS. Emerging technologies, such as ex situ organ perfusion, may further increase the acceptance and utilization of these organs. Patients on MCS represent an underused source of organs for transplantation. Consistent referral criteria and advancements in organ preservation technologies could enhance the potential of this donor population, providing high-quality organs and improving transplant outcomes.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266322","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 Considerations for a Patient with Alpha-Gal Syndrome Undergoing Cardiac Surgery.","authors":"Cole Douglas Rinehart, Kelvin Wang, Carolyn LoBue, John G Augoustides, Saumil Jayant Patel, Patrick Monette, Jessica Zvara, Liliane R Ernst, Rohesh J Fernando","doi":"10.1053/j.jvca.2025.04.037","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.037","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142728","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":"Optimizing Tranexamic Acid Use in Adult Cardiac Surgery: From Rationale to Clinical Practice.","authors":"Luigi La Via, Giuseppe Cuttone, Costantino Terranova, Massimiliano Sorbello, Gennaro Martucci, Federico Pappalardo","doi":"10.1053/j.jvca.2025.04.034","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.034","url":null,"abstract":"<p><p>Tranexamic acid (TXA) has emerged as a cornerstone in blood conservation strategies for cardiac surgery. This comprehensive review synthesizes current evidence on TXA's efficacy, safety, and optimal use in various cardiac surgical procedures. We examine the pharmacological properties of TXA, its historical development as an antifibrinolytic agent, and its evolution in cardiac surgical practice. The review critically evaluates key clinical trials and meta-analyses demonstrating TXA's efficacy in reducing blood loss and transfusion requirements across a spectrum of cardiac surgeries, including coronary artery bypass grafting, valve procedures, and aortic surgery. Special consideration is given to its use in pediatric cardiac surgery. We address ongoing debates surrounding optimal dosing strategies, timing of administration, and integration with other hemostatic interventions. The safety profile of TXA is thoroughly examined, with particular focus on the risk of seizures and thromboembolic events. The review also explores practical aspects of TXA implementation in clinical practice, including its role in comprehensive blood management protocols and potential cost-effectiveness. Emerging research areas, such as pharmacokinetic-guided dosing and topical TXA application, are discussed. Finally, we outline future directions and research priorities, including the need for long-term outcome studies and refinement of patient-specific protocols. This review provides a balanced assessment of TXA's role in modern cardiac surgery, offering clinicians and researchers a comprehensive resource for optimizing its use to improve patient outcomes while minimizing potential risks.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119756","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 Comprehensive Review of Left Atrial Venoarterial Extracorporeal Membrane Oxygenation.","authors":"Ahmad Jabri, Sant Kumar, Al Muthana Shadid, Harish Ramakrishna, Gennaro Giustino, Raef Ali Fadel, Brian O'Neill, Mohammad Alqarqaz, Mir Babar Basir, Pedro Engel-Gonzalez, Tiberio Frisoli, Philippe Genereux, Rodrigo Bagur, Gian Jimenez-Rodriguez, Ivan Hanson, Amr Abbas, Simon Dixon, William O'Neill, Pedro A Villablanca","doi":"10.1053/j.jvca.2025.04.036","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.036","url":null,"abstract":"<p><p>Cardiogenic shock (CS) in patients with structural heart disease (SHD) and severe valvular abnormalities poses unique challenges to traditional mechanical circulatory support (MCS) strategies, such as intra-aortic balloon pumps and ventricular assist devices. These devices may fail to address the complex interplay between ventricular unloading and systemic perfusion. Left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) incorporating left atrial (LA) drainage into the ECMO circuit to reduce left ventricular (LV) preload, mitigate pulmonary congestion, and maintain systemic perfusion. This review explores the pathophysiologic principles and clinical applications associated with LAVA-ECMO. Studies have demonstrated its efficacy in managing CS due to severe valvular disease, biventricular failure, and complex hemodynamic profiles, such as those complicated by aortic regurgitation or ventricular septal defect. Although traditional venoarterial ECMO can incorporate LA drainage, LAVA-ECMO offers distinct advantages by actively unloading the left ventricle, thereby preventing such complications as LV distension and pulmonary edema. Clinical evidence suggests its role as a bridge to definitive interventions, including transcatheter and surgical valve replacements. Despite these benefits, challenges remain, including high in-hospital mortality and complications such as bleeding. LAVA-ECMO represents a transformative advancement in MCS, offering superior hemodynamic stabilization and myocardial recovery for patients with refractory CS and severe valvular disease. Its ability to address LV unloading directly positions it as a pivotal tool in critical care and SHD management; however, significant gaps in evidence, particularly in long-term outcomes and optimal patient selection, underscore the need for further research.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127758","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":"Candidacy Decision Making for Extracorporeal Cardiopulmonary Resuscitation (ECPR): Lessons from a Single-Center Retrospective Analysis.","authors":"Jonah Rubin, Beatriz Rizkallah Alves, Eduardo M H Padrao, John Fountain, Caroline Jensen, James C Henderson, Eddy Fan, Eriberto Michel, Kamal Medlej, Jerome C Crowley","doi":"10.1053/j.jvca.2025.04.031","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.031","url":null,"abstract":"<p><strong>Objective: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used to rescue patients in cardiac arrest. However, minimal data guide candidacy decisions, and centers must develop their own initiation criteria, raising concern for inconsistent application between and even within centers. This single-center analysis of ECPR decisions was conducted to demonstrate an internal review process, identify patterns of inconsistency, and generate hypotheses for potential sources of inappropriate inconsistency and means of mitigation.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single quaternary academic center.</p><p><strong>Participants: </strong>Seventy-three patients for whom ECPR was considered between 2021 and 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Seventy-three consultations resulted in 14 candidates who underwent ECPR, 53 noncandidates, and 6 patients who achieved return of spontaneous circulation before a decision. Twenty unique contraindications were invoked across all noncandidates; the 5 most common were duration of CPR (n = 21), age (n = 17), nonshockable rhythm (n = 16), comorbidities (n = 15), and acidemia (n = 11). We identified 5 patterns of inconsistency: in (1) application of contraindications between candidates and noncandidates, (2) invoked contraindications between noncandidates, (3) application of contraindications in young and peri- and postoperative patients, (4) documentation, and (5) terminology use. We propose Domain-Based Decision-Making invoking contraindications to inform whether the patient belongs to 1 of 3 prognostic domains: (1) inability to achieve cardiovascular recovery/destination therapy or (2) meaningful neurologic recovery, or (3) ECPR technically/practically infeasible.</p><p><strong>Conclusions: </strong>We demonstrate an effective process for assessing internal candidacy decision making processes for centers performing ECPR. We identify 5 patterns of inconsistency, propose a Domain-Based Decision-Making model, and share lessons likely applicable to other centers.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078272","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 Year in Electrophysiology: Selected Highlights from 2024.","authors":"Sophia P Poorsattar, Nicolas Kumar, Matthew W Vanneman, Daniel A Kinney, Jonathan Tang, Christina A Jelly, Natalie J Bodmer, John Bryant, Amit Bardia","doi":"10.1053/j.jvca.2025.04.032","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.032","url":null,"abstract":"<p><p>This special article marks the seventh installment in an annual series featured in the Journal of Cardiothoracic and Vascular Anesthesia. The authors extend their gratitude to Editor-in-Chief Dr. Kaplan, Associate Editor-in-Chief Dr. Augoustides, and the editorial board for the opportunity to contribute to this series, which highlights key research in electrophysiology (EP) relevant to cardiothoracic and vascular anesthesiologists. This collection of articles explores evolving perioperative EP practices, including updated guidelines and therapies for atrial and ventricular fibrillation management, innovations in cardiovascular implantable devices and wearable technologies, and the integration of artificial intelligence into EP. Implications of these advancements on anesthetic management for patients undergoing EP procedures are discussed.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293825","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 Vascular Diseases-Translating the Latest Perspectives From Europe.","authors":"Jesse J Kiefer, John G Augoustides","doi":"10.1053/j.jvca.2025.04.027","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.027","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199227","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":"Artificial Intelligence to Evaluate Aortic Insufficiency: An Exercise in Machine Learning.","authors":"Alan M Smeltz, Bryant W Tran","doi":"10.1053/j.jvca.2025.04.021","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.021","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972526","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}