Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Distal Migration of the Pulmonary Artery Catheter During Cardiac Surgery With Cardiopulmonary Bypass Observed Using Transesophageal Echocardiography: A Prospective Observational Study.","authors":"Nobuko Ohashi, Hidekazu Imai, Mayuko Inaba, Tsurara Wada, Mirai Momose, Tomoaki Kamoda, Tatsuya Abe, Teppei Yamada, Rintaro Hoshino, Keiichiro Matsuda, Yutaka Seino, Keiko Bamba, Tomohiro Yamamoto, Hiroshi Baba","doi":"10.1053/j.jvca.2025.08.047","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.047","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the extent of pulmonary artery catheter (PAC) tip migration during cardiac surgery using cardiopulmonary bypass (CPB), as visualized by transesophageal echocardiography (TEE).</p><p><strong>Design: </strong>A prospective, observational study.</p><p><strong>Setting: </strong>A single tertiary university hospital operating room.</p><p><strong>Participants: </strong>A total of 146 adult patients undergoing elective cardiac surgery with cardiac arrest and CPB who received PAC placement.</p><p><strong>Interventions: </strong>PACs were inserted under TEE guidance, positioning the tip at the 1 o'clock position in the proximal right pulmonary artery. TEE was used throughout surgery to monitor PAC tip position, particularly before and after CPB.</p><p><strong>Measurements and main results: </strong>The primary outcome was the distance of PAC tip migration during surgery. The median migration distance from pre to post CPB was 3.0 cm (interquartile range, 3.0-4.0 cm), prompting catheter withdrawal in these cases. Patients requiring >3 cm withdrawal had significantly longer catheter insertion lengths and higher mean pulmonary artery pressure and central venous pressure before CPB. Identified cutoff values were 46.5 cm for catheter length, 22.5 mmHg for mean pulmonary artery pressure, and 9.5 mmHg for central venous pressure.</p><p><strong>Conclusions: </strong>TEE-enabled direct visualization showed that PAC tips commonly migrate approximately 3 cm during cardiac surgery with CPB, necessitating withdrawal to prevent distal complications. Patients with longer catheter insertions and higher pulmonary artery pressure and central venous pressure may require more extensive withdrawal. TEE monitoring is a valuable tool for guiding PAC management during cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080844","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":"Use of High-dose Intravenous Immunoglobulin as Initial Therapy for Heparin-induced Thrombocytopenia in Patients With High Bleeding Risk.","authors":"Alison V Grazioli, Michael E Plazak, Cynthia S Shen, Thomas M Scalea, Rishi Kundi, Ramon A Riojas, Leonid A Belyayev","doi":"10.1053/j.jvca.2025.08.051","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.051","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131034","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":"Low Cardiac Output Syndrome Complicated by Raynaud Phenomenon Following Cardiopulmonary Bypass Surgery in Suspected Systemic Sclerosis.","authors":"Zhi Wen, Ying Huang, Jian Guo, Shanshan Xiong, Changxue Wu","doi":"10.1053/j.jvca.2025.08.040","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.040","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080356","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":"Real-world Experience of Angiotensin II and Renin Usage in Patients With Distributive Shock:A Single-center Descriptive Study.","authors":"Andreja Möller Petrun, Mario Gorenjak, Franc Svenšek, Nives Matković Lonzarić, Alenka Strdin Košir, Maja Cvikl Knehtl, Evgenija Homšak, Žiga Kalamar, Giovanni Landoni, Andrej Markota","doi":"10.1053/j.jvca.2025.08.044","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.044","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate real-life use of angiotensin II, a novel vasopressor, and renin, which can be used as a marker of endogenous angiotensin II deficiency and disease severity.</p><p><strong>Design: </strong>A retrospective observational single-center cohort study.</p><p><strong>Setting: </strong>Four intensive care units in one university hospital.</p><p><strong>Participants: </strong>Adult patients with distributive shock, no limitations of active care, and with ongoing use of vasoconstrictors (norepinephrine base ≥0.3 mcg/kg/min plus vasopressin), who were admitted between August 2022 and August 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Septic shock (38/42, 90.5%) and post-cardiopulmonary bypass vasoplegia (4/42, 9.5%) were the causes of distributive shock. After the initiation of angiotensin II, a decrease in the norepinephrine base dose at 4, 24, and 48 hours (0.40 ± 0.25 mcg/kg/min, 0.21 ± 0.11 mcg/kg/min, and 0.13 ± 0.06 mcg/kg/min, respectively), and a decrease in vasopressin dose were observed. Renin concentration decreased after initiation of angiotensin II from 376.90 ± 168.50 mU/L to 188.24 ± 167.47 mU/L (p < 0.01). Control renin was lower in survivors to hospital discharge compared with nonsurvivors (78.06 ± 121.14 mU/L in survivors, v 259.07 ± 163.4 mU/L in nonsurvivors, p < 0.01).</p><p><strong>Conclusions: </strong>Angiotensin II can be used to decrease the doses of non-angiotensin II vasopressors, and renin concentration may potentially aid in the prognostication of patients with distributive shock.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228581","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":"Erector Spinae Plane Block Versus Retrolaminar Block for Perioperative Analgesia in Pediatric Cardiac Surgery: A Randomized, Double-blinded, Noninferiority Clinical Trial.","authors":"Rajesh Madavathazathil Gopalakrishnan, Nilkanth Shinde, A R Meghalakshmi, Georg Gutjahr, Malavika Krishnakumar, Sreelakshmi P Leeladharan, Diana Thomas, Sharath Padmanabhan, Raman Krishnakumar","doi":"10.1053/j.jvca.2025.08.029","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.029","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy and safety of retrolaminar block (RLB) with erector spinae plane block (ESPB) for perioperative analgesia in pediatric cardiac surgery.</p><p><strong>Design: </strong>Prospective, randomized, double-blinded, controlled, noninferiority trial.</p><p><strong>Setting: </strong>A pediatric cardiac surgical unit at a tertiary care referral center in South India.</p><p><strong>Participants: </strong>Children aged between 1 day and 18 years who were scheduled for elective cardiac surgery (Risk adjustment for congenital heart surgery categories 1-6) were enrolled in the study. A total of 298 patients were randomly assigned to receive either an ESPB or RLB, with 149 patients in each group.</p><p><strong>Intervention: </strong>Myofascial blocks were performed by one of four anesthesiologists, each administering either ESPB or RLB under ultrasound guidance according to the assigned group. The treating anesthesiologist and intensive care unit (ICU) intensivist were blinded to group allocation.</p><p><strong>Measurements and main results: </strong>This study compared RLB, a safer and less commonly used posterior myofascial block, with ESPB, a widely adopted technique with few reported complications, to establish the noninferiority of RLB. The primary outcome was hemodynamic response to surgical incision, defined as a greater than 10% rise in heart rate. Secondary outcomes included block administration time; intraoperative inhalational anesthetic; dexmedetomidine and opioid use; postoperative pain and sedation scores at 2, 6, and 12 hours; and ICU outcomes such as duration of mechanical ventilation, ICU length of stay, reintubation rate, and cost of ventilator disposables and oxygen. The groups were comparable in baseline characteristics. A rise in heart rate of more than 10% was observed in 46% of patients in the ESPB group and 50% in the RLB group (p = 0.3). Intraoperative drug consumption, pain and sedation scores, as well as ICU outcomes, were similar between the groups.</p><p><strong>Conclusions: </strong>RLB is noninferior to ESPB in pediatric cardiac surgery, providing comparable analgesic efficacy, safety, and postoperative recovery outcomes.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080774","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":"Bridging the Evidence Gap: Perioperative Implications of the 2025 ACC/AHA Antithrombotic Guideline for ACS.","authors":"Miguel Abalo, Kevin Hwang, Michael Fabbro","doi":"10.1053/j.jvca.2025.08.037","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.037","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102667","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":"Dynamic Cause for Elevated Pulmonary Venous and Left Ventricular Inflow Gradients.","authors":"Madan Mohan Maddali, Salim Nasser Al-Maskari","doi":"10.1053/j.jvca.2025.08.034","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.034","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064420","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 Chest Wall on Respiratory Mechanics, Ventilation and Ventilation-Perfusion Matching During Cardiac Surgery.","authors":"Ádám L Balogh, Roberta Südy, József Tolnai, Gergely H Fodor, Ferenc Peták, Barna Babik","doi":"10.1053/j.jvca.2025.08.039","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.039","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate how sternotomy and subsequent sternal closure affect respiratory mechanics, ventilation heterogeneity, ventilation-perfusion (V/Q) matching, and oxygenation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).</p><p><strong>Design: </strong>Prospective consecutive self-controlled clinical investigation.</p><p><strong>Setting: </strong>A university hospital.</p><p><strong>Participants: </strong>53 patients undergoing elective cardiac surgery.</p><p><strong>Interventions: </strong>Measurements performed at 4 protocol stages: before sternotomy, immediately after sternotomy, after weaning from CPB, and after sternal closure.</p><p><strong>Measurements and main results: </strong>Respiratory mechanics (airway resistance, tissue damping, and elastance) were assessed using forced oscillations, and ventilation heterogeneity was evaluated via capnographic slopes (phase 2 and phase 3). Physiologic dead spaces (Bohr and Enghoff fractions), V/Q matching, and oxygenation (partial pressure of oxygen [PaO₂]/fraction of inspired oxygen [FiO₂] ratio, intrapulmonary shunt fraction) were analyzed as well. Sternotomy significantly improved airway resistance (-30%), tissue damping (-25%), and elastance (-35%), thereby enhancing ventilation homogeneity (phase 3 slope reduced by 20%; p < 0.001). Conversely, CPB markedly deteriorated respiratory mechanics and ventilation efficiency (airway resistance, +45%; elastance, +50%; p < 0.001). Sternal closure led to further worsening in respiratory mechanics and ventilation heterogeneity, although without any additional significant impact on V/Q matching or oxygenation parameters (PaO₂/FiO₂ were unchanged after closure).</p><p><strong>Conclusions: </strong>Reestablishing chest wall integrity significantly deteriorates respiratory mechanics and ventilation homogeneity, mirroring improvements initially gained from sternotomy. The absence of additional V/Q mismatch underscores the protective role of pulmonary vascular regulation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064477","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":"TIVA vs Volatile Anesthesia in CABG Surgery: Effects on Inflammatory and Cognitive Outcomes.","authors":"Vipan Garg, Gautham Patel, Banashree Mandal, Shubhkarman Kahlon, Goverdhan Dutt Puri, Shyam Kst, Amit Rawat","doi":"10.1053/j.jvca.2025.08.038","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.038","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the perioperative inflammatory response and early neurocognitive outcomes in adult patients undergoing elective coronary artery bypass grafting (CABG) under total intravenous anesthesia (TIVA) versus volatile anesthesia.</p><p><strong>Design: </strong>Prospective, randomized controlled trial.</p><p><strong>Setting: </strong>A tertiary care academic medical center.</p><p><strong>Participants: </strong>Fifty adult patients aged 18 to 65 years scheduled for elective on-pump CABG surgery.</p><p><strong>Interventions: </strong>Patients were randomized to receive either propofol-based TIVA (Group P) or sevoflurane-based volatile anesthesia (group S). Standardized surgical and cardiopulmonary bypass protocols were followed in all patients.</p><p><strong>Measurements and main results: </strong>Serum interleukin-6 (IL-6) levels were measured preoperatively and at 24 and 48 hours postoperatively. Secondary outcomes included Mini-Mental State Examination scores, ventilation duration, vasoactive-inotropic score, renal function, and intensive care unit stay. IL-6 levels had increased significantly at 24 hours and decreased by 48 hours in both groups, with no significant intergroup difference at any time point. Mini-Mental State Examination scores at 24 and 48 hours were significantly higher in the TIVA group. TIVA was also associated with shorter mechanical ventilation duration. VIS, cardiac function, renal parameters, and intensive care unit stay duration were comparable between groups.</p><p><strong>Conclusions: </strong>TIVA and volatile anesthesia resulted in similar perioperative IL-6 responses in patients undergoing CABG. However, TIVA was associated with better early postoperative cognitive function and faster emergence from mechanical ventilation. These findings suggest a potential neurocognitive benefit of TIVA in this surgical population.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113144","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 Rare Cause of ST-Elevation During Coronary Artery Bypass Grafting: It Might Not Always Be the Heart.","authors":"Nandhu Subramonian, Vignesh Idumban, Shanthi Sharmiya, Mamatha Munaf, Bineesh K Radhakrishnan, Arem Jyothi","doi":"10.1053/j.jvca.2025.08.032","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.032","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080794","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}