Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Emerging Therapeutics in Hypovolemic Shock With Centhaquine Citrate-A Novel Venopressor That Leverages the Alpha Receptor Family.","authors":"John G Augoustides","doi":"10.1053/j.jvca.2025.05.056","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.056","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496728","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":"Integration of Right Ventricular Systolic and Diastolic Function With Invasive Cardiac Output: Association with Renal Replacement Therapy in Ischemic Cardiogenic Shock.","authors":"Hazem Lashin, Olusegun Olusanya, Andrew Smith, Sanjeev Bhattacharyya","doi":"10.1053/j.jvca.2025.05.051","DOIUrl":"10.1053/j.jvca.2025.05.051","url":null,"abstract":"<p><strong>Objective: </strong>To investigate echocardiographic parameters of right ventricular (RV) systolic and diastolic function associated with renal replacement therapy (RRT) in acute myocardial infarction complicated by cardiogenic shock (AMI-CS).</p><p><strong>Design, setting, and participants: </strong>Post hoc exploratory analysis of 43 prospectively identified patients admitted to a tertiary cardiac intensive care unit in London, UK, with AMI-CS.</p><p><strong>Interventions: </strong>Comprehensive transthoracic echocardiographic, clinical, and hemodynamic data were collected concurrently. Patients were classified based on their need for RRT.</p><p><strong>Measurements and main results: </strong>Median age was 61 (interquartile range: 52, 67 years), with predominantly male participants (84%). RRT for acute kidney injury was necessary in 33% (14/43) of patients. Patients requiring RRT had significantly worse RV systolic and diastolic function, reflected by 31% lower tricuspid annulus systolic velocity (RV S', 9 v 13 cm/s, p = 0.001), 19% lower late diastolic velocity (RV a', 13 v 16 cm/s, p = 0.007), and a 19% reduced invasive native cardiac output (CO; 4.3 v 5.3 L/min, p = 0.03). RV S' emerged as the strongest parameter associated with RRT (odds ratio [OR] 0.68, p = 0.006, area under the curve [AUC] = 0.80, cutoff 10.5 cm/s), followed by RV a' (OR 0.84, p = 0.02, AUC = 0.76, cutoff of 14 cm/s), and invasive native CO (OR 0.47, p = 0.02, AUC = 0.75, cutoff of 5 L/min). Combining RV S', RA a', and CO improved the diagnostic accuracy (AUC = 0.87).</p><p><strong>Conclusion: </strong>These results indicate that impaired RV systolic and diastolic functions are associated with RRT in AMI-CS patients. Integrating echocardiographic and hemodynamic parameters significantly enhances diagnostic accuracy and risk stratification, potentially guiding targeted therapeutic interventions.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336531","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":"Acute and Chronic Postsurgical Pain in Children Following Cardiac Surgery: A Cohort Study of Sternotomy and Thoracotomy Surgical Approaches.","authors":"Katherine Taylor, Barny Allan, Carolyne Pehora, Marisa Signorile, Kyle Runeckles, Naiyi Sun, Christoph Haller","doi":"10.1053/j.jvca.2025.05.059","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.059","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the prevalence of chronic postsurgical pain (CPSP) in children after cardiac surgery.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>Quaternary academic pediatric hospital.</p><p><strong>Participants: </strong>Patients age 6 to 18 years at the time of their surgery and a surgery date ≥6 months prior to the study period (June 1, 2014, to November 1, 2021).</p><p><strong>Interventions: </strong>Patients completed 3 validated surveys measuring chronic pain, the impact of pain on quality of life (QoL), and neuropathic pain symptoms. Respondents' medical records were then reviewed for perioperative management.</p><p><strong>Measurements and main results: </strong>Pain severity, pain trajectory, and analgesic consumption are described for each comparative group of interest (time period, 2014-2019 vs 2020-2021), intraoperative opioid selection (remifentanil vs sufentanil), surgical approach (sternotomy vs thoracotomy), and intraoperative pain management technique (presence/absence of fascial plane block). The response rate was 10%. Reference tables from validated scoring systems were used when available. At the time of survey completion or in the preceding week, 34% reported pain, with none to mild interference in QoL. Twenty percent reported symptoms consistent with neuropathic pain, with no difference between recipients of sternotomy and recipients of thoracotomy. Patients who received intraoperative remifentantil had higher pain scores. Single-shot fascial plane blocks reduced postoperative acute pain scores.</p><p><strong>Conclusions: </strong>The validated surveys showed a high prevalence of CPSP, including a sizeable proportion of neuropathic pain. The prevalence of CPSP is within the reported prevalence in adults despite a mean study population age of 10 years. This finding encourages improvements in acute pain management, earlier identification of patients with CPSP for management, and further investigation of CPSP after pediatric cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512014","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":"Evaluation of Intraoperative Bivalirudin Anticoagulation in Neonates and Infants Undergoing Arterial Switch Operation on Integrated ECMO-CPB Circuit: A Prospective Study.","authors":"Mohanish Badge, Suruchi Hasija, Sandeep Chauhan, Sushama Gayatri, Akshay Kumar Bisoi, Alok Kumar","doi":"10.1053/j.jvca.2025.05.058","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.058","url":null,"abstract":"<p><strong>Objectives: </strong>To ascertain the dosage of bivalirudin in neonates and infants undergoing arterial switch operation on integrated extracorporeal membrane oxygenation-cardiopulmonary bypass (CPB) circuit.</p><p><strong>Design: </strong>Pilot study.</p><p><strong>Setting: </strong>A tertiary care hospital.</p><p><strong>Participants: </strong>Ten neonates and infants with transposition of great arteries undergoing an arterial switch operation INTERVENTIONS: The patients received a bivalirudin bolus dose of 1 mg/kg followed by a maintenance dose of 2.5 mg/kg/h. The infusion dose was adjusted to maintain an activated clotting time (ACT) >480 s.</p><p><strong>Measurements and main results: </strong>The mean age and weight were 92 ± 67 days and 4.1 ± 1.45 kg, respectively. There were more male children than female (8:2). The mean baseline ACT score was 207.6 ± 52.4 s. The bolus dose required was 1 mg/kg, and two children required an additional bolus dose of 0.5 mg/kg. The mean ACT of the priming solution was 999 s, and the mean ACT following the bolus dose was 575.9 ± 101 s. The maintenance dose required was 2.1 ± 0.3 mg/kg/h. The mean ACT on CPB after 30 min, 60 min, and 90 min was 956.2 ± 62.8 s, 936.8 ± 137 s, and 829.6 ± 232.5 s, respectively. There was no incidence of clot formation in the circuit or thromboembolic complications.</p><p><strong>Conclusions: </strong>Bivalirudin can be effectively used for anticoagulation during CPB in neonates and infants with transposition of great arteries, at a bolus dose of 1 mg/kg and a maintenance dose of 2.1 ± 0.3 mg/kg/h, utilizing the integrated extracorporeal membrane oxygenation-CPB circuit.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505816","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":"Blimey, More Guidelines! A Practical Approach to the Echocardiographic Assessment of Aortic Regurgitation: The British Society of Echocardiography Guidelines.","authors":"Mario Montealegre-Gallegos, Ronny Munoz-Acuna, Andrew P Notarianni","doi":"10.1053/j.jvca.2025.05.049","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.049","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484386","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":"Assessment of Renal Vein Flow Index by Transesophageal Echocardiography: Precision, Variability, and Association with Cardiac Index During Cardiac Surgery.","authors":"Lee A Goeddel, Marina Hernandez, Lily Koffman, Chelsey Santino, John Muschelli, Xinkai Zhou, Natalie Waldron, Chirag R Parikh, Laeben Lester, Ravie Abozaid, Nauder Faraday, Ciprian M Crainiceanu, Charles Brown","doi":"10.1053/j.jvca.2025.05.052","DOIUrl":"10.1053/j.jvca.2025.05.052","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent and important complication often attributed to decreased kidney blood flow. Ultrasound measurement of renal vein blood flow has been associated with adverse cardiac outcomes but is understudied in cardiac surgery. The renal vein flow index (RVFI) was defined using transesophageal echocardiography (TEE) during cardiac surgery to assess its precision, variability throughout surgery, and relationship to systemic perfusion defined by the cardiac index (CI).</p><p><strong>Design: </strong>Prospective.</p><p><strong>Setting: </strong>University hospital.</p><p><strong>Participants: </strong>Patients undergoing cardiac surgery.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>RVFI was repeatedly measured using TEE every 30 minutes throughout the entire surgery. RVFI precision was assessed using measurement error estimated from RVFI residuals and intraclass correlation coefficient. To quantify the variability of RVFI over the course of surgery, box plots with medians and interquartile ranges were assessed. The relationship between CI and RVFI was analyzed using linear regression with bootstrapping. Data from 10 participants included 324 RVFI measurements from 108 ultrasound images. The estimated measurement error was 0.030 units, which was well below the clinically meaningful threshold of 0.1 units. The intraclass correlation coefficient was 0.99 for RVSI measurements obtained within three consecutive cardiac cycles. RVFI varied across surgery (range 0-1.0 units), and each CI increase of 0.5 L/min/m² was associated with a 0.058 (95% confidence interval 0.04-0.08, p < 0.001) decrease in RVFI.</p><p><strong>Conclusions: </strong>Intraoperative measurement of RVFI by TEE has excellent precision. TEE can detect a clinically meaningful change in RVFI. RVFI varied over the course of surgery and was associated with CI, consistent with expectations for a physiological measure of renal blood flow.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Complications After Thoracic Surgery-An Analysis From the German Thorax Registry.","authors":"Mark Schieren, Erich Stoelben, Jonas Weber, Frank Wappler, Jérôme Defosse","doi":"10.1053/j.jvca.2025.05.034","DOIUrl":"10.1053/j.jvca.2025.05.034","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the incidence and impact of postoperative complications in thoracic surgery using data from the German Thorax Registry.</p><p><strong>Design: </strong>Retrospective analysis of registry data from 2016 to 2023.</p><p><strong>Setting: </strong>Data from 12 hospitals in Germany, including university, general, and specialized thoracic clinics.</p><p><strong>Participants: </strong>A total of 7,923 adult patients undergoing thoracic surgery, with at least 100 documented cases for each type of procedure.</p><p><strong>Interventions: </strong>Thoracic surgical procedures such as wedge resections, lobectomies, bilobectomies, pneumonectomies, and others were analyzed for postoperative complications.</p><p><strong>Measurements and main results: </strong>Complications occurred in 27.7% of patients, with respiratory issues (8.3% respiratory insufficiency, 8.1% prolonged air leaks) being the most common. Bilobectomy (66.4%) and pneumonectomy (54.8%) had the highest complication rates. Respiratory complications had the greatest impact on mortality (odds ratio 13.3), followed by cardiac complications (odds ratio 4.0). Patients with complications had an average extension of hospital stay of 8.7 days.</p><p><strong>Conclusions: </strong>Postoperative complications in thoracic surgery remain common, particularly respiratory complications, which significantly affect hospital mortality and length of stay. These findings highlight the importance of personalized perioperative strategies and vigilant monitoring, especially for high-risk procedures.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340148","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 of Superficial versus Deep Parasternal Intercostal Plane Blocks in Cardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"Burhan Dost, Alessandro De Cassai, Yunus Emre Karapinar, Esra Turunc, Muzeyyen Beldagli, Mirac Selcen Ozkal Yalin, Paolo Navalesi","doi":"10.1053/j.jvca.2025.05.053","DOIUrl":"10.1053/j.jvca.2025.05.053","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the analgesic efficacy of superficial parasternal intercostal plane (S-PIP) block and deep parasternal intercostal plane (D-PIP) to determine which technique provides superior pain relief in cardiac surgery.</p><p><strong>Design: </strong>A systematic search of MEDLINE (via PubMed), Scopus, Embase, Cochrane Library, Web of Science, Google Scholar, and ClinicalTrials.gov from inception until January 18, 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies that compared the S-PIP and D-PIP blocks in patients undergoing cardiac surgery. The primary outcome of the study was postoperative opioid consumption of morphine milligram equivalent (MME) at 24 hours. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 hours, time to first analgesics, incidence of postoperative nausea and vomiting (PONV), extubation time, length of stay (LOS) in the intensive care unit (ICU), and the number of patients requiring rescue analgesics.</p><p><strong>Main results: </strong>Seven RCTs and 1 observational study, including a total of 510 patients, were identified. The findings demonstrated no statistically significant difference in MME at 24 hours between the S-PIP and D-PIP block groups (mean difference, -1.23; 95% confidence interval, -2.51 to 0.05; p = 0.061). Additionally, there were no significant differences in pain scores, PONV incidence, time to rescue analgesics, extubation time, or ICU LOS of stay between the 2 techniques.</p><p><strong>Conclusions: </strong>S-PIP and D-PIP blocks provide comparable postoperative analgesic efficacy in patients undergoing cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336530","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":"Successful Removal of a Giant Intrapericardial Mass: Diagnostic Imaging Methods and Anesthesia.","authors":"Myungsoo Jang","doi":"10.1053/j.jvca.2025.05.044","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.044","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496730","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 the Future With the 'Protected Noncardiac Surgery' Paradigm: Is Temporary Mechanical Circulatory Support the Missing Link to Expanding Surgical Eligibility?","authors":"Samuele Bugo, Viviana Teresa Agosta, Alice Bottussi, Jacopo D'Andria Ursoleo, Fabrizio Monaco","doi":"10.1053/j.jvca.2025.05.002","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.002","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179963","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}