Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Postoperative Blindness Following Thymoma Resection Due to Iatrogenic Superior Vena Cava Syndrome.","authors":"Adi Natan Zarka, Jonathan Frogel, Alexander Kogan, Javier H Campos, Lovkesh Arora, John G Augoustides, Rohesh J Fernando","doi":"10.1053/j.jvca.2025.05.054","DOIUrl":"10.1053/j.jvca.2025.05.054","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336532","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":"Development of Experimental Models of Antithrombin-independent Heparin Resistance Using Platelet Factor 4 and the Effect of Antithrombin in These Models.","authors":"Akira Kitashoji, Natsumi Kawasaki, Yutaka Komiyama, Masahiro Ieko, Fujio Kobayashi","doi":"10.1053/j.jvca.2025.05.045","DOIUrl":"10.1053/j.jvca.2025.05.045","url":null,"abstract":"<p><strong>Objectives: </strong>Antithrombin (AT) deficiency is considered the primary cause of heparin resistance (HR); however, some patients with HR have normal AT activity (AT-independent HR). Supplementation with concentrated human AT is recommended for patients with AT-deficient HR, whereas treatment for AT-independent HR has not been established. Interestingly, the efficacy of concentrated human AT for AT-independent HR has recently been reported. Therefore, this study was designed to experimentally investigate the effects of AT on AT-independent HR using experimentally developed models with platelet factor 4 (PF4), a potent heparin inhibitor and a potential risk factor for AT-independent HR.</p><p><strong>Design: </strong>In vitro and in vivo experimental studies.</p><p><strong>Setting: </strong>Experimental laboratory.</p><p><strong>Participants: </strong>Normal human plasma, whole blood, and 8- or 9-week-old male Institute of Cancer Research mice.</p><p><strong>Interventions: </strong>Recombinant PF4 (rPF4), heparin, and AT were added or administered.</p><p><strong>Measurements and main results: </strong>Coagulation parameters, including activated partial thromboplastin time and clotting time using the INTEM assay of rotational thromboelastometry, were assessed. In addition, the AT activity of the rPF4-containing plasma was measured, and the interaction of rPF4 or AT with heparin was evaluated. Recombinant PF4 shortened activated partial thromboplastin time and clotting time prolonged by heparin, without affecting AT activity. AT ameliorated this shortening in a dose-dependent manner. The binding affinity of AT for heparin was weaker than that of rPF4.</p><p><strong>Conclusions: </strong>This work experimentally demonstrated that AT has the potential to ameliorate AT-independent HR. The potential mechanism was considered to involve an increased absolute number of AT-heparin complexes. This report provides insights into therapeutic strategies for AT-independent HR.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340147","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":"Restrictive Cardiomyopathy and Coronary Artery Bypass Grafting.","authors":"Rami Ghanem, Christopher Barra, Sanjit Menon, Alexander D Shapeton, D Sridhar R Musuku","doi":"10.1053/j.jvca.2025.05.042","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.042","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317004","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":"Mixed Venous Oxygen Saturation-Cardiac Index Dissociation in Ischemic Cardiogenic Shock: Extending Observations Beyond Cardiac Surgery.","authors":"Hazem Lashin, Olusegun Olusanya, Andrew Smith, Sanjeev Bhattacharyya","doi":"10.1053/j.jvca.2025.05.038","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.038","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302171","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 Graduate Medical Education: Selected Highlights from 2024.","authors":"Saumil J Patel, Andrew P Notarianni, Nathan H Waldron, Albert Tsai, Monique L Roberts, Stuart M Sacks, Joseph A Colao, Daniel A Kinney, Mario Montealegre-Gallegos, Hong Liang, Asheen Rama, Vanja Ristovic, Danielle A Pulton, Jared W Feinman","doi":"10.1053/j.jvca.2025.05.037","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.037","url":null,"abstract":"<p><p>This special article is the fourth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia that highlights significant literature from the world of graduate medical education that was published over the past year. Some of the major themes that will be addressed in this review include the use of artificial intelligence by both applicants and training programs, the deployment of virtual reality technology to augment skill training, mental health resources for trainees, advances in simulation technology, and the looming future competency-based graduate medical education. The authors would like to thank the editorial board once again for giving us the space to feature some of the more interesting and significant work published in the field of graduate medical education during 2024. We hope that the readers find these highlights thought-provoking and informative as we all strive to successfully educate the next generation of anesthesiologists.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325839","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":"Effects of Preoperative Low-dose Aspirin on the Incidence of Mesenteric Traction Syndrome in Open Abdominal Aortic Aneurysm Repair: A Retrospective Cohort Study.","authors":"Akihisa Nishigaki, Taiga Ichinomiya, Shuntaro Sato, Shohei Kaneko, Motohiro Sekino, Hiroaki Murata, Tetsuya Hara","doi":"10.1053/j.jvca.2025.05.039","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.039","url":null,"abstract":"<p><strong>Objective: </strong>The effect of preoperative low-dose aspirin on the incidence of mesenteric traction syndrome (MTS) remains unclear. This study was designed to investigate the effect of preoperative low-dose aspirin in patients undergoing open abdominal aortic aneurysm repair.</p><p><strong>Design: </strong>Single-center, retrospective cohort study.</p><p><strong>Setting: </strong>Academic medical center.</p><p><strong>Participants: </strong>A total of 147 patients undergoing open abdominal aortic aneurysm repair for unruptured abdominal aortic aneurysm between July 2016 and December 2022 were recruited. Patients with infectious abdominal aortic aneurysm and those undergoing simultaneous repair of thoracic aortic aneurysm were excluded.</p><p><strong>Intervention: </strong>Overall, 114 patients who met the inclusion criteria were divided into two groups. The aspirin group received preoperative low-dose aspirin (81-100 mg daily) as antiplatelet therapy for the primary and secondary prevention of cardiovascular events and stroke (n = 35), and the nonaspirin group received no aspirin (n = 79).</p><p><strong>Measurements and main results: </strong>The incidence of intraoperative MTS was lower in the aspirin group than in the nonaspirin group (17% v 41%). Twenty-six patients in the aspirin group discontinued daily aspirin within 7 days before surgery, and only one (4%) developed MTS. In contrast, five of nine patients (56%) who discontinued aspirin 8 days or more before surgery developed MTS. After adjusting for confounders, logistic regression analysis revealed that preoperative low-dose aspirin was associated with a lower incidence of MTS (odds ratio: 0.300, 95% confidence interval: 0.102-0.777, p = 0.012).</p><p><strong>Conclusions: </strong>Preoperative low-dose aspirin reduced the risk of MTS in patients undergoing open abdominal aortic aneurysm repair.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325834","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":"Relationship Between the Pulmonary-to-systemic-blood-flow Ratio and the Cross-sectional Area of the Right Internal Jugular Vein in Pediatric Patients With Congenital Heart Disease.","authors":"Jun Takeshita, Yasufumi Nakajima, Yoshiyuki Shimizu, Hirofumi Hamaba, Kazuya Tachibana","doi":"10.1053/j.jvca.2025.05.041","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.05.041","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the relationship between the pulmonary-to-systemic-blood-flow ratio (Qp/Qs) and the cross-sectional area (CSA) and diameter of the right internal jugular vein (RIJV) in pediatric patients with congenital heart disease using multivariate analysis.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Operating room of a tertiary children's hospital.</p><p><strong>Participants: </strong>Pediatric patients aged <10 years with congenital heart disease who underwent cardiovascular surgery under general anesthesia.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Multiple linear regression analyses were performed, with the CSA of the RIJV as the primary outcome and the anteroposterior and transverse diameters of the RIJV as secondary outcomes. These were designated as dependent variables, while Qp/Qs served as the independent variable. The analyses were adjusted for the following factors: weight, sex, postbidirectional Glenn operation, preoperative diuretic use, number of previous median sternotomies, single ventricle, trisomy 21, superior vena cava pressure, systolic blood pressure, heart rate, hemoglobin concentration, partial pressure of carbon dioxide, pH of arterial blood, and cardiac index. The adjusted regression coefficient estimates for Qp/Qs were as follows: 0.88 (95% confidence interval: 0.84-0.94, p < 0.001), 0.94 (95% confidence interval: 0.92-0.97, p < 0.001), and 0.94 (95% confidence interval: 0.91-0.97, p < 0.001) in the CSA, anteroposterior diameter, and transverse diameter of the RIJV, respectively.</p><p><strong>Conclusions: </strong>A higher Qp/Qs was associated with a smaller CSA, as well as reduced anteroposterior and transverse diameters of the RIJV. Specifically, for each unit increase in Qp/Qs, the CSA of the RIJV decreased by approximately 12%.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302172","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":"Anticoagulation Monitoring During Extracorporeal Membrane Oxygenation: A Narrative Review.","authors":"Sasa Rajsic, Christian Irsara, Andrea Griesmacher, Luca Brunelli, Robert Breitkopf, Nicole Innerhofer, Christine Eckhardt, Benedikt Treml","doi":"10.1053/j.jvca.2025.05.040","DOIUrl":"10.1053/j.jvca.2025.05.040","url":null,"abstract":"<p><p>The advancement of extracorporeal life support has introduced a new dimension to managing patients who do not respond to conventional treatment of severe cardiorespiratory failure. Extracorporeal membrane oxygenation (ECMO) is a specialized temporary life support that serves as a bridge to organ recovery or further treatment options. Owing to the interaction between the patient's blood and the large artificial surface of the extracorporeal circuit, ECMO support triggers complex inflammatory and coagulation processes. This interaction can lead to disrupted microcirculation, endothelial injury, end-organ dysfunction, and hemostatic complications. As a result, systemic anticoagulation is essential to mitigate the risk of thromboembolic events and ECMO circuit failure. However, therapeutic anticoagulation carries a significant risk of clinically relevant hemorrhage, which may result in severe disability or death. Similarly, thromboembolic events may occur. To address these challenges, various anticoagulation and monitoring strategies are used, aiming to achieve a delicate balance between procoagulant and anticoagulant factors. This review highlights the latest studies of anticoagulation during ECMO support, emphasizing anticoagulation monitoring, associated costs, and potential future developments.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340146","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":"Not Only Drug Efficacy Counts! A Call for Adequately Powered Safety Trials.","authors":"Gabor Erdoes, Andreas Koster, Hugo Ten Cate","doi":"10.1053/j.jvca.2025.05.025","DOIUrl":"10.1053/j.jvca.2025.05.025","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333220","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 Effects of Preoperative Resting Blood Pressure and Nighttime Blood Pressure on the Associations between Perioperative Blood Pressures and Postoperative Complications: A Prospective, Observational Study in Vascular Surgery Patients.","authors":"Julie Krath, Simone Krogh Christensen, Caroline Dinesen, Esben Beier Gynning, Peter Juhl-Olsen","doi":"10.1053/j.jvca.2025.05.036","DOIUrl":"10.1053/j.jvca.2025.05.036","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the associations between perioperative blood pressures and clinical postoperative outcomes, and to investigate if these associations depend on the preoperative resting and nadir nighttime blood pressures.</p><p><strong>Design: </strong>A prospective, observational study.</p><p><strong>Setting: </strong>A single-center study.</p><p><strong>Participants: </strong>200 patients undergoing vascular surgery under general anesthesia.</p><p><strong>Interventions: </strong>Preoperative (resting- and nighttime), intraoperative, and postoperative blood pressure measurements were performed.</p><p><strong>Measurements and main results: </strong>Intraoperative and postoperative hypotension were defined as time with mean arterial pressure (MAP) < 65 mmHg and the area from the MAP curve up to MAP 65 mmHg (mmHg × min). The burden of postoperative complications was quantified using the Comprehensive Complication Index 30 days after surgery. A hurdle statistical model was used due to the zero-inflated outcome data. In multivariable analyses every minute with MAP < 65 mmHg during anesthesia and in the postanesthesia care unit was associated with a 0.15- and 0.09-point increase in Comprehensive Complication Index at 30 days, respectively. Preoperative resting- and nighttime blood pressures did not significantly modify the associations between intra- or postoperative hypotension and postoperative complications.</p><p><strong>Conclusions: </strong>Intraoperative and postoperative hypotension were significantly associated with postoperative complications in vascular surgery patients. There were no statistically significant interactions between these associations and preoperative nighttime blood pressure, or ambulatory resting blood pressure.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333222","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}