Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Role of del Nido Cardioplegia Solution in Prolonged Aortic Cross-clamp Cardiac Surgery: A Prospective Study","authors":"Sun Lin MD ,&nbsp;Zhou Xiaoyu MD ,&nbsp;Xu Lingfeng MD ,&nbsp;Chang Xin MD ,&nbsp;Guo Zhen MD, PhD","doi":"10.1053/j.jvca.2024.12.006","DOIUrl":"10.1053/j.jvca.2024.12.006","url":null,"abstract":"<div><h3>Objectives</h3><div>The myocardial-protective effect of del Nido cardioplegia solution was evaluated in adult patients undergoing prolonged aortic cross-clamping during cardiac surgery.</div></div><div><h3>Design</h3><div>Prospective cohort.</div></div><div><h3>Setting</h3><div>Single-center tertiary academic medical center.</div></div><div><h3>Participants</h3><div>A total of 462 patients scheduled for cardiac surgery under cardiopulmonary bypass with an expected aortic cross-clamp time &gt;120 minutes between January 2020 and January 2024 were enrolled.</div></div><div><h3>Interventions</h3><div>Patients with an expected aortic cross-clamp time &gt;120 minutes were randomly assigned to low- and high-risk del Nido and Buckberg groups, with 112 patients in each group. Serum levels of cardiac troponin T and creatine kinase-MB were measured at 1, 24, and 48 hours after operation. The occurrence of atrial fibrillation within 48 hours postoperatively and other intraoperative and postoperative parameters were recorded.</div></div><div><h3>Results</h3><div>No significant differences were observed in preoperative parameters between the groups. The level of cardiac troponin T was significantly higher in the low-risk del Nido group than in the Buckberg group at 24 hours postoperatively (p &lt; 0.05). However, no significant differences were observed in cardiac troponin T or creatine kinase-MB levels at the other time points. The incidence of postoperative atrial fibrillation in the Buckberg group at 48 hours was significantly higher than the del Nido group in both the low- and high-risk groups (p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>The incidence of postoperative atrial fibrillation at 48 hours was significantly lower in the del Nido group than in the Buckberg group. del Nido cardioplegia solution can be safely used for high-risk patients undergoing prolonged aortic cross-clamping.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 635-643"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894763","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":"What Is in a Name? When It Comes to Venoarterial Extracorporeal Membrane Oxygenation, Everything","authors":"Jamel Ortoleva MD, FASE ,&nbsp;Saul Ramirez MD ,&nbsp;Dominic V. Pisano MD ,&nbsp;Alex Shapeton MD","doi":"10.1053/j.jvca.2024.12.010","DOIUrl":"10.1053/j.jvca.2024.12.010","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 569-572"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914808","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":"Crossing Boundaries: Utilizing Left-sided Impella for Right Ventricular Mechanical Support and Intraoperative Transesophageal Echocardiogram Considerations","authors":"Yang Gu MD ,&nbsp;Milica Bjelic MD ,&nbsp;Kunal Panda MD ,&nbsp;Julie Wyrobek MD ,&nbsp;Heather Lander MD ,&nbsp;Isaac Wu MD ,&nbsp;Bartholomew Simon MD ,&nbsp;Bryan Barrus MD","doi":"10.1053/j.jvca.2024.12.018","DOIUrl":"10.1053/j.jvca.2024.12.018","url":null,"abstract":"<div><h3>Objective</h3><div>Right ventricular failure is a leading cause of mortality among patients with various etiologies of cardiogenic shock. This case series outlines an innovative approach to directly unloading the right ventricle with the Impella LD or 5.5 without crossing the tricuspid valve in cases requiring tricuspid valve repair or replacement.</div></div><div><h3>Design</h3><div>Retrospective single-center review.</div></div><div><h3>Setting</h3><div>Single tertiary care university hospital.</div></div><div><h3>Participants</h3><div>Patients who underwent Impella LD or 5.5 insertions for right ventricular support.</div></div><div><h3>Interventions</h3><div>Impella LD or 5.5 inserted directly into the right ventricle via the pulmonary artery.</div></div><div><h3>Measurements and Main Results</h3><div>Patients’ baseline, intraoperative, and immediate postoperative clinical and echocardiographic data were obtained. Of the five consecutive patients with severe preoperative right ventricular failure who underwent surgical tricuspid valve procedures and Impella placement, three of the patients underwent concomitant left heart procedures. The Impella was preemptively inserted before separation from cardiopulmonary bypass in all patients. Four patients were extubated within the first 24 hours and ambulated with the Impella by postoperative day (POD) 3. By POD 10, four patients had sufficient right ventricular recovery to allow for Impella LD explant. One patient died due to septic shock with the right ventricular assist device still in place. One patient was transitioned to comfort measures 29 days after explant of the Impella device.</div></div><div><h3>Conclusions</h3><div>Left-sided Impella can be used to support the right ventricle in patients who have undergone surgical tricuspid valve procedures. It provides direct right ventricular unloading, does not cross a newly replaced or repaired tricuspid valve, and allows early ambulation.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 625-634"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931902","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 Perioperative Monitoring of the Right Ventricular Pressure: Development and Evaluation of a New Pulmonary Artery Catheter","authors":"Aaron Wozolek MD ,&nbsp;Leah Soto ,&nbsp;Etienne Couture ,&nbsp;Tjorvi Perry ,&nbsp;Jennifer Cutler ,&nbsp;Peiman Lahsaei ,&nbsp;Jonathan Leff ,&nbsp;Kevin Moses ,&nbsp;Cristhian Potes ,&nbsp;Daniel Scherb ,&nbsp;Antoine Rochon ,&nbsp;André Y. Denault MD, PHD","doi":"10.1053/j.jvca.2024.12.033","DOIUrl":"10.1053/j.jvca.2024.12.033","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 858-859"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931909","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":"Routine Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation—A Therapeutic Conundrum","authors":"Alice Bottussi MD ,&nbsp;Jacopo D'Andria Ursoleo MD ,&nbsp;Enrica Piazza MDs,&nbsp;Edoardo Mongardini MDs,&nbsp;Fabrizio Monaco MD","doi":"10.1053/j.jvca.2024.12.040","DOIUrl":"10.1053/j.jvca.2024.12.040","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 860-861"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949346","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 Effect of Extracorporeal Membrane Oxygenation on the Pharmacokinetics of Dexmedetomidine Hydrochloride","authors":"Tao Wang ,&nbsp;Huifang Zhang ,&nbsp;Rui Tian ,&nbsp;Liu Rong ,&nbsp;Kaige Yang ,&nbsp;Yan Wang ,&nbsp;Ruilan Wang","doi":"10.1053/j.jvca.2024.12.029","DOIUrl":"10.1053/j.jvca.2024.12.029","url":null,"abstract":"<div><h3>Objectives</h3><div>Our objective was to explore the effects of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics of dexmedetomidine hydrochloride via vitro and in vivo experiments</div></div><div><h3>Design</h3><div>A single-center animal investigation.</div></div><div><h3>Setting</h3><div>An experimental animal facility in a tertiary hospital.</div></div><div><h3>Participants</h3><div>Eighteen male Landrace pigs.</div></div><div><h3>Interventions</h3><div>For the in vitro experiment, ECMO circuits were primed with whole blood solutions of dexmedetomidine at different concentrations and ran ex vivo. The adsorption rates of dexmedetomidine hydrochloride in ECMO circuits and control glass tubes were compared at 60 minutes, 5 hours, and 10 hours after the start of the in vitro experiment. In the in vivo experiment, 12 Landrace pigs were randomly allocated to the venovenous ECMO group or the control group. Dexmedetomidine hydrochloride (1 μg/kg) was administered to both groups. Blood samples were collected at 0 minutes, 5 minutes, 10 minutes, 15 minutes, 20 minutes, 30 minutes, 45 minutes, 60 minutes, 90 minutes, 2 hours, 3 hours, 5 hours, 7 hours, and 10 hours after administration. The plasma concentrations of dexmedetomidine were measured, and pharmacokinetic analysis was conducted in both groups.</div></div><div><h3>Measurements and Main Results</h3><div>The results revealed no significant difference in adsorption rates of dexmedetomidine hydrochloride in ECMO circuits at 60 minutes and 5 hours, but differences were observed at 10 hours. In vivo experiment, pharmacokinetic analysis revealed no significant difference in the area under the curve (AUC_0-t), AUC_0-∞, distribution half-life, elimination half-life, clearance, apparent volume of distribution, mean residence time or peak drug concentrations between the 2 groups (p &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>The ECMO circuit had an adsorption effect on dexmedetomidine hydrochloride, but this effect was not sufficient to impact the in vivo pharmacokinetics of dexmedetomidine significantly. The effect of ECMO on the pharmacokinetics of dexmedetomidine hydrochloride was not significant.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 616-624"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949350","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":"Unveiling Baseline Clinical Divergence in VA ECMO vs. ECPELLA: Tailoring Treatment for Distinct Patient Profiles. A Systematic Review and Meta-analysis","authors":"Andrea Montisci MD ,&nbsp;Serena Ambrosi MD ,&nbsp;Massimo Baudo MD ,&nbsp;Rosaria Muratore MD ,&nbsp;Giuseppe Cuttone MD ,&nbsp;Nicoletta D'Ettore MD ,&nbsp;Federico Pappalardo MD","doi":"10.1053/j.jvca.2024.11.033","DOIUrl":"10.1053/j.jvca.2024.11.033","url":null,"abstract":"<div><h3>Objectives</h3><div>The benefit of combining multiple mechanical circulatory support (MCS) systems in patients with cardiogenic shock (CS) is debated. This review examines patient characteristics across studies to identify differences and assesses if patients with a higher-risk clinical profile receive Impella unloading.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis was conducted to examine if there were significant differences in baseline clinical parameters among patients receiving MCS in addition to venoarterial extracorporeal membrane oxygenation (VA ECMO).</div></div><div><h3>Setting</h3><div>A total of nine retrospective, three prospective, and two randomized controlled trials were included in this analysis.</div></div><div><h3>Participants</h3><div>The sample sizes ranged from 34 to 1,678 patients.</div></div><div><h3>Interventions</h3><div>The outcomes were assessments of differences in baseline clinical characteristics and comorbidities among patients that received VA ECMO alone or VA ECMO with intra-aortic balloon pump (IABP) versus ECPella.</div></div><div><h3>Measurements and Main Results</h3><div>ECPella patients showed a higher prevalence of coronary artery disease (65.0% <em>v</em> 34.6%, p &lt; 0.0001), cardiac arrest before MCS implantation (63.1% <em>v</em> 52.7%, p &lt; 0.0001), and ischemic CS (53.1% <em>v</em> 42.6%, p &lt; 0.0001) compared with patients with VA ECMO alone. The comparison between ECPella and VA ECMO + IABP patients showed a higher prevalence of acute myocardial infarction-CS (53.1% <em>v</em> 39.0%, p &lt; 0.0001), preimplantation cardiac arrest (63% <em>v</em> 49.3%, p &lt; 0.0001), and extracorporeal cardiopulmonary resuscitation (25.8% <em>v</em> 20.0%, p = 0.0015). The inclusion of the two randomized controlled trials in the VA ECMO group increased the prevalence of comorbidities compared with the ECPella group.</div></div><div><h3>Conclusions</h3><div>Patients who received a combination of MCS and VA ECMO have a greater prevalence of comorbidities.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 675-682"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005920","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":"Circular Shunt: A Loop Not to Be Ignored","authors":"Madan Mohan Maddali MD ,&nbsp;Salim Nasser Al-Maskari FRCPCH ,&nbsp;Hamood Nasar Al Kindi FRCSC","doi":"10.1053/j.jvca.2024.11.036","DOIUrl":"10.1053/j.jvca.2024.11.036","url":null,"abstract":"<div><div>A circular shunt, initially described by Shone et al. in 1962, refers to abnormal blood recirculation through complete intracardiac or intra- and extracardiac communications, bypassing the capillary beds. This pathophysiological condition is most commonly associated with complex congenital heart defects, such as Ebstein's malformation, pulmonary atresia, Gerbode defect, and so on. Circular shunts significantly disrupt cardiac output and systemic perfusion, leading to heart failure, hypotension, and organ dysfunction. Clinical presentation varies from severe neonatal distress to progressive heart failure in older children. Diagnosis requires a high index of suspicion and careful evaluation, and its management focuses on interrupting or reducing the shunt through surgical repair or transcatheter intervention or, in some cases, medical therapy. Early diagnosis, particularly in prenatal cases, and timely intervention are crucial for improving outcomes in affected neonates.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 813-817"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872016","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":"Transesophageal Echocardiography Imaging of Iatrogenic Pulmonary Vein Stenosis After Left Atrial Reduction Plasty","authors":"Kohei Noto MD ,&nbsp;Junichi Saito MD, PhD ,&nbsp;Hirotaka Kinoshita MD, PhD ,&nbsp;Tetsuya Kushikata MD, PhD ,&nbsp;Kazuyoshi Hirota MD, PhD, FRCA","doi":"10.1053/j.jvca.2024.12.008","DOIUrl":"10.1053/j.jvca.2024.12.008","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 864-865"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894766","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 Neuraxial or General Anesthesia on the Incidence of Postoperative Pulmonary Complications in Patients Undergoing Peripheral Vascular Surgery: A Randomized Controlled Trial","authors":"André P. Schmidt ,&nbsp;Daiane Silvello ,&nbsp;Clovis T. Bevilacqua Filho ,&nbsp;Deborah Bergmann ,&nbsp;Luiz Eduardo C. Ferreira ,&nbsp;Marcos F. Nolasco ,&nbsp;Tales D. Pires ,&nbsp;Walter C. Braga ,&nbsp;Cristiano F. Andrade","doi":"10.1053/j.jvca.2024.12.027","DOIUrl":"10.1053/j.jvca.2024.12.027","url":null,"abstract":"<div><h3>Objectives</h3><div>Postoperative complications after major surgery, especially in vascular procedures, are associated with a significant increase in costs and mortality. Postoperative pulmonary complications (PPCs) have a notable impact on morbidity and mortality. The primary aim of this present study was to evaluate the effects of spinal anesthesia compared with general anesthesia on the incidence of PPCs in patients undergoing lower extremity bypass surgery.</div></div><div><h3>Design</h3><div>This study was designed as a prospective, randomized controlled clinical trial with 2 parallel arms.</div></div><div><h3>Setting</h3><div>Two tertiary teaching hospitals.</div></div><div><h3>Participants</h3><div>We enrolled 128 adult patients with American Society of Anesthesiologists status II to IV who were scheduled to undergo elective lower extremity arterial bypass surgery.</div></div><div><h3>Interventions</h3><div>Patients were assigned randomly to receive either general anesthesia or spinal anesthesia.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcome was the incidence of PPCs and secondary end points included hemodynamic and blood gas analysis perioperatively. A total of 128 patients were included in the study, with 123 patients completing the study protocol. Approximately 26.7% of patients who received general anesthesia experienced PPC, compared with 12.7% of those who received spinal anesthesia (p = 0.051). Patients who underwent spinal anesthesia had a lower incidence of hypotension and required fewer intraoperative vasoactive drugs (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In this study, spinal anesthesia did not significantly reduce the incidence of PPCs in patients undergoing peripheral vascular surgery compared with general anesthesia. Neuraxial anesthesia may reduce the incidence of hypotension and the need for hemodynamic pharmacological support in patients undergoing peripheral arterial surgery, although further dedicated studies are required to validate these findings.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 724-732"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949340","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}