Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Residual Heparinization Post Cardiac Surgery: Implications of Heparin Sequestration in Adipose Tissue and the Need Reassessment of Protamine Reversal.","authors":"Khaled Ebrahim Al Ebrahim","doi":"10.1053/j.jvca.2025.08.033","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.033","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064518","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":"Automated Inferior Vena Cava Distensibility Index for Assessing Fluid Responsiveness in Ventilated Patients After Cardiac Surgery: A Prospective Pilot Comparative Study.","authors":"Amr Salah Omar, Praveen C Sivadasan, Suraj Sudarsanan, Hany O Ragab, Alaa Rahhal, Samy Hanoura, Sameh Aboulnaga, Abdelrahman Abdalla, Abdulwahid Almulla","doi":"10.1053/j.jvca.2025.08.023","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.023","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the accuracy of inferior vena cava distensibility index (IVC-DI) measurements, as well as the ability to track fluid responsiveness (FR) over time.</p><p><strong>Design: </strong>Prospective, descriptive, single-center study.</p><p><strong>Setting: </strong>A single tertiary academic center.</p><p><strong>Participants: </strong>Fifty consecutive after cardiac surgery.</p><p><strong>Interventions: </strong>We compared (1) the automated echocardiographic method with (2) the stroke volume variation (SVV) technique and (3) the manual echocardiographic method.</p><p><strong>Measurements: </strong>FR was measured simultaneously with all 3 methods in 50 patients after cardiac surgery. A second comparison was performed 90 to 180 minutes later. The outcomes assessed included the correlations between SVV with the automated IVC-DI and the manual IVC-DI, respectively, before and after fluid challenge, as well as the accuracy of FR according to the automated and manual IVC-DI. FR is defined as an increase in cardiac output by more than 10% after receiving a fluid challenge.</p><p><strong>Results: </strong>A total of 50 patients who underwent cardiac surgery were included (age 51 ± 8 years; 86% males). Before the fluid challenge, a negative correlation between automated and manual IVC-DI was observed (r = -0.141; p = 0.328) with a concordance rate of 98%, although the correlation became positive after the fluid challenge (r = 0.172; p = 0.233) with a concordance rate of 98%. After fluid challenge, SVV correlation with automated IVC-DI and manual IVC-DI was positive, with the latter being statistically significant (r = 0.352; p = 0.012). FR predicted by automated IVC-DI was found to have a sensitivity of 64% and specificity 49% with a receiver operating characteristic area under the curve of 0.55.</p><p><strong>Conclusions: </strong>Among cardiac surgical patients, manual IVC-DI correlated significantly with SVV in assessing FR. However, the automated IVC-DI mode demonstrated less reliability.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069607","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":"Anesthesiologists' Intraoperative Analgesic Practices for Patients Undergoing Cardiac Surgery.","authors":"Michael H-G Li, Guanqing Chen, Samantha Harrison, Krystal Capers, Balachundhar Subramaniam","doi":"10.1053/j.jvca.2025.08.018","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.018","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to ascertain the international practice patterns of cardiac anesthesiologists pertaining to analgesic prescription in the intraoperative period for patients undergoing cardiac surgery.</p><p><strong>Design: </strong>Survey was conducted in 2024.</p><p><strong>Setting: </strong>International, focusing on Australia, New Zealand, and North America.</p><p><strong>Participants: </strong>Members of the Society of Cardiovascular Anesthesiologists and members of the Cardiac, Thoracic, Vascular and Perfusion Special Interest Group of the Australian & New Zealand College of Anaesthetists. The Society of Cardiovascular Anesthesiologists distributed the survey among its 2,134 members, and the Australian & New Zealand College of Anaesthetists Clinical Trials Network distributed it to its 802 members.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements: </strong>Perceptions and practice patterns regarding opioid and non-opioid analgesic practices within the intraoperative cardiac surgery period.</p><p><strong>Main results: </strong>There were 377 participants who responded, with fentanyl being the primary opioid analgesic of choice (73.5%), and acetaminophen (72.3%) being the adjunct of choice. Most respondents agree that there is a role for intraoperative multimodal analgesia in cardiac surgery (79.1%). Conventional practice was principally mentioned as a barrier to utilizing an opioid-sparing technique (50%), followed by a lack of institutional policy (35.1%), and a lack of familiarity or comfort with the technique (34.8%) CONCLUSIONS: The efficacy of non-opioid drugs, in addition to comparisons between opioids, needs to be further established with longer-term, patient-centered clinical outcomes in mind. Educational and institutional policy interventions may play a ole in standardizing the use of intraoperative opioid use.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091529","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 Impact of Perioperative Hemodynamic and Blood Pressure Variability in Outcomes and Mortality: A Comprehensive Systematic Review.","authors":"Pandit Bagus Tri Saputra, Wynne Widiarti, Paulus Parholong Siahaan, Rendra Mahardhika Putra, Prihatma Kriswidyatomo, Novia Nurul Faizah, Firas Farisi Alkaff","doi":"10.1053/j.jvca.2025.08.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.026","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of perioperative blood pressure variability (BPV) on cardiovascular outcomes and mortality in cardiac surgery patients.</p><p><strong>Methods: </strong>Literature searches were performed across scientific databases up to December 31, 2024. Studies reporting perioperative BPV in patients undergoing cardiac surgery and its association with mortality and clinical outcomes were included.</p><p><strong>Results: </strong>Fifteen studies with 16,407 patients were included. Increased BPV was significantly associated with higher rates of 30-day mortality, acute kidney injury (AKI), prolonged intensive care unit stay, and cognitive dysfunction. Among patients with fewer comorbidities and perioperative risk, 30-day mortality ranged from 0.2% to 0.5%, while in patients with higher risk, it increased from 42.4% to 60.7% (p < 0.001). Elevated BPV was linked to a 23.2% higher risk of AKI per unit increase in blood pressure (BP) standard deviation (SD) and a 15% increased incidence of postoperative delirium. The findings emphasize the critical need for precise perioperative BP control, with advanced metrics like BP fragmentation providing valuable insights into patient risk.</p><p><strong>Conclusions: </strong>Perioperative BPV appears to be a crucial factor influencing postoperative outcomes in cardiac surgery patients. Effective management of BPV may help reduce complications and improve patient outcomes, highlighting the potential benefits of tailored hemodynamic strategies. However, further research is needed to establish standardized BPV thresholds and optimal management approaches.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053663","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":"Comparison between the Fibrinogen Clauss Assay and the TEG6S Citrated Functional Fibrinogen in Cardiac Surgery.","authors":"Terrence Alfred, Luiz Guilherme Villares da Costa, Christopher Harle, Raffael Zamper","doi":"10.1053/j.jvca.2025.08.022","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.022","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the correlation between fibrinogen levels measured by the TEG6s citrated functional fibrinogen (CFF) assay and the standard Clauss method across three phases of cardiac surgery involving cardiopulmonary bypass (CPB), and to assess the potential of CFF for timely clinical decision-making and bleeding prediction.</p><p><strong>Design: </strong>A prospective observational study.</p><p><strong>Setting: </strong>A single tertiary academic center specializing in cardiac surgery.</p><p><strong>Participants: </strong>Twenty adult patients (≥18 years) scheduled for elective cardiac surgery requiring CPB.</p><p><strong>Interventions: </strong>Arterial blood samples were collected at three intraoperative time points: (1) baseline (pre-CPB), (2) during CPB at rewarming (core temperature ≥36°C), and (3) 5 minutes post-protamine administration. Each sample was analyzed using both the TEG6s CFF and Clauss fibrinogen assays.</p><p><strong>Measurements and main results: </strong>A total of 60 paired measurements were obtained. The primary outcome was the correlation between the TEG6s CFF and Clauss fibrinogen values across surgical phases. A strong correlation was observed at baseline (Spearman's ρ = high, p < 0.01), which significantly weakened during rewarming (p < 0.05), and partially recovered post-protamine. Turnaround times for CFF were significantly faster than for Clauss across all phases. However, CFF values alone did not reliably predict major postoperative bleeding (defined as ≥500 mL chest tube output in 24 hours), and neither assay showed statistically significant differences between bleeding and nonbleeding groups.</p><p><strong>Conclusion: </strong>The TEG6s CFF assay demonstrates a strong correlation with Clauss fibrinogen levels before CPB, but this relationship weakens during CPB and remains moderate post-protamine administration. Despite limitations during high-heparin states, the TEG6s offers significantly faster results, suggesting utility for real-time intraoperative decision-making. However, CFF values alone are insufficient to predict postoperative bleeding. Further large-scale studies are needed to validate the integration of TEG6s into transfusion algorithms in cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069642","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 Nonpharmacological Interventions on Sleep Quality in Cardiac Surgical Patients: A Prospective Randomised Controlled Study.","authors":"Annushha Gayatri, Nagarjuna Panidapu, Praveen Kumar Neema, Thushara Madathil, Devika Poduval, Don Jose Palamattam, Praveen Kerala Varma","doi":"10.1053/j.jvca.2025.08.036","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.036","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective of the current study was to evaluate whether the use of eye masks and ear plugs improves postoperative sleep quality in patients undergoing cardiac surgery. The secondary objectives include the evaluation of nonpharmacological interventions on daytime sleepiness, opioid consumption, and postoperative complications DESIGN: Prospective, randomized, controlled, parallel-group study.</p><p><strong>Participants and setting: </strong>The study was conducted in 100 adult patients undergoing elective cardiac surgery in a quaternary care hospital.</p><p><strong>Interventions: </strong>The intervention group received ear plugs and an eye mask from 10:00 pm to 6:00 am. The quality of sleep was assessed on the morning of the next day using the Richards-Campbell Sleep Questionnaire.</p><p><strong>Measurements and main results: </strong>The intervention group had significantly higher Richards-Campbell Sleep Questionnaire scores (78 v 62; p < 0.05) and a significant reduction in daytime sleepiness (30% v 62%; p < 0.05) and opioid consumption (7.35 mg v 12.75 mg; p < 0.05). The incidence of postoperative atrial fibrillation, delirium, and length of stay in the intensive care unit were comparable between the groups.</p><p><strong>Conclusions: </strong>Eye masks and ear plugs improve the quality of sleep and reduce daytime sleepiness and opioid consumption in patients undergoing cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064489","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":"Building a Foundation: The Consensus Statements for a Standardized Curriculum in Robotic Thoracic Surgery Training.","authors":"Daniel S Cormican, Walter E McGregor","doi":"10.1053/j.jvca.2025.08.021","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.021","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102653","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":"Guidelines for Anesthesia in Adults with Congenital Heart Disease for Noncardiac Surgery.","authors":"J C Waldman, B Ahlgren, R J Ing","doi":"10.1053/j.jvca.2025.08.024","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.024","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053678","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":"ECMO in Pregnancy: Analysis of Indications, Management and Outcomes.","authors":"Juan G Ripoll, Yul O Kahn-Pascual, Troy G Seelhammer, Edward A Bittner, Marvin G Chang, Jamel Ortoleva, Juan C Diaz Soto, Omar Elmadhoun, Emily E Naoum, Patrick M Wieruszewski, Christoph G Nabzdyk, Harish Ramakrishna","doi":"10.1053/j.jvca.2025.08.030","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.030","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) has become a critical rescue therapy for pregnant and peripartum patients experiencing life-threatening cardiac or respiratory failure that is refractory to standard treatments. Pregnancy induces unique physiologic changes that influence ECMO initiation, cannulation, and management, necessitating specialized approaches to optimize outcomes for both mother and fetus. Pharmacologic challenges include altered drug kinetics and the risks associated with placental drug transfer, while anticoagulation strategies require a careful balance between thrombosis and bleeding, particularly around delivery. Obstetric management involves continuous fetal monitoring, individualized timing of delivery, and multidisciplinary coordination among critical care, obstetrics, neonatology, and anesthesiology teams. Evidence from case series, registries, and meta-analyses indicates favorable maternal survival, especially with venovenous ECMO, although fetal outcomes vary depending on gestational age and clinical circumstances. Ethical considerations are complex, emphasizing maternal autonomy alongside fetal well-being, often requiring decisions amid considerable uncertainty. Emerging technologies, such as artificial placenta systems, may offer future support options. Despite encouraging results, significant gaps remain in prospective data, standardized fetal monitoring, and ethical guidance. This review synthesizes current knowledge and underscores the need for ongoing research and multidisciplinary collaboration to improve care for pregnant patients requiring ECMO.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053577","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":"Clinical Machine Learning Pitfalls: Reliability of Feature Importance in Prediction of Continuous Renal Replacement Therapy in Acute Type A Aortic Dissection Assessment.","authors":"Souichi Oka, Yoshiyasu Takefuji","doi":"10.1053/j.jvca.2025.08.035","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.035","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040311","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}