Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"A Preoperative Prediction Model for Acute Kidney Injury After Off-Pump Coronary Artery Bypass Grafting.","authors":"Tatsuya Kunigo, Masakiyo Hayashi, Yuta Ikeshima, Naoyuki Hirata, Shigeo Tsuchiya, Masaki Toriyabe, Kazutoshi Kasaba, Ryo Miyashita, Nao Yoshida, Masahito Omote, Sho Ohno, Yasuaki Sawashita, Tomoya Ito, Koki Nishikawa, Hitoshi Namba, Junichi Sato, Naoki Tsujiguchi, Yuji Neppu, Yusuke Yoshikawa, Shiro Hinotsu, Michiaki Yamakage","doi":"10.1053/j.jvca.2026.09.016","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.016","url":null,"abstract":"<p><strong>Objectives: </strong>Off-pump coronary artery bypass (OPCAB) is considered renal-protective; however, the incidence of acute kidney injury (AKI) remains high. Because AKI is associated with adverse outcomes, accurate prediction and prevention are essential. We developed and evaluated a preoperative prediction model for AKI after OPCAB. Model performance was also evaluated by applying the AKI model to predict renal replacement therapy (RRT).</p><p><strong>Design: </strong>Diagnostic/prognostic study.</p><p><strong>Setting: </strong>Two university hospitals and 10 tertiary care centers.</p><p><strong>Participants: </strong>A total of 1,640 OPCAB patients.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Model performance was evaluated in terms of discrimination, calibration, and net benefit. AKI occurred in 290 patients (17.7%), and RRT was required in 33 patients (2.0%). Preoperative predictors were male sex, obesity, contrast use within 7 days, diabetes, absence of aspirin therapy, anemia, and chronic kidney disease. Postoperative predictors included unplanned cardiopulmonary bypass, oliguria, and prolonged surgery. The area under the receiver operating characteristic curves (AUCs) were 0.715 for the preoperative model and 0.753 for the postoperative model (p < .001). For RRT prediction, the AUCs of the preoperative and postoperative models were 0.776 and 0.800 (p = .441), respectively. All calibration plots confirmed agreement between predicted and observed probabilities (all Hosmer-Lemeshow goodness-of-fit tests p > .05). The preoperative and postoperative models provided greater net benefit compared with previously reported models using decision curve analysis.</p><p><strong>Conclusion: </strong>We developed a preoperative AKI prediction model based solely on 7 simple variables, which demonstrated good performance comparable to models incorporating postoperative factors and was also applicable to RRT prediction.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136595","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":"Prognostic Value of Vasoactive-Inotropic Score and Inotropic Score for Mortality After Pediatric Congenital Heart Surgery:A Retrospective Cohort Study.","authors":"Selen Bozdemir, Nurgul Yurtseven","doi":"10.1053/j.jvca.2026.09.006","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.006","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the associations of admission vasoactive-inotropic score (VIS) and inotropic score (IS) with postoperative mortality and compare their incremental discrimination beyond baseline clinical and surgical risk.</p><p><strong>Design: </strong>Retrospective single-center cohort study.</p><p><strong>Setting: </strong>Pediatric intensive care unit of a tertiary referral center.</p><p><strong>Participants: </strong>Pediatric patients (<18 years) undergoing congenital heart surgery with cardiopulmonary bypass between January 2020 and September 2022. A total of 1,450 procedures in 1,324 patients were analyzed; 120 patients underwent more than 1 procedure.</p><p><strong>Interventions: </strong>No specific intervention was performed. VIS and IS were calculated from vasoactive and inotropic drug doses at the time of pediatric intensive care unit admission.</p><p><strong>Measurements and main results: </strong>Mortality occurred after 107 procedures (7.38%), representing 107 unique patients (8.1% patient-level mortality). Separate patient-clustered generalized estimating equation logistic models were adjusted for age, sex, weight, and STAT mortality category. Both VIS (odds ratio 1.126 per point, 95% confidence interval 1.101-1.151; p < .001) and IS (odds ratio 1.225, 95% confidence interval 1.177-1.274; p < .001) were independently associated with mortality. The baseline model area under the curve was 0.626 and increased to 0.869 with VIS and 0.852 with IS. The difference between the adjusted VIS and IS models was not statistically significant (Δ area under the curve = 0.017; p = .101).</p><p><strong>Conclusion: </strong>Admission VIS and IS were independently associated with postoperative mortality and improved discrimination beyond baseline risk factors. VIS was not statistically superior to IS. Both scores should be interpreted as objective measures of early postoperative cardiovascular support and illness severity rather than standalone predictive tools.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136684","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 Cardiopulmonary Bypass Duration on the Development of Postoperative Delirium in Cardiac Surgery: A Secondary Subgroup Analysis of an Observational Study.","authors":"Johanna Feggeler, Andrea Kunsorg, Markus Velten, Andreas Mayr, Maria Wittmann, Georg Baumgarten","doi":"10.1053/j.jvca.2026.08.163","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.163","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative delirium (POD) is an acute brain impairment linked to higher morbidity and mortality after surgery. This issue is especially prevalent in older cardiac surgery patients receiving cardiopulmonary bypass (CPB), who face unique pathophysiological risks and heightened POD susceptibility. Identifying risk factors is crucial for targeted prevention and therapy.</p><p><strong>Design: </strong>This investigation represents a subgroup analysis derived from a prospective observational study.</p><p><strong>Setting: </strong>In this subgroup analysis, 274 cardiac surgery patients from a prospective observational study were examined. Data collection was performed during the patients' postoperative hospital stay across 5 consecutive assessment days.</p><p><strong>Participants: </strong>A total of 274 adult patients were included in the analysis. POD was considered present if any of the following screening tools indicated delirium on at least 1 of the 5 evaluation days: Confusion Assessment Method for the ICU, Confusion Assessment Method, 4 'A's Test, or Delirium Observation Screening scale.</p><p><strong>Intervention: </strong>No intervention was performed; the study was purely observational.</p><p><strong>Measurement and main results: </strong>The incidence of POD was 50.4% in a cohort with a mean age of 70.7 years (standard deviation, 6.4 years). The regression model showed a significant effect of CPB duration category (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.12-1.75; p = 0.003) and preoperative troponin T level (OR, 1.64; 95% CI, 1.07-2.51; p = 0.024) on POD.</p><p><strong>Conclusions: </strong>This subgroup analysis examined several risk factors for POD in a cardiac surgery cohort. The duration of CPB has been shown to be a risk factor for the development of POD. This information can help identify patients at increased risk of POD during the perioperative period.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149084","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 Postoperative Mechanical Ventilation Duration on Visual and Auditory Hallucinations After Cardiac Surgery: Insights from the VAACS Study.","authors":"Mohammad Alnees, Nizar Abu Hamdeh, Duha Najajra, Abdalaziz Darwish, Alaa Dabash, Yahya Z Fraitekh, Kareem Ibraheem, Mohammad Masu'd, Reem J Saad, Nasim Abukaresh, Izzeddin Swidan, Mohammed Alra'e, Amal M Shawabka, Taha Z Makhlouf, Mahdi Awwad, Wafiq Othman, Ruzan Jamaleddin, Nouraldin Hih, Mousa Bsharat, Mohammed Aburemaileh, Anwar Zahran, Basem Bali, Osama Ewidat, Mohammad Bdair, Laith Ahmad, Omar Qasem Heih, Qais Salahat, Hasan Alkhatib, Ameen Abu Awad, Hamza Abdul-Hafez, Michael Matarweh, Oday Nana, Kasem Hamoudy, Haitham Abu Khadija","doi":"10.1053/j.jvca.2026.08.167","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.167","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether postoperative mechanical ventilation duration is associated with the risk and timing of visual and auditory hallucinations after adult cardiac surgery.</p><p><strong>Design: </strong>Prospective multicenter cohort study.</p><p><strong>Setting: </strong>Ten major cardiac surgery centers in the West Bank, Palestine.</p><p><strong>Participants: </strong>A total of 1,332 adults undergoing coronary artery bypass grafting or valve surgery, stratified by postoperative ventilation duration: ≤6 hours or >6 hours.</p><p><strong>Interventions: </strong>No experimental intervention was performed; patients were grouped by early versus delayed postoperative extubation.</p><p><strong>Measurements and main results: </strong>Visual and auditory hallucinations were assessed during the first 7 postoperative days using the Questionnaire for Psychotic Experiences. Cox regression and restricted mean survival time analyses evaluated associations between ventilation duration and hallucination outcomes. Delayed extubation (>6 hours) was associated with lower overall adjusted risk of visual hallucinations (adjusted hazard ratio, 0.70; 95% confidence interval, 0.62-0.80; p < .001) and auditory hallucinations (adjusted hazard ratio, 0.49; 95% confidence interval, 0.31-0.77; p = .002). However, time-varying analysis showed increased immediate postoperative hazard in the delayed-extubation group, with risk declining rapidly over time. Restricted mean survival time analysis showed that auditory hallucination-free time was approximately 0.24 days shorter in patients with delayed extubation (p < .001). Preoperative white blood cell count was the most consistent predictor.</p><p><strong>Conclusion: </strong>Delayed postoperative extubation was associated with lower overall 7-day hallucination risk but higher immediate postoperative vulnerability, suggesting that the early postextubation period may represent a critical window for targeted monitoring and preventive neuropsychiatric care after cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244792","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":"Echocardiography Training Across Specialties: Lessons From Cardiothoracic Anesthesia and Critical Care.","authors":"Luke Flower, Stephen Shepherd","doi":"10.1053/j.jvca.2026.09.011","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.011","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165540","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 Peril of Silent Titration: Preserving the Shared Mental Model in Dynamic Clinical Environments.","authors":"Rafael Ortega","doi":"10.1053/j.jvca.2026.09.010","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.010","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127458","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":"Clarifying the Clinical Risk Associated With Preoperative Iron Deficiency in Pediatric Cardiac Surgery.","authors":"Teruhiko Imamura","doi":"10.1053/j.jvca.2026.09.012","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.012","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127344","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":"Prognostic Value of Preoperative 2-Dimensional Left Ventricular, Right Ventricular, and Left Atrial Strain in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study.","authors":"Samrat S Madanaik, Rakesh Gupta, Ashish Pokharkar, Shefali Mishra, Prithiviraj Patil","doi":"10.1053/j.jvca.2026.08.171","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.171","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether preoperative speckle-tracking strain of the left ventricle, right ventricle, and left atrium predicts new-onset postoperative atrial fibrillation (POAF) and other adverse outcomes after off-pump coronary artery bypass grafting (OPCAB).</p><p><strong>Design: </strong>Prospective, single-center, observational, prognostic cohort study.</p><p><strong>Setting: </strong>Tertiary-care university cardiac surgical center in western India.</p><p><strong>Participants: </strong>One hundred fifty consecutive adults undergoing elective isolated OPCAB (January 2024-March 2025).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Transthoracic echocardiography with offline speckle tracking was performed within 24 hours before surgery; left ventricular (LV) global longitudinal strain (GLS), right ventricular free-wall longitudinal strain (RVFWLS) and left atrial (LA) reservoir strain (peak atrial longitudinal strain [PALS]) were measured. POAF occurred in 62 of 150 patients (41.3%). Patients with POAF had less negative LV GLS (-16.07% v -17.85%), less negative RVFWLS (-21.85% v -24.47%), lower PALS (32.45% v 38.31%), and larger LA volume index (LAVI) (43.71 mL/m² v 33.01 mL/m²) (all p < 0.001). LAVI showed the highest discrimination (area under the curve [AUC], 0.867), followed by RVFWLS (AUC, 0.771), LV GLS (AUC, 0.766), and PALS (AUC, 0.765); LV ejection fraction did not discriminate (AUC, 0.541). After adjustment for age, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, and LAVI, RVFWLS (adjusted odds ratio, 1.436; p = 0.008) and PALS (1.118 per 1% decrement, p = 0.039) were the only strain parameters that remained independent predictors, together with LAVI and age. RVFWLS was also independently associated with prolonged inotropic support beyond 48 hours.</p><p><strong>Conclusions: </strong>Preoperative strain of the left ventricle, right ventricle, and left atrium carries prognostic information for POAF after OPCAB, but only RVFWLS and LA reservoir strain were independent strain predictors after adjustment; these parameters may identify a high-risk subgroup warranting intensified rhythm monitoring and prophylaxis. These associations do not establish causation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136738","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":"Desaturation Duration or Unsampled Hypotension? Interpreting Cerebral Oximetry Between Blood Pressure Measurements.","authors":"Kaoru Suzuki, Kentaro Yamakawa","doi":"10.1053/j.jvca.2026.08.169","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.169","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110162","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 Limb Ischemia as the Presenting Manifestation of Severe Mitral Stenosis With Giant Left Atrial Thrombi: Multimodality Cardiac Imaging.","authors":"Aibek E Mirrakhimov, Aaron D Fain, Eugene A Hessel","doi":"10.1053/j.jvca.2026.09.007","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.007","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080922","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}