Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Surgery for Acute Type A Aortic Dissection in Patients Aged ≥75 Years: Six-Month Outcomes and Predictors of Mortality.","authors":"Nicolas Polge, Corentin Delorme, Georges Abi Abdallah, Diane Zlotnik, Marie Potier, Charles-Henri Gautier, Johanne Poisson, Elodie Lang, Anne Godier","doi":"10.1053/j.jvca.2026.09.003","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.003","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110114","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":"When Long-Term Outcomes Matter: Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement and the Need for Lifetime Stewardship in Younger, Lower-Risk Patients.","authors":"Gabor Erdoes, Axel Unbehaun, Andreas Koster, Lars G Svensson, Anders Jeppsson","doi":"10.1053/j.jvca.2026.09.004","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.004","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110143","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 Noninvasive Ventilatory Therapies Through Different Interfaces in the Postoperative Care of Cardiac Surgery Patients: A Randomized Controlled Trial.","authors":"Bruno Memória Rodrigues Okubo, José Glauco Lobo Filho, Heraldo Guedis Lobo Filho, Antônio Brazil Viana Júnior, Andréa da Nóbrega Cirino Nogueira","doi":"10.1053/j.jvca.2026.09.001","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.001","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the clinical efficacy of 5 noninvasive ventilatory strategies-delivered via a conventional oronasal mask, a conventional full-face mask, the Wolf Mask full-face interface, the ELMO helmet (continuous positive airway pressure), and high-flow nasal cannula-against conventional physiotherapy without active ventilatory support in patients following elective cardiac surgery.</p><p><strong>Design: </strong>Prospective, randomized, controlled trial.</p><p><strong>Setting: </strong>High-complexity intensive care unit (ICU) of a tertiary care hospital from July 2023 to May 2026.</p><p><strong>Participants: </strong>In total, 172 patients undergoing elective coronary artery bypass grafting or valve surgery, randomized into 6 groups (G-FA, G-FULL, G-WOLF, G-ELMO, G-TAF, and G-CONTR).</p><p><strong>Interventions: </strong>Three daily 60-minute sessions of the assigned ventilatory modality integrated into standard physiotherapy care, from ICU admission to discharge.</p><p><strong>Measurements and main results: </strong>The primary outcomes were interface comfort and mobilization progression, with postoperative pulmonary complications as a secondary outcome. The Wolf Mask achieved the highest comfort score (9.41 ± 0.68 on a 0-10 visual analog scale) and required the lowest inspiratory pressure support (5.62 ± 2.08 cmH₂O) to reach the target tidal volume (6 mL/kg ideal body weight), suggesting superior mechanical efficiency. It was the only interface with no recorded cases of bibasal atelectasis and showed the lowest overall pulmonary complication rate. The conventional full-face mask yielded the second-best performance in comfort, arterial oxygenation, and pulmonary protection. High-flow nasal cannula proved safe but offered no advantage over full-face interfaces in pulmonary or functional outcomes. The ELMO helmet was hemodynamically safe and produced no hypercapnia but registered comfort scores among the lowest, statistically comparable to those of the conventional oronasal mask, along with the poorest oxygenation values. The control group had the highest complication rate, the lowest mobilization levels, and the smallest proportion of patients reaching mobilization level 3 at ICU discharge (18% v 73%-74% in the full-face groups). Interface comfort was identified as an independent positive predictor of mobilization progression by linear mixed-effects modeling (p = 0.004).</p><p><strong>Conclusions: </strong>In this trial, full-face interfaces, and the Wolf Mask in particular, were associated with the highest comfort and the lowest inspiratory pressure support, and interface comfort was an independent predictor of mobilization progression. The pulmonary and oxygenation findings were exploratory and hypothesis-generating. These results support the deliberate selection of well-tolerated full-face interfaces in postoperative cardiac surgery care and warrant confirmation in multicenter trials with longer follow-up.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074894","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":"Resuscitative Transesophageal Echocardiography Simulation-Based Education for Extracorporeal Cardiopulmonary Resuscitation Cannulation Guidance.","authors":"Govind Pandompatam, Albert Bui, Anna Shapiro, Jon Christensen, Ricardo Diaz Milian","doi":"10.1053/j.jvca.2026.09.002","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.09.002","url":null,"abstract":"<p><strong>Objectives: </strong>A simulation-based learning (SBL) resuscitative transesophageal echocardiography (TEE) course was developed to teach a focused extracorporeal cardiopulmonary resuscitation (ECPR) cannulation guidance protocol for critical care practitioners.</p><p><strong>Design: </strong>The four-hour SBL course was conducted for critical care practitioners with no prior formal TEE training.</p><p><strong>Setting: </strong>University hospital, simulation center.</p><p><strong>Participants: </strong>Critical care practitioners, voluntary.</p><p><strong>Interventions: </strong>The course implemented ordered sessions: didactics, TEE simulation, and hands-on ECPR cannulation simulation scenarios.</p><p><strong>Measurements and main results: </strong>Pre and post course knowledge assessment and surveys were completed. Median knowledge assessment score improved from 53% to 93% (P < .001). Survey responses yielded significant median score improvement in comfort levels of SBL TEE for ECPR guidance using a 5-point Likert scale (p-value <0.001).</p><p><strong>Conclusions: </strong>An SBL resuscitative TEE course focused on ECPR cannulation guidance can provide a framework for teaching these skills to critical care practitioners.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110150","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":"Cerebral Arterial Gas Embolism in Cardiovascular and Aortic Procedures: A Narrative Review of the Mechanisms, Diagnosis, Management, and Prevention.","authors":"Bridget Si Min Ng, Suneel Ramesh Desai, Nian Chih Hwang","doi":"10.1053/j.jvca.2026.08.173","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.173","url":null,"abstract":"<p><p>Cerebral arterial gas embolism (CAGE) is an uncommon but potentially catastrophic complication of cardiothoracic surgery, extracorporeal circulation, mechanical circulatory support, and catheter-based cardiac interventions. During these procedures, gas may be introduced to the cardiac chambers, aorta, and cerebral arterial circulation through different mechanisms. Clinical presentation ranges from abrupt intraoperative hemodynamic and neurologic deterioration to delayed, subtle focal deficits emerging after an apparently uneventful emergence from anesthesia. As intracranial air is detectable on computed tomography in only a minority of confirmed cases, CAGE remains fundamentally a clinical diagnosis, and a high index of suspicion in the correct procedural context should not be delayed by or dependent on imaging confirmation. Immediate management prioritizes cessation of further gas entry, 100% oxygen, and hemodynamic optimization to preserve cerebral perfusion, with hyperbaric oxygen therapy representing the definitive treatment; outcomes are most favorable when hyperbaric oxygen is initiated within 6 hours of symptom onset, although benefit may still occur with delayed treatment. Most mechanisms of CAGE-inadequate deairing, direct gas introduction, and entrainment-are preventable through meticulous circuit vigilance, standardized deairing protocols, and human factor safeguards. Cavitation and unpredictable outgassing, however, may occur despite optimal technique, placing greater weight on early recognition. This review synthesizes procedure-specific mechanisms, presentation, diagnosis, acute and preventive management across cardiac and aortic surgery, mechanical circulatory support, and catheter-based interventions, with the goal of supporting rapid recognition and coordinated multidisciplinary response by the perfusion, surgical, procedural, and anesthesiology teams. Specific anesthesia considerations and the role of transesophageal echocardiography are discussed.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074908","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":"Lactate and pH as Predictors of In-Hospital Mortality in Extracorporeal Cardiopulmonary Resuscitation: A Single-Center Retrospective Study.","authors":"Kriyana P Reddy, Salim E Olia, Asad A Usman, Michael E Ibrahim, Christian A Bermudez, Marisa Cevasco, Wilson Y Szeto, John G Augoustides, William J Vernick, Jacob T Gutsche, Audrey E Spelde","doi":"10.1053/j.jvca.2026.08.166","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.166","url":null,"abstract":"<p><strong>Objectives: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for patients with refractory cardiac arrest, yet optimal criteria for patient selection remain poorly understood. Precannulation lactate and pH values are prognostic markers, but given the wide ranges in existing literature, there is no consensus on threshold values that optimally stratify risk. This study aims to evaluate individual and combined prognostic values of precannulation lactate and pH in predicting hospital mortality.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single, quaternary academic center.</p><p><strong>Participants: </strong>Adult patients undergoing ECPR between September 2011 and April 2025 (n = 484).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Pre- and postcannulation lactate and pH values were retrospectively identified. Logistic regression‒assessed associations between lactate and pH and hospital mortality, receiver operating characteristic curves, and area under the curve values were calculated. Optimal cut-off values for lactate and pH were calculated using the Youden index in receiver operating characteristic analyses. Median lactate was 8.7 mmol/L (IQR 4.1-12.3), and median pH was 7.23 (IQR 7.09-7.34). In-hospital mortality was 62.4%. Non-survivors had significantly higher median lactate (9.3 v 7.3, p < .001) and lower median pH (7.2 v 7.27, p < .001) values. In multivariable logistic regressions, lactate (OR 1.13 per mmol/L, 95% CI 1.05-1.22) and pH (OR 0.61 per 0.1 unit, 95% CI 0.47-0.76) were each independently associated with mortality. However, in models including both variables, pH remained a significant predictor of mortality, whereas lactate did not. Optimal cut points were 10.85 mmol/L for lactate and 7.2 for pH.</p><p><strong>Conclusion: </strong>These findings support the inclusion of lactate and pH in a cumulative, multifactorial risk stratification framework to inform real-time prognostication and patient selection for ECPR on an individual programmatic basis.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110212","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":"Could Short-Acting β-Blocker Infusions Have a Role in Selected Perioperative Patients at Risk for Takotsubo Syndrome?","authors":"John E Madias","doi":"10.1053/j.jvca.2026.08.172","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.172","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038792","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":"Kidney Function Following Cardiopulmonary Bypass: The Harbinger of a Poor Outcome?","authors":"Kelly Byrne, Kamil Patel","doi":"10.1053/j.jvca.2026.08.153","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.153","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037819","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":"Beyond \"See Before You Advance\": Choosing and Sizing a Lung Isolation Device.","authors":"Evangelia Samara, Petros Tzimas, Mohamed R El Tahan","doi":"10.1053/j.jvca.2026.08.174","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.174","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038797","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 Intraoperative Fluid Management on Postoperative Complications Following Thoracic Surgery: An Evaluation From the German Thoracic Registry.","authors":"H Niedmers, F Wappler, J Defosse, J Weber, M Schieren","doi":"10.1053/j.jvca.2026.08.155","DOIUrl":"https://doi.org/10.1053/j.jvca.2026.08.155","url":null,"abstract":"<p><strong>Objectives: </strong>This study assessed the impact of perioperative crystalloid volume on postoperative complications after lung surgery. Postoperative pulmonary complications significantly affect morbidity and mortality, but the role of fluid management remains unclear.</p><p><strong>Design: </strong>Retrospective matched-pair analysis of the German Thoracic Registry (2016-2020), a national registry database.</p><p><strong>Setting: </strong>German Thoracic Registry data from multiple thoracic surgery centers across Germany (specialized, tertiary, and university hospitals).</p><p><strong>Participants: </strong>A total of 6,917 patients undergoing thoracic surgery were included, and after patient selection (wedge resection, segmentectomy, lobectomy, bilobectomy, pneumonectomy) and application of exclusion criteria, a matching process was carried out. Two hundred four matched triplets (n = 612) were formed.</p><p><strong>Interventions: </strong>Differences were analyzed only in patients receiving crystalloid administration. Data on biometrics, perioperative management, and postoperative complications were analyzed, including subgroup analyses (wedge v anatomic resections). Regression and exploratory analyses identified potential volume thresholds with regard to the development of postoperative complications.</p><p><strong>Measurements and main results: </strong>A total crystalloid volume ≥2,500 mL was associated with higher overall and respiratory complication rates, especially the rate of pneumonia, in anatomic resections. Pleural drainage duration and hospital stay were prolonged, while nonpulmonary complications were unaffected. In wedge resections, infusion volume had minimal impact, except for longer pleural drainage and increased use of noninvasive ventilation.</p><p><strong>Conclusions: </strong>Intraoperative crystalloid volume-largely independent of patient characteristics-is associated with increased postoperative complications. The effect is pronounced in anatomic resections and minimal in wedge resections. A total infusion volume ≥2,500 mL represents a critical threshold. These findings support evidence-based recommendations for perioperative fluid management to improve patient safety and highlight that a restrictive approach appears to be beneficial.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136712","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}