Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Articles to Appear in Future Issues","authors":"","doi":"10.1053/S1053-0770(25)00229-0","DOIUrl":"10.1053/S1053-0770(25)00229-0","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 5","pages":"Page xii"},"PeriodicalIF":2.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817460","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":"Outcomes Following Perioperative Stroke in Cardiac Surgery Patients: A Retrospective Cohort Study.","authors":"Jaycee R Farmer, Jason M Sutherland, Thalia S Field, Daniel I McIsaac, Adrian W Gelb, Lily W Zhou, Terri Sun, Stephan K W Schwarz, Alana M Flexman","doi":"10.1053/j.jvca.2025.04.010","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.010","url":null,"abstract":"<p><strong>Objectives: </strong>To identify independent predictors of 30-day mortality, adverse discharge, and length of hospital stay following a perioperative stroke among cardiac surgical patients, and to measure trends in outcomes over time.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2020.</p><p><strong>Participants: </strong>Cardiac surgery patients with perioperative stroke (n = 906).</p><p><strong>Interventions: </strong>None. Observational analysis.</p><p><strong>Measurements and main results: </strong>Patient demographics, comorbid conditions, timing of stroke, procedure characteristics, and type of anesthesia information were extracted. The least absolute shrinkage and selection operator technique were employed to identify variables associated with 30-day mortality (the primary outcome), adverse discharge (death or a nonhome facility), and length of hospital stay. Perioperative stroke occurred a median (interquartile range) of 4 days (2-8 days) after surgery, 15% (134/906) of patients died, and 52% (351/906) were discharged to a facility that was not home. Factors significantly associated with 30-day mortality included increasing age, postoperative complications, fewer days from operation to stroke, and increased operative time (C-statistic = 0.794). Significant temporal changes in mortality or adverse discharge outcomes were not identified over the 15-year study period.</p><p><strong>Conclusion: </strong>Cardiac perioperative strokes are associated with high rates of nonhome discharge and mortality, and those occurring sooner after cardiac surgery were associated with higher mortality, in addition to other factors. Outcomes did not change significantly over the 15-year study period. Further research should focus on effective interventions to improve outcomes after stroke following cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982237","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":"Analysis of Risk Factors for Heparin Resistance During Cardiac Surgery: Does Antithrombin Deficiency Cause Heparin Resistance?","authors":"Youngin Kim, Sang Yoon Kim, Hyoung Woo Chang, Joon Chul Jung, Jae Hang Lee, Sanghon Park, Jun Sung Kim","doi":"10.1053/j.jvca.2025.04.004","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.004","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether heparin resistance (HR) occurring during cardiopulmonary bypass (CPB) is associated with antithrombin (antithrombin III) activity.</p><p><strong>Design: </strong>Retrospective review of data collected prospectively in a single center.</p><p><strong>Setting: </strong>A tertiary referral hospital.</p><p><strong>Participants: </strong>A total of 605 patients who underwent cardiovascular surgery with CPB, excluding emergency aortic dissection cases.</p><p><strong>Interventions: </strong>Cardiac valve and aortic surgeries were performed.</p><p><strong>Measurements and main results: </strong>HR was defined as an activated clotting time of less than 450 seconds measured after initial heparin administration (3 mg/kg) prior to CPB. Among the 605 patients, 164 were categorized into the HR group. Multivariable analysis revealed that patients with an active infection who underwent surgery had a significantly higher risk of developing HR (odds ratio [OR]: 2.30, 95% confidence interval [CI]: 1.25-4.21, p = 0.007). Compared with isolated valve surgery, isolated aortic surgery was associated with a higher risk of HR (OR: 1.74, 95% CI: 1.12-2.71, p = 0.014). Preoperative antithrombin activity did not show a significant association with HR (OR: 1.00, 95% CI: 0.98-1.01, p = 0.786). The incidence of major composite complications was significantly higher in the heparin-resistant group (33/164, 20.1%) compared with the non-heparin-resistant group (55/441, 12.5%, p = 0.025). However, no clear differences were observed in the incidence of individual complications.</p><p><strong>Conclusions: </strong>An active infection and aortic surgery were identified as risk factors for HR. Antithrombin deficiency was not a significant risk factor for HR in cardiovascular surgery; thus, preoperative antithrombin supplementation for the prevention of HR may not be necessary.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998412","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 Noninvasive Central Blood Pressure and Arterial Stiffness in Hemodynamic Shock.","authors":"Konstantinos Markakis, Eleni Georgianou, Nikolaos Pagonas, Sebastian Bertram, Maximilian Seidel, Nina Babel, Timm H Westhoff, Felix S Seibert","doi":"10.1053/j.jvca.2025.04.002","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.04.002","url":null,"abstract":"<p><strong>Objectives: </strong>Elevated central blood pressure (BP) and arterial stiffness are risk factors for cardiovascular mortality. However, their prognostic value in patients with hemodynamic shock has not been studied broadly. Evolved BP monitoring devices enable the noninvasive assessment of central BP and arterial stiffness. The objective of this study was to evaluate the prognostic value of central BP and arterial stiffness measurements, delivered by 2 noninvasive devices, in patients with septic or cardiogenic shock admitted to the intensive care unit.</p><p><strong>Design: </strong>This is a monocenter, prospective, cohort study.</p><p><strong>Setting: </strong>This study was conducted in a tertiary university hospital.</p><p><strong>Participants: </strong>We enrolled 57 patients who were admitted to the intensive care unit with septic or cardiogenic shock.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Central BP and arterial stiffness indices like pulse wave velocity (PWV) and Aix were recorded with a Mobil-o-Graph 24h PWA and SphygmoCor XCEL. Age, catecholamine dosage, resuscitation incidence before inclusion, C-reactive protein, leukocytes, and creatinine were recorded as possible confounders. With regard to the confounders, central systolic BP measured in the first 24 hours, was predictive of 6-month mortality (odds ratio, 0.9; p < 0.05). Aix, recorded by Mobil-o-Graph 24h PWA, was associated with death in the first 14 days (odds ratio, 1.11; p = 0.03). An increased PWV was not associated with adverse outcomes.</p><p><strong>Conclusions: </strong>Low central BP and increased Aix were linked to a higher mortality in shock patients. PWV had no prognostic value.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063822","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":"Pro: The Use of Sugammadex Does Not Preclude the Need for Objective Neuromuscular Monitoring","authors":"J. Ross Renew MD, FASA FASE ,&nbsp;Dustin D. Linn PharmD, MBA, BCPS, BCCCP","doi":"10.1053/j.jvca.2025.04.001","DOIUrl":"10.1053/j.jvca.2025.04.001","url":null,"abstract":"<div><div>Based on strong evidence, optimal management of neuromuscular block should incorporate objective (or quantitative) neuromuscular monitoring with appropriately dosed antagonists such as sugammadex. Sugammadex has the unique ability to antagonize aminosteroidal-induced neuromuscular block at any level; however, neostigmine is a reasonable alternative at minimal levels. Blind or excessive administration of sugammadex does not eliminate the risk of patients having postoperative residual neuromuscular block. Significant variability exists in how patients respond both to neuromuscular blocking agents and their antagonists.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1878-1881"},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967231","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":"A Systematic Review and Meta-Analysis of Local-Regional versus General Anesthesia for Elective Endovascular Abdominal Aortic Aneurysm Repair.","authors":"Cynthia Florencio de Mesquita, Ivo Queiroz, Milena Monteiro Mastra Fontoura, Mariano Gallo Ruelas, Arthur H Tavares, Lucas M Barbosa, Enrico Prajiante Bertolino, Miguel Godeiro Fernandez, Dilson da Silva Pimentel, Grace Carvajal Mulatti","doi":"10.1053/j.jvca.2025.03.045","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.045","url":null,"abstract":"<p><p>Endovascular aneurysm repair (EVAR) is a minimally invasive treatment for abdominal aortic aneurysms. The choice between general anesthesia (GA) and local-regional anesthesia (LRA) may impact outcomes, but evidence remains inconsistent. This systematic review and meta-analysis aimed to compare GA and LRA in elective EVAR, focusing on mortality, major adverse cardiovascular events (MACE), endoleaks, intensive care unit admissions, and hospital stay (HS). A comprehensive search of PubMed, Embase, Cochrane Central, and ClinicalTrials.gov included studies from inception to December 2024. Observational studies meeting predefined criteria were analyzed using a fixed-effects model in R, and evidence certainty was assessed using the GRADE framework. This work was registered on PROSPERO (CRD42024547446). Seventeen studies with 91,560 patients were included. LRA was associated with reduced mortality (OR 0.75; 95% CI 0.59-0.97), lower MACE (OR 0.74; 95% CI 0.61-0.90), fewer intensive care unit admissions (OR 0.77; 95% CI 0.73-0.81), fewer type 1 endoleaks (OR 0.84; 95% CI 0.72-0.97), fewer type 2 endoleaks (OR 0.63; 95% CI 0.57-0.70), and shorter HS (-0.38 days; 95% CI -0.46 to -0.30). Sensitivity analyses confirmed most results, but mortality lost significance in some cases. The certainty of evidence ranged from low to very low due to some inconsistencies in studies. LRA may offer better outcomes than GA in elective EVAR, including lower mortality, MACE, and shorter HS. However, further randomized trials are needed to confirm these findings and guide clinical practice.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002135","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":"Transfusion, Bleeding, or Coagulopathy: What Matters Most in Patients After Cardiac Surgery?","authors":"Daniel Bolliger MD ,&nbsp;Isabelle Frei MD ,&nbsp;Kenichi Tanaka MD","doi":"10.1053/j.jvca.2025.03.043","DOIUrl":"10.1053/j.jvca.2025.03.043","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1615-1618"},"PeriodicalIF":2.3,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010898","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":"A Dragon in the Heart? An Interesting Observation in Two Cases of Constrictive Pericarditis","authors":"U. Abinaya Prakashbabu MBBS, MD,&nbsp;H. Amrutha MBBS, MD, DNB,&nbsp;Mamatha Munaf MD, DNB, DM, PDF, FTEE","doi":"10.1053/j.jvca.2025.03.048","DOIUrl":"10.1053/j.jvca.2025.03.048","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1897-1898"},"PeriodicalIF":2.3,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998473","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 Perioperative Echocardiography: Selected Highlights from 2024","authors":"Swapnil Khoche MD ,&nbsp;Sophia Poorsattar MD ,&nbsp;Perin Kothari DO ,&nbsp;Marcus Bruce MD ,&nbsp;Sarah Ellis MD ,&nbsp;Timothy M. Maus MD, FASE","doi":"10.1053/j.jvca.2025.03.046","DOIUrl":"10.1053/j.jvca.2025.03.046","url":null,"abstract":"<div><div>This article is the ninth of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the <em>Journal of Cardiothoracic and Vascular Anesthesia</em>. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series. In most cases, these will be research articles that are targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but in some cases, these articles will target the use of perioperative echocardiography in general.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1644-1652"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984917","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":"Vasoplegia in Cardiac Surgery: Progress in Definition, Etiology, and Integrated Therapy","authors":"John G. Augoustides MD, FASE, FAHA ,&nbsp;Sarah Kumar MD ,&nbsp;Michael Mazzeffi MD","doi":"10.1053/j.jvca.2025.03.049","DOIUrl":"10.1053/j.jvca.2025.03.049","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1830-1831"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985159","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}