Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Sex-Based Differences in Ruptured Abdominal Aortic Aneurysm Management and Outcomes: An Update","authors":"Shirin Saeed MD ,&nbsp;Mark Robitaille MD ,&nbsp;Usman Ahmed MD ,&nbsp;Rayaan A. Yunus BS ,&nbsp;Mahnoor Sohail MD ,&nbsp;Nadav Levy MD ,&nbsp;Sara Neves MD ,&nbsp;Marc L. Schermerhorn MD ,&nbsp;Robina Matyal MD ,&nbsp;Feroze Mahmood MD","doi":"10.1053/j.jvca.2024.12.025","DOIUrl":"10.1053/j.jvca.2024.12.025","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate sex-based differences in outcomes following ruptured abdominal aortic aneurysm (AAA) repair, focusing on mortality, morbidity, and postoperative complications.</div></div><div><h3>Design</h3><div>Retrospective cohort study</div></div><div><h3>Setting</h3><div>Multi-institutional data from the Vascular Quality Initiative national database, covering a period from January 2003 to December 2022.</div></div><div><h3>Participants</h3><div>We included 7,548 patients undergoing open or endovascular repair for ruptured AAA: 5,829 men (77.2%) and 1,719 women (22.8%).</div></div><div><h3>Interventions</h3><div>Patients underwent either open surgical repair or endovascular aneurysm repair for ruptured AAA.</div></div><div><h3>Measurements and Main Results</h3><div>Between 2003 and 2022, the rate of mortality decreased significantly for both sexes (57.1% to 31.6% in women and 38.5% to 19.6% in men). Men had a higher incidence of coronary artery disease (22.7% <em>v</em> 17.3%; p &lt; 0.001), more frequent occurrences of prior percutaneous coronary intervention (12.8% <em>v</em> 10.2%; p = 0.004), and previous aneurysm repair (7.2% <em>v</em> 5.3%; p = 0.005) compared with women. Men demonstrated worse cardiovascular (OR 0.82 [0.72-0.94]; p = 0.005) and pulmonary (OR 0.86 [0.73-1.00]; p = 0.025) complications. Women exhibited higher in-hospital mortality (OR 1.27 (1.12-1.44); p &lt; 0.001) and presented at an older age (76.0 years <em>v</em> 71.0 years; p &lt; 0.001), with a higher incidence of hypertension (78.1% <em>v</em> 75.0%; p = 0.008). Women experienced a significantly longer average time from symptom onset to repair (8.00 hours <em>v</em> 7.00 hours; p = 0.002).</div></div><div><h3>Conclusions</h3><div>Significant sex-based disparities were found in AAA repair outcomes. Men had higher comorbidity burdens while women presented at an older age with an increased time from symptom onset to repair. These findings support the need for sex-specific guidelines and interventions to improve outcomes for both women and men.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 711-723"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965130","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":"Utilization and Outcomes of Epidural Anesthesia Versus Regional Anesthesia for Thoracic Surgery: An ACS-NSQIP Analysis","authors":"Kayla M. Knuf MD ,&nbsp;Matthew D. Smith MD ,&nbsp;Raymond B. Kroma MS ,&nbsp;Krista B. Highland PhD","doi":"10.1053/j.jvca.2024.12.020","DOIUrl":"10.1053/j.jvca.2024.12.020","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the use of epidural anesthesia compared with regional anesthesia as an adjunct to general anesthesia in thoracic surgery over time, and compare length of stay, overall morbidity, serious morbidity, and mortality between epidural and regional anesthesia when utilized as adjuncts to general anesthesia in thoracic surgery.</div></div><div><h3>Design</h3><div>Retrospective data analysis from the American College of Surgeons National Surgical Quality Improvement Project data registry, years 2014 to 2022.</div></div><div><h3>Setting</h3><div>Over 800 U.S. hospitals.</div></div><div><h3>Participants</h3><div>Patients over 18 years of age undergoing thoracic surgery (N = 18,433).</div></div><div><h3>Interventions</h3><div>Thoracic surgery with general anesthesia and either epidural or regional anesthesia adjuncts.</div></div><div><h3>Measurements and Main Results</h3><div>Peripheral nerve block utilization increased over time, with a steady increase for patients undergoing lobectomy or pneumonectomy. In propensity score–weighted generalized linear models, patients receiving peripheral nerve blocks had shorter hospital stays relative to those receiving epidurals (3.91 days, 95% confidence interval [CI]: 3.83, 3.99 <em>v</em> 5.48 days, 95% CI: 5.40, 5.56, p &lt; 0.001), lower odds of serious morbidity (odds ratio 0.81, 95% CI: 0.76, 0.86, p &lt; 0.001), and lower odds of mortality (odds ratio 0.74, 95% CI: 0.59, 0.92, p = 0.008).</div></div><div><h3>Conclusions</h3><div>The rate of peripheral nerve blocks in thoracic surgery increased over time. Patients receiving peripheral nerve blocks, relative to epidural anesthesia, had better outcomes. Future, adequately powered research is needed to evaluate whether findings remain consistent when accounting for other factors (eg, surgical approach, providers, institutions).</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 733-741"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143637444","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":"Navigating Cardiovascular Events in Non-Cardiac Surgery: A Comprehensive Review of Complications and Risk Assessment Strategies","authors":"Muhammad Hamza Shuja MBBS ,&nbsp;Areeba Sajid MBBS ,&nbsp;Eman Anwar MBBS ,&nbsp;Barka Sajid MBBS ,&nbsp;Muhammad Omar Larik MBBS","doi":"10.1053/j.jvca.2024.09.149","DOIUrl":"10.1053/j.jvca.2024.09.149","url":null,"abstract":"<div><div>Cardiovascular complications following non-cardiac surgery pose a significant global concern, affecting millions of patients annually. These complications, ranging from asymptomatic troponin elevations to major adverse cardiac events, contribute to heightened morbidity, mortality, and health care expenditures. The underlying mechanisms involve oxygen supply-demand imbalances and acute coronary syndromes precipitated by perioperative stressors. High-risk surgeries, including vascular and major abdominal procedures, are particularly susceptible to these complications. Risk assessment tools and biomarkers, especially high-sensitivity cardiac troponins, play pivotal roles in prognostication. However, despite advances in perioperative care, optimal management strategies remain elusive, as underscored by conflicting guidelines regarding interventions such as β-blockers and statins. This review aims to consolidate current evidence on cardiovascular complications following non-cardiac surgery, evaluate the utility of biomarkers, and discuss international guidelines for risk mitigation. An enhanced understanding regarding the standardized approaches is imperative in mitigating these complications effectively. Further research is essential to refine risk prediction models, validate biomarker thresholds, and elucidate the efficacy of preventive measures. Addressing these challenges can eventually lead to improved patient outcomes and more efficient healthcare resource utilization worldwide.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 792-802"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"(Dis)continuation of Beta-blockers after Myocardial Infarction: The AβYSS Trial Examined","authors":"Shashank Shekhar MD ,&nbsp;Seshasayee Narasimhan MBBS, MRCP (UK), FRACP, FACC ,&nbsp;Harish Ramakrishna MD, FACC, FESC","doi":"10.1053/j.jvca.2024.12.011","DOIUrl":"10.1053/j.jvca.2024.12.011","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 562-564"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894728","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 Inflammation After Cardiac Surgery on 30-Day Mortality and Machine Learning Risk Prediction","authors":"Enrico Squiccimarro ,&nbsp;Roberto Lorusso ,&nbsp;Antonio Consiglio ,&nbsp;Cataldo Labriola ,&nbsp;Renard G. Haumann ,&nbsp;Felice Piancone ,&nbsp;Giuseppe Speziale ,&nbsp;Richard P. Whitlock ,&nbsp;Domenico Paparella","doi":"10.1053/j.jvca.2024.12.013","DOIUrl":"10.1053/j.jvca.2024.12.013","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the impact of systemic inflammatory response syndrome (SIRS) on 30-day mortality following cardiac surgery and develop a machine learning model to predict SIRS.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Single tertiary care hospital.</div></div><div><h3>Participants</h3><div>Patients who underwent elective or urgent cardiac surgery with cardiopulmonary bypass (CPB) from 2016 to 2020 (N = 1,908).</div></div><div><h3>Interventions</h3><div>Mixed cardiac surgery operations were performed on CPB. Data analysis was made of preoperative, intraoperative, and postoperative variables without direct interventions.</div></div><div><h3>Measurements and Main Results</h3><div>SIRS, defined using American College of Chest Physicians/Society of Critical Care Medicine parameters, was assessed on the first postoperative day. The primary outcome was 30-day mortality. SIRS incidence was 28.7%, with SIRS-positive patients showing higher 30-day mortality (12.2% <em>v</em> 1.5%, p &lt; 0.001). A multivariate logistic model identified predictors of SIRS. Propensity score matching balanced 483 patient pairs. SIRS was associated with increased mortality (OR 2.77; 95% CI 1.40-5.47, p = 0.003). Machine learning models to predict SIRS were developed. The baseline risk model achieved an area under the curve of 0.77 ± 0.04 in cross-validation and 0.73 (95% CI 0.70-0.85) on the test set, while the procedure-adjusted risk model showed improved performance with an area under the curve of 0.81 ± 0.02 in cross-validation and 0.82 (95% CI 0.76-0.85) on the test set.</div></div><div><h3>Conclusions</h3><div>SIRS is significantly associated with increased 30-day mortality following cardiac surgery. Machine learning models effectively predict SIRS, paving the way for future investigations on potential targeted interventions that may mitigate adverse outcomes.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 683-691"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transesophageal Echocardiographic Identification of an Inadvertent Coronary Vein Bypass Graft","authors":"Aaron Wozolek MD ,&nbsp;Athanase Courbe MD ,&nbsp;Maria Rosal Martins MD ,&nbsp;Andres Parisi MD ,&nbsp;Pierre Couture MD","doi":"10.1053/j.jvca.2024.11.035","DOIUrl":"10.1053/j.jvca.2024.11.035","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 755-758"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894765","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":"Pain Management in Open Abdominal Aortic Aneurysm Repair: Potential Alternatives to Epidural Anesthesia","authors":"Keisuke Yoshida MD,&nbsp;Tatsumi Yakushiji MD,&nbsp;Ryosuke Sasaki MD,&nbsp;Shinju Obara MD,&nbsp;Satoki Inoue MD","doi":"10.1053/j.jvca.2024.12.028","DOIUrl":"10.1053/j.jvca.2024.12.028","url":null,"abstract":"<div><div>Despite significant advances in endovascular techniques, open abdominal aortic aneurysm (AAA) repair continues to play an important role in vascular surgery. Many studies have described the advantages of epidural anesthesia combined with general anesthesia over general anesthesia alone as an analgesic method for open AAA repair. Several recent guidelines have recommended epidural anesthesia as the first option for pain management in open AAA repair. However, AAA repair requires perioperative anticoagulation, and bleeding complications are an inevitable concern. In the past 2 decades, new methods of analgesia, represented by ultrasound-guided nerve blocks, have been developed and become popular in major abdominal surgery. These analgesic methods may address the concern of bleeding complications associated with epidural anesthesia in open AAA repair. Although the efficacy and safety of ultrasound-guided nerve blocks, continuous local wound infiltration, and intravenous administration of lidocaine in open AAA repair have been evaluated in several studies, few studies have evaluated the efficacy of continuous nerve blocks compared with epidural anesthesia. In this article, the authors present a narrative review of pain management techniques used in open AAA repair, focusing on pain management techniques other than epidural anesthesia. Research gaps and the need for further studies on this topic are also discussed.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 785-791"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931906","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 Kidney and Lung Injuries After Elective Ascending Aortic Surgery","authors":"Sahar Abdallah MD ,&nbsp;Amine Fikani MD ,&nbsp;Alessandro Piccardo MD ,&nbsp;Romain Chauvet MD ,&nbsp;Slah Smairi MD ,&nbsp;Franck Pihan MD ,&nbsp;Jérémy Tricard MD ,&nbsp;David Vandroux MD, PhD","doi":"10.1053/j.jvca.2024.12.038","DOIUrl":"10.1053/j.jvca.2024.12.038","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 861-863"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970865","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 Role of Fluoroscopic Guidance in Spinal Drain Placement for Thoracoabdominal Aneurysm Repair Patients: A Retrospective Study","authors":"Amna Shaikh MD ,&nbsp;Alyssa Martin ,&nbsp;Syed-Muhammad Waqar MD ,&nbsp;Dragos Galusca MD","doi":"10.1053/j.jvca.2024.12.039","DOIUrl":"10.1053/j.jvca.2024.12.039","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate outcomes after implementation of a preoperative protocol requiring fluoroscopic guidance in patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair identified as being at risk for spinal drain placement complications.</div></div><div><h3>Design</h3><div>This retrospective analysis included patients who underwent spinal drain placement for TAAA repair between November 2013 and November 2018. Patient outcomes were assessed before (control) and after (study) protocol implementation.</div></div><div><h3>Setting</h3><div>Single tertiary care hospital.</div></div><div><h3>Participants</h3><div>A total of 58 patient records were analyzed.</div></div><div><h3>Intervention</h3><div>The protocol was implemented in November 2015 to identify at-risk patients for difficult spinal drain placement undergoing TAAA repair who would benefit from placement under fluoroscopic guidance.</div></div><div><h3>Measurement and Main Results</h3><div>The mean operating room arrival time to drain placement was lower in the study group than in the control group (44.9 ± 12.7 minutes <em>v</em> 80.5 ± 55.8 minutes; p = 0.03). The mean time to incision was lower in the study group than in the control group (114.9 ± 38.1 minutes <em>v</em> 172.4 ± 32.0 minutes; p &lt; 0.001), and fewer drain placement attempts were done in the study group than in the control group (mean, 1.3 ± 0.7 attempts <em>v</em> 2.7 ± 2.5 attempts; p = 0.006). The mean length of stay was lower in the study group (9.5 ± 6.7 days <em>v</em> 18.7 ± 22.7 days; p = 0.04).</div></div><div><h3>Conclusions</h3><div>Preoperative identification of at-risk patients before TAAA repair may reduce operating room arrival to the incision time, operating room to spinal drain placement time, number of spinal drain placement attempts, length of hospital stay, and complications associated with spinal drain placement.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Pages 610-615"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005919","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":"Articles to Appear in Future Issues","authors":"","doi":"10.1053/S1053-0770(25)00063-1","DOIUrl":"10.1053/S1053-0770(25)00063-1","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 3","pages":"Page xvii"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143637380","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}