Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Provocation Testing for Left Ventricular Outflow Tract Obstruction in Patients Presenting for Concurrent Cardiac Procedures","authors":"Chukwudubem Obianagha DO, MPH, MBA , Jordan Holloway MD , Cassidy Wernke DO , Nayer Toma MD , Louis Ma MD , Michael Essandoh MD , Lori Jean-Baptiste BS , Andrews Adjapong MD , Matthew Henn MD , Jonathan Tang MD","doi":"10.1053/j.jvca.2025.03.042","DOIUrl":"10.1053/j.jvca.2025.03.042","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1782-1786"},"PeriodicalIF":2.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019658","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":"Comparative Analysis of Thrombosis in ECPella Patients Between Bivalirudin versus Heparin Anticoagulation Strategies","authors":"Andrew J. Cho BS ,&nbsp;Kunal Panda MD ,&nbsp;Renae Gozelski Pharm D, BCCCP ,&nbsp;Andrew Jones BA ,&nbsp;Katherine Wood MD ,&nbsp;Yang Gu MD","doi":"10.1053/j.jvca.2025.03.041","DOIUrl":"10.1053/j.jvca.2025.03.041","url":null,"abstract":"<div><h3>Objective</h3><div>To review and compare the frequency of thrombus and adverse events in patients treated with heparin or bivalirudin systemic anticoagulation strategies supported on combined venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella support (ECPella)</div></div><div><h3>Design</h3><div>Retrospective observational study</div></div><div><h3>Setting</h3><div>Single tertiary academic medical center</div></div><div><h3>Participants</h3><div>Patients age &gt;18 years who were supported by ECPella between July 2021 and April 2024</div></div><div><h3>Interventions</h3><div>None</div></div><div><h3>Measurements and Main Results</h3><div>The study population comprised 98 patients, including 29 patients treated with heparin, 35 patients treated with bivalirudin, and 34 patients treated with a combination of heparin and bivalirudin. Thirteen patients had aortic thrombus and 23 patients had deep vein thrombosis (DVT), with no difference between anticoagulation strategies. Multivariate regression suggested that age and sex were factors in the increased risk for thrombus. Twenty-five of the 29 patients treated with heparin alone died, compared to 15 of the 35 patients treated with bivalirudin. There were no significant differences in intensive care unit length of stay (LOS) (13.89 days vs 24.77 days vs 26.65 days) across the 3 anticoagulation groups. Patients with either aortic thrombosis or DVT had a longer hospital LOS compared to those without either disorder (45.09 days vs 28.12 days; p = 0.049).</div></div><div><h3>Conclusions</h3><div>The frequency of aortic thrombus in patients supported on ECPella is high despite therapeutic anticoagulation. Routine screening with imaging is encouraged, and embolectomy should be considered at the time of decannulation to reduce postoperative complications.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1689-1695"},"PeriodicalIF":2.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991693","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 2024 EACTS/EACTAIC/EBCP Guidelines on Cardiopulmonary Bypass in Adult Cardiac Surgery","authors":"Juan G. Ripoll MD ,&nbsp;Edward A. Bittner MD, PhD, FCCM ,&nbsp;Solomiia Zaremba MD ,&nbsp;Christoph S. Nabzdyk MD ,&nbsp;Troy G. Seelhammer MD ,&nbsp;Patrick M. Wieruszewski Pharm.D., FCCM ,&nbsp;Marvin G. Chang MD, PhD ,&nbsp;Harish Ramakrishna MD, FACC, FESC","doi":"10.1053/j.jvca.2025.03.044","DOIUrl":"10.1053/j.jvca.2025.03.044","url":null,"abstract":"<div><div>Cardiopulmonary bypass (CPB) in cardiac surgery involves the integration of multidisciplinary expertise, requiring collaboration among clinical perfusionists, surgeons, anesthesiologists, intensivists, and patients. This updated guideline, developed by the European Association for Cardio-Thoracic Surgery, the European Association for Cardiothoracic Anesthesia and Intensive Care, and the European Board of Cardiovascular Perfusion, incorporates the latest evidence to offer evidence-based recommendations for CPB. It expands on previous guidelines by addressing a broader range of CPB-related factors that impact patient outcomes. Although significant advances have been made in CPB technology and techniques, significant knowledge gaps remain. Bridging these gaps requires coordinated effort from all stakeholders in cardiac surgery, ensuring that future revisions of the guidelines are more comprehensive, practical, and applicable across various clinical settings. Ongoing improvements in CPB outcomes are contingent upon continued collaboration among cardiac surgeons, anesthesiologists, intensivists, and perfusionists, supported by specialized training programs in accredited institutions. These efforts aim to enhance patient safety, optimize CPB procedures, and improve overall cardiac surgery outcomes. This manuscript provides an overview of the key changes introduced in the new guidelines.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1853-1865"},"PeriodicalIF":2.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997579","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":"Anesthesia Management for the Personalized External Aortic Root Support (PEARS) Procedure: A Single-Center Experience","authors":"Anil K. Pandey MD ,&nbsp;Athiná M. Kougioumtzoglou MD ,&nbsp;Bobby C.Y. Lam BSc ,&nbsp;Eline Kho MSc ,&nbsp;Susanne Eberl MD, PhD ,&nbsp;José Dilai MSc ,&nbsp;Dave R. Koolbergen MD, PhD ,&nbsp;Henning Hermanns MD, PhD","doi":"10.1053/j.jvca.2025.03.047","DOIUrl":"10.1053/j.jvca.2025.03.047","url":null,"abstract":"<div><h3>Objective</h3><div>To delineate anesthesia management during the personalized external aortic root support (PEARS) procedure, with a focus on the use of multimodal monitoring and deliberate profound hypotension.</div></div><div><h3>Design</h3><div>A single-center retrospective cohort study.</div></div><div><h3>Setting</h3><div>Tertiary academic hospital.</div></div><div><h3>Participants</h3><div>Patients undergoing the PEARS procedure due to aortic aneurysm.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Methods</h3><div>Patient characteristics and anesthesia management are described, with particular emphasis on multimodal hemodynamic, cerebral monitoring, and transesophageal echocardiography during the deliberate profound hypotension phase during the isolated PEARS procedure.</div></div><div><h3>Results: Seventy-three</h3><div>patients underwent an isolated PEARS procedure in an academic hospital in The Netherlands between January, 2018, and December, 2023. Fifty-six patients were male (72.2%), and the mean patient age was 38 ± 15.7 years. Five patients required conversion to cardiopulmonary bypass. There were no in-hospital deaths, myocardial infarction, stroke, major bleeding, reoperation for any cause, prosthesis infection, or postoperative delirium. Postoperative atrial fibrillation occurred in 11 patients (15.1%). The mean duration of intensive care unit admission was 1.3 days, and the mean hospital length of stay was 7.6 days. All procedures were performed by a single surgeon.</div></div><div><h3>Conclusions</h3><div>The PEARS procedure appears to be a viable alternative for preventive replacement of the aorta in selected patients with aortic aneurysms. Anesthesia is safe; in particular, profound deliberate hypotension can be used without relevant complications using multimodal monitoring, with electroencephalographic burst suppression as the guiding factor for cerebral perfusion. As published by other groups, PEARS has excellent outcomes in experienced centers.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1681-1688"},"PeriodicalIF":2.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998705","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":"Standby Extracorporeal Membrane Oxygenation Use in Obstetric Patients: A Systematized Review","authors":"Catherine P. Marudo BA ,&nbsp;Arya I. Kermanshah MS ,&nbsp;Daniel Montes de Oca MBA ,&nbsp;John M. Reynolds MLIS ,&nbsp;Sandy Ren MD ,&nbsp;Amanda D. Saab MD ,&nbsp;Paloma Toledo MD, MPH ,&nbsp;Daniel H. Buitrago MD ,&nbsp;Brandon M. Parker MD ,&nbsp;Ioannis K. Angelidis MD, MSPH","doi":"10.1053/j.jvca.2025.03.037","DOIUrl":"10.1053/j.jvca.2025.03.037","url":null,"abstract":"<div><div>EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) is a potentially life-saving intervention often used in critically ill patients with severe respiratory or cardiac failure unresponsive to conventional treatments. As the prevalence of high-risk obstetric patients has increased, indications for ECMO have been identified in this population, as evidenced by an increased number of cases reported in the last decade. Although the indications for ECMO are not different for pregnant patients and nonpregnant patients, given the high-risk nature of certain peripartum conditions, there has been increased interest in the use of standby ECMO or precannulation ECMO, to enable rapid deployment of venoarterial ECMO should it be necessary. The present systematized review identified 14,717 obstetric patients, of whom 1041 received ECMO and 11 were considered for or received standby ECMO. The indications, risks, and considerations related to stand-by ECMO use are described. As no consensus guidelines exist for the peripartum use of stand-by ECMO, more research is needed to establish future practice guidelines for determining suitable candidates and improving maternal outcomes.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1844-1852"},"PeriodicalIF":2.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972449","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":"Examining the Safety of Continuing Preoperative Renin-angiotensin System Inhibitors in Noncardiac Surgery.","authors":"Carson C Welker, Jeffrey Huang, Omar Elmadhoun, Adam K Jacob, Harish Ramakrishna","doi":"10.1053/j.jvca.2025.03.040","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.040","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993120","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":"Transcatheter Aortic Valve Replacement Intervention for Asymptomatic Severe Aortic Stenosis: A Matter of Perspective","authors":"Daniel S. Cormican MD, FCCP","doi":"10.1053/j.jvca.2025.03.038","DOIUrl":"10.1053/j.jvca.2025.03.038","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1630-1632"},"PeriodicalIF":2.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985158","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 Aortic Valve Replacement and Revascularization Odyssey: Individualized Treatment Decisions in Severe Aortic Stenosis with Coronary Artery Disease","authors":"Alexander D. Shapeton MD ,&nbsp;Jamel Ortoleva MD, FASE ,&nbsp;Zaid I. Almarzooq MD, MPH","doi":"10.1053/j.jvca.2025.03.034","DOIUrl":"10.1053/j.jvca.2025.03.034","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1626-1629"},"PeriodicalIF":2.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007824","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 Cardiothoracic Anesthesiology Workforce in 2025: The Good, the Bad, and the Admittedly Ugly.","authors":"Michael Mazzeffi, Yianni Augoustides","doi":"10.1053/j.jvca.2025.03.035","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.03.035","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017902","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":"Mapping the Global Cardiac Anesthesia Workforce","authors":"Dominique Vervoort MD, MPH, MBA","doi":"10.1053/j.jvca.2025.03.039","DOIUrl":"10.1053/j.jvca.2025.03.039","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1898-1899"},"PeriodicalIF":2.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007822","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}