Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Machine Learning in Clinical Trials: Developing a Framework for Transparency and Interpretation.","authors":"John G Augoustides","doi":"10.1053/j.jvca.2025.08.002","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.002","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955554","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 of Extracorporeal Membrane Oxygenation in Patients with COVID-19 and Pulmonary Hypertension: An ELSO Registry Analysis.","authors":"Raysa Morales-Demori, Jamel Ortoleva, Sukru Aras, Marc Anders","doi":"10.1053/j.jvca.2025.08.008","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.08.008","url":null,"abstract":"<p><strong>Objective: </strong>To describe the characteristics and outcomes of patients with COVID-19 infection with acute or chronic pulmonary hypertension (PH) supported by extracorporeal membrane oxygenation (ECMO). It was hypothesized that patients with acute or chronic PH supported by ECMO would have higher mortality rates compared to those without a diagnosis of PH.</p><p><strong>Design: </strong>A retrospective analysis of the Extracorporeal Life Support Organization registry.</p><p><strong>Setting: </strong>Global registry data from patients who received ECMO support for severe COVID-19 between 2020 and 2021.</p><p><strong>Participants: </strong>Patients with COVID-19 who required ECMO support, categorized into those with acute PH (177 patients), chronic PH (147 patients), and no PH (7465 patients).</p><p><strong>Interventions: </strong>None (retrospective study).</p><p><strong>Measurements & main results: </strong>Overall, there were no statistically significant differences in mortality among the 3 groups (52.2% for No-PH v 52.0% for Acute-PH v 61.9% for Chronic-PH; p = 0.07). Venoarterial ECMO was used most frequently in Acute-PH (17.5%, compared to 5.2% for No-PH and 6.8% for Chronic-PH; p < 0.001). Patients with chronic PH had more liver disease (26.5%, compared to 3.0% for No-PH and 4.0% for Chronic-PH; p < 0.0001). Patients with chronic PH had the highest overall complication rate (84.4%, compared to 70.0% for No-PH and 78.5% for Acute-PH; p < 0.0001), although the Acute-PH group had the highest incidences of limb ischemia and neurologic complications.</p><p><strong>Conclusions: </strong>Patients with acute or chronic PH who required ECMO for severe COVID-19 had higher risk profiles compared to those without PH. While outcomes for patients with acute PH were similar to those for patients without PH, the complication rate was significantly higher in acute PH. Chronic PH was associated with significantly higher, (although nonprohibitive) mortality and a higher risk of complications. Thoughtful patient selection is important for optimal outcomes in this high-risk population.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992662","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":"Advancing Training in Cardiac Anesthesiology: Telemedicine for Real-Time Echocardiography Education and Monitoring","authors":"Lev Krichevskiy PhD","doi":"10.1053/j.jvca.2025.07.044","DOIUrl":"10.1053/j.jvca.2025.07.044","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 3206-3207"},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955415","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 Normovolemic Hemodilution in Cardiac Surgery: Evidence-Based Exit or a Chance for Refinement?","authors":"Gabor Erdoes MD, PhD ,&nbsp;Matteo Aldo Bonizzoni MD ,&nbsp;Valentina Ajello MD","doi":"10.1053/j.jvca.2025.07.042","DOIUrl":"10.1053/j.jvca.2025.07.042","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2916-2918"},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955472","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":"Effects of Preoperative Oral Carbohydrates on Insulin Resistance and Postoperative Recovery in Diabetic Patients Undergoing Coronary Artery Bypass Grafting: A Preliminary Prospective, Single-Blinded, Randomized Controlled Trial.","authors":"Shicheng Zhang, Lixian He, Yiping Yu, Xin Yuan, Tao Yang, Fuxia Yan, Fei Xu, Yan Zhang, Shiwei Pan, Huaijun Zhang, Zujun Chen, Lu Xie, Rong Wu, Wei Feng, Yuntai Yao","doi":"10.1053/j.jvca.2025.07.036","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.036","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies have demonstrated that preoperative oral carbohydrates (CHO) can alleviate postoperative insulin resistance (IR) and enhance recovery in non-diabetic patients undergoing cardiac surgery. However, the potential benefits in diabetic patients remain unclear. This study aimed to investigate the effects of preoperative CHO on IR and postoperative recovery in diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB).</p><p><strong>Design: </strong>A prospective, single-center, single-blind, randomized controlled trial.</p><p><strong>Setting: </strong>The study was conducted in the Adult Cardiac Surgery Ward 6 of a large-volume cardiovascular center.</p><p><strong>Participants: </strong>A total of 62 consecutive diabetic patients scheduled for isolated OPCAB were prospectively enrolled between July 8, 2022, and April 28, 2023. Participants were randomized in a 1:1 ratio to the CHO group or the control (CTRL) group using computer-generated random numbers.</p><p><strong>Interventions: </strong>Patients in the CHO group received 335 mL of a carbohydrate drink containing 50 g of carbohydrates 8 to 12 hours before surgery, while those in the CTRL group followed routine fasting protocols.</p><p><strong>Measurements and main results: </strong>The primary endpoint was postoperative IR, assessed by the homeostasis model assessment. Secondary endpoints included postoperative inflammatory markers and stress responses (e.g., serum cortisol levels), while exploratory endpoints focused on in-hospital clinical outcomes. Baseline characteristics were comparable between groups. CHO administration significantly reduced postoperative inflammatory markers but did not significantly improve IR. Stress response was attenuated in the CHO group, though the difference was not statistically significant. Postoperative drainage was higher in the CHO group, but no differences were observed in other clinical outcomes.</p><p><strong>Conclusion: </strong>Preoperative CHO may attenuate inflammatory and stress responses without increasing perioperative risk in diabetic patients undergoing OPCAB, although its effect IR remains uncertain.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992661","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 Behavior: The Rationalization of Abuse as Professionalism in the Operating Room","authors":"Pei-Yi Hung RN,&nbsp;Shu-Yueh Cheng RN,&nbsp;Ming-Hui Hung MD, MSc","doi":"10.1053/j.jvca.2025.07.043","DOIUrl":"10.1053/j.jvca.2025.07.043","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Page 3206"},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955470","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 Hunt for Antithrombin-independent Heparin Resistance: Can You Find It With Partial Thromboplastin Time?","authors":"Min U. Jang MD ,&nbsp;Nika Moumenzadeh ,&nbsp;Kenichi A. Tanaka MD, MSc ,&nbsp;Amir L. Butt MD, MPH","doi":"10.1053/j.jvca.2025.07.045","DOIUrl":"10.1053/j.jvca.2025.07.045","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 3197-3198"},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955498","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":"Preoperative Rectus Femoris Muscle Characteristics as Predictors of Postoperative Walking Ability in Elderly Cardiac Surgery Patients: A Prospective Observational Study","authors":"Ryo Abe BS ,&nbsp;Junji Shiotsuka MD, MS, PhD ,&nbsp;Keita Aida BS, MS ,&nbsp;Naoki Tani BS, MS ,&nbsp;Shohei Ono MD, MPH ,&nbsp;Naoyuki Kimura MD, PhD ,&nbsp;Shigehiko Uchino MD, PhD ,&nbsp;Masamitsu Sanui MD, PhD","doi":"10.1053/j.jvca.2025.07.041","DOIUrl":"10.1053/j.jvca.2025.07.041","url":null,"abstract":"<div><h3>Objective</h3><div>Postoperative walking ability has been identified as a crucial prognostic indicator for older patients undergoing major cardiac surgeries. This study was designed to investigate the predictive value of preoperative lower extremity muscle mass and muscle echo intensity for postoperative walking ability in older patients undergoing cardiac surgeries.</div></div><div><h3>Design</h3><div>A prospective observational study.</div></div><div><h3>Setting</h3><div>A single-center study conducted at a university hospital.</div></div><div><h3>Participants</h3><div>A total of 109 elective cardiac surgery patients, 65 years of age or older, were prospectively enrolled.</div></div><div><h3>Interventions</h3><div>Preoperative muscle mass and quality of the rectus femoris were assessed using muscle cross-sectional area and echo intensity on ultrasound images, respectively.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcome of interest was the walking distance achieved in a 6-minute walk test after cardiac surgery. Multiple regression analysis was performed to identify factors independently associated with 6-minute walk distance after surgery. Higher muscle cross-sectional area and lower echo intensity of the rectus femoris, measured by ultrasonography, were associated with a significantly longer 6-minute walk distance upon discharge. Higher muscle mass and lower echo intensity were also significantly associated with shorter hospital length of stay.</div></div><div><h3>Conclusions</h3><div>The preoperative measurement of cross-sectional area and echo intensity of the quadriceps muscles can be used as a predictor of postoperative 6-minute walk distance in elderly patients undergoing cardiac surgery.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2963-2969"},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955539","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":"Hemodynamic Impact of Mechanical Ventilation in Anesthetized Patients With Cavopulmonary Connection: A Physiologic Crossover Study","authors":"Yevgeni Plotkin MD ,&nbsp;Margaret J. Klein MS ,&nbsp;Neil Patel MD ,&nbsp;Patrick Sullivan MD ,&nbsp;Cheryl Takao MD ,&nbsp;Sarah Badran MD ,&nbsp;Sheldon Stohl MD","doi":"10.1053/j.jvca.2025.07.037","DOIUrl":"10.1053/j.jvca.2025.07.037","url":null,"abstract":"<div><h3>Objectives</h3><div>In patients with single-ventricle hearts and cavopulmonary connection, both pulmonary and systemic blood flow rely on passive venous drainage through the lungs. Conventional wisdom teaches that spontaneous breathing, as opposed to positive-pressure mechanical ventilation, enhances cardiac output in these patients. However, the hemodynamic effects of spontaneous versus mechanical ventilation under general anesthesia have not been systematically studied.</div></div><div><h3>Design</h3><div>A prospective, crossover, single-center clinical study.</div></div><div><h3>Setting</h3><div>The cardiac catheterization laboratory, Children’s Hospital Los Angeles, Los Angeles, California.</div></div><div><h3>Participants</h3><div>Thirty-five anesthetized children with cavopulmonary (Glenn or Fontan) anastomosis undergoing elective cardiac catheterization.</div></div><div><h3>Interventions</h3><div>Hemodynamics for each patient were assessed under each of two conditions: spontaneous breathing and mechanical ventilation. Hemodynamic parameters were analyzed and compared between the two ventilation methods using a mixed linear model to adjust for potential confounders.</div></div><div><h3>Measurements and Main Results</h3><div>Cardiac index was significantly higher during spontaneous breathing (mean difference: 0.6 L/min/m², p = 0.022). Atrial pressure was also higher with spontaneous breathing (mean difference: 1.9 mmHg, p &lt; 0.001). Pulmonary vascular resistance, transpulmonary gradient, and the ratio of pulmonary to systemic blood flow (Qp:Qs) did not differ significantly between ventilation methods.</div></div><div><h3>Conclusions</h3><div>In anesthetized Glenn and Fontan patients with secured airways, spontaneous ventilation produces a superior hemodynamic profile compared with mechanical ventilation. The current data suggest that the enhanced cardiac output results from increased systemic ventricular preload. These results should guide perioperative ventilatory management and interpretation of catheterization data in this population.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 3075-3081"},"PeriodicalIF":2.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955478","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: Supplemental Cardioplegia During Heart Transplant Implantation","authors":"James Robbins CCP ,&nbsp;Karina Anam MD ,&nbsp;Zaid Falah CCP ,&nbsp;Andrew Hicks CRNA ,&nbsp;Michael Essandoh MD ,&nbsp;Kukbin Choi MD","doi":"10.1053/j.jvca.2025.07.039","DOIUrl":"10.1053/j.jvca.2025.07.039","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 3185-3187"},"PeriodicalIF":2.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955573","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}