Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"How Would We Treat Our Own Left Ventricular Outflow Tract Obstruction in Transcatheter Mitral Valve Replacement?","authors":"Jacopo D'Andria Ursoleo, Viviana Teresa Agosta, Alice Bottussi, Filippo D'Amico, Fabrizio Monaco","doi":"10.1053/j.jvca.2025.02.019","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.019","url":null,"abstract":"<p><p>This article aims to provide a comprehensive review of the current knowledge on the prevention and treatment of left ventricular outflow tract obstruction (LVOTO) associated with transcatheter mitral valve replacement-a novel and evolving treatment alternative for mitral regurgitation-encompassing both surgical and pharmacological interventions. LVOTO is a potentially catastrophic complication of transcatheter mitral valve replacement. Therefore, identifying patients at high risk for LVOTO and implementing a carefully tailored medical and surgical strategy are essential for optimizing perioperative management and improving patient outcomes.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615256","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":"Left Ventricular Unloading on Venoarterial Extracorporeal Membrane Oxygenation Support: Before We Know When We Need to Know How.","authors":"Jordan Holloway, Cassidy Wernke, Melissa Lee, Michael Essandoh","doi":"10.1053/j.jvca.2025.02.024","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.024","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615386","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":"Intraoperative Factors Associated With Mechanical Ventilation Duration Following Aortic Surgery.","authors":"Nan Leng, Aaron M Mittel, Dov Levine, Suzuka Nitta, Mitchell F Berman, May Hua, Virendra I Patel, Paul A Kurlansky, Hiroo Takayama, Marcos F Vidal Melo","doi":"10.1053/j.jvca.2025.02.021","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.021","url":null,"abstract":"<p><strong>Objectives: </strong>Prolonged postoperative mechanical ventilation is a common complication after major aortic surgery. The relationship between prolonged ventilation and intraoperative variables influenced by anesthesiologists, such as ventilation practices, fluid administration, and blood pressure control during major aortic surgery is unknown. We sought to identify perioperative factors, including intraoperative physiologic and anesthesia-related variables, which are associated with ventilation duration following aortic surgery.</p><p><strong>Design: </strong>Single-center retrospective observational study.</p><p><strong>Setting: </strong>A tertiary, high-volume cardiac surgery referral center.</p><p><strong>Participants: </strong>Adult patients undergoing major aortic surgery requiring cardiopulmonary bypass (CPB).</p><p><strong>Interventions: </strong>None (retrospective observational study).</p><p><strong>Measurements and main results: </strong>The primary outcome was the duration of postoperative ventilation (hours). Mixed-effects regression was performed to identify factors associated with the primary outcome. Among the 647 patients included in this study, the median of postoperative mechanical ventilation duration was 9.0 (IQR 6.0, 14.4) hours, with 73 (11.3%) of patients receiving mechanical ventilation for more than 24 hours. Variables significantly associated with the outcome were increases in pre- to post-CPB driving pressure (β = 4.23; 95% CI [0.08, 8.39]; p = 0.04), reduction in pre- to post-CPB end-tidal carbon dioxide partial pressure (β = -5.12; 95% CI [-8.85, -1.39]; p < 0.001), and normalized transfusion volumes (β = 11.14; 95% CI [4.36, 17.91]; p < 0.001). Mechanical power was not associated with postoperative ventilation duration (β = -2.29; 95% CI [-6.48, 1.90]; p = 0.52).</p><p><strong>Conclusions: </strong>Patients undergoing major aortic surgery are at risk for prolonged mechanical ventilation. Transfusion volume and pre- to post-CPB changes in driving pressures and end-tidal carbon dioxide are significantly associated with postoperative ventilation duration. Intraoperative mechanical ventilator power is not a significant predictor of mechanical ventilation duration after major aortic surgery. These variables are potentially modifiable by anesthesiologists and may be future therapeutic targets.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557018","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":"Left Ventricle to Left Atrial Communication: An Intriguing Echocardiographic Finding.","authors":"Madan Mohan Maddali, Sowmiya Raju, Is'haq Al Aamri, Tuqa Al Lawati, Asim Yousuf Al Balushi, Abdullah Mohammed Al Farqani, Mohammed Ismail Al-Yamani, Salim Nasser Al Maskari","doi":"10.1053/j.jvca.2025.02.020","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.020","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531483","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":"Implementation of a Multidisciplinary Team for Initiation of Extracorporeal Cardiopulmonary Resuscitation in Patients Presenting After Out-of-hospital Cardiac Arrest.","authors":"Sean Hickey, Christopher Ortiz, Wei-Ting Chen, Phoebe Johnson Black, Tristan Grogan, Peyman Benharash, Vadim Gudzenko","doi":"10.1053/j.jvca.2025.02.018","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.018","url":null,"abstract":"<p><strong>Objectives: </strong>Patents with out-of-hospital cardiac arrest (OHCA) are at high risk of death or poor neurologic recovery if spontaneous circulation is not rapidly restored. Emergent mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of extracorporeal cardiopulmonary resuscitation (ECPR) offers a bridge to diagnostic and therapeutic interventions but can be challenging to provide in a timely fashion. Coordination of multidisciplinary institutional resources into an ECMO Shock Team (ECMO-ST) may improve the survival of ECPR patients while concurrently increasing the number of OHCA patients placed on ECMO.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single-center urban university hospital in the United States with an active mechanical circulatory support and cardiac transplantation program.</p><p><strong>Participants: </strong>55 OHCA patients who received ECPR after presenting to the emergency department from May 2013 to December 2022.</p><p><strong>Interventions: </strong>Ad hoc emergent ECPR support versus activation of the ECMO-ST.</p><p><strong>Measurements and main results: </strong>The primary outcome was survival to hospital discharge. Secondary outcomes included time to ECMO cannulation, duration of ECMO support, renal failure requiring dialysis, diagnosis of hypoxic brain injury, intensive care unit length of stay, 6-month survival, and functional neurologic recovery quantified by cerebral performance category score at discharge and 6 months. Implementation of the ECMO-ST was associated with an increase in the rate of survival to hospital discharge from 22% (2/9 patients) to 52% (24/46 patients), although the result was not statistically significant due to the small sample size of the preintervention cohort. A total of 69% of those discharged from the hospital had favorable neurologic function as defined by cerebral performance category scores of 1-2.</p><p><strong>Conclusions: </strong>The organization and implementation of a multidisciplinary institutional ECPR response team trended toward an association with higher rates of survival to hospital discharge, with favorable neurologic function in patients presenting to the emergency department after OHCA.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566683","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":"ECPella 5+ in Patients With Cardiogenic Shock: Potential for Improved Outcomes.","authors":"Nicoletta D'Ettore, Astrid Cardinale, Giulia Maj, Stephanie Bertolin, Andrea Audo, Andrea Montisci, Alina Gallo, Corrado Cavozza, Federico Pappalardo","doi":"10.1053/j.jvca.2025.02.017","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.017","url":null,"abstract":"<p><p>The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for temporary mechanical circulatory support (MCS) is a common treatment in patients with cardiogenic shock (CS) but is associated with high morbidity and mortality. The combination therapy of VA- ECMO and Impella (ECPella) results in better outcomes. Currently, multiple generations of Impella are available for use in ECPella, however limited data exist to compare devices. Here, we explored whether ECPella 5+ adds further benefit to patient outcomes. We reviewed published studies focused on ECPella in CS to summarize clinical outcomes specifically pertaining to ECPella 5+. Findings were compared to outcomes from a contemporary cohort of 10 patients admitted for cardiogenic shock and treated with ECPella 5+ between January 2022 and May 2023. We evaluated 84 studies published in Pubmed between January 2017 and October 2023. Of these, 24 articles were selected for full analysis. Use of ECPella 5+ increased over time, with more than 50% of patients receiving this configuration in studies published in 2023. Mortality rate for ECPella 5+ (reported in 5 of 24 studies) was 33% compared to 49% for all ECPella combinations. Mortality outcomes of our patient cohort were consistent with a rate of 30%. These findings suggest that Impella 5+ may further improve outcomes of ECPella. However, the interpretation is limited by the small sample size and the descriptive nature of the data. Further larger, prospective studies are needed to determine potential improvements in complication rates, VA-ECMO and inotropic therapy duration, and native heart recovery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531470","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":"Comparison of Sugammadex Versus Neostigmine for Postoperative Outcomes in Coronavirus Disease 2019 Patients Undergoing Thoracic Surgery: A Cohort Study.","authors":"Ti-Chuan Chiu, Chia-Li Kao, Kuo-Chuan Hung, Yi-Chen Lai, Jheng-Yan Wu, Shu-Wei Liao, Wei-Cheng Liu, I-Wen Chen","doi":"10.1053/j.jvca.2025.02.015","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.015","url":null,"abstract":"<p><strong>Objective: </strong>This study was designed to evaluate whether the use of sugammadex was associated with a lower incidence of pulmonary complications than neostigmine in patients with coronavirus disease 2019 (COVID-19) undergoing thoracic surgery.</p><p><strong>Design: </strong>This was a matched cohort study using data from the TriNetX database.</p><p><strong>Setting: </strong>Operating room.</p><p><strong>Participants: </strong>Adult patients with COVID-19 within 6 weeks before thoracic surgery.</p><p><strong>Intervention: </strong>The use of sugammadex or neostigmine to reverse muscular blockade.</p><p><strong>Measurements and main results: </strong>Outcomes included the incidence of composite pulmonary complications (CPCs) (primary outcome), pneumonia, respiratory failure, need for intensive care, mortality, sepsis, and acute kidney injury at 30-day follow-up. The potential benefits of sugammadex were also assessed at 90-day follow-up. Predictors of pulmonary complications were identified in those receiving sugammadex. After matching, 985 patients were included in each group. At 30 days, the incidence of CPCs (5.69% v 9.75%; odds ratio [OR]: 0.56, p = 0.0009), pneumonia (1.83% v 4.37%; OR: 0.41, p = 0.0016), and respiratory failure (1.42% v 3.25%; OR: 0.43, p = 0.0087) were significantly lower with sugammadex than neostigmine. No differences were found in other 30-day outcomes. Diabetes and chronic obstructive pulmonary disease were identified as risk factors for pneumonia and respiratory failure. At 90 days, no significant differences were observed, although mortality tended to be lower with sugammadex.</p><p><strong>Conclusion: </strong>In patients with COVID-19 undergoing thoracic surgery, sugammadex was associated with a reduction in 30-day postoperative pulmonary complications compared with neostigmine. However, this finding requires validation in larger, randomized trials.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557015","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":"Heparin Versus Bivalirudin in Pediatric Patients Assisted With Mechanical Circulatory Support: A Retrospective Before-and-after Study.","authors":"Chiara Giorni, Nicoletta Cantarutti, Alessandro Olimpieri, Simona Benegni, Alessandra Rizza, Isabella Favia, Giovina Di Felice, Leonardo Vallesi, Gianluca Brancaccio, Antonio Amodeo, Luca Di Chiara, Zaccaria Ricci","doi":"10.1053/j.jvca.2025.01.041","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.041","url":null,"abstract":"<p><strong>Objectives: </strong>Children assisted with mechanical circulatory support experience bleeding and thrombotic complications that may depend upon anticoagulation strategies. The primary aim of this study was to compare the incidence of thrombotic events in pediatric heart failure patients assisted with mechanical circulatory support with the use of bivalirudin versus heparin anticoagulation. A secondary aim was to compare the percentage of out-of-range partial thromboplastin time values between these anticoagulants.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary pediatric cardiac intensive care unit.</p><p><strong>Participants: </strong>Pediatric patients undergoing mechanical circulatory support for cardiac failure.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 36 pediatric patients on mechanical support treated with either heparin (n.18) or bivalirudin (n.18) during the first 30 days of intensive care unit admission were compared. Bivalirudin group data were retrieved from February 2018 to August 2020 while data on the heparin group were extrapolated from 2015 to 2017. A comparison of anticoagulation was conducted specifically in EXCOR Berlin Heart and extracorporeal membrane oxygenation patients. Berlin Heart patients showed 1 (12.5%) versus 8 (80%) thrombotic episodes in the bivalirudin and heparin groups, respectively (p = 0.005), 0 and 3 (30%) cerebrovascular events, and 0 versus 3 (30%) death episodes, respectively (p = 0.054). In extracorporeal membrane oxygenation patients, the bivalirudin and heparin groups showed 0 versus 1 (8.3%) patient with a thrombosis episode (p = 0.40), 0 and 0 cerebrovascular events, and 5 (50%) versus 3 (25%) death episodes, respectively (p = 0.169). The number of out-of-range partial thromboplastin time values was higher in the heparin group both in Berlin Heart and extracorporeal membrane oxygenation patients (p < 0.0001).</p><p><strong>Conclusions: </strong>In a cohort of children with heart failure, bivalirudin use was associated with a reduction in thrombotic events in Berlin Heart patients compared with heparin over a period of 30 days.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531480","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":"To Be, or Not to Be: Is It Better to Be HFrEF or HFpEF or Somewhere In Between (HFmrEF)?","authors":"Steven Bartels, Rebecca Lee, Jenny Kwak","doi":"10.1053/j.jvca.2025.02.016","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.016","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501410","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 and EMI: Ensuring Safe CIED Management During Surgical Procedures.","authors":"Ariana Y Ramirez, Stephanie Howes, Kevin Sanchez, James Mullin, Robert J Chilton","doi":"10.1053/j.jvca.2025.02.006","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.02.006","url":null,"abstract":"<p><p>When planning surgical procedures for patients with conventional pacemakers, leadless pacemakers, cardiac resynchronization therapy devices, or implantable cardioverter-defibrillators, it is imperative to assess the risk of electromagnetic interference to ensure the safe functioning of these cardiac implantable electronic devices (CIEDs) during surgery. This paper explores the strategies for managing both conventional CIEDs and leadless devices during such procedures, emphasizing the importance of the preoperative evaluation, appropriate device programming, intraoperative monitoring, and postoperative evaluation. This report highlights the critical role of collaboration with cardiology and the CIED team in ensuring patient safety during surgical procedures. Ultimately, diligent intraoperative management, adherence to guidelines when available, and preparedness to address any complications are essential for protecting CIED function during surgical procedures.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531467","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}