Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Hemolysis Index and Cardiopulmonary Bypass Time as Predictors of Cardiac Surgery-associated Acute Kidney Injury: An Observational Cohort Study","authors":"Michela Di Pierro MD ,&nbsp;Matteo Pozzi MD ,&nbsp;Marta Frazzei MD ,&nbsp;Benedetta Fumagalli MD ,&nbsp;Marco Casati MD ,&nbsp;Silvia Mariani MD ,&nbsp;Giovanni Marchetto MD, PhD ,&nbsp;Giuseppe Foti MD ,&nbsp;Emanuele Rezoagli MD, PhD ,&nbsp;Marco Giani MD","doi":"10.1053/j.jvca.2025.07.038","DOIUrl":"10.1053/j.jvca.2025.07.038","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute kidney injury (AKI) is a common and serious complication of cardiac surgery, often linked to the use and duration of cardiopulmonary bypass (CPB). The Hemolysis Index (HI) has been proposed as a surrogate marker of hemolysis and a potential predictor of cardiac surgery-associated AKI (CS-AKI). This study was designed to evaluate the associations between CPB time and HI with the onset of CS-AKI.</div></div><div><h3>Design</h3><div>An observational cohort study; retrospective analysis of prospectively collected data.</div></div><div><h3>Setting</h3><div>A single-center, Italian university tertiary care hospital.</div></div><div><h3>Participants</h3><div>Patients admitted to the cardiothoracic intensive care unit (ICU) following cardiac surgery between 2019 and 2023.</div></div><div><h3>Interventions</h3><div>HI was measured at ICU admission. CS-AKI and its severity were defined using the Kidney Disease: Improving Global Outcomes creatinine-based criteria. Associations between HI, CPB duration, and CS-AKI were assessed using logistic regression analyses, adjusting for the Cleveland Clinic Score.</div></div><div><h3>Measurements and Main Results</h3><div>A total of 1,195 patients were included in the analysis. Median age was 70 years (interquartile range [IQR] 62-75), and 310 patients (26%) were female. Median CPB duration was 110 minutes (IQR 80-140), and median HI at ICU admission was 25 (IQR 15-42). HI showed a moderate correlation with CPB duration (r = 0.367, p &lt; 0.001). CS-AKI occurred in 103 patients (9%). In multivariable analysis, both HI and CPB time were independently associated with CS-AKI (odds ratio per 10-unit increase in HI 1.52, 95% confidence interval 1.04-2.18, p = 0.027; odds ratio per hour of CPB 1.32, 95% confidence interval 1.08-1.63, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>HI and CPB time were independently associated with CS-AKI. The utility of incorporating these parameters into CS-AKI predictive models warrants further evaluation.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2953-2962"},"PeriodicalIF":2.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955473","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":"Timing Is Everything—Or Is It? When to Perform Non-Cardiac Surgery after Cardiac Surgery","authors":"Perin Kothari DO, FASE ,&nbsp;Natalie J Bodmer MD ,&nbsp;Matthew W. Vanneman MD, FASE","doi":"10.1053/j.jvca.2025.07.035","DOIUrl":"10.1053/j.jvca.2025.07.035","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2930-2932"},"PeriodicalIF":2.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955493","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":"Association Between COVID-19 Infection and Postoperative Outcomes Following Coronary Artery Bypass Grafting: A Retrospective Cohort Study.","authors":"Henry Hoang, Erik Romanelli, Felix Borngaesser, Ibraheem M Karaye, Joseph Derose, Daniel J Goldstein, Bilal Tufail, Danielle Nogoy, Matthias Eikermann, Jonathan Leff","doi":"10.1053/j.jvca.2025.07.022","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.022","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between preoperative Coronavirus disease 2019 (COVID-19) infection and complications in patients undergoing coronary artery bypass grafting (CABG), focusing on the timing of infection.</p><p><strong>Design: </strong>A retrospective cohort study using the National Covid Cohort Collaborative (N3C) database SETTING: Multi-institutional data from the National COVID Cohort Collaborative, representing diverse US healthcare settings PARTICIPANTS: Adult patients undergoing CABG during the COVID-19 pandemic, identified through CPT codes. COVID-19 infection timing was stratified into 3 groups: 0 to 2 weeks, 2 to 6 weeks, and 6 to 12 weeks before surgery. Outcomes were analyzed based on the timing of COVID-19 infection and compared to patients without a history of COVID-19.</p><p><strong>Interventions: </strong>No direct interventions were performed. Outcomes were analyzed based on the timing of COVID-19 infection.</p><p><strong>Measurements and main results: </strong>Postoperative complications were assessed using International Classification of Disease, Tenth Revision codes, including venous thromboembolism (VTE), sepsis, acute kidney injury, surgical site infection, acute myocardial infarction (AMI), 30-day mortality, and 1-year mortality. For COVID-19 infection occurring within 0 to 2 weeks before surgery, significantly increased odds were observed for VTE (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.36-3.59]; p = 0.001), sepsis (OR, 1.74; 95% CI, 1.01-2.81; p = 0.032), 30-day mortality (OR, 3.60; 95% CI, 2.32-5.35; p < 0.0001), and 1-year mortality (OR, 3.10; 95% CI, 2.24-4.21; p < 0.0001), with no significant associations for surgical site infection (OR, .94; 95% CI, 0.48-1.64; p = 0.849), or AMI (OR, 1.21; 95% CI, 0.84-1.69; p = 0.274) compared to COVID-19-negative patients.</p><p><strong>Conclusions: </strong>COVID-19 infection within 2 weeks before CABG is associated with a significantly increased risk of complications. Further research is needed to understand the mechanisms and optimize care for these patients.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955395","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":"Noninvasive Ventilation in Cardiac Surgery Patients to Reduce Pulmonary Complications: Teaching an Old Dog New Tricks.","authors":"Kristin Constantine Trela, Richa Dhawan","doi":"10.1053/j.jvca.2025.07.023","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.023","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955485","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":"Ipsilateral High Thoracic Ultrasound-Guided Erector Spinae Plane Block for Post-Thoracotomy Shoulder Pain in Thoracic Cancer Surgeries: A Randomized Controlled Clinical Trial","authors":"Tamer A. Kotb MD ,&nbsp;Algohary Moussa Tantawy MD ,&nbsp;Essam Mahran MD ,&nbsp;Osama Mahmoud Mahmoud Elbosraty MD ,&nbsp;Fady Samy Saad MD ,&nbsp;Muhammad M. Megahed MD ,&nbsp;Randa Elshiha MD ,&nbsp;Samuel Fayez Samy MD","doi":"10.1053/j.jvca.2025.07.034","DOIUrl":"10.1053/j.jvca.2025.07.034","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the safety and efficacy of ultrasound-guided high thoracic erector spinae plane block (HT-ESPB) in the management of post-thoracotomy ipsilateral shoulder pain (PTISP).</div></div><div><h3>Design</h3><div>Randomized, double-blind, parallel-group, controlled, clinical trial.</div></div><div><h3>Setting</h3><div>The National Cancer Institute.</div></div><div><h3>Participants</h3><div>Seventy-six adult patients undergoing thoracic cancer surgery.</div></div><div><h3>Interventions</h3><div>Patients were randomized into two equal groups: A control group received thoracic epidural analgesia (TEA) alone (TEA group), and a study group received ultrasound-guided HT-ESPB plus TEA (ESPB group).</div></div><div><h3>Measurements and Main Results</h3><div>Outcomes included the incidence of PTISP, time to first rescue analgesia and total rescue analgesic doses for ISP, intraoperative fentanyl consumption, heart rate, mean arterial pressure, oxygen saturation, and complications. The ESPB group had a significantly lower incidence of ISP in the first postoperative hour compared to the TEA group (60.5% <em>v</em> 97.4%, p &lt; 0.001). The ESPB group also exhibited lower postoperative visual analog scale scores, longer time to first rescue analgesia, and a reduced number of rescue analgesic doses for ISP, as well as lower heart rate and mean arterial pressure. No significant complications were reported.</div></div><div><h3>Conclusions</h3><div>Ultrasound-guided HT-ESPB is a safe and efficacious strategy for the management of PTISP. It demonstrated a significant reduction in the incidence and severity of ISP and postoperative analgesic requirements when compared to TEA alone. This approach enhanced hemodynamic stability without significant complications.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 3053-3059"},"PeriodicalIF":2.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955519","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 Foley in the Heart: Management of Cardiac Injury.","authors":"Allan E Stolarski, Sabrina Sanchez, Crisanto Torres, Alexandros Karavas, Noelle Saillant, Jamel Ortoleva","doi":"10.1053/j.jvca.2025.07.028","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.028","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859239","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 Single-blind, Randomized Controlled Trial Comparing Postoperative Analgesic Effects of Superficial and Deep Parasternal Intercostals Blocks in Patients Undergoing Coronary Artery Bypass Grafting Surgery.","authors":"Melike Korkmaz Toker, Serkan Yazman, Basak Altıparmak, Ali Ihsan Uysal, Bugra Harmandar","doi":"10.1053/j.jvca.2025.07.027","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.027","url":null,"abstract":"<p><strong>Objective: </strong>To compare the analgesic efficacy of anesthesiologist-performed ultrasound-guided superficial parasternal intercostal plane block (SPIPB) and surgeon-performed deep parasternal intercostal plane block (DPIPB) in patients undergoing coronary artery bypass grafting (CABG) via median sternotomy.</p><p><strong>Design: </strong>A prospective, randomized, single-blind clinical trial.</p><p><strong>Setting: </strong>A single, tertiary care university hospital.</p><p><strong>Participants: </strong>Seventy-five participants (aged 45-80 years, ASA III-IV) scheduled for elective isolated CABG surgery.</p><p><strong>Interventions: </strong>Participants were randomly assigned to the SPIPB, DPIPB, or control groups. Regional blocks were performed either under ultrasound guidance after sternal closure and sterilization of the surgical site (SPIPB) or intraoperatively under direct vision (DPIPB). Postoperative pain was managed with multimodal analgesia protocols.</p><p><strong>Measurements and main results: </strong>Outcomes included pain scores and tramadol administration at the 1st, 4th, 12th, and 24th postoperative hours, as well as after extubation. The cumulative 24-hour tramadol administration (primary outcome) was significantly lower in the DPIPB group (95 ± 44 mg) compared with the SPIPB (141 ± 58 mg) and control groups (176 ± 61 mg) (p < 0.001). Compared with the control group, the DPIPB group had a significantly reduced likelihood of requiring high-dose tramadol (odds ratio [OR]: 0.18, 95% confidence interval [CI]: 0.06-0.56, p = 0.003). The SPIPB group showed an intermediate effect compared with control (OR: 0.52, 95% CI: 0.23-1.18, p = 0.095). When directly compared, DPIPB was associated with significantly lower tramadol use than SPIPB (OR: 0.34, 95% CI: 0.16-0.72, p < 0.001). Pain scores at all time points were significantly lower in both block groups compared with control (p < 0.05), with DPIPB showing the most pronounced effect. No block-related complications were observed.</p><p><strong>Conclusions: </strong>Both parasternal intercostal blocks improved postoperative analgesia compared with standard care. The SPIPB was performed under ultrasound guidance, whereas the DPIPB was applied under direct vision by the surgeon. The DPIPB demonstrated superior opioid-sparing effects and improved dynamic pain control. These findings support the use of parasternal fascial plane blocks, whether performed under ultrasound guidance or direct vision, as effective components of multimodal analgesia in cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955477","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":"Advances in Acute Type A Aortic Dissection: Expanding the Roles of Goal-Directed Echocardiographic Imaging throughout the Perioperative Period","authors":"Joseph Colao MD ,&nbsp;John G. Augoustides MD, FASE, FAHA","doi":"10.1053/j.jvca.2025.07.030","DOIUrl":"10.1053/j.jvca.2025.07.030","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2907-2909"},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859240","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":"Dependability of Large Language Models in Cardiovascular Medicine: A Scoping Review.","authors":"Ying Ying Jia, Lin Yan Pang, Ming Ming Bi, Xiang Lu Yang, Jian Ping Song","doi":"10.1053/j.jvca.2025.07.026","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.026","url":null,"abstract":"<p><strong>Background: </strong>The adoption of large language models (LLMs) in both clinical and consumer healthcare settings has surged exponentially. However, there remains limited evidence on their reliability and impact in cardiovascular practice.</p><p><strong>Objectives: </strong>This scoping review was designed to consolidate the existing biomedical literature on applicability, reliability, and quality improvement strategies for the integration of LLMs into the cardiovascular domain. Following Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, three electronic databases (PubMed, Web of Science, and Embase) were systematically searched to identify pertinent studies published between August 2020 and February 2025. Articles addressing the development, implementation, and assessment of LLMs in cardiovascular medicine were selected for comprehensive analysis.</p><p><strong>Results: </strong>Twenty-five eligible publications evaluated the performance of LLMs in responding to cardiology-related questions, encompassing parameters such as accuracy, response latency, indirectness, completeness, and so on. The assessment methodology varied considerably across studies. LLMs demonstrated potential utility in cardiovascular decision-making, myocarditis management, cardiac arrest diagnosis and treatment, and image differentiation.</p><p><strong>Conclusions: </strong>Although some LLM-generated responses to cardiovascular-related questions exhibit acceptable levels of quality, significant drawbacks persist. These include verbosity, inaccuracies, occasional misinformation, inconsistent outputs to identical questions, bias, and poor reproducibility. Overall, this work highlights the urgent need for continued refinement and validation.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955411","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":"Ethical Considerations for Patients Requiring Extracorporeal Cardiopulmonary Resuscitation.","authors":"Sasa Rajsic, Benedikt Treml, Robert Breitkopf, Wolfgang Lederer","doi":"10.1053/j.jvca.2025.07.032","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.032","url":null,"abstract":"<p><p>Immediate recognition of cardiac arrest and the initiation of cardiopulmonary resuscitation (CPR) can significantly improve survival chances. The use of extracorporeal membrane oxygenation during CPR (eCPR) could further enhance survival rates. Current evidence supports the implementation of eCPR as a part of the Advanced Life Support protocol, which may positively affect survival and long-term neurological outcomes and provide additional time for diagnosing and treating the underlying cause of cardiac arrest. Based on the patient's potential for recovery and neurological outcome, multidisciplinary teams can pursue weaning of the patient from mechanical support or withdrawal of care in the case of an unfavorable outcome. These decisions should align with the patient's values, prognosis, and ethical guidelines. A healthcare system that actively promotes eCPR as a standardized part of every Advanced Life Support protocol may face challenges, such as an increased number of patients requiring constant care in long-term care facilities. This could potentially lead to a reduced quality of life and create burdens on patients, families, the healthcare system, and society. Furthermore, in cases of potential organ donation, the principles of beneficence and autonomy may place healthcare providers in significant ethical dilemmas. Given the potential for eCPR to become a standard of care for eligible patients, this work focuses on the ethical and social implications, as well as the impact on the healthcare system.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955418","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}