Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"VVECPella: Combined Venovenous ECMO and Impella 5.5 for Cardiopulmonary Failure.","authors":"Elizabeth J Bashian, Carson L Campisi, Thomas F O'Shea, Deanna I Dwyer, Nicholas R Teman, Michael T Cain, Jordan R H Hoffman","doi":"10.1177/10892532261483998","DOIUrl":"https://doi.org/10.1177/10892532261483998","url":null,"abstract":"<p><p>Survival with acute cardiopulmonary failure remains a formidable challenge despite advances in mechanical circulatory support (MCS). Although venoarterial extracorporeal membrane oxygenation (ECMO) provides combined cardiopulmonary support, patients with improving cardiac function and persistent respiratory failure may no longer require arterial ECMO. We describe our early experience using a combine venovenous (VV) ECMO and Impella 5.5 (VVECPella) as a de-escalation strategy in this setting. We report a series of five patients supported with the VVECPella configuration at our institution from January 2025 to January 2026. Impella 5.5 was implanted via axillary, innominate, or direct ascending grafts. Operative details, hospital course, and patient outcomes were retrospectively reviewed. In total, five patients underwent VVECPella support. The most common indication was persistent severe respiratory failure despite improving hemodynamics following cardiogenic shock. Median VV ECMO duration was 4 days (range 1-8), Impella support 6 days (3-15), and combined support 4 days (2-8). Four patients (80%) were successfully weaned from both devices with recovery of cardiac and respiratory function, while one patient died from multiorgan failure. Major hemolysis occurred in 3 patients (60%), whereas vascular complications were attributable to prior VA ECMO cannulation rather than the VVECPella configuration. In conclusion, VVECPella appears to be a feasible de-escalation strategy for carefully selected patients with improving circulatory failure but persistent respiratory insufficiency, allowing independent titration of cardiac and respiratory support while avoiding prolonged arterial ECMO. Larger multicenter studies are warranted.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261483998"},"PeriodicalIF":1.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Continuous Bilateral Erector Spinae Plane Block on Neutrophil-Lymphocyte Ratio in On-Pump CABG: A Prospective Randomized Study.","authors":"Alok Kumar, P Sai Dheeraj, Nihar Ameta","doi":"10.1177/10892532261481584","DOIUrl":"https://doi.org/10.1177/10892532261481584","url":null,"abstract":"<p><strong>Background: </strong>Cardiac surgery using cardiopulmonary bypass causes a pronounced systemic inflammatory response. The neutrophil-lymphocyte ratio (NLR) is a readily accessible inflammatory biomarker associated with adverse outcomes after cardiac surgery. Regional anesthesia has been shown to modulate the inflammatory process by various mechanisms. Erector spinae plane (ESP) block reduces nociception and opioid use, but its effect on perioperative inflammatory markers is not well described. This study evaluated whether bilateral ESP block attenuates the perioperative rise in NLR in patients undergoing on-pump coronary artery bypass graft (CABG) surgery.</p><p><strong>Methods: </strong>This prospective randomized study included 120 adults undergoing elective on-pump CABG randomized to bilateral ultrasound-guided ESP block (ESP, n = 60) or conventional opioid-based analgesia (Opioid, n = 60). ESP was performed pre-induction. NLR and platelet-lymphocyte ratio (PLR) were measured until the second postoperative day (POD). Secondary endpoints included ICU length of stay, mechanical ventilation duration, and total opioid consumption.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. NLR increased in both groups after surgery and peaked at POD1. However, POD1 NLR was significantly lower in the ESP group compared with the opioid group (13.99 vs 18.58, <i>P</i> = 0.007). The ESP group showed shorter ICU stay (<i>P</i> = 0.02) and lower total perioperative opioid consumption (<i>P</i> = 0.01).</p><p><strong>Conclusions: </strong>Bilateral ESP block attenuated the early postoperative rise in NLR and reduced opioid requirements in on-pump CABG patients, suggesting modulation of the inflammatory response in addition to analgesic benefits.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261481584"},"PeriodicalIF":1.1,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Perioperative Management of Cold-Induced Urticaria in Cardiac Surgery With Hypothermia on Cardiopulmonary Bypass.","authors":"Alexander Bell, Noah John, Anne Campbell","doi":"10.1177/10892532261480212","DOIUrl":"https://doi.org/10.1177/10892532261480212","url":null,"abstract":"<p><p>Cold-induced urticaria is a chronic urticaria subtype which can result in a severe, life-threating, anaphylaxis type reaction to cold stimuli. While a rare condition, it has potentially significant implications in cardiac surgery, where a degree of hypothermia may often be used for neurological or myocardial protection. We present a case of the successful perioperative management of this condition for surgical aortic root replacement with a mechanical aortic valve conduit, pulmonary vein isolation and left atrial appendage clipping performed on cardiopulmonary bypass. Review of the limited number of previously published case reports, current non-perioperative management guidelines and an immunology specialist consult informed our perioperative plan. A 5-day oral course of high-dose second-generation H1-antihistamine was provided pre-operatively. High-dose oral H1-antihistamines were continued over the immediate perioperative period, in addition to a short course of corticosteroids. No H2-antihistaminergic agents or additional intraoperative intravenous H1-antihistamines were used. Intraoperatively, systemic cooling was limited to 32°C on cardiopulmonary bypass and active warming used at other times. No manifestations of cold-induced urticaria occurred perioperatively demonstrating this can be an effective treatment strategy.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261480212"},"PeriodicalIF":1.1,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative ICU Biomarkers and Early Mortality After Surgical Aortic Valve Replacement in Severe Aortic Stenosis With Reduced Left Ventricular Ejection Fraction: Limited Discrimination of High-Sensitivity Troponin T.","authors":"Francisco Javier González-Ruiz, Luis Efrén Santos-Martínez, Daniel J Woytowich, Chantale Gilles-Herrera, Jacob J Cruz-Sánchez, Rafael Magaña-González, Bin Xie","doi":"10.1177/10892532261476117","DOIUrl":"https://doi.org/10.1177/10892532261476117","url":null,"abstract":"<p><p>Early postoperative risk stratification after surgical aortic valve replacement remains challenging in patients with severe aortic stenosis and reduced left ventricular ejection fraction. Although postoperative troponin elevation is expected after open-heart surgery, the discriminatory value of ICU admission high-sensitivity cardiac troponin T (hs-cTnT) in this specific myocardial phenotype remains uncertain. We evaluated whether ICU admission hs-cTnT provides useful early discrimination for 30-day all-cause mortality after surgical aortic valve replacement in patients with severe aortic stenosis and reduced left ventricular ejection fraction and compared its performance with other postoperative ICU biomarkers. We conducted a single-center retrospective cohort study of 184 adults with severe aortic stenosis and left ventricular ejection fraction ≤40% who underwent surgical aortic valve replacement between 2020 and 2024 and had complete 30-day follow-up. ICU admission hs-cTnT was available in 183 patients. Biomarkers included ICU admission hs-cTnT, ICU admission lactate, peak ICU C-reactive protein, and ICU admission B-type natriuretic peptide. Discrimination was assessed using receiver operating characteristic analysis, DeLong comparisons, repeated stratified 5-fold cross-validation, and bootstrap optimism correction. Multivariable models were interpreted as exploratory because of the limited number of mortality events. Thirty-day mortality occurred in 29 of 184 patients (15.8%). ICU admission hs-cTnT showed poor discrimination for 30-day mortality in the hs-cTnT analytic cohort and remained non-discriminatory after repeated cross-validation. In the common four-biomarker cohort, lactate outperformed hs-cTnT by DeLong testing, whereas the four-biomarker model did not significantly improve discrimination beyond lactate alone. Bootstrap optimism correction attenuated the apparent performance of multimarker models, supporting cautious interpretation. Exploratory analyses also suggested that mortality did not increase monotonically across hs-cTnT quartiles. In patients with severe aortic stenosis and reduced left ventricular ejection fraction undergoing surgical aortic valve replacement, ICU admission hs-cTnT did not provide reliable early mortality discrimination. Lactate remained the strongest early individual biomarker, whereas multimarker models showed exploratory discrimination but require external validation. These findings support a phenotype-specific interpretation of postoperative hs-cTnT rather than reliance on universal postoperative troponin assumptions.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261476117"},"PeriodicalIF":1.1,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of Anesthetic Considerations for Subcutaneous and Extravascular Implantable Cardioverter-Defibrillators.","authors":"Kenji Tanabe, Broc Burke, Jillian Vitter, Matthew Zipse, Samuel Gilliland","doi":"10.1177/10892532261477463","DOIUrl":"https://doi.org/10.1177/10892532261477463","url":null,"abstract":"<p><p>Implantable cardioverter-defibrillators (ICDs) are critical for the prevention of sudden cardiac death due to ventricular arrhythmias and are commonly encountered in the perioperative space. Traditional devices contain transvenous leads that are susceptible to mechanical failure or infection. To reduce these complications, two entirely extravascular ICDs are currently approved for implantation: the subcutaneous Emblem MRI S-ICD and the extravascular Aurora EV-ICD. This article provides an evidence-based review of the indications for use, implantation technique, and anesthetic considerations for these novel systems.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261477463"},"PeriodicalIF":1.1,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Beyond 72 hours After Penetrating Arrow Injury to the Heart Managed Without Cardiopulmonary Bypass: A Case of Delayed Physiologic Stabilization and Off-Pump Repair.","authors":"Krishna Rao Maremanda, Hemalatha Bora, Prasad Rao Kaluvala, Prasadh Dilli, Noorain Naqiya, Roja Emani, Sumana Bhaskarapanthula","doi":"10.1177/10892532261469240","DOIUrl":"https://doi.org/10.1177/10892532261469240","url":null,"abstract":"<p><p>Penetrating chest injuries are associated with high mortality because visceral and vascular structures are situated close together, and injury to these can be devastating due to the limited time for resuscitation. Such injuries often cause massive hemorrhage, tension pneumothorax, hemothorax, cardiac tamponade, or direct penetration of the heart and great vessels. Survival in penetrating chest injuries involving the heart, especially with delayed hospital presentation, is very uncommon. The mechanism of penetration significantly influences the diagnostic approach and necessary interventions. Bedside POCUS protocols, such as eFAST, RUSH, and BLUE, enable immediate resuscitation before further investigations. High-velocity injuries like gunshots and crossbow bolts are linked to high mortality due to rapid tissue destruction caused by kinetic energy transfer. Certain pathological conditions, such as cardiac tamponade or effusion, may sometimes be beneficial in these injuries. We present a case of an accidental penetrating arrow injury to the chest, piercing the heart, yet the patient survived after more than three days of delayed transfer to higher care with hemopneumothorax and mediastinal involvement. Survival after a penetrating chest injury through the heart is very rare. Prompt, rapid resuscitation with a multidisciplinary approach can improve outcomes. However, the prognosis depends on factors such as the type and location of the injury, the speed of medical response, the presence of cardiac tamponade, and the patient's pre-existing clinical condition.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261469240"},"PeriodicalIF":1.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasopressor Selection and Postoperative Delirium in Older Adults: A Propensity-Matched Database Analysis.","authors":"Tiffany Dong, William Mao, Christopher Baker, Blake Han, Leonard J Soloniuk, Gary Stier, Daniel A Novak, Ioana Pasca, Jiapeng Huang","doi":"10.1177/10892532261465066","DOIUrl":"https://doi.org/10.1177/10892532261465066","url":null,"abstract":"<p><p>ObjectivesVasopressor choice potentially contributes to postoperative delirium due to differences in end-organ perfusion. This study seeks to determine the rates of postoperative delirium after perioperative phenylephrine, ephedrine, or norepinephrine administration.DesignRetrospective, propensity-score matched multicenter database study.ParticipantsPatients aged 60 and older undergoing surgery of the integumentary, musculoskeletal, respiratory, hematologic/lymphatic, gastrointestinal, genitourinary/reproductive, endocrine, or sensory organ systems.InterventionsPerioperative vasopressor administration (phenylephrine, ephedrine, norepinephrine).Measurements and Main ResultsThe primary outcome was the incidence of postoperative delirium based on ICD-10 diagnostic codes within seven days of surgery. After propensity score matching, there was no difference in the rate of postoperative delirium between phenylephrine and norepinephrine (OR 0.97; 95% CI 0.61-1.54; <i>P</i> = .9065) or between ephedrine and norepinephrine (OR 0.74; 95% CI 0.41-1.32; <i>P</i> = .3062). Phenylephrine was associated with a higher rate of postoperative delirium when compared to ephedrine (OR 1.30; 95% CI 1.05-1.60; <i>P</i> = .0162), although absolute risk difference was small (0.05%).ConclusionsThis study highlights the potential influence of vasopressor selection on postoperative neurocognitive outcomes in older adults. Understanding the physiologic and pharmacologic mechanisms underlying these associations may help guide individualized intraoperative management and reduce delirium risk in clinical practice.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"10892532261465066"},"PeriodicalIF":1.1,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Year in Review: Anesthesia for Congenital Heart Disease 2025.","authors":"Matthew M Goodmanson, Gregory J Latham","doi":"10.1177/10892532261438993","DOIUrl":"10.1177/10892532261438993","url":null,"abstract":"<p><p>This review highlights the published literature in 2025 that pertains to the anesthetic management of patients with congenital heart disease. Four major themes are discussed: (i) anesthesia for adults with congenital heart disease (ii) perioperative blood management and cardiopulmonary bypass-associated decision-making (iii) enhanced recovery after cardiac surgery and (iv) noncardiac procedural safety and workforce sustainability.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"115-125"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal Organ Transplantation: Noteworthy Literature in 2025.","authors":"Akira Katayama, Marc Casale, Rob Huseby, Ryan Wang, Tetsuro Sakai","doi":"10.1177/10892532261433411","DOIUrl":"10.1177/10892532261433411","url":null,"abstract":"<p><p>This review highlights noteworthy literature published in 2025 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We feature 19 studies from 5334 peer-reviewed publications on kidney transplantation, four studies from 2231 publications on pancreas transplantation, and four studies from 2162 publications on intestinal transplantation. The liver transplantation section includes a special focus on 28 studies from 4925 clinical trials published in 2025. The notable research articles were found in the areas including machine perfusion in kidney and liver transplantations, donor and recipient pain management, and impact of recipient sarcopenia on the outcome in liver transplantation.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"126-143"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Year in Review 2025: New and Noteworthy Literature in Cardiothoracic Critical Care.","authors":"Sarah M Alber, Kevin K Kim, Xiang Li, Kenji Tanabe, Samuel Gilliland","doi":"10.1177/10892532261438445","DOIUrl":"10.1177/10892532261438445","url":null,"abstract":"<p><p>This article reviews noteworthy literature published in 2025 pertinent to the care of critically ill cardiothoracic surgical patients. We reviewed over 9000 articles to identify 12 publications that provided new or supportive evidence on a diverse range of topics including the management of cardiogenic shock, pulmonary and renal failure, precision immunotherapy in sepsis care, and resuscitation. Additional topics included outcomes following mechanical thrombectomy and methods of hemodynamic monitoring.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"90-102"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}