Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Contemporary Prevention and Management of Postoperative Delirium in Cardiac Surgery Patients","authors":"Syed M. Ali Hassan MD ,&nbsp;Shubh K. Patel ,&nbsp;Miriam S. Badross ,&nbsp;Nitish K. Dhingra MD ,&nbsp;Raj Verma ,&nbsp;Meena Verma ,&nbsp;Ryuta Seguchi MD, PhD ,&nbsp;Bobby Yanagawa MD, PhD ,&nbsp;Jessica Spence MD, PhD ,&nbsp;C. David Mazer MD ,&nbsp;Ahmad Alli MD, Mmed ,&nbsp;Subodh Verma MD, PhD ,&nbsp;Rakesh C. Arora MD, PhD","doi":"10.1053/j.semtcvs.2025.04.008","DOIUrl":"10.1053/j.semtcvs.2025.04.008","url":null,"abstract":"<div><div><span>This review examines the prevention and management of postoperative delirium<span><span> in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium </span>pathophysiology, risk factors, </span></span>diagnostic<span><span> approaches, and pharmacologic and non-pharmacologic interventions. A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium. The pathogenesis of postoperative delirium is complex, involving </span>neuroinflammation<span><span><span>, neurotransmitter imbalance, and </span>endothelial dysfunction<span>, compounded by baseline vulnerabilities and perioperative stressors. Early screening using tools like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and </span></span>Intensive Care Delirium<span> Screening Checklist<span> (ICDSC) aid in timely detection. Prevention emphasizes non-pharmacologic interventions, such as the Hospital Elder Life Program and the ABCDEF bundle, alongside pharmacologic strategies to minimize high-risk sedatives. Emerging technologies, including intraoperative neurophysiologic monitoring modalities and machine learning models, enhance postoperative delirium risk assessment and enable targeted interventions. Effective postoperative delirium management in cardiac surgery requires a balanced approach incorporating non-pharmacologic and pharmacologic methods. Integration of evidence-based practices and innovative technologies into routine care holds promise for improving patient outcomes. Ongoing research is essential to optimize postoperative delirium management and standardize practices in high-risk populations.</span></span></span></span></div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 263-274.e3"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECLS-SHOCK Trial","authors":"Guillaume Thery MD, MSc,&nbsp;Pierre-Emmanuel Noly MD, PhD,&nbsp;Yiorgos Alexandros Cavayas MD, MSc,&nbsp;Ismail Bouhout MD, PhD,&nbsp;Philippe Demers MD, MSc, FRCS,&nbsp;Yoan Lamarche MD, MSc","doi":"10.1053/j.semtcvs.2025.01.004","DOIUrl":"10.1053/j.semtcvs.2025.01.004","url":null,"abstract":"<div><div>ECLS-SHOCK is the largest randomized control trial on Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in Acute Myocardial Infarction-related Cardiogenic Shock (AMI-CS). Unfortunately, ECLS-SHOCK failed to demonstrate a reduction of mortality in AMI-CS with VA-ECMO. Interpretation of these findings must account for frequent crossover to VA-ECMO or other temporary mechanical circulatory support (tMCS) devices in the control group, as well as the exceptionally high severity of illness among participants. We detail here point by point what could explain the outcomes and the unanswered questions. In the light of these results, a liberal use of VA-ECMO might be avoided. Further trials are needed to refine patient selection criteria and determine the optimal timing (“sweet-spot”) for VA-ECMO implementation. Current practice and future guidelines will have to take in count ECLS-SHOCK results.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 298-302"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of the Composite Allocation Score System for Lung Transplantation in the United States: Review of the New System","authors":"Isaac S. Alderete MHS ,&nbsp;Cathlyn K. Medina BA ,&nbsp;Samantha E. Halpern MD MHS ,&nbsp;Arya Pontula BSPH ,&nbsp;Matthew G. Hartwig MD MHS","doi":"10.1053/j.semtcvs.2024.09.001","DOIUrl":"10.1053/j.semtcvs.2024.09.001","url":null,"abstract":"<div><div>Due to criticism regarding undue adherence to fixed geographic boundaries, the Lung Allocation Score system was recently replaced by the more holistic allocation via continuous distribution. This review highlights the historical evolution of US lung allocation paradigms, outlines rationale for continuous distribution under the Composite Allocation Score system and discusses expected implications of this new system.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 329-333"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Artificial Heart vs Left Ventricular Assist Device and Biventricular Assist Device.","authors":"Tessa Watt, Ranjit John","doi":"10.1053/j.semtcvs.2025.08.002","DOIUrl":"10.1053/j.semtcvs.2025.08.002","url":null,"abstract":"<p><p>Biventricular heart failure remains a challenging issue in patients with end-stage cardiomyopathy requiring mechanical circulatory support options. Also, the Achilles heel of durable left ventricular assist devices (LVADs) remains right ventricular failure that significantly impacts morbidity and mortality. With recent changes in the heart transplant allocation system, there has been major shifts in practice patterns in the use of extracorporeal membranous oxygenation (ECMO), temporary VADs, and durable VADs in the treatment of biventricular failure and strategies for bridge to heart transplantation. Direct comparisons between devices are often difficult to make as there is a learning curve both at the provider level and institution level for each of these devices and strategies. The field continues to rapidly evolve, and the application of artificial intelligence may further hasten this growth.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: If You Can't Beat Them, Join Them - Thoracoabdominal Normothermic Regional Perfusion in Lung Transplantation.","authors":"Vuong-Lam Hoang Pham, Ramiro Fernandez","doi":"10.1053/j.semtcvs.2025.07.002","DOIUrl":"10.1053/j.semtcvs.2025.07.002","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Membrane Oxygenation for Cardiogenic Shock-Who Should Cannulate?","authors":"Nazari Dvirnik, Vivek Rao","doi":"10.1053/j.semtcvs.2025.03.016","DOIUrl":"10.1053/j.semtcvs.2025.03.016","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Primary Graft Dysfunction - Lung Transplantation's Most Relentless Opponent.","authors":"Caitlin T Demarest","doi":"10.1053/j.semtcvs.2025.05.016","DOIUrl":"10.1053/j.semtcvs.2025.05.016","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Protection in Donation after Circulatory Death with Thoracoabdominal Normothermic Regional Perfusion.","authors":"Sarah Y Park, Elizabeth J Bashian, Emily Hay-Arthur, Thomas F O'Shea, Michael T Cain, Jordan R H Hoffman","doi":"10.1053/j.semtcvs.2025.05.011","DOIUrl":"10.1053/j.semtcvs.2025.05.011","url":null,"abstract":"<p><p>Donation after circulatory death (DCD) has expanded the lung transplantation donor pool akin to other solid organ transplants, and thoracoabdominal normothermic regional perfusion (TA-NRP) of DCD lung allografts is a growing area of study. There remain some concerns regarding the impact of TA-NRP on DCD lung allograft pulmonary edema and subsequent development of primary graft dysfunction impacting graft and recipient survival and postoperative lung function. Here we present a review article discussing the existing literature on DCD lung transplantation, with a focus on TA-NRP recovery, and lung protection strategies during DCD lung recovery with TA-NRP.</p>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Challenges to In-Hospital Extracorporeal Cardiopulmonary Resuscitation.","authors":"Kaitlyn A Brennan, Aditi Balakrishna, Christina Anne Jelly","doi":"10.1053/j.semtcvs.2025.06.001","DOIUrl":"10.1053/j.semtcvs.2025.06.001","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At the Heart of It All: Leadership in the Operating Room","authors":"Alex M. Wisniewski MD, MSc,&nbsp;Irving L. Kron MD","doi":"10.1053/j.semtcvs.2025.02.005","DOIUrl":"10.1053/j.semtcvs.2025.02.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 2","pages":"Pages 171-173"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}