Annals of Cardiac Anaesthesia最新文献

{"title":"Emergency Transcatheter Aortic Valve Implantation for Decompensated Aortic Stenosis accompanied by Cardiogenic Shock.","authors":"Ajmer Singh, Christy P Kaliyadan, Praveen Chandra","doi":"10.4103/aca.aca_2_26","DOIUrl":"10.4103/aca.aca_2_26","url":null,"abstract":"<p><strong>Abstract: </strong>Patients with severe aortic stenosis (AS) often present acutely with decompensated heart failure, cardiogenic shock or cardiac arrest requiring immediate intervention. Treatment options for these patients include palliative care, balloon aortic valvuloplasty (BAV), emergency transcatheter aortic valve implantation (TAVI), or surgical aortic valve replacement. TAVI procedure is performed electively in majority of the patients. However, it can be considered a rescue therapy in patients with cardiogenic shock secondary to acutely decompensated valvular AS. Here, we report the successful use of emergent TAVI for a patient presenting with cardiogenic shock secondary to decompensated AS.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"638-641"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164781","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":"Bivalirudin Versus Heparin and Protamine in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"Matthew Cadd, Samira Green, Daniel Puntis, Hans van Huellen, Miles Seavill, Sam Bullard","doi":"10.4103/aca.aca_28_26","DOIUrl":"10.4103/aca.aca_28_26","url":null,"abstract":"<p><strong>Objectives: </strong>To summarize the evidence on the morbidity, mortality, and transfusion requirements of adult patients undergoing cardiac surgery using bivalirudin for anticoagulation compared to unfractionated heparin (UFH).</p><p><strong>Measurements and main results: </strong>A total of 407 patients in three randomized controlled trial (RCTs) were included for pooled analysis. There was no significant difference in the primary outcome; reexploration for hemorrhage between groups (risk ratio: 1.38, 95% confidence interval: 0.42 to 4.48). There were no observable differences in any of the secondary outcomes; thromboembolic events (myocardial infarction, stroke, pulmonary embolism), mortality, or postoperative transfusion requirements (packed red cells (PRC), platelets, cryoprecipitate, fresh frozen plasma (FFP)). All studies included were assessed to have some concern for risk of bias. Interstudy heterogeneity was low across all comparisons.</p><p><strong>Conclusion: </strong>Bivalirudin has not been shown to have any significant difference to UFH on clinical outcomes in patients undergoing cardiac surgery, and as per current international guidelines, can be considered for safe use in those patients for whom UFH is contraindicated. The study is limited by the bias of the included studies and the variability of bivalirudin drug dosage and its therapeutic monitoring; further, well-powered RCTs are required.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"494-502"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164173","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 Rare Case of Leptospirosis-Induced Fulminant Myocarditis: A Case Report.","authors":"Nakul Mittal, Manoranjan Sahoo","doi":"10.4103/aca.aca_325_25","DOIUrl":"10.4103/aca.aca_325_25","url":null,"abstract":"<p><strong>Abstract: </strong>Leptospirosis is a rare but deadly disease that is often difficult to diagnose. Very often, it is a late presentation, and clinicians have limited time to save the patient's life. The authors hereby present a similar case in which extracorporeal membrane oxygenation played a crucial role.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"646-649"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163701","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":"Reply to: Comment on: \"A Review on the Echocardiographic Estimation of Left Ventricular Filling Pressures: From Guideline to What is in the Pipeline\".","authors":"Devishree Das, Rohan Magoon, Neeti Makhija","doi":"10.4103/aca.aca_40_26","DOIUrl":"10.4103/aca.aca_40_26","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"660-661"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163925","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":"Predatory Conference Invitations: An Increasing Nuisance in the Digital Era.","authors":"Nagarjuna Panidapu, Barsha Sen","doi":"10.4103/aca.aca_20_26","DOIUrl":"10.4103/aca.aca_20_26","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"665-666"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164384","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":"GLP-1 Receptor Agonists and Insulin Versus Insulin for Perioperative Glycemic Control in Patients with Type 2 Diabetes Undergoing Cardiac Surgery: A Systematic Review.","authors":"Danish Hassan, Rida Shakeel, Waleed Qaisi, Syed Rayyan Ahmed, Javeria Taj, Mohammad Adi, Ahmed Yousry Ahmed, Ammir Abuzahra, Emad Uddin Sajid, Hamza Arshad Khan, Tuba Basit, Javed Iqbal, Asraf Hussain","doi":"10.4103/aca.aca_307_25","DOIUrl":"10.4103/aca.aca_307_25","url":null,"abstract":"<p><strong>Abstract: </strong>Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing cardiac surgery and is linked to adverse outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer glucose-dependent insulinotropic effects and potential cardiac benefits, but their perioperative role remains uncertain. This review evaluated the efficacy and safety of GLP-1 RA therapy as an adjunct to insulin in this setting. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for relevant articles up to October 2025. The primary endpoint was blood glucose levels during the perioperative period, while secondary endpoints included hypoglycemia incidence, total insulin requirement, time in target glucose range, and postoperative complications. Three randomized controlled trials (RCTs) including 168 patients with type 2 diabetes undergoing cardiac surgery were assessed. Perioperative use of liraglutide (subcutaneously in doses of 0.6-1.8 mg/day) was associated with preliminary evidence of improved glycemic control across preoperative, intraoperative, and early postoperative periods, including lower glucose levels, reduced glycemic variability, and fewer insulin adjustments, with a low incidence of hypoglycemia. However, heterogeneity in dosing, timing, and monitoring protocols across studies limits direct comparisons. Mild gastrointestinal adverse events, such as nausea and vomiting, were more frequent with liraglutide. One study reported exploratory immunometabolic effects in adipose tissue. Preliminary evidence from these heterogeneous studies suggests that adding liraglutide to insulin may improve perioperative glycemic control compared to insulin or placebo in patients with type 2 diabetes undergoing cardiac surgery. However, findings are limited by the small number of studies, methodological variability, and lack of long-term outcomes, necessitating larger, standardized trials.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"464-470"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164391","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":"Complex Cardiac Tumor with Concomitant Pericardial Effusion and Hemodynamic Compromise in a Septuagenarian: Case Report of Anesthetic and Surgical Considerations.","authors":"Amir Zabida, Ascher Schmelczer, Ehud Karni, Yuval Kahila, Leonid Sternik","doi":"10.4103/aca.aca_11_26","DOIUrl":"10.4103/aca.aca_11_26","url":null,"abstract":"<p><strong>Abstract: </strong>Primary cardiac tumors are rare, and cardiac lymphomas are particularly uncommon. Their presentation can mimic benign tumors, but perioperative management is highly challenging due to risks of tumor-related obstruction or invasion of surrounding cardiac structures. We present a 76-year-old woman with rapidly progressing dyspnea, found to have large biatrial masses, significant pericardial and pleural effusions, and evidence of tamponade. The patient underwent successful surgical resection of bilateral atrial tumors after careful anesthetic preparation and intraoperative monitoring. Histology revealed diffuse large B-cell lymphoma, and systemic chemotherapy was commenced. This case highlights the critical importance of multidisciplinary collaboration, preoperative hemodynamic stabilization, careful anesthetic planning, and prompt histological diagnosis in managing primary cardiac lymphoma presenting with tamponade physiology.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"642-645"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164958","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":"Retrospective Analysis of the Management of Congenital Tracheal Stenosis in Patients Undergoing Pediatric Cardiac Surgery.","authors":"Jessin P Jayasankar, Brijesh P Kottayil, Praveen Reddy Bayya, Sreelakshmi P Leeladharan, Abu Talha, Madhumita Kumar, Abish Sudhakar, Praveen K Neema","doi":"10.4103/aca.aca_99_26","DOIUrl":"10.4103/aca.aca_99_26","url":null,"abstract":"<p><strong>Context: </strong>Congenital airway or tracheal stenosis (CTS) during pediatric cardiac surgery (PCS) can modify the perioperative course.</p><p><strong>Aim: </strong>To find the effect of CTS on mortality and morbidity during PCS.</p><p><strong>Settings and design: </strong>University hospital; Retrospective observational cohort study.</p><p><strong>Material and methods: </strong>Database of PCS patients between January 2019 and April 2025 was analyzed for the incidence of CTS, and perioperative morbidity and mortality. Redo-surgeries were excluded for analyzing CTS incidence.</p><p><strong>Statistical analysis: </strong>Continuous variables are described as median and interquartile range (IQR) of 25-75% and analyzed using the Mann-Whitney U test. A P value of < 0.05 was considered significant.</p><p><strong>Results: </strong>A total of 4222 patients underwent PCS; 66 underwent redo-surgeries , and 9 (0.21%) had CTS. One neonate died during investigation. CTS was diagnosed preoperatively in two, intraoperatively in five, and postoperatively in one. Two patients who underwent PCS-only had a stormy perioperative course and required emergent tracheoplasty. In the PCS-only, 68 patients (1.9%) died; in PCS with CTS, two patients (25%) died (P < 0.01). Odds ratio for mortality with 95% CI in PCS with CTS was 16.8 (3.3-84.6). Median intensive care unit (ICU) stay with IQR in PCS patients was 72 h (44-144 h); whereas, it was 300 h (120-648 h) in PCS with CTS patients (P < 0.002). Median hospital stay with IQR in PCS patients was 10 days (8-14 days); whereas, it was 15 days (12-47 days) in PCS with CTS patients (P < 0.019).</p><p><strong>Conclusion: </strong>We found a significantly increased mortality of PCS in presence of CTS; it was also associated with increased ICU and hospital stays. PCS with CTS requires concomitant tracheoplasty; PCS alone is unsafe.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"554-563"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164254","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":"Comparison of a Novel Geometric Landmark Method Versus Conventional Palpation Technique for Central Venous Cannulation: A Comparative Observational Study of Two Techniques.","authors":"Muhammad Arslan Zahid, Ahmed Arslan Shahbaz, Dawood Hasan Khan, Maqsood Ahmed Siddiqui, Wajid Ali, Akbar Mistry","doi":"10.4103/aca.aca_43_26","DOIUrl":"10.4103/aca.aca_43_26","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness and safety of a novel geometric landmark technique with the conventional palpation technique for central venous cannulation.</p><p><strong>Study design: </strong>Comparative observational study.</p><p><strong>Place and duration of the study: </strong>This study was conducted at National Medical Centre (NMC) from January 01, 2025 to June 30, 2025.</p><p><strong>Methods: </strong>A total of 100 adult patients requiring central venous cannulation were enrolled and allocated into two groups based on the technique used. Group A (n = 50) underwent cannulation using the geometric landmark method, while Group B (n = 50) underwent cannulation using the conventional palpation technique. First-attempt success rate was the main outcome. Secondary outcomes were the number of attempts, arterial puncture, and change of technique. SPSS software was used for analysis. Chi-square test was used to compare categorical variables whereas the Mann-Whitney U test was applied to the non-normally distributed continuous variables. A P value of less than 0.05 was considered statistically significant.</p><p><strong>Results: </strong>First-attempt success was significantly higher in the geometric landmark group compared to the palpation group (98% vs. 86%; P = 0.027). The geometric landmark technique was associated with fewer cannulation attempts (mean 1.00 ± 0.00 vs. 1.18 ± 0.57; P = 0.012). Arterial puncture occurred in one patient (2%) in each group, with no statistically significant difference (P = 1.000). Technique change was required in one patient (2%) in each group, with no statistically significant difference between the two techniques (P = 1.000). The two groups had similar baseline demographic and clinical characteristics.</p><p><strong>Conclusion: </strong>The geometric landmark technique significantly improves first-attempt success and reduces the number of cannulation attempts compared with the conventional palpation method while maintaining a comparable safety profile. This technique represents a practical and cost-effective alternative for central venous cannulation, particularly in resource-limited settings.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"503-509"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164568","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":"Prediction of Acute Kidney Injury with Venous Excess Ultrasound (VExUS) Scoring Versus Renal Resistive Index (RRI) in Patients Undergoing On-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study.","authors":"Shaswati Prusty, Manoj Kamal, Sadik Mohammed, Rakesh Kumar, Pradeep Kumar Bhatia, Geeta Singariya, Anita Chouhan","doi":"10.4103/aca.aca_26_26","DOIUrl":"10.4103/aca.aca_26_26","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of acute kidney injury (AKI) using conventional markers such as serum creatinine and urine output is often delayed, prompting interest in bedside ultrasound-based predictors. This study compared renal resistive index (RRI) and venous excess ultrasound (VExUS) scoring for early prediction of AKI after on-pump coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>In this prospective observational study, 180 adult patients were enrolled. RRI and VExUS assessments were performed preoperatively and within 3 hours of cardiothoracic ICU admission. AKI was diagnosed within 48 hours postoperatively using kidney disease: improving global outcomes (KDIGO) criteria. Receiver operating characteristic (ROC) curves were constructed for RRI and VExUS parameters, and diagnostic accuracy was assessed using area under ROC curve (AUROC), sensitivity, and specificity.</p><p><strong>Results: </strong>AKI occurred in 48 patients (26.7%). Postoperative RRI showed excellent discrimination for AKI (AUROC 0.854; cut-off ≥0.68: sensitivity 75%, specificity 86%, negative predictive value [NPV] 90.5%), outperforming preoperative RRI (AUROC 0.681). VExUS showed limited predictive performance (preoperative AUROC 0.588; postoperative AUROC 0.623). The baseline estimated glomerular filtration rate (eGFR) in the AKI group was significantly lower than in the patients who did not develop AKI [70.3 ml/min/1.73 m2 vs 79.4 ml/min/1.73 m2]. Diabetes mellitus was more common in the AKI group (62.5% vs 35.6%, P = 0.002). Postoperative urine output remained significantly lower in AKI patients on day 1 and day 2 (P < 0.001).</p><p><strong>Conclusion: </strong>Postoperative RRI ≥ 0.68 demonstrated the best predictive performance for early AKI in our cohort, outperforming preoperative RRI, ΔRRI or change in RRI, and VExUS scores, supporting the predominant role of intrarenal arterial hemodynamic alterations in early postoperative renal injury.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 4","pages":"546-553"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165027","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}