Journal of cardiothoracic and vascular anesthesia最新文献

英文中文

Ethical Aspects of Organ Donation Following Extracorporeal Cardiopulmonary Resuscitation With Unfavorable Neurologic Outcomes: A Systematic Review of Literature 体外心肺复苏后器官捐赠的伦理方面与不利的神经系统结果：文献的系统回顾。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.10.003

Sasa Rajsic, Robert Breitkopf, Beatrix Reyer, Felix Berent, Benedikt Treml, Wolfgang Lederer

Objective

Given the growing imbalance between the demand for solid organ transplants and the limited availability of donor organs, the potential for organ donation from patients with unfavorable neurologic outcomes following extracorporeal cardiopulmonary resuscitation (eCPR) is gaining attention. This work analysed recent studies on organ procurement following eCPR and evaluated the ethical concerns raised by the study authors.

Design

Systematic literature review (Scopus and PubMed, from inception to July 2024).

Setting

All study designs.

Participants

Patients with unfavorable outcomes following eCPR.

Intervention

Ethical challenges raised by the authors.

Measurements and Main Results

Of 1,725 screened publications, 17 studies were included, comprising a total of 254 patients with unfavorable outcomes following eCPR. A total of 689 grafts were reported, and 469 organ recipients. Seven studies addressed ethical aspects, emphasizing that eCPR is primarily initiated to save patients with cardiac arrest who have a likely favorable neurologic prognosis. Organ donation is considered only secondarily, in cases where patients experience an unfavorable outcome.

Conclusion

Organ procurement following eCPR is a sensitive issue that impacts the donor’s relatives, transplant recipients, and healthcare professionals. There is a clear need for internationally coordinated, ethically grounded, and legally binding regulations governing organ procurement. These should include clearly defined criteria for the continuation or termination of eCPR, standardized consent procedures, and structured frameworks for transparent, multidisciplinary decision-making. Establishing such protocols would help ensure ethically consistent practices that balance the potential benefits of organ donation with respect for individual dignity and societal justice.

目的：鉴于实体器官移植的需求和供体器官的有限供应之间日益不平衡，体外心肺复苏（eCPR）后神经系统预后不良的患者器官捐赠的潜力正在引起人们的关注。这项工作分析了最近关于eCPR后器官获取的研究，并评估了研究作者提出的伦理问题。设计：系统文献综述（Scopus和PubMed，从成立到2024年7月）。环境：所有研究设计。参与者：eCPR后预后不良的患者。干预：作者提出的伦理挑战。测量结果和主要结果：在1,725篇筛选的出版物中，纳入了17项研究，共包括254例eCPR后不良结果的患者。共报告移植689例，受者469例。七项研究涉及伦理方面，强调eCPR主要用于挽救可能具有良好神经预后的心脏骤停患者。器官捐赠是次要的，只有在患者经历不利结果的情况下才会考虑。结论：eCPR后的器官获取是一个敏感问题，影响到供体亲属、移植受者和医疗保健专业人员。显然需要制定国际协调的、合乎道德的、具有法律约束力的器官采购条例。这些措施应包括明确界定继续或终止eCPR的标准、标准化的同意程序以及透明、多学科决策的结构化框架。建立这样的协议将有助于确保在道德上保持一致的做法，在器官捐赠的潜在利益与尊重个人尊严和社会正义之间取得平衡。

{"title":"Ethical Aspects of Organ Donation Following Extracorporeal Cardiopulmonary Resuscitation With Unfavorable Neurologic Outcomes: A Systematic Review of Literature","authors":"Sasa Rajsic, Robert Breitkopf, Beatrix Reyer, Felix Berent, Benedikt Treml, Wolfgang Lederer","doi":"10.1053/j.jvca.2025.10.003","DOIUrl":"10.1053/j.jvca.2025.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>Given the growing imbalance between the demand for solid organ transplants and the limited availability of donor organs, the potential for organ donation from patients with unfavorable neurologic outcomes following extracorporeal cardiopulmonary resuscitation (eCPR) is gaining attention. This work analysed recent studies on organ procurement following eCPR and evaluated the ethical concerns raised by the study authors.</div></div><div><h3>Design</h3><div>Systematic literature review (Scopus and PubMed, from inception to July 2024).</div></div><div><h3>Setting</h3><div>All study designs.</div></div><div><h3>Participants</h3><div>Patients with unfavorable outcomes following eCPR.</div></div><div><h3>Intervention</h3><div>Ethical challenges raised by the authors.</div></div><div><h3>Measurements and Main Results</h3><div>Of 1,725 screened publications, 17 studies were included, comprising a total of 254 patients with unfavorable outcomes following eCPR. A total of 689 grafts were reported, and 469 organ recipients. Seven studies addressed ethical aspects, emphasizing that eCPR is primarily initiated to save patients with cardiac arrest who have a likely favorable neurologic prognosis. Organ donation is considered only secondarily, in cases where patients experience an unfavorable outcome.</div></div><div><h3>Conclusion</h3><div>Organ procurement following eCPR is a sensitive issue that impacts the donor’s relatives, transplant recipients, and healthcare professionals. There is a clear need for internationally coordinated, ethically grounded, and legally binding regulations governing organ procurement. These should include clearly defined criteria for the continuation or termination of eCPR, standardized consent procedures, and structured frameworks for transparent, multidisciplinary decision-making. Establishing such protocols would help ensure ethically consistent practices that balance the potential benefits of organ donation with respect for individual dignity and societal justice.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 583-594"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431569","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}

引用次数: 0

Unapproved and Undeveloped Rescue Drugs in High-risk Settings: Time for Focused Use of Investigational Resources 高危环境中未批准和未开发的抢救药物：集中使用研究资源的时间。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.09.033

Gabor Erdoes MD, PhD , Andreas Koster MD

引用次数: 0

Bubble-like Echogenic Signals During ECPELLA Support: Differentiating Air Embolism from Cavitation Using Transesophageal Echocardiography ECPELLA支持时的气泡样回声信号：经食管超声心动图鉴别空气栓塞和空化。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.09.036

Mikiko Tomino MD, PhD, Ryoji Maeda MD

引用次数: 0

Postoperative Cost-effectiveness of Prophylactic Amino Acid Therapy for Renal Protection: A Modeled Economic Evaluation 预防性氨基酸治疗肾保护的术后成本效益：模型经济评估。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.08.042

Alayna Carrandi MPH , Mussab Faggery PhD , Rosario Losiggio MD , Domenico Pontillo MSc , Alessandro Pruna MD , Giovanni Landoni MD , Rinaldo Bellomo MD , Alisa M. Higgins PhD

Objective

To assess the cost-effectiveness of intravenous amino acids (AA) versus placebo in decreasing cardiac surgery–associated acute kidney injury (AKI) among adult patients after cardiac surgery.

Design

Data on resource use and outcomes were obtained from relevant studies reported in a recent meta-analysis. Cost-effectiveness analyses were conducted using a decision tree model to quantify the incremental costs and health outcomes of AA versus placebo.

Setting

Cost-effectiveness analyses were conducted separately for Australia, the United States, China, Italy, and the United Kingdom using local unit costs.

Participants

Adult patients after cardiac surgery.

Interventions

Intravenous AA versus placebo.

Measurements and Main Results

The cost-effectiveness analyses expressed outcomes in terms of cost per instance of AKI averted with an in-hospital time horizon and from a healthcare payer perspective. The expected total healthcare cost after surgery in patients treated with AA ranged from $1,871 in China to $37,692 in the United States versus $2,055 in China to $40,213 in the United States for the placebo group, with a per patient cost saving ranging from $184 (95% confidence interval [CI], -$331 to -$32) in China to $2,521 (95% CI, -$3,770 to -$1,260) in the United States. AA also resulted in a 5.2% (95% CI, 5.1%-5.3%) absolute risk reduction in AKI. AA was dominant (cost-saving and cost-effective) across all jurisdictions.

Conclusions

Compared with placebo, AA infusion decreases the occurrence of AKI and is cost-saving. Perioperative AA therapy is a rational approach to patient care that simultaneously protects renal function and decreases healthcare costs.

目的：评估静脉注射氨基酸（AA）与安慰剂在降低心脏手术后成人患者心脏手术相关急性肾损伤（AKI）方面的成本-效果。设计：有关资源利用和结果的数据来自最近荟萃分析中报道的相关研究。使用决策树模型进行成本-效果分析，量化AA与安慰剂的增量成本和健康结果。设置：分别对澳大利亚、美国、中国、意大利和英国进行成本-效果分析，使用当地单位成本。参与者：心脏手术后的成年患者。干预措施：静脉注射AA与安慰剂。测量和主要结果：成本-效果分析从住院时间范围和医疗保健支付者的角度表达了每例AKI避免成本的结果。接受AA治疗的患者术后预计总医疗费用在中国为1,871美元至美国为37,692美元，而安慰剂组在中国为2,055美元至美国为40,213美元，每位患者的成本节约在中国为184美元（95%置信区间[CI]， - 331美元至- 32美元），在美国为2,521美元（95% CI, - 3,770美元至- 1,260美元）。AA也导致AKI的绝对风险降低5.2% （95% CI, 5.1%-5.3%）。AA在所有司法管辖区都占主导地位（节省成本和成本效益）。结论：与安慰剂相比，AA输注降低了AKI的发生，节约了成本。围手术期AA治疗是一种合理的患者护理方法，同时保护肾功能和降低医疗保健费用。

{"title":"Postoperative Cost-effectiveness of Prophylactic Amino Acid Therapy for Renal Protection: A Modeled Economic Evaluation","authors":"Alayna Carrandi MPH , Mussab Faggery PhD , Rosario Losiggio MD , Domenico Pontillo MSc , Alessandro Pruna MD , Giovanni Landoni MD , Rinaldo Bellomo MD , Alisa M. Higgins PhD","doi":"10.1053/j.jvca.2025.08.042","DOIUrl":"10.1053/j.jvca.2025.08.042","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the cost-effectiveness of intravenous amino acids (AA) versus placebo in decreasing cardiac surgery–associated acute kidney injury (AKI) among adult patients after cardiac surgery.</div></div><div><h3>Design</h3><div>Data on resource use and outcomes were obtained from relevant studies reported in a recent meta-analysis. Cost-effectiveness analyses were conducted using a decision tree model to quantify the incremental costs and health outcomes of AA versus placebo.</div></div><div><h3>Setting</h3><div>Cost-effectiveness analyses were conducted separately for Australia, the United States, China, Italy, and the United Kingdom using local unit costs.</div></div><div><h3>Participants</h3><div>Adult patients after cardiac surgery.</div></div><div><h3>Interventions</h3><div>Intravenous AA versus placebo.</div></div><div><h3>Measurements and Main Results</h3><div>The cost-effectiveness analyses expressed outcomes in terms of cost per instance of AKI averted with an in-hospital time horizon and from a healthcare payer perspective. The expected total healthcare cost after surgery in patients treated with AA ranged from $1,871 in China to $37,692 in the United States versus $2,055 in China to $40,213 in the United States for the placebo group, with a per patient cost saving ranging from $184 (95% confidence interval [CI], -$331 to -$32) in China to $2,521 (95% CI, -$3,770 to -$1,260) in the United States. AA also resulted in a 5.2% (95% CI, 5.1%-5.3%) absolute risk reduction in AKI. AA was dominant (cost-saving and cost-effective) across all jurisdictions.</div></div><div><h3>Conclusions</h3><div>Compared with placebo, AA infusion decreases the occurrence of AKI and is cost-saving. Perioperative AA therapy is a rational approach to patient care that simultaneously protects renal function and decreases healthcare costs.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 724-731"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495482","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}

引用次数: 0

Ketamine in Cardiac Surgery: A Systematic Review and Meta-Analysis of Effects on Inflammatory Markers and Clinical Outcomes 氯胺酮在心脏手术中的应用：对炎症标志物和临床结果影响的系统回顾和荟萃分析。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.09.229

Priscila Ferreira de Lima e Souza MD , Milton Morais Correia Neto , Mauricio Cardoso Paz , Raul Valério Ponte MD

Cardiac surgery triggers a systemic inflammatory response, especially when cardiopulmonary bypass (CPB) is used, which may contribute to postoperative complications. Ketamine, an NMDA receptor antagonist, has shown anti-inflammatory potential by inhibiting nuclear factor kappa B and reducing cytokine release, but its perioperative immunomodulatory effects remain unclear. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) comparing intraoperative ketamine to placebo in cardiac surgery. The primary outcome was interleukin (IL)-6 level; secondary outcomes included C-reactive protein (CRP) level, intensive care unit (ICU) length of stay, mechanical ventilation duration, and transfusion requirements. Eight RCTs, including a total of 377 patients, were included in the analysis. Ketamine did not significantly reduce IL-6 levels at 24 hours postoperatively (standardized mean difference [SMD], –0.96; 95% confidence interval [CI], –2.56 to 0.65; I² = 96%), although a significant decrease was observed in off-pump procedures (mean difference [MD], –59.57 pg/mL; I² = 0%). IL-6 levels measured immediately after CPB and CRP levels immediately after surgery also were reduced, but findings were limited by high heterogeneity. No significant differences were observed in ICU length of stay (MD, –0.10 days), ventilation time (MD, –0.86 hours), or transfusion rates (risk ratio, 1.01). The certainty of the evidence was rated low to moderate owing to imprecision and inconsistency. Although ketamine’s immunomodulatory effects were observed in selected subgroups, they did not translate into improved clinical outcomes. Current evidence does not support the routine use of ketamine for inflammation control in cardiac surgery, although its effect in off-pump procedures warrants further research.

心脏手术会引发全身炎症反应，特别是当使用体外循环（CPB）时，这可能会导致术后并发症。氯胺酮是一种NMDA受体拮抗剂，通过抑制核因子κ B和减少细胞因子释放显示出抗炎潜力，但其围手术期免疫调节作用尚不清楚。本系统综述和荟萃分析评估了在心脏手术中比较术中氯胺酮和安慰剂的随机对照试验。主要终点是白细胞介素(IL)-6水平；次要结局包括c反应蛋白（CRP）水平、重症监护病房（ICU）住院时间、机械通气持续时间和输血需求。8项随机对照试验共纳入377例患者。氯胺酮在术后24小时没有显著降低IL-6水平（标准化平均差[SMD]， -0.96； 95%可信区间[CI]， -2.56至0.65;I²= 96%），尽管在非泵操作中观察到显著降低（平均差[MD]， -59.57 pg/mL; I²= 0%）。CPB术后立即测量的IL-6水平和手术后立即测量的CRP水平也有所降低，但研究结果受到高度异质性的限制。ICU住院时间（MD, -0.10天）、通气时间（MD, -0.86小时）和输血率（风险比1.01）均无显著差异。由于不精确和不一致，证据的确定性被评为低至中等。虽然氯胺酮的免疫调节作用在选定的亚组中观察到，但它们并没有转化为改善的临床结果。目前的证据不支持在心脏手术中常规使用氯胺酮来控制炎症，尽管它在非泵手术中的效果值得进一步研究。

{"title":"Ketamine in Cardiac Surgery: A Systematic Review and Meta-Analysis of Effects on Inflammatory Markers and Clinical Outcomes","authors":"Priscila Ferreira de Lima e Souza MD , Milton Morais Correia Neto , Mauricio Cardoso Paz , Raul Valério Ponte MD","doi":"10.1053/j.jvca.2025.09.229","DOIUrl":"10.1053/j.jvca.2025.09.229","url":null,"abstract":"<div><div>Cardiac surgery triggers a systemic inflammatory response, especially when cardiopulmonary bypass (CPB) is used, which may contribute to postoperative complications. Ketamine, an NMDA receptor antagonist, has shown anti-inflammatory potential by inhibiting nuclear factor kappa B and reducing cytokine release, but its perioperative immunomodulatory effects remain unclear. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) comparing intraoperative ketamine to placebo in cardiac surgery. The primary outcome was interleukin (IL)-6 level; secondary outcomes included C-reactive protein (CRP) level, intensive care unit (ICU) length of stay, mechanical ventilation duration, and transfusion requirements. Eight RCTs, including a total of 377 patients, were included in the analysis. Ketamine did not significantly reduce IL-6 levels at 24 hours postoperatively (standardized mean difference [SMD], –0.96; 95% confidence interval [CI], –2.56 to 0.65; <em>I</em>² = 96%), although a significant decrease was observed in off-pump procedures (mean difference [MD], –59.57 pg/mL; <em>I</em>² = 0%). IL-6 levels measured immediately after CPB and CRP levels immediately after surgery also were reduced, but findings were limited by high heterogeneity. No significant differences were observed in ICU length of stay (MD, –0.10 days), ventilation time (MD, –0.86 hours), or transfusion rates (risk ratio, 1.01). The certainty of the evidence was rated low to moderate owing to imprecision and inconsistency. Although ketamine’s immunomodulatory effects were observed in selected subgroups, they did not translate into improved clinical outcomes. Current evidence does not support the routine use of ketamine for inflammation control in cardiac surgery, although its effect in off-pump procedures warrants further research.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 690-698"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512882","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}

引用次数: 0

Surgical and Anesthesia-Related Concerns forRobot-Assisted Pediatric Cardiac Surgery 机器人辅助儿童心脏手术的外科和麻醉相关问题。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.11.005

John A. Kucera MD , Fintan Hughes MB BCh BAO , Seth E.M. Wolf MD , Michael Greenberg MD , Edmund Jooste MB BCh , Michael Mensah-Mamfo BS , Lindsey Reynolds BS , Douglas M. Overbey MD, MPH , Joseph W. Turek MD, PhD, MBA , Lisa Einhorn MD , Warwick Ames MB BS , Natalia Diaz-Rodriguez MD, MHS

Objective

The purpose of this study is to describe a cohort of pediatric patients undergoing robot-assisted cardiac surgery at a single center and to discuss the anesthetic implications and perioperative considerations to optimize outcomes.

Design

A retrospective observational cohort study.

Setting

Academic tertiary care medical center.

Participants

Nine children underwent robot-assisted cardiac surgery from 2022 to 2024. Indications for operation included atrial septal defect (n = 8) and mitral valve regurgitation with concomitant Marfan syndrome (n = 1).

Interventions

Eight patients underwent atrial septal defect closure; 1 patient underwent mitral valve repair.

Measurements and Main Results

Mean (SD) age was 13.1 (2.5) years, mean (SD) weight was 48.5 (20.3) kg, and mean (SD) body mass index was 21.7 (5.4) kg/m². Mean (SD) operative time was 388.2 (40.7) minutes, fibrillation time was 92.4 (25.8) minutes, and cardiopulmonary bypass time was 192.1 (31.3) minutes. None of the patients required 1-lung ventilation based on surgeon preference, and most patients (77.8%) were extubated in the operating room. The median (IQR) intensive care unit length of stay was 45 (26) hours, and the median (IQR) hospital stay was 3 (2.5) days. One patient required conversion to median sternotomy due to aortic insufficiency in the setting of Marfan syndrome and aortic root dilation. One patient required a reoperation due to bleeding following an emesis episode in the intensive care unit. There were no mortality events.

Conclusions

Robot-assisted cardiac surgery is well tolerated in appropriately selected pediatric patients, including children as small as 24 kg. Our experience suggests that the success of this approach is predicated upon a center with institutional experience and multidisciplinary collaboration. Furthermore, it is critical that the anesthesiologist understands the unique anatomic, airway, monitoring, positioning, and surgical considerations that are unique for this patient population.

目的：本研究的目的是描述一组在单中心接受机器人辅助心脏手术的儿科患者，并讨论麻醉意义和围手术期注意事项，以优化结果。设计：回顾性观察队列研究。环境：学术三级医疗中心。参与者：从2022年到2024年，9名儿童接受了机器人辅助心脏手术。手术指征包括房间隔缺损（8例）和二尖瓣返流合并马凡氏综合征（1例）。干预措施：8例患者行房间隔缺损闭合术；1例患者行二尖瓣修复术。测量及主要结果：平均（SD）年龄为13.1（2.5）岁，平均（SD）体重为48.5 (20.3)kg，平均（SD）体重指数为21.7 (5.4)kg/m2。平均（SD）手术时间388.2（40.7）分钟，纤颤时间92.4（25.8）分钟，体外循环时间192.1（31.3）分钟。所有患者均不需要单肺通气，多数患者（77.8%）在手术室拔管。重症监护病房的中位（IQR）住院时间为45（26）小时，中位（IQR）住院时间为3（2.5）天。1例患者由于马凡综合征和主动脉根部扩张的主动脉功能不全，需要转换为正中胸骨切开术。1例患者在重症监护室因呕吐后出血需要再次手术。没有死亡事件。结论：机器人辅助心脏手术在适当选择的儿童患者中耐受性良好，包括小至24公斤的儿童。我们的经验表明，这种方法的成功取决于一个具有机构经验和多学科合作的中心。此外，麻醉师了解该患者独特的解剖、气道、监测、定位和手术注意事项是至关重要的。

{"title":"Surgical and Anesthesia-Related Concerns forRobot-Assisted Pediatric Cardiac Surgery","authors":"John A. Kucera MD , Fintan Hughes MB BCh BAO , Seth E.M. Wolf MD , Michael Greenberg MD , Edmund Jooste MB BCh , Michael Mensah-Mamfo BS , Lindsey Reynolds BS , Douglas M. Overbey MD, MPH , Joseph W. Turek MD, PhD, MBA , Lisa Einhorn MD , Warwick Ames MB BS , Natalia Diaz-Rodriguez MD, MHS","doi":"10.1053/j.jvca.2025.11.005","DOIUrl":"10.1053/j.jvca.2025.11.005","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study is to describe a cohort of pediatric patients undergoing robot-assisted cardiac surgery at a single center and to discuss the anesthetic implications and perioperative considerations to optimize outcomes.</div></div><div><h3>Design</h3><div>A retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Academic tertiary care medical center.</div></div><div><h3>Participants</h3><div>Nine children underwent robot-assisted cardiac surgery from 2022 to 2024. Indications for operation included atrial septal defect (n = 8) and mitral valve regurgitation with concomitant Marfan syndrome (n = 1).</div></div><div><h3>Interventions</h3><div>Eight patients underwent atrial septal defect closure; 1 patient underwent mitral valve repair.</div></div><div><h3>Measurements and Main Results</h3><div>Mean (SD) age was 13.1 (2.5) years, mean (SD) weight was 48.5 (20.3) kg, and mean (SD) body mass index was 21.7 (5.4) kg/m<sup>2</sup>. Mean (SD) operative time was 388.2 (40.7) minutes, fibrillation time was 92.4 (25.8) minutes, and cardiopulmonary bypass time was 192.1 (31.3) minutes. None of the patients required 1-lung ventilation based on surgeon preference, and most patients (77.8%) were extubated in the operating room. The median (IQR) intensive care unit length of stay was 45 (26) hours, and the median (IQR) hospital stay was 3 (2.5) days. One patient required conversion to median sternotomy due to aortic insufficiency in the setting of Marfan syndrome and aortic root dilation. One patient required a reoperation due to bleeding following an emesis episode in the intensive care unit. There were no mortality events.</div></div><div><h3>Conclusions</h3><div>Robot-assisted cardiac surgery is well tolerated in appropriately selected pediatric patients, including children as small as 24 kg. Our experience suggests that the success of this approach is predicated upon a center with institutional experience and multidisciplinary collaboration. Furthermore, it is critical that the anesthesiologist understands the unique anatomic, airway, monitoring, positioning, and surgical considerations that are unique for this patient population.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 606-612"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695925","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}

引用次数: 0

Use of High-dose Intravenous Immunoglobulin as Initial Therapy for Heparin-induced Thrombocytopenia in Patients With High Bleeding Risk 高剂量静脉注射免疫球蛋白作为肝素性血小板减少高危出血患者的初始治疗。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.08.051

Alison V. Grazioli MD , Michael E. Plazak PharmD , Cynthia S. Shen DO, M.S. , Thomas M. Scalea MD , Rishi Kundi MD , Ramon A. Riojas MD , Leonid A. Belyayev MD

引用次数: 0

Minimally Invasive, Maximally Effective: Anesthetic Management for Endoscopic Cardiac Surgery 微创，最有效：内镜心脏手术的麻醉管理。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.09.020

Melina Heine , Jay S. Saggu MD, DMD , Christoph G.S. Nabzdyk MD , Tommaso Hinna Danesi MD , Jakob Wollborn MD, MPH

Endoscopic cardiac surgery is associated with faster recovery, shorter hospital stays, less blood loss, fewer postoperative infections, and better cosmetic results. Although not suitable for every patient, minimally invasive cardiac surgery, including endoscopic cardiac surgery, may demonstrate advantages over standard sternotomy-based approaches. On the other hand, the steep learning curve and specific setup present challenges to surgeons and anesthesiologists. This review provides a comprehensive overview of the anesthetic challenges encountered in the perioperative management of patients undergoing endoscopic cardiac surgery.

内窥镜心脏手术与更快的恢复、更短的住院时间、更少的失血、更少的术后感染和更好的美容效果有关。虽然并不适合所有患者，但微创心脏手术，包括内窥镜心脏手术，可能比标准的胸骨切开术有优势。另一方面，陡峭的学习曲线和特定的设置对外科医生和麻醉师提出了挑战。这篇综述提供了在内镜心脏手术患者围手术期管理中遇到的麻醉挑战的全面概述。

引用次数: 0

Perioperative Management of a Patient with α2-Plasmin Inhibitor Deficiency Undergoing Open Aortic Arch Repair α2-纤溶酶抑制剂缺乏患者行开放主动脉弓修复术的围手术期处理。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.09.028

Aidan Murray BS , Ian Welsby MBBS, FRCA , Maria Notini MT , Thomas L. Ortel MD, PhD , G. Chad Hughes MD , Damian Silbermins MD , Grace Lee MD

引用次数: 0

Selection Matters: Use of Microaxial Flow Pumps in Acute Myocardial Infarction–Associated Cardiogenic Shock/Danger Shock Trial 选择事项：在急性心肌梗死相关心源性休克/危险休克试验中使用微轴流泵。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2026-02-01 DOI: 10.1053/j.jvca.2025.09.023

Daniel S. Cormican MD , Karthikeyan Ranganathan MD

引用次数: 0

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of cardiothoracic and vascular anesthesia

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀