Journal of cardiothoracic and vascular anesthesia最新文献

英文中文

Commentary: Diffuse Coronary Artery Vasospasm Following Aortic Valve Replacement in a Patient With Scleroderma 硬皮病患者主动脉瓣置换术后的弥漫性冠状动脉血管痉挛

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-23 DOI: 10.1053/j.jvca.2024.07.029

引用次数: 0

Comparison Between Histidine-Tryptophan-Ketoglutarate Cardioplegia and Cold Blood Cardioplegia for Myocardial Protection in Tetralogy of Fallot Patients Undergoing Surgical Repair: A Randomized Clinical Trial 组氨酸-色氨酸-酮戊二酸心脏麻痹与冷血心脏麻痹对接受手术修复的法洛氏四联症患者心肌保护作用的比较：随机临床试验

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-23 DOI: 10.1053/j.jvca.2024.07.038

Objectives

This study was conducted to compare the efficacy of histidine-tryptophan-ketoglutarate (HTK) cardioplegia and cold blood cardioplegia (CBC), especially for postoperative right ventricular (RV) function after tetralogy of Fallot repair.

Design

Randomized, double-blinded, parallel-group, controlled clinical trial.

Setting

Ain Shams University Hospitals.

Participants

A total of 100 children (1 to 5 years old) scheduled for tetralogy of Fallot repair.

Interventions

Patients were allocated (double-blinded 1:1 allocation ratio) to either the HTK group that received HTK cardioplegia (30 mL/kg via antegrade route) or the CBC group that received cold blood cardioplegia with blood-to-Ringer solution (4:1) in a volume of 20 mL/kg.

Measurements and Main Results

The HTK group showed a statistically significant reduction of the vasoactive inotropic score on admission to the pediatric intensive care unit (13.0 ± 4.1) in comparison to the CBC group (15.5 ± 5.4), with a p value of 0.011. However, after 24 hours, the vasoactive-inotropic score was comparable. Lactate level during the first 24 hours was 6.2 ± 0.7 mmol/L in the HTK group and 6.9 ± 0.4 mmol/L in the CBC group (p < 0.0001). Serial troponin measurements were lower in the HTK group (1.49 ± 0.45) compared to the CBC group (1.69 ± 0.18) at the first 72 hours postoperatively (p = 0.005). Postoperative echocardiographic assessment of RV function by means of tricuspid annular plane systolic excursion and myocardial performance index were better in the HTK group than in the CBC grpup (p < 0.05).

Conclusions

HTK cardioplegia may offer better cardiac protection to pediatric patients undergoing tetralogy of Fallot repair than our institutional standard CBC with better recovery for the hypertrophic RV.

目的本研究旨在比较组氨酸-色氨酸-酮戊二酸（HTK）心脏麻痹和冷血心脏麻痹（CBC）的疗效，尤其是对法洛氏四联症修复术后右心室（RV）功能的疗效。干预措施患者被分配（双盲 1:1 分配比例）到 HTK 组（通过前向途径接受 30 mL/kg HTK 心脏麻痹）或 CBC 组（接受血液与林格溶液（4:1）体积为 20 mL/kg 的冷血心脏麻痹）。测量和主要结果与 CBC 组（15.5 ± 5.4）相比，HTK 组在进入儿科重症监护室时血管活性肌力评分（13.0 ± 4.1）明显降低，P 值为 0.011。然而，24 小时后，血管活性-肌张力评分相当。在最初的 24 小时内，HTK 组的乳酸水平为 6.2 ± 0.7 mmol/L，CBC 组为 6.9 ± 0.4 mmol/L（p < 0.0001）。在术后 72 小时内，HTK 组的肌钙蛋白序列测量值（1.49 ± 0.45）低于 CBC 组（1.69 ± 0.18）（p = 0.005）。通过三尖瓣环平面收缩期偏移和心肌性能指数对 RV 功能进行术后超声心动图评估，HTK 组的效果优于 CBC 组（P < 0.05）。

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引用次数: 0

Hyperoxia and VA-ECMO Outcomes: Getting to the Heart of the Problem 高氧与 VA-ECMO 结果：找到问题的核心

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-22 DOI: 10.1053/j.jvca.2024.07.032

引用次数: 0

Alpha-Gal Syndrome and Cardiac Surgery α-γ综合征与心脏手术

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-22 DOI: 10.1053/j.jvca.2024.07.035

Galactose-alpha-1,3-galactose (alpha-gal) is a carbohydrate expressed by all mammals except for humans and certain old-world primates. It can be found in a plethora of products derived from mammals, including milk, organs, skeletal muscle and gelatin, in addition to products prepared with mammalian cells or constituents. In the late 2000s, an association between tick bites and the development of immunoglobulin E antibodies to the alpha-gal carbohydrate was discovered. The term “alpha-gal syndrome” (AGS) was then coined to describe allergic reactions to mammalian meat or other alpha-gal–containing products derived from mammals. Symptoms are often delayed several hours from consumption and can be urticarial and/or gastrointestinal. Medications and bioprosthetic inserts derived from mammals were also noted to cause allergic reactions in affected patients. Cardiac surgery, in particular, is considered high risk, given that unfractionated heparin has a bovine or porcine origin and is administered in large doses for cardiopulmonary bypass. Bioprosthetic valves have similar origins and risks. Awareness of AGS in cardiac surgery patients can lead to decreased risk preoperatively and inform management perioperatively and postoperatively. In this narrative review, we have reviewed the published literature relevant to AGS in patients undergoing cardiac surgery and shared our treatment approach.

半乳糖-α-1,3-半乳糖（α-gal）是一种碳水化合物，除人类和某些古老的灵长类动物外，所有哺乳动物都能表达它。除了用哺乳动物细胞或成分制备的产品外，它还存在于大量源自哺乳动物的产品中，包括牛奶、内脏、骨骼肌和明胶。2000 年代末，人们发现蜱虫叮咬与产生α-gal 碳水化合物免疫球蛋白 E 抗体之间存在关联。随后，人们创造了 "α-gal 综合征"（AGS）一词来描述对哺乳动物肉类或其他从哺乳动物提取的含有α-gal 的产品的过敏反应。症状通常在食用后数小时才会出现，可表现为荨麻疹和/或胃肠道症状。人们还注意到，源自哺乳动物的药物和生物假体插入物也会导致患者出现过敏反应。心脏手术尤其被认为是高风险手术，因为非分细肝素来源于牛或猪，并被大剂量用于心肺旁路。生物人工瓣膜也有类似的来源和风险。认识到心脏手术患者的 AGS 可降低术前风险，并为围手术期和术后的管理提供参考。在这篇叙述性综述中，我们回顾了已发表的与心脏手术患者 AGS 相关的文献，并分享了我们的治疗方法。

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引用次数: 0

Comparison of 4% Albumin and Ringer's Acetate on Hemodynamics in On-pump Cardiac Surgery: An Exploratory Analysis of a Randomized Clinical Trial 4% 白蛋白和醋酸林格液对泵上心脏手术血流动力学的影响比较--随机临床试验的探索性分析

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-20 DOI: 10.1053/j.jvca.2024.07.025

Objectives

Compare hemodynamics between 4% albumin and Ringer's acetate.

Design

Exploratory analysis of the double-blind randomized ALBumin In Cardiac Surgery trial.

Setting

Single-center study in Helsinki University Hospital.

Participants

We included 1,386 on-pump cardiac surgical patients.

Intervention

We used 4% albumin or Ringer's acetate administration for cardiopulmonary bypass priming, volume replacement intraoperatively and 24 hours postoperatively.

Measurements and Main Results

Hypotension (time-weighted average mean arterial pressure of <65 mmHg) and hyperlactatemia (time-weighted average blood lactate of >2 mmol/L) incidences were compared between trial groups in the operating room (OR), and early (0-6 hours) and late (6-24 hours) postoperatively. Associations of hypotension and hyperlactatemia with the ALBumin In Cardiac Surgery primary outcome (≥1 major adverse event [MAE]) were studied. In these time intervals, hypotension occurred in 118, 48, and 17 patients, and hyperlactatemia in 313, 131, and 83 patients. Hypotension and hyperlactatemia associated with MAE occurrence. Hypotension did not differ between the groups (albumin vs Ringer's: OR, 8.8% vs 8.5%; early postoperatively, 2.7% vs 4.2%; late postoperatively, 1.2% vs 1.3%; all p > 0.05). In the albumin group, hyperlactatemia was less frequent late postoperatively (2.9% vs 9.1%; p < 0.001), but not earlier (OR, 22.4% vs 23.6%; early postoperatively, 7.9% vs 11.0%; both p > 0.025 after Bonferroni-Holm correction).

Conclusions

In on-pump cardiac surgery, hypotension and hyperlactatemia are associated with the occurrence of ≥1 MAE. Compared with Ringer's acetate, albumin did not decrease hypotension and decreased hyperlactatemia only late postoperatively. Albumin's modest hemodynamic effect is concordant with the finding of no difference in MAEs between albumin and Ringer's acetate in the ALBumin In Cardiac Surgery trial.

目的比较 4% 白蛋白和醋酸林格氏液的血液动力学.设计双盲随机 ALBumin In Cardiac Surgery 试验的探索性分析.设置赫尔辛基大学医院的单中心研究.参与者我们纳入了 1,386 名泵上心脏手术患者.干预我们使用 4% 白蛋白或醋酸林格氏液进行心肺旁路引流、术中和术后 24 小时的容量补充。测量和主要结果比较了试验组在手术室、术后早期（0-6 小时）和晚期（6-24 小时）的低血压（时间加权平均平均动脉压为 65 mmHg）和高乳酸血症（时间加权平均血乳酸为 2 mmol/L）发生率。研究了低血压和高乳酸血症与 ALBumin In Cardiac Surgery 主要结果（≥1 次主要不良事件 [MAE]）的相关性。在这些时间间隔内，分别有 118、48 和 17 例患者出现低血压，313、131 和 83 例患者出现高乳酸血症。低血压和高乳酸血症与 MAE 的发生有关。低血压在各组之间没有差异（白蛋白 vs 林格液：OR，8.8% vs 8.5%；术后早期，2.7% vs 4.2%；术后晚期，1.2% vs 1.3%；所有 p > 0.05）。在白蛋白组中，术后晚期高乳酸血症的发生率较低（2.9% vs 9.1%；p <0.001），但不早于白蛋白组（OR，22.4% vs 23.6%；术后早期，7.9% vs 11.0%；Bonferroni-Holm 校正后，两者的 p >0.025）。与醋酸林格液相比，白蛋白不能减轻低血压，只能在术后晚期减轻高乳酸血症。白蛋白对血流动力学的适度影响与 "ALBumin In Cardiac Surgery "试验中发现的白蛋白与醋酸林格氏盐之间的 MAEs 无差异是一致的。

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引用次数: 0

Noninvasive Ventilation to Preoxygenate for Emergency Intubation? Not so Fast 无创通气为紧急插管预充氧？没那么快

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-20 DOI: 10.1053/j.jvca.2024.07.031

引用次数: 0

Sudden Failure of Impella Left Ventricular Assist Device Immediately After Implantation 植入 Impella LVAD 后立即发生突然故障

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-18 DOI: 10.1053/j.jvca.2024.07.027

引用次数: 0

Extracorporeal Membrane Oxygenation and Cardiac Surgery in Acute Myocardial Infarction: Strategy for Cardiogenic Shock 急性心肌梗死中的 ECMO 和心脏手术：心源性休克策略

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-16 DOI: 10.1053/j.jvca.2024.07.023

引用次数: 0

The Fontan Circulation in Pregnancy: Hemodynamic Challenges and Anesthetic Considerations 妊娠期的 Fontan 循环：血流动力学挑战和麻醉注意事项

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-14 DOI: 10.1053/j.jvca.2024.07.021

Pregnancy in patients with Fontan physiology presents unique challenges due to altered cardiovascular dynamics inherent to both conditions. The Fontan procedure reroutes venous blood directly to the pulmonary arteries, bypassing the heart, and necessitating precise regulation of pulmonary venous resistance and systemic venous pressure to maintain effective cardiac output. The significant cardiovascular adaptations required during pregnancy to meet the metabolic demands of the mother and fetus can overburden the limited preload capacity and venous compliance in Fontan patients, predisposing them to a spectrum of potential complications, including arrhythmias, heart failure, thromboembolism, and obstetric and fetal risks. This review delineates the essential physiological adaptations during pregnancy and the challenges faced by Fontan patients, advocating for a comprehensive care approach involving multidisciplinary collaboration, vigilant monitoring, tailored anesthetic management, and postpartum care. Understanding the complex dynamics between Fontan physiology and pregnancy is crucial for anesthesiologists to develop and execute individualized management strategies to minimize risks and optimize outcomes for this high-risk population.

由于两种情况下固有的心血管动态变化，Fontan 生理学患者的妊娠带来了独特的挑战。Fontan 手术将静脉血直接输送到肺动脉，绕过了心脏，因此需要精确调节肺静脉阻力和全身静脉压，以维持有效的心输出量。为满足母亲和胎儿的新陈代谢需求，妊娠期间心血管需要进行重大调整，这可能会使 Fontan 患者有限的前负荷能力和静脉顺应性不堪重负，从而易引发一系列潜在并发症，包括心律失常、心力衰竭、血栓栓塞以及产科和胎儿风险。这篇综述阐述了妊娠期间的基本生理适应以及丰坦患者面临的挑战，提倡采取综合护理方法，包括多学科协作、警惕性监测、量身定制的麻醉管理和产后护理。了解丰坦生理学与妊娠之间的复杂动态关系对麻醉医生制定和执行个性化管理策略至关重要，从而最大限度地降低这一高风险人群的风险并优化其预后。

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引用次数: 0

Standard versus High Cardiopulmonary Bypass Flow Rate: A Randomized Controlled Subtrial Comparing Brain Injury Biomarker Release 标准与高心肺旁路流速--比较脑损伤生物标志物释放的随机对照子试验

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2024-07-14 DOI: 10.1053/j.jvca.2024.07.017

Objectives

To compare brain injury biomarker release levels between two different cardiopulmonary bypass (CPB) flow rates in elective cardiac surgery and to explore differences in postoperative delirium between groups and associations between age, sex, CPB time, oxygen levels, and near-infrared spectroscopy, and biomarker levels.

Design

A randomized controlled substudy trial

Setting

Sahlgrenska University Hospital, Sweden

Participants

Forty patients undergoing elective cardiac surgery with CPB

Intervention

Patients were assigned at random to either a standard (2.4 L/min/m²) or a high (2.9 L/min/m²) CPB flow rate.

Measurements and Main Results

Glial fibrillary acidic protein, neurofilament light chain, total-tau, and phosphorylated-tau217 were sampled in plasma before anesthesia induction, after 60 minutes on CPB, and at 30 minutes, 24 hours, and 72 hours post-CPB. Mixed models for repeated measures were used to analyze differences in biomarker levels between groups and to assess relationships, which showed no differences between the 2 flow rate groups. There also was no difference in the occurrence of delirium between the 2 groups. Associations were found between age and increased neurofilament light chain levels. Female sex, oxygen delivery >330 mL/min/m², and near-infrared spectroscopy level >60% were associated with lower biomarker levels.

Conclusions

An increased flow rate did not have any significant effects on biomarker levels compared to a standard flow rate. Several associations were identified between treatment characteristics and biomarker levels. No difference in delirium was seen.

目的比较择期心脏手术中两种不同心肺旁路（CPB）流速下脑损伤生物标志物的释放水平，并探讨不同组间术后谵妄的差异以及年龄、性别、CPB 时间、血氧水平、近红外光谱与生物标志物水平之间的关联。设计随机对照子研究试验地点瑞典Sahlgrenska大学医院参与者40名接受CPBI的择期心脏手术患者干预患者被随机分配到标准（2.4 L/min/m2）或高（2.测量和主要结果在麻醉诱导前、CPB 60 分钟后、CPB 术后 30 分钟、24 小时和 72 小时采集血浆中的神经纤维酸性蛋白、神经丝轻链、总-tau 和磷酸化-tau217。使用重复测量混合模型分析了各组之间生物标志物水平的差异并评估了相关关系，结果显示两组流速之间没有差异。两组之间的谵妄发生率也没有差异。研究发现，年龄与神经丝轻链水平升高之间存在关联。结论与标准流速相比，增加流速对生物标志物水平没有显著影响。在治疗特征和生物标志物水平之间发现了一些关联。在谵妄方面没有发现差异。

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