Journal of cardiothoracic and vascular anesthesia最新文献

英文中文

Thoracic Aorta Measurements Using Intraoperative Transesophageal Echocardiography: Validation via Cardiac Magnetic Resonance.

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-03 DOI: 10.1053/j.jvca.2025.01.038

Lisa Q Rong, Sena Chun, Pablo Villar-Calle, Mahniz Reza, Edan Leshem, Giorgia Falco, Jiwon Kim, Richard B Devereux, Jonathan W Weinsaft

Objectives: To examine the association and magnitude of agreement between intraoperative transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (CMR) on aortic diameter measurements, to guide perioperative decision making for ascending aortic aneurysms.

Design: This prospective study included patients with an ascending aortic aneurysm undergoing surgical ascending aortic repair using a prosthetic graft between February 2018 and December 2019. Intraoperative TEE in 2-dimensional (2D) and 3-dimensional (3D) views were obtained and assessed relative to preoperative cine-CMR and contrast-enhanced 3D magnetic resonance angiography.

Setting: Weill Cornell Medicine, a single large academic medical center.

Participants: Thirty patients undergoing ascending aortic repair using a prosthetic graft (polyethylene terephthalate [Dacron]) without severe aortic valve disease (stenosis or regurgitation).

Interventions: CMR, TEE, and ascending aortic repair using prosthetic grafts.

Measurements and main results: TEE-derived measurements correlated significantly with CMR at all aortic segments: root (r = 0.94-0.97; p < 0.001 for all), ascending (r = 0.95-0.98; p < 0.001 for all), arch (r = 0.88; p < 0.001), and descending (r = 0.91; p < 0.001). Bland-Altman analyses showed small mean differences between 2D and 3D TEE versus CMR (range, 0.05-0.22 cm and 0.04-0.18 cm, respectively), with narrow limits of agreement at all segments, although TEE underestimated CMR-derived measurements.

Conclusions: This study demonstrates the feasibility of intraoperative TEE to accurately measure aortic diameters in patients with ascending aortic aneurysms. The excellent correlations with CMR and small mean differences with narrow limits of agreement support intraoperative TEE to guide surgical decision making for possible aortic replacement.

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引用次数: 0

Pulmonary Hemorrhage During Pulmonary Artery Stenting Necessitating Venovenous Extracorporeal Membrane Oxygenation 肺动脉支架置入术中肺出血需要静脉-静脉体外膜氧合。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.007

Tyler E. Powell MD , Theodore O. Loftsgard APRN, CNP , Arnoley S. Abcejo MD , Omar Elmadhoun MD, MPH

引用次数: 0

Inhaled Nitric Oxide Therapy Is Associated With a Low Prevalence of Postoperative Delirium Among Patients Who Undergo Aortic Arch Surgery: A Propensity Score Matching Analysis 吸入一氧化氮治疗与主动脉弓手术患者术后谵妄发生率低相关：倾向评分匹配分析

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.031

Kimito Minami MD, PhD , Tatsutoshi Shimatani MD, PhD , Yosuke Inoue MD, PhD , Hitoshi Matsuda MD, PhD , Muneyuki Takeuchi MD, PhD

引用次数: 0

Personalizing Permissive Hypercapnia in Acute Severe Respiratory Failure 急性严重呼吸衰竭患者容许性高碳酸血症的个体化治疗。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.12.005

Vasileios Zochios MD , Hakeem Yusuff MBBS , Matthieu Schmidt PhD

引用次数: 0

The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part II: Cardiac Transplantation 心胸移植麻醉年：2022 年亮点精选》第二部分：心脏移植。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.10.026

Elizabeth Ungerman MD, MS , Oriana C. Hunter MD, PhD Procirca MCS , Arun L. Jayaraman MD, PhD , Swapnil Khoche MBBS , Steven Bartels MD , Robert M. Owen MD , Klint Smart MD , Heather K. Hayanga MD, MPH, FASE, FASA , Bhoumesh Patel MD , Alice M. Whyte MBBS , Joshua Knight MD , T. Everett Jones MD , S. Michael Roberts DO, FASE , Ryan Ball MD, MBA , Marguerite Hoyler MD , Theresa A. Gelzinis MD

These highlights focus on research published in the year 2022 and is divided into preoperative, intraoperative, and postoperative sections. The preoperative section includes research on the assessment and optimization of candidates for heart transplantation; donor optimization and the use of extended donors; organ protection systems; donation after circulatory death allografts; recipient factors including cannabis use, sex, race, and comorbidities such as obesity, diabetes mellitus, and peripartum cardiomyopathy; the effects of the 2018 heart allocation policy change on waitlist and postoperative mortality; updates on heart transplantation in patients with coronavirus disease 2019; in pediatric patients; and those who require a bridge to transplant. The intraoperative section includes the use of a multidisciplinary team, a proposed transfusion algorithm, bench surgery on the allograft, and size matching. The postoperative section focuses on the research on the development and management of tricuspid regurgitation, echocardiography, arrhythmia management, and, finally, xenotransplantation.

这些重点关注的是2022年发表的研究，分为术前、术中和术后三个部分。术前部分包括以下方面的研究：心脏移植候选者的评估和优化；供体优化和扩展供体的使用；器官保护系统；循环死亡异体移植后的捐献；受体因素，包括大麻使用、性别、种族和合并症（如肥胖、糖尿病和围心肌病）；2018 年心脏分配政策变化对等待名单和术后死亡率的影响；2019 年冠状病毒疾病患者心脏移植的最新情况；儿科患者；以及需要移植桥梁的患者。术中部分包括多学科团队的使用、拟议的输血算法、异体移植的台式手术和大小匹配。术后部分的重点是三尖瓣反流的发展和管理研究、超声心动图、心律失常管理，最后是异种移植。

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引用次数: 0

Prebypass Critical Closing Pressure Predicts Acute Kidney Injury After Cardiopulmonary Bypass 体外循环前临界闭合压预测体外循环后急性肾损伤。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.010

Brian C. Ayers MD, MBA , Raimon Padrós-Valls MS , Sarah Brownlee MD , Benjamin S. Steinhorn MD, PhD , Kenneth Shann CCP , Asishana Osho MD , Thoralf M. Sundt MD , Aaron D. Aguirre MD, PhD

Objectives

Optimal blood pressure goals during cardiopulmonary bypass (CPB) remain uncertain and new metrics to individualize perfusion targets are needed. Critical closing pressure (Pcrit) is a fundamental property of the arterial circulation related to vascular tone and represents the outflow pressure impacting flow across the systemic circulation. We examined Pcrit as a prognostic marker of acute kidney injury (AKI).

Design

Retrospective cohort study.

Setting

Single tertiary care hospital

Participants

We included 1,038 adult cardiac surgery patients who underwent CPB.

Interventions

Pcrit was calculated using arterial waveform data before initiation of CPB. Pcrit was examined in relation to incidence of stage 2 or higher postoperative AKI according to standard Kidney Disease Improving Global Outcomes definitions.

Measurements and Main Results

Of the 1,038 patients included in the study, 50 (5%) experienced AKI. Patients who suffered AKI had significantly higher preoperative risk factors, including higher incidence of severe chronic kidney disease and higher Society of Thoracic Surgeons risk score (p < 0.01). They also had longer operative times and longer cross-clamp times (p < 0.01). All patients were maintained at similar mean arterial pressure while on CPB. Patients who suffered AKI had a significantly higher prebypass Pcrit than those who did not (49.0 mmHg vs 44.1 mmHg; p = 0.018). In a multivariate regression, Pcrit remained a significant predictor, representing a 16% increased risk of AKI for each 5 mmHg increase in prebypass Pcrit (p = 0.011).

Conclusions

A higher prebypass Pcrit is associated with a significantly higher incidence of postoperative AKI. Future study is warranted to investigate using intraoperative Pcrit to determine a personalized blood pressure goal during CPB.

目的：体外循环（CPB）期间的最佳血压目标仍然不确定，需要新的指标来个性化灌注目标。临界闭合压（Pcrit）是与血管张力相关的动脉循环的基本特性，代表了影响整个体循环流量的流出压力。我们研究了Pcrit作为急性肾损伤（AKI）的预后标志物。设计：回顾性队列研究。背景：单一三级医院研究对象：我们纳入了1038例接受CPB的成人心脏手术患者。干预措施：使用CPB开始前的动脉波形数据计算Pcrit。根据标准肾脏疾病改善全球结局定义，检查Pcrit与2期或更高期术后AKI发生率的关系。测量和主要结果：在纳入研究的1038例患者中，50例（5%）经历AKI。AKI患者术前危险因素较高，重度慢性肾脏疾病发生率较高，胸外科学会危险评分较高（p < 0.01）。手术次数和交叉钳夹次数均较长（p < 0.01）。所有患者在CPB期间保持相似的平均动脉压。患有AKI的患者比未患有AKI的患者有明显更高的旁路预压(49.0 mmHg vs 44.1 mmHg；P = 0.018)。在多变量回归中，Pcrit仍然是一个重要的预测因子，预分流Pcrit每增加5 mmHg， AKI风险增加16% （p = 0.011）。结论：较高的预分流prcrit与较高的术后AKI发生率相关。未来的研究有必要探讨在CPB期间使用术中Pcrit来确定个性化的血压目标。

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引用次数: 0

Outcomes in Women Undergoing Coronary Artery Bypass Grafting: Analysis of New Data and Operative Trends 女性冠状动脉旁路移植术的疗效：新数据和手术趋势分析。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.10.031

Sarvie Esmaeilzadeh MBBCh, Nathan Vinzant MD, Harish Ramakrishna MD, FACC, FESC

In 2019, coronary artery bypass grafting (CABG) made up more than one-half of all adult cardiac surgical procedures in the United States, with an estimated 301,077 procedures performed, of which 161,816 were isolated CABG, and approximately 25% of which were performed in women. Women undergoing CABG are statistically more likely to present for surgery at an older age, with a greater burden of comorbidities such as diabetes and hypertension, and in decompensated clinical states (eg, acute myocardial infarction or cardiogenic shock) versus their male counterparts. However, sex has been shown to be an independent risk factor for worse outcomes even when controlling for these differences.

Although evidence has long suggested that women seem to be at significantly increased risk of adverse perioperative outcomes and worse long-term outcomes, overall trends for patients undergoing CABG in the United States (US) have improved over the last decades. Despite this, the recent evidence from Gaudino et al⁵ suggests that the outcomes gap between men and women has not improved. In their cohort study examining 1,297,204 patients undergoing isolated CABG from 2011 to 2020 in the US, women had a higher unadjusted risk of operative (30-day) morbidity and mortality, with no signs of improvement in this gap over the study period, suggesting that a greater understanding of and attention to sex-based outcomes in CABG operations are warranted. A thorough understanding of this discrepancy and the possible contributing factors is essential to improving outcomes for women undergoing CABG.

2019 年，冠状动脉旁路移植术（CABG）占美国所有成人心脏外科手术的二分之一以上，估计共进行了 301,077 例手术，其中 161,816 例为单独的冠状动脉旁路移植术，其中约 25% 为女性手术。据统计，与男性患者相比，接受 CABG 手术的女性患者更有可能在年龄较大、糖尿病和高血压等合并症较多、临床状态失代偿（如急性心肌梗死或心源性休克）的情况下接受手术。然而，即使控制了这些差异，性别仍被证明是导致不良预后的独立风险因素。尽管长期以来一直有证据表明，女性围术期不良预后和长期预后恶化的风险似乎明显增加，但在过去几十年中，美国接受 CABG 患者的整体趋势已有所改善。尽管如此，来自 Gaudino 等人5 的最新证据表明，男女之间的预后差距并未得到改善。他们的队列研究对 2011 年至 2020 年期间在美国接受孤立 CABG 手术的 1,297,204 名患者进行了调查，结果显示女性的手术（30 天）发病率和死亡率的未调整风险更高，而且在研究期间这种差距没有改善的迹象，这表明有必要进一步了解和关注 CABG 手术中基于性别的结果。要改善女性接受 CABG 手术的结果，就必须彻底了解这种差异和可能的诱因。

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引用次数: 0

Termination of Ventricular Septal Defect Device Closure Due to an Insurmountable Obstruction 因无法克服的阻塞而终止室间隔缺损装置的闭合。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.011

Madan Mohan Maddali MD , Swaroopa Ghatnatti MD , Salim Nasser Al-Maskari FRCPCH

引用次数: 0

Association Between Pulmonary Artery Pulsatility Index and Radial Artery Pulse Pressure and Successful Separation from Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation: A French Single-Center Retrospective Study From 2017 to 2021 肺动脉脉搏指数和桡动脉脉压与外周静脉-动脉体外膜氧合成功分离的关系：2017年至2021年法国单中心回顾性研究

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.013

Viet-Dung Duong MD , Chadi Aludaat MD , Geoffrey Kouadri MD , Vincent Scherrer MD , Thomas Clavier MD, PhD , Zoe Demailly MD , Vincent Compère MD, PhD , Nathalie Rey MD , Jean Selim MD, PhD , Emmanuel Besnier MD, PhD

Objective

Few reliable tools exist to predict weaning patient outcomes from venoarterial extracorporeal membrane oxygenation (ECMO; VA-ECMO). Pulmonary artery pulse pressure indexed on right atrial pressure (PAPi) reflects the ventricle-pulmonary coupling and may be representative of right ventricular recovery. Radial artery pulse pressure (rPP) may be representative of left ventricular recovery. We intended to explore the usefulness of these indices in the weaning from VA-ECMO.

Design

Retrospective cohort study.

Setting

Single center in a tertiary university hospital.

Participants

Patients benefiting from a VA-ECMO for all-cause refractory cardiogenic shock between 2017 and 2021. Non-inclusion criteria were minor/pregnant patients and ECMO within 48 hours. Univariate and multivariate logistic regression analyses explored the relationship between PAPi and rPP with weaning success.

Interventions

We explored the association between the pulmonary artery pulse pressure indexed on PAPi, rPP, and the success of weaning from VA-ECMO.

Measurements and Main Results

We included 124 patients for rPP analysis and 82 patients for PAPi analysis. Higher rPP and PAPi (50.43 v 26.3 mmHg, p < 0.001: 1.78 v 0.88, p < 0.001, respectively) and shorter ECMO duration were associated with weaning success. Areas under ROC for rPP and PAPi were 0.85 and 0.88. The combination of rPP ≥ 40 mmHg and PAPi ≥ 1.09 predicted weaning with a sensitivity of 0.94, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of 0.84.

Conclusion

Higher PAPi and rPP were predictors of successful weaning from VA-ECMO in this retrospective study.

目的：目前很少有可靠的工具来预测静脉动脉体外膜氧合(ECMO；VA-ECMO)。肺动脉脉压右房压（PAPi）反映心室-肺耦合，可能是右心室恢复的代表。桡动脉脉压（rPP）可能是左心室恢复的代表。我们打算探讨这些指标在VA-ECMO断奶中的实用性。设计：回顾性队列研究。环境：三级大学医院的单中心。参与者：2017年至2021年间接受VA-ECMO治疗全因难治性心源性休克的患者。未纳入标准为未成年/孕妇患者和48小时内ECMO。单因素和多因素logistic回归分析探讨了PAPi和rPP与断奶成功率的关系。干预措施：我们探讨了PAPi、rPP指标肺动脉脉压与VA-ECMO成功脱机之间的关系。测量和主要结果：我们纳入124例患者进行rPP分析，82例患者进行PAPi分析。较高的rPP和PAPi（分别为50.43 v 26.3 mmHg, p < 0.001: 1.78 v 0.88, p < 0.001）和较短的ECMO持续时间与脱机成功相关。rPP和PAPi的ROC下面积分别为0.85和0.88。rPP≥40 mmHg和PAPi≥1.09联合预测断奶的敏感性为0.94，特异性为1.00，阳性预测值为1.00，阴性预测值为0.84。结论：在本回顾性研究中，较高的PAPi和rPP是VA-ECMO成功脱机的预测因素。

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引用次数: 0

Introduction of a Vendor-Independent Application for Clinical Generation of Pressure-Volume Loops from Routine Hemodynamic Data: A Methodological Exploration 介绍了一种独立于供应商的应用程序，用于从常规血流动力学数据生成压力-容量循环的临床应用：方法学探索。

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia

Pub Date : 2025-02-01 DOI: 10.1053/j.jvca.2024.11.024

Michael Vandenheuvel MD , Stefaan Bouchez MD , Jakob Labus MD , Patrick Wouters MD, PhD , Eckhard Mauermann MD, PhD

Objectives

In the dynamic perioperative setting, changing fluid states complicate determination of ventricular function. This study evaluated the feasibility of clinical ventricular pressure-volume loop (PVL) construction using routine monitoring (echocardiography and invasive pressure monitoring). An application was developed and tested with biventricular simulated data and right ventricular (RV) clinical data.

Design

Prospective observational study.

Setting

Single center, university teaching hospital.

Participants

Adults requiring cardiac surgery.

Interventions

After code development, a simulated dataset (Harvi simulator) was used to test the application. Next, RV data from 12 consenting adult elective cardiac surgery patients were analyzed in 4 distinct physiologic settings, comparing supine baseline condition with a passive leg raise setting, during maintained elevated positive end-expiratory pressure (PEEP), and after chest wall opening.

Measurements and Main Results

Overall PVL feasibility combining 3 acquisitions was 97.6%. Derived PVL parameters followed expected patterns: during leg raise, end-diastolic volume (+36 ± 23%; p = 0.0054) and stroke volume (+32 ± 27%; p = 0.017) augmented with stable heart rate (HR), resulting in a trend toward increased cardiac output (+34 ± 33%; p = 0.06). PEEP resulted in a marked increase in arterial elastance (+126 ± 80%; p = 0.0000068) compared to the other conditions. Chest opening resulted in minor effects.

Conclusions

This study introduces a vendor-independent application to generate PVLs from routinely available clinical data. The results highlight the potential application of the pressure-volume framework in cardiovascular research and patient care. A lack of external validation must be taken into account. Further research is warranted to validate the application. The app can be accessed at https://michael-vandenheuvel.shinyapps.io/eMv_Looper/.

目的：在动态围手术期，液体状态的变化使心室功能的测定复杂化。本研究通过常规监测（超声心动图和有创压力监测）评估临床心室压力-容积环（PVL）构建的可行性。应用程序开发和测试双心室模拟数据和右心室（RV）临床数据。设计：前瞻性观察研究。环境：单中心，大学教学医院。参与者：需要心脏手术的成年人。干预措施：代码开发后，使用模拟数据集（harvey模拟器）来测试应用程序。接下来，研究人员分析了12名自愿接受选择性心脏手术的成人患者在4种不同生理环境下的RV数据，比较了仰卧基线状态与被动抬腿状态、维持高呼气末正压（PEEP）期间和胸壁打开后的情况。测量和主要结果：PVL综合3项收购的总体可行性为97.6%。得到的PVL参数符合预期模式：抬腿时，舒张末期容积(+36±23%；P = 0.0054)、脑行程量（+32±27%）；p = 0.017)与稳定心率（HR）增强，导致心输出量增加（+34±33%）；P = 0.06)。PEEP显著增加动脉弹性（+126±80%）；P = 0.0000068)。开胸只造成轻微影响。结论：本研究引入了一个独立于供应商的应用程序，从常规可用的临床数据中生成pvl。结果突出了压力-体积框架在心血管研究和患者护理中的潜在应用。必须考虑到缺乏外部验证。需要进一步的研究来验证该应用。该应用程序可通过https://michael-vandenheuvel.shinyapps.io/eMv_Looper/访问。

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