Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Perceptions, Definitions, and Preparedness Regarding Low-Performing and Impaired Colleagues in Cardiothoracic and Vascular Anesthesia: An International Survey","authors":"Evangelia Samara MD, PhD ,&nbsp;Mona Momeni MD, PhD ,&nbsp;Agathi Karakosta MD, PhD ,&nbsp;Anna Smyrli MD ,&nbsp;Konstantina Kolonia MD ,&nbsp;Petros Tzimas MD, PhD ,&nbsp;Jiapeng Huang MD, PhD ,&nbsp;Vojislava Neskovic MD, PhD, DEAA, FESAIC ,&nbsp;Manuel Granell Gil MD, PhD ,&nbsp;Gianluca Paternoster MD ,&nbsp;Abdelazeem Eldawlatly MD ,&nbsp;Mikhail Kirov MD, PhD ,&nbsp;Evgeny Grigoryev MD, PhD ,&nbsp;Hushan Ao MD, PhD ,&nbsp;Davy Cheng MD, FRCPC, FCAHS ,&nbsp;Fawzia Aboulfetouh MD ,&nbsp;Eric Benedet Lineburger MD, MSc, PhD, FASE ,&nbsp;Jakob Wittenstein MD ,&nbsp;Mert Senturk MD, PhD ,&nbsp;Zerrin Sungur MD, PhD ,&nbsp;Mohamed R. El Tahan MD","doi":"10.1053/j.jvca.2025.08.055","DOIUrl":"10.1053/j.jvca.2025.08.055","url":null,"abstract":"<div><h3>Objective</h3><div>To define low-performing colleagues in cardiothoracic and vascular anesthesia (LPC-CTVA), evaluate institutional preparedness to identify and manage such individuals, and identify predictors of recognition, reporting, and response behaviors.</div></div><div><h3>Design</h3><div>International cross-sectional survey.</div></div><div><h3>Setting</h3><div>Web-based data collection from June to September 2024.</div></div><div><h3>Participants</h3><div>Of 878 responses, 537 (61.2%) were complete and analyzed, representing 57 countries.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and Main Results</h3><div>A 43-item questionnaire was developed by a multidisciplinary team and distributed via professional societies, social media, and email. It assessed definitions of LPC-CTVA, institutional protocols, and preparedness to address underperformance. Consensus was defined as ≥70% agreement. Thirteen of the 18 statements met consensus. Common indicators included non-compliance with infection control (80.0%), outdated knowledge (80.3%), repeated procedural failures (80.0%), and persistent negligence (79.1%). Institutional support was limited: among 464 respondents, 22.2% reported active supervision for underperformance, 15.3% reported the presence of identification mechanisms, and 11.7% indicated the existence of formal management processes. Although 39.9% of 434 had encountered a low-performing colleague, only 23.1% of 447 had reported one. Preparedness to manage impaired colleagues was reported by 46.2% of 418 respondents, and preparedness to manage underperforming colleagues by 44.1% of 416 respondents. Key barriers included the belief that others would act (33.7% of 265), perceived ineffectiveness (28.3%), and fear of retaliation (21.9%). Preparedness was more prevalent among older, more experienced clinicians, those in leadership roles, and those with prior experience in reporting.</div></div><div><h3>Conclusions</h3><div>A consensus-based definition of LPC-CTVA has been established. However, institutional readiness and clinician confidence remain limited. Experience and structured systems enhance response capability.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 522-538"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251215","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}

{"title":"The Rotated Aortic Root: A Hidden Anatomical Variant Revealed by Three-dimensional Echocardiography","authors":"Usman Ahmed MD,&nbsp;Fatima Noor MBBS,&nbsp;Siraj Ahmad MBBS,&nbsp;Aidan Sharkey MD,&nbsp;Mark Robitaille MD,&nbsp;Feroze Mahmood MD","doi":"10.1053/j.jvca.2025.08.056","DOIUrl":"10.1053/j.jvca.2025.08.056","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 758-760"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131047","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}

{"title":"Epidemiology and Outcomes of Patients with Adult Congenital Heart Disease in Queensland Intensive Care Units: A Multicentre Retrospective Observational Study","authors":"Alexander C. Ashby BMBS, MMedSc ,&nbsp;Christopher Anstey MBBS, MSc, FANZCA, FCICM, PhD ,&nbsp;Maithri Siriwardena MBChB, FRACP, FCICM ,&nbsp;Dan Mullany MBBS, MMedSc, FANZCA, FCICM, PhD ,&nbsp;Sainath Raman MBBS, FCICM ,&nbsp;Aashish Kumar MBBS, FCICM ,&nbsp;Christopher Pryke B.Med ,&nbsp;Kevin B. Laupland MD, PhD ,&nbsp;Alexis Tabah MD, FCICM ,&nbsp;Kiran Shekar MBBS, FCICM, PhD ,&nbsp;Sebastiaan Blank FCICM ,&nbsp;Stephen Whebell MBBS, FCICM ,&nbsp;Stephen Luke MBBS, BSc (Hons), FCICM ,&nbsp;Peter Garrett MBBS, BSc(Hons), FCICM, FACEM, FCEM ,&nbsp;James McCullough FCICM, MMed ,&nbsp;Kyle C. White BSc, MPH, MBBS, FCICM, FRACP ,&nbsp;Mahesh Ramanan BSc (Med), MBBS(Hons), MMed, FCICM ,&nbsp;Antony G. Attokaran MBBS, FCICM, FRACP","doi":"10.1053/j.jvca.2025.08.049","DOIUrl":"10.1053/j.jvca.2025.08.049","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the epidemiology, clinical characteristics, and outcomes of adult congenital heart disease (ACHD) patients admitted to intensive care units (ICUs) across Queensland, Australia.</div></div><div><h3>Design</h3><div>A multicenter, retrospective cohort study.</div></div><div><h3>Setting</h3><div>Twelve adult ICUs across Queensland, including tertiary referral and regional centers, from January 1, 2015, to December 31, 2021.</div></div><div><h3>Participants</h3><div>Adults (≥18 years) with ACHD.</div></div><div><h3>Interventions</h3><div>No interventions.</div></div><div><h3>Measurements and Main Results</h3><div>ACHD cases were stratified by lesion complexity and admission type (medical vs surgical). Outcomes included ICU and hospital length of stay and 30-day and 1-year mortality.</div><div>Of 89,184 ICU admissions, 1,870 (2.1%) involved ACHD. The most common diagnoses were valvular (57.9%) and septal (31.0%) malformations. Lesion complexity was classified as simple (1,543/1,870; 82.5%), moderate (220/1,870; 11.8%), and complex (60/1,870; 3.2%). Medical patients (253/1,870; 13.5%) had greater illness severity, more frequent use of renal replacement therapy and ECMO, and longer ICU (3 [2-6] <em>v</em> 2 [2-6] days; p &lt; 0.001) and hospital length of stay: 18 [10-33] <em>v</em> 8 [6-13] days; p &lt; 0.001) when compared to surgical patients. Mortality was significantly higher in medical admissions (30 day: 34/253: 13.4%; 1 year: 50/253: 19.8%) than in surgical (30 day: 20/1,617: 1.2%; 1 year: 42/1617: 2.6%; p &lt; 0.001). One-year mortality was also higher in patients with complex lesions (11/60; 18.3%) versus simple (67/1,543; 4.3%).</div></div><div><h3>Conclusions</h3><div>ACHD patients are an uncommon but important ICU population. Outcomes vary significantly by admission type and lesion complexity. Emergency and medical admissions are associated with disproportionately high mortality compared to elective surgical admissions and should prompt early escalation of care.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 595-605"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421869","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}

{"title":"Nonsteroidal Anti-Inflammatory Drugs as Part of a Multimodal Postoperative Pain Management Strategy in Patients Undergoing Cardiac Surgery: A Meta-Analysis of 11 Randomized Clinical Trials","authors":"Mohammed S. Beshr MBBS ,&nbsp;Rana H. Shembesh MBBCh, BSc ,&nbsp;Abdelaziz H. Salama MD ,&nbsp;Arwi Omar Kara MBBCh ,&nbsp;Rakesh C. Arora MD, PhD ,&nbsp;Maram Abuajamieh MBBCH ,&nbsp;Esraa Arhaym MBBCh ,&nbsp;Michael C. Grant MD ,&nbsp;Alexander J. Gregory MD ,&nbsp;Muhammed Elhadi MBBCh, MSc","doi":"10.1053/j.jvca.2025.09.041","DOIUrl":"10.1053/j.jvca.2025.09.041","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Effective and safe pain management is crucial for optimal recovery after cardiac surgery. Traditionally, opioids have been the mainstay for postoperative pain control, but their negative health effects have led to a recent shift toward multimodal analgesia to minimize opioid use. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been controversial owing to concerns about bleeding, acute kidney injury (AKI), graft patency, and cardiovascular risks. Despite these concerns, many perioperative teams continue to use NSAIDs alongside opioids as part of multimodal analgesia. This meta-analysis evaluated the efficacy and safety of NSAIDs as a multimodal pain management tool following cardiac surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;An electronic search was conducted on November 15, 2024, using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only controlled trials that combined NSAIDs with opioids for pain management following cardiac surgeries were included. The primary outcome was the visual analog scale (VAS), a 0 to 10 scale measuring pain intensity assessed at 6, 12, 18, 24, and 48 hours. Total opioid consumption was measured at 6, 12, 24, and 48 hours. Secondary outcomes included myocardial infarction, atrial fibrillation, kidney function, gastrointestinal bleeding, nausea, and vomiting. The mean difference (MD) was used for continuous outcomes, and the odds ratio (OR) was used for dichotomous outcomes. A random-effects model was applied for the analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Out of the 1,194 articles screened, 11 articles, totaling 1,463 patients, were included in the meta-analysis. The NSAID group demonstrated significantly lower VAS scores at the 12-hour (MD, -1.19, 95% confidence interval [CI], -1.83 to -0.56; p &lt; 0.001), 24-hour (MD, -0.61; 95% CI, -0.97 to -0.24; p = 0.001), 18-hour (MD, -1.43; 95% CI, -2.58 to -0.28; p = 0.01), and 48-hour (MD, -0.68; 95% CI, -0.87 to -0.49; p &lt; 0.001) time points. However, no significant differences in VAS scores were observed at the 6-hour mark. Regarding opioid consumption, the NSAID group demonstrated significantly lower opioid consumption at the 24-hour (MD, -8.10; 95% CI, -10.60 to -5.61; p &lt; 0.001) and 48-hour (MD, -7.13; 95% CI, -12.44 to -1.82; p = 0.009); however, no differences were observed at the 6-hour and 12-hour marks. Finally, there were no significant differences between the NSAID and control groups in the incidence of gastrointestinal bleeding, atrial fibrillation, myocardial infarction, or AKI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;NSAID use was associated with modestly reduced VAS scores at 12, 18, 24, and 48 hours, while opioid consumption was significantly lower at 24 and 48 hours postoperatively. Short-term NSAID use can be effective in reducing pain and opioid requirements. Although no significant difference in complications was observed, the analysis was limited by small sample sizes. More extens","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 699-709"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312989","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}

{"title":"Recombinant Factor VIIa Versus Prothrombin Complex Concentrate in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis","authors":"Matthew Cadd FRCA ,&nbsp;Daniel Puntis FRCA ,&nbsp;Sam Bullard FRCA ,&nbsp;Samira Green FRCA ,&nbsp;Thomas Kilpatrick FRCA ,&nbsp;Ben Hardy FRCA ,&nbsp;Miles Seavill FRCA","doi":"10.1053/j.jvca.2025.09.043","DOIUrl":"10.1053/j.jvca.2025.09.043","url":null,"abstract":"<div><div>Perioperative hemorrhage during cardiac surgery is a frequent occurrence and can result in significant morbidity and mortality for patients. Prothrombin complex concentrate (PCC) and recombinant factor VIIa (rFVIIa) are therapies that have been used extensively in cardiac surgery with some promise, but with some concern around acute kidney injury (AKI) and thromboembolic disease with rFVIIa use. In this meta-analysis and systematic review, the authors summarize the evidence regarding the effects of PCC and rFVIIa on chest tube output, incidence of adverse events, and mortality of adult patients undergoing cardiac surgery. A total of 962 patients from seven retrospective observational studies were included in the pooled analysis. There was a significant reduction in the primary outcome: total chest tube output (mean difference: –301.01 mL, 95% confidence interval [CI] –550.54 to –51.48). PCC was associated with a significant reduction in total thromboembolic disease (odds ratio: 0.55, 95% CI 0.34 to 0.89), deep vein thrombosis (odds ratio 0.28, 95% CI 0.15 to 0.52), and cryoprecipitate transfusion (mean difference: –3.93, 95% CI –7.64 to –0.21). There were no significant differences between groups in the incidence of AKI or mortality. Five studies were deemed at moderate risk of bias, and two at serious risk. PCC has been shown to have a beneficial effect on reducing chest tube output and incidence of thromboembolic disease, with no increase in AKI compared with rFVIIa.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 676-689"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345368","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}

{"title":"Suspected Malignant Hyperthermia in a Patient Undergoing Cardiac Surgery: Perioperative Challenges and Management","authors":"Jamie Bloom MD ,&nbsp;Eduardo Alvarado MD ,&nbsp;Regina Linganna MD ,&nbsp;John G. Augoustides MD, FASE, FAHA ,&nbsp;Viktoriia Ivanova MD ,&nbsp;Jonathan Frogel MD ,&nbsp;Reed W. Kamyszek MD ,&nbsp;Rohesh J. Fernando MD, FASE, FASA","doi":"10.1053/j.jvca.2025.10.050","DOIUrl":"10.1053/j.jvca.2025.10.050","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 751-757"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633974","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}

{"title":"Bedside Pericardiocentesis and Pericardial Drain Placement by Critical Care Physicians After Cardiac Surgery: A Retrospective Analysis","authors":"Chase Donaldson MD ,&nbsp;Abdullah Alzahrani MD ,&nbsp;Marcelo Gama de Abreu MD ,&nbsp;John Levasseur DO ,&nbsp;Justin Tabah MD ,&nbsp;Saleh Alotaibi MD ,&nbsp;Eric Harvester CNP ,&nbsp;Nichol Hirz CNP ,&nbsp;Junhui Mi MS ,&nbsp;Faisal Bakaeen MD ,&nbsp;Michael Tong MD ,&nbsp;Dale Marsh MD","doi":"10.1053/j.jvca.2025.10.035","DOIUrl":"10.1053/j.jvca.2025.10.035","url":null,"abstract":"<div><h3>Objective</h3><div>Our primary objective was to assess the incidence of operating room drainage of postoperative pericardial effusion after cardiac surgery for patients treated at the bedside with ultrasound-guided drainage and to evaluate the safety of this procedure.</div></div><div><h3>Design</h3><div>Single-center retrospective cohort conducted between January 2018 and December 2023.</div></div><div><h3>Setting</h3><div>A 95-bed postoperative cardiothoracic intensive care unit (ICU).</div></div><div><h3>Patients</h3><div>Adult patients with postoperative pericardial effusion who required pericardiocentesis and pericardial drain placement by cardiothoracic ICU physicians.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcome was the need for operating room drainage after percutaneous drainage. The secondary outcome was a collapsed composite of serious adverse events, including significant site bleeding, cardiac tamponade, cardiac perforation, cardiac ischemia from coronary artery injury, hemothorax, and pneumothorax. Of the 324 patients entered into the analysis, 18 (5.56%; 95% CI 3.06%, 8.05%) required surgical drainage. No serious adverse events, including significant site bleeding, cardiac perforation, hemothorax, or pneumothorax, were observed. Patients who required surgical drainage were more likely to have lower initial drainage volumes (400 mL [250, 500] <em>v</em> 175 mL [93, 525], p = 0.03) and to have tamponade as the indication for drainage (39% <em>v</em> 8%, p &lt; 0.01). The odds of requiring reoperation were higher with tamponade as the indication for drainage (OR 9.61; 95% CI 3.35, 17.6, p &lt; 0.01) and with a shorter time from index surgery to pericardiocentesis (OR 1.04; 95% CI 1.01, 1.07, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>In this patient population, pericardiocentesis was safely performed by cardiothoracic ICU physicians at the bedside and was associated with a low rate of subsequent surgical drainage. Bedside drainage of pericardial effusions may reduce the need for reoperation and related patient morbidity. Future studies should further refine the indications for postoperative pericardiocentesis and better identify the predictors of a successful procedure.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 554-560"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633812","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}

{"title":"Herpes Simplex Virus Pneumonia in Immunocompetent Patients Undergoing Cardiac Surgery: Case Series","authors":"Doriana Lacalaprice PhD ,&nbsp;Pietro Vitale MD ,&nbsp;Alessio Alleva MD ,&nbsp;Özgün Ömer Asiller MD ,&nbsp;Roberto Scaini MD ,&nbsp;Giulia Franceschini MD ,&nbsp;Marzia Flaminio MD ,&nbsp;Paolo Prati MD ,&nbsp;Andrea Farinaccio MD, Phd ,&nbsp;Manuela Moresco MD ,&nbsp;Paolo Nardi MD ,&nbsp;Loredana Sarmati MD ,&nbsp;Valentina Ajello MD","doi":"10.1053/j.jvca.2025.10.020","DOIUrl":"10.1053/j.jvca.2025.10.020","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the frequency, diagnosis, and management, of herpes simplex virus-1 (HSV-1) pneumonia in patients without known immunodeficiency undergoing cardiac surgery with cardiopulmonary bypass.</div></div><div><h3>Design</h3><div>Retrospective observational case series.</div></div><div><h3>Setting</h3><div>Intensive care unit.</div></div><div><h3>Participants</h3><div>Adult patients without known immunodeficiency who developed HSV-1 pneumonia after cardiac surgery.</div></div><div><h3>Interventions</h3><div>Baseline, perioperative, and postoperative data were collected. HSV-1 pneumonia was diagnosed by a multidisciplinary team when progressive respiratory deterioration was unresponsive to standard antibiotic therapy and quantitative HSV-1 polymerase chain reaction in a bronchoalveolar lavage (BAL) or bronchial aspirate (BAS) sample documented a viral load &gt;10,000 copies/mL.</div></div><div><h3>Measurements and Main Results</h3><div>Among 818 patients undergoing cardiac surgery during the study period, 43 were tested for HSV. Among them, 15 (34.9%) had a positive BAL/BAS for HSV-1. In these patients (8 males [53%]; median age, 69 years [interquartile range (IQR), 63-73 years]), quantitative HSV-1 polymerase chain reaction on BAL/BAS documented a median of 3.21 × 10⁶ (IQR, 5.62 × 10⁵-5.73 × 10⁶) copies/mL. Diagnosis was made at a median of 12 days (range, 7.5-19 days) after surgery. Thirteen of the 15 patients (86.7%) were mechanically ventilated, and 11 (73.3%) met criteria for acute respiratory distress syndrome. Median C-reactive protein and procalcitonin values were 108.6 (IQR, 85.7-141.4) mg/L and 1.1 (IQR, 0.4-1.4) ng/mL, respectively. All patients received antiviral therapy. The median length of stay in the intensive care unit was 54 days, and in-hospital mortality of 66.7%, higher after urgent surgery (85.7%) compared to elective surgery (50.0%).</div></div><div><h3>Conclusions</h3><div>HSV-1 infection emerged as a relevant finding among these cardiac surgery patients with respiratory deterioration. Further studies are warranted to clarify the impact of HSV-1 on patient outcomes and to optimize treatment strategies.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 501-508"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476629","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}

{"title":"Preserving the Glycocalyx During Cardiopulmonary Bypass: Beyond Syndecan-1","authors":"Jen-Wei Hong MD,&nbsp;Fang-Yi Lo RN,&nbsp;Ming-Hui Hung MD, MS","doi":"10.1053/j.jvca.2025.10.031","DOIUrl":"10.1053/j.jvca.2025.10.031","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 767-768"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564053","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}

{"title":"Increased Incidence of Thrombosis in Patients at Risk of Heparin-Induced Thrombocytopenia Receiving Epoprostenol for Cardiac Surgery","authors":"Edwin L. Becher MD ,&nbsp;Shelley A. Porter PharmD ,&nbsp;Michael P. Eaton MD ,&nbsp;Lola Chabtini MD ,&nbsp;Zachary Cohen MD","doi":"10.1053/j.jvca.2025.11.016","DOIUrl":"10.1053/j.jvca.2025.11.016","url":null,"abstract":"<div><h3>Objective</h3><div>Heparin-induced thrombocytopenia (HIT) is a serious concern in cardiac surgery, as heparin use in the at-risk patient can lead to devastating thrombosis. Management strategies for patients with confirmed or suspected HIT include using alternative anticoagulants, such as bivalirudin, but heparin administration in the presence of a potent antiplatelet agent, such as a prostacyclin analogue, has been reported as a safe approach. This retrospective study aimed to evaluate the incidence of thromboembolism in patients with confirmed or suspected HIT who received heparin with intravenous epoprostenol for anticoagulation during cardiac surgery.</div></div><div><h3>Design</h3><div>A single-center retrospective observational study.</div></div><div><h3>Setting</h3><div>An adult tertiary care referral center.</div></div><div><h3>Participants</h3><div>Sixteen patients who underwent cardiac surgery between 2014 and 2024. All patients had a suspicion of HIT or confirmed HIT by testing.</div></div><div><h3>Interventions</h3><div>Patients presenting for cardiac surgery with confirmed or suspected HIT received heparin with intravenous epoprostenol intraoperatively according to an institutional protocol.</div></div><div><h3>Measurements and Main Results</h3><div>Collected data included preoperative testing for HIT antibody and serotonin release assay results, as well as whether a thromboembolic event was diagnosed postoperatively. Of the 9 patients who had a positive HIT antibody, 6 had a positive serotonin release assay. Of these 6 patients, 4 had a confirmed thromboembolic event (66.7%).</div></div><div><h3>Conclusions</h3><div>The rate of thrombosis in our review was considerably higher than the published data on the use of prostacyclin analogues with heparin in patients with HIT, suggesting that this strategy may not be as effective for preventing thrombosis as previously thought. Until larger studies can be conducted, it may be in the best interest of patients with HIT for surgical teams to utilize alternative agents, such as bivalirudin, for anticoagulation in cardiac surgery.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 462-466"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668539","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}