Journal of cardiothoracic and vascular anesthesia最新文献

英文中文

Comparison between the Fibrinogen Clauss Assay and the TEG6S Citrated Functional Fibrinogen in Cardiac Surgery 心脏手术中纤维蛋白原Clauss测定与TEG6S柠檬酸功能纤维蛋白原比较。

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.2025.08.022

Terrence Alfred MD , Luiz Guilherme Villares da Costa MD, PhD , Christopher Harle MD , Raffael Zamper MD, PhD

Objective

To evaluate the correlation between fibrinogen levels measured by the TEG6s citrated functional fibrinogen (CFF) assay and the standard Clauss method across three phases of cardiac surgery involving cardiopulmonary bypass (CPB), and to assess the potential of CFF for timely clinical decision-making and bleeding prediction.

Design

A prospective observational study.

Setting

A single tertiary academic center specializing in cardiac surgery.

Participants

Twenty adult patients (≥18 years) scheduled for elective cardiac surgery requiring CPB.

Interventions

Arterial blood samples were collected at three intraoperative time points: (1) baseline (pre-CPB), (2) during CPB at rewarming (core temperature ≥36°C), and (3) 5 minutes post-protamine administration. Each sample was analyzed using both the TEG6s CFF and Clauss fibrinogen assays.

Measurements and Main Results

A total of 60 paired measurements were obtained. The primary outcome was the correlation between the TEG6s CFF and Clauss fibrinogen values across surgical phases. A strong correlation was observed at baseline (Spearman’s ρ = high, p < 0.01), which significantly weakened during rewarming (p < 0.05), and partially recovered post-protamine. Turnaround times for CFF were significantly faster than for Clauss across all phases. However, CFF values alone did not reliably predict major postoperative bleeding (defined as ≥500 mL chest tube output in 24 hours), and neither assay showed statistically significant differences between bleeding and nonbleeding groups.

Conclusion

The TEG6s CFF assay demonstrates a strong correlation with Clauss fibrinogen levels before CPB, but this relationship weakens during CPB and remains moderate post-protamine administration. Despite limitations during high-heparin states, the TEG6s offers significantly faster results, suggesting utility for real-time intraoperative decision-making. However, CFF values alone are insufficient to predict postoperative bleeding. Further large-scale studies are needed to validate the integration of TEG6s into transfusion algorithms in cardiac surgery.

目的：评价TEG6s柠檬酸纤维蛋白原（CFF）测定法与标准Clauss法测定的心脏手术伴体外循环（CPB）三个阶段纤维蛋白原水平的相关性，并评估CFF在临床及时决策和出血预测方面的潜力。设计：前瞻性观察性研究。环境：一个专门从事心脏外科的单一三级学术中心。参与者：20例（≥18岁）计划进行选择性心脏手术需要CPB的成年患者。干预措施：在术中三个时间点采集动脉血样本：(1)基线（CPB前），(2)CPB过程中再加热（核心温度≥36°C），(3)鱼精蛋白给药后5分钟。每个样品都使用TEG6s CFF和Clauss纤维蛋白原分析。测量值及主要结果：共获得60个成对测量值。主要结果是TEG6s CFF和Clauss纤维蛋白原值在手术阶段的相关性。在基线时观察到很强的相关性（Spearman's ρ =高，p < 0.01），在复温期间显著减弱（p < 0.05），并且在鱼精蛋白后部分恢复。在所有阶段，CFF的周转时间明显快于Clauss。然而，单独的CFF值并不能可靠地预测术后大出血（定义为24小时内胸管输出量≥500 mL），两项测定在出血组和非出血组之间均没有统计学上的显著差异。结论：TEG6s CFF分析显示CPB前与Clauss纤维蛋白原水平有很强的相关性，但CPB期间这种相关性减弱，并且在给鱼精蛋白后保持适度。尽管在高肝素状态下存在局限性，但TEG6s可提供明显更快的结果，提示可用于实时术中决策。然而，仅凭CFF值不足以预测术后出血。需要进一步的大规模研究来验证TEG6s与心脏手术输血算法的整合。

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引用次数: 0

On-Table Extubation following Cardiac Surgery: Clinical Outcomes and Associated Cost Reductions from a Single Academic Medical Center 心脏手术后桌上拔管：来自单一学术医疗中心的临床结果和相关成本降低

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.2025.10.014

John Tobia BA , Russell Pepe MD , Fady Soliman MD , NaYoung Yang MD , Tana Laplaca DNP , Stacey Telenson APN , Chandravathi Sayani BA , Ankur Sethi MD , Antionio Chiricolo MD , Enrique Pantin MD , Anthony Lemaire MD , Hirohisa Ikegami MD , Mark J. Russo MD, MS , Leonard Y. Lee MD

Objective

To determine whether extubation timing influences clinical outcomes and resource utilization.

Design

A retrospective observational cohort study.

Setting

A single academic medical center in the United States.

Participants

Patients who underwent cardiac surgery between January 2020 and December 2023 and were extubated with either on-table extubation (OTE) or early extubaion (EE).

Interventions

None, as this study was a retrospective analysis of clinical practice data comparing two extubation strategies.

Measurements and Main Results

Of 2014 patients meeting inclusion criteria, 1026 (50.9%) underwent OTE. At baseline, OTE patients had fewer comorbidities and less frequent combined procedures than EE patients. After adjustment for baseline characteristics, OTE was associated with a significantly shorter hospital length of stay (regression coefficient –0.78 days; 95% CI –1.2 to –0.36; p < 0.001) and lower direct hospital costs (regression coefficient –$3,029; 95% CI –$4,831 to –$1,227; p = 0.001). There were no significant differences in reintubation, intensive care unit readmission, discharge mortality, 30-day mortality, or initial intensive care unit hours between groups.

Conclusions

OTE is a safe and effective alternative to EE in appropriately selected cardiac surgery patients, associated with shorter hospitalization and reduced cost without compromising patient safety. Further prospective studies are warranted to validate these findings and identify predictors of OTE success.

目的：探讨拔管时机对临床疗效和资源利用的影响。设计：回顾性观察队列研究。环境：美国唯一的学术医疗中心。参与者：在2020年1月至2023年12月期间接受心脏手术并采用桌上拔管（OTE）或早期拔管（EE）拔管的患者。干预措施：无，因为本研究是对比较两种拔管策略的临床实践数据的回顾性分析。测量结果及主要结果：2014例符合纳入标准的患者中，1026例（50.9%）行OTE。在基线时，OTE患者比EE患者有更少的合并症和更少的联合手术。调整基线特征后，OTE与较短的住院时间（回归系数-0.78天；95% CI -1.2至-0.36;p < 0.001）和较低的直接住院费用（回归系数- 3,029美元；95% CI - 4,831至- 1,227美元；p = 0.001）相关。两组患者在再插管、重症监护病房再入院、出院死亡率、30天死亡率或初始重症监护病房小时数方面无显著差异。结论：在适当选择的心脏手术患者中，OTE是一种安全有效的替代EE的方法，与更短的住院时间和更低的成本相关，且不影响患者的安全。需要进一步的前瞻性研究来验证这些发现并确定OTE成功的预测因素。

{"title":"On-Table Extubation following Cardiac Surgery: Clinical Outcomes and Associated Cost Reductions from a Single Academic Medical Center","authors":"John Tobia BA , Russell Pepe MD , Fady Soliman MD , NaYoung Yang MD , Tana Laplaca DNP , Stacey Telenson APN , Chandravathi Sayani BA , Ankur Sethi MD , Antionio Chiricolo MD , Enrique Pantin MD , Anthony Lemaire MD , Hirohisa Ikegami MD , Mark J. Russo MD, MS , Leonard Y. Lee MD","doi":"10.1053/j.jvca.2025.10.014","DOIUrl":"10.1053/j.jvca.2025.10.014","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether extubation timing influences clinical outcomes and resource utilization.</div></div><div><h3>Design</h3><div>A retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>A single academic medical center in the United States.</div></div><div><h3>Participants</h3><div>Patients who underwent cardiac surgery between January 2020 and December 2023 and were extubated with either on-table extubation (OTE) or early extubaion (EE).</div></div><div><h3>Interventions</h3><div>None, as this study was a retrospective analysis of clinical practice data comparing two extubation strategies.</div></div><div><h3>Measurements and Main Results</h3><div>Of 2014 patients meeting inclusion criteria, 1026 (50.9%) underwent OTE. At baseline, OTE patients had fewer comorbidities and less frequent combined procedures than EE patients. After adjustment for baseline characteristics, OTE was associated with a significantly shorter hospital length of stay (regression coefficient –0.78 days; 95% CI –1.2 to –0.36; p < 0.001) and lower direct hospital costs (regression coefficient –$3,029; 95% CI –$4,831 to –$1,227; p = 0.001). There were no significant differences in reintubation, intensive care unit readmission, discharge mortality, 30-day mortality, or initial intensive care unit hours between groups.</div></div><div><h3>Conclusions</h3><div>OTE is a safe and effective alternative to EE in appropriately selected cardiac surgery patients, associated with shorter hospitalization and reduced cost without compromising patient safety. Further prospective studies are warranted to validate these findings and identify predictors of OTE success.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 467-477"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495520","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

A New Kid on the Block for Perioperative Management of Acute Heparin-induced Thrombocytopenia? 急性肝素性血小板减少症围手术期治疗的新课题？

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.2025.10.037

Grace M. Lee MD , Bruce Spiess MD , Ian Welsby MD

引用次数: 0

The Vital Role of Echocardiography in Carcinoid Heart Disease 超声心动图在类癌性心脏病中的重要作用。

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.2025.10.047

Menachem M. Weiner MD

引用次数: 0

Identifying Predictors of Postoperative Myocardial Infarction Following Repair of Abdominal Aortic Aneurysm Using a Retrospective Claims-Based Analysis 腹主动脉瘤修复术后心肌梗死预测因素的回顾性分析

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.2025.09.030

Courtney Vidovich MD , Matthew Reslink BS , Nasir Hussain MD , Michael Essandoh MD , Manoj Iyer MD , David Stahl MD , Amy Baumann MD , Karina Anam MD , Tristan Weaver MD , Samiya Saklayen MD

Objectives

To evaluate the incidence of postoperative myocardial infarction (POMI) at 30 and 90 days following abdominal aortic aneurysm (AAA) repair and to examine its association with surgical approach (open v endovascular), preexisting comorbidities, and preoperative medications using a large national cohort.

Design

A non-randomized, retrospective cohort study.

Setting

Analysis of the PearlDiver Mariner Database, a nationally representative all-payer claims database in the United States.

Participants

A total of 37,386 patients who underwent AAA repair between 2010 and 2023 were included.

Interventions

Patients underwent either open surgical AAA repair or endovascular aneurysm repair (EVAR).

Measurements and Main Results

The incidence of POMI was 2.7% at 30 days and 3.7% at 90 days postoperatively. Despite EVAR patients having a greater burden of baseline comorbidities, open repair was associated with significantly higher odds of POMI at both time points. After multivariable logistic regression adjusted for baseline characteristics, these associations persisted. Several comorbidities were independently associated with increased risk of POMI, with prior myocardial infarction showing the strongest association at both 30 and 90 days.

Conclusions

Open AAA repair is linked to significantly greater odds of POMI compared to EVAR after multivariate analysis. A history of myocardial infarction was the most predictive risk factor for postoperative cardiac events. These findings raise the possibility that extending postoperative surveillance beyond 30 days may identify additional clinically relevant events, warranting further investigation in prospective studies.

目的：评估腹主动脉瘤（AAA）修复后30天和90天的术后心肌梗死（POMI）发生率，并研究其与手术入路（开放或血管内）、既往合并症和术前用药的关系。设计：一项非随机、回顾性队列研究。背景：对PearlDiver Mariner数据库进行分析，该数据库是美国具有全国代表性的所有付款人索赔数据库。参与者：2010年至2023年间接受AAA修复的患者共37386例。干预措施：患者接受开放手术AAA修复或血管内动脉瘤修复（EVAR）。测量方法及主要结果：POMI的发生率在术后30天和90天分别为2.7%和3.7%。尽管EVAR患者有更大的基线合并症负担，但在两个时间点开放修复与POMI的发生率显著升高相关。在多变量逻辑回归调整基线特征后，这些关联仍然存在。一些合并症与POMI风险增加独立相关，其中既往心肌梗死在30天和90天的相关性最强。结论：在多因素分析后，与EVAR相比，开放式AAA修复与POMI的发生率明显更高。心肌梗死史是术后心脏事件最具预测性的危险因素。这些发现提高了将术后监测延长至30天以上的可能性，可能会发现其他临床相关事件，值得在前瞻性研究中进一步调查。

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引用次数: 0

Analysis of the Updated EACTS/STS Aortic Guidelines 更新后的EACTS/STS主动脉指南分析

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.2025.08.058

Ankit Jain MBBS, MBA , Lai Jiang MD , Nicolas Kumar MD , Amit Bardia MBBS, MPH , Akbar Herekar MBBS , Brian R. Gebhardt MD, MPH , Ashish Sakharpe MBBS , Harish Ramakrishna MD

引用次数: 0

Postoperative Ketoacidosis in Cardiac Surgery: Incidence, Analytical Profile, and Association With Sodium-Glucose Cotransporter 2 Inhibitors—A Prospective Observational Study 心脏手术术后酮症酸中毒：发生率、分析概况和与钠-葡萄糖共转运蛋白2抑制剂的关系——一项前瞻性观察研究

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.2025.11.014

José Ginestal-Calvo MD , J.L. Flordelís-Lasierra MD, PhD , J.L. Pérez-Vela MD , Laura Campos-Bermejo RN , Cristian Coso-Garrido MD , Luis Blanco-Carrasco MD , Carmen Galiano-Carrilero MD , Helena Domínguez-Aguado MD , Emilio Renes-Carreño MD

Objective

To determine the incidence of postoperative ketoacidosis after elective cardiac surgery and to evaluate its association with sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy and perioperative biochemical parameters.

Design

A prospective observational study.

Setting

Cardiac intensive care unit of a tertiary academic hospital in Madrid, Spain, between July 2024 and May 2025.

Participants

Adult patients undergoing elective cardiac surgery. Patients undergoing emergency procedures or those without informed consent were excluded.

Interventions

Standard perioperative care. Arterial blood gases and capillary ketone measurements were obtained at intensive care unit (ICU) admission (defined as postoperative hour 0), at postoperative hour 6, and at postoperative hour 16.

Measurements and Main Results

Postoperative ketoacidosis was defined as arterial pH <7.30 and ketonemia ≥0.6 mmol/L in the absence of preoperative ketoacidosis. A total of 107 patients were included (28 SGLT2 inhibitor users and 79 nonusers). Postoperative ketoacidosis occurred in 17 of 28 patients (54.8%) receiving SGLT2 inhibitors, compared with 8 of 79 (10.1%) in the non-SGLT2 inhibitor group (p < 0.001). Diabetes mellitus was independently associated with ketoacidosis (odds ratio, 5.13; p = 0.001). Patients with ketoacidosis had lower arterial pH (7.31 v 7.35, p < 0.001), lower bicarbonate (21.6 v 22.8 mmol/L, p = 0.012), and more negative base excess (–4.2 v –2.6, p = 0.03). No significant differences were observed in ICU length of stay, duration of mechanical ventilation, reintervention, or mortality.

Conclusions

Postoperative ketoacidosis, frequently euglycemic, is relatively common after cardiac surgery and strongly associated with SGLT2 inhibitor therapy. Careful monitoring and tailored perioperative management should be considered for this high-risk group.

目的：了解择期心脏手术后酮症酸中毒的发生率，并评价其与钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂治疗及围手术期生化指标的关系。设计：前瞻性观察性研究。环境：2024年7月至2025年5月，西班牙马德里一家三级学术医院的心脏重症监护室。参与者：接受择期心脏手术的成年患者。接受紧急手术的患者或未经知情同意的患者被排除在外。干预措施：标准围手术期护理。在重症监护病房（ICU）入院时（定义为术后0小时）、术后6小时和术后16小时测量动脉血气和毛细血管酮。结论：术后酮症酸中毒，常为血糖正常值，在心脏手术后较为常见，且与SGLT2抑制剂治疗密切相关。对于这一高危人群，应考虑严密的监测和量身定制的围手术期管理。

{"title":"Postoperative Ketoacidosis in Cardiac Surgery: Incidence, Analytical Profile, and Association With Sodium-Glucose Cotransporter 2 Inhibitors—A Prospective Observational Study","authors":"José Ginestal-Calvo MD , J.L. Flordelís-Lasierra MD, PhD , J.L. Pérez-Vela MD , Laura Campos-Bermejo RN , Cristian Coso-Garrido MD , Luis Blanco-Carrasco MD , Carmen Galiano-Carrilero MD , Helena Domínguez-Aguado MD , Emilio Renes-Carreño MD","doi":"10.1053/j.jvca.2025.11.014","DOIUrl":"10.1053/j.jvca.2025.11.014","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the incidence of postoperative ketoacidosis after elective cardiac surgery and to evaluate its association with sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy and perioperative biochemical parameters.</div></div><div><h3>Design</h3><div>A prospective observational study.</div></div><div><h3>Setting</h3><div>Cardiac intensive care unit of a tertiary academic hospital in Madrid, Spain, between July 2024 and May 2025.</div></div><div><h3>Participants</h3><div>Adult patients undergoing elective cardiac surgery. Patients undergoing emergency procedures or those without informed consent were excluded.</div></div><div><h3>Interventions</h3><div>Standard perioperative care. Arterial blood gases and capillary ketone measurements were obtained at intensive care unit (ICU) admission (defined as postoperative hour 0), at postoperative hour 6, and at postoperative hour 16.</div></div><div><h3>Measurements and Main Results</h3><div>Postoperative ketoacidosis was defined as arterial pH <7.30 and ketonemia ≥0.6 mmol/L in the absence of preoperative ketoacidosis. A total of 107 patients were included (28 SGLT2 inhibitor users and 79 nonusers). Postoperative ketoacidosis occurred in 17 of 28 patients (54.8%) receiving SGLT2 inhibitors, compared with 8 of 79 (10.1%) in the non-SGLT2 inhibitor group (p < 0.001). Diabetes mellitus was independently associated with ketoacidosis (odds ratio, 5.13; p = 0.001). Patients with ketoacidosis had lower arterial pH (7.31 <em>v</em> 7.35, p < 0.001), lower bicarbonate (21.6 <em>v</em> 22.8 mmol/L, p = 0.012), and more negative base excess (–4.2 <em>v</em> –2.6, p = 0.03). No significant differences were observed in ICU length of stay, duration of mechanical ventilation, reintervention, or mortality.</div></div><div><h3>Conclusions</h3><div>Postoperative ketoacidosis, frequently euglycemic, is relatively common after cardiac surgery and strongly associated with SGLT2 inhibitor therapy. Careful monitoring and tailored perioperative management should be considered for this high-risk group.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 539-545"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714550","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

Viscoelastic Hemostatic Assays and the Pursuit of Universal Adoption in Cardiac Surgery 粘弹性止血试验及其在心脏外科手术中的普遍应用。

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.2025.11.002

Kelly G. Ural MD , Kamrouz Ghadimi MD, MHSc, FAHA

引用次数: 0

The Effects of Daytime Variation on Short-Term Outcomes of Cardiac Surgical Patients: A PRISMA-Compliant Systemic Review and Meta-Analysis 日间变化对心脏外科患者短期预后的影响：一项符合prisma的系统评价和荟萃分析。

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.2025.11.029

Yun-Tai Yao MD, PhD , Shuo Huang MS , Mark Chao BS , Aditya More BS

Objective

Circadian rhythms influence cardiovascular physiology and surgical stress responses, raising the possibility that the timing of cardiac surgery may affect outcomes. Previous studies have reported conflicting results regarding whether morning (AM) versus afternoon (AF) surgery influences perioperative morbidity and mortality. The present study aimed to systematically evaluate whether the timing of cardiac surgery, specifically AM versus AF procedures, influences short-term outcomes.

Design

A meta-analysis of observational cohort studies.

Settings

Cardiovascular centers.

Participants

Patients who underwent elective cardiac surgery.

Interventions

The AM or the AF group.

Measurements

The primary outcome was hospitalized mortality. Secondary outcomes included major morbidities (new-onset atrial fibrillation, myocardial infarction, stroke, renal and infectious complications, reexploration, mechanical circulatory support) and postoperative recovery profiles (mechanical ventilation duration, length of stay [LOS] in the intensive care unit and hospital).

Main Results

Fourteen observational studies involving 135,672 patients (81,391 in the AM group and 54,281 in the AF group) were included. Pooled analysis showed no significant difference in hospitalized mortality between the two groups (1.25% [998/79,550] v 1.17% [615/52,442], OR = 1.09, 95% CI = 0.99 to 1.21; p = 0.08]. The incidences of myocardial infarction, stroke, renal and infectious complications, reexploration, and mechanical circulatory support use were also comparable. However, AM surgery was associated with a modestly higher incidence of new-onset atrial fibrillation (26.05% [2,319/8,907] v 25.50% [1,000/3,921], OR = 1.11, 95% CI = 1.01 to 1.21; p = 0.03). No significant differences were observed in mechanical ventilation duration [MD = –0.20 hours, 95% CI = –0.40 to 0.00; p = 0.05], intensive care unit LOS [MD = –0.35 hours, 95% CI = –6.14 to 5.43; p = 0.90], or hospital LOS [MD = –0.10 days, 95% CI = –0.39 to 0.19; p = 0.49].

Conclusions

These findings suggest that circadian influences on elective cardiac surgical outcomes are limited. Future multicenter prospective studies are warranted to further define the role of surgery timing in high-risk populations.

目的：昼夜节律影响心血管生理和手术应激反应，增加了心脏手术时机可能影响预后的可能性。先前的研究报告了关于上午（AM）和下午（AF）手术是否影响围手术期发病率和死亡率的相互矛盾的结果。本研究旨在系统地评估心脏手术的时机，特别是AM和AF手术，是否会影响短期结果。设计：观察性队列研究的荟萃分析。设置：心血管中心。参与者：接受择期心脏手术的患者。干预措施：AM或AF组。测量：主要终点是住院死亡率。次要结局包括主要发病率（新发房颤、心肌梗死、中风、肾脏和感染并发症、再探索、机械循环支持）和术后恢复情况（机械通气时间、在重症监护病房和医院的住院时间[LOS]）。主要结果：纳入14项观察性研究，涉及135,672例患者（AM组81,391例，AF组54281例）。合并分析显示两组住院死亡率无显著差异（1.25% [998/79,550]vs 1.17% [615/52,442], OR = 1.09, 95% CI = 0.99 ~ 1.21; p = 0.08）。心肌梗死、卒中、肾脏和感染并发症、再探查和机械循环支持使用的发生率也具有可比性。然而，AM手术与新发房颤的发生率较高相关（26.05% [2319 / 8907]vs 25.50% [1000 / 3921], OR = 1.11, 95% CI = 1.01 ~ 1.21; p = 0.03）。机械通气持续时间无显著差异[MD = -0.20小时，95% CI = -0.40 ~ 0.00；p = 0.05]，重症监护病房LOS [MD = -0.35 h, 95% CI = -6.14 ~ 5.43；p = 0.90]或医院LOS [MD = -0.10天，95% CI = -0.39 ~ 0.19；P = 0.49]。结论：这些发现表明，昼夜节律对择期心脏手术结果的影响是有限的。未来的多中心前瞻性研究有必要进一步确定手术时机在高危人群中的作用。

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引用次数: 0

Exercise Prehabilitation and 90-Day Self-Rated Health Status in Cardiac Surgery Patients with Poor Early Recovery: A Secondary Analysis of a Randomized Controlled Trial 早期恢复不良的心脏手术患者的运动康复和90天自评健康状况：一项随机对照试验的二次分析

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.2025.11.032

Derek King Wai Yau PhD, MScMed(PainMgt) , Gavin Matthew Joynt MBBCh, FCICM , Kwok Ming Ho PhD, MPH , Anna Lee PhD, MPH

引用次数: 0

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