Pub Date : 2026-01-01DOI: 10.1053/j.jvca.2025.09.024
Jakob Wollborn MD, MPH , Kitae Chang MD, MS , Jan O. Friess MD , Amy E. Hackmann MD , Raghu Seethala MD, MSc
As survival among patients with congenital heart disease (CHD) continues to improve, the population of adults with CHD (ACHD) is rapidly growing. These patients often present with complex anatomy, prior surgical repairs, residual hemodynamic lesions, and progressive physiologic derangements that require lifelong surveillance and specialized care. When circulatory or respiratory failure occurs, extracorporeal membrane oxygenation (ECMO) may be lifesaving; however, its use in ACHD poses unique challenges. Indications for ECMO, particularly veno-arterial (VA) support, include refractory cardiogenic shock, cardiac arrest, and postoperative low-cardiac output syndrome, while veno-venous (VV) ECMO may be indicated in select ACHD patients with respiratory failure. Complex circulations such as Fontan physiology, systemic right ventricles after atrial switch operations, and cyanotic heart disease require careful individualized planning, particularly for cannulation strategies and perfusion goals. Anatomic variations, prior surgeries, vascular access issues, and special considerations such as right-to-left shunts complicate ECMO initiation and management. Despite high reported mortality - especially in patients with Fontan circulation - ECMO can provide an effective bridge to recovery or transplant in carefully selected patients. Given the unique risks and resource demands, ACHD patients requiring ECMO support should ideally be managed in specialized centers with multidisciplinary expertise. This review outlines the anatomical and physiological considerations, indications, cannulation strategies, and outcomes associated with ECMO in the ACHD population, providing a framework for decision-making in this increasingly relevant clinical scenario.
{"title":"Extracorporeal Membrane Oxygenation in Adults with Congenital Heart Disease: Considerations, Cannulation and Challenges for Complex Cardiac Anomalies","authors":"Jakob Wollborn MD, MPH , Kitae Chang MD, MS , Jan O. Friess MD , Amy E. Hackmann MD , Raghu Seethala MD, MSc","doi":"10.1053/j.jvca.2025.09.024","DOIUrl":"10.1053/j.jvca.2025.09.024","url":null,"abstract":"<div><div>As survival among patients with congenital heart disease (CHD) continues to improve, the population of adults with CHD (ACHD) is rapidly growing. These patients often present with complex anatomy, prior surgical repairs, residual hemodynamic lesions, and progressive physiologic derangements that require lifelong surveillance and specialized care. When circulatory or respiratory failure occurs, extracorporeal membrane oxygenation (ECMO) may be lifesaving; however, its use in ACHD poses unique challenges. Indications for ECMO, particularly veno-arterial (VA) support, include refractory cardiogenic shock, cardiac arrest, and postoperative low-cardiac output syndrome, while veno-venous (VV) ECMO may be indicated in select ACHD patients with respiratory failure. Complex circulations such as Fontan physiology, systemic right ventricles after atrial switch operations, and cyanotic heart disease require careful individualized planning, particularly for cannulation strategies and perfusion goals. Anatomic variations, prior surgeries, vascular access issues, and special considerations such as right-to-left shunts complicate ECMO initiation and management. Despite high reported mortality - especially in patients with Fontan circulation - ECMO can provide an effective bridge to recovery or transplant in carefully selected patients. Given the unique risks and resource demands, ACHD patients requiring ECMO support should ideally be managed in specialized centers with multidisciplinary expertise. This review outlines the anatomical and physiological considerations, indications, cannulation strategies, and outcomes associated with ECMO in the ACHD population, providing a framework for decision-making in this increasingly relevant clinical scenario.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 1","pages":"Pages 324-332"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292254","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}
To evaluate whether autologous platelet-rich plasma (aPRP) improves blood conservation and postoperative outcomes in emergency surgery for acute type A aortic dissection (ATAAD).
Design
Systematic review and meta-analysis of randomized controlled trials and observational studies.
Setting
Cardiac surgery centers from multiple institutions.
Participants
Six studies comprising 2,150 adult patients undergoing ATAAD repair, of whom 906 (42.1%) received intraoperative aPRP.
Interventions
Use of intraoperative aPRP versus no aPRP during ATAAD repair.
Measurements and Main Results
Primary outcomes included reoperation for bleeding and allogeneic blood product transfusion volumes. Secondary outcomes were mechanical ventilation duration, hospital stay, and postoperative complications. aPRP was associated with significantly shorter mechanical ventilation time (MD –13.8 hours; 95% CI –23.9 to –3.7; p = 0.008), lower incidence of prolonged ventilation (OR 0.3; 95% CI 0.2 to 0.7; p = 0.004), reduced reoperation rates (OR 0.4; 95% CI 0.2 to 0.7; p = 0.005), and decreased platelet (MD –2.2 units; 95% CI –3.5 to –0.9; p = 0.001) and cryoprecipitate use (MD –1.9 units; 95% CI –3.0 to –0.8; p < 0.001). No differences were observed in mortality, hospital stay, or rates of neurological or renal complications. Subgroup analysis of randomized controlled trial and propensity-matched data confirmed several of these findings and additionally showed reduced plasma transfusion volumes.
Conclusions
In ATAAD surgery, aPRP may reduce transfusion needs, reoperations, and ventilation duration without increasing adverse outcomes. Given that most evidence is observational, high-quality randomized trials are needed to confirm these findings.
目的：评价自体富血小板血浆（aPRP）是否能改善急性A型主动脉夹层（ATAAD）急诊手术的血液保存和术后预后。设计：对随机对照试验和观察性研究进行系统评价和荟萃分析。环境：多家机构的心脏外科中心。参与者：6项研究，包括2150例接受ATAAD修复的成年患者，其中906例（42.1%）接受术中aPRP。干预措施：在ATAAD修复过程中，术中使用aPRP与不使用aPRP。测量结果和主要结果：主要结果包括出血再手术和异体血液制品输血量。次要结局是机械通气时间、住院时间和术后并发症。aPRP与较短的机械通气时间（MD -13.8小时；95% CI -23.9至-3.7;p = 0.008）、较低的延长通气发生率（OR 0.3; 95% CI - 0.2至0.7;p = 0.004）、较低的再手术率（OR 0.4; 95% CI -3.5至- 0.7;p = 0.005）、血小板减少（MD -2.2单位；95% CI -3.5至-0.9;p = 0.001）和低温沉淀使用（MD -1.9单位；95% CI -3.0至-0.8;p < 0.001）相关。在死亡率、住院时间、神经系统或肾脏并发症发生率方面没有观察到差异。随机对照试验和倾向匹配数据的亚组分析证实了其中的一些发现，并进一步显示血浆输注量减少。结论：在ATAAD手术中，aPRP可以减少输血需求、再手术和通气时间，而不会增加不良后果。鉴于大多数证据是观察性的，需要高质量的随机试验来证实这些发现。
{"title":"Does Autologous Platelet-Rich Plasma Improve Blood Conservation and Postoperative Outcomes in Acute Type A Aortic Dissection Surgery? A Systematic Review and Meta-Analysis","authors":"Kristine Santos , Kensei Oya , Takumi Umibe , Neel Patel , Toru Abo , Wataru Sakai , Tomasz Płonek","doi":"10.1053/j.jvca.2025.09.029","DOIUrl":"10.1053/j.jvca.2025.09.029","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate whether autologous platelet-rich plasma (aPRP) improves blood conservation and postoperative outcomes in emergency surgery for acute type A aortic dissection (ATAAD).</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis of randomized controlled trials and observational studies.</div></div><div><h3>Setting</h3><div>Cardiac surgery centers from multiple institutions.</div></div><div><h3>Participants</h3><div>Six studies comprising 2,150 adult patients undergoing ATAAD repair, of whom 906 (42.1%) received intraoperative aPRP.</div></div><div><h3>Interventions</h3><div>Use of intraoperative aPRP versus no aPRP during ATAAD repair.</div></div><div><h3>Measurements and Main Results</h3><div>Primary outcomes included reoperation for bleeding and allogeneic blood product transfusion volumes. Secondary outcomes were mechanical ventilation duration, hospital stay, and postoperative complications. aPRP was associated with significantly shorter mechanical ventilation time (MD –13.8 hours; 95% CI –23.9 to –3.7; p = 0.008), lower incidence of prolonged ventilation (OR 0.3; 95% CI 0.2 to 0.7; p = 0.004), reduced reoperation rates (OR 0.4; 95% CI 0.2 to 0.7; p = 0.005), and decreased platelet (MD –2.2 units; 95% CI –3.5 to –0.9; p = 0.001) and cryoprecipitate use (MD –1.9 units; 95% CI –3.0 to –0.8; p < 0.001). No differences were observed in mortality, hospital stay, or rates of neurological or renal complications. Subgroup analysis of randomized controlled trial and propensity-matched data confirmed several of these findings and additionally showed reduced plasma transfusion volumes.</div></div><div><h3>Conclusions</h3><div>In ATAAD surgery, aPRP may reduce transfusion needs, reoperations, and ventilation duration without increasing adverse outcomes. Given that most evidence is observational, high-quality randomized trials are needed to confirm these findings.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 1","pages":"Pages 49-57"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312934","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}
Pub Date : 2026-01-01DOI: 10.1053/j.jvca.2025.09.231
Natalie J. Bodmer MD, Matthew W. Vanneman MD
{"title":"REUPing Cardiac Transplant Anesthesia: Innovation or Unknowns Ahead?","authors":"Natalie J. Bodmer MD, Matthew W. Vanneman MD","doi":"10.1053/j.jvca.2025.09.231","DOIUrl":"10.1053/j.jvca.2025.09.231","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 1","pages":"Pages 1-4"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421844","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}
Pub Date : 2026-01-01DOI: 10.1053/j.jvca.2025.10.005
Minmin Cai BM , Xiaoya Mao BM , Xuesi Chen MM
{"title":"Preoperative Aspirin and Mesenteric Traction Syndrome: Mechanism, Diagnosis, and Clinical Outcomes","authors":"Minmin Cai BM , Xiaoya Mao BM , Xuesi Chen MM","doi":"10.1053/j.jvca.2025.10.005","DOIUrl":"10.1053/j.jvca.2025.10.005","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 1","pages":"Pages 408-409"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426604","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}
Pub Date : 2026-01-01DOI: 10.1053/j.jvca.2025.10.009
Michael T. Kuntz MD , Steven J. Staffa MS , Jay G. Berry MD, MPH , Viviane G. Nasr MD, MPH
Objectives
Mortality when undergoing noncardiac surgery for patients with congenital heart disease (CHD) remains higher than for patients without CHD. We sought to determine the impact of institutional volume on outcomes for noncardiac surgery for patients with CHD.
Design
Retrospective database study.
Participants
Inpatients undergoing noncardiac procedures identified using the Pediatric Health Information System (2016–2023) were included in the assessment. Data were organized by hospital volume quintile, based on the number of patients with CHD undergoing noncardiac procedures.
Measurements and Main Results
Of 662,680 patients undergoing noncardiac surgery, 617,396 had no CHD, 23,712 had simple heart disease, 16,243 had complex heart disease, and 5,329 had single-ventricle disease. Quintile 1 hospitals performed fewer than 500 noncardiac procedures for patients with CHD over the study period, quintile 3 hospitals performed 900 to less than 1,100, and quintile 5 hospitals performed more than 1,500.
Demographics were similar across volume quintiles. Mortality was highest in quintile 3 among the full cohort (0.83%, p < 0.001), the non-CHD cohort (0.56%, p = 0.009), and the complex CHD cohort (6.28%, p = 0.024). For simple and single-ventricle lesions, in-hospital mortality rates were similar across quintiles. The longest length of stay varied, including quintile 3 (simple), quintile 1 (complex), and quintiles 2 and 3 (single ventricle). In multivariable analysis, volume quintile 3 was associated with higher in-hospital mortality (adjusted odds ratio 1.14, 95% confidence interval 1.01-1.3, p = 0.034).
Conclusions
In-hospital mortality is higher for patients with CHD undergoing noncardiac surgery at mid-volume centers; length of stay demonstrates a more variable pattern. The reasons for such differences and the implications for regionalization of care require further study.
{"title":"Hospital Volume and Noncardiac Surgery Outcomes for Patients With Congenital Heart Disease","authors":"Michael T. Kuntz MD , Steven J. Staffa MS , Jay G. Berry MD, MPH , Viviane G. Nasr MD, MPH","doi":"10.1053/j.jvca.2025.10.009","DOIUrl":"10.1053/j.jvca.2025.10.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Mortality when undergoing noncardiac surgery for patients with congenital heart disease (CHD) remains higher than for patients without CHD. We sought to determine the impact of institutional volume on outcomes for noncardiac surgery for patients with CHD.</div></div><div><h3>Design</h3><div>Retrospective database study.</div></div><div><h3>Participants</h3><div>Inpatients undergoing noncardiac procedures identified using the Pediatric Health Information System (2016–2023) were included in the assessment. Data were organized by hospital volume quintile, based on the number of patients with CHD undergoing noncardiac procedures.</div></div><div><h3>Measurements and Main Results</h3><div>Of 662,680 patients undergoing noncardiac surgery, 617,396 had no CHD, 23,712 had simple heart disease, 16,243 had complex heart disease, and 5,329 had single-ventricle disease. Quintile 1 hospitals performed fewer than 500 noncardiac procedures for patients with CHD over the study period, quintile 3 hospitals performed 900 to less than 1,100, and quintile 5 hospitals performed more than 1,500.</div><div>Demographics were similar across volume quintiles. Mortality was highest in quintile 3 among the full cohort (0.83%, p < 0.001), the non-CHD cohort (0.56%, p = 0.009), and the complex CHD cohort (6.28%, p = 0.024). For simple and single-ventricle lesions, in-hospital mortality rates were similar across quintiles. The longest length of stay varied, including quintile 3 (simple), quintile 1 (complex), and quintiles 2 and 3 (single ventricle). In multivariable analysis, volume quintile 3 was associated with higher in-hospital mortality (adjusted odds ratio 1.14, 95% confidence interval 1.01-1.3, p = 0.034).</div></div><div><h3>Conclusions</h3><div>In-hospital mortality is higher for patients with CHD undergoing noncardiac surgery at mid-volume centers; length of stay demonstrates a more variable pattern. The reasons for such differences and the implications for regionalization of care require further study.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 1","pages":"Pages 143-150"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426550","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}
The primary objective of the current study was to evaluate whether the use of eye masks and ear plugs improves postoperative sleep quality in patients undergoing cardiac surgery.
The secondary objectives include the evaluation of nonpharmacological interventions on daytime sleepiness, opioid consumption, and postoperative complications
The study was conducted in 100 adult patients undergoing elective cardiac surgery in a quaternary care hospital.
Interventions
The intervention group received ear plugs and an eye mask from 10:00 pm to 6:00 am. The quality of sleep was assessed on the morning of the next day using the Richards–Campbell Sleep Questionnaire.
Measurements and Main Results
The intervention group had significantly higher Richards–Campbell Sleep Questionnaire scores (78 v 62; p < 0.05) and a significant reduction in daytime sleepiness (30% v 62%; p < 0.05) and opioid consumption (7.35 mg v 12.75 mg; p < 0.05). The incidence of postoperative atrial fibrillation, delirium, and length of stay in the intensive care unit were comparable between the groups.
Conclusions
Eye masks and ear plugs improve the quality of sleep and reduce daytime sleepiness and opioid consumption in patients undergoing cardiac surgery.
目的：本研究的主要目的是评估眼罩和耳塞的使用是否能改善心脏手术患者的术后睡眠质量。次要目的包括评估非药物干预对白天嗜睡、阿片类药物消耗和术后并发症的影响。设计：前瞻性、随机、对照、平行组研究。参与者和环境：该研究在一家第四护理医院进行了100例选择性心脏手术的成年患者。干预措施：干预组于晚上10点至早上6点接受耳塞和眼罩。第二天早上使用Richards-Campbell睡眠问卷对睡眠质量进行评估。测量和主要结果：干预组的Richards-Campbell睡眠问卷得分显著提高（78 vs 62; p < 0.05），白天嗜睡（30% vs 62%; p < 0.05）和阿片类药物消耗（7.35 mg vs 12.75 mg; p < 0.05）显著减少。术后心房颤动、谵妄的发生率和在重症监护病房的住院时间在两组之间具有可比性。结论：眼罩和耳塞可改善心脏手术患者的睡眠质量，减少白天嗜睡和阿片类药物的消耗。
{"title":"The Effects of Nonpharmacological Interventions on Sleep Quality in Cardiac Surgical Patients: A Prospective Randomised Controlled Study","authors":"Annushha Gayatri MD , Nagarjuna Panidapu MD, DM , Praveen Kumar Neema MD, PDCC , Thushara Madathil MD, DM , Devika Poduval MD, DM , Don Jose Palamattam MD, DM , Praveen Kerala Varma MS, MCH","doi":"10.1053/j.jvca.2025.08.036","DOIUrl":"10.1053/j.jvca.2025.08.036","url":null,"abstract":"<div><h3>Objectives</h3><div>The primary objective of the current study was to evaluate whether the use of eye masks and ear plugs improves postoperative sleep quality in patients undergoing cardiac surgery.</div><div>The secondary objectives include the evaluation of nonpharmacological interventions on daytime sleepiness, opioid consumption, and postoperative complications</div></div><div><h3>Design</h3><div>Prospective, randomized, controlled, parallel-group study.</div></div><div><h3>Participants and setting</h3><div>The study was conducted in 100 adult patients undergoing elective cardiac surgery in a quaternary care hospital.</div></div><div><h3>Interventions</h3><div>The intervention group received ear plugs and an eye mask from 10:00 <span>pm</span> to 6:00 <span>am</span>. The quality of sleep was assessed on the morning of the next day using the Richards–Campbell Sleep Questionnaire.</div></div><div><h3>Measurements and Main Results</h3><div>The intervention group had significantly higher Richards–Campbell Sleep Questionnaire scores (78 <em>v</em> 62; p < 0.05) and a significant reduction in daytime sleepiness (30% <em>v</em> 62%; p < 0.05) and opioid consumption (7.35 mg <em>v</em> 12.75 mg; p < 0.05). The incidence of postoperative atrial fibrillation, delirium, and length of stay in the intensive care unit were comparable between the groups.</div></div><div><h3>Conclusions</h3><div>Eye masks and ear plugs improve the quality of sleep and reduce daytime sleepiness and opioid consumption in patients undergoing cardiac surgery.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 1","pages":"Pages 229-234"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064489","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}
Pub Date : 2026-01-01DOI: 10.1053/j.jvca.2025.08.046
Luke Foster MMBS, BSc (Hons), Kelly Byrne MBChB, FANZCA, Gwilym Rivett BSc, BM
{"title":"Obesity and Heart Failure: The (Fried) Chicken or the Egg?","authors":"Luke Foster MMBS, BSc (Hons), Kelly Byrne MBChB, FANZCA, Gwilym Rivett BSc, BM","doi":"10.1053/j.jvca.2025.08.046","DOIUrl":"10.1053/j.jvca.2025.08.046","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 1","pages":"Pages 8-11"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130901","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}
Pub Date : 2026-01-01DOI: 10.1053/j.jvca.2025.08.017
Fangzhou Li MD, Jinfeng Luo MD, Lijuan Guo BN, Wei Wei MD
Objectives
To investigate the potential contribution of tissue oxygenation prediction in cardiac surgery–associated acute kidney injury (CSA-AKI) using near-infrared spectroscopy (NIRS) and serum lactate level measurements.
Design
A retrospective study analyzing tissue oxygenation parameters and serum lactate levels during the perioperative period in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Setting
A single-center cardiac surgery unit in which patients underwent procedures requiring CPB.
Participants
A cohort of 391 patients who underwent cardiac surgery with CPB.
Interventions
Measurement of brain tissue oxygen saturation (SctO2) and skeletal muscle tissue oxygen saturation (StO2) using NIRS. Perioperative serum lactate levels were collected through blood gas analysis via radial artery catheterization.
Measurements and Main Results
Tissue oxygen saturation measured by NIRS: During CPB, the SctO2 cutoff was 56.75% and the StO2 cutoff was 65.85%; after CPB, the SctO2 cutoff was 60.15% and the StO2 cutoff was 67.20%. These values demonstrate high predictive accuracy for CSA-AKI. Serum lactate levels: Postoperative levels ≥2.65 mg/L were independent predictors of CSA-AKI. Predictive model: The 5 independent significant variables combined had an area under the receiver operating characteristic curve of 91.8% (95% confidence interval, 0.762-0.887).
Conclusions
Tissue oxygen saturation measured during CPB and elevated postoperative serum lactate levels are valuable early parameters for predicting CSA-AKI risk in patients undergoing cardiac surgery with CPB. These findings highlight the clinical utility of these parameters in guiding early intervention strategies.
{"title":"Tissue Oxygen Saturation Combined With Serum Lactic Acid Can Predict Cardiac Surgery–Associated Acute Kidney Injury","authors":"Fangzhou Li MD, Jinfeng Luo MD, Lijuan Guo BN, Wei Wei MD","doi":"10.1053/j.jvca.2025.08.017","DOIUrl":"10.1053/j.jvca.2025.08.017","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the potential contribution of tissue oxygenation prediction in cardiac surgery–associated acute kidney injury (CSA-AKI) using near-infrared spectroscopy (NIRS) and serum lactate level measurements.</div></div><div><h3>Design</h3><div>A retrospective study analyzing tissue oxygenation parameters and serum lactate levels during the perioperative period in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).</div></div><div><h3>Setting</h3><div>A single-center cardiac surgery unit in which patients underwent procedures requiring CPB.</div></div><div><h3>Participants</h3><div>A cohort of 391 patients who underwent cardiac surgery with CPB.</div></div><div><h3>Interventions</h3><div>Measurement of brain tissue oxygen saturation (SctO<sub>2</sub>) and skeletal muscle tissue oxygen saturation (StO<sub>2</sub>) using NIRS. Perioperative serum lactate levels were collected through blood gas analysis via radial artery catheterization.</div></div><div><h3>Measurements and Main Results</h3><div>Tissue oxygen saturation measured by NIRS: During CPB, the SctO<sub>2</sub> cutoff was 56.75% and the StO<sub>2</sub> cutoff was 65.85%; after CPB, the SctO<sub>2</sub> cutoff was 60.15% and the StO<sub>2</sub> cutoff was 67.20%. These values demonstrate high predictive accuracy for CSA-AKI. Serum lactate levels: Postoperative levels ≥2.65 mg/L were independent predictors of CSA-AKI. Predictive model: The 5 independent significant variables combined had an area under the receiver operating characteristic curve of 91.8% (95% confidence interval, 0.762-0.887).</div></div><div><h3>Conclusions</h3><div>Tissue oxygen saturation measured during CPB and elevated postoperative serum lactate levels are valuable early parameters for predicting CSA-AKI risk in patients undergoing cardiac surgery with CPB. These findings highlight the clinical utility of these parameters in guiding early intervention strategies.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 1","pages":"Pages 187-194"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431563","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}
Pub Date : 2026-01-01DOI: 10.1053/j.jvca.2025.10.032
Paul S. Pagel MD, PhD , Jiapeng Huang MD, PhD , John G.T. Augoustides MD , Alan Jay Schwartz MD, MSEd , Eugene A. Hessel II MD , Joel A. Kaplan MD
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