Seminars in Cardiothoracic and Vascular Anesthesia最新文献

Background: Right ventricular (RV) function changes after on-pump cardiac surgery but the impact of the surgical procedure is largely unexplored. For this purpose, we aimed to describe the changes of RV function through the intraoperative period by transesophageal echocardiography (TEE) in patients scheduled for isolated on-pump coronary artery bypass grafting (CABG) or for isolated surgical aortic valve replacement (AVR). Methods: Thirty patients each scheduled for on-pump CABG and for isolated surgical AVR were included into this prospective observational study. TEE was performed intraoperatively after induction of anesthesia [T1], after termination of cardiopulmonary bypass [T2], and after sternal closure [T3]. Echocardiographic evaluation included the assessment of RV fractional area change (FAC), RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), and RV free wall strain (FWS). Results: Although there was no significant difference in RVEF and FAC before and immediately after bypass, TAPSE decreased significantly. In contrast, FWS remained unchanged in the same period (-22.7% (IQR -18.9 to -29.6) v -22.1% (IQR -17.1 to -26.1), P = 1). After sternal closure [T2 v T3], there was a significant deterioration of FWS (-22.1% (IQR -17.1 to -26.1) v -17.1% (IQR -13.3 to -21.7), P < 0.001). In the same interval, the values of RVEF, FAC, and TAPSE remained unchanged. These alterations in RV contractile pattern were observed in both groups of patients. Conclusion: There was no difference in the change of RV contractile pattern after on-pump CABG and AVR surgery, suggesting similar impact of both procedures on RV function.

PurposeThis study quantified trends and regional disparities in cardiothoracic anesthesia procedures across China from 2016 to 2023, assessing workforce adequacy to inform policy development.MethodsData were extracted from the White Book of Chinese Cardiovascular Surgery and standardized monthly reports of the Chinese Society of Cardiothoracic and Vascular Anesthesiology (CSCTVA). Cardiac anesthesia volumes reflected national aggregates, while thoracic anesthesia data derived from 100 CSCTVA member hospitals. Regional economic stratification (GDP tiers) and workforce surveys from top-tier centers complemented procedural analyses.ResultsCardiac anesthesia procedures increased by 25% (2016: 158,268 and 2023: 197,937), with cardiopulmonary bypass utilization growing at 13.3% CAGR. Thoracic anesthesia volumes tripled from 114 460 in 2016 to 301 412 in 2023, coinciding with a rise in minimally invasive techniques from 67% to 91.4% of all procedures. Significant regional disparities emerged: High-GDP regions exhibited fivefold greater thoracic surgery density (52.26 vs 10.56 per 100 000; P < .01). Top 10 centers performed 32%-42% of thoracic procedures, yet a 60.5% workforce expansion lagged demand, yielding sub-optimal doctor-patient ratios (e.g., 1:4.7).ConclusionsRapid growth in cardiothoracic anesthesia is juxtaposed with persistent geographic inequities and critical workforce shortages. Strategic interventions are urgently needed to ensure equitable access; these findings establish a comprehensive baseline framework for hypothesis-driven research on health system optimization.

Cannabis use has grown both recreationally and medicinally in the United States over the past decades, alongside increased legalization and social acceptance. However, there remains little research investigating the effects of preoperative cannabis use on postoperative pain in patients undergoing surgery. We conducted a single-center prospective study in adults undergoing cardiac surgery via sternotomy. Patients seen for preoperative consultation in clinic were asked a standardized survey about cannabis use. Clinical data was collected via chart review. Primary outcomes were morphine equivalents in the first 48 hours postoperatively and Visual Analog Scale (VAS) scores. Secondary outcomes were time to extubation, postoperative nausea/vomiting, ICU length of stay (LOS), reoperation, and in-hospital mortality. The non-cannabis user group had 50 patients, and the cannabis user group had 23 patients. Average morphine equivalents in the first 48 hours were similar between cannabis users and non-users (60.98 vs 59.90; P = 0.93), as were VAS scores at 24 hours (5.52 vs 4.84; P = 0.414) and 48 hours (4.74 vs 3.90; P = 0.23). Average time to extubation (minutes) was nearly identical between cannabis users and non-users (718.41 vs 718.67; P = 0.99). There was also no significant difference in average LOS (days) between cannabis users and non-users (2.91 vs 3.48; P = 0.26). There were no differences in postoperative nausea/vomiting, reoperation, or in-hospital mortality. In patients undergoing cardiac surgery via sternotomy, there was no effect of cannabis use on any outcomes, including morphine equivalents, Visual Analog Scale scores, time to extubation, ICU length of stay, postoperative nausea or vomiting, reoperation, or in-hospital mortality.

Cardiac tumors are rare and often diagnostically challenging to identify and treat. The diagnosis of cardiac tumors (primary or secondary) is largely based on a constellation of findings, including patient history, symptomatology, clinical index of suspicion, early diagnostic testing, and thorough examination. Here, we present a case of a 46-year-old patient who underwent a mechanical valved conduit replacement of the aortic valve and dilated aortic root (Bentall procedure), as well as the excision of a recently diagnosed 1.1 cm left ventricular mass. The utilization of intraoperative TEE by cardiac anesthesiology proved to be essential in this surgery and is for any case involving cardiac tumor excision for both dynamic surgical guidance and real-time hemodynamic monitoring of the patient.

Background: Ventilation methods during ICU transport after cardiac surgery are critical. This study aimed to assess the effects of manual and mechanical ventilation on post-transport hypotension in patients undergoing cardiac surgery. Methods: This prospective clinical trial was conducted at a tertiary academic hospital. Adult patients who underwent open heart surgery were randomized to either (1) manual ventilation or (2) mechanical ventilation during transport. The primary outcomes were the hemodynamic parameters change. The secondary outcomes were the PaO2/FiO2 ratio and PaCO2 change. Results: A total of 78 patients were randomized into two groups: manual ventilation (n = 39) and mechanical ventilation (n = 39). Significant hypotension (>20% drop in mean arterial pressure post-transport) was noted in nine patients in the manual ventilation arm, but not in any patient in the mechanical ventilation arm. In manually ventilated patients, receiver operating characteristic curve analysis of systemic vascular resistance for significant hypotension showed that the area under the curve was 0.962 (95% CI, 0.891-1). No mechanically ventilated patients had significant hypotension. No significant difference was observed in % change in PaO2 and PaCO2 between the manual and mechanical ventilation arms. Conclusion: This study demonstrated that significant post-transport hypotension was more common in the manually ventilated arm than in the mechanically ventilated arm. No significant differences in oxygenation or ventilation were observed between the groups. The low systemic vascular resistance showed excellent predictive value for significant post-transport hypotension. Further research is warranted to identify patient-specific risk factors to enhance transportation safety.

ObjectivesThe prognostic value of preoperative serum albumin in patients undergoing elective aortic aneurysm repair remains uncertain. This systematic review and meta-analysis evaluated whether hypoalbuminemia predicts mortality in this population.MethodsA comprehensive search of PubMed, Scopus, Cochrane Library, Ovid, and CENTRAL was conducted up to January 21, 2024. Eligible studies included patients undergoing elective aortic aneurysm repair, comparing mortality between those with hypoalbuminemia and those with normal serum albumin levels. The Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias. Adjusted data were pooled to calculate odds ratios (ORs), and sensitivity analysis was performed.ResultsFour studies, comprising 14 136 patients were included. Meta-analysis demonstrated that hypoalbuminemia was significantly associated with increased odds of all-cause mortality (OR 3.18; 95% CI 1.78-5.67; P < 0.0001; I² = 88%). Subgroup analysis of endovascular procedures (EVAR, fenestrated or branched devices [F/B], and TEVAR) demonstrated a similar trend (OR 3.85; 95% CI 2.52-5.89; P < 0.00001; I² = 68%). Sensitivity analysis confirmed the validity of these findings.ConclusionsDespite the limited number of available studies and evidence level, preoperative hypoalbuminemia appears to be an independent predictor of mortality following elective aortic aneurysm repair, with most available evidence derived from endovascular procedures. Given its association with comorbidity decompensation, inflammation, and malnutrition, serum albumin assessment may serve as a valuable preoperative risk stratification tool. Further high-quality research is needed to validate these findings and explore their clinical applicability.

Objectives: This study aimed to compare short-term outcomes in patients extubated in the operating room (ORE) vs those extubated in the intensive care unit (ICUE) following cardiac surgery. Methods: A systematic search of MEDLINE and EMBASE was conducted from inception through September 2024. Pooled outcome estimates were calculated, and subgroup analyses were performed focusing on studies utilizing propensity score matching, weighting, or randomization. Results: Fourteen studies published between 2000 and 2024, encompassing 679,749 patients, were included. Of these, 6 utilized propensity score matching, 1 applied overlap weighting, and 1 employed randomization. Overall, ORE group had shorter aortic cross-clamp (P = 0.02) and cardiopulmonary bypass (P < 0.01) times. ORE patients had shorter ICU (P < 0.01) and hospital stays (P < 0.01). Rates of reintubation (P = 0.78), reoperation for bleeding (P = 0.18), prolonged mechanical ventilation (P = 0.12), and hospital readmission (P = 0.71) were comparable between the groups. Postoperative stroke rate (P < 0.01) and short-term mortality (P = 0.04) were lower in the ORE group. In the subgroup analysis, ICU stay, hospital stay, and cardiopulmonary bypass time remained shorter in ORE groupfund, while reoperation for bleeding was significantly higher (P < 0.01). However, the differences in postoperative stroke (P = 0.52) and short-term mortality (P = 0.42) were no longer statistically significant. Conclusion: This meta-analysis demonstrates that ORE after cardiac surgery can be performed in selected patients, with comparable postoperative outcomes to ICUE. The ORE strategy may result in shorter ICU and hospital stays.

. This single-center prospective observational study aimed to assess the correlation of net atrioventricular compliance (Cn) with pulmonary artery pressure in 26 adult patients with severe mitral stenosis (MS) undergoing surgical mitral valve replacement (MVR). Cn was estimated by doppler echocardiography, and pulmonary artery pressures measured by pulmonary artery catheter. Early outcomes including duration of intensive care unit (ICU) stay, mechanical ventilation duration, and vasoactive inotropic scores (VIS) were recorded. Cn showed moderate to strong negative correlation with systolic, diastolic, and mean pulmonary artery pressures at all time points. Receiver operating characteristic (ROC) curve analysis determined a cut-off of 2.31 to predict postoperative pulmonary artery systolic pressure. Cn with a cut-off value of 2.3 ml/mmHg serves as an indicator of persistent pulmonary hypertension following MVR surgery.

We present the case of a 73-year-old female with chemotherapy-induced cardiomyopathy, severe mitral regurgitation status post bioprosthetic mitral valve (MV) replacement one year prior, and atrial fibrillation, admitted for evaluation for left ventricular assist device (LVAD) implantation. While her preoperative transthoracic echocardiogram (TTE) did not reveal a discrete mass, it showed a mean mitral gradient of 7 mmHg; intraoperative transesophageal echocardiography (TEE) identified a 2 cm × 1.2 cm thrombus on the bioprosthetic MV. Given these findings, the surgical team decided to replace the mitral valve concurrently with LVAD implantation. Although this approach is not routine, the goal was to improve her quality of life and reduce postoperative complications. Post-procedure TEE showed an improved MV mean gradient of 3 mmHg with no evidence of paravalvular leak. The patient was subsequently discharged home in stable condition without any thromboembolic events. This case highlights the challenges of managing complex valvular pathology in patients undergoing LVAD placement.