Seminars in Cardiothoracic and Vascular Anesthesia最新文献

Background: The novel method of non-invasive right ventricular (RV) myocardial work (MW) analysis provides a load-independent assessment of RV function by combining myocardial strain with loading conditions. However, its use has not been well described in the perioperative setting to date. We aimed to evaluate the feasibility of assessing RV MW, and to describe the perioperative course of this new technique. Methods: In this retrospective study, patients scheduled for LVAD surgery were evaluated for feasibility of RV MW analysis. Preoperative (T1) and postoperative (T2) transthoracic echocardiography (TTE) included the assessment of conventional echocardiographic measurements, myocardial strain, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) for the evaluation of RV function. Results: Ten patients had complete TTE data available for RV MW analysis, which indicated significant reduction of effective and ineffective RV MW (GWI, 212 mmHg% (IQR 128; 266) v 96 mmHg% (IQR 63; 150), P = 0.02; GCW, 331 mmHg% (IQR 263; 476) v 198 mmHg% (IQR 136; 274), P < 0.01; GWW, 171 mmHg% (IQR 102; 243) v 98 mmHg% (IQR 48; 153), P = 0.04), while GWE remained stable (69% (IQR 37; 78) v 64% (IQR 61; 78), P = 0.26) after LVAD implantation. Conventional parameters were not able to detect these changes. Moreover, there were different trends of RV MW indices in patients with and without postimplant RV failure. Conclusion: This study demonstrates that non-invasive RV MW assessment is feasible in the perioperative setting of LVAD implantation and provides valuable insights into RV function that are not captured by conventional echocardiographic methods. Further research is warranted to validate these findings.

Introduction: Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with higher morbidity and mortality. This paper presents several studies that conclude the presence of an aberrant p-terminal force vector in lead V1 (PTFV1) has been identified as a significant predictor of atrial fibrillation in the non-surgical population. It is uncertain whether or not there is an association of PTFV1 and new-onset POAF in patients after cardiac surgery. Methods: In this secondary analysis, adult patients undergoing on-pump cardiac surgery for aortocoronary bypasses, valve surgery, combined bypass, and valve surgery were analyzed from 12/2018 to 08/2020. Patients who had a previous occurrence of atrial fibrillation or atrial flutter, patients with pacemakers and/or Implantable Cardioverter-Defibrillators (ICDs), and those who did not have an electrocardiogram (ECG) performed within the 3 months before surgery were excluded. In addition, ECGs that were considered to be of low quality were also removed. Preoperative 12-lead ECGs were examined and the PTFV1 was measured. Secondarily, we examined the P-wave length in lead II, the area under the P-wave in lead II, PR interval, and QRS duration in lead V1 and II. The occurrence of POAF was extracted from the hospital record. Results: Out of a total of 252 patients, 62 patients (24.6%) developed new onset POAF during their hospital stay. POAF occurred primarily in older patients, with poor renal function, and exhibited larger left atria. Analysis of ORs (odds ratios) revealed that age, creatinine clearance, valve surgery, and left atrial volume index (LAVI) were associated with POAF. In the context of the multivariable analysis, it was demonstrated that only age presented a significant correlation with postoperative atrial fibrillation (POAF). There was no observed relationship between any of the parameters based on ECG and the occurrence of POAF. Conclusion: No association was found between PTFV1 or other ECG-based measurements and new onset POAF in cardiac surgery patients. Age was the only independent predictor of POAF.

Internationally, extracorporeal membrane oxygenation (ECMO) is now a core and standard organ support tool to provide tertiary critical care and cardiac services within a network of hospitals and a key tool for running an effective and efficient cardio-respiratory pathways. The letter aims to put the spotlight on some of the missing clinical evidence on respiratory ECMO and including them will help to arrive at a better-informed national ECMO policy decision.

IntroductionPostoperative acute kidney injury (AKI) is a common postoperative complication in cardiac surgery, with varying reported incidences and prognostic factors. Renal hypoperfusion is believed to be a key factor contributing to postoperative AKI. Near-infrared spectroscopy (NIRS) monitoring, which assesses regional tissue saturation (RSO₂), has been suggested as a tool to predict postoperative AKI. The aim of this systematic review was to examine the prognostic value of perioperative NIRS monitoring in predicting postoperative AKI in pediatric patients.Methods and ResultsAfter a systematic search in PubMed, EMBASE, and Cochrane library, twenty studies (1517 patients) were included. The inter-rater agreement on study quality was strong, yet a high risk of bias was identified.ConclusionThe heterogeneity of the results-in part attributable to several potential confounding factors regarding study population, monitoring technique and the definition of AKI-together with the lack of a clear and consistent association between RSO₂ values and AKI, currently preclude recommending NIRS monitoring as a reliable and valid clinical tool to "predict" AKI in the individual patient.

Flash pulmonary edema can affect up to 10% of women with preeclampsia. Although there is growing literature describing the use of extracorporeal membrane oxygenation (ECMO) in pregnant patients, there is very little research describing its use in the setting of preeclampsia. In this case report, an encouraging story of a woman with this complication who was successfully managed is described. In addition, the impact of normal physiologic changes of pregnancy on ECMO management is discussed.

BackgroundWhile several studies have summarised the clinical effectiveness evidence for extracorporeal membrane oxygenation (ECMO), there are no evidence syntheses of the impact of centres' ECMO patient volume on patient outcomes or the impact of bedside ECMO care being delivered by either a perfusionist or a nurse. There is also limited information on the cost-effectiveness of ECMO.PurposeThis review was carried out to evaluate the clinical effectiveness and cost of different service delivery models of pulmonary ECMO to inform NHS Wales commissioning policy.Research DesignThe study utilised rapid review methodology, consisting of a systematic literature search and the inclusion of the highest quality of evidence available.Data CollectionOut of 1997 records identified via literature searches, 12 studies fell within the scope. The 2 meta-analyses comparing ECMO with lung-protective ventilation favoured ECMO.ResultsFive studies looking at the clinical impact of centre patient volume had large heterogeneity. Three studies estimated that with sufficient patient volume, nurse-delivered ECMO was cost-saving, with thresholds varying between 92 and 155 patient days per year. Three studies looked at the cost impact of ECMO delivery, with ECMO being cost incurring, but potentially cost-effective, with costs per patient being lower at higher volume centres.ConclusionsThe available evidence supports the use of ECMO in adult respiratory failure patients, despite it being cost-incurring. ECMO can be nurse-delivered without a significant negative impact on patient care. Yet decision-makers need to consider their local circumstances when making commissioning decisions.

Congenital heart block (CHB) is a rare congenital cardiac disease where disruption of the atrioventricular (AV) node results in cardiac conduction abnormalities. The majority of CHB cases are associated with neonatal lupus antibodies that are associated with autoimmune destruction and fibrosis of the AV node, most commonly resulting in a congenital complete heart block (CCHB). We report the case of a 23-year-old mother who was found to have a fetus with significant bradycardia at a 21-week anatomy ultrasound. Subsequent fetal echocardiograms demonstrated a third-degree heart block, and laboratory workup of the mother was positive for SSA antibodies. Successful care of the fetus required multidisciplinary coordination to ensure adequate antepartum care, successful delivery of the fetus, and proper cardiovascular management of the neonate after birth. We discuss etiologies of fetal bradycardia, proper imaging techniques to diagnose fetal cardiac abnormalities, and the management of a neonate with CCHB after birth. Lastly, we emphasize how adequate operating room preparation and multidisciplinary planning are essential for optimal outcomes during time-sensitive and high-risk operating room procedures.

This review focuses on highlighting published literature in 2024 relating to the anesthetic management of children with congenital heart disease (CHD). Four major themes are discussed: (i) enhanced recovery after pediatric cardiac surgery (ERAS); (ii) acute kidney injury following cardiac surgery; (iii) neurodevelopmental outcomes and neuromonitoring; and (iv) cardiopulmonary bypass (CPB) and blood conservation strategies.

This review highlights noteworthy literature published in 2024 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We feature 13 studies from over 5555 peer-reviewed publications on kidney transplantation, 4 studies from 1963 publications on pancreas transplantation, and 3 studies from 1879 publications on intestinal transplantation. The liver transplantation section includes a special focus on 22 studies from 4571 clinical trials published in 2024. We identified the new findings with our specialty interest, including cardiovascular risk assessment, machine perfusion, hemodynamic management, mode of anesthesia and regional techniques, donor management, fluid management, intraoperative monitoring, blood salvage, frailty, and rehabilitation and prehabilitation.