Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Ultrafiltration During Cardiac Surgery Requiring Cardiopulmonary Bypass and Its Effect on Acute Kidney Injury.
To explore whether ultrafiltration (UF) volume adjusted for weight is associated with an increased risk of acute kidney injury (AKI) after cardiopulmonary bypass (CPB) in cardiac surgery patients. ⋯ This study suggests that conventional UF is a potential risk factor for AKI incidence following surgery with CPB. The results demonstrate an association between higher weight-adjusted ultrafiltration volume and a higher incidence of AKI. Future studies should incorporate a multicenter, prospective approach to test the generalizability of the present findings and validate modified ultrafiltration strategies that use hemodynamic variables to determine fluid removal volume.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Observational StudyReduction in Postoperative Right Ventricular Echocardiographic Indices Predicts Longer Duration of Vasoactive Support After Cardiac Surgery.
To assess perioperative right ventricular (RV) echocardiographic indices and their relationship to vasopressor and inotropic support in cardiac surgical patients. The authors hypothesized that a reduction in echocardiographic parameters of RV function would be associated with a longer duration of vasopressor and inotropic support in the intensive care unit (ICU). ⋯ Patients with post-CPB TAPSE <17 mmHg require a longer duration of inotropic support in the ICU. From all measured RV echocardiographic indices, post-CPB FAC is an independent predictor of vasopressor and inotropic support. A reduction of post-CPB TAPSE and FAC in patients undergoing cardiac surgery is indicative of RV dysfunction requiring a longer use of vasopressor and inotropic support and potentially longer stay in the cardiovascular ICU.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
The Hemodynamic Effects of Protamine in Pediatric Patients Undergoing Pulmonary Artery Reconstruction and Unifocalization Surgery: A Pilot StudyHemodynamic Effects of Protamine in Children.
To determine protamine administration increases pulmonary artery pressures (PAPs) in patients undergoing unifocalization or pulmonary artery reconstruction surgeries. ⋯ Protamine administration led to a small increase in PAP after separation from cardiopulmonary bypass in patients undergoing pulmonary artery reconstruction or unifocalization surgeries. Calcium coadministration did not lead to a greater increase in PAP.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Correlation Between Intraoperative Near-infrared Spectroscopy Values and Neurologic Outcomes in Patients Undergoing Total Aortic Arch Replacement Using the Frozen Elephant Trunk Technique.
To correlate intraoperative near-infrared spectroscopy (NIRS) values with neurologic outcomes in patients undergoing total aortic arch replacement using the frozen elephant trunk (FET) technique. ⋯ NIRS is a reliable tool to monitor intraoperative frontal lobe cerebral oxygen saturation. However, its use to predict postoperative stroke remains limited. Further refinements are needed to develop the technique into a prediction tool.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Case ReportsPulmonary Artery Pseudoaneurysm Due to Pulmonary Artery Catheter Placement: A New Minimally Invasive Approach to Solve a Life-threatening Complication.
This article discusses a pulmonary artery pseudoaneurysm (PAP) formation following pulmonary artery catheter (PAC) placement for cardiac surgery. The patient, an 82-year-old female with a history of hypertension and chronic heart failure, underwent elective mitral and tricuspid valve surgery. After surgery, bleeding was observed in the endotracheal tube, indicating a potential complication. ⋯ While conservative, surgical, and interventional approaches are discussed, the preferred treatment is coil embolization due to its effectiveness and minimal invasiveness. The authors emphasize the importance of rapid diagnosis, multidisciplinary collaboration, and the feasibility of using the pulmonary artery route for embolization to rapidly reach the lesion to stabilize. Overall, the case demonstrates the successful resolution of a life-threatening complication through timely intervention and coordinated teamwork.