Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Review Meta AnalysisHemodynamic Impact of the Trendelenburg Position: A Systematic Review and Meta-analysis.
To systematically evaluate the impact of the Trendelenburg position on hemodynamic parameters in adult patients. ⋯ The Trendelenburg position significantly increases stroke volume and improves multiple hemodynamic parameters in adult patients. These results confirm the position's potential clinical relevance in hemodynamic management and suggest the possibility of a tailored application in selected clinical settings. The duration of the beneficial effects of the Trendelenburg position and the possible side effects should be the focus of further investigation.
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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
Review Meta Analysis Comparative StudySingle Arterial Cannulation vs. Dual Arterial Cannulation during Acute Type A Aortic Dissection Repair: A Systematic Review and Meta-Analysis.
Acute type A aortic dissection (ATAAD) is a cardiovascular emergency with high mortality and morbidity. We compared the effects on outcomes of single arterial cannulation (SAC) via axillary, femoral, or ascending aorta with double arterial cannulation (DAC) via axillary and femoral artery during ATAAD repair. ⋯ Despite comparable overall outcomes, we observed that DAC was associated with higher risks of requiring continuous renal replacement therapy or dialysis, and reintubation. This emphasizes the need to carefully consider cannulation strategies based on patient factors to balance potential benefits and risks.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Randomized Controlled Trial Multicenter StudyLevosimendan in Patients with Low Cardiac Output Syndrome After Cardiac Surgery: A Substudy of the Multicenter Randomized CHEETAH Trial.
To test the hypothesis that levosimendan administration in patients with low cardiac output syndrome after cardiac surgery is associated with improved long-term (5-year follow-up) outcomes. ⋯ Among patients requiring hemodynamic support after cardiac surgery with CPB, perioperative levosimendan infusion did not affect long-term survival (1-5 years) compared with placebo. Levosimendan also had no effect on major clinical outcomes such as AKI, ICU stay, hospital stay, and 30-day mortality.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Review Historical ArticlePerspectives on the History of Coronary Physiology: Discovery of Major Principles and Their Clinical Correlates.
Coronary circulation plays an essential role in delivering oxygen and metabolic substrates to satisfy the considerable energy demand of the heart. This article reviews the history that led to the current understanding of coronary physiology, beginning with William Harvey's revolutionary discovery of systemic blood circulation in the 17th century, and extending through the 20th century when the major mechanisms regulating coronary blood flow (CBF) were elucidated: extravascular compressive forces, metabolic control, pressure-flow autoregulation, and neural pathways. Pivotal research studies providing evidence for each of these mechanisms are described, along with their clinical correlates. ⋯ Despite reliance on crude experimental techniques, the pioneers in coronary physiology made groundbreaking discoveries upon which our current knowledge is predicated. Further advances in coronary physiology were facilitated by technological developments, including methods to measure phasic CBF and its regional distribution, and by biochemical discoveries, including endothelial vasoactive molecules and adrenergic receptor subtypes. The authors recognize the invaluable contribution made by basic scientists toward the understanding of CBF regulation, and the enormous impact that this fundamental information has had on improving clinical diagnosis, decision-making, and patient care.