Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
ReviewOutcomes in Women Undergoing Coronary Artery Bypass Grafting: Analysis of New Data and Operative Trends.
In 2019, coronary artery bypass grafting (CABG) made up more than one-half of all adult cardiac surgical procedures in the United States, with an estimated 301,077 procedures performed, of which 161,816 were isolated CABG, and approximately 25% of which were performed in women. Women undergoing CABG are statistically more likely to present for surgery at an older age, with a greater burden of comorbidities such as diabetes and hypertension, and in decompensated clinical states (eg, acute myocardial infarction or cardiogenic shock) versus their male counterparts. However, sex has been shown to be an independent risk factor for worse outcomes even when controlling for these differences. ⋯ Despite this, the recent evidence from Gaudino et al5 suggests that the outcomes gap between men and women has not improved. In their cohort study examining 1,297,204 patients undergoing isolated CABG from 2011 to 2020 in the US, women had a higher unadjusted risk of operative (30-day) morbidity and mortality, with no signs of improvement in this gap over the study period, suggesting that a greater understanding of and attention to sex-based outcomes in CABG operations are warranted. A thorough understanding of this discrepancy and the possible contributing factors is essential to improving outcomes for women undergoing CABG.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
ReviewSpinal Cord Injury Following Venoarterial Extracorporeal Membrane Oxygenation: A Scoping Review.
Spinal cord infarction (SCI) or ischemia is a rare but devastating complication of venoarterial extracorporeal membrane oxygenation (VA ECMO). The natural course and outcomes are poorly studied. ⋯ Spinal infarction/ischemia on VA ECMO typically presents with paraplegia of lower extremities with low potential for even partial recovery. Because no treatment is currently available, the efforts should be focused on prevention. Several strategies have been proposed, but they need further testing under controlled settings.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Multicenter StudyThe Use of Methadone and Ketamine for Intraoperative Pain Management in Cardiac Surgery: A Retrospective Cohort Study.
To evaluate whether the addition of ketamine to intraoperative methadone is associated with superior postoperative pain management and decreased opioid consumption compared with methadone alone in cardiac surgery patients. ⋯ Adding ketamine to methadone prolonged the time to first opioid consumption postoperatively but showed no benefits beyond POD 0. Future studies should consider protocolized dosing to optimize pain control.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Observational StudyPredicting Extent of Opioid Use Following Cardiac Surgery: A Pilot Study.
This study was designed to test whether a negative affect phenotype reflecting depression, anxiety, anger, and pain catastrophizing predicts inpatient and outpatient opioid use outcomes following cardiac surgery. ⋯ Patients with higher preoperative levels of negative affect (depression, anxiety, anger, and pain catastrophizing) use more inpatient and outpatient opioid analgesics following cardiac surgery, a pattern similar to noncardiac surgery populations. Results support further study of patient-specific approaches to opioid prescribing to reduce the risk for opioid use disorder post-cardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Observational StudyIntroduction of a Vendor-Independent Application for Clinical Generation of Pressure-Volume Loops from Routine Hemodynamic Data: A Methodological Exploration.
In the dynamic perioperative setting, changing fluid states complicate determination of ventricular function. This study evaluated the feasibility of clinical ventricular pressure-volume loop (PVL) construction using routine monitoring (echocardiography and invasive pressure monitoring). An application was developed and tested with biventricular simulated data and right ventricular (RV) clinical data. ⋯ This study introduces a vendor-independent application to generate PVLs from routinely available clinical data. The results highlight the potential application of the pressure-volume framework in cardiovascular research and patient care. A lack of external validation must be taken into account. Further research is warranted to validate the application. The app can be accessed at https://michael-vandenheuvel.shinyapps.io/eMv_Looper/.