Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Performance of Hemochron ACT-LR and ACT+ Test Cuvettes in Monitoring Low to Moderate Heparin Concentrations: An In Vitro Study.
According to the manufacturer, the Hemochron ACT-LR cuvette is designated for heparin concentrations of 0 to 2.5 IU/mL, while the optimal concentration range for the ACT+ cartridge is 1 to 6 IU/mL. We hypothesized that at low to moderate heparin concentrations, the ACT-LR is more reliable than the ACT+. ⋯ The performance of ACT+ is equal to that of ACT-LR up to a concentration of 0.5 IU/mL, above which ACT+ is superior to ACT-LR, questioning the rationale for a specific low-range test. However, there is a significant bias between ACT-LR and ACT+ measurements that needs to be considered if switching from one test to the other.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Intraoperative Methadone in Adult Cardiac Surgical Patients and Risks for Postoperative QTc Prolongation.
To evaluate the effect of intraoperative intravenous methadone within a standardized enhanced recovery after cardiac surgery pathway on the perioperative corrected QT interval (QTc). ⋯ A single intraoperative intravenous methadone dose did not prolong the QTc significantly or increase the incidence of arrhythmias and may be safe in adult cardiac surgical patients.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Association Between Pulmonary Artery Pulsatility Index and Radial Artery Pulse Pressure and Successful Separation from Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation: A French Single-Center Retrospective Study From 2017 to 2021.
Few reliable tools exist to predict weaning patient outcomes from venoarterial extracorporeal membrane oxygenation (ECMO; VA-ECMO). Pulmonary artery pulse pressure indexed on right atrial pressure (PAPi) reflects the ventricle-pulmonary coupling and may be representative of right ventricular recovery. Radial artery pulse pressure (rPP) may be representative of left ventricular recovery. We intended to explore the usefulness of these indices in the weaning from VA-ECMO. ⋯ Higher PAPi and rPP were predictors of successful weaning from VA-ECMO in this retrospective study.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Observational StudyAnesthetic and Perioperative Considerations for Convergent Procedure for Atrial Fibrillation: A Retrospective Observational Cohort Study.
To summarize anesthetic and perioperative considerations in patients undergoing the convergent procedure for atrial fibrillation (AF). ⋯ This retrospective analysis of medical records showed that many patients with recurrent AF presenting for convergent procedure carry a burden of multiple comorbidities (eg, obesity, obstructive sleep apnea), and history of unsuccessful ablations. Multistage multidisciplinary convergent procedure might be lengthy and potentially complicated and requires meticulous preparation (eg, endotracheal intubation, lung isolation, advanced cardiac monitoring, central venous access) to ensure optimal outcomes. Anesthesiologists and perioperative physicians should tailor their approach to this multimorbid population while anticipating perioperative respiratory events, rapid hemodynamic shifts, blood loss, and the possibility of CPB.
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J. Cardiothorac. Vasc. Anesth. · Feb 2025
Prebypass Critical Closing Pressure Predicts Acute Kidney Injury After Cardiopulmonary Bypass.
Optimal blood pressure goals during cardiopulmonary bypass (CPB) remain uncertain and new metrics to individualize perfusion targets are needed. Critical closing pressure (Pcrit) is a fundamental property of the arterial circulation related to vascular tone and represents the outflow pressure impacting flow across the systemic circulation. We examined Pcrit as a prognostic marker of acute kidney injury (AKI). ⋯ A higher prebypass Pcrit is associated with a significantly higher incidence of postoperative AKI. Future study is warranted to investigate using intraoperative Pcrit to determine a personalized blood pressure goal during CPB.