Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewVasoplegia in Heart, Lung, or Liver Transplantation: A Narrative Review.
Vasoplegia is a pathophysiologic state of hypotension in the setting of normal or high cardiac output and low systemic vascular resistance despite euvolemia and high-dose vasoconstrictors. Vasoplegia in heart, lung, or liver transplantation is of particular interest because it is common (approximately 29%, 28%, and 11%, respectively), is associated with adverse outcomes, and because the agents used to treat vasoplegia can affect immunosuppressive and other drug metabolism. This narrative review discusses the pathophysiology, risk factors, and treatment of vasoplegia in patients undergoing heart, lung, and liver transplantation. ⋯ Occasionally, agents, including methylene blue, hydroxocobalamin, and angiotensin II, are administered. Though retrospective literature suggests a hemodynamic response to these agents in the transplant population, minimal evidence is available to guide management. In what follows, we discuss the treatment of vasoplegia in the heart, lung, and liver transplant populations based on patient characteristics and potential risk factors associated with non-catecholamine agents.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Thrombotic Complications Associated With Right Atrial Lines in Neonates and Infants Undergoing Cardiac Surgery. Is Calcium Chloride a Culprit?
To determine if a change from calcium chloride to calcium gluconate infusion resulted in a decreased incidence of atrial thrombi and thrombotic events in neonates undergoing cardiac surgery. ⋯ In this single-center study, a significant decrease in the odds of an atrial catheter-related thrombus when a calcium gluconate infusion is used instead of calcium chloride was shown.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
How Would We Prevent Our Own Acute Kidney Injury After Cardiac Surgery?
Acute Kidney Injury (AKI) is a common complication after cardiac surgery affecting up to 40% leading to increased morbidity and mortality. To date, there is no specific treatment for AKI, thus, clinical research efforts are focused on preventive measures. The only pharmacological preventive intervention that has demonstrated a beneficial effect on AKI in a high-quality, double-blind, randomized controlled trial is a short perioperative infusion of a balanced mixture of amino acid solution. ⋯ The Kidney Disease Improving Global Outcomes (KDIGO) bundle includes the discontinuation of nephrotoxic agents, volume status and perfusion pressure assessment, renal functional hemodynamic monitoring, serum creatine, and urine output monitoring, and the avoidance of hyperglycemia and radiocontrast procedures. However, pooled data from a meta-analysis did not find a significant reduction in AKI. The aim of this review is to delineate the most appropriate evidence-based approach to prevent AKI in cardiac surgery patients.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Predictors of Mortality in Venoarterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience.
The use of an intra-aortic balloon pump (IABP) has been suggested to unload the left ventricle while on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS), leading to possibly improved in-hospital mortality. However, the predictors of mortality on dual mechanical circulatory support have not yet been evaluated, especially in real-world clinical settings. Therefore, a case-control study was conducted to determine the rate of all-cause mortality associated with VA-ECMO use regardless of left ventricular (LV) unloading, and with early LV unloading in the setting of CS, and to identify the predictors of mortality associated with VA-ECMO, with concurrent early LV unloading. ⋯ The mortality rate in CS requiring VA-ECMO, regardless of IABP use, remains high. However, only one predictor (ie, prolonged CPR) was found to increase the likelihood of 30-day mortality with early LV unloading, suggesting that concomitant IABP use might minimize the effect of mortality predictors.