Journal of cardiothoracic and vascular anesthesia
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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.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Multicenter StudyEnhanced Recovery after Surgery (ERAS) in Pediatric Cardiac Surgery: Status Quo of Implementation in Europe.
Enhanced recovery after surgery (ERAS) is a multimodal care pathway to enhance recovery after surgery that is well established in various surgical disciplines. In pediatric cardiac surgery, implementation of ERAS protocols remains inconsistent. We conducted a survey of active European pediatric cardiac surgical centers to assess the current state of ERAS concepts and the current practice in perioperative pediatric cardiac care. ⋯ This European survey revealed that implementation of ERAS concepts in pediatric cardiac surgery is generally low, with considerable heterogeneity in clinical practice regarding the timing of extubation, the choice of surgical procedures triggering on-table extubation, the choice of anesthetic drugs and the use of regional anesthesia. More coordinated efforts are needed to implement ERAS concepts in pediatric cardiac surgery and harvest the benefits of ERAS concepts for the pediatric cardiac population.
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
Randomized Controlled Trial Comparative StudySelf-Directed Virtual Reality-Based Training versus Traditional Physician-Led Teaching for Point-of-Care Cardiac Ultrasound: A Randomized Controlled Study.
To assess the learning efficacy of self-directed virtual reality ultrasound simulators as an alternative to traditional physician-led teaching for cardiac point-of-care ultrasound (POCUS) training. ⋯ Our study demonstrates that at 1 month post-training, self-directed VR training was noninferior to PL training. Although differences observed were not significant, there were trends to suggest enhanced retention of knowledge and skills with VR learning.