Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2025
ReviewEffect of del Nido Cardioplegia on Isolated Coronary Artery Bypass Grafting: A Study-level Meta-analysis.
The purpose of this study was to evaluate the effect of del Nido cardioplegia versus conventional cardioplegic solutions on early outcomes of isolated coronary artery bypass grafting (CABG). PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched through July 2024 to conduct a meta-analysis for a comparison between del Nido and other cardioplegic solutions in isolated CABG. Major end points of the study included operative mortality and morbidities. ⋯ Subgroup analyses also demonstrated these significant differences. In patients undergoing isolated CABG, del Nido cardioplegia provides comparable mortality compared with other cardioplegic solutions. Del Nido solution was significantly protective against myocardial infarction and renal failure.
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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
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.