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
Review Meta AnalysisHemodynamic Impact of the Trendelenburg Position: A Systematic Review and Meta-analysis.
To systematically evaluate the impact of the Trendelenburg position on hemodynamic parameters in adult patients. ⋯ The Trendelenburg position significantly increases stroke volume and improves multiple hemodynamic parameters in adult patients. These results confirm the position's potential clinical relevance in hemodynamic management and suggest the possibility of a tailored application in selected clinical settings. The duration of the beneficial effects of the Trendelenburg position and the possible side effects should be the focus of further investigation.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Review Meta AnalysisCorrelation Between Tissue Doppler Imaging Method (E/e') and Invasive Measurements of Left Ventricular Filling Pressures: A Systematic Review, Meta-Analysis, and Meta-Regression.
Evaluation of pulmonary capillary wedge pressure (PCWP) through right heart catheterization can indirectly provide an estimation of the filling pressure of the left ventricle. Echocardiography can estimate left ventricular compliance using mitral annular tissue Doppler imaging (TDI). The E/e' ratio refers to the correlation between the peak mitral inflow (E-wave) velocity and early diastolic tissue Doppler mitral annular velocity (e'). The main purpose of this systematic review was to establish the correlation between echocardiographic E/e' ratio and PCWP. The correlation between E/e' and left ventricular end-diastolic pressure (LVEDP) was evaluated as a secondary objective. ⋯ The E/e' ratio moderately correlated with PCWP/LVEDP. The correlation was stable irrespective of the sites where e' was measured, but each site has its own limitations for specific patient subpopulations. The correlation was weak in patients with heart failure with a preserved ejection fraction.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Review Meta AnalysisLocal Adverse Events Associated with Peripheral Vasoactive Infusion in Children: A Systematic Review with Meta-analysis.
Prior meta-analysis suggested a low incidence of local adverse events after infusion of vasoactive agents via a peripheral venous catheter in children. However, the number of included patients was relatively low, and the vasoactive agents used were mostly dopamine. We performed an updated systematic review with meta-analysis using databases of MEDLINE (via PubMed) and Cochrane Central Register of Controlled Trials to explore the safety of infusing vasoactive agents, including epinephrine and norepinephrine, through peripheral venous catheters or intraosseous access in critically ill children. ⋯ The pooled incidence rates of local adverse events associated with infusion of vasoactive agents through peripheral venous catheters or intraosseous access, peripheral venous catheters only, and intraosseous access only were 2.1% (95% confidence interval [CI]: 0.8%-3.9%), 2.3% (95% CI: 1.0%-4.0%), and 1.1% (95% CI: 0.0%-9.8%), respectively. Based on the findings of this meta-analysis, the incidence rate of local adverse events associated with peripheral vasoactive infusion appears to be low. Peripheral infusion of vasoactive agents, including epinephrine and norepinephrine, can be considered when necessary.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Meta AnalysisEfficacy of Therapeutic Plasma Exchange or Cangrelor as an Adjunctive Strategy to Facilitate Cardiopulmonary Bypass in Patients with Heparin-Induced Thrombocytopenia: A Systematic Review and Meta-Analysis.
Conduct a systematic review and meta-analysis of the efficacy of therapeutic plasma exchange (TPE) or intravenous cangrelor to prevent thromboembolism in patients with heparin-induced thrombocytopenia (HIT) who undergo cardiopulmonary bypass (CPB) with heparin. ⋯ TPE and cangrelor are feasible strategies to prevent thromboembolism in adults with HIT who require CPB with heparin. Given the relatively small number of cases in the published literature and a high likelihood for publication and detection biases, prudence remains warranted when using these strategies.