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Clinical Advances in Cardiac Anesthesia and Critical Care
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Clinical Advances in Cardiac Anesthesia and Critical Care

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 3092

Special Issue Editors

Prof. Dr. Marc Licker

E-Mail Website
Guest Editor
1. Department of Cardiovascular & Thoracic Anaesthesia and Critical Care Medicine, University Hospital of Martinique, F-97200 Fort de France, France
2. Faculty of Medicine, University of Geneva, Geneva, Switzerland
Interests: cardiovascular and thoracic anesthesia; myocardial protection; postoperative pulmonary complications; mechanical ventilation; critical care; transesophageal echocardiography
Prof. Dr. Tiziano Cassina

E-Mail Website
Guest Editor
Department of Cardiovascular Anesthesia & Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
Interests: anesthesia; medicina intensiva; cardiovascular anesthesia; intensive care

Special Issue Information

Dear Colleagues,

Over the last decade, cardiac anesthesia and critical care have evolved remarkably to embrace a broad spectrum of interventions extending from minimally invasive procedures for valvular repair/replacement, to combined/hybrid complex cardiac procedures and to mechanical circulatory support devices as an alternative or a bridge to transplantation. Although cardiological and surgical procedures are increasingly performed in higher-risk patients due to age, frailty, comorbidities or critical status, excellent results are achieved thanks to a dynamic multidisciplinary approach involving cardiac surgeons, cardiologists, cardiac anesthesiologists and critical care physicians (i.e., these last two subspecialists are often merged into a single team). Evidence-based practices in perioperative organ protection are pivotal in improving clinically relevant outcomes as well as ensuring patient safety and comfort. Multimodal analgesia and minimizing the dose of opiate with ultrasound-guided regional anesthesia or spinal analgesia have made early extubation and enhanced recovery after surgery (ERAS) possible. Perioperative imaging including 3D transesophageal echocardiography coupled with newer hemodynamic monitors (i.e., tissue oximetry, pulse contour analysis of arterial pressure), point-of-care monitors of hemostasis and short-acting drugs are essential for safe cardiac anesthesia.

It is our pleasure to invite investigators and experts in the field of cardiac anesthesia and critical care to join the scientific debate and participate with their contributions (narrative or systematic reviews, original papers) to be submitted to this Special Issue devoted to “Clinical Advances in Cardiac Anesthesia and Critical Care”.

Prof. Dr. Marc Licker
Prof. Dr. Tiziano Cassina
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiac anesthesia
  • critical care
  • perioperative organ protection
  • multimodal analgesia
  • regional anesthesia
  • spinal analgesia
  • perioperative imaging
  • 3D transesophageal echocardiography

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Published Papers (3 papers)

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Research

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11 pages, 778 KiB  
Article
Perioperative Red Blood Cell Transfusion and Long-Term Mortality in Coronary Artery Bypass Grafting: On-Pump and Off-Pump Analysis
by Seung Hyung Lee, Ji Eon Kim, Jun Ho Lee, Jae Seung Jung, Ho Sung Son and Hee-Jung Kim
J. Clin. Med. 2025, 14(8), 2662; https://doi.org/10.3390/jcm14082662 - 13 Apr 2025
Viewed by 166
Abstract
Background/Objectives: The impact of different coronary artery bypass grafting (CABG) strategies, particularly on-pump versus off-pump techniques, on red blood cell (RBC) transfusions and their associated outcomes has not been fully investigated. This study aims to evaluate the association between RBC transfusion and [...] Read more.
Background/Objectives: The impact of different coronary artery bypass grafting (CABG) strategies, particularly on-pump versus off-pump techniques, on red blood cell (RBC) transfusions and their associated outcomes has not been fully investigated. This study aims to evaluate the association between RBC transfusion and survival in CABG patients, focusing on-pump strategy. Methods: Data from CABG patients were retrieved from the National Health Insurance Service database (2003 to 2019). Perioperative RBC transfusions were classified into three groups: no transfusion, RBC 1, and RBC ≥ 2 units. The primary endpoint was all-cause mortality rate. Subgroup analysis assessed the impact of RBC transfusion on mortality across the conventional on-pump (CCAB) and off-pump (OPCAB) groups. Results: Among the 6150 participants who underwent CABG, 2028 underwent CCAB and 4122 underwent OPCAB. The mean age was 66.2 ± 9.7 years, with a mean follow-up of 2.9 (2.53–3.35) years. Multivariable analysis showed a significant association between transfusion of ≥2 RBC units and increased mortality risk (HR 2.34 [1.65–3.32], p < 0.001). Subgroup analysis showed a similar trend in both CCAB and OPCAB groups (p for interaction = 0.2). Transfusion of ≥2 units significantly increased mortality in OPCAB (HR 2.28 [1.55–3.37], p < 0.001) but not in CCAB (HR 2.96 [0.97–9.06], p = 0.057). OPCAB and surgery at large volume center was associated with a reduced risk of RBC transfusion (p < 0.01). Conclusions: Increased RBC transfusion is associated with higher long-term mortality in patients undergoing CABG. Based on a large cohort predominantly consisting of OPCAB patients, OPCAB is associated with decreased RBC transfusion requirements. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiac Anesthesia and Critical Care)
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13 pages, 1526 KiB  
Article
Effects of Implementing an Enhanced Recovery After Cardiac Surgery Protocol with On-Table Extubation on Patient Outcome and Satisfaction—A Before–After Study
by Adelina Werner, Hannah Conrads, Johanna Rosenberger, Marcus Creutzenberg, Bernhard Graf, Maik Foltan, Sebastian Blecha, Andrea Stadlbauer, Bernhard Floerchinger, Maria Tafelmeier, Michael Arzt, Christof Schmid and Diane Bitzinger
J. Clin. Med. 2025, 14(2), 352; https://doi.org/10.3390/jcm14020352 - 8 Jan 2025
Viewed by 1119
Abstract
Background/Objectives: Enhanced recovery after surgery (ERAS) protocols aim to improve clinical outcomes, shorten hospital length of stay (LOS), and reduce costs through a multidisciplinary perioperative approach. Although introduced in colorectal surgery, they are less established in cardiac surgery, especially in combination with [...] Read more.
Background/Objectives: Enhanced recovery after surgery (ERAS) protocols aim to improve clinical outcomes, shorten hospital length of stay (LOS), and reduce costs through a multidisciplinary perioperative approach. Although introduced in colorectal surgery, they are less established in cardiac surgery, especially in combination with on-table extubation (OTE). This study evaluates the impact of a novel ERAS concept with OTE (RERACS) in elective aortic-valve-replacement and coronary bypass surgery. Methods: In a monocentric study, we compared a prospective RERACS-group (n = 114) to a retrospective control group (n = 119) (TRIAL Registration (DRKS00031402). The RERACS concept contained multiple perioperative treatment measures such as respiratory training, short fasting, and OTE. The control group received standard care. Results: Primary endpoint: postoperative LOS. Secondary measurements: length of postoperative vasoactive drug support, duration of mechanical ventilation, complication rate, and patient satisfaction on the second postoperative day. RERACS patients showed significantly shorter postoperative length of stay (ICU: 40 ± 34 h vs. 56 ± 51 h, p = 0.005; hospital: 9 ± 4 d vs. 11 ± 6 d, p = 0.028), lower nosocomial infection rates (24% vs. 40%), fewer cases of postoperative cognitive dysfunction ((subsyndromal) delirium 40% vs. 57%), reduced nausea and vomiting (14.9% vs. 32.8%), and faster weaning from catecholamines (22 ± 30 h vs. 42 ± 48 h, p < 0.001), as well as high patient satisfaction. Conclusions: Our study indicated that an ERAS concept with OTE is safe and associated with faster and improved recovery, including lower catecholamine requirements, reduced LOS, and high patient satisfaction in low-risk cardiac surgery. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiac Anesthesia and Critical Care)
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Review

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10 pages, 2336 KiB  
Review
The Management of Postpartum Cardiorespiratory Failure in a Patient with COVID-19 and Sickle Cell Trait Requiring Extraorporeal Membrane Oxygenation Support and Airflight Transportation
by Alexandre Pelouze, Sylvain Massias, Diae El Manser, Adrien Koeltz, Patricia Shri Balram Christophe, Mohamed Soualhi and Marc Licker
J. Clin. Med. 2025, 14(1), 213; https://doi.org/10.3390/jcm14010213 - 2 Jan 2025
Viewed by 1137
Abstract
Acute cardiovascular disorders are incriminated in up to 33% of maternal deaths, and the presence of sickle cell anemia (SCA) aggravates the risk of peripartum complications. Herein, we present a 24-year-old Caribbean woman with known SCA who developed a vaso-occlusive crisis at 36 [...] Read more.
Acute cardiovascular disorders are incriminated in up to 33% of maternal deaths, and the presence of sickle cell anemia (SCA) aggravates the risk of peripartum complications. Herein, we present a 24-year-old Caribbean woman with known SCA who developed a vaso-occlusive crisis at 36 weeks of gestation that required emergency Cesarean section. In the early postpartum period, she experienced fever with rapid onset of acute respiratory distress in the context of COVID-19 infection that required tracheal intubation and mechanical ventilatory support with broad-spectrum antibiotics and blood exchange transfusion. Shortly thereafter, transthoracic echocardiography documented severe biventricular dysfunction associated with raising levels of cardiac troponin and ECG signs of myocardial ischemia. Medical treatment with incremental dobutamine and noradrenaline infusion failed to improve cardiac output and blood gas exchange. After consultation with the regional cardiac center, a prompt decision was made to provide cardiac and respiratory support via implantation of femoral cannula and initiation of veno-arterial extracorporeal membrane oxygenation (ECMO, Cardiohelp®). Under stable ECMO, the patient was transferred by helicopter to a specialized cardiac center. There were no signs of ongoing hemolysis, and progressive recovery of the right and left ventricular function facilitated forward blood flow through the aortic valve. Three days after implantation, ECMO was weaned, and the cannula were removed. One day later, the patient’s chest X-rays showed partial resolution of lung edema. The patient was successfully extubated, and non-invasive ventilation with pulmonary rehabilitation was initiated to speed up her functional recovery. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiac Anesthesia and Critical Care)
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