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Cardiac Anesthesia: Current Research and Future Prospects

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

Deadline for manuscript submissions: closed (20 February 2026) | Viewed by 2292

Special Issue Editors


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Guest Editor
Anaesthesia and Intensive Care, ASST Valtellina e Alto Lario, 23100 Sondrio, Italy
Interests: ECMO; perioperative echocardiography; endothelial function; cardiac anaesthesia; cardiac arrest; ECPR

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Guest Editor
Department of Anaesthesia, Critical Care and Emergency Medicine, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
Interests: emergency medicine; pulmonary hypertension; echocardiography; heart failure; pulmonary circulation

Special Issue Information

Dear Colleagues,

Advances in the field of cardiac anesthesia have made it possible to treat increasingly elderly and complex patients.

Furthermore, from the original environment of the operating theatre, over the years, cardiac anesthetists have taken on an increasingly prominent role in the fields of interventional cardiology, short- and medium-term mechanical support, extracorporeal resuscitation (ECPR), and highly complex non-cardiac surgery in cardiac patients.

The number of procedures—in and out of the cardiac theatre—requiring the skills of cardiac anesthetists is constantly increasing.

Preoperative evaluation and risk stratification are pivotal in the management of patients in an era where personalized medicine, tailored to the single patient, has become the standard of care.

Perioperative diagnostic techniques, echocardiography above all, have been in the armamentarium of cardiac anesthesia from the beginning, but their role in minimally invasive and robotic procedures, in interventional cardiology, and in intensive care units has largely increased, as well as the complexity of the available techniques.

Mechanical circulatory assistance has grown both in surgical and medical patients, leading to increased possibilities of intervention, as well as improved outcomes.

On top of conventional treatments, there is a need for advanced therapies, such as long-term mechanical circulatory support and heart transplants. Furthermore, on the one hand, there is a need for better knowledge of right ventricular failure and temporary assistance, and on the other hand, there is a need for the development of techniques and protocols to increase organ availability and preservation, and ultimately the number of organs available for transplant, and hence patients’ outcomes.

Dr. Fabio Sangalli
Dr. Lorenzo Stephan Cesare Grazioli
Guest Editors

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Keywords

  • cardiac anesthesia
  • cardiac surgery
  • echocardiography
  • interventional cardiology
  • anesthesia
  • cardiology

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Published Papers (2 papers)

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Research

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13 pages, 696 KB  
Article
The Development of an Automated Fluid Infusion Management System to Prevent Hypotension During General Anesthesia: A Randomized Clinical Trial
by Yuka Matsuki, Yukie Mizuta, Shuko Matsuda, Koyo Nishio, Midoriko Higashi, Ken Yamaura and Kenji Shigemi
J. Clin. Med. 2025, 14(24), 8952; https://doi.org/10.3390/jcm14248952 - 18 Dec 2025
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Abstract
Background/Objectives: This study aimed to develop and evaluate an automated fluid infusion management system for preventing hypotension during general anesthesia. Methods: This study was a single-blind, randomized, non-inferiority, clinical trial. Seventy-nine patients undergoing surgery under general anesthesia were randomly assigned to either an [...] Read more.
Background/Objectives: This study aimed to develop and evaluate an automated fluid infusion management system for preventing hypotension during general anesthesia. Methods: This study was a single-blind, randomized, non-inferiority, clinical trial. Seventy-nine patients undergoing surgery under general anesthesia were randomly assigned to either an automatic group or a manual group. In the automatic group, the infusion rate was automatically adjusted based on stroke volume (SV) and effective arterial elastance (Ea), whereas in the manual group, the attending anesthesiologist manually adjusted the infusion rate according to the Enhanced Recovery After Surgery (ERAS) protocol. The primary endpoint was the proportion of time during anesthesia that mean arterial pressure (Pm) was maintained at ≥65 mmHg. Secondary endpoints included the proportion of time the estimated stroke volume index (esSVI) was below the threshold, total fluid volume administered, total phenylephrine dose, urine output, blood loss, and average estimated stroke volume variation (esSVV). Results: The results demonstrated non-inferiority of the automatic group to the manual group in maintaining Pm ≥ 65 mmHg (automatic group: 82.0 ± 12.7%, manual group: 79.9 ± 15.7%; difference [automatic group−manual group]: 2.0 percentage points; one-sided 97.5% CI lower limit: −4.7%; non-inferiority margin: −5%). There were no significant differences between the groups in total fluid volume, phenylephrine dose, urine output, or blood loss. No severe adverse events or device-related adverse events were observed. Conclusions: The automated system maintained intraoperative blood pressure safely and effectively. Full article
(This article belongs to the Special Issue Cardiac Anesthesia: Current Research and Future Prospects)
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Review

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30 pages, 1687 KB  
Review
Aortic Arch and Frozen Elephant Trunk Surgery: Anesthetic Challenges and Strategies for Organ Protection
by Debora Emanuela Torre and Carmelo Pirri
J. Clin. Med. 2026, 15(2), 877; https://doi.org/10.3390/jcm15020877 - 21 Jan 2026
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Abstract
Background: Aortic arch surgery using the frozen elephant trunk (FET) technique remains one of the most complex scenarios in cardiac anesthesia. The anesthesiologist plays a central role in maintaining neuroprotection, organ perfusion and hemodynamic stability during hypothermic circulatory arrest and selective cerebral [...] Read more.
Background: Aortic arch surgery using the frozen elephant trunk (FET) technique remains one of the most complex scenarios in cardiac anesthesia. The anesthesiologist plays a central role in maintaining neuroprotection, organ perfusion and hemodynamic stability during hypothermic circulatory arrest and selective cerebral perfusion. This review summarizes key anesthetic principles aimed at improving neurologic and systemic outcomes. Methods: This narrative review examines current evidence and expert recommendation on temperature and perfusion management, neuromonitoring, coagulation control and postoperative strategies specific to FET procedures. Results: Modern approaches emphasize moderate hypothermia with tailored selective cerebral perfusion, multimodal neuromonitoring and structured organ protection bundles. Evidence supports the use of physiology-guided perfusion, viscoelastic-based coagulation management and coordinated teamwork with surgical and perfusion specialists to reduce neurologic injury, bleeding and postoperative organ dysfunction. Conclusions: Anesthetic management in FET surgery requires an integrated, physiology-based strategy supported by advanced monitoring and close interdisciplinary coordination. Adoption of standardized organ-protection and perfusion protocols is essential to optimize neurologic and systemic outcomes in this high-risk population. Full article
(This article belongs to the Special Issue Cardiac Anesthesia: Current Research and Future Prospects)
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