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Clinical Advances in Cardiothoracic Anesthesiology
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Clinical Advances in Cardiothoracic Anesthesiology

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

Deadline for manuscript submissions: 10 April 2027 | Viewed by 1601

Editor

Dr. Marc Vives

E-Mail Website
Guest Editor
1. Department of Anesthesiology & Critical Care Medicine, Clínica Universidad de Navarra, Pamplona, Spain
2. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
Interests: intensive care medicine; cardiac surgery; acute kidney injury; sepsis; septic shock

Special Issue Information

Dear Colleagues,

The field of cardiothoracic anesthesiology is undergoing a transformative shift as clinicians manage an increasingly elderly and comorbid patient population. Current research reflects a shift away from the traditional “one size fits all” approach toward personalized, data-driven care. Central to this evolution is the integration of artificial intelligence (AI) for predictive modeling and the widespread adoption of Enhanced Recovery After Surgery (ERAS) protocols to mitigate systemic inflammatory responses and organ dysfunction.

The primary aim of this Special Issue is to address core clinical problems, including preventing perioperative neurocognitive disorders and acute kidney injury (AKI) and optimizing mechanical circulatory support (MCS). By highlighting advances in 3D transesophageal echocardiography (TEE) and opioid-sparing analgesia, this issue seeks to bridge the gap between technological innovation and bedside safety.

Scope of the Special Issue

  • Precision Medicine: Tailored hemodynamic monitoring and AI-assisted risk stratification.
  • Organ Protection: Strategies to prevent AKI, neurocognitive disorders, and myocardial dysfunction.
  • Mechanical Circulatory Support: Personalizing and optimizing mechanical circulatory support.
  • Minimally Invasive Care: Anesthetic management for TAVR, MitraClip, and robotic surgeries.
  • Enhanced Recovery: Early extubation (ultra-fast-track) and multimodal pain management.

Dr. Marc Vives
Guest Editor

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 250 words) can be sent to the Editorial Office for assessment.

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-anonymized 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 anesthesiology
  • thoracic anesthesiology
  • precision medicine
  • prevention of organ dysfunction
  • mechanical circulatory support
  • minimally invasive surgery

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Published Papers (3 papers)

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Research

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16 pages, 1449 KB  
Article
Predictive Preoperative Score of Prolonged Mechanical Ventilation After Coronary Artery Bypass Grafting
by Alba López-Lede, Juan Bertó, Jose María Barrio, María Jesus Pérez-Granda, Ignacio Vasserot, Manuel Martínez-Sellés, Begoña Quintana-Villamandos and Javier Hortal
J. Clin. Med. 2026, 15(16), 6402; https://doi.org/10.3390/jcm15166402 - 19 Aug 2026
Viewed by 73
Abstract
Background and Objective: Prolonged mechanical ventilation (PMV) after cardiac surgery is a common complication associated with increased morbidity, mortality and intensive care resource utilization. Our aim was to determine predictors of PMV > 48 h in patients undergoing coronary artery bypass grafting (CABG). [...] Read more.
Background and Objective: Prolonged mechanical ventilation (PMV) after cardiac surgery is a common complication associated with increased morbidity, mortality and intensive care resource utilization. Our aim was to determine predictors of PMV > 48 h in patients undergoing coronary artery bypass grafting (CABG). Methods: This was a single-center retrospective observational study including adult patients who underwent CABG between January 2011 and December 2024. The primary outcome was PMV. Results: From 2083 patients, 241 had PMV (11.6%). Compared with patients without PMV, those with PMV had lower hemoglobin levels (12.6 ± 2.1 vs. 13.4 ± 1.9 g/dL, p < 0.001) and worse estimated Glomerular Filtration Rate (67.1 ± 26.9 vs. 78.1 ± 22.6 mL/min, p < 0.001). The model with preoperative variables predicted the risk of PMV (with an area under the receiver operating characteristic curve [AUROC] of 0.789). The prediction improved with the addition of intraoperative variables (AUROC 0.832) and with the further addition of early postoperative re-exploration for bleeding (AUROC 0.847). A simplified preoperative score showed good discrimination (AUROC 0.78; 95% CI 0.749–0.81) and stratified patients into clinically meaningful risk categories. Restricted cubic spline analysis showed a non-linear association between cardiopulmonary bypass duration and PMV, with risk increasing progressively after 120 min. Conclusions: PMV after CABG can be predicted using simple preoperative variables. This prediction has relevant implications for clinical management, intensive care resource allocation, and surgical scheduling. Preoperative anemia. Preoperative anemia was independently associated with PMV and represents a potentially modifiable perioperative risk factor. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesiology)
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10 pages, 231 KB  
Article
Use of Intravenous Lidocaine, Ketamine, and Magnesium for Acute Pain Control After Lung Resection Surgery: A Prospective Cohort Study
by Julissa Herrera, Silvia Torres, Maria Diaz, Iñaki Gascó, Alessandro Ruggiero, Nicolas Varela, Manuel Murie-Fernandez and Marc Vives
J. Clin. Med. 2026, 15(13), 5295; https://doi.org/10.3390/jcm15135295 - 7 Jul 2026
Viewed by 585
Abstract
Background: Thoracic surgery is associated with severe postoperative pain caused by chest wall manipulation and intercostal nerve injury. Multimodal analgesia with non-opioid agents such as lidocaine, ketamine and magnesium might be beneficial for pain control and reduce opioid consumption. Methods: In [...] Read more.
Background: Thoracic surgery is associated with severe postoperative pain caused by chest wall manipulation and intercostal nerve injury. Multimodal analgesia with non-opioid agents such as lidocaine, ketamine and magnesium might be beneficial for pain control and reduce opioid consumption. Methods: In this prospective cohort study, we recruited 118 consecutive patients who underwent lung resection via thoracotomy from January 2019 to January 2021 at Hospital Universitari de Girona Doctor Josep Trueta. The primary outcome was total intravenous morphine consumption within the first 24 h postoperatively. Multivariable linear regression modeling was used to determine the adjusted association between lidocaine, ketamine and magnesium administration and morphine consumption in the first 24 h after surgery. Statistical analysis was performed using Wilcoxon’s rank-sum and Fisher’s exact tests. Results: In total, 71 patients received lidocaine, ketamine and magnesium intraoperatively (LKM group) while 47 patients did not receive this regimen (non-LKM group). The LKM group had a higher prevalence of hypertension and higher proportions of patients undergoing lobectomy and pneumonectomy. Morphine consumption within 24 h postoperatively was lower in the LKM group than in the non-LKM group (median (interquartile range), 2 (0–6) mg vs. 5 (3–8) mg; p = 0.001). No drug-related adverse events were observed. After multivariable risk adjustment, lidocaine, ketamine and magnesium use was associated with significantly decreased total intravenous morphine consumption within 24 h postoperatively (−1.76, 95% confidence interval = −3.40 to −0.12, p = 0.03). Conclusions: Lidocaine, ketamine and magnesium use was associated with lower 24 h morphine consumption in our prospective cohort. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesiology)

Review

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29 pages, 7966 KB  
Review
Fibrinogen Concentrate in Acute Hemorrhage: Mechanistic Insight, Thresholds, and Targeted Replacement
by Niels Rahe-Meyer, Justyna Bartoszko and Jerrold H. Levy
J. Clin. Med. 2026, 15(16), 6156; https://doi.org/10.3390/jcm15166156 - 7 Aug 2026
Viewed by 468
Abstract
Fibrinogen is an essential component of hemostasis and clot formation that stabilizes the platelet-dependent primary hemostatic process. Low fibrinogen levels can be primary (congenital) or secondary (acquired). Acquired hypofibrinogenemia may result from chronic diseases (e.g., liver, autoimmune diseases, and malignancies) or major hemorrhage [...] Read more.
Fibrinogen is an essential component of hemostasis and clot formation that stabilizes the platelet-dependent primary hemostatic process. Low fibrinogen levels can be primary (congenital) or secondary (acquired). Acquired hypofibrinogenemia may result from chronic diseases (e.g., liver, autoimmune diseases, and malignancies) or major hemorrhage (e.g., trauma, surgery). Low fibrinogen levels are both a symptom and a precipitating factor for coagulopathy and ongoing bleeding. Fibrinogen repletion with fibrinogen-containing products is important for managing coagulopathic bleeding with suspected or documented hypofibrinogenemia. Different available fibrinogen sources include fibrinogen concentrate, cryoprecipitate, and frozen plasma and vary based on multiple factors including fibrinogen content, purity, other clotting or non-clotting proteins (e.g., immunomodulating proteins or proteins of unknown function), preparation time, safety, volumes, and availability. Fibrinogen replacement strategies have been studied in trauma but also in patients undergoing spine, cytoreductive, and cardiac surgery. In this review, we discuss the physiological actions of fibrinogen, strategies for control of coagulopathic bleeding related to hypofibrinogenemia, and the therapeutic, logistical, and economic factors that influence treatment decisions. In addition, current guidelines and clinical studies were considered regarding the formation of evidence-based treatment strategies that can be individualized at the patient’s bedside. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesiology)
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