Circulación extracorpórea

J Clin Med. 2025 Jun 9;14(12):4083. doi: 10.3390/jcm14124083.

ABSTRACT

This review provides an in-depth analysis of argatroban as an alternative anticoagulant in cardiac surgery, with a focus on its use in patients with heparin-induced thrombocytopenia (HIT). We examine argatroban's pharmacokinetics and dosing regimens and the challenges associated with cosnventional monitoring methods-such as activated clotting time (ACT) and activated partial thromboplastin time (aPTT)-to evaluate its safety and effectiveness in high-risk surgical settings. Drawing on data from multiple case reports and series, our review highlights both the potential benefits and limitations of argatroban, including complications such as clot formation in extracorporeal circulation systems and prolonged postoperative coagulopathy. In addition to the literature review, we present a detailed clinical case of urgent HeartMate 3 left ventricular assist device implantation in a patient with advanced heart failure and active HIT. In this case, despite targeting an ACT above 400 s, intraoperative complications such as clot formation in the heart-lung machine and difficulty achieving hemostasis highlight the need for improved monitoring and dosing protocols. Our findings call for refined anticoagulation strategies and advanced monitoring techniques to optimize argatroban use in cardiac surgery, offering valuable insights for clinicians managing complex scenarios where conventional heparin therapy is contraindicated.

PMID:40565829 | PMC:PMC12194504 | DOI:10.3390/jcm14124083

J Cardiothorac Surg. 2025 Jun 24;20(1):272. doi: 10.1186/s13019-025-03505-8.

ABSTRACT

OBJECTIVE: To explore the application and effect of aortic annulus reconstruction (AAR) with bovine pericardium during surgical aortic valve replacement (SAVR) for severe calcific aortic stenosis (AS).

METHODS: We retrospectively reviewed 12 patients with severe calcified AS who underwent bovine pericardium aortic annulus reconstruction between January 2021 to December 2023. The average age of the patients was 58 ± 8.8 years. All patients were diagnosed with severe AS, along with aortic valve and annulus calcification, through chest computed tomography (CT) and transthoracic echocardiography (TTE) prior to surgery. After the resection of severely calcified aortic annulus tissue, all patients were given a bovine pericardial patch to repair the annular defect, and five of these patients underwent Y-incision aortic annular enlargement (AAE). The patients were followed up for a duration of 0.5 to 2 years.

RESULTS: A total of 12 patients undergoing SAVR were enrolled, and all received bovine pericardial patches to repair the annular defects, with a mean preoperative indexed effective orifice area (iEOA) of 0.58 ± 0.098 cm²/m². The average extracorporeal circulation time during the operation was 150.83 ± 34.5 min, and the average cross-clamp time was 95.42 ± 17.46 min. Postoperative evaluations indicated that the structural integrity of the valve annulus remained intact, demonstrating hemodynamic stabilization without any recorded fatalities among participants. Compared to preoperative levels, the aortic valve mean gradient (4.67 ± 1.15 vs. 59.67 ± 17.94 mmHg, P < 0.001), peak gradient (13 [10-15.75] vs. 92 [82.25-110.25] mmHg, P < 0.001), mean aortic jet velocity (99.67 ± 15.44 vs. 367.17 ± 58.13 cm/s, P < 0.001), and peak aortic jet velocity (182.25 ± 23.40 vs. 495.67 ± 61.74 cm/s, P < 0.001) significantly decreased after 0.5 years of follow-up. There were no complications such as hemolysis, perivalvular leakage, thrombosis or endocarditis during follow-up.

CONCLUSION: In patients with severe calcified AS, the AAR technique using bovine pericardium during SAVR is safe and effective, with stable hemodynamic performance and satisfactory clinical outcomes.

PMID:40556029 | PMC:PMC12186314 | DOI:10.1186/s13019-025-03505-8

J Cardiothorac Surg. 2025 Jun 25;20(1):273. doi: 10.1186/s13019-025-03491-x.

ABSTRACT

BACKGROUND: Thyroid storm (TS) is an endocrine emergency requiring aggressive medical management. In severe cases, hemodynamic instability may necessitate extracorporeal membrane oxygenation (ECMO) support as a bridge to definitive surgical treatment. ECMO is categorized into two types: venoarterial (V-A) ECMO, which provides both cardiac and pulmonary support, and venovenous (V-V) ECMO, which supports only pulmonary function. Surgery is generally not recommended for patients with unstable TS due to the high risk of complications, even when ECMO support is in place. Here, we present a case of a 44-year-old man initially improved with V-A ECMO for TS with cardiogenic shock, but later developed refractory hypoxemia due to pulmonary thromboembolism (PTE). He subsequently underwent emergency thyroidectomy with continuous support from V-V ECMO.

CASE PRESENTATION: A 44-year-old man presented to our hospital with complaints of palpitations. He had a recent history of coronavirus disease of 2019 (COVID-19) infection, which may have exacerbated undiagnosed hyperthyroidism, leading to thyroid storm and cardiogenic shock (left ventricular ejection fraction [LVEF], 13%). Heart failure improved with immediate medical management and V-A ECMO for 4 days, resulting in LVEF, 30%. V-A ECMO provide both respiratory and cardiac support, allowing myocardial recovery. Although the patient's cardiac output improved, uncontrolled tachycardia persisted. Medical treatment for hyperthyroidism-associated tachycardia was continued after V-A ECMO weaning but failed to achieve adequate rate control. Ten days after weaning V-A ECMO, the patient suddenly developed pulmonary thromboembolism and hypoxia despite ongoing heparinization. To manage refractory hypoxia, V-V ECMO was initiated, as it exclusively provides respiratory support. Given that persistent TS was the underlying cause of the patient's instability, we proceeded with thyroidectomy under general anesthesia with V-V ECMO support, despite the associated risks. On postoperative day 4, the patient was successfully weaned off V-V ECMO. By postoperative day 18, he was discharged without complications, with an improved LVEF of 52.5%.

CONCLUSIONS: This is the first reported case of total thyroidectomy performed while on V-V ECMO support for TS complicated by PTE. Although V-V ECMO is more susceptible to hemodynamic instability than V-A ECMO, this case demonstrates that thyroidectomy can be successfully performed with appropriate anesthesia management. Additionally, careful selection of the ECMO modality based on the patient's condition is crucial for optimal management.

PMID:40556009 | PMC:PMC12188653 | DOI:10.1186/s13019-025-03491-x

Medicine (Baltimore). 2025 Jun 20;104(25):e43043. doi: 10.1097/MD.0000000000043043.

ABSTRACT

RATIONALE: Heart transplantation (HT) represents the optimal treatment for patients with end-stage heart disease. However, it is prone to numerous postoperative complications, among which cardio-renal syndrome (CRS) is particularly serious and carries a high mortality rate. Continuous renal replacement therapy is an essential supportive treatment for these patients, but its efficacy is highly dependent on precise nursing management. Currently, there are few reports on the care of CRS complicating HT both domestically and internationally. This case is presented in this report to provide reference for clinical work.

PATIENT CONCERNS: This report details the case of a 31-year-old man who underwent an in situ HT due to dilated cardiomyopathy with class IV cardiac function. Following the operation, he developed CRS, which led to oliguria, rapid deterioration of renal function, and cardiac failure.

DIAGNOSES: Cardiorenal syndrome, chronic kidney disease stage 4, post-dilated cardiomyopathy surgery, HT status, heart function class IV (NYHA classification).

INTERVENTIONS: This includes implementing a personalized continuous renal replacement therapy (CRRT) program and providing excellent CRRT care; closely monitoring for rejection and the side effects of immunosuppressants; and offering comprehensive psychological support.

OUTCOMES: After undergoing CRRT for 5 weeks, the patient's 24-hour urine volume, glomerular filtration rate, and N-terminal brain natriuretic peptide precursor levels stabilized, leading to discharge with improved renal function.

LESSONS: The key to a favorable renal function prognosis is the use of CRRT for precise volume management. Careful management of internal jugular vein catheterization is crucial for preventing infections in post-heart transplant patients. Additionally, monitoring the side effects of immunosuppressive drugs and signs of rejection are essential nursing points for patients with cardiorenal syndrome. Providing psychological care in various forms to patients and their families can help improve disease outcomes and ensure long-term efficacy after transplantation.

PMID:40550023 | PMC:PMC12187291 | DOI:10.1097/MD.0000000000043043

Exp Clin Transplant. 2025 May;23(5):317-327. doi: 10.6002/ect.2025.0089.

ABSTRACT

OBJECTIVES: Donation after circulatory death offers a promising solution to expand the thoracic organ donor pool, yet its application remains limited because of warm ischemia and technical barriers, especially in uncontrolled donation after circulatory death. We aimed to evaluate a pulsatile normothermic car-diopulmonary bypass-based strategy for thoracic organ recovery of uncontrolled donors after circulatory death and the effects of this strategy on graft function and recipient outcomes.

MATERIALS AND METHODS: In this prospective single-center study, we studied thoracic organs recovered from uncontrolled donors after circulatory death after ≥60 minutes of unsuccessful cardiopulmonary resuscitation. After heparinization and pharmacologic optimization, donors underwent median sternotomy and were connected to a cardiopulmonary bypass circuit with pulsatile flow. Organ assessment was performed in vivo. Donor, graft, and recipient functional data were recorded, with follow-up results studied through at least 1 year.

RESULTS: Forty-two donors were included. All hearts (n = 42) and 40 lungs (from 84 donors) were successfully transplanted. Despite prolonged cardiopulmonary resuscitation, no graft failure or recipient mortality occurred. One year survival for both heart and lung recipients was 100%. Heart grafts showed progressive improvement in functional status, including left ventricular ejection fraction, lactate levels, and New York Heart Association classification; lungs demonstrated sustained gains in gas exchange, pulmonary function tests, and 6-minute walk distance. Mild primary graft dysfunction (grade 1-2) occurred in 10% of lung recipients (all unilateral transplants). Pericardial effusion increased, likely because of trauma before procurement, but resolved without effects on function.

CONCLUSIONS: Pulsatile normothermic cardiopulmonary bypass enables successful procurement of thoracic organs from uncontrolled donors after circulatory death with excellent outcomes. This low-cost physiological approach may offer a viable strategy to expand availability of donors in resource-limited settings.

PMID:40548529 | DOI:10.6002/ect.2025.0089

Crit Care. 2025 Jun 20;29(1):255. doi: 10.1186/s13054-025-05495-4.

ABSTRACT

BACKGROUND: A systemic inflammatory response can contribute to poor outcomes in an advanced stage of cardiogenic shock (CS). We investigated the efficacy of extracorporeal endotoxin and cytokine adsorption using oXiris in patients with CS undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO).

METHODS: In this prospective, single-center, randomized, open-label pilot trial, 40 patients with CS who were undergoing VA-ECMO were randomly assigned to receive either oXiris for 24 h (n = 20) or usual care (n = 20). The primary endpoint was endotoxin levels at 48 h. Secondary endpoints included changes in inflammatory cytokines, vasoactive-inotropic score (VIS), ECMO weaning success, and in-hospital and 30-day mortality.

RESULTS: The median endotoxin levels at 48 h were 0.5 (IQR 0.4-1.0) in the oXiris group and 0.4 (IQR 0.2-0.5) in the control group, with no significant difference between them (P = 0.097). The oXiris group showed significant temporal reductions in GDF-15 and IL-6 levels, with IL-6 revealing significant reductions from baseline to 24 h (P = 0.020) and from baseline to 7 days (P = 0.003). VIS decreased significantly from baseline to 48 h (-13.63, 95% CI: -20.90 - -6.34, P < 0.001) and 7 days (-12.19, 95% CI: -21.0 - -3.31, P = 0.007) in the oXiris group, but intergroup differences were insignificant. ECMO weaning success, duration of ECMO support, and mortality rates were similar between the groups.

CONCLUSION: In this pilot study conducted on CS patients requiring VA-ECMO, oXiris treatment did not significantly reduce endotoxin levels or improve patient centered clinical outcomes.

TRIAL REGISTRATION: NCT05642273, registered 8 December 2022.

PMID:40542431 | PMC:PMC12181899 | DOI:10.1186/s13054-025-05495-4

JACC Case Rep. 2025 Jun 18;30(15):103679. doi: 10.1016/j.jaccas.2025.103679.

ABSTRACT

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction, distinctly from atherosclerotic disease. Conservative management is typically recommended, but the incidence of mechanical complications is poorly defined, with only 7 cases reported. We describe a 62-year-old woman with SCAD complicated by left ventricular free wall rupture. Despite initial conservative management, she developed in-hospital cardiac arrest just moments before discharge and was treated with extracorporeal membrane oxygenation (ECMO), stabilizing her condition and enabling emergency surgical repair. This case underscores the potential role of ECMO in managing SCAD with life-threatening complications and underscores the need for a tailored approach to the management of SCAD patients, which differ from classical atherosclerotic myocardial infarction.

PMID:40541339 | PMC:PMC12198654 | DOI:10.1016/j.jaccas.2025.103679

Eur J Cardiothorac Surg. 2025 Jun 3;67(6):ezaf135. doi: 10.1093/ejcts/ezaf135.

ABSTRACT

OBJECTIVES: In the last decades, minimally invasive cardiac surgery has emerged as an alternative approach to conventional median sternotomy. However, some reports state an increased risk of iatrogenic acute aortic dissection. Evidence remains limited regarding preoperative diagnostics for risk reduction and the appropriate adjustment of surgical procedures if acute aortic dissection is detected intraoperatively.

METHODS: In this retrospective single-centre observational study, we analysed 1065 patients who underwent minimally invasive cardiac surgery via right anterolateral thoracotomy for atrioventricular valves and atrial structures with femoral cannulation for cardiopulmonary bypass from August 2009 to June 2021. Occurrence of iatrogenic acute aortic dissection was evaluated, along with patient profiles and the primary composite outcome of major adverse cardiovascular events (non-fatal stroke, myocardial infarction or cardiovascular death). An optimal perioperative strategy was subsequently described.

RESULTS: Intraoperative iatrogenic acute aortic dissection was observed in 8 patients (0.75%). It was identified at the start of cardiopulmonary bypass in 4 patients (50.0%). All patients underwent conversion to full sternotomy; 7 patients underwent additional aortic surgery with circulatory arrest thereafter. In-hospital mortality was 37.5% (n = 3), including 1 intraoperative death. Non-fatal stroke was observed in 12.5% (n = 1). A preoperative computed tomography scan was missing in 3 patients with aortic calcification (n = 1) and hostile peripheral arteries (n = 2).

CONCLUSIONS: Intraoperative aortic dissection in minimally invasive cardiac surgery remains a rare complication. Frequent major adverse cardiovascular events highlight the importance of preoperative imaging based procedure planning. Intraoperatively, early diagnosis with standardized monitoring and time- and location-specific surgical adaptations might increase safety and outcomes.

PMID:40534225 | PMC:PMC12199776 | DOI:10.1093/ejcts/ezaf135

Braz J Cardiovasc Surg. 2025 Jun 18;40(4):e20240039. doi: 10.21470/1678-9741-2024-0039.

ABSTRACT

INTRODUCTION: The present study evaluated systemic microcirculatory alterations occurring in the early postoperative period of cardiopulmonary bypass-assisted heart valve surgery compared to preoperative parameters through noninvasive point-of-care microcirculatory imaging of the sublingual area using incident dark field imaging.

METHODS: This was a single-center cross-sectional observational study that included 23 patients aged 49 ± 13 years. Sublingual microcirculatory density and perfusion were evaluated using a handheld camera based on incident dark field imaging before surgery and in the early postoperative period.

RESULTS: The total number of capillary vessels (1029 ± 13, P=0.0006), total length of capillary vessels (29.4 ± 3.2 mm, P=0.0005), and capillary vessel density (16.8 ± 1.8 mm/mm2, P=0.0005) were all higher after surgery. On the other hand, the total number of noncapillary vessels (85 ± 34, P=0.05), total length of noncapillary vessels (1.9 ± 0.8 mm, P=0.07), and noncapillary vessel density (1.1 ± 0.5 mm/mm2, P=0.07) were similar before and after surgery. The total number of capillary vessels was higher after surgery (1109 ± 92) in patients who received milrinone infusion (P=0.002) but not in patients who did not receive milrinone (986 ± 129, P=0.05).

CONCLUSION: After cardiac valve surgery, there was an improvement in microvascular parameters concerning capillary vessels and in the total number of microvessels. Moreover, significant positive correlations were found between the use of milrinone and these parameters. The study demonstrated the usefulness of handheld cameras for bedside evaluation of the microcirculation.

PMID:40530991 | PMC:PMC12175618 | DOI:10.21470/1678-9741-2024-0039

Clin Nurse Spec. 2025 Jul-Aug 01;39(4):180-184. doi: 10.1097/NUR.0000000000000904.

ABSTRACT

BACKGROUND: Cardiopulmonary bypass use during surgery disrupts microcirculation, which can contribute to lung injury, particularly in patients with pulmonary comorbidities. Continuous transcutaneous carbon dioxide (CO2) monitoring assists clinicians to trend values related to metabolic and respiratory status between intermittent arterial blood gas measurements. We sought to review the literature to support adoption of this technology to optimize weaning in patients with pulmonary comorbidities following open heart surgery.

METHODS: Multiple databases were reviewed. Inclusion criteria were limited to results of peer-reviewed articles in English published within the past 5 years. The findings were presented to relevant levels of hospital leadership, who approved adoption of the technology for this population. From there, monitors were positioned in 4 surgical intensive care unit rooms for monitoring of patients up to the point of extubation.

RESULTS: The literature review yielded 12 articles, with a majority deeming transcutaneous monitoring feasible and appropriate in the postoperative patient, including those having cardiopulmonary bypass. Clinical interventions and trending were valuable additions to improve patient outcomes and nursing autonomy. During the fiscal quarter following adoption of the technology, mean time spent on the ventilator dropped 30%, reintubation dropped 4%, and mortality decreased by 24%.

CONCLUSIONS: Transcutaneous monitoring of CO2, with improved specificity over end-tidal CO2 monitoring, offers meaningful trending to inform clinician decision-making around readiness to wean. Additionally, transcutaneous monitoring allows for noninvasive, reliable continuous metabolic monitoring to serve as an early clinical indicator for at-risk patients.

PMID:40526768 | DOI:10.1097/NUR.0000000000000904

J Extra Corpor Technol. 2025 Jun;57(2):96-104. doi: 10.1051/ject/2025008. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: It is difficult to clinically detect a new infection in patients with Mechanical Circulatory Support (MCS; including veno-arterial and veno-veno extracorporeal membrane oxygenation, and ventricular assist devices). The prompt, accurate identification of new infection utilizing plasma biomarkers could prompt earlier initiation of antimicrobial agents and may improve outcomes.

METHODS: We utilized ELISA to evaluate novel biomarkers, soluble Triggering Receptor Expressed on Myeloid cells (sTREM-1) and Presepsin, as well as existing biomarkers (C-Reactive Protein (CRP) and Procalcitonin) before MCS, daily for the first week of MCS and for the 72 h in advance of the development of a new infection for patients prospectively enrolled in a biobank and who developed a culture positive infection.

RESULTS: Serial samples from 18 patients were analyzed. On average post-cannulation Presepsin and sTREM-1 values were not significantly different, however they have higher baseline values than reported in other patient populations. On average during periods of infection, Presepsin was 41% lower (51,462-30,188 pg/mL) (P = 0.001) and procalcitonin was 51% lower (0.77-0.38 ng/mL) (P < 0.001) compared to non-infected periods. Neither CRP or sTREM-1 were significantly different between infected and un-infected periods.

CONCLUSION: Presepsin and Procalcitonin decreased in advance of the development of a new infection in the MCS patient population, a direction of change different than expected. These findings highlight the importance of biomarker studies specifically performed in the MCS patient population, and the potential lack of translatability of biomarkers in other patient populations to the MCS patient population.

PMID:40523137 | PMC:PMC12169701 | DOI:10.1051/ject/2025008

J Extra Corpor Technol. 2025 Jun;57(2):82-88. doi: 10.1051/ject/2025007. Epub 2025 Jun 16.

ABSTRACT

INTRODUCTION: Perfusion safety in cardiothoracic surgery is critical, particularly in Pakistan where variability in practice standards exists. This survey investigates the current perfusion practices among Pakistani perfusionists, focusing on the adherence to safety standards during cardiopulmonary bypass (CPB) procedures.

METHODS: The survey was conducted over two weeks to explore key areas of perfusion practice, including the use of bubble detectors, level detectors, arterial filters, and saturation monitoring during CPB procedures. Out of approximately 350 practicing perfusionists in Pakistan, 66 responded, resulting in a response rate of 18.9%. The data was collected through an online platform, ensuring anonymity and voluntary participation. The survey included mainly Yes/No questions. To ensure reliability and validity, the questionnaire was reviewed by experts, pilot tested, and refined based on feedback, ensuring it was effective in gathering meaningful insights.

RESULTS: The survey results indicate a variable use of essential safety devices such as bubble and level detectors, arterial filters, and continuous venous saturation and cerebral saturation monitoring. While some perfusionists adhere to recommended safety protocols, gaps in the use of critical monitoring equipment were evident.

CONCLUSION: The findings highlight the need for standardized perfusion practices in Pakistan to ensure safety and efficacy during CPB. Addressing the gaps in the use of safety and monitoring equipment could lead to improved patient outcomes. Further research is needed to explore the barriers to uniform safety standards and to develop strategies for enhancing perfusion safety across the country.

PMID:40523135 | PMC:PMC12169702 | DOI:10.1051/ject/2025007

J Extra Corpor Technol. 2025 Jun;57(2):66-73. doi: 10.1051/ject/2024037. Epub 2025 Jun 16.

ABSTRACT

Medical procedural registries are uniquely positioned to support shared decision-making through risk prediction modeling, support quality assessment and improvement through performance benchmarking, and provide public reporting of evidence-based practices and outcomes. For example, the Centers for Disease Control and Prevention (CDC) consulted the Extracorporeal Life Support Organization (ELSO) registry to assess the severity of the swine flu outbreak in 2009-2010. The development and growth of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has positively contributed to the congenital heart surgery community by developing objective mortality STAT categories and complexity stratification for operations, a common nomenclature for classifying operations and reporting the costs associated with complications for nine benchmark operations. Within the setting of adult cardiac surgery, the Perfusion Down Under Collaborative has used its registry to develop quality improvement initiatives, including those related to the management of arterial outlet temperature, glucose, and arterial pCO2. The PERForm registry leverages data from nearly 50 US hospitals to support targeted quality improvement initiatives within the setting of adult cardiac surgery. The PERForm registry participants receive benchmark reports and participate in quarterly collaborative learning meetings noted for unblinding hospital performance data. In 2014, with no current congenital cardiopulmonary bypass (CPB) registries, various experts within the congenital perfusion community and leaders from the PERForm registry began working to develop a pediatric perfusion registry. From this work, the PediPERForm Learning Network (PLN) and its associated congenital perfusion registry became active and began collecting data in October 2021.

PMID:40523133 | PMC:PMC12169737 | DOI:10.1051/ject/2024037

Circulation. 2025 Jun 17;151(24):1752-1754. doi: 10.1161/CIRCULATIONAHA.124.073533. Epub 2025 Jun 16.

NO ABSTRACT

PMID:40523048 | DOI:10.1161/CIRCULATIONAHA.124.073533

J Am Heart Assoc. 2025 Jun 17;14(12):e039673. doi: 10.1161/JAHA.124.039673. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: Fulminant myocarditis is life-threatening and often requires mechanical circulatory support. Predicting its clinical course is crucial, yet data on early recovery predictors, particularly with veno-arterial extracorporeal membrane oxygenation, remain lacking.

METHODS AND RESULTS: We aimed to identify prognostic factors of early recovery in fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation by retrospective analysis of a nationwide registry in Japan. Early recovery was defined as successful weaning from mechanical circulatory support within 7 days and discharge without heart transplantation or long-term mechanical circulatory support. A total of 343 patients were analyzed; 71 were classified as early recovery and 272 as nonearly recovery. The early recovery group was significantly younger, had higher white blood cell counts, and lower creatine kinase-myocardial band level than the nonearly recovery group. To enhance clinical interpretability, we dichotomized continuous variables using optimal cutoff values derived from the Youden index. Multivariable logistic regression analysis showed the independent factors of early recovery were age ≤40 years (odds ratio [OR], 3.25), white blood cell count ≥11 000/μL (OR, 3.10), and creatine kinase-myocardial band ≤61 U/L (OR, 2.46), and if all conditions were fulfilled, the early recovery rate increased to 61.5%. Additionally, although not statistically significant, the number of rehospitalization with cardiovascular causes, death, or heart transplantation at 1-year follow-up was higher in the nonearly recovery group.

CONCLUSIONS: Our study suggested younger patients who have a strong inflammatory response but less myocardial damage on admission could recover earlier. Conversely, in cases where mechanical circulatory support duration is prolonged, careful monitoring is required for prolonged left ventricular dysfunction and subsequent prognosis.

REGISTRATION: URL: https://www.umin.ac.jp/; Unique identifier: UMIN000039763.

PMID:40521639 | DOI:10.1161/JAHA.124.039673

Metabolomics. 2025 Jun 14;21(4):80. doi: 10.1007/s11306-025-02276-6.

ABSTRACT

INTRODUCTION: Amino acids (AAs) serve diverse roles, and insufficient delivery is associated with worse outcomes in ill patients. In the case of congenital heart disease (CHD) surgery with cardiopulmonary bypass (CPB), AA levels are often dysregulated. Changes at the individual AA level, impact of clinical factors, and association with outcomes are less understood.

OBJECTIVES: We evaluated AA levels at multiple timepoints, the impact of pre-operative nutrition on these levels, and their association with the combined outcome: cardiac arrest, death, mechanical circulatory support, or ICU length of stay (LOS) above the 75% quantile of the cohort.

METHODS: Infants < 120 days undergoing CHD surgery with CPB were evaluated, excluding those < 2 kg or 34 weeks corrected gestational age. Relative AA quantification was performed pre-operatively, during rewarming, and 24 h post-ICU admission. Partial least squares discriminant analysis was used to compare AA levels between timepoints and feeding status. Univariate and multivariate analysis assessed for association with the combined outcome.

RESULTS: 16 of 19 AAs decreased during rewarming with 11 continuing to decrease at 24 h. Patients who did not receive enteral feeds pre-operatively had lower levels of certain AAs. Univariate analysis identified that decreased levels of glutamine, aspartate, and glutamate, and increased phenylalanine and lysine levels, were associated with increased risk of the combined outcome.

CONCLUSION: AA levels decreased following CPB and are impacted by pre-operative feeding status. Decreased levels of certain AAs are associated with increased risk of the combined outcome. Emphasizing pre-operative enteral nutrition and post-operative AA supplementation could improve outcomes in this population.

PMID:40515782 | DOI:10.1007/s11306-025-02276-6

J Clin Med. 2025 Jun 5;14(11):4011. doi: 10.3390/jcm14114011.

ABSTRACT

Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Methods: Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. Conclusions: The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial.

PMID:40507773 | PMC:PMC12155902 | DOI:10.3390/jcm14114011

Kyobu Geka. 2025 Apr;78(4):301-306.

ABSTRACT

Although our hospital is not a heart transplant facility, we accept many patients requiring temporary mechanical circulatory support (T-MCS), such as extracorporeal membrane oxygenation (ECMO), as part of our role as a destination therapy (DT) facility. From May 2021 to December 2024, we performed 17 cases of DT using HeartMate 3. The patients' average age was 58±7 years. The underlying conditions included ischemic heart disease (nine cases), idiopathic dilated cardiomyopathy (seven cases), and drug-induced cardiomyopathy( one case). The average J-HeartMate risk score was 1.52. In this paper, we discuss the current status and challenges of DT at non-heart transplant facilities and present our unique approach to T-MCS strategies and patient education.

PMID:40494527

Acta Anaesthesiol Scand. 2025 Jul;69(6):e70073. doi: 10.1111/aas.70073.

ABSTRACT

INTRODUCTION: Cardiac surgery in infants often triggers a severe inflammatory response. The role of biomarkers in predicting clinical outcomes in this group of patients has been debated in the literature. This study aimed to investigate the predictive value of 20 inflammatory biomarkers, in combination with clinical data, for acute kidney injury, ventilator support duration, and inotropic score following infant cardiac surgery by developing and comparing three models: Clinical-Data-Only, Biomarker-Only, and Combined.

METHODS: This secondary analysis of the MiLe-1 study included infants undergoing surgery with cardiopulmonary bypass. Biomarkers were measured before and after CPB. Using BIC-guided logistic regression, we developed and compared three multivariable models-Clinical-Data-Only, Biomarker-Only, and Combined-for each outcome. Model performance was assessed using c-statistics and p-contrast tests.

RESULTS: Regarding AKI risk prediction, the c-statistics for Biomarker-Only, Clinical-Data-Only, and Combined Model were 0.79, 0.60, and 0.78 respectively. The difference in performance between the Combined and Clinical-Data-Only Models was statistically significant (p < 0.001). Concerning ventilator support time prediction, the c-statistics were 0.80, 0.72, and 0.77 for the models respectively (p-contrast = 0.10). As for inotropic score prediction, the c-statistics were 0.83, 0.77, and 0.85 for the models (p-contrast = 0.007).

CONCLUSION: Inflammatory biomarkers may enhance risk stratification for postoperative outcomes in infant cardiac surgery. However, given the exploratory nature of this study, further validation in larger and more diverse cohorts is needed.

PMID:40492379 | PMC:PMC12150254 | DOI:10.1111/aas.70073

Front Cardiovasc Med. 2025 May 26;12:1588088. doi: 10.3389/fcvm.2025.1588088. eCollection 2025.

ABSTRACT

INTRODUCTION: Cardioplexol™ was recently proven effective and non-inferior to Buckberg's solution in a pivotal Phase-3 clinical trial. We hypothesized here that a standardized training program for surgeons without prior experience of Cardioplexol™ could increase its administration reliability and participate to its overall benefit.

METHODS: Open label, single group, observational study involving 29 surgeons from 7 centers in 3 countries. The training program included a theoretical part, and two surgical procedures performed under trainer supervision. In a subsequent evaluation part, surgeons operated on 4 additional patients. The number of major deviations from the pre-defined administration protocol (incorrect volume of initial/second/third/fourth dose, incorrect duration of injection of initial dose, incorrect timing of application of initial/second/third/fourth dose) was set as primary endpoint.

RESULTS: A total of 171 patients were screened of which 157 were operated on (57 in the training part and 100 in the evaluation part). No major deviations were observed. Other outcomes, including postoperative TnT and CK-MB profiles, cumulative inotropic support provided during the first 24 h after myocardial reperfusion, cardiac conversion rate, ICU length of stay, were all similar to or better than the results observed in the previous pivotal study.

CONCLUSION: Cardiac surgeons not familiar to Cardioplexol™ benefit from a structured and supervised training. This kind of training contributes to improve the efficiency and safety of a new cardioplegic solution such as Cardioplexol™.

TRIAL REGISTRATION: [ClinicalTrials.gov]: identifier [NCT03823521, and EudraCT No: 2018-002311-10].

PMID:40491721 | PMC:PMC12146177 | DOI:10.3389/fcvm.2025.1588088