Extracorporeal circulation

Sci Rep. 2025 Aug 25;15(1):31271. doi: 10.1038/s41598-025-15746-7.

ABSTRACT

Allogeneic red blood cells (RBCs) are commonly used for cardiopulmonary bypass (CPB) circuit priming in congenital heart surgery. While convection-based pre-bypass ultrafiltration (PBUF) corrects acid-base, electrolyte, and metabolite imbalances, its efficacy in removing RBC cytokines/chemokines remains unclear. In a prospective observational study, 22 children (median age: 4.1 months) undergoing congenital heart surgery were enrolled. PBUF of RBC-primed CPB circuits was conducted using bicarbonate-buffered hemofiltration solution. Cytokines/chemokines were quantified in RBC supernatants, CPB priming (before and after PBUF), preoperative patient plasma, and PBUF effluent using Luminex-based multiplex technology. 30 of 50 cytokines were detected in > 50% of RBC supernatants. RBC priming significantly elevated concentrations of 25 cytokines, with 20 further rising after PBUF. At CPB onset, eight mediators (MIF, IL-15, CCL11/Eotaxin, CCL2/MCP-1, VEGF, IL-5, VCAM-1, ICAM-1) exceeded patient plasma concentrations. PBUF filtered cytokines with different efficiencies (0.6-97%). Despite poor filtration or increased concentrations, total mediator load of 42 cytokines decreased significantly (33.3-69.1% of pre-processing levels) after PBUF. In conclusion, PBUF effectively removed multiple cytokines/chemokines released from RBC. Beyond filtration, decrease of total mediator load may be attributed to adsorption to circuit components or rebinding to RBCs. Improved washing techniques may further optimize mediator levels in RBC-primed CPB circuits.

PMID:40854943 | PMC:PMC12379243 | DOI:10.1038/s41598-025-15746-7

Braz J Cardiovasc Surg. 2025 Nov 1;40(6):e20250028. doi: 10.21470/1678-9741-2025-0028.

ABSTRACT

Cardiopulmonary bypass (CPB) in children presents challenges related to blood volume and surface area of the circuit. Conventional ultrafiltration (CUF) is used to minimize complications, but modified ultrafiltration (MUF) can optimize clinical outcomes. We propose a modification to the CPB circuit, incorporating three luer connectors and a 12 Fr extension tube, allowing for simple and safe MUF implementation. Since 2014, this technique has been applied to approximately 3,500 children weighing < 20 kg, proving to be effective and low-cost. The new configuration does not require additional pumps, facilitates volume replacement, and maintains blood temperature, thereby improving procedural safety. Results indicate that this circuit modification for MUF offers safe and efficient management strategy for pediatric patients, with low risk of complications and potential easy implementation in various cardiovascular surgery centers.

PMID:40854153 | PMC:PMC12379719 | DOI:10.21470/1678-9741-2025-0028

J Thorac Cardiovasc Surg. 2025 Aug 22:S0022-5223(25)00636-1. doi: 10.1016/j.jtcvs.2025.07.029. Online ahead of print.

NO ABSTRACT

PMID:40848039 | DOI:10.1016/j.jtcvs.2025.07.029

Catheter Cardiovasc Interv. 2025 Oct;106(4):2637-2644. doi: 10.1002/ccd.70098. Epub 2025 Aug 21.

ABSTRACT

BACKGROUND: Data regarding the long-term outcomes of patients undergoing venoarterial extracorporeal membrane oxygenator (VA-ECMO) assisted high-risk percutaneous coronary intervention (PCI) and the impact of the operator experience is limited.

AIMS: We aimed to investigate the long-term outcomes of patients undergoing VA-ECMO-assisted PCI and the effect of the operator experience.

METHODS: The study was a retrospective cohort study that consecutively enrolled patients who were declined by the Heart Team for coronary artery bypass grafting (CABG) due to high surgical risk and treated with VA-ECMO-assisted PCI from November 1, 2016, to March 1, 2024, in Xijing Hospital, China. The primary endpoint was all-cause death at 1 year.

RESULTS: A total of 220 patients were included. The mean age ± SD was 65.6 ± 11.4 years and the median LVEF% (IQR) was 36.0 (30.0-40.0). The mean ± SD of the SYNTAX score was 34.7 ± 6.9. The median (IQR) follow-up was 1.9 (1.3-4.9) years, and the vital status of all patients was available at 1 year. The all-cause death occurred in 56 (25.5%) of patients at 1 year. Utilizing the restricted cubic spline, the threshold to categorize an experienced operator was performing > 10 cases of VA-ECMO-assisted PCI. Compared to the ≤ 10 cases group, the > 10 cases group was associated with a 44% decrease in risk of all-cause death (19.8% vs. 31.5%, HR adjusted: 0.56, 95% CI: 0.33-0.97, p = 0.039).

CONCLUSION: VA-ECMO-assisted PCI appeared to be a feasible option for patients unsuitable for CABG. Performing > 10 cases could be a threshold to categorize an experienced operator.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06713876.

PMID:40842186 | DOI:10.1002/ccd.70098

Cardiovasc Diabetol. 2025 Aug 21;24(1):344. doi: 10.1186/s12933-025-02902-6.

ABSTRACT

BACKGROUND: Metabolic Syndrome (MetS) significantly increases the risk of cardiovascular disease (CVD), with central obesity and insulin resistance as major contributors. The TyG-ABSI index is a newly proposed composite measure that combines the TyG index and ABSI, aiming to assess both insulin resistance and central obesity simultaneously. Previous studies have shown that TyG-ABSI has potential in predicting cardiovascular mortality, but its applicability in MetS populations remains unclear. This study aims to explore the association between TyG-ABSI and cardiovascular events in individuals with MetS and compare its predictive value with the traditional TyG index in this specific population.

METHODS: Participants from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 were selected, with all data weighted for sample design, clustering, and stratification to ensure national representativeness. Associations between TyG-ABSI and other TyG indices with cardiovascular mortality and all-cause mortality were assessed using weighted Cox proportional hazards models; CVD prevalence was analyzed using weighted logistic regression models. Additional analyses included Kaplan-Meier survival curves and restricted cubic spline regression. Model performance was compared between TyG-ABSI, TyG, and its derived indices using ROC curves, NRI, IDI, and DCA. E-value, subgroup analyses, and competing risks models were conducted to assess robustness.

RESULTS: This study analyzed data from 12,813 individuals with metabolic syndrome in the NHANES cohort to systematically compare the performance of TyG-ABSI and other TyG-related indices in assessing CVD and mortality. The results revealed significant associations between TyG-ABSI and CVD, cardiovascular mortality, and all-cause mortality. Specifically, for each 1-unit increase in TyG-ABSI, the risk of CVD increased by 28%, cardiovascular mortality by 25%, and all-cause mortality by 28%. These associations showed a dose-response relationship in stratified analyses based on tertiles, and TyG-ABSI outperformed the traditional TyG index in overall analysis. Compared to other TyG-related indices, TyG-ABSI demonstrated superior predictive performance in metrics such as the ROC curve, NRI, and DCA. Further analyses, including competing risks models, E-value estimation, and RCS modeling, confirmed the robustness of these associations. Subgroup analyses also supported the stability of TyG-ABSI, with limited interaction effects.

CONCLUSION: Our study highlights the value of TyG-ABSI in assessing cardiovascular disease and mortality risk in populations with MetS, providing new evidence for medical practice and public health interventions.

PMID:40841630 | PMC:PMC12372269 | DOI:10.1186/s12933-025-02902-6

Kyobu Geka. 2025 Aug;78(8):613-616.

ABSTRACT

An 82-year-old man was admitted to our hospital with chest pain as a chief complaint and diagnosed with a ruptured aortic aneurysm in the distal arch by contrast-enhanced computed tomography (CT). The patient underwent surgery using artificial heart-lung and selective cerebral extracorporeal circulation, and a semi-circumferential aortic arch incision was made around the anterior surface of the aortic arch. An open stent graft was inserted through the incision, trimmed to fit the size, and the aortic wall and the stent graft were fixed with 3-0 proline continuous sutures, and finally the incision was closed with 3-0 proline. This method was useful because it may shorten the operation time and decrease the amount of blood loss compared to the common aortic arch replacement with frozen elephant trunk.

PMID:40840883

J Med Biochem. 2025 Jul 4;44(4):854-862. doi: 10.5937/jomb0-54272.

ABSTRACT

BACKGROUND: To investigate the effects of modified ultrafiltration in extracorporeal circulation valve replacement surgery.

METHODS: A total of 62 patients with valvular disease who underwent valve replacement were included. They were randomly divided into the conventional ultrafiltration group (CUF group, n=31) and the modified ultrafiltration group (MUF group, n=31). The hematocrit (Hct) values, volume of pleural fluid drainage at 24 hours after operation, Intensive Care Unit (ICU) stay time, postoperative 24-hour blood loss, bank blood usage, postoperative 24-hour urine volume, ventilator support time, cardiac function indexes, postoperative changes of respiratory function, and levels of inflammatory factors in both groups were compared.

RESULTS: After ultrafiltration, the MUF group showed higher Hct value and reduced volume of pleural fluid drainage, blood loss, bank blood usage, urine volume and ventilator support time 24 hours after operation compared with the CUF group (P<0.05). After surgery, left ventricular ejection fraction (LVEF) levels were elevated, and those in the MUF group were higher than those in the CUF group. Left ventricular end-diastolic diameter (LVEDD) and heart rate (HR) were decreased in both groups after surgery. They were lower in the MUF group than in the CUF group (P<0.05). After ultrafiltration, the OI value in the MUF group was higher, and the alveolar-arterial oxygen partial pressure gradient (P (A-a)O2) value was lower than the CUF group (P<0.05). The plasma concentrations of interleukin 6 (IL-6) and tumour necrosis factor-alpha (TNF-a) were increased after cardiopulmonary bypass (CPB) in both groups and then decreased after ultrafiltration, and IL-6 and TNF-a levels in MUF group were lower than those in CUF group (P<0.05).

CONCLUSIONS: MUF attenuates the postoperative systemic inflammatory response, reduces the lung injury caused by CPB, and improves the lung function of patients in the early postoperative period, which benefits patient recovery after surgery and is valuable in heart valve replacement.

PMID:40837350 | PMC:PMC12363347 | DOI:10.5937/jomb0-54272

Card Electrophysiol Clin. 2025 Sep;17(3):311-326. doi: 10.1016/j.ccep.2024.12.008.

ABSTRACT

Hemodynamically significant pulmonary embolism (PE) remains a widely prevalent, underdiagnosed condition associated with mortality rates as high as 30%. The main driver of poor outcomes is acute right ventricular failure that remains clinically challenging to diagnose and requires critical care management. Treatment of high-risk (or massive) acute PE has traditionally included systemic anticoagulation and thrombolysis. Mechanical circulatory support, including both percutaneous and surgical approaches, are emerging as treatment options for refractory shock due to acute right ventricular failure in the setting of high-risk acute pulmonary embolism.

PMID:40835301 | DOI:10.1016/j.ccep.2024.12.008

Eur J Med Res. 2025 Aug 19;30(1):767. doi: 10.1186/s40001-025-03004-5.

ABSTRACT

BACKGROUND: The combination of percutaneous coronary intervention (PCI) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become a widely used approach for resuscitating patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA). Nonetheless, limited research has focused on predicting in-hospital mortality in affected patients. This study aims to identify factors associated with in-hospital mortality and develop a clinical prediction model for these patients.

METHODS: Clinical presentations of AMI patients with CA undergoing PCI supported by VA-ECMO at two hospitals in Zhengzhou were evaluated. Patients were stratified based on their survival status at discharge. A comprehensive analysis, which included univariate logistic regression, LASSO regression, and multivariate logistic regression, was conducted to identify predictors and develop a nomogram for in-hospital mortality. The nomogram's predictive performance was subsequently compared to that of existing models.

RESULTS: The study included 139 patients, of whom 84 died during hospitalization. Using factors such as age, current smoking, left main culprit vessel, lactic acid levels, and serum creatinine, a nomogram model was developed. The model demonstrated good predictive performance, with an area under the curve of 0.826 (95% CI 0.757-0.894) in the training dataset and 0.783 (95% CI 0.706-0.859) in the internal validation dataset, indicating high accuracy and stability. Clinical decision curve analysis confirmed the model's utility, particularly for risk thresholds above 20%, outperforming existing models.

CONCLUSIONS: This study identified independent predictors of in-hospital mortality in AMI patients with CA undergoing PCI supported by VA-ECMO and developed a clinically applicable prediction model.

PMID:40830896 | PMC:PMC12363090 | DOI:10.1186/s40001-025-03004-5

Clin Transplant. 2025 Aug;39(8):e70283. doi: 10.1111/ctr.70283.

ABSTRACT

BACKGROUND: The new United Network of Organ Sharing (UNOS) allocation policy emphasizes those supported by mechanical circulatory support devices (MCSD). We evaluated the outcomes based on temporary mechanical circulatory support (TMCS) devices that have a timeline restriction (Status 1: Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) and Status 2: Intra-Aortic Balloon Pump (IABP) and Impella) and extension status among Status 1 and 2 patients.

METHODS: The UNOS database was used to identify adult patients (age > 17) listed for heart transplants as Status 1 or 2 at any point during their listing from October 2018 to June 2024.

RESULTS: Among Status 1 patients, extensions have stayed steady throughout the years but with significant regional variations across the UNOS region (0%-30.2%). Those extensions granted had worse waitlist outcomes but comparable post-transplant survival. Among Status 2 patients, the use of IABP and Impella has significantly increased over the years, with the use of extensions increased during our study period. The majority of the patients were supported on IABP. Again, regional variations existed with the UNOS region that ranged from 12% to 25% use of the extension. Those who were extended had better waitlist survival, with comparable post-transplant outcomes (p < 0.05).

CONCLUSION: The timeline restriction for Status 1 and 2 patients with TMCS are not seen in practice with more patients remaining in their respective status through extensions. Extension criteria as well as timeline restriction should be revisited in the UNOS heart allocation policy.

PMID:40828460 | DOI:10.1111/ctr.70283

Methodist Debakey Cardiovasc J. 2025 Aug 12;21(4):14-25. doi: 10.14797/mdcvj.1654. eCollection 2025.

ABSTRACT

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains a critical clinical challenge associated with high morbidity and mortality. Temporary mechanical circulatory support (tMCS) devices can stabilize hemodynamics, improve cardiac output, and enhance survival, thereby continuing to be more favorable with operators. This review summarizes the pathophysiology of AMI-CS and examines the evidence informing recommendations for tMCS device implementation-specifically the intra-aortic balloon pump, Impella (Abiomed/J&J MedTech), TandemHeart™ (LivaNova, Inc.), and venoarterial extracorporeal membrane oxygenation-with a particular focus on clinical trial data and recent guideline recommendations to assist operators in implementing decision-making.

PMID:40822370 | PMC:PMC12352399 | DOI:10.14797/mdcvj.1654

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jun;37(6):595-598. doi: 10.3760/cma.j.cn121430-20250117-00066.

ABSTRACT

OBJECTIVE: To investigate the efficacy and safety of autologous blood transfusion during weaning from venous-arterial extracorporeal membrane oxygenation (VA-ECMO) under controlled rotational speed.

METHODS: A retrospective study was conducted, selecting patients who underwent extracorporeal membrane oxygenation (ECMO) and successfully weaned at the emergency and critical care medicine center of Henan Provincial Third People's Hospital from January 2023 to May 2024. General data including gender, age, body mass index (BMI), European system for cardiac operative risk evaluation (EuroScore), and disease types were collected. Vital signs at weaning [heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and peripheral oxygen saturation], parameters before and after weaning [B-type natriuretic peptide (BNP), hemoglobin (Hb), partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), arterial lactate, central venous pressure (CVP), inferior vena cava collapsibility index, left ventricular ejection fraction (LVEF), and right heart load], post-weaning inflammatory markers at 1-day and 3-day [body temperature, white blood cell count (WBC), neutrophil percentage (NEU%), C-reactive protein (CRP), procalcitonin (PCT), interleukin-10 (IL-10)], as well as complications (infection, thrombosis, renal failure, gastrointestinal bleeding) and post-weaning blood return status were recorded. Patients were divided into an observation group (with post-weaning blood return) and a control group (without post-weaning blood return) based on the presence of blood return after weaning. The changes in the aforementioned parameters were compared between the two groups.

RESULTS: A total of 62 patients were included, with 31 cases in each group. No statistically significant differences were observed between the two groups in baseline characteristics including gender, age, BMI, and EuroScore. At weaning, the observation group exhibited relatively stable vital signs, with no significant differences in heart rate, SBP, DBP, or peripheral oxygen saturation compared to the control group. After weaning, the observation group showed significantly lower levels of BNP, PaCO2, arterial lactate, CVP, and right heart load compared to pre-weaning values [BNP (ng/L): 2 325.96±78.51 vs. 4 878.48±185.47, PaCO2 (mmHg, 1 mmHg≈0.133 kPa): 35.23±3.25 vs. 40.75±4.41, arterial lactate (mmol/L): 2.43±0.61 vs. 6.19±1.31, CVP (cmH2O, 1 cmH2O≈0.098 kPa): 8.32±0.97 vs. 15.34±1.74, right heart load: 13.24±0.97 vs. 15.69±1.31, all P < 0.05], while Hb, PaO2, inferior vena cava collapsibility index, and LVEF were significantly higher than pre-weaning values [Hb (g/L): 104.42±9.78 vs. 96.74±6.39, PaO2 (mmHg): 94.12±7.78 vs. 75.51±4.39, inferior vena cava collapsibility (%): 28±7 vs. 17±3, LVEF (%): 62.41±6.49 vs. 45.30±4.51, all P < 0.05]. No statistically significant differences were found between the observation group and control group in these parameters. At 3 days post-weaning, the observation group demonstrated significantly lower levels of body temperature, WBC, NEU%, CRP, PCT, and IL-10 compared to 1 day post-weaning [body temperature (centigrade): 36.83±1.15 vs. 37.94±1.41, WBC (×109/L): 7.82±0.96 vs. 14.34±2.15, NEU%: 0.71±0.05 vs. 0.80±0.07; CRP (mg/L): 4.34±0.78 vs. 8.94±1.21, PCT (μg/L): 0.11±0.02 vs. 0.26±0.05, IL-10 (ng/L): 8.93±1.52 vs. 13.51±2.17, all P < 0.05], with no significant differences compared to the control group. No statistically significant differences were observed between the two groups in the incidence of complications including infection, thrombosis, renal failure, and gastrointestinal bleeding.

CONCLUSION: Autologous blood reinfusion during VA-ECMO weaning under controlled rotational speed is safe and effective, without increasing risks of infection or thrombosis.

PMID:40820537 | DOI:10.3760/cma.j.cn121430-20250117-00066

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jun;37(6):576-582. doi: 10.3760/cma.j.cn121430-20240329-00298.

ABSTRACT

OBJECTIVE: To observe the degree of myocardial cell injury and the changes in autophagy level in rats with myocardial ischemia/reperfusion (I/R) injury induced by cardiopulmonary bypass (CPB), and to explore the regulatory role of the long non-coding RNA-urothelial carcinoma antigen 1-microRNA-143-Notch1 axis (lncRNA-UCA1-miR-143-Notch1 axis) in myocardial I/R injury induced by CPB.

METHODS: Healthy male Sprague-Dawley (SD) rats were randomly divided into the following groups using the random number method: Sham operation (Sham) group, myocardial I/R injury model group (model group), empty lentivirus group, lncRNA-UCA1 upregulation group, miR-143 downregulation group, and lncRNA-UCA1 upregulation+miR-143 upregulation group, with 9 rats in each group. The rat model of myocardial I/R injury induced by CPB was established by thoracotomy aortic ligation under cardiopulmonary bypass support; in the Sham group, only threading was performed without ligation, and other procedures were the same. Seventy-two hours before modeling, the lncRNA-UCA1 upregulated group was injected with 100 μL of myocardial tissue-specific adeno-associated virus (AAV) overexpression vector of lncRNA-UCA1 via tail vein, the miR-143 downregulated group was injected with 100 μL of AAV short hairpin RNA (shRNA) vector of miR-143 via tail vein, the lncRNA-UCA1 upregulation+miR-143 upregulation group was injected with 100 μL of myocardial tissue-AAV overexpression vector of lncRNA-UCA1 and 100 μL of AAV overexpression vector of miR-143 via tail vein, and the empty vector lentivirus group was injected with 100 μL of AAV empty vector (virus titers were 1×109 TU/mL); the Sham group and the model group were injected with equal amounts of normal saline. The animals were euthanized 24 hours after intervention and cardiac tissue specimens were collected. After hematoxylin eosin (HE) staining, the damage of myocardial cells and the changes of muscle fiber tissue were observed under a light microscope; after dual staining with uranyl acetate and lead citrate, the ultrastructural damage of heart tissue was observed under a transmission electron microscopy; the expression of lncRNA-UCA1, miR-143, and Notch1 mRNA in myocardial tissue was detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR); the expression of microtubule 1 light chain 3-II/I (LC3-II/I) and Notch1 protein in myocardial tissue was detected by Western blotting.

RESULTS: Compared with the Sham group, the myocardial cells of rats in the model group were enlarged, the intercellular space increased, autophagosomes increased, the arrangement of myocardial fibers was disordered, mitochondrial proliferated and deformed. The expression levels of lncRNA-UCA1 and Notch1 mRNA, as well as the protein expression levels of LC3-II/I and Notch1 were significantly increased, while the expression level of miR-143 was significantly decreased. Compared with the model group, the degree of myocardial cell injury in the lncRNA-UCA1 upregulation group and miR-143 downregulation group was significantly alleviated, the expression levels of Notch1 mRNA, LC3-II/I, and Notch1 protein were significantly increased [Notch1 mRNA (2-ΔΔCt): 2.66±0.24, 2.03±0.23 vs. 1.45±0.13, LC3-II/I: 2.10±0.21, 1.92±0.19 vs. 1.39±0.14, Notch1 protein (Notch1/GAPDH): 1.72±0.16, 1.57±0.16 vs. 1.34±0.13, all P < 0.05], and the expression level of miR-143 was significantly decreased (2-ΔΔCt: 0.50±0.06, 0.52±0.06 vs.0.71±0.06, P < 0.05). The expression level of lncRNA-UCA1 in the lncRNA-UCA1 upregulated group was significantly higher than that in the model group (2-ΔΔCt: 2.47±0.22 vs. 1.43±0.14, P < 0.05), while there was no significant difference in the miR-143 downregulation group compared with the model group (2-ΔΔCt: 1.50±0.16 vs. 1.43±0.14, P > 0.05). There was no significant difference in the degree of myocardial cell injury in the empty load lentivirus group and the lncRNA-UCA1 upregulation+miR-143 upregulation group compared to the model group. There were no significant differences in the expression of miR-143, Notch1 mRNA, and the autophagy level in these two groups compared to the model group. The expression level of lncRNA-UCA1 in the lncRNA-UCA1 upregulation+miR-143 upregulation group was significantly higher than that in the model group (2-ΔΔCt: 2.47±0.20 vs. 1.43±0.14, P < 0.05).

CONCLUSIONS: Autophagy is involved in the pathological process of myocardial I/R injury induced by CPB. The lncRNA-UCA1-microRNA-143-Notch1 axis may regulate the autophagy level to participate in the I/R injury process.

PMID:40820534 | DOI:10.3760/cma.j.cn121430-20240329-00298

JACC Case Rep. 2025 Aug 13;30(23):104182. doi: 10.1016/j.jaccas.2025.104182.

ABSTRACT

BACKGROUND: Amniotic fluid embolism is a rare potential complication in the peripartum period.

CASE SUMMARY: A 27-year-old nulliparous woman presented for elective induction at 41 weeks' gestation. Due to nonreassuring fetal heart tracing, the patient underwent emergent caesarean section complicated by pulseless electrical activity arrest secondary to suspected amniotic fluid embolism after fetus delivery. Despite return of spontaneous circulation, the patient remained in cardiogenic shock with right ventricular failure. The patient was cannulated for venoarterial extracorporeal membrane oxygenation. After 5 days, she was converted to a right ventricular assist device, with ultimate complete biventricular recovery.

DISCUSSION: The use of multidisciplinary cardiogenic shock team aids in swift escalation of care in patients with refractory shock requiring mechanical circulatory support. It is crucial to initiate cardiogenic shock teams early in a patient's clinical course.

TAKE-HOME MESSAGES: Amniotic fluid embolism is a known cause of mortality in postpartum women. Severe cases can lead to cardiac arrest. Rapid initiation of mechanical circulatory support can save lives.

PMID:40816834 | PMC:PMC12462143 | DOI:10.1016/j.jaccas.2025.104182

BMC Cardiovasc Disord. 2025 Aug 14;25(1):605. doi: 10.1186/s12872-025-05044-5.

ABSTRACT

BACKGROUND: The primary causes of heart failure include myocardial damage and structural abnormalities. In addition to cardiovascular disease, noncardiovascular disease can also lead to heart failure. Identifying these etiologies is critical for accurate diagnosis and timely, targeted treatment.

CASE PRESENTATION: The patient presented with a 10-month history of recurrent chest tightness and shortness of breath, with symptoms significantly worsening 6 hours before admission. She was diagnosed with acute heart failure in the decompensated phase, complicated by cardiogenic shock. Stabilization was achieved via an intra-aortic balloon pump (IABP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Further evaluation revealed pheochromocytoma as the underlying cause of acute heart failure. The patient underwent successful surgical resection of the pheochromocytoma, with no recurrence of heart failure symptoms observed during follow-up.

CONCLUSION: Acute heart failure is a rare but critical condition with rapid onset, often presenting as an emergency. Effective management necessitates life support therapy to stabilize the patient, allowing time for further diagnostic and therapeutic measures.

PMID:40813639 | PMC:PMC12355791 | DOI:10.1186/s12872-025-05044-5

Braz J Cardiovasc Surg. 2025 Nov 1;40(6):e20250906. doi: 10.21470/1678-9741-2025-0906.

ABSTRACT

Mechanical circulatory support (MCS) devices have evolved significantly over the past decades and play a vital role in managing end-stage heart failure, especially as a bridge to heart transplantation. From the pioneering heart-lung machines to third-generation ventricular assist devices (VADs), MCS technology has advanced to provide more durable, efficient, and safer options for both shortand long-term support. This review outlines the historical development of mechanical assist devices, the types of available supports - ranging from intra-aortic balloon pumps and extracorporeal membrane oxygenation to implantable devices like HeartMate 3 - and their clinical indications and complications. Special attention is given to right ventricular dysfunction, thromboembolic and hemorrhagic complications, and infections, which remain major challenges in the management of patients with MCS devices.In Brazil, despite the growing evidence supporting MCS in critically ill patients, access remains limited due to financial and systemic constraints. The review explores the current landscape of device availability in the country, national guidelines, cost-effectiveness data, and the impact of recent changes in transplant allocation criteria that prioritize patients receiving mechanical support. Notably, the approval of long-term VADs for destination therapy in the public health system in 2024 marks a significant milestone.This review offers a comprehensive perspective on MCS utilization, highlighting both global advances and Brazil-specific challenges. By identifying gaps in access and proposing future directions, it advocates for expanded use of these life-saving technologies to improve survival and quality of life in advanced heart failure patients.

PMID:40811591 | PMC:PMC12352751 | DOI:10.21470/1678-9741-2025-0906

Front Public Health. 2025 Jul 30;13:1560587. doi: 10.3389/fpubh.2025.1560587. eCollection 2025.

ABSTRACT

INTRODUCTION: This study aims to evaluate the impact of oXiris continuous renal-replacement therapy (CRRT) on the prognosis of patients with severe intra-abdominal infections (IAIs) and to analyze potential risk factors for early off-machine of oXiris CRRT during treatment.

METHODS: A total of 49 patients with severe abdominal infections admitted to the intensive care unit of the First Affiliated Hospital of Fujian Medical University from October 2020 to October 2023 were retrospectively analyzed. The patients were divided into a conventional group and an oXiris group. Heart rate, blood lactate level, mean arterial pressure, and total CRRT operation time were observed 72 h before and after CCRT treatment.

RESULTS: When comparing changes in indicators over the 72-h period between the two groups, no significant difference in survival rate was observed between the two groups. D-dimer [per 1 ng/mL increase, odds ratio (OR) = 0.930, 95% confidence interval (CI): 0.866-0.999] was identified as a risk factor for early off-machine. In contrast, prothrombin time (PT, per 1-s increase, OR = 1.117, 95% CI: 1.017-1.226), activated partial thromboplastin time (APTT, per 1-s increase, OR = 1.021, 95% CI: 1.006-1.037), and blood flow velocity (per 1 mL/min increase, OR = 1.027, 95% CI: 1.009-1.046) were found to be protective factors.

CONCLUSION: oXiris CRRT is associated with a better prognosis in the treatment of severe abdominal infections. APTT, PT, D-dimer, and blood flow velocity are associated with early off-machine during oXiris CRRT.

PMID:40809760 | PMC:PMC12343586 | DOI:10.3389/fpubh.2025.1560587

Cardiol Young. 2025 Jul;35(7):1472-1475. doi: 10.1017/S1047951125101406. Epub 2025 Aug 13.

ABSTRACT

We present an extremely rare case of anomalous single coronary artery from the pulmonary artery in a 2-month-old infant with severe heart failure. Due to the unique coronary anatomy, a modified venous arterial extracorporeal membrane oxygenation technique was employed to maintain coronary perfusion and prevent coronary steal. Following surgical reimplantation, the patient showed significant recovery and remains stable at 2-year follow-up.

PMID:40799112 | DOI:10.1017/S1047951125101406

Medicine (Baltimore). 2025 Aug 8;104(32):e43741. doi: 10.1097/MD.0000000000043741.

ABSTRACT

RATIONALE: Streptococcal toxic shock syndrome (STSS) is an invasive Streptococcus pyogenes infection characterized by hypotension and multiple organ failure with rapid progression and high mortality. Although extracorporeal membrane oxygenation (ECMO) has been used in adults with STSS, mortality remains high and optimal mechanical circulatory support is controversial. Veno-arterial ECMO has specific complications in severe cardiopulmonary failure, including differential hypoxia and increased left ventricular end-diastolic pressure due to retrograde flow.

PATIENT CONCERNS: A 51-year-old man presented to the emergency department with fever and dyspnea, progressing rapidly from an initially diagnosed upper respiratory tract infection to severe respiratory distress and refractory shock requiring oxygen supplementation and vasopressor support.

DIAGNOSES: The patient was diagnosed with STSS, which manifested as septic shock with severe cardiopulmonary compromise.

INTERVENTIONS: We implemented a combined approach using veno-arteriovenous ECMO (V-AV ECMO) and Impella CP® support (veno-arteriovenous extracorporeal membrane oxygenation and Impella [VAVEcpella]). This strategy provided oxygenated blood to the right heart while achieving left ventricular unloading. This was done in conjunction with appropriate antibiotic therapy and source control measures.

OUTCOMES: The novel VAVEcpella approach successfully supported the patient through severe cardiopulmonary failure secondary to STSS-induced septic shock. To our knowledge, this is the first reported case of VAVEcpella implementation specifically for the management of STSS.

LESSONS: The VAVEcpella approach (combined V-AV ECMO and Impella support) may represent a viable rescue strategy for patients with severe cardiopulmonary failure secondary to septic shock, such as STSS, where traditional support methods have shown limited success.

PMID:40797469 | PMC:PMC12338243 | DOI:10.1097/MD.0000000000043741

Eur J Cardiothorac Surg. 2025 Sep 2;67(9):ezaf263. doi: 10.1093/ejcts/ezaf263.

ABSTRACT

OBJECTIVES: The "German Registry for Acute Aortic Dissection Type A" (GERAADA) long-term follow-up firstly investigates the neurologic outcomes over a 16-year timeframe and secondly determines whether acute Stanford type A aortic dissection (ATAAD) patients are at risk for secondary neurologic complications.

METHODS: Thirty-three centres provided follow-up data of 2686 individuals. Of those, 814 provided long-term data regarding their neurological status and incidence of stroke. Multivariable regression analysis was used to identify risk factors of both postoperative and secondary neurologic deficits. Subgroup analyses of patients operated in hypothermic circulatory arrest with or without selective antegrade cerebral perfusion was performed to assess further influencing factors.

RESULTS: Four hundred and fifteen (15%) out of the 2686 patients experienced postoperatively a new-onset neurologic deficit while being hospitalized. Age, renal malperfusion, dissected supra-aortic vessels, extracorporeal circulation time, and re-exploration were independent risk factors (all P < .05) for worse neurological outcomes while hemiarch replacement seemed to have a protective effect (OR = 0.68; P = .008). Neither cerebral protection strategy nor temperature management showed significant differences between the groups regarding neurological outcome. Out of the 814 follow-up patients, 188 (23%) experienced secondary neurologic deficits after initial treatment for ATAAD within a median follow-up of 10.2 years. Long-term risk factors were a persistent cerebral malperfusion and late reoperation. No association between perioperative neurologic damage and operative techniques on long-term neurologic outcomes could be found.

CONCLUSIONS: Surgery for ATAAD is associated with frequent early neurologic complications that can be predicted by perioperative factors. Open treatment of the aortic arch shows a positive effect on neurological outcome. Further, every fourth follow-upped patients suffered from secondary neurological damage highlighting the importance of a close surveillance.

PMID:40796127 | DOI:10.1093/ejcts/ezaf263