This study aimed to investigate the clinical effects of early recruitment maneuver (RM) combined with prone position (PP) in improving acute respiratory distress syndrome (ARDS) after aortic dissection (AD) surgery.
A before-and-after single-arm interventional study was conducted to collect data on patients with Stanford type A aortic dissection (STAAD), who underwent surgical treatment from April 2017 to October 2023 in the Department of Cardiac Major Vascular Surgery, a teaching hospital in China. Comparisons of hemodynamic indices, changes in respiratory parameters, and adverse events were performed at six time points: before the intervention, immediately after early RM combined with PP, and at 30 min, 1 h, 2 h, and 4 h thereafter.
A total of 41 patients (80.49% male; mean age 49.05 ± 11.64 years) were included. Following early lung recruitment combined with prone positioning, PaO2 increased from 66 mmHg at baseline to a peak of 102 mmHg post-intervention at 1 hour, and the PaO2/FiO2 ratio improved from 95 mmHg to 154 mmHg, indicating enhanced oxygenation. PaCO2 remained stable throughout the observation period. FiO2 initially increased from 60% to 70% and returned to baseline levels, while SpO2 improved from 94.5% to 97%, demonstrating a sustained improvement in peripheral oxygen saturation. Hemodynamic parameters, including heart rate and central venous pressure, remained largely stable. All changes in oxygenation indices were statistically significant (p < 0.001 following the Friedman test).
Early lung recruitment combined with prone positioning significantly improved oxygenation in post-operative ARDS patients with STAAD, as evidenced by increased PaO2 and PaO2/FiO2 ratios. These benefits were achieved without significant changes in PaCO2, heart rate, or lactate levels, suggesting that this strategy enhances gas exchange while maintaining hemodynamic stability.
The Ross procedure is ideal for children and young adults that require an aortic valve replacement; However, long-term autograft durability remains a concern. Numerous techniques revolving around supporting the autograft have been developed with the goal of preventing dysfunction and subsequent reoperation. Short- and long-term results of various supported Ross techniques are promising and demonstrate significant autograft preservation. Further work is needed to determine the optimal surgical approach.
Heart valve disease remains a significant global health burden, with an estimated 290 million people affected worldwide. Prosthetic heart valves have become essential therapeutic options, with mechanical valves offering superior durability compared to biological alternatives, though requiring lifelong anticoagulation. Since the inception of mechanical heart valves, these valves have evolved significantly—from early cage-ball designs to modern bileaflet configurations—addressing various hemodynamic and biocompatibility challenges. This review comprehensively examines the evolution, design principles, and clinical applications of mechanical heart valves. The developmental trajectory of mechanical heart valves demonstrates remarkable engineering innovation, progressing from the pioneering Starr–Edwards caged-ball valve to sophisticated bileaflet designs such as the St. Jude Medical and ON-X valves. Material science advancements, particularly pyrolytic carbon technology, have revolutionized valve durability and thromboresistance. Clinical outcomes data demonstrate excellent long-term durability exceeding 25 years, with principal complications relating to thromboembolism and anticoagulation-related bleeding. Current research focuses on novel designs incorporating computational fluid dynamics optimization and innovative materials such as superhydrophobic surfaces and nanomaterials. Therefore, optimizing the design of valve structures may provide greater assurance of mechanical durability. However, despite some progress, the ideal mechanical valve that balances perfect hemodynamics, thromboresistance without anticoagulation, and lifelong durability, remains elusive. Continued advancement will require multidisciplinary collaboration between engineers, materials scientists, clinicians, and regulatory bodies to address remaining challenges in mechanical heart valve technology.
Acute kidney injury (AKI) is a common and serious complication of cardiac valve surgery, and is associated with high mortality and healthcare costs. Existing prediction models for AKI are often incapable of capturing complex biomarker interactions. This study aimed to build an interpretable machine learning (ML) model that incorpates preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) and serum creatinine (SCr) levels to predict of AKI risk in valve surgery patients.
Consecutive adults who underwent isolated valve surgery with cardiopulmonary bypass (CPB) in the first affiliated hospital of Nanchang University from October 2016 to October 2021 were included in this retrospective cohort study. Patients who had preoperative dialysis or were having an emergency surgery were excluded as well as those with missing NT-proBNP/SCr data. The main outcome was any stage AKI within 7 days after surgery (Kidney Disease: Improving Global Outcomes, KDIGO criteria). Utilizing preoperative variables, five ML models Logistic regression, support vector machine (SVM), Random Forest (RF), extreme gradient boosting (XGBoost), and K-nearest neighbors (KNN) were developed after handling class imbalance synthetic minority oversampling technique (SMOTE). Key predictors were identified through feature selection techniques. Evaluation of model performance was done at area under the curve (AUC), sensitivity, specificity and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) values provided interpretability.
Among 333 patients eligible for inclusion, 106 experienced AKI (31.8%). Seven predictors were consistently selected: age, NT-proBNP, SCr, CPB duration, aortic cross-clamp (ACC) duration, hemoglobin and albumin. Overall, the RandomForest model outperformed the other models, with AUC of 0.872, accuracy of 0.835, sensitivity of 0.718, specificity of 0.923 and F1-score of 0.789 in the testing cohort (n = 91). DCA demonstrated excellent calibration and the highest net benefit with this model. SHAP analysis identified NT-proBNP, SCr, and duration of ACC as the three leading risk factors with clear, personalized risk evaluation.
This novel, interpretable ML model leverages preoperative NT-proBNP and SCr to accurately predict AKI after cardiac valve surgery. It demonstrated promising predictive performance in internal validation, with the potential to surpass traditional models and have future potential for clinical application. Prospective trials are needed to assess whether model-guided interventions can truly reduce AKI incidence.
Thrombus burden in patients with ST-segment elevation myocardial infarction (STEMI) facilitates distal embolization and microvascular obstruction (MVO), jeopardizing tissue reperfusion despite an open epicardial artery. Early single-center randomized trials (Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS), Thrombectomy With Export Catheter in Infarct-Related Artery During Primary Percutaneous Coronary Intervention (EXPIRA)) have exhibited improved microvascular surrogates and suggested clinical benefit; however, pragmatic multicenter trials did not confirm efficacy for a routine aspiration strategy, i.e., Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) and Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL) did not demonstrate a reduction in death, reinfarction, or heart failure with aspiration plus percutaneous coronary intervention (PCI) versus PCI alone. In TOTAL, routine aspiration intake increased stroke: 0.7% versus 0.3% at 30 days (hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.13–3.75), while the excess was evident within 48 hours and the signal was sustained to 180 days (1.0% versus 0.5%, HR 2.00, 95% CI 1.25–3.20); meanwhile, disabling or fatal strokes were also more frequent (HR 2.69). Accordingly, the current European Society of Cardiology (ESC) 2023 and American College of Cardiology/American Heart Association (ACC/AHA) 2025 guidelines dissuade routine manual aspiration (Class III, Level A) while supporting selective bailout application when large residual thrombus or refractory no-reflow exists despite standard measures. Device-based alternatives (rheolytic thrombectomy, distal protection) have failed to improve hard outcomes in native vessel primary PCI; meanwhile, newer continuous aspiration and coronary stent-retriever systems remain practical but unproven in outcomes trials. This narrative review appraises randomized and mechanistic evidence and proposes a practical, safety-first algorithm. This approach includes performing primary PCI rapidly with guideline-directed antithrombotic therapy; considering thrombectomy only in rare cases of very large thrombus burden when it is likely to improve flow; if aspiration is utilized, careful purging must be ensured to prevent air embolism, continuous negative pressure must be maintained, and a single slow pass performed with sustained suction to minimize embolization. Currently, in practice, the evidence overwhelmingly argues against routine aspiration. However, a selective and technically disciplined bailout approach may still be warranted in carefully chosen patients.
Patients with ST-segment elevation myocardial infarction (STEMI) remain at risk for major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI). Current risk scores lack detailed myocardial tissue characteristics from cardiac magnetic resonance (CMR) imaging for long-term prediction. The aim of this study was therefore to develop and validate a prognostic nomogram that integrates CMR and clinical data to better predict 1- to 3-year MACE in new-onset STEMI patients post-PCI.
This retrospective study included patients who underwent PCI for new-onset STEMI between January 2020 and June 2022. Data from two centers were pooled. The combined cohort was then randomly divided into a derivation cohort (n = 107) for model development and an internal validation cohort (n = 46) for performance assessment. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent risk factors and construct a nomogram. The predictive performance of this nomogram was assessed using C-indexes, time-dependent Receiver Operating Characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).
A total of 107 new-onset STEMI patients were included in the derivation cohort and 46 in the internal validation cohort. Cumulative MACE incidence rates at 1-, 2-, and 3- years were 20.6%, 34.6%, and 44.9% in the derivation cohort, and 21.7%, 34.8%, and 50.0% in the internal validation cohort, respectively. The final nomogram incorporated six independent predictors derived from both clinical and CMR data: the Gensini Score (hazard ratio [HR]: 1.012, 95% confidence interval [CI]: 1.003–1.020, p = 0.006), albumin (HR: 0.849, 95% CI: 0.769–0.938, p = 0.001), low-density lipoprotein cholesterol (LDL-C; HR: 1.377, 95% CI: 1.037–1.828, p = 0.027), Left Ventricular Ejection Fraction (LVEF; HR: 0.890, 95% CI: 0.833–0.951, p = 0.001), Left Ventricular End-Diastolic Volume (LVEDV; HR: 1.014, 95% CI: 1.003–1.025, p = 0.015), and the mean of Left Ventricular Wall Motion (LVWM; HR: 0.464, 95% CI: 0.288–0.747, p = 0.002), derived from both clinical and CMR data. The nomogram demonstrated good discriminatory ability in the derivation cohort (C-index: 0.803; 95% CI: 0.739–0.867) and moderate discrimination in the internal validation cohort (C-index: 0.693; 95% CI: 0.570–0.816). Calibration plots indicated good agreement between the predicted and observed MACE probabilities in both cohorts. DCA confirmed the potential clinical utility of the nomogram.
Our validated prognostic nomogram, integrates CMR parameters and clinical data. It effectively discriminates high- and low-risk new-onset STEMI patients for 1-, 2-, and 3-year MACE following PCI. This tool may assist with risk stratification and in guiding personalized therapeutic strategies.
This study aimed to explore the clinical advantages of the non-free left subclavian artery and single-branch stent graft technique in treating acute DeBakey Type I aortic dissection, with a focus on evaluating the impact of the technique on intraoperative efficiency, postoperative complications, and prognosis.
This study retrospectively analyzed 58 patients with acute DeBakey type I aortic dissection admitted between August 2023 and October 2024. All enrolled patients underwent ascending aorta replacement in combination with total aortic arch replacement and descending aortic stent graft implantation. In the experimental group (n = 28), the left subclavian artery (LSA) was reconstructed using branched stent grafts for distal descending aortic repair, maintaining the anatomical integrity of the vessel and deliberately preserving the thoracic duct and recurrent laryngeal nerve. In the control group (n = 30), conventional minimally invasive stent reconstruction was employed for distal descending aortic repair with anatomical isolation of the LSA. Statistical analyses were conducted on intraoperative parameters (total operative time, heparinization duration), complications (chylothorax, hoarseness), and prognostic indicators (duration of tracheal intubation, mortality rate) using SPSS, version 26.0.0.0 (IBM Corp., Armonk, NY, USA), after controlling for preoperative baseline characteristics between groups.
The total surgical time in the experimental group was significantly shorter than that in the control group (256.21 ± 53.08 minutes vs. 298.97 ± 51.09 minutes; p = 0.003). The intensive care unit (ICU) length of stay (159.50 minutes vs. 257.00 minutes; p < 0.001) and postoperative hospital stay duration (14.00 days vs. 21.00 days; p = 0.001) were also shorter in the experimental group. There was no significant difference in mortality (28.57% vs. 10.00%; p = 0.071) and rethoracotomy rates (10.71% vs. 10.00%; p = 0.732) between the two groups. No cases of recurrent laryngeal nerve injury or chylothorax occurred in the experimental group, whereas the control group reported a 6.67% incidence of chylothorax and 10.00% noted hoarseness.
The non-free left subclavian artery and single-branch stent graft technique can significantly shorten surgical time and reduce postoperative drainage volume and ICU stay duration. Additionally, no recurrent laryngeal nerve injury or chylothorax was observed in this group. Thus, this technique represents a safe and effective surgical approach for acute DeBakey Type I aortic dissection.
Atrial fibrillation (AF) is a common complication following cardiac surgery, particularly in populations undergoing complex cardiac procedures. This randomized clinical trial aimed to evaluate the effectiveness of posterior pericardiotomy (PP) in preventing postoperative atrial fibrillation (POAF) in a Yemeni cardiac surgical population.
This prospective, single-center, randomized clinical trial conducted in Yemen enrolled 210 patients undergoing open-heart surgery involving coronary artery bypass grafting (CABG), aortic valve replacement, ascending aortic surgery, or a combination of these procedures. Patients were randomized using sealed opaque envelopes into either the PP group (n = 106), in which a posterior left pericardiotomy was performed, or the control group (n = 104), which received standard care without pericardiotomy.
A total of 436 patients were screened between January 1, 2022, and June 30, 2024, and 210 were randomized. The median age was 60 years (interquartile range (IQR) 50–65), with 165 males (78.5%) and 45 females (21.5%). The incidence of POAF was significantly lower in the PP group compared to the control group (8.5% vs. 22.1%; p = 0.006). Cardiac tamponade occurred exclusively in the control group (n = 10). The PP group also demonstrated significantly shorter mechanical ventilation time (p < 0.001) and intensive care unit (ICU) stay (p = 0.004). In-hospital mortality was significantly lower in the PP group compared to the control group (p = 0.067).
Our findings reinforce the evidence supporting PP as a simple, low-cost adjunct to cardiac surgery. Thus, PP may improve postoperative recovery and resource utilization by reducing POAF, pericardial effusion, and tamponade, particularly in resource-limited settings such as Yemen.
NCT07266935, https://clinicaltrials.gov/study/NCT07266935.
The optimal cannulation strategy for acute type A aortic dissection (ATAAD) remains controversial. Femoral artery, axillary artery, ascending aorta, or apical cannulation is used depending on the clinical scenario; however, no consensus on use has currently been established. Thus, this study aimed to compare the outcomes of femoral artery and central aortic cannulation.
This study retrospectively analyzed 92 patients who underwent emergency surgery for ATAAD between April 2023 and March 2025. Femoral artery cannulation was performed in 71 patients (77%), ascending aortic cannulation in 11 (12%), brachiocephalic in 6 (7%), and apical in 4 (4.3%).
Baseline characteristics did not differ significantly between the femoral and central aortic groups. Total arch replacement was performed more frequently in the femoral group (32%) than in the central aortic cannulation group (0%; p = 0.029). Postoperative stroke occurred in 2.8% of the individuals in the femoral group and 0% of the central aortic cannulation group. Similarly, 30-day mortality did not differ between the groups. The multivariate analysis did not identify any significant predictors of postoperative stroke. However, prolonged operative time was associated with 30-day mortality (odds ratio, 1.01; p = 0.00467). The time from skin incision to cardiopulmonary bypass initiation did not significantly affect patient outcomes.
Excluding cases at high risk of embolization due to retrograde perfusion, both ascending aortic and femoral cannulations can be safely utilized as arterial inflow sites. Therefore, tailoring the cannulation strategy to each patient is essential.
Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, typically confined to the coronary arteries and managed conservatively.
We report a unique case of a 45-year-old man who presented with chest pain and syncope. Initial electrocardiography revealed ST-segment elevation, and imaging suggested aortic dissection. Emergency surgery revealed a hematoma in the sinus of Valsalva compressing the right coronary artery (RCA) ostium, caused by a SCAD extending beyond the coronary artery. The affected segment was resected, and coronary artery bypass grafting was performed. To our knowledge, this is the first reported case of SCAD extending into the sinus of Valsalva, mimicking an ascending aortic dissection. Although the angiographic appearance resembled type 1 SCAD, the anatomical pattern challenges existing classification.
This case highlights the need for heightened awareness of atypical SCAD presentations, consideration of conservative management when appropriate, and the importance of interdisciplinary collaboration in diagnosis and surgical planning.