This study aimed to investigate the incidence, associated factors, and outcomes of nosocomial infections (NIs) among adult patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO).
This retrospective study included 97 adult patients who underwent VA-ECMO between July 2020 and January 2025. All patients were treated in a single-center intensive care unit (ICU). The incidence, pathogen characteristics, associated factors, and outcomes of NIs were analyzed.
A total of 61 (62.89%) patients developed NIs. Acinetobacter baumannii was identified as the major pathogen. The hospital mortality rate for patients receiving VA-ECMO with NIs was 49.18%. A long ECMO duration (odds ratio (OR) = 1.26, 95% confidence interval (CI): 1.05–1.51; p = 0.013), blood transfusion (OR = 7.45, 95% CI: 1.89–29.28; p = 0.004), a long central venous catheterization (CVC) duration (OR = 1.13, 95% CI: 1.01–1.27; p = 0.041), and long ICU stay (OR = 1.14, 95% CI: 1.07–1.22; p < 0.001) were factors significantly associated with NIs. The occurrence of adverse events was positively related to that of death (OR = 11.85, 95% CI: 4.52–31.08; p < 0.001). A restricted cubic spline (RCS) revealed that when the ICU stay exceeded 24.13 days, the risk of NIs increased dramatically (p for nonlinearity = 0.036).
NIs are common in ICU patients supported by VA-ECMO. Acinetobacter baumannii was identified as the most common microorganism associated with NI. Longer ECMO and CVC durations, blood transfusions, and a longer ICU stay were associated with NIs. The occurrence of adverse events early in the ICU increased the risk of death in ECMO-supported patients.
A limited number of studies have analyzed outcomes following surgery for infective endocarditis (IE) in patients with opioid misuse. Therefore, this study aimed to assess post-surgery survival rates for IE in opioid users compared to those with community-acquired IE (CA-IE). The secondary outcomes included mortality, readmission, and reinfection rates during mid-term follow-up.
Our retrospective study included 126 patients with IE who underwent surgical intervention from June 2007 to September 2024. Of the 126 patients, 75 were opioid abusers, while the remaining 51 were diagnosed with CA-IE. IE was diagnosed using the modified Duke criteria. To confirm malnutrition as a risk factor of mortality and morbidity MN after cardiac surgery, the patients were evaluated by an experienced dietitian preoperatively. Transthoracic echocardiography, with or without transesophageal echocardiography (TOE), was conducted to assess vegetation growth, valve dysfunction, and myocardial function. The key endpoint was mortality occurring within 30 days post-surgery. The secondary endpoints were the rates of IE recurrence, reoperation, and mortality during the follow-up period. Multivariable regression was employed to assess the relationship between mortality and opioid addiction over the follow-up period.
Over 65% of patients (n = 49) reported a history of intravenous heroin use, while 16 patients (21.3%) were identified as cocaine users, with various methods of admission recorded, including snorting and intravenous injection. Of the remaining 10 patients (13.3%), all had a history of using oral methamphetamine and dextroamphetamine, both of which are psychostimulant drugs, in combination with injected substances. The mean drug use duration was 9.4 years, with a standard deviation of 3.2 years, and a range of 3 to 11 years. In-hospital mortality rates were comparable between the two groups (three patients with opioid abuse (6.6%) vs. five patients with CA-IE (5.8%); p = 0.685). Isolated right-sided IE was more prevalent in individuals with opioid addiction compared to community-acquired IE (45.3% vs. 17.6%; p = 0.012), followed by mitral valve IE (14% vs. 21.5%; p = 0.004). The patients who abused opioids were significantly younger and exhibited fewer comorbidities. The mean intensive care unit duration for opioid-abusing IE patients was considerably greater than for non-abusing patients (3.9 days vs. 2.1 days; p = 0.01). The median duration of hospitalization was significantly longer for opioid users than for patients with CA-IE (49.9 ± 19.4 days vs. 27.1 ± 12.2 days; p = 0.022). Multivariate Cox regression analysis indicated that opioid abuse (hazard ratio (HR): 2.012, 95% confidence interval (CI): 1.96–4.56; p = 0.002), urgent surgery (HR: 1.96, 95% CI: 1.41–5.12; p = 0.024), congestive heart failure (HR: 2.58, 95% CI: 1.94–5.07; p = 0.032), and redo valvular surgery (HR: 1.78, 95% CI: 1.29–6.04; p = 0.002) were independent predictors of mortality. The median follow-up duration for individuals with opioid abuse and CA-IE was 60.7 ± 23.3 months and 59.4 ± 24.9 months, respectively. The incidence of readmission was more prevalent among patients who abused opioids than among those who did not. Nine opioid users with IE (12.8%) were readmitted due to a new episode of IE, whereas the readmission rate in the CA-IE group was 4% (n = 2 patients) due to recurrence of IE (odds ratio (OR): 3.96; p = 0.004). Reoperation rates in patients with a tendency to misuse opioids were considerably elevated compared to those with CA-IE (8.5% vs. 4%; OR: 4.12; p = 0.01).
Mortality rates following surgery for IE were markedly elevated in patients with a history of opioid abuse throughout mid-term follow-up relative to those with CA-IE. Opioid users with IE had elevated readmission and reoperation rates compared to patients with community-acquired IE. Intravenous opioid administration, revision surgery, congestive heart failure, and emergency surgery were independent mortality risk factors. Prospective randomized studies are required to investigate risk factors for mortality, comorbidities, and readmission following a new episode of IE during the follow-up period.
Contrast-induced nephropathy (CIN) is a common complication after coronary angiography (CAG), especially in patients with diabetes. Sodium–glucose cotransporter-2 (SGLT-2) inhibitors are well known for their cardio–renal protective effects, but their impact on CIN remains unclear. This study aimed to evaluate the renal safety of SGLT-2 inhibitors in patients undergoing CAG and to examine the role of glycemic control in the risk of CIN.
This retrospective study included 270 patients with type 2 diabetes who underwent elective or urgent CAG. Patients were divided into SGLT-2 users (n = 127) or non-users (n = 143). Demographic characteristics, comorbidities, laboratory data, and antidiabetic therapies were collected. CIN was defined as a ≥25% or ≥0.5 mg/dL increase in serum creatinine within 48 hours after contrast exposure. Hemoglobin A1c (HbA1c) categories were used to perform subgroup analyses.
The incidence of CIN was similar between SGLT-2 inhibitor users and non-users (18.1% vs. 14.7%; p = 0.447). Patients administered SGLT-2 inhibitors had higher HbA1c but lower uric acid levels. Overall, renal function decline was more evident in patients with HbA1c >6.4%; however, SGLT-2 inhibitor users showed a milder decrease in estimated glomerular filtration rate (eGFR). The frequent use of metformin and insulin may also influence CIN outcomes.
SGLT-2 inhibitors appear to be safe during CAG and may reduce the risk of CIN in patients with poorly controlled diabetes. Larger prospective studies are required to confirm these findings.
This study aimed to investigate the incidence and risk factors of postoperative bloodstream infections (BSIs) in patients with Stanford type A aortic dissection (SAAD) and to develop a reliable predictive model to provide a more comprehensive understanding of the characteristics of this complication.
Clinical data from 257 patients who underwent surgical repair for SAAD at the Shandong Provincial Hospital Affiliated to Shandong First Medical University between January 2017 and July 2023 were retrospectively analyzed. Risk factors for postoperative BSIs were identified using univariate and multivariate logistic regression. A predictive model was constructed and validated based on the receiver operating characteristic (ROC) curve.
Based on a comprehensive analysis of 257 patients who underwent surgical repair for type A aortic dissection, this study identified an incidence of postoperative BSIs of 10.5%. Patients with BSIs experienced significantly worse outcomes, including prolonged intensive care unit (ICU) and overall hospital stays, and a higher incidence of complications such as liver failure, acute kidney injury, and cerebral infarction. In addition, postoperative BSI was associated with an increase in in-hospital mortality. Blood culture analysis revealed Gram-negative bacilli as the primary pathogens, with Acinetobacter baumannii and Enterobacter cloacae being the most prevalent, collectively accounting for 22.22% of all BSI cases. Multivariable analysis identified the following independent risk factors for postoperative BSI: preoperative C-reactive protein (odds ratios (OR) = 1.010, 95% confidence interval (CI) 1.002–1.019, p = 0.020), tracheostomy (OR = 9.186, 95% CI 2.463–34.266, p = 0.001), infectious pneumonia (OR = 32.872, 95% CI 4.186–258.174, p = 0.001), circulatory arrest time (OR = 1.048, 95% CI 1.004–1.093, p = 0.033), and age (OR = 1.055, 95% CI 1.010–1.103, p = 0.016). A predictive model constructed from these factors demonstrated strong discriminatory power, with an area under the ROC curve of 0.897. The model exhibited a sensitivity of 85.0% and a specificity of 90.0%, indicating good predictive accuracy within the study cohort.
Postoperative bloodstream infection is a significant complication after surgical repair of Stanford type A aortic dissection, and is associated with worse clinical outcomes. A predictive model incorporating the independent risk factors of advanced age, elevated preoperative C-reactive protein, prolonged circulatory arrest time, tracheostomy, and infectious pneumonia aids in the early identification of high-risk patients. Future large-scale, multi-center studies are warranted to further validate and future refine these findings.
Atrial fibrillation (AF) is associated with an increased risk of thromboembolism, primarily due to thrombus formation in the left atrial appendage (LAA). While anticoagulation represents the standard therapy, patients with a high risk of bleeding require alternative strategies such as LAA clipping (LAAC); hypotension has been observed in some patients post-LAAC. This study aimed to investigate the hypotensive effect after LAAC in patients with AF, and to explore the potential mediating role of B-type natriuretic peptide (BNP).
A retrospective single-center analysis was conducted on 99 patients who underwent a standalone totally thoracoscopic LAAC. Plasma BNP levels, aldosterone, electrolyte levels, and blood pressure were measured preoperatively and at defined intervals postoperatively. Echocardiographic parameters and medication use were also analyzed.
A significant increase in BNP level was observed following LAAC (150.9 pg/mL [interquartile range (IQR) 77.8–260.7] to 316.2 pg/mL [IQR 197.5–466.8]; p < 0.001), accompanied by a significant decrease in aldosterone (5.5 ng/dL [IQR 3.0–8.7] to 2.5 ng/dL [IQR 1.4–3.4]; p < 0.001). Moreover, LAAC was associated with a marked reduction in systolic (127.3 ± 12.3 mmHg to 116.9 ± 12.4 mmHg; p < 0.001) and diastolic (80.7 ± 7.7 mmHg to 67.4 ± 9.3 mmHg; p < 0.001) blood pressure. Significant decreases in serum sodium and increases in serum potassium were also noted. A significant reduction in the use of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and calcium channel blocker (CCB) antihypertensive agents was observed postoperatively. No significant changes in cardiac structure or function were detected. The decrease in blood pressure persisted at 6-month follow-up.
LAAC-induced hypotension may be partly mediated by BNP-driven suppression of aldosterone, thereby promoting natriuresis and reduced blood volume. These findings highlight the need for postoperative hemodynamic monitoring and antihypertensive medication adjustment in AF patients who undergo LAAC.
Heart transplantation (HT) remains the only therapeutic option that significantly improves long-term survival for patients with end-stage cardiomyopathy. However, clinical practice faces challenges including the shortage of donor organs, increased surgical risks, and limitations in long-term survival. Recent advancements in minimally invasive surgery, precision immunosuppression, xenotransplantation, and artificial heart technologies have substantially improved transplant safety and outcomes; however, a systematic integration of these innovations is lacking. This study reviews technological advancements and current trends in HT to optimize clinical decision-making and promote individualized treatment strategies. A systematic review of literature published between 2015 and 2025 was conducted using PubMed and Web of Science databases. The search focused on five key areas of HT: minimally invasive surgery, donor expansion, precision immunosuppression, xenotransplantation, and postoperative management. Literature screening and analysis were performed independently by two researchers to ensure the objectivity and accuracy of the findings. Minimally invasive techniques, including partial Maryland and robot-assisted surgery, have significantly reduced postoperative bleeding and complications in high-risk patients. Normothermic machine perfusion (NMP) has extended donor heart preservation up to 12 hours, improving marginal donor utilization. Genotype-guided immunosuppressive therapy and donor-derived cell-free DNA (dd-cfDNA) monitoring enhance the precision of immunosuppression management. CRISPR-Cas9-mediated xenotransplantation has enabled successful transplantation of genetically modified pig hearts into humans, with reported survival exceeding 60 days. Magnetic Resonance Imaging (MRI) T1/T2 mapping and implantable hemodynamic monitoring technologies also show promise for the non-invasive early detection of rejection. Technological innovations have greatly enhanced clinical outcomes in HT. However, further long-term data and standardized evidence are necessary. Future efforts should focus on standardizing techniques, translating immune tolerance strategies into clinical practice, and establishing safety frameworks for xenotransplantation.
Advances in percutaneous cardiac interventions for both coronary and valvular diseases have led to a decline in the number of redo cardiac surgical procedures. Patients who require redo cardiac surgery have typically exhausted percutaneous options, placing these patients in a high-risk category where surgical intervention remains the only viable option. Contemporary redo operations most often involve native or prosthetic valve endocarditis, aortic graft infections, or complex valvular reconstructions in patients with failing hearts. In addition, novel challenges have emerged following transcatheter valve replacement, leading to new forms of redo valve surgery. Redo coronary artery bypass grafting (CABG) has become uncommon due to the widespread use of durable arterial grafts at initial operation and the increasing expertise of interventional cardiologists in treating conduit or native vessel stenoses percutaneously. Patients who still require redo CABG often have multiple coronary stents, complicating surgical revascularization. Consequently, morbidity and mortality remain significantly higher for redo cardiac surgery compared with primary procedures. This review summarizes predictors of perioperative morbidity and mortality and outlines best practices in the risk assessment and management of patients undergoing redo cardiac surgery.
Left ventricular assist device (LVAD) implantation is a common intervention for patients with end-stage heart failure. However, comorbid chronic obstructive pulmonary disease (COPD) poses significant challenges in perioperative management. In such cases, ultrafast track anesthesia (UFTA) has been proposed to minimize cardiopulmonary disturbances and promote rapid recovery.
This report describes the case of a 53-year-old man diagnosed with dilated cardiomyopathy and COPD. Despite extensive medical treatment, the patient's condition did not improve, and his activities were strictly limited (New York Heart Association Class IV). Echocardiography revealed an enlarged heart with an ejection fraction of 24%. The patient was scheduled to undergo LVAD implantation via minimally invasive surgery. An UFTA protocol based on propofol and remifentanil was consequently designed and implemented. Postoperatively, the patient regained consciousness and exhibited stable respiratory function and hemodynamic parameters. On-table extubation was performed, and the patient was transferred to the intensive care unit. However, he received a butorphanol infusion after surgery and had to be re-intubated 23 h later.
This case reveals that if a multidisciplinary team effort and tailored treatment protocols had not been executed, reintubation may not have been avoided, even though the patient had been extubated in the operating room shortly after surgery.
Transcatheter cardiac surgery (TCS), which primarily comprises transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (M-TEER), has transformed the treatment of valvular heart disease over the past two decades. Moreover, TAVR is now supported by robust randomized trial evidence across the surgical risk spectrum, establishing this technique as a cornerstone therapy for aortic stenosis. Moreover, M-TEER is gaining clinical relevance, with expanding registry and trial data further defining the role of this technique. Meanwhile, advanced imaging has become central to both TAVR and M-TEER, extending beyond diagnosis to patient selection, procedural planning, and risk assessment of complications. Furthermore, advanced imaging enhances procedural safety and improves short- and mid-term clinical outcomes by enabling accurate anatomical characterization, precise device sizing, and early detection of complications such as paravalvular leak or leaflet thrombosis. Echocardiography and computed tomography form the backbone of the preprocedural evaluations, whereas cardiac magnetic resonance and positron emission tomography provide complementary insights into myocardial pathology and prosthetic valve dysfunction. Imaging enables structured surveillance for paravalvular leak, leaflet thrombosis, recurrent regurgitation, and structural valve degeneration, all of which directly affect outcomes. However, despite considerable progress, important challenges persist, including limited evidence on the long-term durability of TAVR, a lack of standardized grading of residual mitral regurgitation after M-TEER, and the need to integrate right heart–pulmonary circulation assessments into decision-making. Recent innovations such as quantitative three-dimensional echocardiography, fusion imaging, and artificial-intelligence-based image analysis are expected to refine procedural planning further, reduce operator variability, and enable more predictive, patient-specific management. Nonetheless, multimodality imaging is slated to remain the cornerstone for lifetime management strategies in TCS.