Search Results (64)

Introduction: Coronary artery bypass grafting (CABG) in patients with chronic kidney disease/chronic renal failure (CKD/CRF) poses additional surgical risk, both perioperatively and beyond, compared to their non-renal failure counterparts. Patients with end-stage renal disease (ESRD) are at particularly high risk for complications with prognoses limited by cardiovascular (e.g., myocardial infarction, heart failure, stroke) and non-cardiovascular (e.g., infection) conditions associated with the disease itself and the treatment of it (i.e., dialysis). For decades, cardiac surgeons have continued to offer CABG to patients with ESRD on dialysis with variable success. The purpose of this report is to describe a relatively contemporary analysis of CABG surgery in ESRD patients utilizing a pump-assisted beating-heart technique with the analysis of and comparison to outcomes reported by other investigators as well as predictions generated by the Society of Thoracic Surgery outcome tool. We report both short- and intermediate-term outcomes. Methods: From 1 January 2019 through 31 May 2025, the data from all consecutive patients undergoing BH-CABG at a single institution by a single surgeon were collected. Demographic information as well as a preoperative risk assessment was performed using the Society of Thoracic Surgeon (STS) Risk Assessment tool. The BH-CABG was performed via median sternotomy with maintenance of normothermia and ventilation throughout the case. Postoperative outcomes were recorded including mortality, major morbidity, and length of stay (LOS). Hospital/operative results were compared to the STS risk calculations. On-going intermediate-term follow-up beyond the index hospitalization was completed using direct or indirect methods (i.e., clinic, telephone, email). Results: There were 439 BH-CABG patients during the study period. Fifty-nine patients (13.4%) had ESRD on HD. There were 39 men and 20 women with a mean age of 61 years (41–76 years). Fifty-one (86%) underwent pump-assisted BH-CABG (PADCAB) and eight patients underwent complete off-pump BH-CABG (OPCAB). The mean ejection fraction (EF) was 48% (15–70%). The mean number of grafts was 2.3 (1 to 4) and the mean cardiopulmonary bypass (CPB) time for the PADCAB cases was 80 min (34 to 118 min). Patient presentation consisted of the following: one with cardiogenic shock, one with cardiac arrest, two with STEMI, 18 with NSTEMIs, 10 with CHF, five with NSTEMI/CHF, six with unstable angina (USA), and 16 with a positive stress test in preparation for renal transplant consideration. There was one operative mortality (1.7%), one stroke (1.7%), no reoperation for bleeding, no deep sternal wound infection, one prolonged ventilation (1.7%), and one prolonged length of stay (1.7%); overall mortality/morbidity was 5.1%. Comparatively, the STS-predicted mortality was 5.7%, stroke 2.2%, reoperation for bleeding 3.5%, deep sternal wound infection 0.6%, prolonged ventilation 17.8%, prolonged LOS 14.8%, and combined mortality/morbidity 26.8%. Thirty-six of the 59 patients remained alive (61%) in the follow-up period. Twenty-three patients expired (39%) in the follow-up: 11 of cardiac issues, eight of sepsis, two of stroke, one of gastrointestinal issues, and one of cancer. The average duration of survival for expired patients was 2.28 years (13 days to 5 years and 4 months). Nine patients (15%) underwent renal transplantation and six of them remained alive (67%). Conclusions: CABG surgery in patients with ESRD is complicated with historically high mortality and morbidity. The results of this study demonstrate significant improvement in the reduction in hospital mortality and morbidity. However, intermediate-term outcomes remain poor with a preponderance of cardiovascular and infectious deaths. A trend toward improved intermediate-term outcomes appears in patients in whom CABG surgery was performed for purposes of renal transplantation. Full article

Background: Refractory cardiac arrest, cardiogenic shock, and severe acute respiratory failure remain associated with substantial mortality despite advances in advanced life support and extracorporeal membrane oxygenation (ECMO). Transportable ECMO platforms may enable rapid deployment, uninterrupted extracorporeal support, and safer in-hospital transport, but early real-world experience with newer systems remains limited. Methods: We conducted a retrospective single-center observational cohort study including all VitalFlow veno-arterial ECMO (VA-ECMO) and veno-venous ECMO (VV-ECMO) deployments performed between November 2025 and March 2026 at a high-volume tertiary cardiac surgery center. Fifteen cases were analyzed, comprising 12 VA-ECMO and 3 VV-ECMO deployments. Data were extracted from electronic health records, perfusion protocols, and ICU documentation. Outcomes included survival to hospital discharge, 30-day survival, neurological outcomes, and complications. Analyses were descriptive. Results: The cohort was exclusively male and clinically unstable at implantation, with high lactate and low pH levels consistent with severe hypoperfusion. Median time-to-flow was 33 min, and median ECMO duration was 8 days. Survival to discharge was 60% overall (66.7% VA-ECMO, 33.3% VV-ECMO), with ECMO weaning success in 86.7% and the primary death cause being multiorgan failure (83.3% of non-survivors). All survivors achieving a favorable neurologic outcome (CPC 1). Thirty-day survival was 73.3%. No major bleeding or stroke occurred. Limb ischemia was observed in 4 patients, with 2 patients requiring fasciotomy, all in the VA-ECMO group. Bronchial infection occurred in 3 patients. Lactate levels improved within the first 24 h, and survivors showed a more pronounced metabolic response. Conclusions: In this early single-center experience, VitalFlow ECMO was feasible and associated with rapid flow establishment, survival to discharge of 60% of patients, and good neurologic outcome among survivors. The complication profile was acceptable, with limb ischemia as the main adverse event. These findings support further evaluation of this transportable ECMO platform in larger multicenter cohorts. Full article

Peripartum cardiomyopathy (PPCM) is a distinct condition that presents as heart failure (HF) in a woman who was previously healthy and has no prior cardiovascular issues. It results from idiopathic left ventricular (LV) dysfunction, characterized by a reduced LV ejection fraction below 45%. PPCM is a life-threatening condition with a high mortality rate (MR) that demands urgent treatment. Methods: This narrative review aims to define PPCM and its pathophysiology and conduct a scoping review of the latest data on the management of patients with peripartum cardiomyopathy during pregnancy and the postpartum period. Results: Currently, treatment follows standard HF protocols for reduced ejection fraction, with the possible addition of bromocriptine, and during pregnancy, medications that do not harm the fetus. Conclusions: Early, aggressive therapy is essential for a better prognosis, but managing PPCM can be challenging. Treatment of PPCM patients should be led by a team of highly qualified specialists, known as the Obstetric and Cardiac Care Team, comprising an obstetrician-perinatologist, an anesthesiologist, a cardiologist, and a cardiac intensive care specialist. Baseline left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) are the main prognostic factors. LVEF less than 30%, significant LV dilatation, LVEDD ≥ 6.0 cm, and right ventricular involvement are factors indicative of a poor prognosis. While pregnancy after PPCM is possible, it should be discouraged due to the significant risk of complications and even death. The most common causes of death in patients with PPCM are thromboembolic complications, severe HF, serious ventricular arrhythmias, cardiogenic shock, and sudden cardiac arrest. Full article

Background: Cardiogenic shock (CS) and post-cardiac arrest syndrome (PCAS) are frequently associated with a systemic inflammatory response resulting from ischemia–reperfusion injury, endothelial dysfunction, and microcirculatory impairment. This inflammatory biology may be further amplified by temporary mechanical circulatory support (tMCS) through blood–surface interactions and shear-related hemolysis. Extracorporeal cytokine adsorption has therefore been proposed as an adjunctive strategy to attenuate hyperinflammation and facilitate shock reversal in selected patients. Methods: We conducted a narrative review, guided by a targeted PubMed and Scopus search and reference screening, to summarize the current pathophysiological concepts and clinical evidence on extracorporeal cytokine adsorption in CS-, PCAS-, and tMCS-supported states. Results: Across porous polymer hemoadsorption cartridges (e.g., CytoSorb^®), membrane-based or hybrid filters with adsorptive properties (e.g., oXiris^®), and selective approaches targeting inflammatory mediators (e.g., PentraSorb^® CRP), available studies most consistently report short-term physiological effects, including reduced vasopressor demand, improved metabolic stabilization, and modulation of inflammatory markers. However, evidence of benefits to clinically relevant endpoints remains inconsistent in various clinical settings, and randomized data are limited. Conclusions: Extracorporeal cytokine adsorption is a biologically plausible adjunct in inflammation-driven acute cardiovascular syndromes, but current evidence does not support routine use. Phenotype-guided patient selection, early timing, and adequately powered, mechanism-informed randomized trials are required to define clinical efficacy and safety in defined patient populations. Full article

Deleterious variants in SCN5A lead to a wide clinical spectrum that includes pathologies characterized by life-threatening cardiac events (CEs). In the pediatric population, early identification, management, and risk stratification of these pathologies are the main current challenges. This study analyzed a Spanish pediatric cohort (≤18 years) carrying rare SCN5A variants to explore genotype–phenotype correlations. A retrospective descriptive cohort study, including clinical, demographic, and genetic data of probands and their relatives, was conducted. Out of 100 children studied, 69 had definitively deleterious SCN5A variants (26 females, 38%; median age: 3 years, IQR 1–12). The main diagnoses were isolated Brugada syndrome (BrS) (31; 45%); isolated long QT syndrome type 3 (LQT3) (5; 7%); isolated progressive cardiac conduction disease (PCCD) (1; 2%); isolated familial atrial fibrillation (1; 2%); overlapping phenotypes (7; 10%) including: BrS-PCCD (2; 2.8%); BrS-LQT3 (1; 1.4%); premature ventricular contraction-dilated cardiomyopathy (1; 1.4%); BrS-LQT3-PCCD (1; 1.4%); BrS-PCCD-sick sinus syndrome (SSS) (1; 1.4%) and BrS-PCCD-SSS-familial atrial fibrillation (1; 1.4%). Of them, 13 (19%) patients presented with CEs (cardiogenic syncope, ventricular tachycardia/fibrillation, sudden cardiac arrest/death, and appropriate implantable cardio defibrillator shock). These findings underscore the utility of genetic testing for early diagnosis, risk stratification, and personalized management, enhancing preventive strategies for CE prevention in pediatrics. Full article

Background: Frail patients undergoing AF ablation face elevated periprocedural risks. However, prior studies often examined composite or long-term outcomes and did not stratify acute complication risks by frailty severity. Objective: The objective of this study was to assess the impact of frailty, measured by the Hospital Frailty Risk Score (HFRS) on in-hospital outcomes after AF ablation, and to delineate the risk of specific acute complications across frailty levels. Methods: We analyzed a national inpatient cohort of AF ablation hospitalizations (2016–2021). Patients were stratified into low-, intermediate-, and high-frailty groups by HFRS. In-hospital mortality and major complications (stroke, respiratory failure, sepsis, acute dialysis, cardiac arrest, cardiogenic shock) were compared across frailty groups, and multivariable logistic regression identified independent predictors of these outcomes. Results: Among an estimated 42,830 AF ablation admissions, 80.0% were low-frailty, 15.0% intermediate, and 5.0% high-frailty. High-frailty patients had markedly higher complication rates than low-frailty patients. In-hospital mortality was 6.1% in high frailty vs. 1.0% in low frailty, and stroke occurred in 4.0% vs. 0.3%, respectively. Rates of respiratory failure (18.0% vs. 3.5%), sepsis (8.0% vs. 1.2%), and acute dialysis (4.0% vs. 0.5%) were also significantly higher in the high-frailty group (all p < 0.001). In multivariate analyses, frailty remained a strong independent predictor of complications; high frailty conferred over four-fold higher odds of in-hospital mortality and five-fold higher odds of stroke compared to low frailty. Conclusions: Frailty is a powerful predictor of periprocedural complications and mortality in AF ablation patients. Even after accounting for age and comorbidities, patients with higher frailty scores experienced substantially worse in-hospital outcomes. These findings highlight the importance of frailty assessment to identify high-risk patients and inform clinical decision-making for AF ablation. Full article

High-risk pulmonary embolism (PE) is a life-threatening condition characterized by hemodynamic instability, often leading to catastrophic outcomes such as cardiac arrest and cardiogenic shock. We conducted a retrospective analysis of patients diagnosed with high-risk PE at a single tertiary center between 2018 and 2024. Catastrophic PE was defined as high-risk PE with hemodynamic collapse, including cardiac arrest and/or the requirement for high-dose vasopressors. Data on clinical characteristics, treatments, and outcomes were analyzed. Catastrophic PE accounted for 59% of cases. Systemic thrombolysis was the most frequent reperfusion strategy (67%), while catheter-directed therapies (35.4%) and VA-ECMO (11.4%) were used selectively. Despite aggressive management, catastrophic PE exhibited significantly higher mortality rates at 7 days (40%) and 30 days (49%) compared to non-catastrophic cases (9% and 12.5%, respectively). These patients also showed higher rates of multiorgan failure and required more invasive support. This study underscores the importance of early recognition and tailored treatment strategies for catastrophic PE, highlighting its distinct clinical presentation and worse outcomes compared to non-catastrophic high-risk PE. Further research is essential to refine treatment protocols and improve survival in this critically ill population, emphasizing the utility of a standardized classification to enhance clinical management and research consistency. Full article

Background: Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with life-threatening complications such as acute chest syndrome (ACS), which may necessitate extracorporeal membrane oxygenation (ECMO) in refractory cases. Despite growing use, ECMO in SCD remains challenging due to risks of hemolysis, thrombosis, and anticoagulation complications. This systematic review consolidates existing evidence on ECMO outcomes in SCD, focusing on indications, complications, and survival. Methods: A systematic search of MEDLINE, Cochrane CENTRAL, and Google Scholar was conducted up to January 2025, identifying case reports/series on ECMO use in SCD. Studies reporting venovenous (VV) or venoarterial (VA) ECMO for acute cardiopulmonary failure were included. Data on demographics, laboratory findings, management, and outcomes were extracted. Quality assessment was performed using the Joanna Briggs Institute checklist. Results: Sixteen case reports (23 patients) were included. Most patients were female (65.2%), with ACS (47.8%) and pulmonary embolism (13.0%) as common ECMO indications. VV-ECMO (69.6% of cases) was primarily used for respiratory failure, with a 69% survival rate, while VA-ECMO (30.4%) had a 29% survival rate, often due to cardiogenic shock or cardiac arrest. Complications included hemorrhage (26.1%), neurological injury (21.7%), and thrombosis (13.0%). Exchange transfusion was frequently employed (43.5%), with post-ECMO echocardiography showing improved right ventricular function in survivors. Conclusions: VV-ECMO demonstrates favorable outcomes in SCD-related respiratory failure, whereas VA-ECMO carries higher mortality risks. Careful patient selection, anticoagulation management, and multidisciplinary coordination are essential. Larger prospective studies are needed to refine ECMO utilization in this high-risk population. Full article

Background/Objectives: To evaluate the safety and feasibility of continuous positive airway pressure (CPAP) in patients with acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) during percutaneous coronary intervention (PCI). Non-invasive ventilation (NIV) is an established treatment for ADHF. Methods: All consecutive patients admitted to Santa Croce Hospital of Cuneo, receiving CPAP for ADHF in the cath lab during PCI for AMI, were included in a case series. Results: Between December 2018 and March 2021, 25 pts were included (median age 78 yrs, 48% female), with 64% of patients presenting with ST-elevation AMI and 17 (69%) in cardiogenic shock. At admission median left ventricular ejection fraction was 35 (20–60)% and eight (32%) patients had severe mitral regurgitation. Median PaO₂/FiO₂ was 183 (141–261) mmHg/%, lactate level 2.4 (1.3–3.8) mmol/L, and NTproBNP 7882 (3139–35,000) ng/L. CPAP was positioned and managed by nurses in all cases. Median FiO₂ was 50 (35–100)% and median positive end-expiratory pressure was 7.5 (5–12) cmH₂O. CPAP was generally well tolerated in 22 (88%) patients. One patient suffered cardiac arrest that led to CPAP interruption due to resuscitation maneuvers. No patient required orotracheal intubation in the cath lab. The post-procedural PaO₂/FiO₂ ratio substantially improved to 230 (175–356) mmHg/% (p = 0.007) and lactate decreased to 1.5 (1.0–1) mmol/L (p = 0.002). One patient died during hospital stay due to underlying disease, unrelated to the study procedure. Conclusions: CPAP during PCI in patients with AMI and ADHF seems feasible, safe, and well tolerated. Larger studies are warranted to confirm these results. Full article

Background: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used to support patients with refractory cardiogenic shock or cardiac arrest. While femoral artery cannulation remains the most common arterial access, axillary artery cannulation has emerged as a valuable alternative in selected cases. Objective: This narrative review aims to synthesize current evidence and expert opinion on axillary artery cannulation in V-A ECMO, focusing on its technical feasibility, physiologic implications, and clinical outcomes. Methods: A comprehensive literature search was performed in PubMed and Scopus using relevant keywords related to ECMO, axillary artery, cannulation techniques, and outcomes. Emphasis was placed on prospective and retrospective clinical studies, expert consensus statements, and technical reports published over the past two decades. Results: Axillary cannulation provides antegrade aortic flow, potentially reducing the risk of differential hypoxia and improving upper body perfusion. However, the technique presents unique technical challenges and may carry risks such as hyperperfusion syndrome or arterial complications. Emerging data suggest favorable outcomes in selected patient populations when performed in experienced centers. Conclusions: Axillary cannulation represents a promising arterial access route in V-A ECMO, particularly in cases with contraindications to femoral cannulation or when upper-body perfusion is a concern. Further prospective studies are needed to better define patient selection criteria and long-term outcomes. Full article

Background: Mitochondrial DNA (mtDNA) has strong pro-inflammatory potential and was found to be associated with mortality in critically ill patients. The purine bases from circulating cell-free DNA, including mtDNA, are catabolised into uric acid, contributing to elevated systemic levels. However, the prognostic value of uric acid in unselected critically ill intensive care unit (ICU) patients remains unclear. We aimed to investigate the association between uric acid levels at admission and 30-day mortality, assess its correlation with mtDNA, and examine prognostic relevance based on the primary cause of admission. Methods: This prospective single-centre study included 226 patients admitted to a tertiary care ICU. Uric acid and mtDNA levels were assessed at admission. Survival analyses were performed in the overall cohort and in subgroups stratified by primary diagnosis. Results: Uric acid showed a U-shaped association with 30-day mortality, with both low and high levels linked to reduced survival. In multivariate analysis, the 4th quartile of uric acid remained associated with adverse outcomes, independent of sex, vasopressors, mechanical ventilation, and creatinine (HR 2.549, 95% CI: 1.310–4.958, p = 0.006). A modest correlation was observed between uric acid and mtDNA (r = 0.214, p = 0.020). However, prognostic relevance varied by diagnosis. While uric acid predicted mortality in patients following cardiac arrest (p = 0.017), mtDNA was found to bear prognostic value in cardiogenic shock and decompensated heart failure (p = 0.009). Conclusions: Uric acid was independently associated with mortality in critically ill patients, with both low and high levels carrying prognostic value. Its predictive capabilities differed from mtDNA but showed partial overlap. However, both markers exhibited varying prognostic performance depending on the primary cause of admission. Full article

Background/Objectives: Cangrelor, an intravenous P2Y12 inhibitor, is increasingly used during percutaneous coronary intervention (PCI) for rapid and reversible platelet inhibition in patients unable to take oral antiplatelet agents, particularly in emergencies such as ST-elevation myocardial infarction (STEMI), cardiac arrest, or cardiogenic shock. This single-centre study evaluates cangrelor and outcomes in a non-surgical centre. Methods: Between June 2017 and December 2021, all the patients for whom cangrelor was used at a district general hospital (DGH) in the UK were included in this study. Data collection included baseline characteristics, admission, procedural details, and patient outcomes. The primary outcome was a composite of all-cause mortality, bleeding, and cardiovascular events, including myocardial infarction, stent thrombosis, and stroke, within 48 h. Secondary outcomes included predictors of the composite outcome at 48 h. Results: During the study period, cangrelor was administered peri-procedurally to 93 patients. Males comprised 85% of the patients; the mean age was 65.5 ± 10.6 years. A total of 1 patient (1.1%) had a cardiovascular event within 48 h of cangrelor administration, whereas all-cause mortality occurred in 17 patients (18%) within 48 h. No major bleeding events were noted at 48 h following cangrelor administration. Regression analysis did not find predictors of composite outcomes at 48 h. Conclusions: Cangrelor offers a potential alternative to oral P2Y12 inhibitors in specific high-risk scenarios. Further research is needed to validate its role in broader populations. Full article

Background and Objectives: Assessing risk is essential for optimal care in acute pulmonary embolism (PE). The present research seeks to evaluate the value of admission blood cellular indices as predictors of in-hospital outcome in acute PE and their utility in conjunction with validated risk tools such as the Pulmonary Embolism Severity Index (PESI) score and the European Society of Cardiology (ESC) risk stratification. Materials and Methods: A total of 1058 individuals hospitalized at Bihor County Emergency Hospital, Oradea, Romania, with a diagnosis of acute PE confirmed by contrast-enhanced computed tomographic pulmonary angiography were retrospectively evaluated. Results: A total of 165 patients (18.2%) experienced adverse outcomes, including in-hospital mortality, cardiac arrest, cardiogenic shock, or persistent hypotension, and required rescue thrombolytic therapy. The neutrophil-to-lymphocyte ratio (NLR) was an independent predictor for in-hospital adverse outcome OR = 1.071 (95% CI 1.01–1.137), p < 0.001. NLR as a predictor of adverse outcome had an AUC of 0.712 (95% CI 0.661–0.742), p < 0.001, sensitivity of 72.56%, and specificity of 64.19% for a cutoff value of >5.493. In a combined model with PESI or with ESC risk classification, NLR is leading to a significant improvement in their AUC (p < 0.001). Conclusions: Among hematological markers, NLR holds the greatest relevance for stratifying risk in acute pulmonary embolism and serves as an independent indicator of unfavorable in-hospital prognosis. NLR had an acceptable discriminative power to predict short-term complications and can increase the predictive value of the PESI score and of ESC risk classification. Full article

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. Full article

Non-ST-segment elevation myocardial infarction (NSTEMI) can be managed by ischemia guide strategies or early invasive strategies. Here, we present the findings of an updated contemporary analysis regarding the use of intracoronary imaging (ICI)-guided PCI versus angiography-guided PCI and in-hospital mortality in patients with NSTEMI in the United States using the NIS database from 2016 to 2021. ICI use increased by nearly threefold between 2016 and 2021, without a significant difference in in-hospital mortality, though interestingly, mortality rates compared with angiography guidance were similar and relatively low. In this study, the use of ICI was associated with lower adjusted odds of in-hospital mortality, cardiogenic shock, and cardiac arrest, but with a longer length of stay and cost of hospitalization. Full article