Background: Myocardial injury-related cardiogenic shock (MICS) is significantly associated with poor outcomes in patients after cardiac surgery. Herein, we aimed to investigate the risk factor for postoperative MICS. Methods: We performed a case-control study on 792 patients undergoing cardiac surgery from 2016 to 2019, including 172 patients with postoperative MICS and 620 age- and sex-matched controls. MICS was defined as composite criteria: a cardiac index of < 2.2 L/m²/min, arterial lactate levels of > 5 mmol/L at the end of the surgery, a vasoactive-inotropic score of > 40 at the end of the surgery, and a cardiac troponin T (cTnT) level of > 0.8 µg/L on postoperative day 1 (POD1) with an increase of > 10% on POD 2. Results: A total of 4671 patients who underwent cardiac surgery in our hospital between 2016 and 2019 were included; of these, 172 (3.68%) had MICS and the remaining 4499 did not. For investigating the risk factors, we selected 620 age- and sex-matched controls. In the univariate analysis, MICS was significantly associated with death (P < 0.05), extracorporeal membrane oxygenation (P < 0.05), continuous renal replacement therapy (P < 0.01), and ventricular arrhythmias (P < 0.05). Multivariable logistic regression analysis revealed that diabetes mellitus (OR:8.11, 95% CI: 3.52–18.66, P < 0.05) and a cardiopulmonary bypass (CPB) time of > 2 h (OR: 3.16, 95% CI: 1.94–5.15, P < 0.05) were associated with postoperative MICS. Moreover, long-time administration of preoperative calcium channel blocker (CCB) was associated with a less incidence of MICS (OR: 0.11, 95% CI: 0.05–0.27, P < 0.05). Conclusions: Postoperative MICS is significantly associated with poor outcomes. Diabetes mellitus and long CPB time are associated with MICS. Preoperative CCB administration is associated with less incidence of MICS.

Postburn auricular reconstruction presents significant challenges due to scar contracture and compromised vascularity of the surrounding tissue. This study introduces and evaluates a specialized 3-stage surgical protocol that integrates expanded scarred skin with residual cartilage and a custom-shaped autologous costal cartilage framework. A retrospective case series was conducted on 21 patients with postburn ear defects treated between January 2021 and 2024. The surgical approach involved 3 stages: (1) subcutaneous implantation of a tissue expander to release scar contractures and expand residual tissue; (2) formation of a composite flap using the expanded scarred skin and mobilized residual cartilage to envelop a custom-sculpted framework carved from selected costal cartilages; and (3) refinement of anatomic subunits. Aesthetic outcomes were assessed by independent plastic surgeons using a 4-point Likert scale, and patient-reported satisfaction and quality of life were evaluated with the EAR-Q questionnaire. The mean follow-up duration was 21.93±16.01 months. Aesthetic evaluations yielded high satisfaction, with most cases rated as “Excellent” (n=7, 33.3%) or “Good” (n=13, 61.9%). Patient-reported outcomes through the EAR-Q demonstrated high mean scores in the “Psychological” (63.00, IQR=55.50–89.00) and “Social” (64.00, IQR=6.00–85.50) domains. A strong positive correlation was observed between psychological adjustment and social functioning (τ=0.670, P <0.001). No patients reported dissatisfaction or major complications. By integrating residual cartilage into the expanded flap, this technique effectively addresses the challenges of compromised vascularity and scar contracture, resulting in improved auricular symmetry and projection, as well as significant psychosocial benefits for patients.