Introduction: The impact of different degrees of hypothermia in patients undergoing type A aortic dissection (TAAD) repair remains controversial. The purpose of this study was to compare the clinical outcomes of patients who received deep hypothermic circulatory arrest (DHCA) (<20°C) and those of patients who received moderate hypothermic circulatory arrest (MHCA) (20–28°C).Methods: Between January 2011 and December 2020, 143 patients underwent surgical treatment for TAAD with CA and unilateral antegrade selective cerebral perfusion (uSCP). In this retrospective analysis, we evaluated the clinical outcomes of 143 individuals (103 who received DHCA vs. 40 who received MHCA). The primary outcome was the composite of major events (CMEs) including delirium, acute kidney injury (AKI), and in-hospital mortality. The secondary outcomes were overall mortality, bleeding, rethoracotomy, and length of intensive care unit (ICU) stay, among other things.Results: Compared with the MHCA group, the DHCA group presented a greater incidence of postoperative complications, as follows: AKI (26 (25.2%) vs. 3 (7.5%), p = 0.020), delirium (23 (22.3%) vs. 2 (5%), p = 0.014), re-exploration rate (21 (20.4%) vs. 2 (5.0%), p = 0.024), and prolonged intensive care unit (ICU) stay (7.8 (4.4, 14.1) vs. 5.7 (2.4, 10) days, p = 0.019). The median cardiopulmonary bypass time (255 (210, 280) vs. 210 (190, 251) min, p = 0.010) and median cross-clamp time (140 (110, 180) vs. 125 (100, 160) min, p = 0.023) were significantly longer in the DHCA group. The German Registry for Acute Aortic Dissection Type A (GERAADA) score was significantly higher in the MHCA group (22.7 ± 9.1 vs. 19 ± 7.2, p = 0.012). The adjusted odds ratio for CME in the MHCA group was 0.78 (95% CI: 0.52–1.17, p = 0.001). The use of MHCA demonstrated a protective effect on reducing postoperative delirium (OR: 0.28, 95% CI: 0.14–0.46, p < 0.01) and postoperative AKI (OR: 0.29, 95% CI: 0.14–0.49, p < 0.01). Overall survival after two years did not differ between the two groups (log-rank, p = 0.16).Conclusion: The principal findings of our study indicate that DHCA elevates the risk of postoperative AKI and delirium. As a result, the duration of hospitalization and intensive care unit stay was markedly extended. Consequently, MHCA should be favored over DHCA when the clinical circumstances permit, since DHCA remains a secure alternative in intricate dissection instances.

Objectives: This study aimed to investigate the correlation between apical sparing of longitudinal strain (LS), as measured by speckle-tracking echocardiography (STE), and the histological presence of myocardial fibrosis (MF), in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: Twenty-seven HOCM patients who underwent elective Morrow procedures +/− aortic valve replacement (AVR) were included. All patients had standard echocardiography, with STE pre- and post-operatively. Intraoperative probes of the interventricular septum were sent for histological analysis. Correlation of different regional LS patterns with the histological findings of MF and with clinical outcome were analyzed. In addition, a logistic regression and ROC analysis were performed. Results: All patients underwent the Morrow procedure for HOCM, with 33.3% also undergoing AVR. A total of 74.1% showed evidence of MF in the histological analysis. Patients with MF had significantly lower GLS than patients without MF (−12.7 ± 2.7% vs. −23.0 ± 5.7%, p < 0.001). The LS in patients with MF was significantly lower at the basal regions of the LV segments and increased significantly towards the apex as compared to the patients without MF (mean basal-strain %: −10.6 ± 2.6 vs. −17.3 ± 4.6, p < 0.001; mean apical strain %: −21.8 ± 4.8 vs. −16.7 ± 5.6, p = 0.032). In the logistic regression, only the GLS remained as an independent predictor of MF with an Odds ratio of 1.07 (95%-CI: 1.05–1.09, p < 0.001). Conclusions: Our study highlights the significant correlation between GLS and MF in HOCM patients. These findings contribute to the growing understanding of MF in HOCM and may inform future approaches to patient management and risk stratification.

Background: Perioperative right ventricular (RV) dysfunction is a frequent complication of cardiac surgery linked to poor outcomes and may result from the loss of pericardial support. We investigated whether pericardial closure preserves early postoperative RV function. Methods: We compared patients with pericardial closure versus open pericardium. Co-primary endpoints were early postoperative RV longitudinal function by tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV). Adjusted comparisons used analysis-of-covariance (postoperative value adjusted for baseline) with prespecified covariates (baseline outcome, LV global longitudinal strain, left-ventricular ejection fraction, LVEDVI, sex, procedure; cardiopulmonary bypass and cross-clamp times when available). Holm correction-controlled multiplicity across the co-primary endpoints. Sensitivity linear mixed-effects models (time × group) were performed. Results: Pericardial closure was associated with better early RV longitudinal function after multivariable adjustment. TAPSE: adjusted mean difference (AMD, Closed–Open) 1.531 mm (95% CI 0.130–2.931; p = 0.033). TASV: AMD 1.694 cm/s (95% CI 0.437–2.951; p = 0.009; Holm-adjusted p = 0.018). Sensitivity analyses yielded consistent estimates. Conclusions: Pericardial closure was independently associated with improved early RV longitudinal function. These adjusted findings address baseline LV imbalances and support considering closure to preserve RV performance; confirmation in prospective trials is warranted.

Background: To compare overall and hemocompatibility‐related outcomes across third‐generation centrifugal‐flow HeartMate 3 (HM3) versus second‐generation axial‐flow HeartMate II (HMII) and centrifugal‐flow HeartWare (HVAD) in routine clinical practice. Methods: We conducted a multicenter observational cohort of adult LVAD recipients ( n = 327: HVAD n = 112, HMII n = 142, HM3 n = 73). Baseline characteristics and perioperative variables were recorded. Overall survival was analyzed using Kaplan–Meier and Cox proportional hazards models with HM3 as reference. Hemocompatibility‐related adverse events (HRAE; pump thrombosis, ischemic stroke, major bleeding) were assessed with cumulative incidence functions (Aalen–Johansen) and Fine–Gray competing‐risk regression with death as a competing event; the hemocompatibility score (HCS) summarized event burden over follow‐up. Results: HM3 demonstrated superior long‐term survival compared with both HMII and HVAD in Kaplan–Meier analyses (log‐rank p < 0.001); this advantage persisted in multivariable Cox models. HRAE‐free survival was also higher with HM3 on competing‐risk analysis, driven by substantially lower pump thrombosis and fewer ischemic strokes relative to HMII and HVAD. Bleeding burden did not differ materially between devices, consistent with a class effect of continuous‐flow support. LDH‐based hemolysis markers and HCS distributions further favored HM3. Perioperative course and general postoperative complications were otherwise broadly comparable across devices. Conclusions: In this real‐world, multicenter cohort, HM3 was associated with better overall survival and a lower thromboembolic burden than HMII and HVAD, while bleeding risk remained similar. These findings support preferential selection of HM3 when device choice is feasible, and emphasize the need for targeted strategies to mitigate hemostatic complications across all LVADs.

Background/Objectives: In the context of acute heart failure, proenkephalin A (penKid) has emerged as a prognostic marker for acute kidney injury (AKI), whereas bioactive adrenomedullin (bio-ADM) has been identified as a significant biomarker linked to shock and organ dysfunction. This raises the question of whether they can serve as predictors of postoperative complications in patients receiving left ventricular assist devices (LVADs). Methods: This observational study prospectively enrolled patients who had received LVAD implantation. Routine laboratory values as well as plasma levels of penKid and bio-ADM were assessed at four time intervals, spanning from preinduction of anesthesia to 48 h post surgery. Clinical data, the HeartMate 3-risk-score (HM3RS), HeartMateII-risk-score (HMRS), Michigan-right-heart-failure risk score (MRHFS), Euromacs-RHFS (EURORHFS), and kidney failure risk score (KFR) were calculated. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were performed. We entered the biomarkers with the established risk scores into the models. Results: In 20 patients who had undergone LVAD implantation, preoperative penKid level was a predictor of postoperative AKI (OR: 1.05, 95%-CI: 1.0–1.09; p = 0.049) and 30-day mortality (OR: 1.01, 95%-CI: 1.0–1.02; p = 0.033). Bio-ADM was the only predictor of postoperative right heart failure (RHF) (OR: 1.11, 95%-CI: 1.01–1.23; p = 0.034) and rehospitalization (OR: 1.06, 95%-CI: 1.0–1.13; p = 0.047). In the ROC analysis, bio-ADM, as a predictor of post-LVAD RHF, had an area under the curve (AUC) of 0.88. When bio-ADM was added to the accepted clinical scores for post-LVAD RHF prediction (CRITT-score, MRHFS, and EURORHFS), the AUC reached 0.98. The AUC for preoperative penKid, as a predictor of postoperative AKI, was 0.95, and after adding its predictive value to the KFR score, the AUC reached 0.97. Conclusions: In the present study, the biomarkers penKid and bio-ADM predicted clinically significant patient outcomes after LVAD implantation such as AKI, RHF, and 30-day mortality. Adding biomarkers to well-established risk scores improved the AUC for prediction of postoperative complications.

Background: Sex‐related differences after cardiac surgery remain controversial because women often present with higher baseline risk and complexity than men. We performed a post hoc propensity score–matched analysis of the SUSTAIN‐CSX (Sodium Selenite Administration in Cardiac Surgery) trial to evaluate sex differences in mortality, postoperative complications, and recovery after high‐risk cardiac surgery. Methods: Of 1394 trial participants, 1386 had complete data. Women were matched 1:1 to men using nearest‐neighbor propensity score matching based on age and European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), with exact matching on surgical category, yielding 327 female–male pairs. Prespecified sensitivity analyses adjusted for frailty, baseline hemoglobin, renal disease, left ventricular ejection fraction, previous myocardial infarction, preoperative medications, and baseline creatinine. Results: In the primary matched analysis, 180‐day survival did not differ between women and men (log‐rank P =0.086; unadjusted hazard ratio, 1.80 [95% CI, 0.91–3.55]; P =0.091). In descriptive matched comparisons, women had numerically longer intensive care unit stay (median, 3 days [quartile 1, quartile 3 (Q1, Q3)=1, 6 days] versus 2 days [Q1, Q3=1, 5 days]) and hospital stay (median, 10 days [Q1, Q3=7, 18 days] versus 9 days [Q1, Q3=6, 16 days]; P =0.292), whereas major postoperative complications were similar. In adjusted sensitivity analyses accounting for the matched design and residual imbalance, female sex remained associated with longer intensive care unit stay (adjusted incidence rate ratio [IRR], 1.8 [95% CI, 1.2–2.9]; P =0.009) and hospital stay (adjusted IRR, 1.4 [95% CI, 1.0–1.9]; P =0.031). Mortality sensitivity analyses were model‐dependent. Conclusions: In this propensity score–matched cohort of high‐risk cardiac surgery patients, women showed a longer postoperative recovery trajectory in adjusted analyses, whereas mortality findings were sensitive to model specification and should be interpreted cautiously. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02002247.