Abstract:Objective To evaluate the effect of hierarchical nursing management constructed based on the intensive care nursing scoring system(ICNSS)on the perioperative nursing outcomes of patients with Stanford type A aortic dissection.Methods A total of 366 surgical patients with Stanford type A aortic dissection at the Department of Cardiothoracic Surgery of the Eastern Theater Command General Hospital from June 2023 to June 2025 were selected as research subjects.They were ran-domly divided(using a random number table method)into an experimental group(n=183,receiving ICNSS-based hierarchical nursing)and a control group(n=183,receiving routine nursing).The study observed changes in blood pressure levels(including systolic and diastolic pressures)and Brief Health Interview(SF-36)scores before and after intervention,while also analyzing complication rates,hospital stays,and nursing satisfaction scores.Results Before the intervention,there was no significant difference in blood pressure levels between groups(P>0.05).After intervention,both groups showed lower systolic and diastolic pressures than pre-intervention levels(P<0.05),with the experimental group achieving significantly lower values than the control group(P<0.05).SF-36 scores showed no statistically significant differences before intervention(P>0.05).Post-intervention,SF-36 scores increased across all dimensions compared to pre-intervention levels(P<0.05).The experimental group demonstrated a significantly lower postoperative complication rate(12.57%vs.30.05%,P<0.05),the hospitalization time(9.2±1.5 d)was significantly shorter than that of the control group(14.3±2.1 d),and a marked improvement in nursing satisfaction scores(98.4%vs.90.2%,P<0.05)compared to the control group.Conclusion ICNSS-based hierarchical nursing can effectively improve the clinical outcomes for surgical patients with Stanford type A aortic dissection and optimize the allocation of nursing resources.

Abstract:Objective To evaluate the effect of COVID-19 pandemic on the prognosis of totally thoracoscopic cardiac surgery.Methods Retrospectively analyzed patients undergoing totally thoracoscopic cardiac surgery during the post-pandemic period(January 8 to March 31,2023;observation group,n=110)with a historical control group(January 8 to March 31,2018;n=111).Clinical outcomes were analyzed to assess pandemic-related effects.Results Among 221 enrolled patients significant differences were observed between groups in ventilator support time(Z=-6.06,P=0.000),ICU time(Z=-2.175,P=0.030)and total hospitalization time(Z=-3.534,P=0.000).Subgroup analysis showed that the observation group had a higher proportion of patients with ventilator support≤8 hours(65.45%vs.control group,P<0.05),a lower proportion of patients requiring 8-24 hours(29.09%vs.47.75%,P<0.05),and fewer patients with>24 hours of support(5.45%vs.17.11%,P<0.05).Prolonged ven-tilator use(>24 hours)was associated with increased rates of extracorporeal membrane oxygenation support,continuous renal replacement therapy,reintubation,in-hospital mortality,and voluntary discharge.Conclusion Under optimized clinical mea-sures,such as enhanced recovery after surgery protocols,the COVID-19 pandemic did not adversely affect short-term outcomes of thoracoscopic cardiac surgery.However,prolonged mechanical ventilation(>24 hours)postoperatively may predict serious adverse outcomes.

Abstract:Extracorporeal life support(ECLS),particularly extracorporeal membrane oxygenation(ECMO),is a critical intervention for severe cardiopulmonary failure,with its clinical efficacy highly dependent on the precision of initiation tim-ing.This article systematically reviews the influencing factors and recent advancements in determining the optimal timing for ECMO initiation,focusing on patient age,indications,contraindications,underlying comorbidities,and their associations with clinical outcomes.Evidence indicates that advanced age(>70 years),diabetes,chronic kidney disease,and other comorbidities significantly increase the risk of complications.Key indications include refractory respiratory failure(e.g.,PaO2/FiO2<50 mmHg persisting>3 hours)and cardiogenic shock(e.g.,cardiac index<2.2 L/(min·m²)),contingent upon strict exclusion of absolute contraindications such as irreversible neurological injury or advanced malignancies.Current guidelines emphasize integrating hemodynamic,metabolic,and oxygenation parameters for decision-making,yet global heterogeneity in initiation criteria per-sists,contributing to variable survival rates(29.5%-57.3%in adults).Future research should prioritize multicenter randomized controlled trials to validate dynamic risk assessment models and integrate artificial intelligence-driven strategies for personalized ECMO initiation,thereby advancing precision medicine in critical care.

Abstract:Objective To investigate the protective effect of mild hypothermia on postoperative neurobehavioral devel-opment in CHD patients with ECMO.Methods This was a randomized controlled study.Since Oct.2018,patients who met the inclusion criteria after cardiac surgery were randomly divided into mild hypothermia ECMO group or normal temperature ECMO group by envelope method.Mild hypothermia was achieved by using a water tank,and the core temperature was controlled at 34℃±0.5℃for 48-72 hours.The other treatment plans were the same.The children were followed up regularly for brain MRI and Griffiths neurobehavioral development assessment.Results From Oct.2018 to Jun.2020,a total of 33 cases were enrolled.The overall survival rate was 69.70%(23/33 cases),with no significant difference between the two groups.The minimum tem-perature of the mild hypothermia was 34.28℃±0.53℃,the mean duration was 58.00 hrs±15.56 hrs,and no obvious compli-cations related to mild hypothermia treatment were identified.By Oct.2021,the follow-up rate of the mild hypothermia group was 83.33%(10/12 cases)and that of the normal temperature group was 63.64%(7/11 cases).The brain MRI score of the two groups was 1.33±1.06 and 1.21±1.15,respectively,with no significant difference between the two groups(P=0.833).In terms of Griffiths assessment results,the DQ of patients in the mild hypothermia group was higher than that of patients in the normal temperature group in B person-society,C language,D hand-eye coordination,and E performance,and there were statistically significant differences in C and E(P=0.049 and P=0.012).Conclusion ECMO combined with mild hypothermia did not sig-nificantly increase the complications of blood system and circulation system in CHD patients after surgery.The early postopera-tive neurobehavioral development results of children in the mild hypothermia group were better than those in the normothermia group,especially in the fields of language and performance.

Abstract:Objective To investigate the effect of extracorporeal membrane oxygenation(ECMO)in the treatment of patients with severe acute respiratory distress syndrome(ARDS)caused by seawater drowning.Methods A retrospective study was conducted to select 34 patients with severe ARDS caused by seawater drowning,including 18 patients treated with ECMO as study group and 16 patients treated with oscillatory ventilation as control group.The oxygenation indexes and prognosis of the two groups were compared.Results After 72 h of treatment,the oxygenation indexes,vital signs and survival rate in the study group were more stable than those in the control group(P<0.05).Conclusion ECMO treatment can improve the oxygenation indexes and survival rate of patients with severe ARDS caused by seawater drowning.It is worthy of clinical promotion and ap-plication.

Abstract:Objective The aim of this study was to explore the impact of high vasoactive inotropic score(VIS)on the prognosis of septic patients receiving veno-venous extracorporeal membrane oxygenation(V-V ECMO).Methods We retro-spectively reviewed the clinical data from the Chinese Society of Extracorporeal Life Support registry database between January 2017 and June 2023.279 adult septic patients receiving V-V ECMO were finally included.Based on a VIS of 60 as the cutoff,patients were divided into two groups:high VIS and medium-low VIS.In-hospital mortality,configurations converting,and complications were compared between the groups.Results There were 122 patients in the high VIS group and 157 patients in the other group,and the overall mortality rate was 49.8%.The in-hospital mortality rate was significantly higher in the high VIS group than in that in the medium-low VIS group(59.8%vs.42.0%,P<0.05).Sixteen patients required configurations converting,and the mortality rate after conversion was 62.5%.The incidence of configurations converting showed no difference between the two groups,but hyperbilirubinemia was significantly more in the high VIS group(27.9%)compared to the medium-low VIS group(12.7%)(P<0.05).Conclusion High VIS in septic patients receiving VV-ECMO support is associated with higher mor-tality and complication.Optimizing the timing of ECMO run and hemodynamic management is necessary.

Abstract:Temporary mechanical circulatory support(tMCS)has emerged as a critical component in the management of cardiogenic shock,with its clinical application expanding significantly in recent years.However,current evidence remains limited by the paucity of large-scale randomized controlled trials(RCTs)demonstrating mortality reduction with its tMCS implementa-tion.A comprehensive understanding of the distinct therapeutic roles and hemodynamic effects of various tMCS devices in cardi-ac dysfunction management is essential for developing personalized treatment strategies.This review will systematically examine the evolutionary trajectory and contemporary clinical landscape of commonly employed tMCS technologies,while identifying critical knowledge gaps and future investigative priorities in this rapidly advancing field.

Abstract:Various factors during extracorporeal circulation can lead to inflammation activation,causing systemic inflammatory responses that affect patient outcomes.This paper,based on the"expert consensus on improving systemic inflammatory response associated with extracorporeal circulation"and combining existing clinical research evidence with evidence-based medicine,provides a comprehensive analysis of the application value of cytokine adsorbers in extracorporeal circulation.It aims to offer a reference for the use of cytokine adsorbers in this process.

Abstract:Objective To investigate the optimal timing,prognostic benefits and influencing factors of awake extracorporeal membrane oxygenation(ECMO)in patients following cardiac surgery.Methods The clinical data of 56 patients with"awake ECMO"after cardiac surgery from January 2022 to June 2024 in Xijing Hospital were retrospectively analyzed.Patients were categorized into a fully awake group(no mechanical ventilation during ECMO)and a non-fully awake group(mechanical ventilation required during ECMO).The non-fully awake group was further stratified into an early awake subgroup(mechanical ventilation duration<40%of total ECMO support time)and a non-early awake subgroup(mechanical ventilation duration≥40%).The baseline data,extubation factors and clinical outcomes were compared between groups.Multivariate analysis was performed to identify predictors of early tracheal extubation in the non-fully awake group.Results The fully awake group exhibited significantly higher hospital survival rates compared to the non-fully awake group(P=0.04).The fully awake group also demonstrated shorter total mechanical ventilation time,reduced ICU stays,shorter hospitalization,and lower rates of major complications In the non-fully awake group,the early awake subgroup achieved higher survival rates and lower complication rates(P<0.001).Albumin and prealbumin significantly improved during awake ECMO compared to tracheal intubation(P<0.05).Multivariate analysis identified postoperative pulmonary complications and oxygenation index as independent predictors of successful awake ECMO implementation.Conclusion Early awake V-A ECMO in post-cardiac surgery patients is associated with improved survival,reduced complications,enhanced nutritional status,and shorter hospital stays.

Abstract:With advancements in surgical techniques,some children with complex congenital heart disease(CHD)are able to survive.However,they are still faced with the severe complication of long-term heart failure.Stem cell infusion has been shown to protect cardiac function and delay the onset of heart failure.Umbilical cord blood stem cells,as an easily accessible source of stem cells,exert their protective effects on the heart by secreting exosomes that alleviate myocardial injury.This paper reviews the animal and clinical studies on the use of umbilical cord blood stem cells for cardiac function preservation,as well as the methods for stem cell delivery.

Abstract:Objective To evaluation of the thermal exchange efficacy of a novel blood perfusion device(XJ-40-20)for cardioplegia delivery.Methods According to the"Technical Requirements for Disposable Cardioplegia Perfusion Devices,"in vitro experiments were conducted comparing the novel XJ-40-20(experimental group,n=8)and a demestic comparator device(control group,n=8).Parameters measured included priming volume,cooling coefficients,and pressure drop.For in vivo evaluation,blood cardioplegia(blood:crystalloid ratio of 4:1)of 1250±0 ml was delivered by XJ-40-20 at a pressure of 149.7±6.4 mmHg for 5 minutes in a porcine cardiopulmonary bypass(CPB)model(n=6).In both in vitro and in vivo studies,the blood temperatures at the inlet and outlet of the perfusion device and the water temperatures were measured.In the animal study,the cardiac function was assessed after 90 minutes of aortic cross-clamping,and myocardial pathological examination was performed at 2 hours post-declamping.Results In vitro experiments although the prime volumes were similar between groups(P=0.30),the cooling coefficient of XJ-40-20 was significantly higher than that of the control group,with statistical significance.In animal experiments,XJ-40-20 effectively cooled the blood cardioplegia solution to 11℃ at a flow rate of 250 ml/min.Hearts were recovered after the 90-minute myocardial ischemia in all animals,with successful weaning from CPB after an average of 13.43±9.14 minutes of assistance.The normal structure of myocardial tissue was shown in pathological examination.Conclusion XJ-40-20 can provide satisfactory effects of cooling and myocardial protection for blood cardioplegia delivery.

Abstract:Objective To evaluate the effect of high versus low oxygen partial pressure(PaO2)management on organ function in neonates undergoing cardiac surgery with cardiopulmonary bypass(CPB).Methods Neonates who underwent CPB-supported cardiac surgery at our institution from January 2023 to December 2024 were stratified into two groups:a high-PaO2 group(PaO2>200 mmHg)and a low-PaO2 group(PaO2≤200 mmHg).Preoperative and postoperative serum total bilirubin,creatinine,and serial lactate levels(pre-incision,intraoperative,and 6 hours post-CPB)were analyzed.Organ dysfunction and perfusion status were compared between groups.Results Sixty neonates(male:41;female:19;mean age:11.29±7.50 days;mean weight:3.39±0.61 kg)were included,with 30 patients in each group.High-PaO2 group:Postoperative total bilirubin and creatinine levels increased significantly compared to preoperative baselines(P<0.05).Intraoperative and 6-hour postoperative lactate levels were elevated versus pre-incision values(P<0.05).Low-PaO2 group:Postoperative bilirubin and creatinine level showed non-significant increases.Lactate levels rose intraoperatively and at 6 hours postoperatively(P<0.05).Intergroup comparisons revealed higher postoperative bilirubin and creatinine in the high-PaO2 group,though differences were non-significant.Intraoperative and 6-hour lactate levels trended higher in the high-PaO2 group.Conclusion High PaO2 management during neonatal CPB is associated with aggravated postoperative hepatic/renal dysfunction and impaired systemic perfusion.Restrictive oxygen strategies(PaO2≤200 mmHg)may mitigate organ injury and improve lactate clearance.

Abstract:Objective To investigate the relationship between preoperative coagulation factor ⅩⅢ(FⅩⅢ)activity,postoperative chest tube drainage(CTD)and transfusion requirements for coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB).Methods A retrospective study was conducted from March 2022 to March 2024,which included 73 patients who underwent CPB CABG at our cardiovascular surgery center.Patients with transfusion requirements were transfused postoperatively according to transfusion guidelines.Preoperative FⅩⅢ activity was assayed by using a color-emitting substrate method,and the CTD volume in the first 48 h postoperatively was recorded.Results Of the 73 patients,a total of 50(68.49%)received postoperative blood transfusions.Of these,36(49.32%)were transfused with packed red blood cells(PRBCs);13(17.81%)were transfused with platelets(PLTs);and 42(57.53%)were transfused with fresh frozen plasma(FFP).Compared with patients who were transfused postoperatively,those who were not transfused had significantly lower ICU length of stay,postoperative intubation time,48 h postoperative CTD relative volume(total volume/body weight),and intraoperative blood loss(P<0.05);whereas central venous pressure(CVP)and preoperative FⅩⅢ activity level were significantly higher(P<0.05).Multifactorial logistic modeling showed that preoperative FⅩⅢ activity<96.81%(median value)and 48 h postoperative CTD relative volume≥16.70 ml/kg(median value)in the first 48 h postoperatively were independent risk factors affecting postoperative blood transfusion(P<0.05).The area under the curve(AUC)of preoperative FⅩⅢ activity and the 48 h postoperative CTD relative volume predicting postoperative blood transfusion was 0.731(95%CI:0.619～0.844)and 0.799(95%CI:0.688～0.911),respectively,and the AUC was increased to 0.879(95%CI:0.785～0.973)for the combination of the two predicting postoperative blood transfusion.Spearman's correlation showed that the 48 h postoperative CTD relative volume was positively correlated with the total amount of PRBC transfusion(Rho=0.529)and FFP transfusion(Rho=0.3779),P<0.05.Conclusion The results of this study demonstrate that although preoperative FⅩⅢ activity is not related to the amount of postoperative CTD,patients with low preoperative FⅩⅢ activity and a relatively high amount of postoperative CTD are more likely to receive postoperative transfusions.

Abstract:Objective To analyze academic literature on cardiac surgery-associated acute kidney injury(CS-AKI),we employed bibliometric methods to explore the current research status,hotspots,and frontiers,providing insights for researchers and clinicians.Methods We retrieved core literature on CS-AKI published between January 2004 and January 2025 from Web of Science,then processed the date by cleaning,deduplicating,and analyzing with COOC and VOSviewer.Visualization were conducted on publication years,journals,journal sources,and keywords to elucidate the research status,hotspots,and hotspots CS-AKI.Results A total of 2,303 literatures related to CS-AKI were screened.The annual publications volume exhibited a general upward trend.The top three journals were Journal of Cardiothoracic and Vascular Anesthesia,Journal of Thoracic and Cardiovascular Surgery,and Pediatric Nephrology.The United States contributed the most publications and achieved the highest average citation rates per article.Cluster analysis of high-frequency keywords revealed three dominant research themes:①Diagnosis,treatment,and prognosis of CS-AKI;②Exploration of novel biomarkers for diagnosing CS-AKI;③Construction of machine learning-based risk prediction models for CS-AKI patients.Keyword evolution analysis identified current research hotspots:pathogenesis,risk factors,and exploration of novel biomarkers for kidney injury.Research frontiers include:CS-AKI prognosis,protective measures,treatment strategies,and the construction of risk prediction models.Conclusion CS-AKI has become a growing research priority.This study provides a comprehensive analysis and summary of the CS-AKI research field.Future research directions will primarily focus on the prevention and managemen of CS-AKI.

Abstract:Objective THis single-center retrospective study evaluates the clinical outcomes of extracorporeal membrane oxygenation(ECMO)therapy in patients with Williams syndrome(WS)undergoing congenital heart disease correction surgery with cardiopulmonary bypass(CPB).Methods Data of patients under 18 years old with WS who received ECMO support after cardiac surgery from January 2017 to December 2023 at the Shanghai Children's Medical Center were collected,including demographic data,clinical information during CPB and ECMO,complications,and prognosis.Results A total of 8 patients were enrolled in this study.4 cases(50%)failed to wean off CPB and were directly converted to ECMO,1 case(12.5%)received extracorporeal cardiopulmonary resuscitation(ECPR)following cardiac arrest,and the remaining 3 cases(37.5%)required ECMO for postoperative low cardiac output syndrome(LCOS).ECMO support lasted 44-192 hours(mean 99.88±53.81),with mechanical ventilation lasting 66 to 360 hour(mean 257.75±127.67),Intensive care unit stays ranged from 3 to 23 days(mean 15.25±7.91),and total hospitalization ranged from 5 to 55 days(mean 29.5±15.78).Seven patients(87.5%)successfully weaned off ECMO,with an overall survival-to-discharge rate of 87.5%.Conclusion WS patients are prone to LCOS after surgery due to the removal of aortic valve stenosis,which alters coronary circulation.ECMO utilization in WS patients is higher than in general congenital heart disease.ECMO support facilitates adaptation to new coronary perfusion patterns,improving cardiac function with favorable outcomes.Cardiac catheterization can reveal potential anatomical issues and provide targeted treatment.

Abstract:Copper is an essential trace element,but its overload triggers cellular apoptosis.The heart,being highly sensitive to oxidative stress,suffers severe damage under myocardial copper overload.While intracellular copper homeostasis is maintained by absorption,utilization,and export mechanisms mediated by copper chaperones,endogenous defense against copper overload exist in the cytosol..Mitochondria,the primary source of reactive oxygen species(ROS),possess intrinsic antioxidant systems.During hypoxia,copper accumulation in cardiomyocytes exacerbates ROS generation,establishing a pathological cycle of"hypoxia-copper accumulation-oxidative stress".Crucially,copper overload induces post-arrest myocardial injury through three interconnected pathways:disruption of cardiac oxygen supply-demand balance;aggravation of ROS-mediated ischemia-reperfusion injury;and impairment of excitation-contraction coupling.This paper analyzes the mechanisms of cellular copper metabolism and the generation and scavenging of ROS.It aims to explore how cellular copper overload mediates ROS generation and subsequently causes myocardial injury after cardiac arrest,providing a theoretical basis and new ideas for donor heart protection.

Abstract:Objective To evaluate the association between right ventricular dysfunction(RVD)and with the risk of cardiovascular events and all-cause mortality in patients undergoing maintenance hemodialysis(MHD).Methods Between February 2019 and February 2023,137 patients with end-stage renal disease(ESRD)who had undergone MHD for more than one year were assessed for cardiac function and followed up.The study endpoints included cardiovascular events and all-cause mortality.RVD was defined by meeting at least two of the following criteria:(1)tricuspid annular systolic escursion(TAPSE)<17 mm;(2)tricuspid regurgitation velocity<10 cm/s;or(3)right ventricular area change fraction<35%.Spearman correlation analysis was performed to assess relationships between various cardiac parameters.The COX proportional hazards model and Kaplan-Meier survival analysis were used to evaluate the association between RVD and endpoint events.Results Of the 137 patients,56(40.88%)were classified into the RVD group.Compared with the non-RVD group,the RVD group exhibited significantly higher left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),right ventricular end diastolic volume index(RVEDVI),right ventricular end systolic volume index(RVESVI),and the ratio of mitral flow velocity to annular velocity(E/e')(P<0.05).Conversely,the left ventricular stroke volume index(LVSVI),right ventricular stroke volume index(RVSVI),left ventricular ejection fraction(LVEF),and RVEF were significantly lower in the RVD group(P<0.05).Spearman correlation analysis revealed that RVEDVI was significantly positively correlated with LVEDD(rs=0.516),LVESD(rs=0.341),RVEDD(rs=0.519),LVEDVI(rs=0.491),LVESVI(rs=0.273),LVSVI(rs=0.331),RVESVI(rs=0.345),RVSVI(rs=0.664)and E/e'(rs=0.411),while being significantly negatively correlated with LVEF(rs=-0.233)and RVEF(rs=-0.342),all P<0.05.RVEF showed a significant negative correlation with LVEDD(rs=-0.176),LVESD(rs=-0.436),RVEDD(rs=-0.294),LVEDVI(rs=-0.202),RVESVI(rs=-0.384)and E/e'(rs=-0.229),and a positive correlation with LVSVI(rs=0.336),LVEF(rs=0.507),and RVSVI(rs=0.379),all P<0.05.A weak negative correlation was found between LVEF and E/e'(rs=-0.184,P=0.038).During a median follow-up of 18 months(from 3-18 months),34 patients(24.82%)reached the study endpoint.The incidence of endpoint events was significantly higher in the RVD group compared to the non-RVD group(P<0.001),and the event-free survival time was significantly shorter in the RVD group(P<0.001).COX regression analysis identified RVD as an independent risk factor for the occurrence of endpoint events(P<0.05).Conclusion Accurate assessment of right ventricular function is critical for prognostication in MHD patients,as right ventricular parameters provide valuable prognostic information and may assist in risk stratification of this patient population.