Background: Invasive double-valve infective endocarditis (IE) requiring aorto-mitral curtain reconstruction is rare and technically demanding. Meanwhile, radical surgical interventions are essential for controlling infection and restoring structural integrity.Case: We report the case of a 77-year-old woman with pyogenic spondylitis who developed high fever and cardiogenic shock due to IE involving the aortic and mitral valves. Transesophageal echocardiography confirmed extensive infection extending to the aorto-mitral curtain. Emergency Commando surgery using a single bovine pericardial patch was performed, reconstructing the aorto-mitral curtain. The postoperative course was uneventful, and no recurrence of infection was observed at the 1-year follow-up.Conclusions: This case highlights the effectiveness of radical debridement and anatomic reconstruction using a single-patch Commando technique in extensive infective endocarditis involving the aorto-mitral curtain.
Background: Enteral nutrition (EN) feeding intolerance (ENFI) frequently occurs in intensive care unit (ICU) patients after cardiopulmonary bypass (CPB)-assisted cardiac surgery and may adversely affect postoperative recovery. However, predictive tools specifically tailored to this population remain limited. This study aimed to develop and validate an explainable machine learning model to predict ENFI in postoperative ICU patients following CPB-assisted cardiac surgery.Methods: This retrospective study included 519 adult patients admitted to the ICU following CPB-assisted cardiac surgery between June 2019 and December 2023. ENFI was assessed within 5 days of EN initiation according to standardized clinical criteria. Thirty-nine perioperative variables were collected. The dataset was randomly divided into a training cohort (70%) and a testing cohort (30%). Least absolute shrinkage and selection operator (LASSO) regression was applied for feature selection within the training cohort. Five machine learning algorithms, including support vector machine (SVM), random forest (RF), decision tree (DT), na & iuml;ve Bayes (NB), and extreme gradient boosting (XGBoost), were developed and compared. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration analysis, Brier score, and decision curve analysis (DCA). Shapley Additive Explanations (SHAP) were used to enhance interpretability.Results: Among the 519 patients, 253 (48.7%) developed ENFI. Fourteen predictors were selected by LASSO regression. In the independent testing cohort, the RF model demonstrated the highest discriminative performance, with an AUC of 0.864 (95% confidence interval [CI]: 0.804-0.916), sensitivity of 0.747, specificity of 0.815, and a Brier score of 0.155. Calibration curves indicated good agreement between predicted and observed probabilities, and DCA demonstrated favorable net clinical benefit across a range of threshold probabilities. SHAP analysis identified vasoactive-inotropic score (VIS), serum creatinine, lactate, delayed EN, and estimated glomerular filtration rate (eGFR) as the most influential predictors.Conclusions: An explainable machine learning model, particularly the RF algorithm, showed good discrimination and calibration for predicting ENFI in ICU patients after CPB-assisted cardiac surgery. The identified predictors highlight the importance of hemodynamic instability and organ dysfunction in the development of ENFI and may support early risk stratification and individualized nutritional management in postoperative ICU patients. However, as this model was developed and internally validated in a single-center cohort, further external validation in independent populations is required before broader clinical application.
Background:While numerous meta-analyses have explored the outcomes of various coronary revascularization strategies, the majority of existing literature predominantly concentrates on short-term results. Recognizing the limited focus on mid- and long-term outcomes, this meta-analysis aims to contribute to the understanding of the comparative effectiveness of hybrid coronary revascularization (HCR) and off-pump coronary artery bypass (OPCAB) procedures in these extended timeframes.Methods:A systematic literature review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted across multiple databases, including OVID MEDLINE®, EMBASE, SCOPUS, and PUBMED, up to January 2024. Inclusion criteria focused on studies reporting mid-term mortality (>1 year and <5 years) and/or long-term mortality (≥5 years) in patients undergoing HCR or OPCAB. Statistical analysis included hazard ratios (HRs) with 95% confidence intervals (CIs) using a random-effects model, assessment of heterogeneity with I2 statistics, and publication bias evaluation via funnel plot asymmetry.Results:Nine studies reported mid-term mortality (>1 year and <5 years) and five studies reported long-term mortality (≥5 years), including a total of 10,729 patients. The demographic characteristics of the patients showed no significant differences between the two intervention groups. There was no significant difference in mid-term mortality (HR: 0.94, 95% CI: 0.79–1.13, p = 0.52) and no significant difference in the long-term mortality (HR: 0.71, 95% CI: 0.41–1.23, p = 0.22).Conclusion:HCR demonstrated comparable mid-term and long-term mortality to OPCAB, suggesting similar sustained clinical efficacy between the two interventions. These findings have potential implications for clinical decision-making in cardiovascular care. However, it is crucial to acknowledge the limitations of this study, including potential biases in the included studies and constraints in the available data. Further research is warranted to validate and refine these results, considering the dynamic landscape of cardiovascular care.
Aortic stenosis (AS) is the most commonly treated valvulopathy worldwide, affecting more than 9.4 million patients. Surgical aortic valve replacement (SAVR) has long been the standard treatment for severe AS. As a less invasive approach that avoids open-heart surgery, transcatheter aortic valve replacement (TAVR) has rapidly gained popularity and is now a first-line treatment modality for many patients with AS. Multiple large prospective trials have demonstrated the non-inferiority of TAVR compared with SAVR with respect to survival and other key clinical endpoints. However, long-term data on valve durability and function after TAVR remain limited in select populations. This is particularly important for younger TAVR recipients, whose life expectancy may exceed the functional lifespan of the valve. Furthermore, the efficacy and safety of TAVR in certain patient subsets, such as those with bicuspid aortic valves (BAVs) or a small aortic annulus (SAA), remain uncertain. In contrast, SAVR continues to provide excellent outcomes across a broad range of valve anatomies. Additionally, surgical implantation of a mechanical valve or a pulmonary autograft via the Ross procedure remains an excellent option for appropriately selected younger surgical candidates. A surgical approach also allows for adjunct procedures, such as aortic annular enlargement, which can be particularly beneficial in patients with smaller aortic annuli. Overall, the data comparing SAVR and TAVR is extensive and continues to evolve. This manuscript aims to review the key studies and provide an overview of contemporary treatment options for AS.
Introduction: To investigate the clinical efficacy of perfusion intubation through the three branches of the aortic arch compared with the axillary artery in patients with DeBakey type I aortic dissection.Methods: A total of 63 patients with DeBakey type I aortic dissection who underwent open surgery from September 2023 to December 2024 were included and divided into two groups based on the cerebral perfusion method used. The three-branch perfusion group (Group B, 31 cases) received perfusion through the three branches of the aortic arch, while the axillary artery perfusion group (Group A, 32 cases) received perfusion via the right axillary artery. Preoperative, intraoperative, and postoperative clinical data were collected for both groups, and clinical efficacy was compared using t-tests and chi-square tests.Results: The experimental group had a shorter postoperative awakening time -, fewer cases of permanent neurological dysfunction (PND), lower mortality and reduced serum creatinine levels than the control group; these differences were statistically significant (p < 0.05). Notably, the lowest nasopharyngeal temperature was significantly higher in the experimental group than in the control group (24.90 +/- 1.45 vs. 24.02 +/- 2.17; p = 0.014). There were no significant differences between the two groups in cardiopulmonary bypass time, selective cerebral perfusion time, lower body circulatory arrest time, endotracheal intubation time, postoperative intensive care unit (ICU) stay, hospital stay, temporary neurological dysfunction, paraplegia, reoperation, hypoxemia and gastrointestinal bleeding (p > 0.05).Conclusions: Compared with traditional axillary artery intubation, perfusion intubation through the three branches of the aortic arch is as safe and effective, and is superior in terms of postoperative awakening time and incidence of PND. Moreover, perfusion intubation provides a stronger cerebral protection and can serve as a new cerebral perfusion strategy.
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and a major contributor to ischemic stroke and cardioembolic events. Although oral anticoagulation remains the cornerstone of stroke prevention in AF, its use may be limited by bleeding risk, contraindications, intolerance, and adherence challenges. Because the left atrial appendage (LAA) is the predominant site of thrombus formation in nonvalvular AF, LAA closure has emerged as a mechanistically targeted, non-pharmacologic approach to reduce embolic risk in selected patients. This review critically appraises the evidence supporting surgical and percutaneous LAA occlusion, with emphasis on AF-related thromboembolism, the role of the LAA in thrombogenesis, procedural techniques, patient selection, peri-procedural multimodality imaging, clinical outcomes, and complications. Surgical LAA occlusion performed during concomitant cardiac surgery has been shown in randomized trials and meta-analyses to reduce ischemic stroke and systemic embolism and is endorsed by major society guidelines as an adjunct to continued anticoagulation in eligible patients. Percutaneous LAA closure with contemporary devices, including Watchman FLX and Amulet, offers an alternative to long-term anticoagulation for selected patients with nonvalvular AF and elevated bleeding risk, although randomized trial findings remain mixed. Evidence in special populations, including patients with prosthetic valves, advanced age, chronic kidney disease, congenital heart disease, and prior LAA occlusion, is also reviewed, highlighting unique procedural considerations and persistent knowledge gaps. Continued investigation is needed to refine patient selection across AF phenotypes, standardize post-closure antithrombotic and imaging follow-up strategies, and clarify the net benefit of prophylactic surgical LAA occlusion in patients without pre-existing AF. A multidisciplinary, individualized approach remains essential to balancing thromboembolic and bleeding risks and optimizing patient outcomes.
Background: This study aimed to evaluate the long-term clinical and echocardiographic outcomes of Perceval sutureless aortic valve implantation, with particular emphasis on survival, valve-related events, and hemodynamic performance during extended follow-up.Methods: This retrospective single-center study included 150 consecutive patients aged 70-85 years who underwent Perceval sutureless aortic valve replacement between 2016 and 2025. Of these, 106 patients (70.7%) underwent isolated aortic valve replacement, while 44 (29.3%) underwent additional cardiac procedures. Clinical and echocardiographic data were collected preoperatively, at hospital discharge, and during scheduled long-term follow-up. Overall survival was estimated using Kaplan-Meier analysis.Results: Thirty-day mortality occurred in 5 patients (3.3%), and five patients (3.3%) required permanent pacemaker implantation. Dialysis-requiring acute kidney injury occurred in three patients (2.0%), and stroke or transient ischemic attack occurred in two patients (1.3%). During long-term follow-up (mean 6.1 +/- 1.8 years), three patients (2.0%) required valve-related reintervention, primarily due to technical issues or early prosthetic dysfunction. One patient (0.7%) developed moderate-to-severe transvalvular regurgitation during follow-up. The estimated survival rates from the Kaplan-Meier analysis were 90.0% at 1 year, 78.7% at 5 years, and 71.3% at 8 years. The mean transvalvular gradient decreased from 46 +/- 11 mmHg preoperatively to 9.8 +/- 3.2 mmHg at discharge and remained stable at 11.2 +/- 3.9 mmHg at the last follow-up.Conclusion: Perceval sutureless aortic valve implantation demonstrated favorable early clinical outcomes and sustained good hemodynamic performance during long-term follow-up. The low incidence of valve-related reintervention and the absence of structural valve deterioration indicate that this prosthesis is durable and clinically feasible for carefully selected older patients.
Background: Type II endoleak (T2EL) remains a significant cause of reintervention after endovascular aneurysm repair (EVAR). Current strategies for T2EL management remain suboptimal with low long-term efficacy. Thus, this study aimed to evaluate the feasibility and outcomes of laparoscopic transperitoneal branch artery ligation for T2EL management.Methods: This study included 6 patients with persistent T2EL and aneurysm sac expansion who underwent laparoscopic ligation of the culprit vessels, including the inferior mesenteric, lumbar, and median sacral arteries, at our center between January 2021 and January 2024. Preoperative basic clinical characteristics, operative data, postoperative outcomes, and complications of the patients were recorded and analyzed.Results: The median operative time was 225 minutes (range: 120-360 min) with blood loss of 300 mL (range: 50-500 mL). All patients achieved complete ligation of targeted vessels (median of 5 vessels per patient), with 100% success for the inferior mesenteric artery (IMA) and 50% for the median sacral artery. One patient developed a lymphatic fistula that was managed conservatively. At a median follow-up of 13.5 months (range: 4-54 months), all patients exhibited sac regression (median reduction: 3.5 mm; range: 1-8 mm). Complete endoleak resolution was observed in 4 cases (66.7%), while 2 had asymptomatic persistent T2EL without expansion. No reinterventions or mortality occurred.Conclusions: Laparoscopic transperitoneal branch artery ligation represents a promising, albeit preliminary, option for managing embolization-refractory T2EL. Our findings suggest that laparoscopic T2EL repair may provide durable sac stabilization in selected patients; however, the limited sample size underscores the need for larger studies to clarify patient selection criteria and long-term durability.
Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. While often considered a transient and expected complication, recent evidence suggests that POAF is associated with an increased risk of recurrence, thromboembolic events, and long-term morbidity. Moreover, the management of POAF remains debated, particularly regarding the choice between rate- and rhythm-control strategies and the use of anticoagulation. A narrative literature review was conducted using the PubMed, the Cochrane Library, and Google Scholar databases. Studies that focused on adult patients who developed POAF after coronary artery bypass grafting or valve surgery and addressed at least one of the following were included: recurrence patterns, treatment strategies (rate vs. rhythm control), stroke risk stratification, or anticoagulation. Studies focusing on nonsurgical atrial fibrillation (AF), pediatric populations, or animal models were excluded. A total of 45 articles were included for the final analysis. A total of 8 studies evaluated the recurrence of POAF after discharge. Across these studies, recurrence ranged between 30% and 60%, with many episodes occurring within the first month and remaining asymptomatic. Continuous monitoring tools, such as implantable loop recorders and handheld electriocardiogram (ECGs), showed a significantly higher detection rate than usual care. Seven studies compared rate- and rhythm-control strategies; in most patients, sinus rhythm was maintained regardless of the approach. Rate control, typically with beta-blockers, was favored as a safer first-line option. However, rhythm control, particularly through catheter ablation, showed improved outcomes in patients with heart failure or persistent symptoms. Nine studies examined stroke risk. The risk score for stroke in atrial fibrillation (CHA2DS2-VASc) score, although widely used in the general atrial fibrillation population, was validated primarily in the nonsurgical and transient AF population and may underestimate short-term thromboembolic risk in the postoperative setting. Some studies reported that stroke risk increased significantly once the CHA2DS2-VASc score reached ≥4, highlighting the potential for early postoperative thromboembolism. Several articles explored whether tools designed for subclinical AF, such as the risk stratification tools for subclinical atrial fibrillation (SCAF) score, could better stratify POAF risk. Notably, stroke risk increased significantly when episodes of atrial fibrillation exceeded 48 hours, suggesting that both duration and timing post-surgery are important considerations. Nine studies addressed anticoagulation. Oral anticoagulants, particularly apixaban, were associated with modest reductions in thromboembolic events but also with increased bleeding complications. Meanwhile, despite eligibility, fewer than 30% of patients received anticoagulation upon discharge. POAF is a common but underrecognized complication of cardiac surgery that carries a significant risk. Individualized management strategies guided by early rhythm monitoring and refined risk assessment tools are essential for optimizing outcomes.
Cardiac surgery has undergone significant innovation over the past several years. The increased use of robotic surgery and transcatheter therapies has expanded the armamentarium of interventions available to patients. Here, we discuss the recent technological developments in coronary revascularization, structural heart procedures, and the surgical management of atrial fibrillation and heart failure, with particular emphasis on feasibility, clinical applicability, and potential for further innovation.
Bicuspid aortic valve-associated infective endocarditis (BAV-IE) is a unique and aggressive type of native valve infection. The combined effects of congenital valve malformation, altered hemodynamics, and genetic susceptibility promote endothelial injury and bacterial colonization, predisposing affected individuals to serious infections. Compared with endocarditis in the tricuspid aortic valve, BAV-IE affects young patients with few comorbidities and causes more severe tissue damage, periannular abscesses, and necessitates early surgery. Notably, streptococci and staphylococci remain the predominant pathogens causing the disease. Multimodal imaging, which integrates transthoracic and transesophageal echocardiography into cardiac computed tomography, is crucial for the early detection of structural complications and surgical planning. Prompt surgical interventions, including radical debridement, valve replacement, and appropriate aortic repair, ensure optimal infection control and long-term outcomes. Moreover, long-term survival is favorable, regardless of infection severity, when managed promptly and comprehensively. Lifelong surveillance and preventive strategies focusing on oral hygiene, infection control, and procedural asepsis are critical for reducing recurrence and improving prognoses in this high-risk population.
Background: Low-flow, low-gradient (LFLG) aortic stenosis (AS) is associated with high-risk physiology and poor outcomes; however, the optimal intervention strategy, surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR), remains uncertain. Methods: A systematic review and pooled meta-analysis of studies reporting Kaplan-Meier outcomes after SAVR and TAVR in patients with LFLG AS, published through June 2025, was performed. Individual patient data were reconstructed from published curves. Analyses included Cox frailty models, restricted mean survival time (RMST), and two-stage meta-analyses. Adjusted analyses accounted for baseline differences, including age, comorbidities, and echocardiographic parameters. Results: Five studies comprising 1940 patients (721 SAVR and 1219 TAVR) were included. Patients undergoing TAVR were older and had higher rates of peripheral arterial disease, while other comorbidities and echocardiographic parameters were similar between groups. In unadjusted analyses, TAVR was associated with higher mortality compared with SAVR (hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.11–1.65; p = 0.003). The estimated 5-year survival was 67% for SAVR versus 49% for TAVR, with an RMST of 0.64 years in favor of SAVR. Despite risk adjustment, TAVR was associated with higher mortality (HR 1.42, 95% CI 1.17–1.73), with a reduction in RMST of 1.06 years. Two-stage meta-analyses yielded consistent findings with low-to-moderate heterogeneity. Conclusion: SAVR was associated with significantly lower mortality in patients with LFLG AS than TAVR, both before and after risk adjustment. While these findings suggest a potential survival benefit, the data are observational and hypothesis-generating, and residual confounding cannot be excluded.
Background: Right ventricular failure (RVF) remains a major determinant of morbidity and mortality following left ventricular assist device (LVAD) implantation. In its most severe form, RVF necessitates right ventricular assist device (RVAD) support, which is associated with markedly worse early and long-term outcomes. While numerous studies have examined predictors of post-LVAD RVF, few have focused specifically on RVAD implantation as a discrete and clinically decisive endpoint. We therefore performed a systematic review and meta-analysis to identify robust preoperative predictors of RVAD requirement following LVAD implantation. Methods: A systematic literature search of MEDLINE, EMBASE, SCOPUS, and PubMed was conducted from inception to August 2025 in accordance with PRISMA guidelines. Studies enrolling adult patients undergoing durable or temporary LVAD implantation and reporting preoperative predictors of postoperative RVAD requirement were included. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic, with predefined sensitivity and subgroup analyses based on LVAD era and study size. Results: Twenty studies met inclusion criteria, of which nineteen comprising 31,591 patients were included in the meta-analysis. Several consistent preoperative predictors of RVAD requirement were identified across clinical, haemodynamic, echocardiographic, and laboratory domains. Patients requiring RVAD were younger (MD –3.57 years) and more frequently female, had a higher likelihood of prior cardiac surgery, INTERMACS Profile 1 status, and need for preoperative mechanical support including ventilation and intra-aortic balloon pump. Haemodynamic predictors included elevated central venous pressure, higher CVP/PCWP ratio, lower cardiac index, and reduced right ventricular stroke work index. Echocardiographic predictors included severe tricuspid regurgitation and lower tricuspid annular plane systolic excursion. Laboratory markers of hepatic dysfunction, coagulopathy, malnutrition, anaemia, thrombocytopenia, and elevated natriuretic peptides were also significantly associated with RVAD implantation. Subgroup analyses demonstrated consistent direction of effects across LVAD eras and study sizes. Conclusion: RVAD requirement after LVAD implantation is driven by a constellation of high clinical acuity, haemodynamic compromise, and end-organ dysfunction rather than any single isolated variable. A comprehensive, multi-parameter preoperative assessment is essential to identify patients at highest risk and to guide patient selection, preoperative optimisation, and consideration of planned biventricular support strategies.
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.
Background: The clinical outcomes of rheumatic mitral valve repair (MVP) remain controversial, particularly regarding reoperation rates. Therefore, we conducted a meta-analysis to comprehensively and systematically evaluate clinical outcomes, with a focus on reoperation rates. Methods: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for articles and abstracts published from 1 January 1990 to 21 September 2023, to compare the clinical outcomes of MVP versus mitral valve replacement (MVR) in patients with rheumatic heart disease (RHD). Results: After screening the titles and abstracts of 2703 articles, a total of 165 articles were reviewed. A total of 20 articles met the inclusion criteria, comprising 4492 MVP and 7913 MVR cases. MVP was associated with lower early mortality (odds ratio (OR): 0.63, 95% confidence interval (CI): 0.50–0.78; p < 0.001) and long-term mortality (OR: 0.57, 95% CI: 0.42–0.77; p < 0.001), as well as reduced rates of thromboembolism (OR: 0.58, 95% CI: 0.46–0.74; p < 0.001), bleeding (OR: 0.70, 95% CI: 0.55–0.89; p = 0.004), and heart failure (OR: 0.28, 95% CI: 0.12–0.67; p = 0.004). There were no significant differences between groups in the incidence of infective endocarditis (p = 0.786), stroke (p = 0.503), or atrial fibrillation (p = 0.180). To analyze reoperation rates more objectively, studies were stratified by surgical era into three subgroups. The risk of reoperation after MVP was high before 2000 (OR: 3.67, 95% CI: 1.98–6.78; p < 0.001). However, from 2000 to 2010, the risk of reoperation decreased but remained high overall, whereas after 2010, the reoperation rate was similar to that observed with MVR. Conclusion: In patients with RHD, MVP is associated with lower early and long-term mortality, as well as reduced thromboembolism, bleeding, and heart failure compared with MVR. Although MVP historically carried a higher reoperation rate than MVR, this rate has gradually declined in recent years, and since 2010, reoperation rates have not differed significantly between MVP and MVR.
Endovascular therapy provides a new treatment modality for patients with aortic disease. By avoiding the morbidity of open surgery, endovascular approaches make treatment possible for a larger array of patients. However, the durability and long-term survival benefit of endovascular aortic intervention require further discussion and additional follow-up. We believe that the characterization of the role of endovascular therapy involves close risk-benefit analysis based on patient risk, disease presentation, native and pathological anatomy, and long-term outlook. Through review of the randomized prospective literature and relevant retrospective data, we explore the role of catheter-based solutions in abdominal and thoracic aortic disease, with a focus on aortic aneurysm and aortic dissection (AD). For patients with appropriate anatomy, endovascular aortic repair (EVAR) has largely supplanted open aortic repair (OAR) in the treatment of abdominal aortic aneurysm (AAA), both in the elective setting and during rupture. Similarly, thoracic endovascular aortic repair (TEVAR) has gained popularity in treating disease of the descending thoracic aorta, in both aneurysmal degeneration and AD. Similar adoption has been seen in treating other disease states, namely traumatic aortic injury. However, we recognize the current limitations of endovascular therapy and detail the innovations being pursued to advance endovascular therapy in the future.
End-stage heart failure is the final stage of heart disease. Patients with end-stage heart failure receive much attention due to their often critical condition. Due to the shortage of donors for heart transplantation, left ventricular assist devices (LVADs) have become an important treatment method to replace the heart’s pumping function. Post-operative bleeding and embolism are among the most common complications after LVAD implantation, seriously threatening the recovery and survival of patients. This article systematically classifies the risk factors of bleeding and embolism into either patient-related, LVAD-related, or exogenous. It analyzes the pathogenic differences of adverse events across different device types,exploring the treatment and prevention of gastrointestinal bleeding, stroke, and pump thrombosis. This article highlights the importance of adjusting anticoagulation regimens, endoscopic interventions, and imaging examinations, as well as preoperative optimization of high-risk patients and management of special clinical scenarios. The development ofthird-generation fully magnetically levitated LVADs make it possible to provide more flexible and precise anticoagulation regimens in clinical practice. Based on the use of unfractionated heparin for bridging in the early postoperative period and long-term administration of warfarin, treatment plans should be adjusted according to different clinical situations to increase the time in therapeutic range and the application of new anticoagulant drugs should be explored to improve the prognosis of LVAD patients, optimizing the anticoagulation strategy in this cohort.
