Abstract:The antiphospholipid syndrome (APS) is a complex autoimmune disease that causes a state of hypercoagulability that can result in recurrent venous and arterial thromboses. APS may lead to cardiac manifestations requiring cardiac surgery with cardiopulmonary bypass (CPB). Perioperative anticoagulation management in APS patients is complex. This complexity arises from both the prothrombotic nature of APS and the interference of antiphospholipid antibodies (aPLs) with phospholipid-dependent coagulation assays like activated clotting time. Given that current literature on CPB management in APS patients is largely limited to isolated case reports and lacks a comprehensive synthesis, this review summarizes the cardiac manifestations of APS, challenges posed by CPB, and current strategies for intraoperative anticoagulation management, including heparin dosing, anticoagulation monitoring methods, and protamine reversal practices. We further highlight gaps in evidence and propose a practical three-category framework for managing aPL-positive patients undergoing CPB.

ObjectivesTo evaluate the association between early arterial hyperoxia and 28-day mortality in postcardiotomy VA-ECMO (PC-ECMO) adult patients.MethodsWe conducted a retrospective cohort study including 209 adults who received PC-ECMO across two tertiary centers between January 2019 and December 2024. The primary exposure was the 24-h mean arterial oxygen partial pressure (24h-mean PaO2) after ECMO support. The primary outcome was 28-day all-cause mortality. Cox proportional hazards models were used to assess associations between oxygen metrics and mortality, with adjustment for confounders.ResultsThe cohort had a median age of 59 years, 130 (62.2%) were male, and 80 (38.3%) received ECMO sopport due to failure to wean from cardiopulmonary bypass. The 28-day mortality was 54.1%. Across increasing 24h-mean PaO2 categories, 28-day survival declined from 64.1% in the <150 mm Hg group to 17.9% in the ≥300 mm Hg group (P < .001). Each 10 mm Hg increase in 24h-mean PaO2 was associated with a 2.8% increased mortality risk (adjusted HR 1.028, 95% CI: 1.011-1.046, P = .002). Severe hyperoxia (≥300 mm Hg) was independently associated with higher mortality (adjusted HR 2.392, 95% CI: 1.359-4.210). A nonlinear dose-response curve showed increased mortality beyond ∼200 mm Hg. Associations were more pronounced in elderly and male subgroups.ConclusionsEarly hyperoxia is independently associated with increased 28-day mortality in PC-ECMO patients in a dose-dependent manner, highlighting the need for conservative oxygen management.

Medical–engineering integrated education has become increasingly important as modern healthcare relies more heavily on technology-intensive systems, interdisciplinary collaboration, and innovation-oriented clinical practice. In fields such as extracorporeal life support (ECLS), professionals are expected not only to deliver clinical care, but also to participate in device improvement, workflow optimization, and the translation of clinical needs into technical solutions. However, medical education and biomedical engineering education are still largely delivered through separate pathways, making the cultivation of genuinely interdisciplinary professionals particularly challenging. This narrative review summarizes the major international paradigms of medical–engineering integrated education, analyzes the current status and key challenges of related exploration in China, and proposes a clinically oriented, case-based interdisciplinary paradigm. Internationally, current practice can be broadly categorized into three paradigms: dual-degree, long-duration integrated, and short-term modular. In China, related exploration has mainly taken the form of curriculum-embedded, system-integrated, and research-oriented approaches, but broader implementation remains constrained by insufficient engineering support, fragmented curricula, limited interdisciplinary faculty capacity, traditional teaching methods, and narrow evaluation systems. In response, we propose a clinically oriented, case-based interdisciplinary paradigm that uses authentic clinical problems as the core teaching medium. ECLS is presented not simply as an example, but as a representative field in which medical–engineering integrated education may support both interdisciplinary talent cultivation and future professional development.

OBJECTIVES:This study aims to compare intraoperative blood transfusion and perioperative outcomes for patients undergoing left ventricular assist device (LVAD) implantation before and after the implementation of a blood conservation protocol. METHODS:This retrospective cohort study included patients who underwent LVAD implantation from June 2017 to October 2024 at our Hospital. The primary outcome was total intraoperative transfusion volume, and secondary outcomes included intraoperative transfusion volume and rates of red blood cells (RBC), fresh frozen plasma (FFP), platelets, and reoperation due to bleeding. Exploratory outcomes included mortality and serious complications before hospital discharge. RESULTS:In total, 120 patients were included, with 62 receiving traditional care and 58 treated with blood conservation protocol. After protocol implementation, total intraoperative transfusion volume decreased from 3.23 ± 3.24 units to 1.74 ± 1.56 units (P = 0.002). The intraoperative RBC transfusion rate dropped from 30.6% to 8.6% (P = 0.003), and the transfusion volume fell from 1.00 ± 1.71 units to 0.31 ± 1.05 units (P = 0.009). In multivariate analysis, the protocol was significantly associated with reduced total intraoperative transfusion volume, lower RBC transfusion volume and rate, and shorter ICU and hospital stays, while not correlated with perioperative mortality or serious complications. CONCLUSIONS:The blood conservation protocol significantly reduced intraoperative transfusion in LVAD patients and expedited recovery.

Perioperative red blood cell (RBC) transfusion remains common in cardiac surgery and is associated with increased morbidity and mortality. Accurate preoperative risk prediction is essential for patient blood management. The Fuwai-transfusion risk of on-pump cardiac surgery (FW-TRIC) score was previously developed and internally validated as a tool to estimate transfusion risk. This study aimed to externally validate the FW-TRIC score in a multicenter cohort. A retrospective multicenter study was conducted across nine cardiovascular centers in China from January to December 2024. Adult patients undergoing on-pump cardiac surgery were included, while those undergoing transplantation, mechanical circulatory support, or preoperative transfusion were excluded. The discriminative performance of the FW-TRIC score was evaluated using receiver operating characteristic (ROC) curve analysis, and calibration was assessed through linear regression of observed versus predicted transfusion rates. A total of 3,287 patients met inclusion criteria, with an overall perioperative RBC transfusion rate of 40.1

Severe hyperoxia during venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been associated with adverse clinical outcomes in observational studies. However, causal evidence and optimal oxygen targets remain uncertain. Hyperoxia may exacerbate oxidative stress and organ injury, particularly in the presence of systemic inflammation and ischemic shock. This study aimed to investigate the dose-dependent effects of membrane lung sweep oxygen fraction (FsO₂) during the early phase of VA-ECMO on systemic oxidative stress and early multi-organ injury markers, and to explore the mechanistic role of reactive oxygen species (ROS) using a rat VA-ECMO model. In this randomized experimental study, Sprague–Dawley rats were divided into normal rats and rats with cardiogenic shock induced by septic cardiomyopathy using LPS. Graded membrane FsO2 levels of 30

Continuous-flow left ventricular assist devices (CF-LVAD) have been increasingly implemented in China as a vital life-support strategy for patients with end-stage heart failure. Non-pulsatile blood flow is a defining physiological characteristic of CF-LVAD. Although an association between reduced pulsatility and adverse outcomes continues to be proposed, robust clinical evidence remains lacking. Retrospective study of adults (>18 years) receiving CF-LVAD at four Chinese centers (Jan 2019 - Jul 2024) was conducted. Systemic pulsatility index (SPI, calculated as pulse pressure divided by the mean arterial pressure) was derived from blood pressure measurements pre-LVAD and serially post-LVAD (days 1,7,14,21,28). Latent Class Trajectory Modeling (LCTM) identified distinct population groups based on SPI trajectories. The primary outcome of this study was major adverse events (MAE) within 90 days, including all-cause mortality and complication events. The secondary outcome was the evaluation of each complication event, mortality, ICU and hospital-free days. Among 115 LVAD patients (mean age 49.4 years, 87.8

Background: Albumin is a key protein essential for maintaining multiple physiological functions. During extracorporeal membrane oxygenation (ECMO) support, serum albumin concentration may decline as a result of hemodilution or capillary leakage. This reduction may be more pronounced in pediatric patients, whose hepatic synthetic function is not fully mature. However, evidence regarding the association between serum albumin concentration and clinical outcomes in pediatric postcardiotomy ECMO patients remains limited. This study aims to explore this association in pediatric patients. Methods: This single-center retrospective study included 96 pediatric patients who underwent venoarterial ECMO (VA-ECMO) after cardiac surgery. The association between nadir albumin concentration during ECMO and 30-day and 180-day mortality was explored using Cox regression model. Additionally, exploratory analyses were performed to assess the relationship between albumin concentration and ECMOrelated complications using logistic regression, aiming to further characterize potential factors associated with lower nadir albumin concentration and mortality. Subgroup and sensitivity analyses were performed to assess robustness. Results: In this study, the median age at ECMO initiation was 12.42 months [interquartile range (IQR): 6.42-40.06], with 64% being male. Overall, 30-day and 180-day mortality rates were 37.5% and 52.1%. Nadir albumin concentration was found to be inversely associated with the risk of 30-day [hazard ratio (HR): 0.924, 95% confidence interval (CI): 0.866-0.987] and 180-day mortality (HR: 0.929, 95% CI: 0.880-0.981). Exploratory analyses suggested no statistically significant associations between nadir albumin concentration and continuous renal replacement therapy (CRRT), hemolysis, thrombosis, major bleeding, and liver injury. Subgroup analyses showed no significant interactions by age, weight, or the Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories. Sensitivity analyses restricted to patients with early nadir occurrence and excluding those without albumin supplementation yielded consistent results. Conclusions: In pediatric patients receiving postcardiotomy ECMO support, a lower nadir albumin concentration was independently correlated with an elevated risk of mortality and may serve as a readily available marker for risk stratification, warranting validation in prospective studies.

Objective:To externally validate previously published prognostic models developed exclusively from pre-extracorporeal cardiopulmonary resuscitation (ECPR) variables in a contemporary ECPR cohort. Methods:We conducted a bicenter retrospective external validation of four published pre-ECPR prognostic models (Lee, RESCUE-IHCA, CHIU-S1, and CHIU-S2) in adult patients treated with ECPR between January 2015 and December 2024. Model performance was evaluated for in-hospital survival and favorable neurological outcome (FNO; Cerebral Performance Category 1-2) in the overall cohort, in-hospital cardiac arrest (IHCA), and cardiac-origin cardiac arrest (Cardio_CA) subgroups. Discrimination (the area under the receiver operating characteristic curve, AUROC), calibration, overall model fit (Brier score), and decision curve analysis (DCA) were assessed. For point-based CHIU scores, validation focused on observed outcome rates across predefined risk strata. Results:Among 214 patients, 79.0% (169/214) had IHCA; survival to discharge was 45.8% and FNO occurred in 24.8%. Discrimination for survival was modest across models (overall ECPR AUROC 0.608-0.709; IHCA 0.586-0.672; Cardio_CA 0.591-0.689) but was higher for FNO (overall ECPR 0.709-0.764; IHCA 0.696-0.744; Cardio_CA 0.698-0.718). The Lee model showed poor calibration with slopes far below 1, whereas RESCUE-IHCA model underestimated survival but demonstrated better calibration (slopes close to 1), higher overall accuracy (lower Brier scores) and broader clinical utility (wider net-benefit ranges in DCA). CHIU models provided limited risk separation between adjacent strata. Conclusions:In this external validation, pre-ECPR models showed modest performance, with better discrimination for neurological outcome than for survival. RESCUE-IHCA showed the most favorable overall performance. Future studies should develop and validate more robust, transportable tools.

Neurologic injury remains a critical complication of deep hypothermic circulatory arrest (DHCA) in aortic arch surgery, with neuroinflammation driven by multiple factors in its pathogenesis. While circular RNAs (circRNAs) are known to modulate inflammatory responses, their specific role in DHCA-associated brain injury has not been established. In this study, we demonstrated that circFRRS1 exacerbates hippocampal neuroinflammation via the miR-27a-3p/TLR4 axis through integrated in vivo and in vitro approaches. In a rat model of DHCA, machine learning-based motion sequencing (MoSeq) identified delirium-like behaviors, accompanied by hippocampal neuronal necrosis and activation of NLRP3 inflammasome. circFRRS1 was significantly upregulated in hippocampal tissue following DHCA and in hypoxic-ischemic PC-12 cells. Silencing circFRRS1 attenuated oxygen-glucose deprivation/reperfusion (OGD/R)-induced cytotoxicity and suppressed the TLR4/NF-κB/NLRP3 signaling pathway. Mechanistically, circFRRS1 acts as a molecular sponge for miR-27a-3p, thereby relieving its repression of TLR4; inhibition of miR-27a-3p abolished the observed neuroprotective effects. This study identifies circFRRS1 as the first reported circRNA to regulate DHCA-induced neuroinflammation, uncovering a novel epigenetic mechanism and suggesting the potential of circRNA-targeted therapies as adjuvants to conventional hypothermic strategies.

BACKGROUND:Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving intervention for refractory cardiogenic shock but is frequently complicated by thromboinflammation, leading to high morbidity and mortality. Neutrophil extracellular traps (NETs) and S100A8/A9 are involved in the thromboinflammatory process, yet their value as prognostic biomarkers for adverse outcomes in VA-ECMO patients remains to be further elucidated. OBJECTIVE:This study aimed to investigate the dynamic changes of NETs and S100A8/A9 in VA-ECMO patients and evaluate their predictive value for adverse outcomes. METHODS:A prospective cohort of 24 critically ill patients undergoing VA-ECMO was consecutively enrolled. Plasma levels of CitH3, dsDNA, and S100A8/A9 were measured at three predefined time points: baseline, 48 h post-initiation, and pre-decannulation. Their associations with adverse clinical outcomes were analyzed. Additionally, DNaseI intervention was employed in rat VA-ECMO models to further validate the mechanistic role of NETs. RESULTS:During VA-ECMO support, the thromboinflammatory markers S100A8/A9 and CitH3 remained persistently elevated, with significantly higher concentrations observed in the withdrawal group (54.2%) compared to the successful weaning group. Spearman's correlation analysis indicated significant positive associations between S100A8/A9, CitH3, dsDNA, and the withdrawal of ECMO support. ROC curve analysis demonstrated that these markers were superior to traditional indicators, such as C-reactive protein, in predicting the withdrawal of ECMO support. Multivariate Cox regression analysis identified CitH3 serve as better prognostic indicators in patients undergoing VA-ECMO. In a rat VA-ECMO model, DNaseI treatment effectively reduced S100A8/A9 levels, while significantly extending the duration of ECMO support, thereby providing proof-of-concept for NETs-targeted therapy. CONCLUSION:NETs-associated thromboinflammatory markers are closely associated with adverse outcomes in VA-ECMO patients and offer better prognostic value compared to traditional biomarkers. Targeting NETs may represent a promising therapeutic strategy to mitigate the thromboinflammatory burden and improve patient prognosis.

Background: Corticosteroids are commonly used in neonatal cardiac surgery to reduce inflammation. Previous studies have shown that administering methylprednisolone (MP) during the perioperative period can reduce the inflammatory response. However, the impact of MP on postoperative clinical outcomes in neonates remains unclear. Thus, this study aimed to assess the effects of MP on postoperative inflammation and clinical outcomes in neonates undergoing cardiac surgery involving cardiopulmonary bypass (CPB).Methods: This was a prospective, non-randomized, unblinded, controlled trial in which the clinicians determined treatment assignment. A total of 86 neonates who underwent cardiac surgery with CPB between December 2020 and August 2023 were included. After induction of anesthesia, the MP group received a single dose of 30 mg/kg MP, while the placebo group received an equal volume of saline solution. Primary endpoints were plasma interleukin (IL-6, IL-8, and IL-10) and D-dimer concentrations. Composite outcomes included death, respiratory infection, cardiac arrest, need for extracorporeal membrane oxygenation, acute kidney injury, low cardiac output syndrome, and need for prolonged mechanical ventilation.Results: Consistent with the observed anti-inflammatory effects, MP administration was associated with significantly lower levels of proinflammatory cytokines (IL-6, IL-8) and higher levels of the anti-inflammatory cytokine (IL-10). MP did not significantly reduce the likelihood of the composite outcome (p = 0.664), with 25 patients (58.1%) in the MP group and 23 patients (53.5%) in the placebo group experiencing such outcomes. The MP group also showed a significantly lower postoperative vasoactive-inotropic score and higher postoperative procalcitonin levels and nadir mixed venous oxygen saturation during the first 24 hours. No significant differences in postoperative D-dimer, blood glucose, or insulin administration were observed between the two groups.Conclusions: Prophylactic administration of 30 mg/kg MP in neonates undergoing cardiac surgery with CPB did not result in a statistically significant improvement in clinical outcomes compared with placebo. However, this intervention was associated with a reduction in the inflammatory response.The Clinical Trial Registration: ChiCTR 2000040230, https://www.chictr.org.cn/showproj.html?proj=64716.

We evaluated whether immediate postoperative urine dipstick occult blood after on-pump cardiac surgery could serve as an early indicator of high-risk cardiac surgery-associated acute kidney injury (CSA-AKI). This single-center retrospective study included 11,782 adult patients undergoing elective on-pump cardiac surgery (2018–2024), excluding those with preoperative chronic kidney disease (CKD, stage 3–5), positive preoperative urine occult blood, or postoperative microscopic hematuria. The primary outcome was any-stage CSA-AKI within 7 days after surgery. Multivariable logistic regression was used to evaluate the independent association between immediate postoperative urine occult blood and CSA-AKI. The predictive value was assessed by C-index, the net reclassification improvement index, and integrated discrimination improvement. The goodness-of-fit of models was evaluated through Akaike information criterion, Bayesian information criterion and likelihood ratio test. CSA-AKI occurred in 32.8

Red blood cell distribution width (RDW) is a marker that routinely describes circulating erythrocytes variability and may hold potential prognostic value in cardiac surgery. Our objective is to evaluate the association between peak values of RDW and in-hospital mortality among patients receiving post-cardiotomy veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support. This single-center, retrospective study included adult patients receiving post-cardiotomy V-A ECMO support between January 2017 and December 2024. The association between peak values of RDW and in-hospital mortality was assessed by multivariable logistic regression model. Spearman correlation analysis was used to determine the correlations between related laboratory factors and peak values of RDW. A total of 106 patients were included and in-hospital mortality rate was 54.7