Objective:To explore and model risk factors in patients with major adverse cardiovascular events (MACEs) after acute type A aortic dissection (ATAAD), and to develop and validate a personalized machine learning model to assess risk factors and predict MACEs in these patients.Methods:Clinical data of patients who attended Beijing Anzhen Hospital and underwent surgical treatment for ATAAD from January 2018 to October 2022 were retrospectively analyzed. Using MACEs as the endpoint, 70% of these patients were randomly divided into the training set and the remaining 30% into the validation set. LASSO regression was applied to explore key clinical variables in the training set. The optimal predictive model was selected from nine machine learning algorithms based on area under the curve. And Shapley Additive explanations was used to elucidate the predictive model. Results:Of the 481 patients included in this study, 135 (35.6%) patients experienced an endpoint event. By combining the results of the training and validation sets, when assessing the validity of the single model with the highest predictive accuracy for the outcome, it was shown that the logistic model (0.774, 95% CI: 0.717-0.830) was the most effective in the combined effect and had a high model accuracy (0.743, 95% CI: 0.720-0.766). According to the results of the LASSO, the factors most associated with postoperative MACEs were history of cerebrovascular disease, coronary artery involvement, shock status on admission to the operating room, FDP, PLT, CPB, ascending aortic clamping, and age. Conclusion:In this study, nine machine learning models were developed to predict the occurrence of postoperative MACEs in patients with acute type A aortic dissection. The logistic model performed significantly better compared to other algorithms. Our study successfully predicted postoperative MACES and identified the factors most associated with MACEs.

Objective:To evaluate the correlation between preoperative platelet function and in-hospital mortality in patients with acute Stanford A aortic dissection(ATAAD) undergoing emergency surgery.Methods:ATAAD emergency surgical patients who underwent preoperative thromboelastography(TEG) examination at three cardiovascular disease hospitals from January 2018 to December 2023 were consecutively selected in this study. The patients were divided into two groups according to whether the patient survived to discharge.Results:867 patients were included in this study. The in-hospital mortality was 11.2%(97 cases). Compared with the DG group(97 cases), the age, pericardial effusion volume, lactate concentration, and MA value of patients in the SG group(770 cases) were higher( P<0.001). Factors independently associated with in-hospital mortality were age(>60 years old), coronary hypoperfusion, pericardial effusion volume(>200.00 ml), and MA value(<60.6 mm). There was a correlation between MA value and in-hospital mortality( P=0.012), and the mediating effect between MA value and platelet count was not significant. Conclusion:There is a correlation between preoperative platelet function and in-hospital in ATAAD patients, and improving platelet function may be one of the important ways to improve the clinical prognosis of those patients.

Objective:To explore and model risk factors in patients with major adverse cardiovascular events (MACEs) after acute type A aortic dissection (ATAAD), and to develop and validate a personalized machine learning model to assess risk factors and predict MACEs in these patients.Methods:Clinical data of patients who attended Beijing Anzhen Hospital and underwent surgical treatment for ATAAD from January 2018 to October 2022 were retrospectively analyzed. Using MACEs as the endpoint, 70% of these patients were randomly divided into the training set and the remaining 30% into the validation set. LASSO regression was applied to explore key clinical variables in the training set. The optimal predictive model was selected from nine machine learning algorithms based on area under the curve. And Shapley Additive explanations was used to elucidate the predictive model. Results:Of the 481 patients included in this study, 135 (35.6%) patients experienced an endpoint event. By combining the results of the training and validation sets, when assessing the validity of the single model with the highest predictive accuracy for the outcome, it was shown that the logistic model (0.774, 95% CI: 0.717-0.830) was the most effective in the combined effect and had a high model accuracy (0.743, 95% CI: 0.720-0.766). According to the results of the LASSO, the factors most associated with postoperative MACEs were history of cerebrovascular disease, coronary artery involvement, shock status on admission to the operating room, FDP, PLT, CPB, ascending aortic clamping, and age. Conclusion:In this study, nine machine learning models were developed to predict the occurrence of postoperative MACEs in patients with acute type A aortic dissection. The logistic model performed significantly better compared to other algorithms. Our study successfully predicted postoperative MACES and identified the factors most associated with MACEs.

Objective:To evaluate the correlation between preoperative platelet function and in-hospital mortality in patients with acute Stanford A aortic dissection(ATAAD) undergoing emergency surgery.Methods:ATAAD emergency surgical patients who underwent preoperative thromboelastography(TEG) examination at three cardiovascular disease hospitals from January 2018 to December 2023 were consecutively selected in this study. The patients were divided into two groups according to whether the patient survived to discharge.Results:867 patients were included in this study. The in-hospital mortality was 11.2%(97 cases). Compared with the DG group(97 cases), the age, pericardial effusion volume, lactate concentration, and MA value of patients in the SG group(770 cases) were higher( P<0.001). Factors independently associated with in-hospital mortality were age(>60 years old), coronary hypoperfusion, pericardial effusion volume(>200.00 ml), and MA value(<60.6 mm). There was a correlation between MA value and in-hospital mortality( P=0.012), and the mediating effect between MA value and platelet count was not significant. Conclusion:There is a correlation between preoperative platelet function and in-hospital in ATAAD patients, and improving platelet function may be one of the important ways to improve the clinical prognosis of those patients.

The end of the COVID-19 infection peak in 2022 prompts a backlog of cardiovascular surgical patients to gradually return to the hospital, resulting in a surge in cardiovascular surgeries. However, against the backdrop of the COVID-19 pandemic, the clinical practice of cardiovascular surgery faces many problems. Therefore, organized by Beijing Anzhen Hospital, experts in cardiovascular surgery and related fields have formulated hospital expert experience on perioperative treatment principles of cardiovascular surgery for patients infected with COVID-19. This article summarizes the clinical decision-making of patients requiring cardiovascular surgery after COVID-19 infection, and advises on the corresponding recommendations according to the existing evidence-based medical evidence as well as the actual clinical practice experience of relevant experts. The main content of the article includes special requirements for cardiovascular surgical treatment indications in patients with COVID-19 infection, selection of surgical timing, special requirements of preoperative, intraoperative and postoperative management, etc., which aims to provide COVID-19-infected patients with guidance on rational decision-making when receiving cardiovascular surgery.

Objective:To investigate the current situation of cardiopulmonary bypass(CPB) in China and analyze the causes, to guide the formulation and implementation of technology standard.Methods:The survey task force sent out a nationwide survey to obtain up-to-date information on perfusion practice by ChSECC(Chinese Society of Extracorporeal Circulation). The unit of analysis for the survey was the medical center performs CPB. The survey consisted 48 questions covering four topics of qualifications, including certification and education, policies and practices, device and equipment, techniques used.Results:There were 540 of the 714 centers for an overall response rate of 76%. According to the annual number of CPB, they were divided into 4 groups: group A(≤50 cases/year), group B(50-100 cases/year), group C(100-500 cases/year) and group D(≥500 cases/year). The response rate of center with more than group D last year was 100%. Most of the perfusionists had certification issued by ChSECC. Although there were more than 80% of group D performed regular training and assessment of perfusionist, the result was still not ideal enough. Low utilization of safety equipment was not depend on the annual operation volume in most of responding centers. Ultrafiltration and blood protection technology had high application rate in group D compared with group A and B.Conclusion:The certification rate of perfusionists are high. Lower the number of annual CPB cases, lower the proportion of regular evaluation and training, and lower rate of standards performance. No matter the amount of CPB, the application rate of safety equipment is not ideal. Higher the number of CPB cases, higher the utilization rate of CPB related technologies.

Objective:To identify the risk factors for postoperative acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:The medical records of patients who underwent elective OPCABG from January 1, 2018 to December 31, 2020 from the Heart Center of Henan Provincial People′s Hospital, were retrospectively collected.The patient′s gender, age, body mass index, history of diabetes, history of hypertension, history of hyperlipidemia, history of chronic obstructive pulmonary disease, history of cerebrovascular disease, history of myocardial infarction, New York Heart Association classification of cardiac function, Killip classification, values of last left ventricular ejection fraction measured by transthoracic echocardiography before operation, glycosylated hemoglobin, glucose and serum creatinine, duration of operation, intraoperative fluid intake and output such as red blood cell infusion, crystal fluid, colloid fluid, autologous blood, blood loss and urine volume, intraoperative hypotension, perioperative maximal blood glucose difference (MGD) and serum creatinine concentrations within 48 h and 7 days were recorded.Postoperative AKI was defined according to the Kidney Disease Improving Global Outcomes criteria and the patients were divided into AKI group and non-AKI group according to whether AKI occurred after surgery.Logistic regression analysis was used to identify the risk factors for AKI after OPCABG.Results:A total of 1 203 patients were included in this study, and the incidence of AKI after OPCABG was 28.1%.Logistic regression analysis showed that body mass index, history of hypertension and perioperative MGD were risk factors for AKI after OPCABG ( P<0.05). Conclusion:Body mass index, history of hypertension and perioperative MGD are risk factors for AKI after OPCABG.

Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.

Objective To evaluate the protective value of cardioplegia solution plus metformin in different cardiac arrest time and concentration of metformin in isolated rat hearts .Methods There were 36 male Sprague–Dawley rats divided into six groups randomly, according to the duration of cardioplegic arrest(30 min or 60min) and the concentrations of metformin(50μmol/L or 100 μmol/L) .Langendorff-perfused Sprague-Dawley rat hearts were perfused for 20 minutes with Krebs-Henseleit buffer followed by 30 or 60 minutes of crystalloid cardioplegia or plus metformin (50 or 100 μmol/L) and 60 minutes of reperfu-sion.The left ventricular performance was recorded at 5 time points.The expressions of AMPKαand phosphorylation of AMPKαwere detected by western Blot.The changes of myocardial mitochondria were observed under transmission electron mi-croscope.Results There were no significant differences in Con(A), 50(A) and 100(A) groups in LVDP, ±dp/dtmax and HR.Compared with Con(B) group subjected to 60 minutes of ischemia followed by 60 minutes of reperfusion, the 100(B) group significantly improved myocardial performance , and the ratio of p-AMPKα/AMPKαwas the highest in all 6 groups.The structure of myocardial mitochondria in 100(B) group was better protected than that of Con(B) group.Conclusion These findings suggested that the left ventricular performance was protected in rat heart perfused by cardioplegia plus 100 μmol/L after 60 minutes cardioplegic arrest .The mechanism may be the activation of AMPK and the protection of structures of myocardial mitochondria.

Objective To explore the incidence rate,risk factors and outcome of hyperbilirubinemia in adult cardiac patients supported by extracorporeal membrane oxygenation(ECMO).Methods Clinical data of 89 adult cardiac patients with ECMO in Fuwai Hospital were retrospectively analyzed.All patients were divided into normal group,high bilirubin group and severe high bilirubin group.In a multiple linear regression analysis,logarithmic transformation was performed for non-normally distributed variables.Results The incidence rate of hyperbilirubinemia was 73％,including 30 cases in high bilirubin group and 35 cases in severe high bilirubin group.A multiple linear regression analysis showed that lg(peak TBIL+1)was significantly associated with lg(peak AST+1)(P=0.001),lg(peak free hemoglobin +1)(P=0.003)and TBIL before ECMO(P=0.009).There was also a linear correlation between peak TBIL and TBIL before ECMO support(P=0.011),peak AST(P=0.004)and peak free hemoglobin during ECMO(P<0.001).The patients in severe high bilirubin group had lower platelets during ECMO,and the survival rate was the lowest.Conclusion Hyperbilirubinemia remains common in patients with ECMO,and is associated with low platelet and a high rate of in-hospital mortality.Hemolysis and liver dysfunction during ECMO support and high bilirubin level before ECMO are risk factors of hyperbilirubinemia.