Standardizing the emergency assessment and management process for patients with implantable continuous-flow left ventricular assist device (LVAD) in emergency and intensive care settings is of great significance for reducing delays in diagnosis and treatment, lowering the mortality associated with LVAD-related emergencies, and improving overall prognosis and long-term survival. To this end, a multidisciplinary expert committee was convened to develop this consensus, integrating international evidence-based findings with clinical practice experience in China, with an emphasis on highlighting the characteristics of domestically manufactured devices. The aim is to establish an actionable standardized emergency management protocol to enhance clinical identification and response efficiency, reduce the risk of LVAD-related emergencies, and improve patient outcomes. Using a modified Delphi method, this consensus proposes a structured decision-making pathway that integrates an "ABC" rapid assessment with parallel device troubleshooting, prioritizing the use of point-of-care echocardiography for hemodynamic evaluation and complication assessment. Key emergency scenarios covered include low-flow alarms, pump thrombosis, right heart dysfunction, bleeding and anticoagulation imbalance, arrhythmias, and cardiac arrest. This consensus applies to implantable continuous-flow LVADs commonly used in China, including domestically manufactured devices such as Corheart 6, CH-VAD, EVAHEART, and HeartCon, as well as the imported device HeartMate 3.

Objectives:Recently,domestical developed left ventricular assist devices(LVAD)have been frequently introduced into clinical practice.This study aims to report the anesthesia protocol and perioperative outcomes in Chinese patients receiving LVAD implantation surgery.Methods:This retrospective analysis included patients who underwent LVAD implantation at our center from June 2017 to November 2024.During and after separation from cardiopulmonary bypass,we optimized right heart function through careful adjustments in heart rate,rhythm,preload,myocardial contractility,and afterload.Vasoactive agents were administered as needed,and mechanical ventilation parameters were optimized.We implemented blood conservation strategies and established strict transfusion criteria to minimize allogenic blood transfusions.Results:A total of 100 patients were included in the analysis,with 54.0%classified as Interagency Registry for Mechanically Assisted Circulatory Support(INTERMACS)I or II.Before leaving the operating room,the mean arterial pressure(MAP),mean pulmonary arterial pressure(mPAP),central venous pressure(CVP),lactic acid levels,and urinary output after cardiopulmonary bypass were recorded as(74±7)mmHg,(25±7)mmHg,(7±3)mmHg,(2.3±1.9)mmol/L,and(8.2±5.4)ml/(kg·h),respectively.The transfusion rates for red blood cells and fresh frozen plasma were 20.0%and 28.0%.The in-hospital mortality rate was 3.0%,with a low incidence of severe complications including right heart failure(12%).Left ventricular ejection fraction increased from(23.7±4.8)%preoperatively to(25.3±10.5)%prior to discharge.Conclusions:Patients who received LVAD at our center exhibited low rates of postoperative mortality and complications and significant improvement in left heart function before discharge.

Objectives:To evaluate the incidence of neurological complications following left ventricular assist device(LVAD)implantation and to investigate related risk factors.Methods:A retrospective analysis was conducted on 151 patients who underwent LVAD implantation at Fuwai Hospital between June 2017 and September 2024.Clinical characteristics and postoperative survival outcomes were compared between patients with and without neurological complications.Results:Neurological complications occurred in 21 patients(13.9%)postoperatively,15 cases were ischemic strokes,5 cases were symptomatic intracranial hemorrhages or subarachnoid hemorrhages,and 1 case was transient ischemic attack(TIA).The total incidence of neurological complications was 0.08 events per person-year(EPPY),ischemic stroke was 0.06 EPPY and hemorrhagic stroke was 0.02 EPPY.Compared with patients without neurological complications,patients with neurological complications had a higher proportion of preoperative aortic regurgitation and tricuspid regurgitation,lower triglyceride levels,a lower rate of concurrent left atrial appendage resection and a higher rate of concurrent aortic valve replacement surgery.Multivariate cox regression analysis revealed that higher preoperative triglyceride levels(HR=0.21,95%CI:0.08-0.56,P=0.002)were associated with neurological complications.The median follow-up time was 508.0(186.5,931.5)days,12 out of 15 cases of ischemic stroke experienced no long-term sequelae,while 3 patients had varying degrees of residual deficits.All 5 patients with hemorrhagic stroke died,with 2 deaths directly attributed to hemorrhage.Kaplan-Meier survival curve analysis indicated that patients with neurological complications had a significantly lower survival rate(log-rank P=0.005).Conclusions:Neurological complications after LVAD implantation are predominantly ischemic strokes.Although less frequent,hemorrhagic strokes are associated with worse outcomes.Higher preoperative triglyceride levels is associated with neurological complications.

Objectives:Recently,domestical developed left ventricular assist devices(LVAD)have been frequently introduced into clinical practice.This study aims to report the anesthesia protocol and perioperative outcomes in Chinese patients receiving LVAD implantation surgery.Methods:This retrospective analysis included patients who underwent LVAD implantation at our center from June 2017 to November 2024.During and after separation from cardiopulmonary bypass,we optimized right heart function through careful adjustments in heart rate,rhythm,preload,myocardial contractility,and afterload.Vasoactive agents were administered as needed,and mechanical ventilation parameters were optimized.We implemented blood conservation strategies and established strict transfusion criteria to minimize allogenic blood transfusions.Results:A total of 100 patients were included in the analysis,with 54.0%classified as Interagency Registry for Mechanically Assisted Circulatory Support(INTERMACS)I or II.Before leaving the operating room,the mean arterial pressure(MAP),mean pulmonary arterial pressure(mPAP),central venous pressure(CVP),lactic acid levels,and urinary output after cardiopulmonary bypass were recorded as(74±7)mmHg,(25±7)mmHg,(7±3)mmHg,(2.3±1.9)mmol/L,and(8.2±5.4)ml/(kg·h),respectively.The transfusion rates for red blood cells and fresh frozen plasma were 20.0%and 28.0%.The in-hospital mortality rate was 3.0%,with a low incidence of severe complications including right heart failure(12%).Left ventricular ejection fraction increased from(23.7±4.8)%preoperatively to(25.3±10.5)%prior to discharge.Conclusions:Patients who received LVAD at our center exhibited low rates of postoperative mortality and complications and significant improvement in left heart function before discharge.

Objectives:To evaluate the incidence of neurological complications following left ventricular assist device(LVAD)implantation and to investigate related risk factors.Methods:A retrospective analysis was conducted on 151 patients who underwent LVAD implantation at Fuwai Hospital between June 2017 and September 2024.Clinical characteristics and postoperative survival outcomes were compared between patients with and without neurological complications.Results:Neurological complications occurred in 21 patients(13.9%)postoperatively,15 cases were ischemic strokes,5 cases were symptomatic intracranial hemorrhages or subarachnoid hemorrhages,and 1 case was transient ischemic attack(TIA).The total incidence of neurological complications was 0.08 events per person-year(EPPY),ischemic stroke was 0.06 EPPY and hemorrhagic stroke was 0.02 EPPY.Compared with patients without neurological complications,patients with neurological complications had a higher proportion of preoperative aortic regurgitation and tricuspid regurgitation,lower triglyceride levels,a lower rate of concurrent left atrial appendage resection and a higher rate of concurrent aortic valve replacement surgery.Multivariate cox regression analysis revealed that higher preoperative triglyceride levels(HR=0.21,95%CI:0.08-0.56,P=0.002)were associated with neurological complications.The median follow-up time was 508.0(186.5,931.5)days,12 out of 15 cases of ischemic stroke experienced no long-term sequelae,while 3 patients had varying degrees of residual deficits.All 5 patients with hemorrhagic stroke died,with 2 deaths directly attributed to hemorrhage.Kaplan-Meier survival curve analysis indicated that patients with neurological complications had a significantly lower survival rate(log-rank P=0.005).Conclusions:Neurological complications after LVAD implantation are predominantly ischemic strokes.Although less frequent,hemorrhagic strokes are associated with worse outcomes.Higher preoperative triglyceride levels is associated with neurological complications.

ObjectiveTo provide a basis for human enteroviruses prevention and control by monitoring the enterovirus （EV） and its main virus types. MethodsSamples of hand-foot-and-mouth disease， herpetic angina and fever clinic patients in Dapeng New District of Shenzhen from 2016 to 2022 were tested for EV with real-time polymerase chain reaction （PCR）. To identify the isolates of EV， VP1 genes of EV were amplified with nested reverse transcription PCR， and then sequenced.A geneticphylogenetic tree was constructed based on the VP1 gene. ResultsAmong the 1 124 suspected hand-foot-and-mouth disease cases， 740 （65.84%） tested EV positive. Coxsackievirus A6 （CVA6） and Coxsackievirus A16 （CVA16） were the main two serotypes with regular cycle trends. Of the 137 suspected herpetic angina cases， 88 （64.23%） were EV positive， with Coxsackievirus A4 （CVA4） and CVA16 as the dominant serotypes. Among 428 respiratory infection specimens， 71 （16.59%） were EV positive. Coxsackievirus A4 （CVA4） was the predominant serotype which caused herpetic angina and respiratory infection. The epidemic EV isolates CVA6 from Shenzhen had a close genetic relationship with isolates in China’s mainland. ConclusionThe main serotypes EV CVA6 and CVA16 which caused hand-foot-and-mouth disease exhibit cyclical trends . The risk of EV transmitted from abroad is low， but their genetic variation and virulence change should be monitored continuously. In addition， the monitoring of dominant isolates CVA4 which cause herpetic angina and respiratory infection should be strengthened.

The left ventricular assist device(LVAD)is an effective treatment modality for patients with advanced heart failure and has been gradually promoted in China in recent years.This expert consensus summarizes the latest understanding and diagnostic and treatment standards for intensive care management of patients with LVAD during the early post-implantation period,including handover upon admission to the intensive care unit(ICU),ICU evaluation,ventricular assist device related parameters and issues,pump speed regulation,hemodynamic monitoring and treatment,mechanical ventilation management,coagulation management,anti-infective prevention and treatment,arrhythmia and right heart failure management aiming to guide standardized ICU management after LVAD implantation,reduce early postoperative mortality and incidence of complications,and improve long-term prognosis.

ObjectiveTo determine the pathogenic characteristics and genotype of two outbreaks of herpangina in children in Dapeng New District， Shenzhen， in May 2021. MethodsA total of five throat swabs from children in the two outbreaks of herpangina were collected and examined for common enteroviruses by real-time PCR. The VP1 region was further amplified by nested RT-PCR. The CLUSTAL W program in MEGA7 software was used to conduct the alignment and reconstruct a phylogenetic tree. ResultsThe pathogen causing the 2 cluster outbreaks of herpangina was coxsackievirus A4 （CVA4）. The sequences of CVA4 VP1 genes revealed that a nucleotide identity of 92% between the strains in the two outbreaks. The three CVA4 strains isolated in kindergarten A had the closest phylogenetic relationship with that isolated in Shenzhen in 2018（MN840533）， with the nucleotide identity of 98.11%. The two strains in kindergarten B had the closest phylogenetic relationship with CVA4 strain isolated in Sichuan in 2018（MW178763）， with the nucleotide identity of 97.88%. The phylogenetic tree showed that all five CVA4 strains in this study belonged to the C2 genotype. ConclusionThe C2 genotype of CVA4 is the causative agent in both outbreaks of herpangina.

Objective     To analyze the results of intra-aortic balloon pump (IABP) support in patients receiving coronary artery bypass graft (CABG) and the risk factors of postoperative death. Methods     The clinical data of 334 patients undergoing CABG procedure and receiving IABP support in Fuwai Hospital from January 1999 to April 2012 were retrospectively analyzed. According to the IABP insertion timing, the patients were divided into three groups: pre-, intra- and postoperative IABP groups. There were 45 males and 11 females aged 60.5±10.7 years in the preoperative IABP group, 84 males and 23 females aged 61.1±8.4 years in the intraoperative IABP group and 119 males and 52 females aged 61.4±8.5 years in the postoperative IABP group. Outcomes of the three groups were compared, including mortality, major complications, ICU stay, hospital stay and total costs. Multivariable logistic regression analysis was used to predict independent risk factors for postoperative in-hospital death. Results     The total in-hospital mortality was 16.8% (56/334). Mortality was significantly different among the pre-, intra- and postoperative IABP groups (3.6% vs. 23.4% vs. 17.0%, P=0.006). There was no significant difference in complications among the three groups (P=0.960). Multivariable logistic regression analysis indicated that independent risk factors for postoperative mortality included old age (OR=1.05, P=0.040), female (OR=3.34, P<0.001) and increasing left ventricular end-diastolic diameter (LVEDD, OR=1.06, P=0.040). Preoperative IABP support was protective factor (OR=0.10, P=0.050). Conclusion     The results of IABP support in CABG   patients are satisfactory, and patients with preoperative IABP have a lower mortality. Risk factors for postoperative death include old age, female and increasing LVEDD. Preoperative IABP support is a protective factor.

Objective: To evaluate short-term effect and risk factors for the timing of intra-aortic balloon pump (IABP) implantation with coronary artery bypass grafting (CABG) in high risk coronary artery disease (CAD) patients. Methods: A total of 197 high risk CAD patients received IABP with CABG in our hospital from 2010-01 to 2015-12 were retrospectively analyzed. There were 91 (46.2%) male and the mean arterial pressure (MAP) was (70.3±8.2) mmHg. Based on IABP implantation time, the patients were divided into 2groups: Pre-operative IABP group,n=89 and Intra- , post-operative IABP group,n=108. Peri-operative condition, durations of mechanical ventilation and ICU stay were compared between 2 groups; survival condition was studied by Kaplan-Meier analysis; risk factors causing 30-day mortality was assessed by Logistic regression analysis and its sensitivity and specialty was measured by ROC curve. Results: The mean durations for aortic clamping and cardiopulmonary bypass were (86.7±37.3) min and (147.3±18.4) min in all 197 patients. The age, gender, blood levels of CK-MB c-TnI, creatinine, MAP and European cardiac surgery system scoring were similar between 2 groups, allP>0.05. Compared with Intra- , post-operative IABP group, Pre-operative IABP group had decreased CK-MB (130.6±25.4) mmol/L vs (149.7±18.2) mmol/L at 48h post-operation and mechanical ventilation time (81.5±10.3) h vs (107.9±11.5) h, less in-hospital stay (21.3±4.1) d vs (27.7±9.4) d, reduced acute kidney injury (3.4% vs 23.1%), brain complication (5.6% vs 19.4%) and 30-day mortality (4.5% vs 36.1%), allP<0.05. Kaplan-Meier analysis indicated that the median survival time was longer in Pre-operative IABP group, (27.9±1.2 vs 16.5±2.2) dP<0.05; Logistic regression analysis and ROC curve demonstrated that IABP re-implantation (OR=2.37, 95% CI 1.42-5.72,P=0.01) was an important risk factor for 30-day mortality with the sensitivity of 75.3% and specialty of 67.4%. Conclusion: Pre-operative IABP implantation was helpful for decreasing post-operative level of CK-MB, reducing mechanical ventilation, in-hospital time and short-term mortality in high risk CAD patients; IABP re-implantation was the risk factor for short-term mortality.