OBJECTIVE: To evaluate the association between postoperative acute kidney injury (AKI) and outcomes in adults undergoing cardiovascular surgery who required a prolonged intensive care unit (ICU) stay.
METHODS: We conducted a retrospective cohort study of consecutive cardiovascular surgery patients with ICU stay ≥ 72 hours. AKI was defined and staged using creatinine-based Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcome was in-hospital mortality. Secondary outcomes were time to extubation, ICU days until ward transfer, and perioperative transfusion exposure (red blood cells/fresh frozen plasma/platelet/apheresis); initiation of renal replacement therapy was assessed exploratorily. Multivariable logistic regression examined the association between AKI and mortality, adjusting for age, sex, baseline renal function/chronic kidney disease (estimated glomerular filtration rate category), hypertension, diabetes, chronic obstructive pulmonary disease, ejection fraction (or Age Creatinine Ejection Fraction score), procedure type (coronary artery bypass grafting/valve/combined), cardiopulmonary bypass and cross-clamping times, transfusions, and post-cardiopulmonary bypass vasoactive/inotropic use where available.
RESULTS: AKI was frequent after cardiovascular surgery and was independently associated with higher in-hospital mortality in adjusted analyses. Patients with AKI also had longer time to extubation, greater transfusion requirements, and prolonged ICU stay, with a stepwise worsening across KDIGO stages. Findings were consistent in sensitivity analyses. Incomplete urine-output data were acknowledged as a limitation, as oliguria forms part of KDIGO definitions.
CONCLUSION: Among cardiovascular surgery patients with prolonged ICU stay, postoperative AKI is a strong predictor of in-hospital mortality and adverse resource-related outcomes. Emphasis on prevention, early detection, and optimized perioperative management may improve prognosis in this high-risk population.

INTRODUCTION: This study explored the function and molecular mechanism of long non-coding ribonucleic acid taurine up-regulated gene 1 (TUG1) in children with ventricular septal defect (VSD).
METHODS: To establish an in vivo VSD model, 10 pregnant mice were administered valproic acid via intraperitoneal injection (VSD group, n = 10). Another 10 pregnant mice were used as the control group and administered 0.9% sodium chloride solution via intraperitoneal injection. Subsequently, the cardiac function and cardiac tissue histopathological characteristics in both groups were evaluated. TUG1, miR-222-3p, and hypoxia-inducible factor 1-alpha subunit inhibitor (HIF1AN) expression levels in cardiac tissues were tested. P19 cells were chosen to simulate VSD in vitro model, and the cell progression was tested. P19 cells were induced to differentiate into cardiomyocytes with dimethyl sulfoxide, and test of the shape and beating frequency of cardiomyocytes was conducted. Left ventricular fractional shortening, ejection fraction, and systolic and diastolic thickness of the cardiac anterior wall were significantly reduced in VSD fetal mice. VSD formation, aortic overlay, and dysplasia were observed.
RESULTS: TUG1 and HIF1AN were upregulated, and miR-222-3p was downregulated in VSD mice. Silencing TUG1 or HIF1AN or elevating miR-222-3p facilitated P19 cell progression and differentiation, whereas lowering miR-222-3p did the opposite. TUG1 was a molecular sponge of miR-222-3p, which targeted HIF1AN. Elevating HIF1AN reversed the impacts of silencing TUG1 or elevating miR-222-3p on P19 cells.
CONCLUSIONS: The findings of this study could offer a new insight into the molecular basis of VSD and lay the groundwork for new diagnostic techniques.

INTRODUCTION: Acute Physiologic and Chronic Health Evaluation (APACHE) II is an effective tool to predict outcomes in cardiac surgery recovery. The present study aimed to evaluate the efficacy and compare the performance of the APACHE II and Simplified Acute Physiology Score (SAPS 3) scoring tools as predictive indices of mortality in cardiac surgery patients.
METHODS: This was a retrospective observational study, evaluating patients over 18 years of age who underwent cardiac surgeries between 2020 and 2023. A receiver operating characteristic curve analysis was conducted to evaluate the sensitivity and specificity of the APACHE II and SAPS 3 tools in detecting intensive care unit (ICU) mortality in critically ill patients. Binary logistic regression was performed to assess the odds of mortality between groups (primary outcome) using data on comorbidities.
RESULTS: APACHE II was efficient in predicting mortality in cardiac surgery (sensitivity = 81%; specificity = 75%) as was SAPS 3 (sensitivity = 75%; specificity = 64%). Binary logistic regression revealed that mortality was significantly associated with comorbidities (chronic obstructive pulmonary disease and non-dialysis-dependent chronic kidney disease) and the type of surgery, with a higher risk in emergency procedures compared to elective ones.
CONCLUSION: In conclusion, APACHE II and SAPS 3 proved to be efficient tools for predicting mortality in cardiac surgery patients admitted to the ICU. This study contributes to understanding these tools in a regional context and specifically in cardiac surgeries, as well as assessing other predictors that may be important for identifying risk groups and predicting mortality after cardiac surgeries.

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has become a viable option for patients with severe aortic valve stenosis across a broad range of surgical risk in recent years. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, a novel indicator of malnutrition and inflammation, has been discovered to be inversely linked with prognosis in several cancer types. The purpose of this study is to examine the performance of the HALP score in predicting one-month major adverse cardiac events and one-year mortality in patients treated with TAVI.
METHODS: This study included 395 consecutive patients treated with TAVI, separated into two groups based on their HALP scores: low and high. Our study's primary endpoint was all-cause death within a year after discharge following the TAVI operation. The secondary endpoint was a composite endpoint that included periprocedural complications and events in one month.
RESULTS: Patients with a low median HALP score had a higher risk of one-month composite events and one-month death. In multivariate analysis, chronic kidney disease (odds ratio [OR]: 4.67, 95% confidence interval [CI]: 2.36 - 9.25, P < 0.001) and HALP score < 3.4 (OR: 1.235, 95% CI: 1.091 - 1.397, P < 0.001) were independent predictors of first-year mortality. Kaplan-Meier analysis for computing cumulative survival found that patients with low HALP scores based on a receiver operating characteristic curve cutoff of 3.4 had increased mortality rates throughout short-term follow-up.
CONCLUSION: The HALP score may be a significant independent predictor of short-term prognosis and mortality in patients treated with TAVI, beyond conventional risk-scoring tools for better disease management.

INTRODUCTION: Frailty increases the risk of adverse outcomes after cardiac surgery. However, there is no consensus on how to best assess it.
OBJECTIVE: To verify the prevalence of frailty in patients undergoing elective valve surgery or coronary artery bypass grafting (CABG) and if a more comprehensive assessment of the physical, psychological, and nutritional domains would better discriminate the frailty phenotype and its association with in-hospital mortality.
METHODS: Besides the criteria proposed by Fried, the Mini Nutritional Assessment, gait speed, Duke Activity Status Index, Dutch Exertion Fatigue Scale, and screening for depressive symptoms (Patient Health Questionnaire-9) were used.
RESULTS: Overall, considering Fried's criteria, 43.6% of the patients were frail, and 49.6% were pre-frail. Of those considered frail, 51% were under 60 years old. Fried's frailty phenotype showed no association with postoperative in-hospital mortality. Using additional variables to characterize frailty domains, it was possible to distinguish two groups (clusters) of patients. In cluster 1, 84.8% were frail according to Fried's criteria (vs. 27.4% in cluster 2, P < 0.001), the rate of postoperative infection was higher (24.2% vs. 7.1%, P = 0.022), and in-hospital mortality was significantly higher (27.3% vs. 9.5%, P = 0.020).
CONCLUSION: We observed a considerable proportion of patients with Fried frailty phenotype in patients undergoing CABG or valve surgery, many of them under 60 years old, but those frailty phenotypes were not associated with postoperative hospital outcomes. However, the association of frailty phenotype with higher rates of postoperative in-hospital mortality was evident when additional criteria were used to assess the domains associated with frailty.

INTRODUCTION: Median sternotomy is the gold standard for cardiac surgery but carries a significant risk of wound complications, including sternal dehiscence and wound infections.
OBJECTIVE: This study aimed to compare the early efficacy and complication rates of three distinct steel-wire sternal closure techniques and identify potential risk factors of complications.
METHODS: We conducted a randomized controlled study on patients undergoing cardiac surgery. Patients were randomly allocated into three groups of sternal closure techniques: simple interrupted (Group A), figure-of-eight (Group B), or a modified combined technique (Group C). Baseline characteristics, intraoperative parameters, postoperative recovery outcomes, and sternal wound complications including sternal dehiscence and superficial and deep wound infections were evaluated. Binomial logistic regression was performed to determine independent risk factors for complications.
RESULTS: One hundred sixty-five adult cardiac patients were finally included in the study. All three intervention groups (n = 55) were well-matched regarding baseline characteristics and intraoperative parameters. The incidence of sternal dehiscence (6.1%) and superficial (7.9%) and deep wound infections (3.6%) did not differ significantly among the three wire closure techniques (P > 0.05). However, logistic regression identified numerous factors associated with superficial sternal wound infections including old age, obesity (body mass index > 30), comorbidities, elevated C-reactive protein and HbA1C, prolonged cardiopulmonary bypass time, extended operative time, and longer intensive care unit stay (P < 0.05 for all).
CONCLUSION: The three steel-wire closure techniques demonstrated comparable early postoperative stability and similar rates of sternal wound complications. Technique choice may be based on surgeon preference.