Feroze Mahmood

Background: Oxygen delivery during cardiopulmonary bypass reflects the balance between pump flow, hemoglobin concentration, and arterial oxygenation and is a key determinant of tissue oxygen transport. While inadequate oxygen delivery has been linked to postoperative organ dysfunction, its association with mortality remains unclear. Methods: A retrospective cohort study was conducted including 4,358 adult patients undergoing cardiac surgery with cardiopulmonary bypass at a tertiary center between 2018 and 2024. Time-weighted average indexed oxygen delivery (DO _2i ) was calculated from pump flow, arterial oxygen saturation, hemoglobin concentration, and body surface area. The primary outcome was 30-day mortality. Secondary outcomes included postoperative acute kidney injury (AKI), stroke, and intensive care unit and hospital length of stay. Associations were evaluated using multivariable regression models adjusted for demographic, clinical, and procedural factors. Results: Lower intraoperative DO _2i was associated with higher 30-day mortality. Overall, 75 patients (1.7%) died within 30 days. Each 10-ml · min ⁻¹ · m ⁻² decrease in DO _2i was associated with increased odds of mortality (adjusted odds ratio [OR _adj ], 1.16; 95% CI, 1.09 to 1.23; P < 0.001). The adjusted 30-day mortality was 1.69% (95% CI, 1.32 to 2.05%) at the 25th percentile of DO _2i (226.2 ml · min ⁻¹ · m ⁻² ) compared with 0.74% (95% CI 0.41 to 1.07%) at the 75th percentile (295.6 ml · min ⁻¹ · m ⁻² ). Lower DO _2i was also associated with AKI (OR _adj , 1.05; 95% CI, 1.03 to 1.07; P < 0.001) and with longer intensive care unit (adjusted incidence rate ratio, 1.02; 95% CI, 1.01 to 1.03; P < 0.001) and hospital length of stay (adjusted incidence rate ratio, 1.01; 95% CI, 1.01–1.02; P < 0.001) but not with stroke (OR _adj , 1.00; 95% CI, 0.95 to 1.06; P = 0.877). Conclusions: Patients receiving lower intraoperative DO _2i during cardiopulmonary bypass had a higher risk of postoperative mortality, AKI, and prolonged recovery. These findings support the clinical relevance of oxygen delivery during bypass and provide a rationale for future mechanistic and interventional studies.

Urgent transcatheter edge-to-edge mitral valve repair (TEER) may offer a therapeutic alternative for patients with cardiogenic shock due to severe mitral regurgitation (MR). We reviewed 23 high-risk patients undergoing urgent TEER. Procedural success was 100%, with marked MR reduction and low periprocedural complication rates. Thirty-day and 1-year mortality were 17.4% and 30.4%, respectively. Among survivors with follow-up data, most demonstrated sustained symptomatic improvement. Percutaneous TEER may potentially serve as either definitive therapy or a temporizing intervention for patients in cardiogenic shock with prohibitive surgical risk while preserving the option for subsequent surgical mitral repair after improvement in clinical status.

Double orifice mitral valve is a rare congenital anomaly that is often associated with other congenital cardiac abnormalities. Patients may present with valvular dysfunction or may be asymptomatic and have an incidental diagnosis of double outlet mitral valve. Whether symptoms due to this pathology are present or not it is important to accurately characterize this lesion. Three‐dimensional imaging is a powerful diagnostic modality for diagnosing and characterizing lesions such as this as highlighted in this case image series where we describe how three‐dimensional transesophageal echocardiography was utilized to characterize both complete and incomplete bridge type double orifice mitral valve.

Double orifice mitral valve is a rare congenital anomaly that is often associated with other congenital cardiac abnormalities. Patients may present with valvular dysfunction or may be asymptomatic and have an incidental diagnosis of double outlet mitral valve. Whether symptoms due to this pathology are present or not, it is important to accurately characterize this lesion. 3-dimensional imaging is a powerful diagnostic modality for diagnosing and characterizing lesions such as this as highlighted in this case image series.