Sheng Liu

Background: Invasive aspergillosis (IA) is a severe complication after solid organ transplantation, especially in patients receiving long-term immunosuppressive therapy. Pulmonary artery involvement caused by Aspergillus fumigatus is extremely rare and may mimic pulmonary artery thrombosis or malignancy, resulting in diagnostic challenges. Case Presentation: A 61-year-old male developed fatigue, intermittent fever, cough, and chest discomfort seven months after orthotopic heart transplantation. Computed tomography pulmonary angiography revealed a mass-like filling defect involving the main pulmonary artery and left pulmonary artery, which was initially suspected to represent pulmonary artery thrombosis or tumor. Whole-blood next-generation sequencing identified Aspergillus fumigatus and Streptococcus mitis. The patient was treated with voriconazole, anticoagulation therapy, and adjustment of immunosuppressive therapy. Follow-up imaging demonstrated progressive regression of pulmonary artery lesions and disappearance of pulmonary nodules without evidence of graft rejection. Conclusions: Pulmonary artery aspergillosis should be considered in heart transplant recipients presenting with pulmonary artery-occupying lesions, particularly when imaging findings are atypical. Early pathogen identification combined with appropriate antifungal therapy, individualized immunosuppression adjustment, and careful monitoring may improve clinical outcomes.

In 2018, China implemented a nationally standardized urgency-based heart allocation system, replacing the previous region-based prioritization approach. However, its impact on waitlist dynamics and post-transplant outcomes remains unclear. We retrospectively analyzed heart transplant recipients treated at Fuwai Hospital between 2015 and 2022. The data were obtained from the China Heart Transplant Registry (CHTR). A total of 731 consecutive recipients were stratified into prereform (Era 1) and post-reform (Era 2) cohorts. Era 2 recipients were further classified as urgent or nonurgent. Survival was analyzed using Kaplan–Meier curves and log-rank tests. Multivariable Cox proportional hazards regression identified risk factors for 1-year mortality. After implementation, urgent status transplants increased from 25.7% (2019) to 36.5% (2022), while the waitlist-to-transplant ratio declined from 1.41 to 1.10. Despite COVID-19-related disruptions that peaked waitlist mortality at 15.2% in 2021, urgent recipients had significantly shorter waiting times than nonurgent patients (15 vs. 89 days, P < 0.001). Notably, 1-year survival was similar between eras (92.15% vs. 94.57%, P = 0.181) and urgency groups (93.1% vs. 95.2%, P = 0.324), despite urgent recipients presenting with greater preoperative acuity (71.6% vs. 11.1% IABP dependence), more postoperative complications (74.1% vs. 21.8% IABP support), and longer ICU stays (6 vs. 6 days, P = 0.040). Multivariate analysis identified preoperative dialysis (aHR = 5.67, P = 0.001), elevated bilirubin (aHR = 1.01, P = 0.007), and prolonged cardiopulmonary bypass time (aHR = 1.01/hour, P < 0.001) as predictors of mortality. Our findings provide preliminary evidence that China’s urgency-based allocation system prioritizes critically ill recipients while maintaining comparable 1-year survival. These findings provide initial validation of the policy’s clinical effectiveness in balancing equity and survival benefits. However, larger and more comprehensive datasets are needed for further confirmation.

Objectives: Early prediction is crucial for cardiac surgery-associated acute kidney injury (CSA-AKI). We aimed to develop and validate a simple, clinical- and laboratory-based risk score system for better CSA-AKI prediction. Methods: We developed a new pre-operative risk score system for moderate-to-severe CSA-AKI in a 10-year cohort of patients undergoing coronary artery bypass grafting at one tertiary centre. Most predictive laboratory and clinical variables were identified and constituted a simple and a full model. External testing was performed in patients at another centre. The risk score system was compared with 2 established clinical models. Results: The overall cohort comprised 27 534, 6403, and 1733 patients with moderate-to-severe CSA-AKI rates of 3.3%, 2.8%, and 8.4% for training, validation, and external testing, respectively. A simple 6-variable AB2C-S2 score (Age, Biomarkers of N-terminal pro-B-type natriuretic peptide and haemoglobin, Clinical history of preoperative critical state, Surgical factors of isolated surgery and on-pump surgery) and a full 9-variable AB2C2-S4 score (AB2C-S2 score plus hypertension, urgent surgery, and previous surgery) were developed. The simple model achieved similar performance as the full model in validation (area under the receiver-operating characteristic curve [AUC] 0.78 vs 0.79, P = .37) and external testing (AUC 0.74 vs 0.75, P = .17), and both significantly outperformed than 2 established clinical models: Cleveland Clinic model (validation: AUC 0.71, external testing: AUC 0.65, all P < .001) and Ng model (validation: AUC 0.64, external testing: AUC 0.65, all P < .001). Conclusions: A simple preoperative risk score system for moderate-to-severe CSA-AKI was developed and outperformed established complex clinical models.

Background and Aims: While surgical left atrial appendage occlusion (SLAAO) reduces stroke in atrial fibrillation (AF) patients, its efficacy in patients without pre-operative AF but with CHA₂DS₂-VASc ≥2 remains uncertain despite their high post-operative AF risk (15–54%). The aim of this study was to evaluate whether prophylactic SLAAO reduces post-operative thrombo-embolic events in valvular surgery patients. Methods: The OPINION was a multicentre, open-label, randomized, superiority trial conducted at three cardiac surgery centres in China. Eligible non-AF patients with CHA₂DS₂-VASc ≥2 and an indication for valve repair or replacement due to mitral or aortic valve lesions were randomly assigned (1:1) to undergo SLAAO (intervention arm) or not undergo SLAAO (control arm) during surgery. The primary outcome was a composite of ischaemic stroke, transient ischaemic attack (TIA), or cardiovascular mortality assessed at 1 year. The primary analysis was done in the intention-to-treat population. Results: Between April 2021 and June 2024, a total of 2157 patients were enrolled and randomized. After exclusion of 39 patients who withdrew informed consent, 2118 participants were included in the intention-to-treat population (1062 in the SLAAO group and 1056 in the control group). Baseline characteristics were well-balanced between the SLAAO group and control group (mean age 55.5 [11.4] vs 55.6 [11.5] years, P = .65; female 32.9% vs 32.3%, P = .78; CHA2DS2-VASc score 2.88 [0.98] vs 2.87 [0.96], P = .83; median EuroSCORE II 1.58% [1.42%] vs 1.56% [1.28%], P = .74). The 1-year primary endpoint occurred in 73 (6.9%) patients in the SLAAO group and in 87 (8.2%) patients in the control group (hazard ratio 0.83; 95% confidence interval 0.61–1.14; P = .25). Conclusions: For valvular surgery patients with CHA₂DS₂-VASc scores ≥2 but no pre-operative AF, routine prophylactic left atrial appendage closure did not significantly reduce the incidence of the primary composite endpoint (ischaemic stroke, TIA, and cardiovascular mortality) at 1-year follow-up. Trial Registration: ChiCTR.org registry ChiCTR2100042238

Background: Postoperative atrial fibrillation (POAF) commonly occurs following surgical repair of degenerative mitral regurgitation (DMR) and is associated with unfavorable outcomes. This study aimed to identify preoperative risk factors for acute POAF in patients undergoing mitral valve repair for DMR, with a specific focus on the role of preoperative echocardiography. Methods: A retrospective study was conducted involving 1127 DMR patients who underwent mitral valve repair between 2017 and 2022. The primary endpoint was the occurrence of acute POAF within 30 days after surgery. Univariate and multivariate logistic regression analyses were performed to identify risk factors for POAF. Additionally, subgroup analyses were conducted to evaluate the predictive value of preoperative parameters for the development of acute POAF. Results: Acute POAF was observed in 152 patients (13.5%). After adjusting for covariates, multivariate analysis revealed that age (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.03–1.07, p < 0.001), hypertension (OR 1.50; 95% CI 1.03–2.21, p = 0.037), left ventricular ejection fraction (OR 0.95; 95% CI 0.92–0.98, p = 0.004), and left atrial enlargement (OR 1.03; 95% CI 1.00–1.06, p = 0.019) were independent predictors of acute POAF. The interventricular septum (IVS) thickness demonstrated a strong association with acute POAF (OR 1.21; 95% CI 1.06–1.38, p = 0.005). The optimal cut-off value for the IVS thickness in predicting acute POAF was 11.0 mm. The adjusted OR of association between an IVS thickness >11 mm and acute POAF was 1.73 (95% CI 1.03–2.89, p = 0.037). The IVS thickness was consistently identified as a significant predictor of POAF in the subgroup analyses. Conclusions: Preoperative assessment of clinical morbidity and echocardiographic parameters, particularly IVS thickness, can be valuable in identifying high-risk patients for acute POAF and informing targeted strategies for prevention and management.

Heart transplantation (HTx) remains the definitive treatment for patients with end-stage heart disease. Despite the number of HTx performed annually in worldwide continues to increase, complications of HTx still impact the quality of life and long-term prognosis, including rejection, infection, and allograft dysfunction. Endomyocardial biopsy remains the gold standard for monitoring cardiac allograft rejection post-heart transplantation, yet its invasiveness and interobserver error in histologic grading necessitate the development of novel noninvasive biomarkers to elucidate rejection mechanisms and progression. Cardiac allograft vasculopathy, a critical determinant of long-term outcomes, is challenging to detect early via intravascular ultrasound, underscoring the potential of plasma biomarkers for disease surveillance. Omic technologies usually refers to the application of multiple high-throughput screening technologies enabling comprehensive analysis of biological systems at a molecular level. Multi-omics technologies, including genomics(donor-derived cell-free DNA), transcriptomics(microRNAs panels, gene expression profiling), proteomics(cell signaling molecule), and metabolomics(ex situ heart perfusion), have demonstrated significant promise in post-transplant monitoring. These approaches provide personalized risk stratification and mechanical insights into cardiac allograft rejection, primary graft dysfunction, and cardiac allograft vasculopathy. Single–cell omics technologies and machine learning algorithms further resolve cellular heterogeneity and improve predictive modeling, thereby enhancing the clinical translatability of multi-omics data. This comprehensive review synthesizes these advances and highlights the transformative potential of integrating multi-omics with advanced analytics to achieve precision monitoring and therapy in HTx, ultimately improving long-term patient outcomes.

Background: Ventricular septal rupture (VSR) is a life-threatening complication of myocardial infarction. While surgical repair is regarded as the definitive treatment, the optimal approach to revascularization remains uncertain. This study aims to evaluate the effects of infarct-related artery (IRA) revascularization and the completeness of revascularization on long-term survival and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with VSR. Methods: This retrospective study analyzed 132 VSR patients who underwent surgical repair at the Fuwai Hospital from 2004 to 2022. Patients were categorized based on whether they received IRA revascularization. For those with multi-vessel disease (MVD), revascularization was classified as complete or incomplete. The primary outcome was all-cause mortality, with a mean follow-up of 77.8 months (median 71.0 months). The secondary outcome was MACCE. Results: Of the 132 patients, 28 did not undergo IRA revascularization. Kaplan-Meier analysis showed similar all-cause mortality and MACCE rates between patients with and without IRA revascularization. Adjusted Cox regression confirmed no significant association between IRA revascularization and long-term mortality (adjusted hazard ratio [aHR], 0.62; 95% CI: 0.22–1.79) or MACCE (aHR, 1.30; 95% CI: 0.52–3.27). These findings were consistent across both single-vessel and MVD patients. Among the 84 MVD patients, 53 underwent complete revascularization. Patients with complete revascularization had a lower incidence of MACCE (aHR, 0.26; 95% CI: 0.10–0.67) compared to those with incomplete revascularization, although no significant difference in mortality was observed (aHR, 0.57; 95% CI: 0.17–1.85). Conclusions: IRA revascularization does not affect long-term survival or MACCE rates in VSR patients. However, complete revascularization significantly reduces the risk of MACCE in patients with MVD.