30-Second Takeaway
- Mechanical SAVR in patients aged 50–70 showed lower mortality and MACE but more major bleeding than bioprostheses.
- Integrated versus separate CRRT–ECMO configurations had similar filter life, complications, and short-term mortality in ECMO patients.
- Model-informed protamine:heparin dosing around 0.625:1 achieved reliable UFH reversal after CPB in most patients studied.
Week ending February 7, 2026
Contemporary perioperative strategies in cardiothoracic surgery: valves, circuits, recovery pathways, and acute care interfaces
Mechanical valves improve survival versus bioprostheses in SAVR patients aged 50–70, with more bleeding
This Australian propensity-matched SAVR cohort included 706 patients aged 50–70, with 149 mechanical and 149 bioprosthetic valves matched for comparison. Over 3.6 years’ median follow-up, mechanical valves had lower all-cause mortality than bioprostheses (aHR 0.51, 95% CI 0.27–0.98). Mechanical prostheses also reduced MACE (aHR 0.53, 95% CI 0.30–0.95), without differences in cardiovascular mortality, non-fatal MI, stroke, or DAOH. Major bleeding was higher with mechanical valves (aHR 3.40, 95% CI 1.32–8.77), highlighting anticoagulation tradeoffs in this age band.
Integrated versus separate CRRT during ECMO show similar filter life and safety
The multicenter E-CRRT randomized trial assigned 80 ECMO patients requiring CRRT to integrated (n = 40) versus separate (n = 40) CRRT circuits. Median filter lifespan was similar between groups (72 h [IQR 45–96.5] vs. 71 h [IQR 45–84]; p = 0.52). Twenty-eight–day mortality (32.5% vs. 35%; p = 0.81) and serious adverse events, including air embolism, did not differ. Transmembrane pressures and CRRT machine alarm frequencies were comparable between integration and separation strategies.
PK/PD modeling supports a protamine:heparin ratio of 0.625:1 after CPB
This prospective single-center study enrolled 68 adults undergoing CPB to characterize unfractionated heparin reversal with protamine. Patients received a mean 30,250 IU UFH and 200 mg intravenous protamine, with 757 samples measuring anti-Xa activity and ACT. Anti-Xa activity decreased below 0.10 IU ml−1 within 10 minutes of protamine in all patients, indicating rapid, complete reversal. Monte Carlo simulations predicted a P:H ratio of 0.625:1 would achieve complete reversal in 95% of patients based on cumulative UFH dose.
Nurse-led smartphone follow-up after CABG reduces pain and improves hemodynamic stability
This single-blind randomized trial studied 84 elective CABG patients, with 80 completing (40 intervention, 40 control). The intervention combined preoperative multimedia education, in-hospital symptom monitoring and education, and 30-day post-discharge nurse contact and messaging. Intervention patients had lower pain scores in-hospital (3.96 vs. 4.29) and post-discharge (1.45 vs. 2.01), both p < 0.001. Post-discharge blood pressure and heart rate were reduced, with significant group-by-time interactions for pain and hemodynamic indices.
References
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Additional Reads
Optional additional studies from this edition.