Perfusion-Uk最新文献

{"title":"Towards goal-directed perfusion - Part I: Developing physiology-inspired mathematical framework using high-resolution paediatric CPB data.","authors":"Mansour T A Sharabiani, Alireza S Mahani, Richard W Issitt, Yadav Srinivasan, Alex Bottle, Serban Stoica","doi":"10.1177/02676591251375788","DOIUrl":"10.1177/02676591251375788","url":null,"abstract":"<p><p>BackgroundDuring cardiopulmonary bypass (CPB), goal-directed perfusion (GDP) seeks to match oxygen delivery to metabolic demand, but the dynamics of oxygen extraction and intraoperative oxygen demand remain poorly understood, especially in paediatric populations. Existing models rely on limited data and assume, for example, a linear relationship between log oxygen demand and temperature.MethodsWe developed GARIX (Global AutoRegressive Integrated model with eXogenous variables and an equilibrium force) to predict minute-by-minute changes in oxygen extraction ratio (OER) using high-resolution intraoperative data. GARIX combines: (1) an autoregressive term group (ATG) encoding memory of past OER; (2) an exogenous term group (XTG) incorporating recent and planned changes in cardiac index (CI), haemoglobin (Hb), SaO₂, and temperature; and (3) an equilibrium term group (ETG) that aligns oxygen consumption with demand via nonlinear temperature and patient-specific terms (log age, log weight, and interaction). A baseline model (bGARIX) used a linear temperature term and no patient-specific covariates. We trained on 20,443 min from 293 paediatric CPB procedures and evaluated performance through repeated K-fold cross-validation, simulations, and bootstrap confidence intervals.ResultsGARIX reproduced physiologically plausible OER dynamics. Lagged coefficients captured adaptive responses to CI, Hb, SaO₂, and temperature. Equilibrium analysis estimated a Q₁₀ of 2.5 with bGARIX, matching textbook values (2.4-2.7). Likelihood ratio tests confirmed GARIX's improved fit, revealing age- and weight-related heterogeneity and nonlinearity in temperature dependence. Variable importance showed ATG and XTG dominated predictive accuracy, underscoring the role of system dynamics. Simulations indicated slow OER response to CI and Hb and faster adaptation to temperature.ConclusionsGARIX offers an interpretable, physiology-aligned model of oxygenation dynamics in paediatric CPB, enabling estimation of dynamic responses and latent demand. It provides a foundation for clinical insights and future real-time monitoring and intelligent perfusion control.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1004-1017"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large-scale computed tomography study of aortic arch and supra-aortic artery morphology: Variations and potential implications for arterial extracorporeal life support access.","authors":"Jan Coveliers, Paolo Meani, Eliza Huizinga, Karthik Gutta, Giulia Piccirillo, Emanuele Gasparotti, Emanuele Vignali, Marilena Mazzoli, Mariusz Kowalewski, Wouter Huberts, Hamed Moradi, Michele Di Mauro, Robert J Holtackers, Monique de Jong, Sandro Gelsomino, Domenico Paparella, Simona Celi, Dorela Haxhiademi, Erik Körver, Arne Doddema, Michal J Kawczynski, Samuel Heuts, Elham Bidar, Roberto Lorusso","doi":"10.1177/02676591251370074","DOIUrl":"10.1177/02676591251370074","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BackgroundThe anatomy and morphology of the aortic arch and its supra-aortic arteries can vary significantly among individual patients. This variability may have a particular relevance in cardiovascular procedures or interventions, and specifically during the use of mechanical circulatory support. This importance accounts for a specific influence on hemodynamics in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) through an axillary/subclavian artery access. The related hemodynamic effects and interplay with native cardiac blood flow dynamics have been poorly investigated.MethodsTo assess the existing patterns of aortic arch and related supra-aortic artery morphology, thoracic computed tomography (CT) scans of patients undergoing pre-procedural (trans-catheter aortic valve or aortic or other cardiovascular surgery) assessment were investigated. All CT scans clearly showing the thoracic aorta in all its anatomical parts were selected and evaluated in terms of anatomical features (aortic arch type, position of the supra-aortic arteries along the aortic arch or ascending aorta, length and disposition of the ascendent aorta and aortic valve plane, and descending thoracic aorta). Aortic arch morphology was classified according to the Madhwal description,&lt;sup&gt;1&lt;/sup&gt; namely Type I, II, and III based on the exit point of the left subclavian artery along the aortic arch, with Type III configuration with all the three supra-aortic arteries departing leftwards the aortic arch peak, and Type I presenting the left subclavian artery departing from the peak of the aortic arch.ResultsThe CT scans of 1228 patients were analyzed and categorized. Overall, 70% (860 cases) of the aortic arch were Type III, 16.9% (208 cases) Type II, and 8.4% (103 cases) Type I. No difference was found between male and female patients. Type III aortic arch morphology presents a potentially unfavorable relationship due to a retrograde flow from the right axillary or subclavian artery, in case of such a V-A ECMO perfusion access, allegedly towards/against the aortic valve and left ventricular ejection. Type I and II aortic arch morphology showed patterns potentially more favorable from a mechanistic point of view, with an apparent more favorable anatomical disposition for a blood flow mainly directed towards the descending aorta.ConclusionsAortic arch and supra-aortic artery morphology vary markedly among patients. However, in this large patient population, the majority of aortic arch morphology was Type III which has a potentially unfavorable interaction between the native blood flow and V-A ECMO retrograde flow from the right axillary/subclavian artery compared to the left-sided access. Dedicated fluid-dynamic studies investigating the actual right or left axillary artery-generated retrograde flow direction and distribution along the ascending aorta, aortic arch and descending aorta deserves further investigation. Indeed, the interplay of blood flows generated by th","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1055-1064"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal membrane oxygenation in the immediate post-liver transplantation setting: A national inpatient sample analysis.","authors":"Spencer R Goble, Yasmin O Ali, Justin R Parekh, Thomas M Leventhal","doi":"10.1177/02676591251380660","DOIUrl":"10.1177/02676591251380660","url":null,"abstract":"<p><p>IntroductionThere has been limited generalizable assessment of the utilization and outcomes of ECMO in the post-liver transplantation setting.MethodsThis is a retrospective study using the National Inpatient Sample to assess liver transplantation hospitalizations from 2016 to 2021. Patients who were treated with ECMO were compared to those not treated with ECMO. Furthermore, outcomes when ECMO was initiated on the same day of transplantation were compared to outcomes when ECMO was initiated later. In-hospital mortality, renal replacement therapy (RRT), tracheostomy, discharge to home, length of stay and cost were the assessed outcomes.Results45,420 patients were included, 665 (1.5%) of which were treated with ECMO. Mean age of the combined cohort was 55.1 years and 63.1% of patients were male. Mortality was increased in those treated with ECMO (24.1% vs 2.7%, aOR = 11.20, 95% CI: 6.33-19.79, <i>p</i> < .001), as were rates of RRT (31.6% vs 16.5%, <i>p</i> < .001) and tracheostomy (10.5% vs 3.1%, <i>p</i> < .001). Mortality was increased when ECMO was initiated at least one calendar day after transplantation compared to same day cannulation (53.6% vs 16.2%, aOR = 3.52, 95% CI: 1.06-11.68, <i>p</i> = .039).ConclusionsThree-quarters of patients who undergo ECMO after liver transplantation survive to discharge and outcomes appear better in those who are cannulated on the same day of transplantation compared to those cannulated at least 1 day after transplantation.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"966-973"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is missing from fluid balance calculations during ECMO? Water loss from the membrane lung.","authors":"Graeme MacLaren, Sean M Bagshaw","doi":"10.1177/02676591261471711","DOIUrl":"10.1177/02676591261471711","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"801-802"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of acute normovolemic hemodilution and retrograde autologous priming in reducing intraoperative packed red blood cell transfusion needs in coronary artery bypass surgery: A randomized controlled trial.","authors":"Cindy Elfira Boom, Riza Cintyandy, Hery Widodo, Ayudhia Putri, Muhamad Randy Givano, I Made Adi Parmana","doi":"10.1177/02676591251372497","DOIUrl":"10.1177/02676591251372497","url":null,"abstract":"<p><p>BackgroundAcute normovolemic hemodilution (ANH) and retrograde autologous priming (RAP) are blood conservation techniques designed to reduce transfusion requirements.PurposeThis study evaluated the impact of combining ANH and RAP compared to RAP alone on intraoperative packed red blood cell (PRBC) transfusion and postoperative outcomes in coronary artery bypass grafting (CABG) surgery.Research designA single-center randomized controlled trial.Study sample72 patients scheduled for CABG surgery from July 2024 to December 2024 at the National Cardiovascular Center Harapan Kita in Indonesia. Patients were randomly assigned to ANH + RAP group (<i>n</i> = 36) and RAP group (<i>n</i> = 36).Data analysisMultivariate analysis assessed factors influencing final hemoglobin levels and intraoperative PRBC transfusion needs.ResultsThe ANH + RAP group experienced a significant reduction in the transfusion rate (19.4% vs 47.2%, <i>p</i> = 0.024) and the intraoperative allogeneic packed red blood cell units (0.2 ± 0.4 vs 0.5 ± 0.6, <i>p</i> = 0.012). The optimal ANH volume reduces intraoperative allogeneic PRBC transfusion was 380 mL (ROC area 0.862, 95% CI 0.703-1.000, <i>p</i> = 0.003). Single RAP procedure approaches were less effective when compared to the combination procedure for achieving higher final hemoglobin levels (β = -0.824, 95% CI -1.314 to -0.334, <i>p</i> = 0.001) and reducing the likelihood of intraoperative allogeneic PRBC transfusion (OR = 13.370, 95% CI 2.206 to 81.026, <i>p</i> = 0.005). Postoperative outcomes did not differ between groups.ConclusionThe combined use of ANH and RAP significantly reduces intraoperative allogeneic PRBC needs compared to RAP alone without affecting postoperative outcomes.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1033-1041"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful combined liver-kidney transplant with intraoperative VA-ECMO and Impella 5.5 support.","authors":"Mehran Rahimi, Sarah Madira, Takuya Wada, Jessica Lindemann, Shreya Goswami, Mary Sullivan, Kunal D Kotkar, Muhammad F Masood, Marc A Sintek, Justin Vader, Ivan Kangrga, Jennifer Yu, William C Chapman, Amit A Pawale","doi":"10.1177/02676591251372488","DOIUrl":"10.1177/02676591251372488","url":null,"abstract":"<p><p><i>Introduction:</i> Cardiogenic shock during liver transplantation (LT) is a significant challenge, particularly in patients with comorbidities like end-stage renal disease (ESRD). Mechanical circulatory support (MCS), including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to manage refractory shock in these complex cases. <i>Case Report:</i> This case report discusses the management of a 69-year-old patient who developed intraoperative refractory cardiogenic shock while undergoing combined liver-kidney transplantation and was supported with VA-ECMO and Impella 5.5 support. The simultaneous use of VA-ECMO and Impella, or \"ECPELLA,\" helped stabilize the hemodynamics, reverse the shock, enabling a successful KT, and subsequent left ventricular recovery. <i>Conclusion:</i> This case highlights the importance of interdisciplinary collaboration and careful hemodynamic management in complex transplants.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1076-1078"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current state of extracorporeal membrane oxygenation training in pediatric subspecialty fellowships.","authors":"Elizabeth E Zivick, Jamie M Furlong-Dillard, Katherine Doane, Shubhi Kaushik, Matthew P Malone, Andrea M Ontaneda, Allison Steinauer, Arun Saini","doi":"10.1177/02676591261485156","DOIUrl":"10.1177/02676591261485156","url":null,"abstract":"<p><p>IntroductionExtracorporeal Membrane Oxygenation (ECMO) is a highly complex support modality that requires specialized training for successful and optimal management and patient care. Literature regarding ECMO education provided to pediatric subspecialty physicians is limited. We conducted a survey study of pediatric critical care medicine (PCCM), neonatal-perinatal medicine (NPM), and pediatric surgery (PS) fellowship directors with the goal of understanding the extent of ECMO education offered in these training programs.MethodsSurveys were sent via email to 77 PCCM, 110 NPM, and 51 PS directors.ResultsThe overall response rate was 56%, with PCCM fellowship directors being the highest percentage of respondents. Most fellowships provided separate ECMO training in the form of a course, typically lasting ≤2 days and primarily conducted for first-year fellows. Other ECMO educational opportunities included lectures, simulation, and case-based discussions. A majority of the responding fellowship directors in PCCM and PS felt that ECMO management was a core competency of training (96% PCCM, 95% PS). However, a minority reported a formal assessment of ECMO management competency.ConclusionThis study highlights substantial variation in ECMO educational practices and limited competency evaluation across pediatric subspecialty training programs.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261485156"},"PeriodicalIF":1.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of additional myocardial perfusion on renal function after neonatal arch repair.","authors":"Eun Seok Choi, Chun Soo Park, Dong-Hee Kim, Bo Sang Kwon, Tae-Jin Yun","doi":"10.1177/02676591261485069","DOIUrl":"https://doi.org/10.1177/02676591261485069","url":null,"abstract":"<p><p>IntroductionMyocardial protection during neonatal aortic arch repair may influence postoperative cardiac function and subsequent systemic organ perfusion. We investigated whether the addition of myocardial perfusion during arch repair is associated with improved postoperative renal function in neonates.MethodsWe retrospectively analyzed neonates, including premature infants who underwent surgery beyond the neonatal period after reaching an appropriate corrected gestational age, who underwent aortic arch repair with associated simple defects under cardiopulmonary bypass (CPB) between 2008 and 2019. All patients received selective cerebral perfusion, and additional myocardial perfusion was selectively applied. Acute kidney injury (AKI) was defined using the pediatric modified RIFLE criteria. Multivariable analysis and propensity score matching were performed to evaluate the association between perfusion strategy and renal function.ResultsA total of 202 patients (median age 9 days, weight 3.1 kg) were included. Additional myocardial perfusion was used in 96 patients (47.5%). Postoperative AKI occurred in 49 patients (24.3%). In multivariable analysis, prematurity was associated with increased risk of AKI (odds ratio [OR] 2.669; 95% confidence interval [CI] 1.107-6.433; <i>p</i> = 0.029), whereas additional myocardial perfusion was associated with reduced risk (OR 0.397; 95% CI 0.196-0.806; <i>p</i> = 0.011). Longer CPB time showed a marginal association (<i>p</i> = 0.054). In propensity-matched cohorts, recovery of estimated creatinine clearance was significantly faster in patients receiving additional myocardial perfusion (<i>p</i> < 0.001).ConclusionsAKI is not uncommon after aortic arch repair under CPB in neonates. The use of additional myocardial perfusion was associated with a reduced risk of postoperative AKI and improved recovery of renal function. Prematurity remained an independent risk factor for postoperative AKI.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261485069"},"PeriodicalIF":1.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified cardiopulmonary bypass strategy for severe glucose-6-phosphate dehydrogenase deficiency during coronary artery bypass grafting: A practical perfusion technique.","authors":"Saeed Taiyari","doi":"10.1177/02676591261485088","DOIUrl":"https://doi.org/10.1177/02676591261485088","url":null,"abstract":"<p><p>BackgroundSevere glucose-6-phosphate dehydrogenase (G6PD) deficiency presents unique challenges during cardiopulmonary bypass (CPB) because of increased susceptibility to oxidative injury and haemolysis. Published guidance regarding optimal perfusion management remains limited, particularly in patients with a history of severe haemolytic complications and renal dysfunction.TechniqueA 63-year-old male with severe G6PD deficiency, a previous dialysis-requiring haemolytic crisis, chronic renal impairment and residual hemiparesis following a cerebrovascular accident underwent urgent three-vessel coronary artery bypass grafting. A modified CPB strategy was developed to minimise oxidative stress and mechanical haemolysis. Key components included controlled oxygenation (PaO₂ approximately 10 kPa), alpha-stat management, tepid blood cardioplegia, minimisation of cardiotomy suction and blood-air interface exposure, albumin-enriched priming, continuous haemofiltration, and avoidance of oxidant medications, including methylene blue. Oxygen delivery and haematocrit were maintained to support end-organ perfusion and reduce renal hypoxic stress.ResultsCPB duration was 112 min, with an aortic cross-clamp time of 76 min. No clinically significant intravascular haemolysis or haemoglobinuria occurred. Plasma free haemoglobin, bilirubin and lactate dehydrogenase elevations were modest and transient. A single postoperative haemodialysis session was required, after which renal function improved without the need for ongoing renal replacement therapy. The patient was discharged on postoperative day seven without evidence of delayed haemolysis.ConclusionA carefully modified CPB strategy focused on reducing oxidative stress, preventing haemolysis and protecting renal function may facilitate successful cardiac surgery in selected patients with severe G6PD deficiency. This report provides a practical perfusion approach for managing patients at exceptionally high risk of peri-operative haemolytic complications.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261485088"},"PeriodicalIF":1.3,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral valve repair versus replacement for degenerative mitral regurgitation in patients with poor ejection fraction: A 20-year propensity-score matched analysis of early postoperative outcomes.","authors":"Fadi Ibrahim Al-Zubaidi, Ujjawal Aditya Kumar, Manoraj Navaratnarajah, Maria Pufulete, Gianni Davide Angelini, Hunaid Ahmed Vohra","doi":"10.1177/02676591261479256","DOIUrl":"https://doi.org/10.1177/02676591261479256","url":null,"abstract":"<p><p>ObjectivesTo compare early postoperative outcomes between mitral valve repair (MVr) and replacement (MVR) in patients with degenerative mitral valve disease (DMVD) and poor preoperative left ventricular ejection fraction (LVEF).MethodsA retrospective propensity-score matched analysis of 1,138 patients (612 MVr, 526 MVR) undergoing mitral valve surgery for DMVD with LVEF <30% between 2000-2019 was undertaken using the UK National Adult Cardiac Surgery Audit. The primary outcome was in-hospital mortality; secondary outcomes included stroke, postoperative dialysis, re-exploration for bleeding and length of stay >10 days. Binary logistic regression was conducted to further examine the relationship between procedure and outcomes.ResultsIn unadjusted analyses, MVr demonstrated lower in-hospital mortality (7.2% vs 17.1%, <i>p</i> < 0.001), postoperative dialysis (7.2% vs 14.1%, <i>p</i> < 0.001), and prolonged hospital stay (54.5% vs 67.1%, <i>p</i> < 0.001). After propensity matching, unadjusted outcomes continued to favour MVr for mortality (8.5% vs 13.0%, <i>p</i> = 0.040) and dialysis (8.3% vs 12.8%, <i>p</i> = 0.038). However, multivariable adjustment demonstrated no significant difference in mortality (OR = 0.64, 95% CI 0.39-1.05, p = 0.080) or major morbidity between techniques. Independent predictors of mortality included emergency surgery, concomitant aortic valve surgery, peripheral vascular disease, and redo sternotomy.ConclusionsIn patients with DMVD and severely reduced LVEF, MVr demonstrated comparable early mortality and morbidity to MVR after adjustment. These findings suggest that mitral valve repair is safe and feasible in this higher-risk population when appropriate surgical expertise and careful patient selection are applied. Further investigation with larger cohorts and long-term follow-up is needed to assess durability and functional outcomes.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261479256"},"PeriodicalIF":1.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}