Search Results (1,733)

Background: NT-proBNP is a mechanistically grounded biomarker of ventricular wall stress with established prognostic value in cardiac surgery, but its perioperative role in lung cancer resection remains incompletely characterised. Pulmonary resection imposes unique haemodynamic stressors—including one-lung ventilation-induced right ventricular afterload increase, permanent pulmonary vascular bed reduction, and ischaemia–reperfusion injury—that create a distinct biological context for natriuretic peptide elevation not represented in general surgical cohorts. Methods: A narrative review of the literature was conducted through systematic searches of PubMed, EMBASE/MEDLINE, and the Cochrane Library (January 2000–June 2026), supplemented by manual reference screening. Approximately 135 articles were included in the final synthesis. Results: Perioperative NT-proBNP elevation predicts postoperative atrial fibrillation, major adverse cardiovascular events, and long-term survival after lung resection, with effect sizes substantially exceeding those reported in general surgical populations. The PRESAGE trial established that NT-proBNP-guided prophylaxis reduces postoperative atrial fibrillation from 40% to 6% in high-risk patients. No thoracic surgery-specific NT-proBNP threshold has been prospectively validated in a multicentre setting, and approximately half the evidence base derives from BNP rather than NT-proBNP assays, precluding direct threshold synthesis. Surgical approach—particularly robot-assisted thoracoscopy—modulates postoperative biomarker elevation through OLV duration rather than inflammatory burden alone. The combination of NT-proBNP with high-sensitivity troponin identifies a dual-elevation subgroup with a MACE rate of 18.4%. Conclusions: NT-proBNP measurement is clinically actionable in thoracic surgery but requires assay-standardised, multicentre validation of population-specific thresholds stratified by resection extent and surgical approach. A dual biomarker strategy combining NT-proBNP with high-sensitivity troponin represents the most evidence-based perioperative risk stratification framework currently available. Full article

(1) Background: Type A acute aortic dissection (TAAAD) predominantly affects men, yet conflicting evidence persists regarding sex- and socioeconomic-related differences in outcomes. We evaluated these differences using a large national UK registry. (2) Methods: Patients undergoing TAAAD repair between 1996 and 2019 were identified from the National Adult Cardiac Surgery Audit (NACSA) and stratified by sex and socioeconomic status. In-hospital outcomes were compared and inverse probability weighting was applied to adjust for imbalances between groups and estimate the average treatment effect (ATE) of female versus male. (3) Results: A total of 2857 patients underwent TAAAD repair, including 1907 (67%) men and 950 (33%) women. Women were older and had lower BMI, while men more frequently presented with bicuspid aortic valve and aortic root aneurysm. The rates of aortic root replacement and total arch replacement were comparable between sexes, as was the median circulatory arrest time. No significant differences were observed in socioeconomic deprivation indices. In-hospital mortality (18.7% in men vs. 19% in women), cerebrovascular accident (12.5% vs. 12.5%), dialysis (14.5% vs. 14.6%), and length of stay (13 vs. 13 days) were comparable between sexes. After inverse probability weighting, female sex was not independently associated with in-hospital mortality or post-operative complications. (4) Conclusions: In this large UK registry, female sex was not independently associated with worse in-hospital outcomes after TAAAD repair. Full article

Background/Objectives: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery with cardiopulmonary bypass (CPB), increasing morbidity and prolonging hospitalization. This study aimed to develop and validate an exploratory prediction model that integrates perioperative inflammatory biomarkers with clinical and surgical variables to identify patients at risk of early POAF. Methods: A prospective exploratory cohort of 89 patients undergoing coronary artery bypass grafting (CABG; n = 36), valve surgery (n = 40), or CABG–valve surgery (n = 13) was evaluated. Clinical, surgical, and proinflammatory serum biomarkers (IL-6, IL-8, IL-10, and CRP) were recorded preoperatively (T1) and at 24 h (T2) and 48 h (T3) postoperatively. Multiple-comparison adjustments were made using the Benjamini–Hochberg false discovery rate. Predictor selection was based on bootstrap-derived stability using LASSO-penalized logistic regression, and the final model was estimated using Firth’s bias-reduced logistic regression. Results: POAF incidence was 8.3% in CABG, in contrast to 22.5% and 30.8% in valve and CABG-valve surgeries, respectively. After multiple-comparison corrections, only IL-6 at T2 postoperatively was significantly higher in patients who subsequently developed POAF. Bootstrap-based stability selection retained T2 postoperative IL-10 and magnesium concentrations in the final model, which achieved an apparent AUC of 0.776 and a bootstrap optimism-corrected AUC of 0.728, with acceptable calibration (Brier score = 0.103), negligible multicollinearity (VIF = 1.04), and a negative predictive value of 95.5% at the optimal Youden threshold. Conclusions: Our findings support an exploratory prediction model with moderate discrimination for POAF after cardiac surgery with CPB, providing a methodological foundation for future multicenter validation studies. Full article

Background: Preoperative anaemia and perioperative transfusion are associated with adverse outcomes after cardiac surgery with cardiopulmonary bypass (CPB). Coronavirus disease 2019 (COVID-19) may induce persistent haematological and endothelial alterations. Whether previous infection modifies the relationship between haemoglobin and outcomes is unclear. This study evaluated whether previous COVID-19 infection modified the association between preoperative haemoglobin concentration and perioperative transfusion burden after cardiac surgery with CPB. Early postoperative complications were analysed as predefined secondary outcomes. Methods: This study represents a secondary analysis of a prospective observational cohort of adult patients undergoing elective on-pump cardiac surgery between 1 August 2022 and 30 October 2023. Patients were categorised according to previous COVID-19 infection. Surgery was performed at least seven weeks after infection. The primary outcome was perioperative transfusion burden, defined as the total number of blood products administered from the intraoperative period until hospital discharge. An interaction term between previous COVID-19 and preoperative haemoglobin was included in multivariable linear regression. Results: A total of 280 patients were included, of whom 101 (36.1%) had a previous COVID-19 infection. Preoperative haemoglobin was comparable between patients with and without a previous COVID-19 infection (13.4 [12.4–14.8] vs. 13.8 [12.2–14.6] g/dL; p = 0.472). No significant differences in early postoperative complications, transfusion rates, or transfusion burden were observed according to previous COVID-19 infection. The COVID-19 × haemoglobin interaction was not statistically significant in the adjusted model (B = 0.002, 95% CI −0.081 to 0.085; p = 0.958). Lower preoperative haemoglobin, lower baseline platelet count, longer CPB duration, and CKD were independently associated with greater transfusion burden. In an exploratory multivariable analysis, preoperative anaemia remained associated with postoperative AKI after adjustment for relevant covariates (adjusted OR 5.80, 95% CI 2.23–15.06; p < 0.001). Conclusions: No statistically significant interaction between previous COVID-19 and preoperative haemoglobin was demonstrated for perioperative transfusion burden. Lower preoperative haemoglobin was independently associated with greater transfusion burden, while preoperative anaemia remained associated with postoperative AKI after multivariable adjustment in an exploratory analysis. These findings support systematic preoperative anaemia screening and Patient Blood Management in cardiac surgery. Full article

Background/Objectives: Idiopathic Carpal Tunnel Syndrome (CTS) can be an early manifestation of systemic amyloidosis, particularly transthyretin cardiac amyloidosis (ATTR-CA). The primary purpose of this retrospective case series was to describe the presence of amyloid deposits in tenosynovial tissue and explore potential cardiac involvement in patients undergoing carpal tunnel release surgery. Methods: From a cohort of 54 patients diagnosed with bilateral idiopathic CTS with surgical indication, 12 patients were selected for tenosynovial tissue samples, which were subsequently evaluated using Congo red staining and proteomic confirmation via mass spectrometry. Before the procedure, patients underwent a clinical assessment of medical history, electrocardiogram, and cardiac scintigraphy with Technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD). Transthoracic echocardiogram and cardiac magnetic resonance were subsequently performed in all patients with positive scintigraphy, while a subset of scintigraphy-negative patients underwent an echocardiogram. Results: Congo red staining identified amyloid deposits in 3 of the 12 patients (25%). Proteomic analysis confirmed ATTR amyloidosis deposits in 2 of these patients (17%). One of these 2 patients presented Perugini grade 3 uptake on cardiac scintigraphy, suspicious for ATTR-CA. Complete concordance across histology, proteomics, and cardiac imaging was observed in only 1 patient (8.3%). Three discordances were noted: one case of tenosynovial ATTR without evident cardiac disease, one patient with a discordant Congo red result likely reflecting low amyloid burden or tissue heterogeneity, and one with imaging findings suspicious for ATTR-CA despite a negative tenosynovial biopsy. Conclusions: Tenosynovial biopsy obtained during CTS surgery can reveal early amyloid deposition, which may precede overt cardiac involvement. The variability observed across findings underscores the need for a multimodal diagnostic approach that integrates histological, proteomic, and imaging data, thereby mitigating the risk of amyloidosis misclassification. Full article

Background: Effective opioid-sparing analgesia after median sternotomy remains an unmet need in cardiac surgery. We evaluated whether bilateral intercostal cryoanalgesia, added to standard multimodal analgesia, was associated with postoperative pain, opioid consumption, recovery and early hospital-resource use after isolated coronary artery bypass grafting (CABG). Methods: This single-centre, non-randomised comparative service evaluation included 60 patients undergoing isolated CABG through median sternotomy between 1 November 2025 and 30 May 2026 (30 cryoanalgesia; 30 standard care). The prespecified primary endpoint was cumulative movement-evoked pain burden, quantified as the area under the curve (AUC) for scores recorded on postoperative days 1–3. Secondary endpoints included rest-pain AUC, opioid consumption expressed as oral morphine equivalents (OME), time to first bowel opening, postoperative length of stay and an exploratory break-even calculation. Results: Cryoanalgesia was associated with lower movement-pain AUC (adjusted mean difference −3.56 score-days, 95% confidence interval [CI] −4.62 to −2.50; p < 0.001) and rest-pain AUC (−3.16 score-days, 95% CI −4.19 to −2.14; p < 0.001). Total observed opioid consumption was lower by 112.9 mg OME (95% CI −192.8 to −33.1; p = 0.006), length of stay by 1.32 days (95% CI −1.93 to −0.71; p < 0.001), and time to first bowel opening by 0.49 days (95% CI −0.92 to −0.06; p = 0.027). Conclusions: In this small non-randomised evaluation, bilateral intercostal cryoanalgesia was associated with lower early pain and opioid exposure and faster recovery. Selection, temporal and residual confounding preclude causal or cost-effectiveness conclusions. Prospective randomised evaluation with fixed observation periods and longer-term safety follow-up is required. Full article

Introduction: Cardiac rehabilitation (CR) is an evidence-based secondary prevention strategy that improves functional capacity, quality of life, and cardiovascular outcomes. However, adherence to CR programs remains suboptimal, limiting their effectiveness. Methods: A retrospective multicenter cohort study was conducted among patients enrolled in outpatient CR programs at two specialized cardiovascular centers. Adherence was defined as attendance at ≥70% of the prescribed sessions (≥25 of 36 sessions). Bivariate analyses were performed to compare adherent and non-adherent participants. Variables with p < 0.20 were included in a multivariable logistic regression model to identify factors independently associated with adherence. Results: A total of 210 participants were included, of whom 77.6% (163/210) were classified as adherent. The median age was 68 years (IQR 60.3–75.0), and 64.3% were men. Most participants (70.5%) completed more than 30 rehabilitation sessions. Adherence rates were highest among patients undergoing surgical myocardial revascularization (80.6%) and valve surgery (76.0%). In multivariable analysis, program duration was the only factor significantly associated with adherence (OR = 4.59; 95% CI: 2.46–8.59; p < 0.001). History of dyslipidemia showed a non-significant trend toward higher adherence (OR = 3.29; 95% CI: 0.91–11.90; p = 0.069). Educational level, left ventricular ejection fraction, and health insurance affiliation were not independently associated with adherence. Conclusions: Adherence to CR was high in this cohort. Longer participation in the program was the only independent predictor of adherence, highlighting the importance of strategies that promote sustained engagement throughout the rehabilitation process. Full article

Introduction: Acute type A aortic dissection (ATAAD) is a rare but potentially catastrophic complication following transcatheter aortic valve implantation (TAVI). Most reported cases occur during or shortly after the procedure and are attributed to procedural aortic injury. Very late presentations occurring years after successful TAVI are exceptionally uncommon, and evidence regarding their optimal management remains limited. Case Presentation: An 86-year-old man presented with acute chest pain four years after transfemoral implantation of a self-expanding Evolut R 29-mm transcatheter heart valve. Transthoracic echocardiography revealed pericardial effusion with signs of impending cardiac tamponade. Computed tomography angiography confirmed Stanford type A acute aortic dissection involving the ascending aorta. Emergency surgical repair was performed through replacement of the ascending aorta and hemiarch using a vascular graft. The previously implanted transcatheter valve was preserved because it remained structurally intact and functionally normal. The postoperative course was uneventful, and the patient was discharged on postoperative day 9 with preserved prosthetic valve function (mean gradient 11 mmHg, peak velocity of 2.1 m/s, EOA 1.8 cm², EF 50%, TAPSE 18 mm and no evidence of paravalvular or intraprosthetic regurgitation). Discussion: To better contextualize this rare presentation, a focused review of the literature on delayed and late ATAAD after TAVI was performed. Only a limited number of cases were identified, highlighting the exceptional rarity of this complication. Reported management strategies included conservative treatment, endovascular interventions, and open surgical repair, with considerable heterogeneity in outcomes. Compared with previously published reports, the present case is notable for the exceptionally long interval between TAVI and dissection onset and for the successful valve-preserving surgical repair. These findings suggest that emergency surgery with preservation of a functioning transcatheter valve may be a feasible option in carefully selected patients. Conclusions: Very late ATAAD after TAVI is an exceptionally rare but life-threatening condition. This case demonstrates that valve-preserving surgical repair can be successfully performed even in selected octogenarian patients. As the population of long-term TAVI survivors continues to expand, awareness of late aortic complications, prompt diagnosis, and referral to specialized aortic centers remain essential for achieving favorable outcomes. Full article

Cardiac surgery-associated acute kidney injury (CS-AKI) increases short- and long-term mortality, progression to chronic kidney disease (CKD), and healthcare costs. Its pathogenesis is multifactorial—combining renal hypoperfusion, impaired oxygen delivery, hemodilution, inflammation, ischemia–reperfusion injury, and nephrotoxin exposure—so no single intervention confers universal protection. This narrative review appraises fourteen perioperative prevention strategies, grading each by study design, reproducibility, and concordance with contemporary guidelines. The strongest actionable evidence supports the preservation of renal oxygen delivery during cardiopulmonary bypass through goal-directed perfusion, perioperative amino acid infusion, and biomarker-guided Kidney Disease: Improving Global Outcomes (KDIGO) care bundles. Remote ischemic preconditioning, pulsatile flow, minimally invasive extracorporeal circulation, dexmedetomidine, N-acetylcysteine, levosimendan, hemoadsorption with the oXiris membrane, and natriuretic peptides show variable or subgroup-dependent signals limited by heterogeneous trial design and acute kidney injury (AKI) definitions. Prevention of CS-AKI is, therefore, best conceived as a multimodal, patient-centered process integrating preoperative risk stratification, intraoperative oxygen delivery optimization, patient blood management (PBM), and postoperative nephrotoxin avoidance and surveillance. Full article

Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant—yet often underrecognized—cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care. Full article

Background/Objectives: To quantify the adjusted association of obesity with in-hospital outcomes in adult scoliosis hospitalizations involving spine deformity corrective surgery. Methods: A retrospective cohort study was conducted using the National Inpatient Sample (2016–2021), including adult hospitalizations for scoliosis undergoing corrective spine surgery. Obesity was the primary exposure. The primary outcome was a composite of in-hospital complications. Secondary outcomes included individual complications, length of stay, total hospital charges, and discharge disposition. Weighted multivariable regression models adjusted for patient- and hospital-level factors were used. Sensitivity analysis was performed excluding severity adjustment to assess potential overadjustment, as the All Patient Refined Diagnosis Related Group (APR-DRG) severity score may partially reflect in-hospital complications. Results: Among 9323 unweighted hospitalizations (representing a national estimate of 46,610 weighted hospitalizations) included (16.6% obese), obesity was associated with a 22% increase in the odds of total in-hospital complications (Odds Ratio (OR) 1.22; 95% Confidence Interval (CI) 1.04–1.43). Among individual complication categories, obesity was associated with higher odds of renal complications (OR 1.69; 95% CI 1.29–2.21), whereas no significant differences were observed in pulmonary, cardiac, Venous Thromboembolism (VTE), or sepsis complications. Additionally, obesity was associated with increased odds of non-home discharge (OR 1.28; 95% CI 1.12–1.46). In sensitivity analysis, these associations were more pronounced, with additional complication categories reaching statistical significance. Conclusions: Obesity is associated with increased in-hospital morbidity in adult scoliosis surgery, particularly higher odds of renal complications and non-home discharge. These population-level findings help optimize preoperative risk communication and anticipate post-acute discharge resource needs. Full article

There are limited data on the optimal time of renal replacement therapy (RRT) after cardiac surgery, and published results are controversial. In our study, an answer was sought to the question of the correct timing of RRT in diabetic patients with post-cardiac surgery acute kidney injury (AKI). Forty-four adult patients with DM who required postoperative RRT were included in our single-center prospective study. According to the time of onset of RRT, the patients were divided into two groups: those whose RRT was initiated with the early protocol (RRT started before conventional urgent indications developed) or the standard protocol (RRT started after at least one conventional urgent indication developed). The primary endpoint was in-hospital mortality; secondary endpoints were RRT duration, renal recovery, and ICU and hospital length of stay. A total of 54.5% of the 44 participants were female, while the mean age was 65 ± 9. Early RRT protocol was performed on 21(47.7%) and the standard protocol was performed on 23 (52.3%) patients. Twenty-three patients (52.3%) died during follow-up. Patient survival was found to be significantly higher in the group of patients who received the early RRT protocol, based on univariate analysis, binary regression analysis, Cox regression analysis, and log-rank analysis, compared to the standard protocol group (respectively, p < 0.001, p < 0.03, p < 0.01, and p < 0.001). It was found that RRT initiation with an early protocol was advantageous in terms of survival in the post-cardiac surgery AKI group of diabetic patients. We believe that the study results provide guidance on the follow-up of this group of patients. Full article

Objective: Open surgical repair (OSR) remains an important treatment for abdominal aortic aneurysm (AAA), but its invasiveness contributes to substantial perioperative risk. Although Enhanced Recovery After Surgery (ERAS) pathways have improved outcomes across several surgical specialties, evidence supporting their use in open aortic surgery, particularly in Chinese clinical settings, remains limited. We, therefore, evaluated the association between adherence to a locally adapted ERAS pathway and early perioperative outcomes after elective OSR for AAA. Methods: This single-center retrospective cohort study included 182 patients who underwent elective OSR for AAA. Patients who received at least 70% of the 30 ERAS elements were assigned to the ERAS group (n = 93), whereas those who received less than 70% were assigned to the control group (n = 89). A total of 152 patients remained after 1:1 matching of the two groups using propensity score. Quantile regression and logistic regression models were used to evaluate the impact of the ERAS protocol on postoperative length of stay, 30-day mortality, ICU admission rate, hospital cost, major complications, and readmission. Results: After matching, baseline and aneurysm characteristics were generally comparable between groups. The ERAS group demonstrated a significantly reduced risk of major complications (OR = 0.33; 95% CI 0.16–0.71; p = 0.004) and postoperative nausea and vomiting (OR = 0.10; 95% CI 0.01–0.80; p = 0.030). The time to postoperative bowel movement was 1 day earlier in the ERAS group (p < 0.001). The incidence of postoperative cardiac complications was significantly lower in the ERAS group (2.6% vs. 11.8%; p = 0.028). Pulmonary complications were also markedly reduced in the ERAS group (1.3% vs. 19.7%; p < 0.001). The ERAS group was associated with a reduction in postoperative length of hospital stay by 2 days (p < 0.001) and a decrease in hospital cost by 8065 RMB (p < 0.001). Conclusions: Higher adherence to a locally adapted ERAS pathway was associated with fewer major complications, faster bowel recovery, shorter postoperative hospitalization, and lower hospital costs after elective open AAA repair. These findings support prospective multicenter evaluation and further context-specific implementation of ERAS in open aortic surgery. Full article

Background: This study aims to assess the effectiveness and safety of modified parasternal nerve block (MPSB) in providing perioperative analgesia and improving postoperative recovery in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Sixty-five patients scheduled for OPCABG were randomly assigned to either the intervention group (MPSB group), which received a preoperative modified parasternal block, or the control group. The primary outcome measured was intraoperative opioid consumption. Secondary outcomes included levels of inflammatory markers, postoperative pain scores (assessed using the Visual Analog Scale, VAS), incidence of postoperative nausea and vomiting (PONV), total plasma ropivacaine concentration, gastrointestinal recovery parameters, mobilization metrics, intensive care unit (ICU) parameters (mechanical ventilation duration, ICU length of stay, requirement for rescue analgesics), length of hospital stay, incidence of postoperative pulmonary complications (PPCs), and chronic pain. Results: Intraoperative sufentanil consumption was significantly reduced in the MPSB group (130.0 [IQR, 110.0–167.5] μg vs. 280.0 [IQR, 192.5–327.5] μg; p < 0.01). Inflammatory markers were consistently lower in the MPSB group. Pharmacokinetic analysis revealed a mean peak plasma ropivacaine concentration of 0.88 μg/mL, with the maximum individual concentration reaching 1.76 μg/mL at 5 min post-administration. The MPSB group demonstrated superior postoperative outcomes, including lower VAS pain scores, earlier return of gastrointestinal function, reduced duration of mechanical ventilation, decreased rescue analgesic requirements in the ICU, shorter hospital stays, and lower incidence of PPCs. Conclusions: Preoperative modified parasternal block significantly reduced perioperative opioid consumption in cardiac surgery patients. This intervention demonstrated benefits in facilitating rapid postoperative recovery. The conventional ropivacaine dosing regimen was a safe and effective analgesic approach, associated with a low risk of local anesthetic systemic toxicity. Full article

Infective endocarditis (IE) continues to represent a major challenge for global health systems. In 2019, its annual incidence was estimated at 13.8 cases per 100,000 individuals, contributing to approximately 66,300 deaths worldwide. Due to its high morbidity and mortality rates, enhancing preventive measures has become a priority in both clinical practice and ongoing research efforts. Since the publication of the 2015 ESC Guidelines for the management of IE, several pivotal studies have emerged, prompting a re-evaluation and potential update of the existing recommendations. One growing concern is the increasing antibiotic resistance among oral streptococci, particularly to macrolides such as azithromycin and clarithromycin, which now show higher resistance levels than penicillin. Changes in national antibiotic stewardship programs may have inadvertently contributed to a rise in IE incidence, in part due to altered prophylactic practices. At the same time, advances in diagnostic modalities—including more widespread and targeted use of echocardiography in patients with positive blood cultures for organisms like Enterococcus faecalis, Staphylococcus aureus, and various streptococci—have likely improved detection rates. Additionally, innovations in imaging, particularly computed tomography (CT) and nuclear medicine techniques, have enhanced the diagnosis of IE, especially among patients with prosthetic heart valves or implantable cardiac devices. This has allowed for better characterization of patient populations, aiding in the refinement of diagnostic criteria and therapeutic approaches. Furthermore, updated antibiotic treatment protocols, informed by EUCAST’s antimicrobial susceptibility data, have helped tailor antimicrobial regimens to current resistance trends. The combination of improved diagnostic sensitivity and evolving microbial resistance patterns has also led to an increased number of patients being considered for cardiac surgery as part of their treatment pathway. This review seeks to synthesize the latest findings and guideline revisions, offering an integrated overview of recent progress in the diagnosis, medical treatment, and surgical management of infective endocarditis. It will also explore current therapeutic strategies and operative indications in light of the most recent evidence. Full article