Search Results (215)

Background/Objectives: Adults with single-ventricle physiology (SVP) represent a growing population with complex cardiovascular conditions and an increasing need for noncardiac surgical and interventional procedures. However, perioperative outcomes in this group remain poorly characterized. This study aimed to provide a descriptive characteristic of perioperative management, complications and mortality in adults with SVP undergoing noncardiac surgical and interventional procedures. Methods: We conducted a retrospective cohort study including all adult patients (≥18 years) with SVP who underwent noncardiac surgical and interventional procedures requiring anesthesia or sedation at a tertiary university hospital between 1 January 1995 and 30 November 2023. Demographic data, comorbidities, type of procedure and anesthetic technique were collected. Complications were defined as intraoperative or postoperative adverse events requiring intervention or associated with hemodynamic, respiratory, or cardiovascular instability. Primary outcomes were perioperative complications and all-cause mortality at 24 h, 30 days, and one year, with mortality reported at the patient level. Results: A total of 114 procedures were performed in 67 patients (mean age 32.3 ± 10.8 years). Most procedures were elective (78.9%) and minimally invasive, frequently performed under sedation, with or without local anesthesia (67.5%). Common comorbidities included arrhythmias (46.3%), liver disease (49.3%), and heart failure (17.9%). The overall complication rate was 6.1% (2.6% intraoperative, 3.5% postoperative). Mortality was 1.5% in 24 h, 2.9% in 30 days and 5.9% at one year. Most clinically relevant adverse events occurred in patients with earlier-stage palliation, advanced functional limitation or multiple comorbidities. Conclusions: Perioperative outcomes in adults with SVP undergoing noncardiac surgical and interventional procedures were acceptable when procedures were elective and managed in specialized settings. Risk remains heterogeneous and appears to be influenced by physiological status and stage of palliation. Full article

Background and Objectives: Transcatheter aortic valve implantation (TAVI) is the standard therapy for patients with severe aortic stenosis at intermediate or high surgical risk. Mitral annular calcification (MAC) is frequently observed in this population and has been linked to adverse cardiovascular outcomes. This study evaluated the association between MAC and TAVI-related complications and mortality, and identified predictors of all-cause mortality and permanent pacemaker implantation (PPI) following TAVI. Materials and Methods: Patients undergoing self-expanding TAVI between January 2010 and June 2020 were retrospectively analyzed. Outcomes included TAVI-related complications, in-hospital and long-term mortality, and predictors of all-cause mortality and PPI. Results: A total of 245 patients (98 men [40%], mean age 76.3 ± 8.3 years) were included. Mean left ventricular ejection fraction was 54.8 ± 11.4%, and aortic valve area was 0.74 ± 0.14 cm². MAC was present in 148 patients (60.4%). Pericardial effusion (26.4% vs. 12.4%, p = 0.013) and acute kidney injury (21.6% vs. 7.2%, p = 0.005) were significantly more frequent in patients with MAC. PPI was required in 42 patients (17.8%). In-hospital mortality occurred in 14 patients (5.7%), and all-cause mortality was observed in 89 patients (36.3%) during a median follow-up of 23.1 months (IQR, 11.6–44.3). MAC extension into the left ventricular outflow tract was the only independent predictor of PPI (OR: 3.32, p = 0.002). Independent predictors of all-cause mortality included use of renin–angiotensin–aldosterone system blockers (HR: 0.54, p = 0.012), hemoglobin level (HR: 0.79, p = 0.006), severe MAC (HR: 1.94, p = 0.024), and post-TAVI atrial fibrillation (HR: 2.39, p = 0.002). Conclusions: MAC is common in TAVI patients and is associated with increased procedural complications, including higher rates of pericardial effusion and acute kidney injury. Greater MAC severity independently predicts higher all-cause mortality. In addition, MAC extension into the left ventricular outflow tract is an independent predictor of PPI following self-expanding TAVI, emphasizing the importance of comprehensive pre-procedural imaging. Full article

Background/Objectives: Adult patients supported with extracorporeal membrane oxygenation (ECMO) frequently require invasive diagnostic, therapeutic, surgical, or bedside procedures during ongoing extracorporeal support. These procedures are clinically challenging because ECMO-related anticoagulation, platelet dysfunction, acquired coagulopathy, and circuit-related coagulation activation may increase both bleeding and thrombotic risks. This systematic review evaluated the safety of invasive procedures performed during adult ECMO support, excluding tracheostomy/tracheotomy because this procedure has recently been addressed in a dedicated systematic review. Methods: A systematic search of PubMed/MEDLINE and Scopus was performed. The final bibliographic data collection was completed in April 2026. Studies were eligible if they included adult ECMO or extracorporeal life support patients undergoing invasive procedures during ongoing ECMO support, or with ECMO used as procedural support, and reported at least one procedure-specific safety outcome. Primary outcomes were procedure-related complications, bleeding, major bleeding, and transfusion requirements. Secondary outcomes included thrombotic and circuit-related complications, oxygenator exchange, reintervention, reoperation, procedural failure, ECMO duration, intensive care unit and hospital length of stay, and mortality. Results: The final qualitative synthesis included 46 studies, comprising 26 studies from PubMed/MEDLINE and 20 additional unique studies from Scopus. Included procedures were grouped into six domains: airway, bronchoscopic, and tracheobronchial procedures; thoracic surgery and lung resections; abdominal surgery, gastrointestinal endoscopy, and decompressive laparotomy; lung transplantation and perioperative extracorporeal life support; cardiovascular, vascular, pulmonary embolism-related, and mechanical circulatory support-related procedures; and mixed non-cardiac surgery. Airway and bronchoscopic procedures generally showed high procedural success in selected cohorts, although registry-level tracheal procedure data reported hemorrhagic complications in 26.0% and surgical-site bleeding in 13.0%. Emergency thoracic and abdominal procedures carried the highest bleeding, transfusion, reintervention, and mortality burden. Lung transplantation studies showed that ECMO can be integrated into perioperative pathways, but hemothorax, transfusion, thromboembolism, and anticoagulation strategy remained central safety issues. Conclusions: Invasive procedures during adult ECMO are feasible in selected patients and experienced centers, but procedural safety varies markedly by procedure type, urgency, baseline disease severity, and anticoagulation strategy. A procedure-centered, multidisciplinary approach with individualized anticoagulation management and careful planning is essential. Full article

Background: Penetrating keratoplasty (PK) is a technically demanding corneal transplant procedure frequently performed in elderly patients with substantial systemic comorbidities. In this population, an anesthetic strategy that ensures hemodynamic stability, cooperative sedation, adequate analgesia, and preserved spontaneous ventilation is highly desirable. Dexmedetomidine, a highly selective alpha2-adrenergic agonist, provides “cooperative” sedation with minimal risk of respiratory depression and additional sympatholytic benefits. Methods: This single-center retrospective observational case series included 50 consecutive patients (American Society of Anesthesiologists [ASA] II–III, age 50–90 years) undergoing PK under sub-Tenon block combined with continuous dexmedetomidine infusion. Dexmedetomidine was administered without a loading bolus at 0.7 mcg/kg/h for 10–15 min, then reduced to 0.5 mcg/kg/h, targeting a Ramsay Sedation Scale (RSS) score of 2–3. The sub-Tenon block was performed using a mixture of levobupivacaine 0.5% and lidocaine 2% (3–5 mL). Heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO₂) and RSS were recorded in nine predefined perioperative phases. Data were analyzed descriptively. Results: The mean age was 72 ± 9 years; 52% of patients were ASA III. Hypertension was present in all patients; 30% had cardiovascular disease, 28% diabetes mellitus type II, and 30% chronic obstructive pulmonary disease. Progressive, controlled bradycardia was observed (mean HR decreased from 76 to 57 beats/min during graft transplantation), while MAP gradually decreased from hypertensive baseline values (150–160 mmHg) to an optimal intraoperative range of 115–130 mmHg, without episodes of clinically significant hypotension. SpO₂ remained stable at 98–99% throughout all phases, with no episodes of desaturation or need for airway intervention or supplemental oxygen. Target sedation (RSS 2–3) was achieved in all patients (median RSS 3), with preserved spontaneous breathing and cooperation. Sub-Tenon block-related bulging occurred in 6% of cases. No episodes of clinically significant bradycardia, malignant arrhythmia, respiratory compromise, or need to discontinue dexmedetomidine were recorded. No opioids or non-steroidal analgesics were required intraoperatively or in the early postoperative period. Conclusions: The combination of sub-Tenon block and continuous dexmedetomidine sedation without a loading bolus represents a hemodynamically stable and respiratory-safe anesthetic strategy for PK in elderly, high-risk patients. These preliminary, hypothesis-generating findings suggest that the protocol provides stable surgical conditions and a favorable safety profile, justifying future prospective randomized controlled trials to establish its comparative efficacy against general anesthesia or standard sedative regimens. Full article

The coexistence of cancer and severe aortic stenosis (AS) is increasing as a result of population aging and substantial improvements in cancer survival. Transcatheter aortic valve implantation (TAVI) has transformed the management of AS; however, patients with active malignancy or a history of cancer remain markedly under-represented in pivotal randomized trials. This under-representation has resulted in persistent uncertainty regarding patient selection, risk stratification, and the expected benefit of TAVI in this growing and clinically heterogeneous population. This review provides a comprehensive and contemporary synthesis of the evidence on TAVI in patients with cancer, integrating cardiovascular (CV), oncologic, and geriatric perspectives. Available data on epidemiological overlap, cancer-specific procedural challenges, and short- and long-term outcomes following TAVI are critically examined, with particular emphasis on distinctions between active cancer and cancer survivorship. Key modifiers of risk and benefit—including prior thoracic radiotherapy, competing thrombotic and bleeding risk, immunosuppression, frailty, sarcopenia, and nutritional status—are discussed in detail. Limitations of conventional surgical risk scores in oncology populations are highlighted, underscoring the need for individualized assessment beyond traditional CV metrics. Across registries and meta-analyses, TAVI is associated with high procedural success and comparable short-term outcomes in patients with and without cancer. Excess mortality observed during mid- and long-term follow-up is driven predominantly by non-CV causes related to malignancy rather than valve-related complications. Importantly, patients with cancer in remission demonstrate outcomes similar to those of non-cancer populations, whereas prognosis in active cancer is strongly influenced by disease stage, biology, and competing risks. Overall, cancer diagnosis alone should not preclude consideration of TAVI. Optimal management requires multidisciplinary, goal-oriented decision-making that integrates oncologic prognosis, functional status, and patients’ priorities. As cancer survivorship continues to expand, prospective studies, integrated risk stratification tools, and closer alignment between cardio-oncology and structural heart programs are essential to guide evidence-based and equitable care. Full article

Aortic aneurysms (AAs), both abdominal and thoracic, remain one of the most lethal cardiovascular diseases, with increasing prevalence and incidence, especially in sporadic forms, in our populations, primarily represented by elderly individuals. The high mortality risk is primarily due to delayed management, although their management has shown progress, particularly regarding imaging techniques that facilitate diagnosis and otherwise complex surgical procedures. This is due to the clinical decision-making approach, which, unfortunately, is still based, according to guidelines, on the maximum aortic diameter. The maximum aortic diameter, as repeatedly emphasized, fails to capture the biological and biomechanical complexity of these pathological conditions, which are influenced, among other things, by highly individual factors (genetics, gender, lifestyle, etc.). Thanks to the advent of network medicine and omics sciences, diverse and complex clinical, imaging, and biomarker datasets are available. Artificial intelligence (AI) could process this data to facilitate the complex management of aneurysms and accurately predict risk. AI could prove an excellent tool for aneurysm management, improving risk prediction and radically transforming the way we understand, monitor, and manage aneurysm patients, despite some limitations, as well as improving its therapeutic applications towards personalized strategies. This narrative review provides an overview of these aspects based on current evidence. Full article

Background/Objectives: Postoperative pneumonia is a common complication in surgical patients. Despite its clinical significance, there is limited evidence regarding its occurrence following intracranial tumor resection, the most common procedure in neurosurgery. The objective of this study is to determine the incidence of postoperative pneumonia, to examine its association with length of hospital stay, and to identify potential risk factors. Methods: A retrospective cohort study was conducted on 1481 patients who underwent intracranial tumor resection in our department over a ten-year period, excluding the influence of anticoagulant or antiplatelet medications. Results: Of the 1481 patients included in this study, postoperative pneumonia occurred in 1.48% of cases. Smoking status (p = 0.014) and prolonged hospital stay (p = 0.011) emerged as significant risk factors in the univariate analysis for postoperative pneumonia in patients undergoing brain tumor resection. In contrast, demographic factors (age, sex, body mass index), pre-existing comorbidities (hypertension, diabetes, cardiovascular disease, chronic inflammatory conditions), and laboratory parameters did not show significant associations with the development of postoperative pulmonary infection. Conclusions: This study identified pre- and postoperative risk factors associated with pneumonia following craniotomy for intracranial tumors. These findings may provide a valuable framework for pre- und postoperative risk assessment and guide strategies to mitigate the occurrence of postoperative pneumonia. Full article

Background: Ambient air pollution is an established cardiovascular risk factor; however, its impact on long-term outcomes after coronary artery bypass grafting (CABG) remains insufficiently defined. We aimed to evaluate whether chronic exposure to air pollutants may influence long-term mortality following surgical revascularization. Methods: In this multicenter retrospective cohort study, 1033 consecutive patients undergoing CABG with BIMA (bilateral internal mammary arteries) grafting were analyzed with a median follow-up of 8.1 years. Individual exposure to nitrogen dioxide (NO₂), particulate matter ≤10 μm (PM₁₀), and ≤2.5 μm (PM_2.5) was estimated based on residential data. Multivariable Cox proportional hazards models were used to assess associations with long-term mortality. Model performance was evaluated using receiver operating characteristic (ROC) analysis, while incremental prognostic value was quantified using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Kaplan–Meier analyses were performed using data-driven thresholds and model-based risk stratification. Results: During follow-up, 220 deaths (21.1%) occurred. In multivariable analysis, both NO₂ and PM₁₀ were associated with increased mortality (NO₂: HR 2.70 per 10 μg/m³, 95% CI 2.03–3.59; PM₁₀: HR 2.73 per 10 μg/m³, 95% CI 1.94–3.83; both p < 0.001), whereas PM_2.5 was not significant. The clinical model demonstrated moderate discrimination (AUC 0.73), which improved significantly after inclusion of pollution variables (AUC 0.84; ΔAUC 0.11). Reclassification analysis showed substantial improvement (NRI 0.42, p < 0.001; IDI 0.11, p < 0.001). Kaplan–Meier analysis confirmed enhanced risk stratification, with a hazard ratio of 2.70 for the clinical model and 7.02 for the combined clinical and pollution model (both p < 0.001). Conclusions: In this retrospective cohort of patients undergoing CABG with BIMA grafting, higher long-term residential exposure to NO₂ and PM₁₀ was associated with greater all-cause mortality after adjustment for measured clinical and procedural factors. These findings support further investigation of environmental exposure as a prognostic marker in surgically treated coronary disease, pending external validation and more granular control for contextual confounding. These findings suggest that environmental exposure may represent a relevant component of long-term risk stratification, although confirmation in large-volume cohorts is required. Full article

Background: Cardiovascular disease remains the leading global cause of morbidity and mortality. Mental health disorders are common comorbidities that significantly influence how patients access and navigate specialist care. Increasingly, mental illness is recognized not merely as a comorbidity but as a potential driver of inequities in cardiovascular care, affecting diagnosis, referral, procedural management, and long-term secondary prevention. These concerns are particularly relevant in cardiac surgery, where care pathways are complex and resource-intensive. Aims and Objectives: This narrative review examines recent evidence on inequalities in access to cardiac surgery and postoperative outcomes among patients with mental health disorders. Particular emphasis is placed on severe mental illness, mood disorders, anxiety-related conditions, and mixed psychiatric cohorts. Materials and Methods: A structured narrative review approach was employed. PubMed and ScienceDirect were systematically searched for peer-reviewed studies published between 2020 and 2025, including cohort studies, registry analyses, systematic reviews, and meta-analyses. The evidence was synthesized thematically, focusing on access to care, perioperative management, clinical outcomes, underlying mechanisms, ethical considerations, policy implications, and future research directions. Results: Evidence suggests that patients with mental health disorders are more likely to undergo cardiac surgery via emergency pathways, experience longer hospital stays, and have higher rates of readmission. Individuals with severe mental illness are less likely to receive invasive coronary procedures compared to the general population and exhibit higher short- and long-term mortality following acute coronary syndromes. Among psychiatric subgroups, psychosis-spectrum disorders appear to be associated with the greatest excess risk of morbidity, mortality, and adverse long-term surgical outcomes. Conclusions: Patients with mental health disorders face inequities across the entire surgical pathway, including preoperative, perioperative, and postoperative phases. Key contributing factors include stigma, diagnostic overshadowing, fragmented healthcare systems, socioeconomic disadvantage, and insufficiently developed models of integrated care. Addressing these disparities requires redesigned referral pathways, strengthened multidisciplinary collaboration (including cardiology, cardiac surgery, psychiatry, and primary care), and a shift toward interventional research aimed at reducing inequities rather than solely documenting them. Full article

Background/Objectives: Gastrojejunal–ileal interposition with bipartition and sleeve gastrectomy (GJIB-SG) is a novel metabolic procedure developed to combine functional foregut exclusion with hindgut stimulation while preserving duodenal continuity and endoscopic biliary access. This study evaluated the medium-term glycemic, weight-loss, and nutritional safety outcomes of GJIB-SG in patients with obesity and long-standing type 2 diabetes (T2D). Methods: A retrospective single-center cohort of 30 consecutive patients with obesity and T2D who underwent GJIB-SG between January 2016 and August 2019 and reached at least 60 months of postoperative follow-up was analyzed at baseline and at 12, 24, 36, 48, and 60 months. Longitudinal data were analyzed by repeated-measures ANOVA with Greenhouse–Geisser correction and Bonferroni-adjusted pairwise comparisons. Diabetes remission was classified using the 2021 American Diabetes Association consensus definition (A1C < 6.5%, medication-free). Results: Mean body weight decreased from 102.4 ± 13.6 kg preoperatively to 73.5 ± 7.6 kg at 60 months (p < 0.001; mean %TWL 27.4%, mean %EWL 99.4%). Mean A1C decreased from 9.4 ± 1.6% to 6.0 ± 1.4% at 60 months (p < 0.001). Complete medication-free remission was achieved by 70.0% of patients at 12 months and 44.8% at 60 months; cumulatively, 25 of 30 (83.3%) achieved complete remission at one or more intervals, and 3 patients (10.0%) never achieved A1C < 6.5%. Triglycerides, total cholesterol, and LDL cholesterol decreased by 56%, 39%, and 35%, respectively. No protein–energy malnutrition or hypoalbuminemia occurred; however, a late rise in parathyroid hormone and a return of 25-OH vitamin D toward preoperative insufficient values by 60 months indicate the need for sustained micronutrient surveillance. One cardiovascular death at 24 months was not considered procedure related. Conclusions: In this single-center cohort, GJIB-SG was associated with durable weight loss, sustained glycemic improvement with cumulative complete remission in 83.3% of patients, and absence of severe nutritional complications over 60 months. Prospective comparative studies with longitudinal mixed-effects analysis are warranted to define the role of GJIB-SG within the metabolic–surgical armamentarium. Full article

Background and Clinical Significance: Bicuspid aortic valve (BAV) is the most common congenital heart defect and may coexist with other cardiovascular anomalies. Among these is a single coronary artery (SCA), a rare congenital condition in which the entire coronary circulation originates from a single coronary ostium. Cardiac computed tomography (CCT) enables simultaneous evaluation of coronary artery anatomy and aortic valve morphology with high spatial resolution, which may influence procedural strategy in patients undergoing valve interventions. Case Presentation: This report represents the first documented case of a 59-year-old male with mixed aortic valve disease in whom preoperative CCT revealed the coexistence of BAV, SCA (Lipton type L-I), and myocardial bridging (MB) involving the mid segment of the left anterior descending artery (LAD). Identification of these findings was crucial for preoperative assessment and contributed to the selection of an appropriate surgical strategy. Conclusions: CCT plays a key role in the preoperative evaluation of valvular heart disease, including in patients with coexisting BAV and SCA. It enables individualized procedural planning and minimizes the risk of perioperative complications. Full article

Functionally single-ventricle (FSV) defects are complex congenital heart anomalies that require Fontan palliation, a surgical procedure redirecting systemic venous blood directly to the pulmonary arteries, bypassing the heart. Despite improvements in surgical techniques and perioperative care leading to enhanced survival rates, patients remain vulnerable to significant long-term complications, due to the unique Fontan circulation physiology. This circulation relies on low pulmonary vascular resistance and preserved single-ventricle function but predisposes patients to venous congestion and reduced cardiac output, resulting in multi-organ dysfunction. Key cardiovascular complications include systolic and diastolic dysfunction of the single ventricle, atrioventricular valve regurgitation, arrhythmias, pulmonary vascular disease, and thromboembolic events. Systemic complications encompass Fontan-associated liver disease (FALD), protein-losing enteropathy (PLE), plastic bronchitis (PB), renal impairment, and endocrine and psychosocial burdens. All the problems induce frequent hospitalizations, psychological challenges, and impaired educational and employment opportunities. Comprehensive management requires multidisciplinary approaches addressing the complex interplay of hemodynamic, organ-specific problems, and psychosocial factors inherent to Fontan physiology. Full article

Background and Objectives: Breast cancer surgery is increasingly performed in older patients with multimorbidity, in whom cardiovascular disease and frailty may substantially modify perioperative risk, including vulnerability to heart failure decompensation and other major medical complications. However, most available studies report global perioperative complication rates and composite medical endpoints, with heart failure events only rarely captured as dedicated outcomes, and operative technique, cardiovascular comorbidity, and frailty are often treated as separate domains rather than components of an integrated risk framework. Materials and Methods: We conducted a systematized narrative review with a structured literature search in PubMed/MEDLINE, Scopus, and Web of Science from inception to 31 January 2026, including original studies of adult patients undergoing breast-conserving surgery, mastectomy, and/or reconstruction that reported early postoperative outcomes in relation to comorbidities, cardiovascular risk, or frailty. Eligibility assessment, data extraction, and qualitative synthesis followed key PRISMA 2020 principles, and findings were organized into three prespecified domains: surgical complexity, cardiovascular vulnerability (including patients with heart failure where reported), and frailty. Results: Nineteen studies (retrospective cohorts, registry-based analyses, and large database studies, primarily ACS NSQIP) met inclusion criteria, encompassing diverse breast surgery populations, including elderly, metastatic, and reconstructive cohorts. Across datasets, escalation from breast-conserving surgery to mastectomy and then to increasingly complex reconstruction was associated with a stepwise increase in perioperative complications, reoperations, bleeding, and, in selected series, catastrophic events. Preexisting cardiovascular disease and systemic vascular pathology significantly amplified postoperative morbidity even in procedures considered low or intermediate cardiac risk, with signals that patients with underlying heart failure carry particularly heightened vulnerability, although HF-specific events were infrequently reported as separate endpoints. Frailty, mainly assessed using modified frailty indices, consistently emerged as a strong, age-independent predictor of 30-day complications, mortality, and readmissions across surgical types, including both breast-conserving and reconstructive procedures. Conclusions: Early postoperative outcomes after breast cancer surgery are associated with the interaction between surgical complexity, cardiovascular comorbidity (with limited HF-specific reporting), and frailty rather than by operative technique alone. In this context, our synthesis primarily reflects overall cardiovascular vulnerability in comorbid and frail patients, with heart failure risk inferred indirectly from the available data. These findings support a patient-centered, risk-adapted surgical strategy in which the extent and timing of surgery and reconstruction are tailored to each patient’s cardiovascular profile and frailty status, with preferential use of breast-conserving or less complex procedures in vulnerable individuals. Integrating standardized frailty assessment and cardio-oncologic evaluation into preoperative workflows, and prospectively validating this tri-axial framework in dedicated cohorts, may improve perioperative risk stratification and reduce the burden of postoperative medical complications in an aging breast cancer population. Full article

Background: Extracorporeal membrane oxygenation (ECMO) is lifesaving in pediatric patients with respiratory and/or cardiovascular failure. Cardiac catheterization is an important diagnostic and therapeutic tool in patients with congenital heart disease supported by ECMO, allowing the assessment of residual lesions, hemodynamically significant anatomical abnormalities, and unexplained indications for ongoing ECMO support. The timing and clinical contribution of cardiac catheterization in these patients are still debated. Objective: This study aimed to evaluate the indications, safety, and impact of cardiac catheterization on clinical management in pediatric patients receiving postoperative ECMO support. Methods: This single-center, retrospective study examined 39 pediatric patients under the age of 18 who underwent postoperative cardiac catheterization with ECMO support between January 2022 and December 2025. Demographic data, procedure characteristics, and clinical outcomes were analyzed. Results: Of the 190 patients under postoperative ECMO support, 39 underwent catheterization. The median age of the patients was 2.5 months (range, 6 days–180 months) and median weight was 4.2 kg (range, 2.8–57 kg). The most frequent diagnoses were ventricular septal defect-pulmonary atresia (VSD-PA) in 20.5% (n = 8) and transposition of the great arteries (TGA) in 15.3% (n = 6). The indication for catheterization was to investigate the reason for ECMO placement in 26 patients (66.6%). Most patients underwent catheterization within the first 24 h after ECMO initiation. Patients who underwent catheterization represented a higher-risk subgroup, with a greater proportion of STAT 4-5 procedures (59% vs. 40%) compared with the overall ECMO cohort. Cardiac catheterization resulted in a change in clinical management in 25.6% of patients through catheter-based intervention or surgical revision. Survival in the catheterized subgroup was 12.8%, reflecting the high-risk nature of this population. Conclusions: Cardiac catheterization in pediatric patients on postoperative ECMO support can be performed with a low complication rate and can significantly alter clinical management. Cardiac catheterization should be considered an important diagnostic and therapeutic modality, particularly in the presence of suspected residual lesions or unexplained hemodynamic instability. Additionally, we recommend that cardiac catheterization be performed promptly within the first 24–48 h in this patient group on ECMO support. Full article

Background: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg–Strauss syndrome, is a rare necrotizing vasculitis characterized by asthma, eosinophilia, and systemic granulomatosis vasculitis. Perioperative risk is primarily driven by airway hyperreactivity, potential cardiac disease, chronic immunosuppressive therapy, and reported alterations in plasma cholinesterase activity. Evidence specifically addressing anesthetic management remains scarce and largely limited to case-based reports. Methods: A focused narrative review was conducted by searching MEDLINE (via PubMed), Scopus, and Embase from inception to January 2026 for publications reporting perioperative anesthetic management in patients with EGPA/Churg–Strauss syndrome. Case reports and case-based descriptions providing explicit anesthetic details were qualitatively synthesized. Results: Available evidence consists predominantly of isolated case reports across heterogeneous surgical settings, including ENT, abdominal, orthopedic, ambulatory, pediatric, and rare cardiac procedures. Recurring perioperative principles include optimization of bronchial disease and continuation of inhaled therapy; minimization of airway stimulation and avoidance of histamine-releasing drugs; selection of induction agents preserving hemodynamic stability in the presence of myocardial involvement; preference for non-depolarizing neuromuscular blockade with quantitative monitoring (and consideration for sugammadex when appropriate); individualized corticosteroid management and multimodal, opioid-sparing analgesia, often supported by regional techniques. Conclusions: In the absence of dedicated perioperative guidelines, anesthetic care for EGPA should be individualized based on clinical phenotype and organ involvement. A structured approach targeting airway protection, cardiovascular stability, safe neuromuscular management, and opioid-sparing analgesia may represent a pragmatic risk-mitigation framework. These considerations are illustrated by an institutional experience in mitral valve surgery. Full article