Search Results (173)

Postpericardiotomy syndrome (PPS) is the most frequent inflammatory after-effect of cardiac surgery and is characterized by high morbidity, delayed hospitalization, and increased long-term mortality rates. Although PPS is common, empirical anti-inflammatory therapy has historically been employed for its prevention, and mechanism-based approaches have not yet been standardized. In this literature review, which was conducted on the basis of randomized controlled trials, meta-analyses, cohort studies, and mechanistic research regarding pharmacologic interventions, surgical modalities, and biomarker-based preventive strategies, the deficiencies of a critical synthesis of existing preventive strategies and emerging risk stratification instruments for PPS are addressed. The review affirms that the most evidence-based pharmacologic intervention is colchicine, which demonstrates a consistent reduction in PPS incidence across a range of randomized trials. Nonsteroidal anti-inflammatory drugs show variable responses, whereas corticosteroids are no longer recommended for routine prophylaxis due to relapse. Specific anti–interleukin-1 therapies represent a promising novel approach for high-risk patients. Surgical interventions, such as pericardial closure using biomaterials and posterior pericardiotomy, are important and do not lead to increased hemodynamic complications, while postoperative effusions, atrial fibrillation, and tamponade are reduced. Less invasive methods may also be employed to mitigate inflammatory causes, particularly in valve-sparing procedures and congenital operations. Emerging biomarker data, including postoperative neutrophil-to-lymphocyte ratios, C-reactive protein levels, and pericardial fluid cytokines, enable the identification of high-risk patients and form the basis for a personalized prevention approach. In summary, pharmacologic prophylaxis, innovative surgical techniques, and biomarker-based risk stratification represent a pathway toward reducing the incidence and burden of PPS in modern cardiac surgery. Full article

Background: New-onset postoperative atrial fibrillation (NOAF) is the most prevalent arrythmia after cardiac surgery with a significant clinical and economic impact. Therefore, simple and practical biomarkers for NOAF prediction remain a clinical priority. Increasing evidence indicates that malnutrition is linked to postoperative complications, including the onset of atrial fibrillation. The Prognostic Nutritional Index (PNI), which reflects the immunonutritional and inflammatory status through serum albumin concentration and lymphocyte count, has emerged as a reliable prognostic indicator in cardiovascular disease. The present study aimed to investigate the association between PNI and the development of NOAF in patients undergoing surgical aortic valve replacement (SAVR). Methods: A total of 241 consecutive patients who underwent AVR for severe aortic stenosis or regurgitation were enrolled in this study. The population was stratified into two groups according to the development of NOAF (NOAF group) or the lack thereof (no NOAF group). Results: In both univariate and multivariate logistic regression analyses adjusted for several established NOAF determinants, age and PNI, both as continuous variables, were independently associated with NOAF in both univariate (OR = 1.03; CI 95% = 1.01–1.06, p = 0.009, and OR = 0.9; CI 95% = 0.8–0.9, p = 0.01, respectively) and multivariate models (OR = 1.02; CI 95% = 1.01–1.06, p = 0.05, and OR = 0.9; CI 95% = 0.8–0.9, p = 0.03, respectively). When PNI was analyzed by tertiles, patients in the lowest tertile (PNI < 41.5) showed a significantly higher risk of developing NOAF at both univariate (OR = 1.9; CI 95% = 1.2–2.8, p = 0.004) and multivariate analysis (OR = 1.6; CI 95% = 1–2.6, p = 0.03), whereas age lost statistical significance (OR = 1.0; 95% CI = 0.9–1.05; p = 0.06). Furthermore, when the study population was divided into two groups based on the median age (70 years), PNI values differed significantly between NOAF and no NOAF patients only in patients under 70 years (p = 0.01). In this younger subgroup, PNI remained an independent predictor of NOAF, both when considered as a continuous variable (OR = 0.86; CI 95% = 0.74–0.98, p = 0.02), and nominal variable (PNI < 41.5, OR = 0.88; CI 95% = 0.80–0.97, p = 0.01). Conclusions: Overall, these findings identify PNI as an independent predictor of NOAF following SAVR, particularly in patients younger than 70 years. This study underlines the potential clinical value of preoperative nutritional assessment for risk stratification. Incorporating nutritional parameters such as PNI into current predictive models may enhance the accuracy of prognostic evaluation and support targeted perioperative management strategies. Full article

Atrial fibrillation (AF) is the most prevalent sustained arrhythmia worldwide and is now increasingly regarded as a disease of chronic inflammation and progressive atrial fibrosis. Understanding of molecular mechanisms that mediate the linkage between systemic metabolic dysregulation, inflammation, and structural atrial changes is crucial for informing risk stratification and targeting of prevention strategies. This review provides evidence from 105 studies focusing on the contributions of transforming growth factor-β1 (TGF-β1), tumor necrosis factor-a (TNF-α), interleukin-6 (IL-6), galectin-3, and galectin-1 to cardiac fibrogenesis, atrial fibrosis, and AF pathogenesis. We also link metabolic syndrome to these biomarkers and to atrial remodeling, as well as echocardiographic correlates of fibrosis. TGF-β1 is established as the central profibrotic cytokine and promotes Smad-based fibroblast activation, collagen accumulation, and structural atrial remodeling. Its role is highly potentiated by thrombospondin-1 by turning latent TGF-β1 into its potent form. TNF-α and IL-6 also play an integral role in the inflammatory fibrotic continuum by activating NF-κB and STAT3 signaling, promoting fibroblast proliferation, electrical uncoupling, and extracellular matrix accumulation. Galectin-3 is a potent profibrotic mediator that promotes TGF-β signaling and is a risk factor for negative outcomes, whereas Gal-1 seems to regulate inflammation resolution and may exert context-dependent protective or maladaptive roles. Metabolic syndrome is strongly associated with excessive levels of these biomarkers, chronic low-grade inflammation, oxidative stress, and ventricular and atrial fibrosis. Chronic clinical findings show that metabolic syndrome (MetS) increases AF risk, exacerbates atrial dilatation, and is associated with worse postoperative outcomes. Echocardiographic data are connected to circulating biomarkers and are non-invasive for evaluating atrial remodeling. The evidence to date supports that atrial fibrosis should be considered an end point of systemic inflammation, metabolic dysfunction, and activation of profibrotic molecular pathways. Metabolic syndrome, due to its chronic low-grade inflammatory environment and prolonged levels of metabolic stress, manifests as an important upstream factor of fibrotic remodeling, which continuously promotes the release of cytokines, oxidative stress, and fibroblast activation. Circulating fibrotic biomarkers, in comparison with metabolic syndrome, serve separate yet interdependent pathways that help orchestrate atrial structural remodeling through the simultaneous process but can also provide a long-term indirect measure of ongoing profibrotic activity. The integration of these biomarkers with superior atrial imaging enables a broader understanding of the fibrotic substrate of atrial fibrillation. This combined molecular imaging approach can facilitate risk stratification, refine therapeutic decisions, and facilitate early identification of higher-risk metabolic phenotypes, thus potentially facilitating directed antifibrotic and anti-inflammatory therapy in atrial fibrillation. Full article

Over the past three decades, cardiac surgery has undergone a deep transformation, shifting from full median sternotomy to minimally invasive (MICS) and micro-invasive techniques. These approaches aim to achieve equivalent therapeutic outcomes while reducing surgical trauma, postoperative pain, hospitalization time, and healthcare costs. Minimally invasive strategies are now widely applied to aortic and mitral valve surgery, coronary artery bypass grafting, atrial fibrillation ablation, and combined procedures. Key advancements such as sutureless prostheses, video- and robotic-assisted systems, and enhanced imaging technologies have improved surgical precision and clinical outcomes while promoting faster recovery and superior cosmetic results. Evidence from randomized trials and observational studies demonstrates that MICS provides mortality and morbidity rates comparable to conventional surgery, with additional benefits in high-risk, elderly, and frail patients. Micro-invasive transcatheter interventions, particularly transcatheter aortic valve implantation (TAVI) and transcatheter mitral repair or replacement, have further expanded therapeutic options for patients unsuitable for open-heart surgery. Their success has fostered debate not between conventional and minimally invasive surgery, but between minimally invasive and micro-invasive approaches. Hybrid procedures—combining surgical and percutaneous techniques—exemplify a multidisciplinary evolution aimed at tailoring treatment to patient-specific anatomy, comorbidities, and risk profiles. Despite clear advantages, these techniques present challenges, including a steep learning curve, increased procedural costs, and the requirement for specialized equipment and institutional expertise. Optimal patient selection based on clinical risk assessment and advanced imaging remains essential. Future directions include refinement of robotic platforms, artificial intelligence-based decision support, miniaturization of instruments, and broader validation of emerging technologies in younger and low-risk populations. Minimally and micro-invasive cardiac surgery represent a paradigm shift toward patient-centered care, offering reduced physiological burden, improved functional recovery, and long-term outcomes comparable to conventional techniques. As innovation continues, these approaches are poised to become integral to modern cardiac surgical practice. Full article

Background: Sex-related differences in outcomes following cardiac surgery are well documented, with females generally experiencing higher postoperative mortality rates than males. However, the underlying factors driving this disparity remain incompletely understood. This study aimed to compare the preoperative risk characteristics of female and male patients who died within one year after elective cardiac surgery with those who survived, in order to identify sex-specific risk profiles associated with postoperative mortality. Methods: In this retrospective single-centre cohort study, data were derived from a prospective quality assurance database at Amsterdam University Medical Centres (Amsterdam UMC), The Netherlands, covering January 2001 to December 2020. All adult patients (≥18 years) undergoing elective cardiac surgery were included. Descriptive and comparative analyses were performed to characterise sex-specific preoperative differences between survivors and non-survivors. Results: The study cohort comprised 10,614 patients, including 2804 females (26%; median age 72 years [IQR 65–77]) and 7810 males (74%; median age 67 years [IQR 59–73]). In both sexes, non-survivors more frequently had major comorbidities, including atrial fibrillation, history of reoperation, pulmonary hypertension, chronic obstructive pulmonary disease, cerebrovascular disease, and kidney dysfunction. Within one year post-surgery, 143 (5.1%) females and 299 (3.8%) males had died. Among females, non-survivors within one year of surgery more frequently had several preoperative risk factors compared with survivors, including moderately impaired left ventricular function (16% vs. 11%), pulmonary hypertension (12% vs. 3%), extracardiac arteriopathy (25% vs. 9%), and kidney dysfunction (46% vs. 21%) dependent on the type of surgery (combined valve + coronary artery bypass grafting (CABG) (29% vs. 15%) or aortic surgery (14% vs. 4%)). In male patients, however, different risk factors such as higher age (median 73 years [IQR 66–77] vs. 67 [59–73]), lower Body Surface Area (mean 1.96 m² (SD ± 0.19) vs. 2.02 ± 0.18), hypercholesterolaemia (35% vs. 44%), severely impaired left ventricular function (14% vs. 6%), myocardial infarction (31% vs. 22%), and type of surgery (aortic surgery (9% vs. 3%), or combined valve + CABG (22% vs. 12%)) were preoperative predictors of mortality compared to non-survivors. Conclusions: Our study demonstrates that one-year mortality following elective cardiac surgery is driven by distinct preoperative risk profiles in females and males. Recognising that mortality in females is associated with systemic disease and males by direct cardiac damage is a critical step toward developing more equitable, precise, and effective perioperative management strategies. Full article

Background: The minimally invasive approach is increasingly recognized as the standard for surgical management of mitral valve disease. Advances in endoscopic visualization and surgical instrumentation have enhanced precision while minimizing trauma, improving both functional and esthetic outcomes. This study presents a single-center experience with total endoscopic mitral valve repair (MVR) performed using two- or three-dimensional video-assisted technology. Methods: Between October 2022 and September 2025, 239 patients underwent total endoscopic MVR at our institution. Demographic, operative, and postoperative data were collected and analyzed. Results: Median age was 63 years, with 64.4% male. Median logistic EuroSCORE and EuroSCORE II were 2.53 and 0.83, respectively. Most patients were NYHA class II (54.4%), and 47.7% had pulmonary hypertension. Mitral annuloplasty was performed in 99.2% of cases; 78.6% received Gore-Tex chordae, 6.3% underwent posterior leaflet resection, and 11.7% edge-to-edge repair. Conversion to sternotomy occurred in 0.4%. In-hospital mortality was 1.3%; stroke occurred in 0.4%. Postoperative atrial fibrillation developed in 26.8%, while major complications such as sepsis (2.1%) and renal failure requiring dialysis (1.3%) were infrequent. Median ventilation time was 5 h, ICU stay was 2 days, and hospital stay was 7 days. Pre-discharge echocardiography showed ≤mild regurgitation in 99.2%. Conclusions: Total endoscopic MVR using two- or three-dimensional video assistance is safe, feasible, and yields excellent clinical, functional, and cosmetic results, with low morbidity and rapid recovery. Full article

Background: Postoperative delirium (POD) is one of the most common surgical complications in elderly patients. This study investigated the incidence of and perioperative risk factors for POD following urological surgery. Methods: A total of 162 male patients aged ≥50 years undergoing elective major urological surgery under general anesthesia from May 2024 to March 2025 were included in this prospective observational study. Delirium was assessed using CAM-ICU twice a day for five postoperative days. Groups with and without delirium were compared, and perioperative predictors of delirium were analyzed. Multivariate regression analysis was used to identify independent risk factors for POD. Results: Overall, 16% of patients developed delirium during the follow-up period. Patients with POD were significantly older (mean age, 73.3 ± 5.2 years vs. 66.3 ± 7.2, p < 0.001), had more comorbidities, and lived in rural areas. Atrial fibrillation and COPD were particularly significant. The incidence of POD was higher in patients with mild/moderate alcohol consumption than in those who never drink. Analysis of intraoperative factors revealed a significant difference between groups in the presence of intraoperative hypotension and blood transfusion. Patients with delirium had more severe postoperative pain. Optimal cutoff values of age (≥67.5), number of comorbidities (≥2), preoperative MMSE score (≤25.5), and postoperative NRS score (≥4.85) were determined using ROC curves. The multivariate analysis identified age ≥ 67.5 years, COPD, mild/moderate alcohol consumption, preoperative MMSE score ≤ 25.5, intraoperative hypotension, and postoperative NRS score ≥ 4.85 as independent risk factors in this cohort. Conclusions: Considering that some of the above risk factors can be modified, it is necessary to emphasize that the prevention of POD is possible and should be one of the treatment priorities in older patients. Full article

Background: Postoperative delirium (POD) is commonly observed after surgical aortic valve replacement (SAVR) and could have serious consequences. Its prevalence varied among prior published series. With increasing patient age, a worsening of this problem can be expected. Methods: The association between POD and other adverse events, as well as its effect on 30-day mortality, long-term survival, and later dementia development, was investigated in 1500 consecutive patients (1527 operations) undergoing SAVR with a biological prosthesis, with or without concomitant procedures. An observational retrospective file analysis was performed, using chi-square, Student’s t-test, logistic regression, and Kaplan–Meyer analyses. Results: POD was recorded in 183/1527 (12.0%) of the patient files. Its independent predictors were need for reintervention, age over 80 years, male gender, peripheral artery disease, smoking, need for non-elective SAVR, atrial fibrillation, and a prior TIA. POD was associated with all other postoperative adverse events and increased need for resources. Thirty-day mortality was almost four times higher with POD: 35/182 (19.1%) vs. 59/1345 (4.4%), p < 0.001. Five-year survival was significantly reduced in patients with POD: 79.8 ± 1.2% versus 59.5 ± 4.3%, p < 0.001. The mean time to occurrence of dementia was 89 (84–95) months in patients without POD versus 60 (50–71) months in patients with POD. Five-year freedom from dementia was 69.1 ± 2.9% versus 44.4 ± 6.8%, p < 0.001. Conclusions: POD is associated with short-term complication rates, increased need for resources and hospital mortality, a reduced long-term survival rate, and an increased risk of dementia development. The limitations of this investigation include its retrospective and observational nature; in addition, it did not detect preoperative mild cognitive impairment. Full article

Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially in elderly or high-risk patients. Objectives: The present study aims to assess the influence of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary systolic arterial pressure (PASP) ratio on clinical outcomes in patients with aortic stenosis undergoing TAVR and offer valuable insights into patient selection and tailored management strategies for individuals undergoing TAVR. Methods: A retrospective analysis was conducted on 100 patients with AS who underwent TAVR, included in two distinct groups based on their median TAPSE/PASP ratio. Results: Patients were divided according to their median TAPSE/PASP ratio into two groups. Those with lower TAPSE/PASP ratios had a higher incidence of post-procedural atrial fibrillation (AF) (48% vs. 28%, p = 0.0404), lower left-ventricular ejection fraction (LVEF) (41.06% vs. 49.50%, p < 0.0001), a more pronounced inflammatory and hematologic response, and longer hospitalization. Receiver-operating characteristic (ROC) analysis demonstrated modest but significant discrimination rather than high sensitivity or specificity for postprocedural arrhythmias, particularly atrial fibrillation. Conclusions: TAPSE/PASP should be regarded as a clinically useful risk-stratification marker in patients with AS undergoing TAVR, enabling the identification of high-risk patients and optimizing peri-procedural management. Full article

Background: The aim of this study was to investigate the effect of preoperative statin use on postoperative bleeding and related complications in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: Between 2023 and 2025, 627 patients who underwent isolated CABG were evaluated. The patients were divided into two groups: Group A (n = 241, received preoperative statins) and Group B (n = 386, did not receive preoperative statins). All preoperative, intraoperative parameters, and postoperative outcomes were compared. Results: Patient demographics, comorbidities, laboratory parameters, EuroSCORE II, echocardiographic findings, operative data, cross-clamp times, and cardiopulmonary bypass times were similar. Intraoperative and postoperative blood product use were comparable between the groups. Postoperative total bleeding was higher in Group A than in Group B, but no statistical difference was found. The postoperative exploration rate was higher in Group A than in Group B, but no statistically significant difference was found. There were no significant differences between the groups in terms of gastrointestinal bleeding. Postoperative atrial fibrillation (POAF) was significantly lower in Group A than in Group B (21 (8.7%)–74 (19.2%), p < 0.001). Mortality was higher in Group B than in Group A, but no statistically significant difference was found (3 (1.2%)–14 (3.6%), p = 0.07). Intensive care unit stay was longer in Group B than in Group A. A significant negative association was found between statin usage and POAF (p = 0.001, OR = 0.418). Conclusions: We found no statistically significant increase in postoperative bleeding or blood product use with preoperative statin therapy in isolated CABG patients. However, we found that preoperative statin therapy was protective against POAF. Full article

Background: Despite the increasing adoption of minimally invasive direct coronary artery bypass (MIDCAB), data on its long-term outcomes—particularly regarding sex-based differences—remain limited. This study presents a robust 20-year analysis comparing males and females, assessing perioperative outcomes, long-term survival, and independent predictors of mortality to inform sex-sensitive clinical decision-making. Methods: A retrospective cohort analysis of 676 patients (138 females, 538 males) undergoing MIDCAB was performed. Propensity score matching (PSM) generated balanced female and male cohorts (n = 129 each). Preoperative demographics, short-term outcomes, and long-term survival were assessed using Kaplan–Meier analysis and Cox regression modelling. Results: In unmatched cohorts, females exhibited significantly lower NYHA class distribution (p = 0.011) and higher atrial fibrillation prevalence (p = 0.038), with otherwise comparable comorbidities. Propensity score matching achieved cohort balance, and short-term outcomes—including 30-day mortality, stroke/TIA, and reoperation—were similar across sexes. Kaplan–Meier analysis of matched cohorts revealed no significant survival difference (log-rank p = 0.3370), though females demonstrated greater 20-year survival than males (77.6% versus 55.8%). In females, age 70–79 (HR 2.66; 95% CI: 1.02–6.95; p = 0.046) and cerebrovascular disease (HR 5.33; 95% CI: 1.49–19.03; p = 0.010) were independently associated with mortality. In males, significant predictors included diabetes (HR 1.86; 95% CI: 1.02–3.38; p = 0.042), chronic kidney disease (HR 4.92; 95% CI: 1.21–20.02; p = 0.026), pulmonary disease (HR 2.35; 95% CI: 1.20–4.60; p = 0.013), cerebrovascular disease (HR 4.77; 95% CI: 1.97–11.56; p < 0.001), and reduced left ventricular ejection fraction (HR 0.17; 95% CI: 0.06–0.43; p < 0.001). Conclusions: This 20-year study, the longest to date, demonstrates that MIDCAB achieves durable and equivalent long-term survival in males and females. It highlights sex-specific predictors of mortality, emphasizing the necessity for personalized preoperative risk assessment and postoperative management. Full article

Background: Minimally invasive off-pump coronary artery bypass grafting (MICS-OPCAB) offers potential advantages over conventional sternotomy, including reduced trauma and faster recovery. This study evaluates the safety and feasibility of MICS-OPCAB at our centre. Methods: We retrospectively analysed 50 consecutive MICS-OPCAB procedures performed via left anterior thoracotomy at our institution between January 2023 and June 2025. Data collected included patient demographics, operative details, and postoperative outcomes. Endpoints were 30-day mortality, conversion to sternotomy, and postoperative complications. Results: The cohort included 41 males (82%) with a mean age of 63.1 ± 8.7 years (range 40–80) and mean BMI 27.8 ± 4.3 kg/m². Comorbidities included diabetes mellitus in 26%, COPD in 12%, and chronic kidney disease in 8%. Canadian Cardiovascular Society angina classes III–IV were present in 46%. The majority of patients (64%) had single-vessel CAD while 34% had two-vessel and 2% had three-vessel involvement. The mean Logistic EuroSCORE I was 2.19 ± 1.53. Left internal mammary artery (LIMA) grafting was performed in 96% of cases. Additional conduits included left radial artery in 32% and saphenous vein in 8%, with T-grafts in 26% and sequential grafting in 4%. The average number of grafts per patient was 1.35 ± 0.53 (range 1–3). The procedure was performed off-pump in 96% of cases, with two patients (4%) requiring CPB support during conversion from mini-thoracotomy. The overall conversion rate to sternotomy was 16% (eight patients), predominantly due to difficult or injurious IMA harvest or anatomical limitations. The mean operative time was 197.8 ± 76.8 min and decreased significantly after the first 25 cases (220 min vs. 175 min). Atrial fibrillation occurred in 18%, pleural effusion in 28% (10% requiring drainage), and chest infection in 8%. Wound complications arose in 4%. There was no 30-day mortality. ICU stay averaged 2 ± 2.2 days (range 1–14), and total hospital stay was 5.7 ± 2.7 days where institutional coronary bypass stay is normally 7.9 +/− 7.0 days. Conclusion: These results demonstrate that MICS-OPCAB is a safe and feasible approach for selected patients requiring multivessel coronary artery bypass grafting. There are some technical challenges during the learning curve for which conversion to open surgery can confer good outcomes. Traversing the early learning curve can confer additional benefits to later patients. Full article

Background and Objectives: This study aimed to investigate risk factors for permanent pacemaker (PPM) implantation following the Maze procedure in patients with atrial functional mitral regurgitation (AFMR). Methods: A retrospective cohort of 423 patients who underwent the Maze procedure for persistent or paroxysmal atrial fibrillation from 2010 to 2025 was analyzed. Patients were categorized on the basis of the need for PPM postoperatively. Risk factors and rhythm outcomes were compared using multivariable Cox and logistic regression with backward stepwise selection according to the Akaike Information Criterion. Results: Forty-five patients (10.6%) required PPM implantation following the Maze procedure. The PPM group demonstrated a significantly higher AFMR prevalence than the non-PPM group (28.9% vs. 10.4%, p = 0.001). Preoperative fine P waves and older age were additional significant predictors. The PPM group exhibited lower postoperative sinus rhythm rates and higher junctional rhythm rates. AFMR (hazard ratio [HR], 2.10; p = 0.030), fine P wave (HR, 2.03; p = 0.049), and age (HR, 1.04; p = 0.018) independently predicted PPM implantation. AFMR particularly elevated the late PPM implantation risk. Conclusions: AFMR is an independent risk factor for late nodal dysfunction requiring PPM following Maze procedures. To detect delayed pacemaker requirements postoperatively, extended monitoring is recommended for patients with AFMR. Full article

Background and Objectives: Postoperative atrial fibrillation (POAF) remains one of the most frequent complications after cardiac surgery, increasing the risk of morbidity, prolonged hospitalization, and adverse long-term outcomes. Although several clinical and echocardiographic factors have been associated with POAF, the integrated contribution of atrial conduction delay, biatrial mechanics, and atrioventricular coupling to arrhythmogenesis remains unclear. Materials and Methods: This retrospective study included 131 adult patients undergoing coronary artery bypass grafting and/or aortic valve replacement. Preoperative echocardiography within one week before surgery provided detailed assessment of atrial phasic function, valvular motion, and total atrial conduction time (TACT). Univariate analysis was followed by multivariable modeling using penalized logistic regression (Elastic Net) to identify the most robust predictors of POAF. Discriminative performance and calibration were evaluated via receiver operating characteristic (ROC) and calibration analysis. An exploratory Extreme Gradient Boosting (XGBoost) model with SHapley Additive exPlanations (SHAP) analysis was used to confirm the stability and directionality of nonlinear feature interactions. Results: POAF occurred in 47 (36%) patients. The Elastic Net model identified prolonged TACT, reduced right atrial active emptying fraction (RAAEF), increased indexed minimal left atrial volume (MIN LA/BSA), and lower tricuspid annular plane systolic excursion (TAPSE) as the most informative predictors. The model demonstrated excellent internal discrimination (AUC = 0.95; 95% CI 0.91–0.99) and satisfactory calibration (Hosmer–Lemeshow p = 0.41). Exploratory XGBoost analysis yielded concordant feature hierarchies, confirming the physiological consistency of the results. Conclusions: POAF arises from an identifiable electromechanical substrate characterized by atrial conduction delay, biatrial mechanical impairment, and reduced atrioventricular coupling. A parsimonious, regularized statistical model accurately delineated this profile, while complementary machine-learning analysis supported its internal validity. These findings underscore the potential of echocardiographic electromechanical parameters for refined preoperative risk stratification, pending prospective multicenter validation. Full article

Background/Objectives: Chronic subdural hematoma (CSDH) predominantly affects the elderly population. To optimize care and quality in this demographic, tailored, age-specific counseling and therapeutic decision-making are imperative. Accordingly, this study aimed to identify risk factors for in-hospital mortality and functional outcome at discharge following surgery using an age-stratified approach. Methods: We conducted a retrospective analysis of symptomatic CSDH patients who underwent surgery at our institution between June 2012 and December 2023. Subjects were categorized into three age cohorts: younger adults (18–64 years), older adults (65–79 years), and the oldest old (≥80 years). Clinical and neurological statuses at admission and discharge were evaluated using the Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS), with mRS scores > 3 indicating poor functional outcomes. Results: Among 879 CSDH patients (mean age 75 ± 11.9 years), the sex ratio shifted progressively from a male predominance in younger adults (1:3.2) to a more balanced ratio in the oldest old (1:1.7). In the multivariate analysis, poor admission mRS and GCS score ≤ 7 predicted in-hospital mortality for older adults, while atrial fibrillation and postoperative pneumonia were significant in the oldest old. Poor admission mRS and multimorbidity consistently forecast unfavorable outcomes alongside other predictors, such as preoperative altered state of consciousness, epilepsy, dementia, unilateral CSDH, postoperative seizure, bleeding, and pneumonia varying by age cohort. Recurrence-free intervals were significantly extended with increasing age. Conclusions: This large-scale, age-stratified analysis delineates critical predictors of in-hospital mortality and unfavorable functional outcomes in surgically treated CSDH patients. These findings offer valuable guidance for neurosurgeons in preoperative risk assessment and inform age-specific counseling strategies to better communicate prognosis and tailor treatment plans. Full article