The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from across Africa, China, Europe, South America and the USA to address the growing burden of cardiovascular disease, to share their vision for the fight against cardiovascular disease, to raise standards in the diagnosis, treatment and recovery of patients thereby improving procedural safety and clinical outcomes in Africa. The experts agreed on the need for cost effectiveness in cardiac surgery, simulation skills training, an African regional cardiothoracic surgery database, African heart team fellowship programs and specialized working groups to guide cardiovascular diagnostics and treatments focusing on critical areas such as congenital heart surgery, valve surgery and coronary artery bypass surgery (CABG) procedures which are becoming increasingly necessary in Africa due to the rise in cardiovascular emergencies, and finally explore solutions tailored to the continent's unique healthcare challenges. The incentives generated from the summit are formulated as the "2025 Accra Declaration" to serve as roadmaps and implementable guidelines for promoting high-level cardiovascular surgery and reforms in Africa in collaboration with cardiologists and other allied cardiovascular professionals.
This study aims to compare the efficacy and safety of catheter-directed mechanical thrombectomy using the Tendvia system versus systemic thrombolysis in patients with intermediate-to-high-risk acute pulmonary embolism. This is a 1:1 block-randomized, controlled, open-label parallel-group, multi-center, superiority trial. Eligible patients aged 18-75 years, diagnosed with intermediate-to-high-risk acute pulmonary embolism and hemodynamic deterioration, will be included. The main exclusion criteria are unsuitable target vessel criteria; sustained systolic hypotension; severe pulmonary hypertension; hematocrit < 28%; chronic pulmonary hypertension; left bundle branch block; chronic left heart failure; renal dysfunction; coagulopathy; recent cardiothoracic surgery; intracardiac thrombus. The intervention group will undergo catheter-directed thrombectomy using the Tendvia system under fluoroscopic guidance within 4 h of computed tomography pulmonary angiography. The control group will receive standard alteplase infusion. The primary efficacy endpoint is absolute reduction in the right ventricular/left ventricular diameter ratio from baseline to 48 h post-intervention, measured by blinded core-lab computed tomography pulmonary angiography analysis. The primary safety endpoint is the rate of composite major adverse events within 48 h. Secondary endpoints include the proportion of patients achieving a ≥ 50% reduction from baseline in NT-proBNP level at 48 h post-intervention, dyspnea scores, change in pulmonary arterial pressure, 48-h post-procedure clinical deterioration, symptomatic recurrence within 30 days, major access site complications, device-related serious adverse events, length of post-procedure hospital and intensive care unit stay, and change in cardiac biomarkers. This trial will provide evidence regarding the use of catheter-directed thrombectomy in intermediate-to-high-risk pulmonary embolism. This study was registered in Clinicaltrials.gov on 2025-06-22 (Registration number NCT07032025).
The comparative effectiveness of chlorhexidine gluconate (CHG) versus povidone-iodine (PVI) for preventing surgical site infections (SSIs) remains unclear across surgical types and resource settings. This study compared CHG and PVI overall and within key clinical subgroups. Five databases were searched through February 2025 for randomized controlled trials comparing CHG with PVI and reporting SSI outcomes. Random-effects models generated pooled odds ratios (ORs) with 95% confidence intervals (CIs). Twenty-nine RCTs involving 35,317 patients were included. CHG significantly reduced superficial incisional SSIs (OR = 0.80; 95% CI 0.67-0.95; p = 0.01; I2 = 18.4%), but not overall, deep, or organ/space infections; meta-regression indicated that patient age was a significant effect modifier. In cesarean sections, CHG lowered overall (OR = 0.64; 95% CI 0.48-0.85), superficial (OR = 0.65; 95% CI 0.48-0.87), and deep incisional SSIs (OR = 0.41; 95% CI 0.22-0.75). In abdominal surgery, CHG reduced only superficial incisional SSIs (OR = 0.68; 95% CI 0.52-0.91). No significant differences were observed in gynecologic, cardiothoracic, or orthopedic procedures. By wound classification, CHG had no effect in clean surgery but reduced superficial incisional SSIs in clean-contaminated cases (OR = 0.65; 95% CI 0.48-0.89). By income level, no differences were seen in high-income countries, while in low- and middle-income countries CHG decreased overall (OR = 0.58; 95% CI 0.46-0.74), superficial (OR = 0.54; 95% CI 0.38-0.76), and deep incisional SSIs (OR = 0.48; 95% CI 0.25-0.92). Alcohol-based CHG and alcohol-based PVI are comparably effective in most surgical settings. However, CHG demonstrates superior prevention of SSIs in cesarean, abdominal, and clean-contaminated surgeries, with the most substantial benefit in low- and middle-income settings. Broader use may be justified pending cost-effectiveness evaluation.
The RxPONDER trial established that adjuvant chemotherapy does not confer survival benefit in postmenopausal women with hormone receptor-positive (HR+)/HER2-negative breast cancer, 1-3 positive lymph nodes, and a low 21-gene Recurrence Score (RS ≤ 25). Whether these findings have been adopted in routine clinical practice in Asian populations remains unclear. We conducted a multicentre retrospective cohort study of postmenopausal Chinese patients with HR+/HER2-breast cancer and limited nodal involvement who underwent surgical treatment and Oncotype DX testing between 2017 and 2023. Among 385 eligible patients, 54.8% had an RS ≤ 25, yet 46.4% of this low-genomic-risk group received adjuvant chemotherapy. Chemotherapy use declined substantially following publication of RxPONDER, indicating a marked shift in treatment patterns. Importantly, no disease-free survival (DFS) benefit was observed with chemotherapy in patients with RS ≤ 25. Multivariable analyses revealed that higher nodal burden, high histologic grade, and low progesterone receptor expression independently influenced chemotherapy decision-making despite low genomic risk. These real-world data provide supportive evidence consistent with the RxPONDER findings in a Chinese population; however, given the relatively short follow-up duration, longer-term outcomes are warranted to further substantiate these observations.
Deep sternal wound infection (DSWI) remains a serious complication of coronary artery bypass grafting (CABG), particularly when bilateral internal thoracic arteries (BITA) are used. Concerns regarding DSWI often limit the adoption of multiple arterial grafting. To evaluate the effect of topical vancomycin paste on the incidence of DSWI in patients undergoing primary isolated CABG with BITA. This multicenter, retrospective study analyzed 1,694 patients who underwent BITA grafting between 2006 and 2024. Patients were stratified based on whether topical vancomycin paste was applied to the sternal edges (n = 455) or not (n = 1,239). Propensity score matching was used to account for baseline differences, generating 368 matched pairs. Odds ratios (ORs) were estimated using multivariable and conditional logistic regression. Multivariable logistic regression demonstrated that the use of topical vancomycin paste was independently associated with a 63% reduction in DSWI (OR = 0.37; 95% CI: 0.14-0.97; p = 0.045). Other independent predictors of increased DSWI risk included age ≥ 60 years, obesity, chronic lung disease, insulin therapy, female sex, and heart failure symptoms. After propensity score matching, 368 well-balanced pairs were obtained. In this matched cohort, topical vancomycin paste was associated with a substantial reduction in DSWI (OR = 0.17; 95% CI: 0.05-0.60; p = 0.001). Topical application of vancomycin paste significantly reduces the risk of DSWI in patients undergoing CABG with BITA. This simple and effective prophylactic measure may help enable safer and broader adoption of multiple arterial grafting strategies.
Neurocognitive decline (NCD) after cardiopulmonary bypass is a well-established phenomenon. While numerous preoperative risk factors have been identified, the influence of intraoperative factors on NCD still needs further exploration. We conducted a prospective cohort study to evaluate NCD and associated pre-operative and intra-operative factors. Patients undergoing CABG or valvular surgeries under cardiopulmonary bypass from 2021 to 2023 were recruited. Preoperative characteristics and postop outcomes were extracted from chart review. Intraoperative variables were extracted from anesthesia and perfusionist records. Neurocognitive performance was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) score at baseline, POD4, and 1 month, and NCD is defined as a decrease of ≥ 8 points from baseline. Results were analyzed via multivariable regression models and Pratt score analysis to identify strongest predictors of NCD. Out of the 132 enrolled patients who underwent planned cardiac operations, 94 patients completed neurocognitive assessments on POD4, and 62 patients completed both on POD4 and at 1-month postop. Forty-two (45%) patients had NCD on POD4. NCD in the immediate postop period is more common in patients who are female, with higher BMI, and undergoing valvular surgery compared to CABG (all p < 0.05). Significant intra-op characteristics associated with NCD include lower intraoperative minimum temperature, more transfusion of blood products, and longer CPB and aortic cross-clamp time (all p < 0.05). In multivariable regression models, younger age, lower preoperative creatinine, lower intraoperative hematocrit, longer CPB time and lower volume collected in CellSaver were associated with NCD (all p < 0.05). Pratt score analysis identified CPB time and intraoperative hematocrit as the two strongest intraoperative predictors of NCD on POD4. Patients with NCD had longer ICU and hospital stays, but experienced no significant difference in complication rates compared to the non-NCD cohort. At 1-month follow-up, only 10 (16%) patients experienced persistent NCD, and repeat analyses with multivariable regression models showed only CPB time and cross-clamp time remained statistically significant between cohorts. Longer cardiopulmonary bypass time and lower intraoperative hematocrit were strongly associated with early postoperative NCD. Intraoperative strategies to limit hemodilution should be considered as part of neuroprotective management in cardiac surgery.
Progressive developments in mechanical circulatory support devices have seen the increasing use of devices which directly augment pulmonary blood flow, including the deployment of durable pumps in the biventricular configuration (BiVAD). This paradigm introduces complex haemodynamic interactions which have not been fully characterized, compared to LVAD alone. We sought to investigate the effect of BiVAD support on central hemodynamics with particular regard to assessing pulmonary flow and vascular properties. This retrospective cohort study included LVAD and BiVAD patients who had right heart catheterization (RHC) performed within 6 months prior to MCS implantation and thereafter. Traditional RHC parameters, native LV and RV stroke volume (SV), and measures of pulmonary vascular function, including pulmonary arterial compliance (PAC) and elastance (EPA), were compared between BiVAD and LVAD patients. A total of 62 patients, 13 (21%) BiVAD and 49 (79%) LVAD patients, were studied. At follow-up, despite similar baseline values, the BiVAD vs LVAD cohort had significantly higher pulmonary artery pressures (mmHg): sPAP (37 ± 14 vs 28 ± 11, p = 0.02) and dPAP (22 ± 8 vs 12 ± 6, p < 0.001). A reduction in PVR following BiVAD insertion was observed but remained significantly greater in BiVAD vs LVAD patients (2.1 ± 1.1 vs 1.6 ± 0.6 Wood Units, p = 0.02). Pulmonary arterial compliance (PAC), calculated using "total" stroke volume (SV) comprising the pulsatile and continuous flow components of the BiVAD configuration) was higher in BiVAD vs LVAD patients. However, using the native right ventricular SV, PAC was lower in the BiVAD cohort and remained unchanged compared to baseline. Simulation modeling demonstrated BiVAD support modestly increases pulmonary artery pressure and reduces right heart output, which was observed in our study. The presence of combined pulsatile and continuous flow in BiVAD patients significantly influences the hemodynamic profile compared to LVAD patients, particularly in regard to pulmonary pressures. Our study highlights the potential challenges in applying conventional pulmonary vascular hemodynamic indices in patients with continuous flow components.
Sternal fractures are uncommon but clinically relevant injuries, most often resulting from blunt thoracic trauma in motor vehicle collisions. While most isolated fractures can be treated conservatively, surgical stabilisation may be required in cases of displacement, instability, or polytrauma. Modern plating techniques offer biomechanical advantages over traditional wire fixation, but indications remain variably defined. We report the case of a 33-year-old male polytrauma patient involved in a high-impact motor vehicle accident. He sustained a displaced sternal fracture with manubriosternal dislocation, bilateral rib fractures (right 4th-8th, left 6th-7th), flail chest, pulmonary contusion, a retrosternal haematoma, and left hip dislocation. Surgical management included open reduction and internal fixation of the sternum with 2 titanium plates, haematoma evacuation, and orthopaedic intervention. The postoperative course was initially uneventful; however, the patient was readmitted 1 month later with a surgical site infection caused by Proteus mirabilis.
Surgical explantation of transcatheter aortic valves (TAV-explant) is an emerging but uncommon procedure, increasingly required as TAVI is performed in younger and lower-risk patients. Contemporary evidence on outcomes, timing, and valve type remains limited. We conducted a multicenter retrospective study of patients undergoing surgical TAV-explant. Clinical characteristics, indications, surgical strategies, and outcomes were analyzed. Outcomes were compared according to the interval between index TAVI and explantation (< 1 month, 1-12 months, > 12 months). The indication and the type of initial transcatheter valve (balloon-expandable vs. self-expanding) were also analyzed. The primary outcome was 30-day mortality. A total of 62 patients were included. Indications for TAV-explantation were predominantly bioprosthetic valve dysfunction (45.2%), infective endocarditis. (21%), and procedural failure (33.9%)The 30-day mortality was 16.1% and did not differ according to the delay of explantation (p = 0.816). Overall mortality did not differ according to the indication of explantation, nor by type of explanted valve. Concomitant aortic surgery was required in 18% of cases. Although EuroSCORE II values were elevated in this cohort, this tool underestimated the operative risk, as it was not designed for complex redo surgery. TAV-explantation is technically feasible but remains associated with substantial early mortality. Outcomes are not influenced by the timing of explantation or by valve type. These findings highlight the limitations of current surgical risk scores and underscore the importance of thorough pre-operative planning and Heart Team evaluation. Continued multicenter data collection is essential to optimize patient selection and refine management strategies.
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Central venous catheters (CVCs) are commonly used in patients with haematological diseases but are associated with infectious complications. The CVC Anti-infection Double Lumen Bundle was introduced in December 2020 to reduce this risk. The bundle included a double-lumen noble metal alloy-coated CVC and chlorhexidine-impregnated dressings. This study evaluated whether the bundle was associated with a reduction in catheter-related infections. Non-tunnelled CVC insertions with a dwell time ≥24 h in adults treated for haematological diseases between May 2013 and June 2024 were included. Data were extracted from the electronic health records. The main objectives of the study were to investigate the proportions of suspected catheter-related infection (sCRI) and catheter-related bloodstream infection (CRBSI). Secondary objectives were catheter tip colonization and incidence of sCRI and CRBSI per 1000 catheter-days. A total of 907 CVC insertions in 690 patients were analysed (471 before and 436 after the bundle implementation date). No differences were observed in the proportions of sCRI (6.4% vs 7.6%), CRBSI (0.4% vs 0.7%) or catheter tip colonization (4.7% vs 4.4%). The incidence per 1000 catheter-days also did not differ (sCRI: 1.67 vs 2.34 and CRBSI: 0.11 vs 0.21). In multi-variable analysis, no variables were associated with a higher risk of sCRI, whereas antibiotic administration at insertion was associated with a lower risk. The introduction of the Anti-infection Double Lumen Bundle did not reduce CVC-related infectious complications in patients with haematological diseases.
Existing methods of grading atelectasis are typically subjective and not scalable. We aimed to develop an automated, deep learning-based framework to quantify and grade postoperative atelectasis. We retrospectively included all patients who underwent RULobectomy from 2008 to 2023. We trained three nnU-Net v2 segmentation models for preoperative and postoperative lobes and airways with volumetric quantification of the right middle lobe (RML), right lower lobe (RLL), and total lung volume. Atelectasis severity in the RML was independently graded using a 5-point radiological scale (none, minimal, subsegmental, segmental, lobar). The association between volume metrics with atelectasis severity and clinical outcomes was evaluated. 236 patients comprised the study cohort. Median(IQR) RML volume loss progressively increased with higher atelectasis grades, from -4.6 mL (-78.5, 59.0) in grade 0 to -317.8 mL (-440.7, -194.8) in grade 4 atelectasis (p < 0.001). Normalized RML/right lung (RL) and RML/total lung (TL) volume ratios showed statistically significant differences across the pooled atelectasis grades (p < 0.001). Normalized RLL volumes increased with worsening RML atelectasis (p < 0.001), suggesting compensatory hyperinflation. A higher ΔRML/RL [OR(95%CI): 0.89 (0.81-0.98), p = 0.01] and ΔRML/TL [0.80 (0.65-0.98), p = 0.03] were associated with reduced 1-year need for bronchoscopy. We demonstrate the feasibility and clinical relevance of deep learning-based volumetric assessment of atelectasis after RULobectomy.
Tricuspid regurgitation (TR) is a common yet often overlooked valvular disorder that carries a substantial impact on morbidity and mortality. It is increasingly recognized as a heterogeneous entity with different phenotypes identified (primary, atrial secondary, ventricular secondary, and cardiac implantable electronic device-related). Contemporary population studies and disease-specific registries reveal that secondary TR is highly prevalent in elderly patients, those with heart failure of any phenotype, and in candidates for transcatheter aortic or mitral interventions. Prognosis varies widely according to aetiology, with atrial secondary TR consistently associated with better survival than ventricular secondary TR. Across diverse settings, TR severity is an independent predictor of mortality, and several clinical scores, including the TRI-SCORE, Wang score, and TRIO score, have been developed to refine risk stratification. Recent staging models integrating ventricular function, renal status, and biomarkers suggest that intervention during an intermediate disease phase, before irreversible end-organ damage, may optimize outcomes. Together, these advances underscore the need for accurate phenotyping, structured prognostic assessment, and timely intervention to improve the care of patients with TR.
Donation after circulatory death (DCD) donors have expanded the heart transplant donor pool. Current DCD recovery strategies typically require donor heart reanimation but remain limited by logistical complexity, cost, and ethical concerns. These challenges are further amplified in heart-lung transplantation. Although brain-dead donors (DBD) have historically been the primary source of heart-lung blocs, successful DCD heart-lung transplantation has recently been reported. However, most cases rely on thoracoabdominal normothermic regional perfusion (TA-NRP), which has limited global adoption and raises concerns regarding ethical considerations and lung utilization. Rapid recovery with extended ultra-oxygenation preservation (REUP) has recently emerged as an alternative strategy for DCD heart recovery without pre-implant reanimation. In this report, we describe the first application of the REUP technique in concert with direct lung procurement to recover an en bloc heart-lung, enabling successful combined heart-lung transplantation with excellent early graft function.
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A history of prior cardiac surgery (PCS) determines treatment decision and long-term outcomes in patients requiring aortic valve replacement. This study examined patient profiles, treatment-decisions and long-term outcomes of patients under 75 years with PCS undergoing transcatheter and surgical aortic valve implantation/replacement (TAVI, SAVR) in the Netherlands. Data from 1,284 patients (ages 50-75 years) with PCS undergoing TAVI or SAVR between 2015 and 2020 were analyzed using data from the Netherlands Heart Registration. Logistic and cox regression identified determinants of treatment selection and long-term mortality. Determinants were considered impactful if they had an odds ratio (OR) or hazard ratio (HR) of ≥ 1.5 or ≤ 0.7 and a prevalence of ≥ 5%. Of 1,284 patients, 690 underwent TAVI (54%) and 594 SAVR (46%). Prior index surgery most frequently involved coronary artery bypass grafting (CABG) (57% in the TAVI group vs 40% in the SAVR group; p < 0.001) and previous aortic valve surgery (25% vs 51%; p < 0.001). TAVI patients were significantly older (median 71 vs. 67 years, p < 0.001) and had a higher EuroSCORE II (median 5.7 vs. 4.4, p = 0.003) than SAVR patients. SAVR was the preferred strategy for intermediate-risk patients (62%), while TAVI was favored in high- and prohibitive-risk patients (62% and 94%, respectively). In descending order of odds ratio, the strongest independent determinants of TAVI selection were left ventricular ejection fraction ≤ 30% ((OR: 4.8; 95% CI: 2.6-8.8), poor mobility ((OR: 3.4; 95% CI: 1.6-7.0) and obesity/cachexia (OR 2.7; 95% CI: 1.6-4.4); the key determinants of SAVR selection were pure native aortic regurgitation (OR: 0.1; 95% CI: 0.1-0.3) and failing surgical bioprosthesis (OR: 0.7; 95% CI: 0.5-1.0. Thirty-day, 1- and 5 year survival after TAVI and SAVR was 97% and 96%, 83% and 91%, and 56% and 83%, respectively (p-value < 0.001). Left ventricular ejection fraction ≤ 30% and chronic lung disease were important mortality determinants for both procedures, with higher odds ratios for mortality in SAVR as compared to in TAVI patients. In the Netherlands, TAVI and SAVR rates were comparable among patients < 75 years with PCS. Higher-risk patients were directed toward TAVI except for those presenting with pure native aortic regurgitation and bioprosthesis failure who mainly received SAVR. Severe left ventricular dysfunction and chronic lung disease were key mortality predictors for both procedures.
To evaluate the real-world impact of implementing routine postoperative amino acid infusion on cardiac surgery-associated acute kidney injury (AKI). Before-and-after study. Intensive care unit (ICU). Adult patients undergoing cardiac surgery. Ringer lactate solution as maintenance solution after admission to the ICU for the first 48 postoperative hours versus 4% amino acid solution infusion for the first postoperative 48 hours. The primary outcome was AKI development according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria (stages 1, 2, and 3). The authors performed a multivariable analysis to identify predictors of AKI in the study cohort. During the study period, 520 patients underwent cardiac surgery and were included in the final study cohort: 147 consecutive patients received Ringer lactate solution (June 15, 2024, or earlier) while 373 consecutive patients received amino acid solution (after June 15, 2024). The overall incidence of AKI was higher in the Ringer lactate group than in the amino acid group (41.5% v 30.0%, p = 0.012), with the magnitude and direction of findings confirmed for stage 1, 2, and 3 AKI. The authors performed a multivariable analysis to identify predictors of AKI. After adjustment for potential confounders, amino acids remained associated with a reduction in the overall incidence of AKI in a multivariate analysis. Postoperative amino acids are effective in reducing AKI in a real-world setting.
With the adoption of lung cancer screening worldwide, there will be more patients presenting with early-stage lung cancer. Many of these patients are elderly (≥ 80 years old). We aimed to determine the best treatment option for this group of patients. Between 2013 and 2023, 160 patients aged ≥ 80 years with early-stage lung cancer (T1-2, N0) underwent either surgical resection (78 patients) or stereotactic ablative radiotherapy (SABR) (82 patients). Propensity-score matching with replacement was applied, in conjunction with analysis of the unmatched cohort, to assess differences related to age, performance status (PS), forced expiratory volume in the first second (FEV1), and Charlson Comorbidity Index (CCI). There was a significant difference in overall survival and 5-year survival of patients who underwent surgery compared to SABR (29% vs. 19.9%; p < 0.001; 52.5% vs. 23.1%; p = 0.001). The SABR group had a lower rate of recurrence compared to the surgery group, but this difference was not significant (12.2% vs. 15.3%; p = 0.558). The propensity score-matched cohort yielded 73 pairs, and suggested better survival at 5 years for patients who underwent surgery compared to SABR (54.5% vs. 18.5%; p < 0.001). Surgery may provide a survival benefit when compared to SABR therapy for elderly patients in the longer term. SABR remains an important consideration for those who may not tolerate surgery, especially in the short term.
We present the case of a 22-year-old female with a history of systemic lupus erythematosus and antiphospholipid syndrome, complicated by recurrent deep vein thrombosis of the lower extremities and pulmonary embolism, who subsequently developed chronic thromboembolic pulmonary hypertension. The patient presented with progressive dyspnea, ultimately limiting daily activities, and was managed with long-term anticoagulation and pulmonary vasodilator therapy. Diagnostic workup, including imaging and hemodynamic assessment, revealed multiple bilateral segmental perfusion defects, right heart dilation, and significantly elevated pulmonary pressures with increased pulmonary vascular resistance, consistent with operable chronic thromboembolic disease. The patient underwent pulmonary endarterectomy via median sternotomy under cardiopulmonary bypass with deep hypothermia and intermittent total circulatory arrest. Two periods of circulatory arrest, of 19 and 18 minutes, were utilized during the procedure. Organized thromboembolic material was successfully removed from both pulmonary arteries, achieving adequate endarterectomy planes without major intraoperative complications. In the immediate postoperative period, the patient remained hemodynamically stable, with expected improvement in right ventricular afterload and pulmonary hemodynamics. This case highlights the importance of recognizing chronic thromboembolic pulmonary hypertension in young patients with autoimmune disease and recurrent thrombotic events, as well as the role of pulmonary endarterectomy as a potentially curative treatment when performed in specialized centers.
To compare the diagnostic performance of 4 clinical prediction scores for heparin-induced thrombocytopenia (HIT) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Bicentric retrospective observational study. Two tertiary university hospitals in France. Adult patients who underwent cardiac surgery with CPB between 2014 and 2021 and for whom HIT testing was requested during the postoperative period. None. HIT diagnosis was established using a standardized approach combining anti-platelet factor 4/heparin IgG enzyme-linked immunosorbent assay, a functional platelet activation test, and multidisciplinary clinical adjudication. Among 283 patients investigated for suspected HIT, 55 (19%) were classified as HIT-positive. The diagnostic performance of 4 clinical probability scores, the 4Ts score, the HIT Expert Probability score, the cardiopulmonary bypass score, and the Groupe Français d'Étude sur l'Hémostase et la Thrombose score, was assessed using receiver operating characteristic (ROC) curves and formally compared using the DeLong nonparametric test for correlated ROC curves. Areas under the ROC curve ranged from 0.79 (cardiopulmonary bypass) to 0.86 (HIT Expert Probability), with no statistically significant differences observed between scores. Using optimized thresholds, negative predictive values ranged from 94% to 96%, whereas positive predictive values remained modest (31%-49%). HIT-positive patients exhibited a characteristic biphasic platelet count pattern, with an initial postoperative decline followed by a delayed second nadir around postoperative day 10. Among HIT-positive patients, the 30-day and 1-year mortality rates were 9.1% and 14.5%, respectively. Median intensive care unit and hospital lengths of stay were 11 [6-18] and 23 [18-32] days. In patients undergoing cardiac surgery with CPB, no clinical probability score has demonstrated clear superiority for the diagnosis of HIT. Their principal clinical value lies in their high negative predictive performance, supporting their use as rule-out tools. Diagnostic strategies specifically tailored to the cardiac surgery setting remain needed and warrant prospective validation.