Trasplante cardíaco

Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6):ivaf139. doi: 10.1093/icvts/ivaf139.

NO ABSTRACT

PMID:40538181 | DOI:10.1093/icvts/ivaf139

PM R. 2025 Jun 19. doi: 10.1002/pmrj.13433. Online ahead of print.

ABSTRACT

BACKGROUND: In-reach rehabilitation is a relatively new model of care available in a small number of Australian public hospitals. These multidisciplinary teams deliver evidence-based structured rehabilitation to carefully selected patients during acute care. There are no published rehabilitation outcomes in heart and/or lung transplant recipients.

OBJECTIVE: To describe the rehabilitation outcomes of a cohort of heart and/or lung transplant recipients.

DESIGN: Retrospective cohort study.

SETTING: One metropolitan institution with the largest heart and lung transplant service in Australia.

PATIENTS: Between 2014 and 2023, a total of 957 heart and/or lung transplants were performed at this institution.

INTERVENTION: In-reach rehabilitation was delivered to selected patients during the 10-year period. However, from 2019 onwards, patients were proactively screened by the rehabilitation team for eligibility as well as referred from the acute transplant teams.

MAIN OUTCOME MEASURES: Functional independence measure (FIM) changes and percentage of patients going to inpatient rehabilitation after completion of acute care.

RESULTS: In-reach rehabilitation was received by 223 (24.3%) patients. With the exception of three patients (who died), the vast majority were able to complete an in-reach rehabilitation program and were discharged to the community (n = 98, 43.9%), inpatient rehabilitation (n = 119, 53.4%), or transferred to another hospital (n = 3, 1.3%), demonstrating feasibility. Across the cohort, the median admission and discharge FIM scores were 77.0 (interquartile range, 60-94.8) and 100 (interquartile range, 77-118), respectively, demonstrating significant functional improvements from start to finish of the in-reach rehabilitation program (p < .001). Over this period, the number of patients discharged to inpatient rehabilitation decreased as a proportion of the total number of transplants (25.7% in 2014, 47.8% in 2017, 34.7% in 2019, 26.2% in 2021, 8.0% in 2023). Proactive rehabilitation screening implemented from 2019 allowed for earlier and longer program delivery to more patients.

CONCLUSIONS: In-reach rehabilitation is feasible in acute care after heart and/or lung transplantation and was associated with functional improvements. The addition of proactive rehabilitation screening appeared to improve the effectiveness of the in-reach rehabilitation program.

PMID:40538100 | DOI:10.1002/pmrj.13433

Innovations (Phila). 2025 Jun 19:15569845251337720. doi: 10.1177/15569845251337720. Online ahead of print.

ABSTRACT

OBJECTIVE: Partial heart transplantation (PHT) is a new procedure that delivers growing heart valve implants for children. However, awareness, attitudes, and perceptions of health care professionals regarding PHT remain unexplored.

METHODS: A national survey was conducted among members of the Congenital Heart Surgical Society, pediatric cardiac intensive care unit (ICU) directors, medical students, and organ procurement organization (OPO) representatives. The survey measured their awareness, perceptions, and attitudes toward PHT. Perceptions and attitudes were measured using a 5-point Likert scale. Statistical comparisons in ranked responses between survey questions were calculated using two-way analysis of variance, with multiple comparisons assessed by a Tukey post hoc test.

RESULTS: There were responses from 95 medical students (12.1%), 32 congenital cardiac surgeons (10.26%), 21 pediatric ICU directors (16.8%), and representatives from 8 OPOs (15%). Prior to survey distribution, 20% of students were aware of PHT. In contrast, almost all congenital heart surgeons (96.88%) and pediatric cardiologists (100%) were aware of PHT. Although surgeons and cardiologists understand the concepts of PHT, cardiologists were less likely to recommend and inform their patients about the procedure if they meet the criteria (Likert scale scores of 4.68 vs 3.14, P = 0.01 and 4.38 vs 3.69, P = 0.01, respectively). Surgeon and cardiologist perceptions regarding the use of PHT for different patient age groups were significantly different (P < 0.001).

CONCLUSIONS: Even though PHT is a relatively recent innovation, it is well known among pediatric cardiac surgeons and pediatric intensive care directors.

PMID:40538051 | DOI:10.1177/15569845251337720

Cardiooncology. 2025 Jun 19;11(1):55. doi: 10.1186/s40959-025-00354-1.

ABSTRACT

BACKGROUND: Childhood cancer survivors (CCS) often develop late complications after their primary disease is cured. Cardiovascular disease is one of the most frequent and serious complications that significantly affects prognosis and quality of life. Early detection and appropriate intervention are expected to improve their prognosis. However, the risk factors for late cardiotoxicity in CCS are not well defined, and biomarkers that can detect cardiac dysfunction prior to the development of heart failure have not yet been established.

METHODS: Medical records of childhood hematologic cancer survivors referred to our department for transitional care between January 2016 and October 2023 were reviewed for this cross-sectional study. The relationships between the most recent cardiac function at the review and history of cancer treatment were analyzed.

RESULTS: This study included 34 patients and the median elapsed time since cancer diagnosis was 16.5 years (range, 5-30 years). None of the patients had symptomatic cardiac complications. The E/e' ratio was significantly higher in survivors with a history of hematopoietic stem cell transplantation (HSCT) than in those who did not undergo HSCT (median, 8.4% vs. 6.25%, P = 0.040), while no intergroup differences were observed in ejection fraction (EF), global longitudinal strain (GLS), or the brain natriuretic protein (BNP) level. In addition, the E/e' ratio was positively correlated with years elapsed since cancer diagnosis (ρ = 0.38, P = 0.034). While there was no clear correlation between years since cancer diagnosis and the BNP level in the overall cohort, a strong correlation was found in patients with a history of HSCT (ρ = 0.73; P < 0.01). No significant differences were observed in EF, E/e' ratio, GLS, and BNP level by cumulative anthracycline dose or history of chest irradiation.

CONCLUSIONS: In this study, no patient had late symptomatic cardiac complications. However, in those who had survived for a long time since their cancer diagnosis, particularly those with a history of HSCT, there were significant elevations in the E/e' ratio and the BNP level. Continuous follow-up is required to determine whether these abnormalities lead to symptomatic cardiotoxicity and whether they serve as useful markers for the early detection of cardiac complications.

PMID:40537853 | PMC:PMC12177987 | DOI:10.1186/s40959-025-00354-1

Clin Lymphoma Myeloma Leuk. 2025 May 23:S2152-2650(25)00179-X. doi: 10.1016/j.clml.2025.05.014. Online ahead of print.

ABSTRACT

BACKGROUND: Amyloidosis is a condition characterized by deposition of insoluble protein fibrils in tissues, leading to diverse clinical manifestations. There is limited data addressing amyloidosis from India.

OBJECTIVE: This study aims to systematically review the available clinical data on amyloidosis in India. By synthesizing existing knowledge, the review seeks to identify research gaps that require further exploration.

METHODS: A systematic review was conducted using the PubMed database to identify English-language articles on amyloidosis from India published between 1959-2023. Additionally, abstracts from international conferences were analyzed. Data extracted were-type of amyloidosis, demographics, clinical presentation, diagnostic methods, and outcomes.

RESULTS: The median age at presentation in Indian patients was approximately 10 years younger (50 years) compared to their counterparts in Western countries (60 years), with males comprising 70% of the cases. Renal involvement was the most common, with AA being more prevalent than AL amyloidosis, often secondary to tuberculosis. Cardiac involvement was second most common, affecting 40%-50% of patients. In patients with paraproteinemic neuropathies, AL amyloidosis accounts for the cause in 4% cases. Treatment of AL amyloidosis primarily involved chemotherapy and supportive care, with autologous transplantation underutilized due to resource limitations. Amongst localized amyloidosis, skin was the most common site (68% of all cases).

CONCLUSION: Amyloidosis in India remains a significant and often underdiagnosed condition, with varied presentations and causes. Most data come from retrospective studies, highlighting variability in presentation and outcomes. This review underscores the importance of understanding the disease burden and advancing research to improve outcomes in India.

PMID:40537367 | DOI:10.1016/j.clml.2025.05.014

JACC CardioOncol. 2025 Jun;7(4):411-413. doi: 10.1016/j.jaccao.2025.04.002.

NO ABSTRACT

PMID:40537189 | DOI:10.1016/j.jaccao.2025.04.002

JACC CardioOncol. 2025 Jun;7(4):393-395. doi: 10.1016/j.jaccao.2025.05.008.

NO ABSTRACT

PMID:40537188 | DOI:10.1016/j.jaccao.2025.05.008

JACC CardioOncol. 2025 Jun;7(4):382-392. doi: 10.1016/j.jaccao.2025.05.002.

ABSTRACT

BACKGROUND: Postural orthostatic tachycardia (POTS) and orthostatic hypotension (OH) commonly occur after hematopoietic stem cell transplantation (HSCT).

OBJECTIVES: This study sought to determine the prevalence of POTS and OH before HSCT and the incidence of new cases after HSCT.

METHODS: In this single-center, prospective study, patients were evaluated 30 days before and 30 and 100 days after HSCT. Blood pressure, heart rate, and plasma norepinephrine levels were measured in the supine position and after a 10-minute active stand test to assess for POTS or OH. After HSCT, adrenergic receptor (AR)-modulating autoantibody activity was measured in 8 subjects with POTS and 8 without.

RESULTS: Among 46 patients, 40 (87.0%) underwent autologous and 6 (13.0%) allogeneic HSCT. Multiple myeloma was the most common indication (67.4%). Before HSCT, the prevalence of both POTS and OH was 4.3%. At 30 days after HSCT, POTS was present in 10 (25.6%) of 39 patients, including 9 (23.1%) new cases, and OH in 6 (15.4%), including 5 (12.8%) new cases. Patients with POTS at 30 days showed a significantly greater increase in norepinephrine levels upon standing (median 231% [Q1-Q3: 179%-343%]) compared with before HSCT (median 100% [Q1-Q3: 62%-183%]) (P = 0.005), which positively correlated with heart rate changes. AR-modulating autoantibody activity was also higher in patients with POTS vs those without and directly correlated with heart rate changes.

CONCLUSIONS: Approximately 1 in 4 patients developed POTS after HSCT, characterized by exaggerated increases in norepinephrine upon standing and elevated AR-modulating autoantibody activity.

PMID:40537187 | DOI:10.1016/j.jaccao.2025.05.002

J Mol Med (Berl). 2025 Jun 19. doi: 10.1007/s00109-025-02564-7. Online ahead of print.

ABSTRACT

Tumor necrosis factor-α-inducible protein 8-like 2 (TIPE2) is a novel regulatory factor involved in innate and adaptive immunity that negatively regulates the functions of toll-like receptors and T-cell receptors. Its selective expression within the immune system serves to inhibit inflammatory responses and maintain immune homeostasis. Inflammation and immune cell signaling initiate the innate immune response in the cardiovascular system through intricate acute and chronic adaptation processes, resulting in tissue damage and significantly contributing to the onset and progression of cardiovascular diseases. Consequently, TIPE2 presents a potential target for the diagnosis and treatment of various cardiovascular diseases. This paper reviews the structural characteristics and biological functions of TIPE2, as well as its role in the onset and progression of cardiovascular diseases, providing new strategies for prevention and treatment.

PMID:40536707 | DOI:10.1007/s00109-025-02564-7

J Biosci. 2025;50:49.

ABSTRACT

Inhalation burns, especially when combined with thermal burns, can be fatal and significantly increase mortality rate through inhaling hazardous gas. However, there is no specific treatment for inhalation burns except for relieving bronchospasm and cleaning the airways. In particular, inhaled sulfur dioxide (SO2), a major component of inhalation burns, can easily be hydrated in the respiratory tract to produce sulfurous acid, which subsequently dissociates to form bisulfite and sulfite derivatives. In this study, we intend to assess whether human adipose-derived stem cell (ASC) exosomes rescue respiratory system-related cells damaged by exposure to SO2 derivatives. We found that the uptake of ASC exosomes was high in human respiratory systemrelated cells and they rescue decreased proliferation of cells damaged by treatment with SO2 derivatives. In human pulmonary endothelial cells (HPMECs), total tubule length was increased by pre-treatment of ASC exosomes through an in vitro angiogenesis assay. Besides, we confirmed that ASC exosomes alleviate increased expression of inflammation-related genes by treatment of SO2 derivatives in primary respiratory epithelial cells. Taken together, these results suggest that ASC exosomes have potential in regeneration of human respiratory system-related cells damaged by inhalation burns, which currently lack specific treatment methods.

PMID:40536194

Clin Transplant. 2025 Jun;39(6):e70214. doi: 10.1111/ctr.70214.

ABSTRACT

INTRODUCTION: Consensus regarding what defines acceptable heart transplant (HT) donors or recipients is lacking. This survey analyzed how risk factors guide donor and recipient selection, and how practices vary across systems.

METHODS: An online survey was conducted among adult HT centers in the US and Eurotransplant (ET) region. We aimed to represent at least 50% of the total adult HT volumes in both regions. Centers were stratified by their HT volumes. To compensate for non-responders, a safety margin was included, and centers accounting for at least 75% of the total HT volumes were contacted. Centers were queried on relative thresholds and absolute cutoffs for continuous risk factors. For other factors, their influence on donor heart acceptance or the likelihood of listing recipients was assessed.

RESULTS: Fifty-three centers from five countries participated: 39 US (accounting for 51.0% of the US HT volume), and 14 ET centers (65.0%) from four countries. ET centers more liberally considered advanced age donor hearts (threshold 64.5 [60.0-70.0] vs. 50.0 [50.0-55.0] years, p < 0.001), and hearts with abnormal echocardiography or coronary findings. Diabetes, smoking, and hypertension were rated by a quarter to more than half of US and ET centers as moderately or heavily influencing donor heart acceptance. ET centers more liberally listed candidates with chronic kidney disease (GFR 30.0 [21.5-32.5] vs. 35.0 [30.0-40.0] mL/min/1.73m2, p < 0.001). US centers, conversely, allowed for higher candidate ages (71.5 [70.0-74.0] vs. 68.0 [65.0-70.0] years, p < 0.001), and more likely (76.9%) listed candidates on ECMO support (42.9% of ET centers to less likely list, p = 0.022).

CONCLUSION: Selection practices differed distinctly between the US and ET. Further, practices appear to be driven by caution and are more conservative than current guidelines. Strengthening the evidence base to objectify and optimize donor and candidate selection could help alleviate the unmet need for donor hearts.

PMID:40536071 | DOI:10.1111/ctr.70214

Therap Adv Gastroenterol. 2025 Jun 16;18:17562848251347347. doi: 10.1177/17562848251347347. eCollection 2025.

ABSTRACT

Although radiotherapy is the second most effective cancer treatment, radiation injuries limit its use. About 80% of abdominal-pelvic radiotherapy patients develop acute radiation enteritis, with 20% discontinuing radiotherapy. The lack of effective mitigation measures restricts its clinical application. Recent studies have proposed gut microbiota as a potential biomarker for radiation injuries. However, the interaction between gut microbiota and radiation injuries remains poorly understood. This review summarizes two forms of interaction between gut microbiota and radiation injuries based on the location of the radiation field. One type of interaction, referred to as "direct interaction," involves changes in the diversity and composition of gut microbiota, alterations in microbiota-derived metabolites, disruption of the intestinal barrier, activation of inflammatory responses within the intestine, and involvement of the host's immune system. The second form, called "indirect interaction," includes the influence of the gut microbiota on various body systems, such as gut microbiota-brain axis, gut microbiota-cardiopulmonary axis, and gut microbiota-oral axis. Additionally, we examine promising interventions aimed at reshaping the gut microbiota, including the use of probiotics, prebiotics, and fecal microbiota transplantation. The interaction between radiation injuries and gut microbiota is more complex than previously understood. Therefore, further clarification of the underlying mechanisms will facilitate the application of gut microbiota in preventing and alleviating radiation injuries.

PMID:40535532 | PMC:PMC12174693 | DOI:10.1177/17562848251347347

World J Transplant. 2025 Jun 18;15(2):99992. doi: 10.5500/wjt.v15.i2.99992.

ABSTRACT

BACKGROUND: Since being declared as a pandemic on March 11, 2020, coronavirus disease 2019 (COVID-19) has profoundly influenced heart and lung transplant programs, impacting donor availability, patient management, and healthcare resources. This study offers a citation-based review of the research output on this subject, seeking to understand how the transplant community has responded to these challenges. Through a review of literature from the beginning of the pandemic to early 2023, we evaluate the shifts in academic emphasis and the emerging trends in heart and lung transplantation during the COVID-19 period.

AIM: To assess the impact of COVID-19 on heart and lung transplantation research, highlighting key themes, contributions, and trends in the literature during the pandemic.

METHODS: We conducted an extensive search of the Web of Science database on February 9, 2023. We employed the terms "transplant" and "transplantation", as well as organ-specific terms like "heart", "cardiac", and "lung", combined with COVID-19-related terms such as "COVID-19", "coronavirus", and "SARS-CoV-2". The search encompassed publications from March 11, 2020 to February 9, 2023. Data on authors, journals, countries, institutions, and publication types (articles, reviews, conference papers, letters, notes, editorials, brief surveys, book chapters, and errata) were analyzed. The data was visualized and processed with VOSviewer 1.6.18 and Excel.

RESULTS: We included 847 research items. There were 392 articles (46.3%) and 88 reviews (10.3%). The studies included were referenced 7757 times, with an average of 9.17 citations per article. The majority of the publications (n = 317) were conducted by institutes from the United States with highest citations (n = 4948) on this subject, followed by Germany, Italy, and France. The majority of papers (n = 101) were published in the Journal of Heart and Lung Transplantation.

CONCLUSION: To the fullest extent of our knowledge, this is the first bibliometric study of COVID-19's impact on heart and lung transplantation to offer a visual analysis of the literature in order to predict future frontiers and provide an overview of current research hotspots.

PMID:40535501 | PMC:PMC11886284 | DOI:10.5500/wjt.v15.i2.99992

World J Transplant. 2025 Jun 18;15(2):102384. doi: 10.5500/wjt.v15.i2.102384.

ABSTRACT

BACKGROUND: Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection. However, the risk of malignancy associated with prolonged immunosuppression remains a concern, as it can adversely affect recipients' quality of life and survival. While the link between immunosuppression and increased cancer risk is well-documented, the specific interactions between graft rejection and post-transplant malignancy (PTM) remain poorly understood. Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.

AIM: To investigate whether immunosuppression in PTM reduces rejection risk, while immune activation during rejection protects against malignancy.

METHODS: We analyzed data from the United Network for Organ Sharing's Organ Procurement and Transplantation Network database (1987-2023) on adult, first-time, single-organ transplant recipients with no prior history of malignancy (in donors or recipients). Landmark analyses at 1, 2, 3, 5, 10, 15, and 20 years post-transplant, Kaplan-Meier analyses, and time-dependent Cox proportional hazards regression models, each incorporating the temporal dimension of outcomes, assessed the association between rejection-induced graft failure (RGF) and PTM. Multivariate models were adjusted for clinical and immunological factors, including immunosuppression regimens.

RESULTS: The cohort included 579905 recipients (kidney: 386878; liver: 108390; heart: 45046; lung: 37643; pancreas: 1948) with a mean follow-up of 7.3 years and a median age of 50.6 ± 13.2 years. RGF was associated with a reduction in PTM risk across all time points [hazard ratio (HR) = 0.07-0.20, P < 0.001], even after excluding mortality cases. Kidney transplant recipients exhibited the most pronounced reduction (HR = 0.22, P < 0.001). Conversely, among recipients with PTM, RGF risk decreased across all time points up to 15 years after excluding mortality cases (HR = 0.49-0.80, P < 0.001). This risk reduction was observed in kidney, liver, heart, and lung transplants (HRs = 0.90, 0.21, 0.21, and 0.18, respectively; P < 0.001) but not in pancreas transplants.

CONCLUSION: RGF reduces PTM risk, particularly in kidney transplants, while PTM decreases RGF risk in kidney, liver, heart, and lung transplants.

PMID:40535498 | PMC:PMC11886299 | DOI:10.5500/wjt.v15.i2.102384

World J Transplant. 2025 Jun 18;15(2):99208. doi: 10.5500/wjt.v15.i2.99208.

ABSTRACT

BACKGROUND: The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant (LT).

AIM: To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.

METHODS: This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome, Italy. Cardiac contraindications for LT listing were defined after a center-specific cardiac workup, which included cardiac stress tests for most patients. The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic (AUROC) method.

RESULTS: A total of 342 LT candidates were evaluated between 2015 and 2019, with a moderate cardiovascular risk profile (37% diabetes, 34% hypertension, 22% obesity). Of these, 80 (23%) candidates underwent coronary angiography. Twenty-one (6%) candidates were given cardiac contraindications to LT listing, 48% of which were due to coronary artery disease. The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81. The optimal cut-off for sensitivity was a CAR-OLT score ≤ 23, which showed a 99% negative predictive value for cardiac contraindications to LT listing. A total of 84 (25%) LT candidates with a CAR-OLT score ≤ 23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing, with estimated costs of approximately 48000€. The estimated savings per patient was €574.70 for the Italian National Health System.

CONCLUSION: A CAR-OLT score ≤ 23 can identify LT candidates who can be safely listed without the need for cardiac stress tests, providing time and cost savings. These findings require external validation.

PMID:40535490 | PMC:PMC11886293 | DOI:10.5500/wjt.v15.i2.99208

World J Transplant. 2025 Jun 18;15(2):101005. doi: 10.5500/wjt.v15.i2.101005.

ABSTRACT

Lung transplantation (LT) is now an accepted therapy for end stage lung disease in appropriate patients. Atrial arrhythmias (AA) can occur after LT. Early AA after LT are most often atrial fibrillation, whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia. The causes of AA are multifactorial. The review begins with a brief history of LT and AA. This review further describes the pathophysiology of the AA. The risk factors, incidence, recipient characteristics including intra-operative factors are elaborated on. Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT, the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia. The strategy of rate control vs rhythm control is discussed. The pros and cons of various drug regimen, need for direct current cardioversion and catheter ablation therapies are considered. Possible methods to prevent or reduce the incidence of AA after LT are considered. The impact of AA on the short-term and long-term outcomes following LT is discussed.

PMID:40535489 | PMC:PMC11886302 | DOI:10.5500/wjt.v15.i2.101005

World J Transplant. 2025 Jun 18;15(2):99241. doi: 10.5500/wjt.v15.i2.99241.

ABSTRACT

Lung transplantation (LT) is currently a surgical therapy option for end-stage lung disease. Venous thromboembolism (VTE), which can occur after LT, is associated with significant morbidity and mortality. Because of improved outcomes, increasing numbers of patients are receiving LT as treatment. Patients on the waitlist for LT tend to be older with weakness and frailty in addition to pulmonary symptoms. These factors contribute to a heightened risk of postoperative VTE. Furthermore, patients who clinically deteriorate while on the waitlist may require extra corporeal membrane oxygenation as a bridge to LT. Bleeding and thromboembolism are common in these patients. Pulmonary embolism (PE) in a freshly transplanted lung can have significant effects leading to morbidity and mortality. PE typically leads to impairment of gas exchange and right ventricular strain. In LT, PE can affect healing of bronchial anastomosis and may even contribute to the development of chronic allograft lung dysfunction. This article discussed the incidence, clinical features and diagnosis of VTE after LT. Furthermore, the treatment modalities, complications, and outcomes of VTE were reviewed.

PMID:40535488 | PMC:PMC11886300 | DOI:10.5500/wjt.v15.i2.99241

World J Transplant. 2025 Jun 18;15(2):100460. doi: 10.5500/wjt.v15.i2.100460.

ABSTRACT

Heart transplantation (HTx) is a life-saving procedure for patients with end-stage heart failure and has undergone remarkable advancements since the first successful transplant in 1967. The introduction of cyclosporine in the 1970s significantly improved patient outcomes, leading to a global increase in transplants, including in India, where the practice has grown despite initial challenges. This review provides an extensive overview of HTx, focusing on current practices, technological advancements, and the ongoing challenges the field faces today. It explores the evolution of surgical techniques, such as minimally invasive and robotic-assisted procedures, and the management of posttransplant rejection through tailored immunosuppressive strategies, including new monoclonal antibodies and personalized therapies. The review also highlights emerging innovations such as mechanical circulatory support devices and xenotransplantation as potential solutions to donor shortages while acknowledging the ethical and logistical challenges these approaches entail. Furthermore, the analysis delves into the implications of using extended-criteria donors and the role of multidisciplinary teams in evaluating absolute and relative contraindications. Despite the progress made, the persistent issues of organ scarcity and ethical concerns underscore the need for ongoing research and innovation to further enhance the efficacy, safety, and accessibility of HTx.

PMID:40535486 | PMC:PMC11886295 | DOI:10.5500/wjt.v15.i2.100460

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):933-936. doi: 10.1007/s12055-024-01892-6. Epub 2025 Jan 7.

ABSTRACT

We describe a case of profound coagulopathy during orthotopic heart transplantation in a cyanotic single ventricle pediatric patient with an intracorporeal continuous flow ventricular assist device performed on bivalirudin for heparin-induced thrombocytopenia. This was successfully managed with central veno-arterial extracorporeal membrane oxygenation and hemofiltration as an adjunct to treat bivalirudin-induced coagulopathy due to lack of a reversal agent for bivalirudin.

PMID:40535220 | PMC:PMC12170461 | DOI:10.1007/s12055-024-01892-6

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):892-905. doi: 10.1007/s12055-025-01900-3. Epub 2025 Apr 17.

ABSTRACT

The enhanced survival rates of patients with functionally univentricular hearts can be credited to the ongoing development of surgical techniques and improved perioperative care. Hence, the population of single ventricle patients reaching the treating physician is increasing. Many of these patients go on to develop end-stage heart failure and may need a heart transplant. In this subgroup, the scarcity of donors calls for the potential necessity of employing mechanical circulatory support to facilitate heart transplantation. Ventricular assist devices are crucial in supporting the failing myocardium and improving systemic perfusion and tissue oxygenation. However, their implantation poses significant challenges due to the unique intrinsic anatomical and physiological characteristics of these patients. There is mounting evidence bolstering the use of ventricular assist devices in a subset of patients with functionally univentricular hearts. The purpose is to examine the evolution and current role of ventricular assist devices in this spectrum of patients, including its challenges and outcomes.

PMID:40535218 | PMC:PMC12170974 | DOI:10.1007/s12055-025-01900-3