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Medicine (Baltimore). 2025 Jun 20;104(25):e43043. doi: 10.1097/MD.0000000000043043.

ABSTRACT

RATIONALE: Heart transplantation (HT) represents the optimal treatment for patients with end-stage heart disease. However, it is prone to numerous postoperative complications, among which cardio-renal syndrome (CRS) is particularly serious and carries a high mortality rate. Continuous renal replacement therapy is an essential supportive treatment for these patients, but its efficacy is highly dependent on precise nursing management. Currently, there are few reports on the care of CRS complicating HT both domestically and internationally. This case is presented in this report to provide reference for clinical work.

PATIENT CONCERNS: This report details the case of a 31-year-old man who underwent an in situ HT due to dilated cardiomyopathy with class IV cardiac function. Following the operation, he developed CRS, which led to oliguria, rapid deterioration of renal function, and cardiac failure.

DIAGNOSES: Cardiorenal syndrome, chronic kidney disease stage 4, post-dilated cardiomyopathy surgery, HT status, heart function class IV (NYHA classification).

INTERVENTIONS: This includes implementing a personalized continuous renal replacement therapy (CRRT) program and providing excellent CRRT care; closely monitoring for rejection and the side effects of immunosuppressants; and offering comprehensive psychological support.

OUTCOMES: After undergoing CRRT for 5 weeks, the patient's 24-hour urine volume, glomerular filtration rate, and N-terminal brain natriuretic peptide precursor levels stabilized, leading to discharge with improved renal function.

LESSONS: The key to a favorable renal function prognosis is the use of CRRT for precise volume management. Careful management of internal jugular vein catheterization is crucial for preventing infections in post-heart transplant patients. Additionally, monitoring the side effects of immunosuppressive drugs and signs of rejection are essential nursing points for patients with cardiorenal syndrome. Providing psychological care in various forms to patients and their families can help improve disease outcomes and ensure long-term efficacy after transplantation.

PMID:40550023 | PMC:PMC12187291 | DOI:10.1097/MD.0000000000043043

J Vis Exp. 2025 Jun 6;(220). doi: 10.3791/68090.

ABSTRACT

The number of advanced heart failure patients who can receive a heart transplant is limited by a shortage of suitable organ donors. In efforts to expand the donor pool, alternative donation and procurement methods have been developed, including heart transplantation following donation after circulatory death (DCD HT). While short-term survival following DCD HT is non-inferior to heart transplantation with brain-dead donors, there may be an increased rate of primary graft dysfunction (PGD) associated with DCD HT allografts. The underlying etiology of PGD is multifactorial and incompletely understood. For DCD HT allografts, the period of warm ischemic injury during DCD procurement is a potential risk factor for PGD to which brain death allografts are not exposed. The functional warm ischemic time thus may be an important driver of PGD in DCD HT. However, the mechanisms underlying PGD in this clinical scenario are poorly understood at the molecular level. The work presented herein aims to describe the development and validation of a high-fidelity non-survival porcine model of DCD orthotopic heart transplantation. We hypothesize that the use of this translational large animal model is critical to elucidate molecular mechanisms contributing to PGD, as well as to investigate interventions designed to optimize allograft preservation and early performance. This model replicates the perioperative and surgical approach used in DCD HT clinically, with modifications to account for porcine anatomy and physiology. The development of this large animal surgical model will not only provide mechanistic insights into the development of PGD but also can be modified to enhance translational research efforts aimed at improving organ recovery following DCD HT.

PMID:40549678 | DOI:10.3791/68090

Mol Biol Rep. 2025 Jun 23;52(1):623. doi: 10.1007/s11033-025-10729-3.

ABSTRACT

Recently, immunogene therapy has been of great interest in cardiovascular diseases. In this regard, various immune checkpoint inhibitors (ICIs) are identified to have a crucial role in regulating inflammatory responses. The T-cell immunoglobulin and mucin-domain containing molecule-3 (TIM-3, CD366), a relatively newly discovered group of molecules with a conserved structure, has emerged as a critical immune checkpoint with significant regulatory roles in cardiovascular inflammation and atherosclerosis. This prospective review explores the importance of TIM-3 in modulating immune responses relevant to ischemic heart diseases (IHD), highlighting its interactions with inflammatory pathways such as Toll-like receptor-4 (TLR-4). TIM-3, predominantly expressed on T cells, dendritic cells, and monocytes, acts as an inhibitory receptor that quenches pro-inflammatory signaling, particularly upon binding to ligands like galectin-9. Noteworthy, recent evidence suggests that TIM-3 deficiency or dysregulation can exacerbate inflammatory cascades, contributing to the progression of IHD and related complications. Here, the therapeutic potential of targeting TIM-3 for the management of IHD, especially in the settings of systemic inflammation and post-operative complications, has been discussed. By elucidating the molecular mechanisms and translational prospects of TIM-3 modulation, this work proposes new avenues for immunotherapeutic intervention in cardiovascular disease and post-operative SIRS, warranting further research in clinical trials.

PMID:40549173 | DOI:10.1007/s11033-025-10729-3

ASAIO J. 2025 Jun 23. doi: 10.1097/MAT.0000000000002487. Online ahead of print.

ABSTRACT

Although durable mechanical circulatory support (MCS) has been promising in supporting advanced heart failure patients, device hemocompatibility-related complications remain a major concern compared with heart transplantation. We investigated the blood damage potential of the three most recent clinically available, implantable MCS devices and compared their biocompatibility performance. One axial pump (HeartMate II) and two centrifugal pumps (HeartMate 3 and BrioVAD) were chosen for this study. In vitro experiments with healthy human blood and computational fluid dynamics simulations were performed to compare high-mechanical shear-induced blood trauma in these devices. Regions of higher shear stresses were identified. Power-law relations between shear stress and blood damage were implemented to assess hemolysis, platelet activation, and platelet receptor shedding of key functional receptors (glycoprotein [GP] Ibα, and GPVI) caused by these devices. HeartMate II caused the most severe blood trauma among these three devices, producing an order of magnitude larger values for hemolysis and platelet activation compared with HeartMate 3 and BrioVAD. Also, HeartMate II consistently exhibited the highest levels of receptor shedding, approximately double those caused by the HeartMate 3 and BrioVAD. The HeartMate 3 and BrioVAD centrifugal pumps showed similar performance in terms of blood damage.

PMID:40548579 | DOI:10.1097/MAT.0000000000002487

Exp Clin Transplant. 2025 May;23(5):317-327. doi: 10.6002/ect.2025.0089.

ABSTRACT

OBJECTIVES: Donation after circulatory death offers a promising solution to expand the thoracic organ donor pool, yet its application remains limited because of warm ischemia and technical barriers, especially in uncontrolled donation after circulatory death. We aimed to evaluate a pulsatile normothermic car-diopulmonary bypass-based strategy for thoracic organ recovery of uncontrolled donors after circulatory death and the effects of this strategy on graft function and recipient outcomes.

MATERIALS AND METHODS: In this prospective single-center study, we studied thoracic organs recovered from uncontrolled donors after circulatory death after ≥60 minutes of unsuccessful cardiopulmonary resuscitation. After heparinization and pharmacologic optimization, donors underwent median sternotomy and were connected to a cardiopulmonary bypass circuit with pulsatile flow. Organ assessment was performed in vivo. Donor, graft, and recipient functional data were recorded, with follow-up results studied through at least 1 year.

RESULTS: Forty-two donors were included. All hearts (n = 42) and 40 lungs (from 84 donors) were successfully transplanted. Despite prolonged cardiopulmonary resuscitation, no graft failure or recipient mortality occurred. One year survival for both heart and lung recipients was 100%. Heart grafts showed progressive improvement in functional status, including left ventricular ejection fraction, lactate levels, and New York Heart Association classification; lungs demonstrated sustained gains in gas exchange, pulmonary function tests, and 6-minute walk distance. Mild primary graft dysfunction (grade 1-2) occurred in 10% of lung recipients (all unilateral transplants). Pericardial effusion increased, likely because of trauma before procurement, but resolved without effects on function.

CONCLUSIONS: Pulsatile normothermic cardiopulmonary bypass enables successful procurement of thoracic organs from uncontrolled donors after circulatory death with excellent outcomes. This low-cost physiological approach may offer a viable strategy to expand availability of donors in resource-limited settings.

PMID:40548529 | DOI:10.6002/ect.2025.0089

Infect Control Hosp Epidemiol. 2025 Jun 23:1-8. doi: 10.1017/ice.2025.10217. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the mitigation strategies for a Candida auris outbreak in a cardiothoracic transplant intensive care unit (CTICU) and its implications for infection prevention practices.

DESIGN: Retrospective cohort study from July 2023 to February 2024.

SETTING: A large academic medical center.

METHODS: A multidisciplinary team convened to conduct the outbreak investigation and develop mitigation strategies in the CTICU.

RESULTS: From July 2023 to February 2024, 34 possible hospital-onset cases of C. auris were identified in our CTICU. Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two distinct outbreak clusters. Of the 34 patients, 11 (32.3%) were solid organ transplant recipients and 12 (35.3%) had a mechanical circulatory support device. Of the cohort, only 11/34 (32.3%) had prior exposure to high-risk healthcare facilities within six months prior to admission, as follows: acute inpatient rehabilitation facilities (AIRs) (n = 5, 14.7%), skilled nursing facilities (SNFs) (n = 3, 8.8%), and long-term acute care hospitals (LTACHs) (n = 3, 8.8%). The cohort had a median of 22.0 antibiotic-days prior to their positive results. Five (14.7%) patients had C. auris candidemia, three of whom expired likely due to infection. Infection Prevention (IP) interventions addressed several modes of transmission, including healthcare personnel hands, shared patient equipment, and the environment.

CONCLUSION: Our experience suggests that the epidemiology of C. auris may be changing, pointing towards a rising prevalence in acute care settings. IP interventions targeting hand hygiene behavior and promoting centralizing cleaning and disinfection of shared patient equipment may have contributed to outbreak resolution.

PMID:40548370 | DOI:10.1017/ice.2025.10217

Front Oncol. 2025 Jun 6;15:1570981. doi: 10.3389/fonc.2025.1570981. eCollection 2025.

ABSTRACT

BACKGROUND: POEMS syndrome is a rare multisystem disease secondary to plasma cell neoplasm. Due to its rarity, there are no internationally agreed treatment standards, with very limited data to guide management in the relapse setting.

CASE PRESENTATION: We describe a 51-year-old woman with initially presented with fatigue, anorexia, nausea, abdominal distension, and edema of the face and both lower limbs, who was diagnosed with POEMS syndrome accompanied with Raynaud's phenomenon and cardiac involvement. After multiple lines of treatment, including bortezomib, cyclophosphamide, and dexamethasone (VCD), ixazomib, and daratumumab along with dexamethasone (DD), her clinical and laboratory features, and cardiovascular system continued to deteriorate. Then we started carfilzomib and dexamethasone, and the patient achieved a complete response. She did not develop significant cardiac toxicity and peripheral neuropathy. A total of 4 cycles of carfilzomib and dexamethasone were administered monthly, followed by autologous stem cell transplantation (ASCT). After 4 months of follow-up, a complete remission persists, and no significant complications were observed.

CONCLUSION: We report on the first case of relapsed/refractory POEMS syndrome who received carfilzomib and dexamethasone, and achieved very good remission. Carfilzomib may be a safe and effective treatment option for patients with relapsed/refractory POEMS syndrome.

PMID:40548108 | PMC:PMC12179133 | DOI:10.3389/fonc.2025.1570981

Front Immunol. 2025 Jun 6;16:1538046. doi: 10.3389/fimmu.2025.1538046. eCollection 2025.

ABSTRACT

BACKGROUND: Chronic high-altitude hypobaric hypoxia leads to high-altitude heart disease and heart failure. Recent research has indicated that WJMSCs (Wharton's jelly-derived mesenchymal stem cells, WJMSCs) can alleviate ischemic myocardial injury and improve cardiac dysfunction, and macrophage polarization may have been involved. However, few studies have focused on the cardioprotective effects of WJMSCs against HAHI (high-altitude-induced heart injury, HAHI). Here, our research focused on how WJMSCs regulate macrophage polarization impacted myocardial repair in HAHI.

METHODS: C57/BL6J mice were fed for 28 days at a hypobaric chamber that had a comparable altitude of 6000 m, and WJMSCs were injected intravenously before HH (hypobaric hypoxia, HH) exposure. To assess cardiac function, echocardiography was carried out. Blood and heart tissue were collected for subsequent analysis. We simulated anoxic environment in vitro by inducing BMDMs (bone marrow-derived macrophages, BMDMs) with 1% O2, and employed co-culture system to investigate how WJMSCs affect macrophage polarization.

RESULTS: Abnormal myocardial fibrosis and cardiomyocyte apoptosis, cardiac inflammation and dysfunction were exhibited in the Chronic HAHI mouse model. WJMSCs infusion maintained the cardiac structure and function in HAHI mice. Furthermore, WJMSCs infusion was effective in elevating the M2 macrophages proportion and decreasing inflammation in the heart. In vitro studies revealed that hypoxia stimulation elevated the ratio of M1 macrophages in comparison to those in the Control group and coculturing with WJMSCs encouraged the shift of M1 to M2 macrophages. Surprisingly, the anti-inflammatory effects of WJMSCs on M2 polarization were negated with pretreatment of a COX2 (Cyclooxygenase-2, COX2) inhibitor, which could be reversed with PGE2 (prostaglandin E2, PGE2) addition.

CONCLUSIONS: In conclusions, our findings indicated that WJMSCs infusions may enhance M2 macrophage polarization through the COX2-PGE2 pathway, and therefore safeguard against cardiac damage in HAHI mice.

PMID:40547034 | PMC:PMC12180414 | DOI:10.3389/fimmu.2025.1538046

Front Immunol. 2025 Jun 6;16:1532325. doi: 10.3389/fimmu.2025.1532325. eCollection 2025.

ABSTRACT

BACKGROUND: Epitranscriptomics, with m6A as the most prevalent in mammals, is a novel treatment target for inflammatory diseases, including cardiovascular diseases. However, little is known about m6A RNA-regulation during myocardial infarction (MI).

METHODS: In this explorative sub-study of the ASSAIL-MI trial, we used whole blood samples from patients with acute ST-elevation MI (STEMI) (n=6) at admission and after 3-7 days, and from healthy control subjects (n=3). RNA was isolated, and m6A sites were analyzed using human m6A single nucleotide resolution microarray analysis. mRNA levels were analyzed using RNA sequencing analysis.

RESULTS: Compared with controls, patients with STEMI had a strikingly different pattern of m6A deposition. In total, 845 m6A methylation sites in whole blood RNA were hypomethylated and 36 were hypermethylated compared with controls. Of the hypomethylated transcripts, 194 transcripts were lower expressed, while 197 transcripts were higher expressed. The m6A pattern changed from an overall hypomethylation at admission to an overall hypermethylation 3-7 day after admission. Anti-inflammatory treatment with tocilizumab further altered the m6A deposition.

CONCLUSIONS: In this hypothesis generating study, m6A deposition differs STEMI patients and healthy controls. The m6A pattern changes over the course of 3-7 days. This response is, at least to some degree, is modulated by blocking the IL-6 receptor. Our data may suggest that this post-transcriptional regulation of RNA is involved in the immune response during STEMI, highlighting its potential as a target for therapy in MI.

PMID:40547027 | PMC:PMC12178860 | DOI:10.3389/fimmu.2025.1532325

Pediatr Rheumatol Online J. 2025 Jun 23;23(1):68. doi: 10.1186/s12969-025-01117-z.

NO ABSTRACT

PMID:40551202 | PMC:PMC12186311 | DOI:10.1186/s12969-025-01117-z

Ann Thorac Surg. 2025 Jun 21:S0003-4975(25)00544-2. doi: 10.1016/j.athoracsur.2025.05.046. Online ahead of print.

ABSTRACT

BACKGROUND: Gender disparities are well described in cardiothoracic surgery (CT). However, qualitative data highlighting women's lived experiences are lacking. We aimed to explore women's experiences with mentorship, sponsorship, and leadership in CT.

METHODS: We conducted virtual semi-structured interviews with surgeons who were women in practice for ≥5 years across the United States from 9/2024 to 12/2024. The interview asked questions pertaining to women's experiences with mentorship, sponsorship, leadership pathways, and leadership roles. Interviews were transcribed, coded, and analyzed using the thematic analysis approach.

RESULTS: Participants (n=25) included thoracic (40%), adult cardiac (36%), and congenital (16%) surgeons with 13 median years in practice. Most (84%) currently practiced in an academic setting. There were six main themes: 1) Losing Mentorship and Never Finding Sponsorship - mentorship wanes after early career and sponsorship often is never found; 2) Looking Elsewhere - women look outside their home institutions for sponsorship; 3) Needing He-for-She - men have an important role to play as sponsors; 4) Breaking Imposter Syndrome with Sponsorship - sponsorship helps overcome leadership imposter syndrome; 5) Circling the Service Drain - an overburden of work without title or compensation impedes leadership attainment; and 6) Being the Boss, but Not Bossy - women face double standards as leaders that may increase the challenges of leadership.

CONCLUSIONS: These findings suggest the need to increase cross-gender sponsorship, create support systems for career development within institutions, provide transparency in pay and promotion structures, and develop leadership training tailored to the unique obstacles women may face in order to combat identified barriers.

PMID:40550316 | DOI:10.1016/j.athoracsur.2025.05.046

Gen Thorac Cardiovasc Surg. 2025 Jun 23. doi: 10.1007/s11748-025-02174-7. Online ahead of print.

ABSTRACT

BACKGROUND: Reinterventions after congenital heart disease surgery include not only reoperations but also medical catheter interventions, and the details of these treatment realities are often unclear. This study aimed to elucidate the medical and surgical reinterventions and associated medical costs after the tetralogy of Fallot (TOF) repair using Japanese health insurance claims data.

METHODS AND RESULTS: We analyzed reinterventions and medical costs from insurance claims data of patients who underwent TOF repair between 2005 and 2021. Of 174 patients who underwent TOF repair, 23 (13.2%) received a total of 34 reinterventions. These included 23 percutaneous catheter interventions and 11 reoperations. The 5-year reintervention-free rate was 87.5% overall, 94.9% for surgeries with right ventricular outflow tract reconstruction (N = 130), and 65.6% for surgeries with peripheral pulmonary artery plasty (N = 44). The median (interquartile range) medical cost for patients without reintervention was ¥5.33 million (4.62-7.14 million) and the cost for the patients with reintervention was ¥ 10.59 million (7.73-13.97 million).

CONCLUSION: Using Japanese insurance claims data, we analyzed the reoperation and catheter intervention after the TOF repair. The reintervention-free rate after TOF repair differed significantly by surgical procedure with a tendency for poorer postoperative prognosis, particularly in cases involving the peripheral pulmonary artery plasty. These analysis results may contribute to predicting outcomes after TOF repair for healthcare professionals.

PMID:40549276 | DOI:10.1007/s11748-025-02174-7

A A Pract. 2025 Jun 23;19(6):e01983. doi: 10.1213/XAA.0000000000001983. eCollection 2025 Jun 1.

ABSTRACT

This case report describes an infant with congenital esophageal atresia who underwent thoracoscopic surgery and experienced a tension pneumothorax following the application of a fibrin glue product spray, resulting in critical hemodynamic deterioration close to circulatory arrest due to sudden and extreme elevation of intrathoracic pressure. Prompt action and adequate instruction to the surgeon by the clinical engineer in charge to reduce thoracic pressure facilitated a quick recovery from this critical hemodynamic situation. It is essential to understand the structure of the insufflation unit and manage accidental increases in closed cavity pressure during thoracoscopic or laparoscopic surgery.

PMID:40548758 | DOI:10.1213/XAA.0000000000001983

Ann Cardiothorac Surg. 2025 May 31;14(3):218-224. doi: 10.21037/acs-2025-ravr-0003. Epub 2025 May 29.

ABSTRACT

BACKGROUND: The natural history of aortic valve disease commonly eventuates in percutaneous or open surgical treatment. Percutaneous treatment has been expanding its indication from high-risk patients to low- and moderate-risk patients; however, there are certain groups of patients who are not good candidates for percutaneous treatment, such as those with bicuspid valve disease or pure aortic regurgitation patients. Robotic surgery, as an evolution from traditional approaches, has been gradually expanding its indications in cardiac surgery. The use of a lateral approach, common to robotic mitral procedures, may become a valid alternative for several patients undergoing aortic valve procedures. The aim of the present study was to evaluate and discuss the characteristics, challenges and early results of a newly created robotic aortic valve replacement program.

METHODS: This was a retrospective study analysing prospectively collected data of all patients who have undergone robotic aortic valve replacement (RAVR) in Hospital Clínic Barcelona from December 2021 to October 2024.

RESULTS: Since December 2021, 25 consecutive patients have undergone RAVR. Sixty-eight percent of the cohort were males and the median age was 66 years [interquartile range (IQR), 58.5-71.8 years]. Severe aortic stenosis was the predominant lesion in 76% of patients, and degenerative calcification was the aetiology in 52% of patients. Median cardiopulmonary bypass time was 129 minutes (IQR, 113-145.5 minutes) and median ischemic time was 91 minutes (IQR, 78-105 minutes). Three patients required a re-exploration for bleeding, which was performed through the same approach, and one patient suffered an ischemic cerebro-vascular accident (CVA) with complete recovery. Median intensive care unit (ICU) length of stay and hospital length of stay were 1 and 4 days, respectively.

CONCLUSIONS: Our initial experience shows that expanding a robotic program to include RAVR is feasible, safe, and can provide excellent clinical outcomes in selected patients.

PMID:40547431 | PMC:PMC12177757 | DOI:10.21037/acs-2025-ravr-0003

Front Pediatr. 2025 Jun 6;13:1579212. doi: 10.3389/fped.2025.1579212. eCollection 2025.

ABSTRACT

BACKGROUND: The incidence of parvovirus B19 (B19 V)-associated myocarditis progressing to dilated cardiomyopathy (DCM) is on the rise. We hypothesize that a comprehensive treatment regimen enables cardiac regeneration in young patients with life-threatening B19 V myocarditis.

METHODS: Four patients with clinical and imaging evidence of DCM were referred due to suspected myocarditis. An endomyocardial biopsy (EMB) confirmed the diagnosis. The diastolic dysfunction associated with heart failure and reduced left ventricular ejection fraction (HFrEF) was established invasively. Before surgical pulmonary artery banding (PAB), a transcatheter procedure was performed to create a restrictive atrial defect (rASD).

RESULTS: The drug-treated patients (ages 15-26 months) had a mean LV-EF of 22.5% (20%-25%), a left ventricular end-diastolic diameter (LVEDD) of 49 (45-51) mm (Z-score >5), and elevated LVED pressures (>18 mmHg). EMB revealed B19V-associated acute/subacute or chronic active myocarditis with characteristics of DCM. Drug therapy, including immunoglobulins and creating a rASD, resulted in clinical improvement and enhanced right ventricular function. However, LV enlargement and dysfunction persisted. Four weeks after surgical PAB, all patients showed improvement and were discharged home. The pressure gradient across the PAB ranged from 40 to 45 mmHg, and LVEDD decreased to a mean z-score of +3.5. Within three to six months, LVEDD normalized, and LV-EF increased to a mean of 63% (range: 57%-68%). Clinical and cardiac improvements were sustained over a median follow-up of 7.5 years.

CONCLUSION: A holistic treatment approach allows functional regeneration in B19 V myocarditis with obvious end-stage DCM. Restrictive ASD creation is required before surgical PAB when HFrEF is associated with a diastolic dysfunction component.

PMID:40547134 | PMC:PMC12179178 | DOI:10.3389/fped.2025.1579212

Front Pediatr. 2025 Jun 6;13:1610035. doi: 10.3389/fped.2025.1610035. eCollection 2025.

ABSTRACT

INTRODUCTION: Guillain-Barré syndrome (GBS) is an important cause of flaccid paralysis in children and is mainly associated with antecedent infections. Surgery as an additional trigger for GBS is a well-documented phenomenon in adults, but is significantly less reported in pediatric patients. This case report describes an infant with post-surgical GBS following cardiac surgery, highlighting the diagnostic challenges and differential diagnoses of post-surgical GBS in the pediatric intensive care setting.

CASE DESCRIPTION: A former extremely preterm infant with congenital cytomegalovirus (CMV) infection underwent a second surgery for re-coarctation of the aorta with aortic arch hypoplasia at the chronological age of six months. While requiring extracorporeal membrane oxygenation postoperatively, the girl presented with flaccid paralysis of the lower extremities. Magnetic resonance imaging of the brain, spine, and nerve conduction studies demonstrated findings consistent with acute motor-sensory axonal neuropathy-type GBS. She was treated with intravenous immune globulin and ganciclovir due to CMV reactivation (plasma 14,000 copies/ml). Gradual neurological improvement was noted over the following months, while persistent motor deficits remained, suggesting potential disease transition into chronic inflammatory demyelinating polyneuropathy.

CONCLUSIONS: This case report emphasizes the importance of considering post-surgical GBS in critically ill children with postoperative paralysis. Recognition may be delayed due to variable initial presentations and accompanying factors such as sedation and extracorporeal life support.

PMID:40547133 | PMC:PMC12179211 | DOI:10.3389/fped.2025.1610035

Ann Thorac Surg. 2025 Jun 21:S0003-4975(25)00545-4. doi: 10.1016/j.athoracsur.2025.06.008. Online ahead of print.

ABSTRACT

BACKGROUND: The advanced presentation of rheumatic heart disease in Rwanda often necessitates surgical intervention. We summarize the outcomes of valvular heart surgeries in Rwanda between 2006 and 2023.

METHODS: 366 patients in the Rwandan cardiac surgery registry who underwent valvular surgery were included in this study. We examined surgical details, perioperative outcomes, and long-term outcomes. Cox multivariable analyses were conducted to assess factors predictive of survival outcomes. Additionally, subgroup analyses compared outcomes between mechanical valve replacement and bioprosthetic valve replacement.

RESULTS: The average age at surgery was 25.0±10.2 years, with the majority being female (63.9%). Mitral valve surgery, either alone (45.9%) or in conjunction with tricuspid valve surgery (20.8%), was the most common procedure (66.7%). The 30-day postoperative mortality rate was 2.2%. Over an average follow-up of 7.8±4.5 years, the all-cause mortality rate was 18.2%. Patients who received a bioprosthetic valve replacement had a higher all-cause mortality rate than those who received a mechanical valve replacement (32.7% vs. 15.6%, P=0.008). The most common long-term complications for mechanical valve patients were embolism and bleeding (13.0%), compared to structural valve deterioration (26.5%) in bioprosthetic valve patients.

CONCLUSIONS: The low 30-day mortality rate reflects success in careful patient selection, meticulous surgery, and dedicated perioperative care. Mechanical valve replacement demonstrated superior long-term survival over bioprosthetic valve replacement mainly due to valve degeneration and need for reoperation in bioprosthetic patients. Key areas of improvement include strengthening postoperative follow-up and capacity for increased surgical complexity.

PMID:40550320 | DOI:10.1016/j.athoracsur.2025.06.008

Methodist Debakey Cardiovasc J. 2025 Jun 18;21(1):68-73. doi: 10.14797/mdcvj.1499. eCollection 2025.

ABSTRACT

About 25% of patients diagnosed with coronavirus disease 19 (COVID-19) experience cardiovascular complications, contributing to 40% of related deaths. Here we discuss a 69-year-old male with a history of congestive heart failure and preserved ejection fraction at New York Heart Association (NYHA) class II who presented with new dyspnea, cough, and paroxysmal nocturnal dyspnea. He was subsequently diagnosed with COVID-19 pneumonia, and while he initially recovered, he later showed worsening symptoms with progression to NYHA class IV. Follow-up echocardiogram revealed a decline in ejection fraction to 40% and severe aortic insufficiency. He underwent surgical aortic valve replacement, resolving his symptoms. This case highlights COVID-19's potential to cause rapid progression of valvular disease.

PMID:40547044 | PMC:PMC12180435 | DOI:10.14797/mdcvj.1499

Medicine (Baltimore). 2025 Jun 20;104(25):e43043. doi: 10.1097/MD.0000000000043043.

ABSTRACT

RATIONALE: Heart transplantation (HT) represents the optimal treatment for patients with end-stage heart disease. However, it is prone to numerous postoperative complications, among which cardio-renal syndrome (CRS) is particularly serious and carries a high mortality rate. Continuous renal replacement therapy is an essential supportive treatment for these patients, but its efficacy is highly dependent on precise nursing management. Currently, there are few reports on the care of CRS complicating HT both domestically and internationally. This case is presented in this report to provide reference for clinical work.

PATIENT CONCERNS: This report details the case of a 31-year-old man who underwent an in situ HT due to dilated cardiomyopathy with class IV cardiac function. Following the operation, he developed CRS, which led to oliguria, rapid deterioration of renal function, and cardiac failure.

DIAGNOSES: Cardiorenal syndrome, chronic kidney disease stage 4, post-dilated cardiomyopathy surgery, HT status, heart function class IV (NYHA classification).

INTERVENTIONS: This includes implementing a personalized continuous renal replacement therapy (CRRT) program and providing excellent CRRT care; closely monitoring for rejection and the side effects of immunosuppressants; and offering comprehensive psychological support.

OUTCOMES: After undergoing CRRT for 5 weeks, the patient's 24-hour urine volume, glomerular filtration rate, and N-terminal brain natriuretic peptide precursor levels stabilized, leading to discharge with improved renal function.

LESSONS: The key to a favorable renal function prognosis is the use of CRRT for precise volume management. Careful management of internal jugular vein catheterization is crucial for preventing infections in post-heart transplant patients. Additionally, monitoring the side effects of immunosuppressive drugs and signs of rejection are essential nursing points for patients with cardiorenal syndrome. Providing psychological care in various forms to patients and their families can help improve disease outcomes and ensure long-term efficacy after transplantation.

PMID:40550023 | PMC:PMC12187291 | DOI:10.1097/MD.0000000000043043

Exp Clin Transplant. 2025 May;23(5):317-327. doi: 10.6002/ect.2025.0089.

ABSTRACT

OBJECTIVES: Donation after circulatory death offers a promising solution to expand the thoracic organ donor pool, yet its application remains limited because of warm ischemia and technical barriers, especially in uncontrolled donation after circulatory death. We aimed to evaluate a pulsatile normothermic car-diopulmonary bypass-based strategy for thoracic organ recovery of uncontrolled donors after circulatory death and the effects of this strategy on graft function and recipient outcomes.

MATERIALS AND METHODS: In this prospective single-center study, we studied thoracic organs recovered from uncontrolled donors after circulatory death after ≥60 minutes of unsuccessful cardiopulmonary resuscitation. After heparinization and pharmacologic optimization, donors underwent median sternotomy and were connected to a cardiopulmonary bypass circuit with pulsatile flow. Organ assessment was performed in vivo. Donor, graft, and recipient functional data were recorded, with follow-up results studied through at least 1 year.

RESULTS: Forty-two donors were included. All hearts (n = 42) and 40 lungs (from 84 donors) were successfully transplanted. Despite prolonged cardiopulmonary resuscitation, no graft failure or recipient mortality occurred. One year survival for both heart and lung recipients was 100%. Heart grafts showed progressive improvement in functional status, including left ventricular ejection fraction, lactate levels, and New York Heart Association classification; lungs demonstrated sustained gains in gas exchange, pulmonary function tests, and 6-minute walk distance. Mild primary graft dysfunction (grade 1-2) occurred in 10% of lung recipients (all unilateral transplants). Pericardial effusion increased, likely because of trauma before procurement, but resolved without effects on function.

CONCLUSIONS: Pulsatile normothermic cardiopulmonary bypass enables successful procurement of thoracic organs from uncontrolled donors after circulatory death with excellent outcomes. This low-cost physiological approach may offer a viable strategy to expand availability of donors in resource-limited settings.

PMID:40548529 | DOI:10.6002/ect.2025.0089