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JACC Case Rep. 2025 Jun 25;30(16):104014. doi: 10.1016/j.jaccas.2025.104014.

ABSTRACT

BACKGROUND: Congenital coronary artery abnormalities represent an uncommon class of congenital heart disease with an associated risk of sudden cardiac death. There is a paucity of data for the evaluation and management of affected patients with an intraseptal course.

CASE SUMMARY: A 27-year-old woman was found to have a single coronary trunk arising from the right sinus with a 2.7 cm intraseptal course of the left main coronary artery. She underwent stress cardiac magnetic resonance and catheterization, to assess for inducible ischemia before surgical repair with transconal unroofing. Her recovery was uneventful, and she remains free of symptoms.

DISCUSSION: Management of congenital coronary artery anomalies requires an exhaustive evaluation. Further studies are warranted to define the ideal work-up, indication, and timing of intervention and the efficacy of medical management in improving symptoms.

TAKE-HOME MESSAGES: Congenital coronary anomalies represent a rare but consequential cause of exertional chest pain. This diagnosis requires multimodal imaging to inform decision making.

PMID:40579080 | DOI:10.1016/j.jaccas.2025.104014

JACC Case Rep. 2025 Jun 25;30(16):104249. doi: 10.1016/j.jaccas.2025.104249.

ABSTRACT

BACKGROUND: A 21-year-old male with complex congenital heart disease (pulmonary atresia with intact ventricular septum and major aortopulmonary collateral arteries [MAPCAs]) was seen in our outpatient clinic. Diagnosed shortly after birth, the patient underwent Rashkind atrial septostomy and was deemed amenable to surgical correction/partial unifocalization or palliative intervention.

CASE SUMMARY: On examination, the patient was cyanotic with no signs of heart failure. Multimodality imaging showed MAPCAs from the aorta to the pulmonary circulation with a variable degree of stenosis suggestive of segmental pulmonary hypertension (PH). The decision of the multidisciplinary meeting was for a conservative approach and close monitoring with the potential of palliative interventions if there is a deterioration in patients' functional status.

DISCUSSION: Segmental PH presents a complex scenario, necessitating multimodality imaging for therapeutic considerations.

TAKE-HOME MESSAGE: In cyanotic congenital heart disease, the presence of MAPCAs and segmental PH presents a complex scenario, necessitating multimodality imaging.

PMID:40579077 | DOI:10.1016/j.jaccas.2025.104249

Thorac Cardiovasc Surg. 2025 Jan;73(S 03):e39-e45. doi: 10.1055/a-2635-3320. Epub 2025 Jun 27.

ABSTRACT

Central airway stenosis following congenital heart malformation surgery is a rare but significant cause of postoperative weaning failure. In selected cases, bronchoscopic interventions are effective treatment options for managing these kind of airway obstructions and achieving successful weaning.The data of six pediatric patients who were unable to be weaned from mechanical ventilation due to central airway obstruction following congenital heart malformation surgery were retrospectively analyzed. Rigid and flexible bronchoscopies were performed under general anesthesia for six patients.Six patients (4 males and 2 females; age range: 4 months to 6 years) with an airway obstruction after surgery due to congenital heart malformations included the study. Three patients had an obstruction of the left main bronchus, two of the right main bronchus, and one of bilateral main bronchus. Balloon dilatation was applied to one patient, mechanical dilatation was applied to three patients, and airway stent was applied to two patients. Two of six patients died from nonprocedural causes (acute respiratory distress syndrome due to pneumonia and cardiac arrest due to severe heart failure) and four patients were weaned successfully from mechanical ventilation and they were still alive during the follow-up period. No procedural-related mortality was seen in the study population. In one patient, stent placement could not be performed due to desaturation and hemodynamic instability during the procedure, and in another patient, granulation tissue developed due to a covered metallic stent, and the metallic stent was removed and replaced with a biodegradable stent.In selected cases, bronchoscopic interventions offer efficient approach to managing airway obstructions due to congenital heart malformation surgery.

PMID:40578812 | DOI:10.1055/a-2635-3320

Eur J Cardiothorac Surg. 2025 Jun 3;67(6):ezaf178. doi: 10.1093/ejcts/ezaf178.

ABSTRACT

OBJECTIVES: Current preoperative counselling in neonatal cardiac surgery is mainly focused on the primary procedure. However, other factors must be considered when evaluating the surgical risk of a neonate. We aimed to develop a risk adjustment model to personalize preoperative counselling using data from the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD).

METHODS: A retrospective, multicentre analysis of the ECHSA-CD dataset was conducted, including 20 687 neonates undergoing cardiac surgery between 2013 and 2022. A risk adjustment model was developed on a training set (70%) and validated on a separate cohort (30%).

RESULTS: A model incorporating age, weight, STAT mortality category and need for cardiopulmonary bypass (CPB) demonstrated good predictive performance. Lower age (≤10 days), lower weight (<2.5 kg), higher STAT category and need for CPB were associated with increased risk of operative mortality. The model's area under the receiver operating characteristic curve was 0.701 in the training set and 0.700 in the validation set, indicating good discrimination. Additionally, the Brier quadratic probability score was 0.08 in both datasets, indicating good calibration.

CONCLUSIONS: This study underscores the importance of patient characteristics in predicting outcomes in neonatal cardiac surgery. The developed risk adjustment model can be used as a tool in preoperative counselling, decision-making and risk stratification for neonates undergoing cardiac surgery. By providing a more accurate estimate of operative mortality, this model can help families make more informed decisions about their child's care and improve the overall quality of care for neonates with congenital heart defects.

PMID:40577097 | DOI:10.1093/ejcts/ezaf178

Interdiscip Cardiovasc Thorac Surg. 2025 Jun 27:ivaf153. doi: 10.1093/icvts/ivaf153. Online ahead of print.

ABSTRACT

OBJECTIVES: This study sought to evaluate the feasibility and learning curve of right vertical infra-axillary thoracotomy (RVIAT) in surgical closure of VSD.

METHODS: Clinical outcomes in paediatric patients (<18 years) undergoing VSD surgery between 2018 and 2021 in two tertiary hospitals were retrospectively reviewed. After 1:1 propensity score matching, patients undergoing RVIAT were compared with those undergoing median sternotomy (MS). The learning curve that reflected the number of cases needed to achieve technical proficiency was measured using total operating time as a metric, and was evaluated using a risk-adjusted cumulative sum analysis.

RESULTS: Of the 3515 eligible patients, 2183 (62%) underwent MS and 1332 (38%) underwent RVIAT. After matching, 797 cases in RVIAI and MS group were recorded respectively. Propensity weighting produced excellent balance in patient baseline characteristics including age, weight, and VSD subtypes. There was no between-group difference in postoperative rhythm disturbances (0.6% vs 1.1%; P = 0.83), significant residual VSD (0.1% vs 0.4%, P = 0.62), and reoperation within postoperative 60 days (0.1% vs 0.9%, P = 0.07). RVIAT provided better cosmesis (satisfactory score: 9.21 ± 0.06 points vs 6.98 ± 1.17 points; P < 0.001), shorter median length of hospital stay (5.5 days vs 8.0 days, P < 0.001), and lower cost (8513.3 ± 3193.2 USD vs 9222.3 ± 2504.9 USD; P < 0.001). The surgeons could conquer the early learning phase of RVIAT after performing a mean of 41 operations.

CONCLUSIONS: RVIAT can combine good outcomes with favourable cosmesis in VSD repair, and sufficient exposure to RVIAT procedures is crucial for proficiency.

PMID:40576448 | DOI:10.1093/icvts/ivaf153

Front Cardiovasc Med. 2025 Jun 12;12:1568920. doi: 10.3389/fcvm.2025.1568920. eCollection 2025.

ABSTRACT

INTRODUCTION: The surgical and medical management of aging patients with adult congenital heart disease (ACHD) continues to innovate to meet the evolving needs of this unique patient population, leading to improved life expectancy and quality of life. However, the ACHD population is characterized by high morbidity and mortality. With this study, we aim to describe patient characteristics and surgical outcomes for the over fifty ACHD cardiac surgical cohort, focusing on risk factors for mortality and major complications.

METHODS: This was a retrospective cohort study including ACHD patients undergoing surgical repair from January 2004 to March 2023. Primary outcome was the composite of severe postoperative complications and secondary outcomes were 1-year mortality, ICU stay and hospital length of stay. Descriptive statistics, univariable and multivariable logistic regression models were used.

RESULTS: In the study period, 1381 patients with ACHD underwent cardiac surgery, of which 292 (20.5%) were over 50 years. In the overall group, the most common primary surgery was pulmonary valve replacement in 411 (29.8%), in the over 50 group this was ASD and VSD repairs in 102 (34.9%). The composite of major postoperative complications was different between the overall group and the over 50 years group (10.7% vs. 13.7%; P = 0.049), which in the over 50 group was associated with CPB time (180 min vs. 104 min, OR 1.01; 95%CI 1.00-1.03), and preoperative creatinine levels (84 vs. 77, OR 1.01; 95%CI 1.00-1.03). No difference was seen in 1-year mortality (P = 0.415).

CONCLUSION: With careful patient selection and preoperative optimization, surgical risks remain low, even in aging ACHD patients. Although overall mortality rates are low, postoperative complications increase, and patients over 50 with DM, renal failure, long pump runs or postoperative stroke are at highest risk.

PMID:40574821 | PMC:PMC12198246 | DOI:10.3389/fcvm.2025.1568920

Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6):ivaf145. doi: 10.1093/icvts/ivaf145.

ABSTRACT

Persistent fifth aortic arch (PFAA) is a rare variant of the aortic arch that may be associated with coarctation or interrupted aortic arch. We report the case of a neonate initially referred for coarctation repair. After a left thoracotomy was performed, a rare diagnosis of PFAA associated with interrupted aortic arch was made. Despite this unusual anatomy, the repair was successfully performed via a lateral approach. This unusual anatomy of the aortic arch deserves special consideration in case of association with coarctation. Indeed, repair from the side may not be possible due to the common origin of the neck-vessels, and resection should be extended as far as possible to eliminate remaining ductal tissue and prevent recoarctation.

PMID:40574475 | DOI:10.1093/icvts/ivaf145

JACC Case Rep. 2025 Jun 25;30(16):103761. doi: 10.1016/j.jaccas.2025.103761.

ABSTRACT

BACKGROUND: A sinus of Valsalva aneurysm (SoVA) is a rare cardiac condition caused by the dilation of a coronary sinus. If untreated, it can commonly lead to valvular dysfunction, arrhythmias, or rupture.

CASE SUMMARY: A 71-year-old patient with hypertension and hyperlipidemia presented with an embolic stroke. Multimodality imaging revealed a large, 7.0 cm × 5.6 cm SoVA originating from the noncoronary sinus and causing nearly complete obstruction of the left atrium. The aneurysm was surgically repaired, and the patient made a full recovery.

DISCUSSION: In rare cases, a stroke may be the initial presentation of a SoVA. The probable cause of the patient's stroke was attributed to thrombus formation within the SoVA that embolized.

TAKE-HOME MESSAGES: This case emphasizes the importance of multimodality imaging for the diagnosis of a SoVA and for planning surgical repair. Additionally, clinicians should consider a SoVA in the differential diagnosis for a patient presenting with a stroke.

PMID:40579110 | DOI:10.1016/j.jaccas.2025.103761

Interdiscip Cardiovasc Thorac Surg. 2025 Jun 19:ivaf144. doi: 10.1093/icvts/ivaf144. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the differential impact of low cardiac function (ejection fraction [EF] ≤ 35%) and diabetes mellitus (DM) on survival and to identify causes of death after coronary artery bypass grafting (CABG).

METHODS: Overall, 1036 patients who underwent isolated CABG between 2009 and 2022 were divided into four groups based on EF and DM. Kaplan-Meier analysis was performed to calculate each group's estimated survival. Inter-group multivariate Cox regression was performed with the reference group showing EF > 35% and DM (-). Additional Cox regressions were performed to investigate the associations of EF ≤ 35% and DM (+) with death from heart failure, myocardial infarction, cancer, pneumonia, cerebrovascular disease, and renal failure.

RESULTS: Off-pump techniques were used in 980 patients (95%). Patient population and estimated 10-year postoperative survival were as follows: EF > 35% DM (-), 430, 75.1%; EF > 35% DM (+), 456, 66.3%; EF ≤ 35% DM (-), 73, 62.5%; and EF ≤ 35% DM (+), 77, 53.5%. Hazard ratios (HRs) (P values) for the three groups were as follows: EF > 35% DM (+), 1.53 (0.006); EF ≤ 35% DM (-), 1.84 (0.017); and EF ≤ 35% DM (+), 2.23 (0.001). For death from heart failure, HR (P value) for EF ≤ 35% versus EF > 35% was 3.62 (0.012). For deaths from cancer and pneumonia, HRs (P values) for DM (+) versus DM (-) were 1.73 (0.097), and 2.72 (0.046), respectively.

CONCLUSIONS: EF ≤ 35% and DM (+) are associated with worse post-CABG survival. Each is associated with specific causes of death.

PMID:40577802 | DOI:10.1093/icvts/ivaf144

Cureus. 2025 May 27;17(5):e84874. doi: 10.7759/cureus.84874. eCollection 2025 May.

ABSTRACT

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmia syndrome affecting the structurally normal heart, occurring during high adrenaline levels triggered by exercise or emotional stress. CPVT results from a mutation in the RyR2 gene and is clinically characterized by episodes of syncope, arrhythmias, or sudden cardiac arrest. Optimal perioperative preparation for patients with CPVT aims to prevent increases in catecholamine levels during venipuncture, surgery, and pain management. Levobupivacaine, a long-lasting local anesthetic, was administered to a 28-year-old female patient for an axillary nerve block during orthopedic surgery. The patient had experienced sudden cardiac arrest at the age of 24, where the RyR2 gene mutation was confirmed, leading to the initiation of beta-blocker therapy. Subsequent hypoxic-ischemic encephalopathy, resulting from resuscitation, caused spastic quadriplegia. The patient's vital parameters, such as electrocardiogram, non-invasive blood pressure (NIBP), and oxygen saturation (SpO2), were monitored throughout the perioperative period. Orthopedic surgery was successfully completed, with no changes observed in the electrocardiogram. Levobupivacaine, being less cardiotoxic, ensured good intraoperative conditions without adverse events and provided adequate postoperative pain control for the patient with CPVT during orthopedic surgery.

PMID:40575238 | PMC:PMC12199132 | DOI:10.7759/cureus.84874

Medicina (Kaunas). 2025 May 25;61(6):975. doi: 10.3390/medicina61060975.

ABSTRACT

Background and Objectives: The aim of this study was to compare the effects of sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA) on intraocular pressure (IOP) during coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). Materials and Methods: This prospective observational monocentric study included 68 patients scheduled for CABG with CPB, divided into two groups of propofol-based TIVA (Group P) and sevoflurane-based anesthesia (Group S). Intraocular pressure was measured and recorded at eight predefined time points using a tonometer: before anesthesia induction (T1), 10 min after induction (T2), immediately before the beginning of CPB (T3), 3 min after the beginning of CPB (T4), 3 min after cross-clamping (T5), 3 min after cross-clamp removal (T6), immediately before the weaning of CPB (T7), and at the end of the surgery (immediately after skin closure) (T8). The primary endpoint was to examine the effects of propofol-based TIVA and sevoflurane-based anesthesia methods on IOP during CABG operation. The secondary endpoints included a comparison of hemodynamic variables, blood gas values, and intensive care unit (ICU) and hospital stays. Results: Intraocular pressure values were similar for both groups at all time points. A statistically significant decrease was found in IOP in all measurements after induction compared to pre-induction values in both Group P and Group S (p < 0.05). Compared to IOP measured at 10 min after induction, no statistically significant difference was found at all subsequent time points in both groups. When the right and left IOP values were compared, no statistically significant difference was detected at all time points in both Group P and Group S. Conclusions: The results of the study indicated that propofol-based TIVA and sevoflurane-based anesthesia had similar effects on IOP in patients undergoing CABG with CPB.

PMID:40572662 | PMC:PMC12195263 | DOI:10.3390/medicina61060975

Circ J. 2025 Jun 24. doi: 10.1253/circj.CJ-24-0644. Online ahead of print.

ABSTRACT

BACKGROUND: Nodular calcification (NC) detected via intracoronary imaging is associated with adverse cardiovascular events after percutaneous coronary intervention (PCI). However, the impact of NC detected on pre-PCI non-contrast computed tomography (CT) on clinical outcomes has not been fully investigated.

METHODS AND RESULTS: We retrospectively included 267 consecutive patients with chronic coronary syndrome who underwent electrocardiography-gated non-contrast CT before PCI for severely calcified lesions. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, stroke, non-fatal myocardial infarction, and target lesion revascularization (TLR). Fifty-eight patients had NC detected on non-contrast CT in target lesions. The MACCE-free survival rate was significantly lower in patients with than without NC (P<0.001). All-cause death, cardiac death, and TLR-free survival rates were significantly lower among patients with than without NC. Multivariate Cox regression analysis revealed that hemodialysis (hazard ratio [HR] 3.00; P=0.003), peripheral artery disease (HR 2.65; P=0.01), and the presence of NC (HR 5.25; P<0.001) were independently associated with MACCE. Adding NC to traditional cardiovascular risk factors, peripheral artery disease, and hemodialysis can provide discriminatory and reclassification abilities in predicting MACCE.

CONCLUSIONS: NC detected on non-contrast CT was independently associated with MACCE. Therefore, evaluating NC using preprocedural non-contrast CT may be useful in predicting future clinical outcomes after PCI.

PMID:40571597 | DOI:10.1253/circj.CJ-24-0644

J Nippon Med Sch. 2025 Jun 26. doi: 10.1272/jnms.JNMS.2025_92-609. Online ahead of print.

ABSTRACT

The combination of initial Impella therapy, Impella-supported coronary artery bypass grafting (ISCAB), and postoperative Impella therapy providing antegrade perfusion in myocardial infarction can prove effective. We investigated strategies for Impella stabilization in ISCAB, particularly during peripheral circumflex branch anastomosis. Case 1 was a 70-year-old man treated with an Impella 2.5, followed by urgent ISCAB on the day of hospitalization, for a left main trunk lesion. Use of an apical suction device to position the heart to expose an obtuse marginal branch caused Impella obstruction by applying suction to the left ventricular wall, interrupting revascularization; however, one revascularization was achieved. Case 2 was a 79-year-old man treated with an Impella CP for a three-vessel lesion until ISCAB 4 days later. The Impella was stabilized with appropriate positioning by adjusting the bed angle, minimal heart compression with a deep pericardial stitch without pulling on the cardiac apex, and sufficient preload, even during posterolateral branch anastomosis. Four revascularizations were eventually achieved. Multiple innovations to prevent Impella contact with the left ventricle as described herein improve ISCAB safety, particularly during peripheral circumflex branch anastomosis.

PMID:40571582 | DOI:10.1272/jnms.JNMS.2025_92-609

Int J Cardiol. 2025 Jun 24;438:133542. doi: 10.1016/j.ijcard.2025.133542. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains debated, particularly for bifurcation lesions, which are associated with increased thrombotic risk. Shorter DAPT regimens may reduce bleeding but could compromise ischemic protection.

METHODS: This study analyzed data from the ULTRA and BIFURCAT registries, including patients treated with PCI for bifurcation lesions. Patients requiring oral anticoagulation were excluded. DAPT duration was categorized as ≤6 months, 6-12 months and > 12 months. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis. Cox regression analysis was used to assess the association between DAPT duration and MACE.

RESULTS: Among 6729 patients, 425 (6 %) received DAPT ≤6 months, 3446 (51 %) for 6-12 months and 2858 (42 %) for >12 months. At 800-day follow-up, MACE rates were higher with shorter DAPT (19.5 % vs. 10 % vs. 5.9 %, p < 0.001). Adjusted hazard ratios for MACE were significantly higher for DAPT ≤6 months (HR 4.8, 95 % CI 1.8-12.7) and 6-12 months (HR 2.7, 95 % CI:1.5-4.7) compared to >12 months. This trend was consistent in acute coronary syndrome (ACS) patients but not in stable patients.

CONCLUSION: In PCI-treated bifurcation lesions, particularly in ACS patients, shorter DAPT duration (≤6 months) is associated with a higher risk of adverse events. These findings, albeit hypothesis generating, highlight the need to consider bifurcation lesions as a key factor in tailoring DAPT duration and may warrant confirmation in dedicated trials.

PMID:40571129 | DOI:10.1016/j.ijcard.2025.133542

Int J Cardiol. 2025 Jun 24;438:133542. doi: 10.1016/j.ijcard.2025.133542. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains debated, particularly for bifurcation lesions, which are associated with increased thrombotic risk. Shorter DAPT regimens may reduce bleeding but could compromise ischemic protection.

METHODS: This study analyzed data from the ULTRA and BIFURCAT registries, including patients treated with PCI for bifurcation lesions. Patients requiring oral anticoagulation were excluded. DAPT duration was categorized as ≤6 months, 6-12 months and > 12 months. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis. Cox regression analysis was used to assess the association between DAPT duration and MACE.

RESULTS: Among 6729 patients, 425 (6 %) received DAPT ≤6 months, 3446 (51 %) for 6-12 months and 2858 (42 %) for >12 months. At 800-day follow-up, MACE rates were higher with shorter DAPT (19.5 % vs. 10 % vs. 5.9 %, p < 0.001). Adjusted hazard ratios for MACE were significantly higher for DAPT ≤6 months (HR 4.8, 95 % CI 1.8-12.7) and 6-12 months (HR 2.7, 95 % CI:1.5-4.7) compared to >12 months. This trend was consistent in acute coronary syndrome (ACS) patients but not in stable patients.

CONCLUSION: In PCI-treated bifurcation lesions, particularly in ACS patients, shorter DAPT duration (≤6 months) is associated with a higher risk of adverse events. These findings, albeit hypothesis generating, highlight the need to consider bifurcation lesions as a key factor in tailoring DAPT duration and may warrant confirmation in dedicated trials.

PMID:40571129 | DOI:10.1016/j.ijcard.2025.133542

PLoS One. 2025 Jun 26;20(6):e0326534. doi: 10.1371/journal.pone.0326534. eCollection 2025.

ABSTRACT

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) and diabetes mellitus (DM) are interrelated conditions associated with high morbidity and mortality. This study compared the cardiovascular protective effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) versus sodium-glucose cotransporter-2 (SGLT2) inhibitors in this population.

METHODS: This retrospective cohort study used data from the TriNetX database. It included 2,177 matched pairs of patients with HFpEF and DM treated with either GLP-1 RAs or SGLT2 inhibitors. Outcomes assessed over three years were a composite of all-cause mortality and progression to systolic heart failure, acute myocardial infarction, or stroke.

RESULTS: GLP-1 RAs significantly reduced the risk of composite outcomes at one year (Hazard Ratio, HR 0.784; 95% CI, 0.658-0.934), two years (HR 0.813; 95% CI, 0.702-0.941), and three years (HR 0.825; 95% CI, 0.717-0.950). Specifically, GLP-1 RAs showed significantly reduced risks of progression to systolic heart failure (HR 0.60) and stroke (HR 0.75) compared to SGLT2 inhibitors. These protective effects were most pronounced in the first year and showed a slightly diminishing trend. While not statistically significant, GLP-1 RAs also exhibited a trend towards fewer myocardial infarctions (HR 0.83) and lower mortality rates (HR 0.83) than SGLT2 inhibitors. Subgroup analyses revealed more significant benefits in patients aged ≥60, women, Caucasians, those without moderate-to-severe chronic kidney disease or chronic ischemic heart disease, and those with better-controlled DM.

CONCLUSIONS: Among HFpEF patients with DM, GLP-1 RAs demonstrated superior cardiovascular protective effects compared with SGLT2 inhibitors over a 3-year follow-up period. Further randomized trials are required to confirm these findings.

PMID:40570020 | PMC:PMC12200838 | DOI:10.1371/journal.pone.0326534

Air Med J. 2025 Jul-Aug;44(4):282-285. doi: 10.1016/j.amj.2025.03.006. Epub 2025 May 3.

ABSTRACT

OBJECTIVE: Organ transplantation is an operationally complex process. Centralized recovery centers (CRCs) address multiple logistical issues while decreasing costs and increasing organ transplanted per donor (OTPD). This paradigm is predicated on the safe and effective transport of neurologically deceased donors from index facilities. Although the merits of CRCs are well studied, these transport processes have not been well assessed. We set out to evaluate the safety, feasibility, and efficacy of transporting brain-dead organ donors through air and ground critical care transport.

METHODS: We completed a comprehensive review of our processes and retrospective chart review of all donor transports from index hospitals to the local CRC in an 18-month period. Clinical and transport data were both electronically and manually abstracted from 2 existing databases.

RESULTS: Crews transported 74 donors (32 by air, 42 by ground) resulting in 257 organs transplanted (OTPD3.67). Median operating room time was 237 (interquartile range 205-292) minutes. Donors required a median of 2 (interquartile range 0-3) infusions and a mean norepinephrine equivalent of 0.02 µg/kg/min (standard deviation 0.06). One patient (1.4%) required blood products, 6 (8.1%) developed new hypotension, and 4 (5.4%) had new hypoxemia. There were no cardiac arrests in transport.

CONCLUSION: Through a thoughtful collaboration between a busy organ procurement organization and well-established regional air and ground critical care transport service, in 18 months our system moved 74 donors from index hospitals to a new CRC for organ procurement. Our experience highlights the feasibility, safety, and efficacy of this cost-effective partnership.

PMID:40571385 | DOI:10.1016/j.amj.2025.03.006

J Heart Lung Transplant. 2025 Jun 24:S1053-2498(25)02035-2. doi: 10.1016/j.healun.2025.06.008. Online ahead of print.

ABSTRACT

The Impella 5.5 (Abiomed, USA) is a catheter-based micro-axial flow pump that has emerged as a vital tool in managing patients with cardiogenic shock (CS). Delivering up to 5.5 L/min of flow, it enables full left ventricular (LV) support with beneficial hemodynamic and metabolic effects. Its unique advantages include high-flow, antegrade circulatory support with the potential for prolonged usage, making it suitable for bridging to recovery or heart replacement therapies. This manuscript provides a comprehensive, structured guide for the clinical management of patients supported with the Impella 5.5. It outlines best practices for patient selection, surgical implantation techniques-most commonly via the axillary artery-perioperative management, anticoagulation strategies, and postoperative monitoring. Special emphasis is placed on complication management, including bleeding, hemolysis, right ventricular dysfunction, stroke, aortic valve injury, and vascular complications. Technologies like SmartAssist and Impella Connect are highlighted for their utility in real-time device monitoring and remote management. The manuscript also discusses a three-phase framework for recovery: hemodynamic stabilization, initiation of guideline-directed medical therapy (GDMT), and structured weaning protocols. Considerations for transitioning patients to heart transplantation or durable LVADs, as well as explant techniques, are detailed. The importance of multidisciplinary coordination-including a mechanical circulatory support (MCS) coordinator-is emphasized to ensure optimal patient outcomes. By synthesizing available evidence and institutional experience, this guide aims to standardize Impella 5.5 management, reduce complications, and improve outcomes in critically ill patients with advanced heart failure or CS.

PMID:40571169 | DOI:10.1016/j.healun.2025.06.008

JACC Heart Fail. 2025 Jun 25;13(8):102516. doi: 10.1016/j.jchf.2025.102516. Online ahead of print.

NO ABSTRACT

PMID:40570538 | DOI:10.1016/j.jchf.2025.102516

Echocardiography. 2025 Jul;42(7):e70234. doi: 10.1111/echo.70234.

ABSTRACT

PURPOSE: Pediatric heart transplant patient (PHT) surveillance for chronic graft failure (CGF) remains challenging. Novel echo parameters such as left atrial strain (LAS) has shown to correlate with diastolic dysfunction (DD). However, its role in CGF surveillance in the absence of significant DD has not been well studied in PHT especially in the presence of left atrial anastomosis.

METHODS: Left atrial reservoir, conduit and contractile strain (LAS-r, LAS-cd, LAS-ct), segmental LAS-r (septal wall, lateral wall, and roof), mitral valve (MV) E/A, average E/e', and indexed LA volume were measured on PHT echocardiograms performed within 3 months of surveillance cardiac catheterization at a single center (01/01/21-12/31/21); those with acute rejection on EMB were excluded. EMB was reviewed for qualitative fibrosis (graded on a scale of 0-5) as a histopathological surrogate of CGF. Correlation was studied between echo variables versus fibrosis and pulmonary capillary wedge pressure (PCWP) on cath.

RESULTS: Eighty-four PHT (mean age 11 years, SD: 6.2 years) with median time since transplant of 4.0 years [IQR: 2.0-8.0]) were studied. Mean LV EF was 65% (SD = 5.7%). Mean LAS-r was 23.4% (SD = 8.7%) which was significantly decreased compared to age-matched normative data. Decreased septal and lateral wall LAS-r correlate with elevated PCWP. Median fibrosis score was 3.0 (IQR 2-3.8) and correlated with MV E/A (r = 0.32, p = 0.009) and LAS-ct (r = -0.22, p = 0.043).

CONCLUSIONS: LAS in PHT is decreased compared to age normative values, even in the setting of normal LV systolic function. Left atrial function assessed by global and segmental strain show correlations with EMB fibrosis and PCWP on cardiac catheterization in the absence of rejection. Longitudinal follow up is needed to further study the relationship of these diastolic function measures to CGF outcomes.

PMID:40569980 | DOI:10.1111/echo.70234