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JACC Heart Fail. 2025 Jun 16;13(8):102495. doi: 10.1016/j.jchf.2025.03.039. Online ahead of print.

ABSTRACT

BACKGROUND: Recent advances in heart procurement techniques have facilitated the utilization of hearts obtained after circulatory death. However, discerning the population that stands to benefit most requires an understanding of waitlist outcomes.

OBJECTIVES: The objective of this study was to evaluate waitlist and post-transplant outcomes among patients listed for donation after circulatory death (DCD) hearts in the United States, stratified by listing status.

METHODS: The UNOS (United Network for Organ Sharing) database was queried for all adult patients waitlisted for isolated heart transplantation between October 2018 and June 2024. Patients were stratified by approval for donation after brain death vs DCD hearts. DCD patients were subdivided into those who were DCD candidates at time of listing or later during their waitlist period. Waitlist and post-transplant outcomes were compared using Fine & Gray and Kaplan-Meier analyses.

RESULTS: A total of 24,970 patients were identified; of these, 8,191 (33%) were listed as DCD candidates. DCD status 2, 3, 4, and 6 patients were more likely to be transplanted and less likely to die on the waitlist. There were no differences in post-transplant survival in any group. Receipt of a DCD heart was not predictive of mortality. Patients initially listed as DCD candidates were significantly more likely to be transplanted than those who became DCD candidates later during their waitlist course.

CONCLUSIONS: With exception of status 1, patients waitlisted for DCD hearts experience shorter waitlist duration, improved rates of transplantation, and comparable long-term survival with donation after brain death recipients.

PMID:40527153 | DOI:10.1016/j.jchf.2025.03.039

Metab Syndr Relat Disord. 2025 Jun 17. doi: 10.1089/met.2025.0028. Online ahead of print.

ABSTRACT

Background: Metabolic syndrome (MetS) is increasingly prevalent globally and is linked to inflammation in cardiac tissues. Cardiac allograft vasculopathy (CAV) is a significant inflammatory condition and a leading cause of graft failure after orthotopic heart transplantation (OHT). The relationship between MetS and CAV remains poorly understood. Methods: A literature search was conducted from inception to September 2024, including studies that reported associations between MetS or its components (obesity, hypertension, dyslipidemia, and diabetes mellitus) and CAV. The primary endpoint was the development of CAV after OHT. Results were presented as odds ratios (OR) or hazard ratios (HR) with 95% confidence intervals (CI), employing both random and fixed-effect models based on heterogeneity. Results: A total of 16 studies involving 3,366 patients were included. The prevalence of MetS was high before OHT (32%, 95% CI: 24-41%, I2 = 75%) and increased after OHT (37%, 95% CI: 18-61%, I2 = 83%). MetS was significantly associated with CAV (OR = 1.99, 95% CI: 1.28-3.09, I2 = 36%). Key components of MetS linked to CAV included obesity (OR = 1.54, 95% CI: 1.11-2.13, I2 = 0%) and dyslipidemia (OR = 1.87, 95% CI: 1.49-2.36, I2 = 0%). New-onset diabetes mellitus after transplantation increases the risk of CAV with an HR of 1.71 (95% CI: 1.56-1.88, I2 = 0%). Conclusion: The high prevalence of MetS both before and after OHT is associated with an increased risk of CAV, highlighting the need for targeted interventions to manage MetS in heart transplant recipients.

PMID:40526466 | DOI:10.1089/met.2025.0028

Eur J Heart Fail. 2025 Jun 17. doi: 10.1002/ejhf.3691. Online ahead of print.

ABSTRACT

AIMS: The European Heart Failure (HF) Survey was developed by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) to map HF management resources, reimbursement of drugs/devices for HF treatment, and structure and activities of HF professional and patient organizations.

METHODS AND RESULTS: The survey encompassed 43 ESC member countries. The median number of hospitals with dedicated HF centres was 2.6 (interquartile range [IQR] 0.9-4.7) per million people. Natriuretic peptide assessment was available at a median of 6.1 (IQR 1.8-10.6) emergency departments and 8.2 (IQR 1.3-14.7) hospitals per million people, respectively, whilst cardiac magnetic resonance was available at a median of 2.0 (IQR 0.9-3.8) hospitals per million people. Short-term and long-term mechanical circulatory support and heart transplantation were available at a median of 1.1 (IQR 0.5-2.4), 0.4 (IQR 0.0-0.5) and 0.3 (0.2-0.5) hospitals per million people, respectively. Whilst essential HF medications were mostly available and reimbursed, gaps were observed in availability and funding of newer and advanced therapies. Density of all diagnostic and therapeutic capabilities was greater in countries with more favourable socioeconomic status. National HF societies were reported in 98% of countries, whilst HF patient organizations in 45% of countries.anaemia.

CONCLUSIONS: The European HF Survey is the result of long-standing HFA/ESC efforts to monitor HF epidemiology, management resources, educational and awareness activities. It offers a valuable assessment of current management capabilities, highlighting challenges in providing contemporary standards of care. It also provides insights into future directions needed to address these gaps.

PMID:40526007 | DOI:10.1002/ejhf.3691

World J Pediatr Congenit Heart Surg. 2025 Jun 17:21501351251340669. doi: 10.1177/21501351251340669. Online ahead of print.

ABSTRACT

Background: The Fontan operation is typically performed between two and five years-of-age in the United States. In this study, we analyzed the immediate outcomes of the Fontan operation performed beyond the first decade of life in the United States using a large administrative database. Methods: Kids' Inpatient Database (2003-2019) and Nationwide Inpatient Sample (2016-2021) datasets were used; 10,245 pediatric patients undergoing the Fontan operation were identified. The cohort was divided into: Traditional Fontan (TF, 2-5 years-of-age, n = 9,900) and Late Fontan (LF, ≥10 years-of-age, n = 345); Survivor and non-survivor status were based on discharge mortality. Demographic and clinical characteristics were assessed using standard statistical tests. Results: Only 3% of the Fontan procedures (n = 345/10,245) belonged to the LF group. LF was comprised predominantly of non-Caucasian ethnicity, higher socioeconomic class, and had a greater comorbidity burden. Heterotaxy syndrome and total anomalous pulmonary venous return were more common in the LF group as compared with hypoplastic left heart syndrome in the TF group. Patients in the LF group experienced higher postoperative morbidity but similar mortality and often required specialized healthcare post-discharge. Multivariate regression analysis revealed inferior survival among Fontan patients with ECMO use, atrioventricular septal defect, coagulopathy, acute kidney injury, infection, prolonged mechanical ventilation, but not age at Fontan. Conclusion: The proportion of patients undergoing LF compared with TF has decreased over time signalling a move toward earlier timing of the Fontan procedure. However, within the LF group, the number of LF patients has increased over time signifying an extended application of the Fontan operation. The patients in the LF group experienced greater postoperative morbidity with an associated higher baseline comorbidity but not short-term mortality after the Fontan procedure.

PMID:40525532 | DOI:10.1177/21501351251340669

Artif Organs. 2025 Jun 17. doi: 10.1111/aor.15044. Online ahead of print.

NO ABSTRACT

PMID:40525466 | DOI:10.1111/aor.15044

Ann Thorac Surg Short Rep. 2024 Nov 6;3(2):368-372. doi: 10.1016/j.atssr.2024.10.016. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: The objective of this study was to evaluate long-term outcomes for valve-sparing root replacement (VSRR) in patients with congenital aortopathy.

METHODS: In 107 patients undergoing VSRR in an elective setting with preoperative data from 1998 to 2022, information about operative strategy and postoperative course was collected. Patients were assigned to the congenital aortopathy group if a genetic mutation was confirmed or if a bicuspid aortic valve was present and compared with patients with tricuspid aortic valve. Long-term follow-up was obtained through outpatient visits or by telephone interviews.

RESULTS: Fifty-two percent (n = 56) were congenital aortopathy patients. Patients without congenital aortopathy were older (P < .001) and had higher rates of preoperative hypertension (P = .030) and hyperlipidemia (P = .001). Early survival was excellent with no in-hospital death. Postoperative echocardiography showed a good result, with aortic regurgitation being mild or less in 93% (n = 99). Nevertheless, aortic valve reoperation was needed in 7% of patients. Rates of transient ischemic attacks (2%), strokes (5%), and need for pacemaker implantation (4%) during follow-up were comparable between groups. There was no difference in long-term outcome or need for aortic valve reoperation between the groups.

CONCLUSIONS: VSRR in congenital aortopathy patients has good long-term results. During follow-up, the rate of thromboembolic events might have an impact on optimal medical therapy.

PMID:40525198 | PMC:PMC12167554 | DOI:10.1016/j.atssr.2024.10.016

Ann Thorac Surg Short Rep. 2024 Dec 16;3(2):469-472. doi: 10.1016/j.atssr.2024.12.001. eCollection 2025 Jun.

ABSTRACT

Automated implantable cardioverter defibrillator device implantation in young children is a rare procedure that typically necessitates intrapericardial lead placement. The extravascular implantable cardioverter defibrillator device can be implanted with the patient in a substernal position and with a straightforward and minimally invasive technique. The largest incision is made to accommodate the generator device. The alignment of the coils and device provides a good vector for defibrillation while permitting somatic growth. Here we describe implantation of an extravascular implantable cardioverter defibrillator in a 2-year-old child, among the youngest patients to receive this device to date.

PMID:40525144 | PMC:PMC12167553 | DOI:10.1016/j.atssr.2024.12.001

Int J Cardiol Congenit Heart Dis. 2025 Apr 3;20:100580. doi: 10.1016/j.ijcchd.2025.100580. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: The diagnosis and management of atrioventricular (AV)-conduction disorders in patients with a Fontan circulation can be challenging. Little is known about the effects of various pacing strategies in single-ventricle patients. Here we report 1) the feasibility of transesophageal electrophysiological study (EPS) to assess AV-conduction in a patient with limited venous access and 2) the potential of echocardiography to guide epicardial systemic right ventricular (sRV) lead positioning and to evaluate the hemodynamic consequences of sRV pacing in order to mitigate long-term effects of single site ventricular pacing.

MATERIAL AND METHODS: A 21-year old male with hypoplastic left heart syndrome, palliated with Norwood and Glenn procedures, and ultimately extracardiac total cavopulmonary connection was seen for a regular check-up. He reported difficulty cycling against the wind. During exercise stress test, a 2:1 AV-block occurred at atrial frequencies >100 bpm with recovery of 1:1 AV-conduction at sinus rates of 80-100 bpm. In order to discriminate between a 2:1 conducted atrial tachycardia and an impaired anterograde AV-conduction during sinus rhythm in the setting of bilateral femoral vein and unilateral subclavian/jugular vein occlusion, EPS by transesophageal pacing was proposed.

RESULTS: Bipolar transesophageal pacing of the left atrium confirmed an anterograde AV-Wenckebach point at 103 bpm, confirming the indication for AV-sequential pacing. Epicardial leads were surgically placed on the atrium and sRV apex. During intraoperative sRV pacing, transesophageal echocardiography confirmed the ventricular contraction pattern to remain synchronous with stable estimated cardiac output. Transthoracic echocardiography was performed postoperatively to assess the effects of sRV pacing on ventricular (dys)synchrony, systolic function and estimated cardiac output. These parameters remained unchanged during sRV pacing, compared to intrinsic conduction, an important finding in light of preserving sRV function.

CONCLUSIONS: EPS to assess AV conduction could safely be performed by transesophageal pacing in this patient with Fontan circulation. Moreover, echocardiographic guidance of epicardial sRV pacemaker lead placement was feasible and may help to define the optimal pacing site in Fontan patients.

PMID:40524979 | PMC:PMC12167887 | DOI:10.1016/j.ijcchd.2025.100580

Respirol Case Rep. 2025 Jun 16;13(6):e70223. doi: 10.1002/rcr2.70223. eCollection 2025 Jun.

ABSTRACT

The association of two rare but important congenital conditions-congenital chylothorax (CCT) and congenital pulmonary airway malformation (CPAM)-can be challenging to manage, especially in the absence of well-established protocols. We report an association between CPAM and CCT in a newborn. After birth, CCT did not respond to conservative treatment, and at the time of CPAM resection, thoracic duct ligation and abrasive pleurodesis were also performed. Despite these interventions, the CCT persisted even with the subsequent administration of octreotide and propranolol. Finally, after 56 days, chemical pleurodesis with povidone-iodine was performed. Chest tube drainage ceased, and the thoracic drain was removed 4 days later. Conservative treatment remains the first-line approach for neonatal CCT. However, when CCT is associated with CPAM and fails to respond to conservative measures, thoracic duct ligation should be considered at the time of lung malformation resection. If these interventions remain ineffective, chemical pleurodesis is a viable therapeutic option.

PMID:40524891 | PMC:PMC12168237 | DOI:10.1002/rcr2.70223

Medicine (Baltimore). 2025 Jun 13;104(24):e42753. doi: 10.1097/MD.0000000000042753.

ABSTRACT

Atrial fibrillation (AF) is the most common arrhythmia, significantly increasing the risk of adverse events such as stroke, heart failure, and cognitive impairment. catheter ablation is a first-line treatment for AF, with pulmonary vein isolation (PVI) as a common procedure. Although studies have reported sex-based differences in complication rates following PVI, these findings remain controversial. This study aimed to explore sex differences and identify independent risk factors associated with complications after PVI in non-valvular AF patients. This retrospective cohort study included 1092 patients with non-valvular AF who underwent PVI at the First Affiliated Hospital of Xinjiang Medical University between January 2018 and December 2021. The patients were divided into male and female groups, with propensity score matching used to reduce baseline differences. Data on clinical characteristics, intraoperative variables, and postoperative complications were collected. The primary outcome was the occurrence of complications after PVI, categorized into overall, mild, and major complications. Multivariate logistic regression analysis was performed to identify independent risk factors for complications. The study found that female patients experienced a higher incidence of postoperative complications compared to male patients (30.38% vs 19.89%, P = .001). The female group had significantly higher rates of pericardial effusion (20.17% vs 12.71%, P = .007) and mild complications, such as vagal hyperactivity (3.87% vs 1.38%, P = .036). Multivariate logistic regression revealed that female sex, obesity, New York Heart Association functional class ≥ II, and ablation of non-pulmonary veins were significantly associated with overall and mild complications. Sex differences significantly influence the occurrence of postoperative complications after PVI in non-valvular AF patients, with female patients at a higher risk. Targeted interventions considering these risk factors may improve patient outcomes. Further research is required to explore the underlying mechanisms driving these differences.

PMID:40527821 | PMC:PMC12173257 | DOI:10.1097/MD.0000000000042753

BMJ Open. 2025 Jun 17;15(6):e083677. doi: 10.1136/bmjopen-2023-083677.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the impact of the Charlson Comorbidity Index (CCI) on in-hospital outcomes in patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR) and to compare the efficacy of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with different comorbidity burdens.

SETTING: The National Clinical Research Center for Cardiovascular Diseases.

PARTICIPANTS: A retrospective analysis was conducted on 3380 AS patients who underwent AVR in Beijing Anzhen Hospital from January 2015 to October 2021.

INTERVENTIONS: Patients were stratified into low (0-1) and high (≥2) CCI groups.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was Valve Academic Research Consortium-2 (VARC-2) composite early safety endpoints.

RESULTS: Patients with high CCI scores exhibited significantly higher rates of VARC-2 composite adverse outcomes compared with those with low scores (50.3% vs 44.2%, p=0.001). After adjusting for confounding factors, high CCI scores were independently associated with the VARC-2 composite adverse outcomes (OR=1.36, 95% CI 1.17 to 1.58, p<0.001). In patients aged ≥65 years, TAVR demonstrated lower composite event rates compared with SAVR, regardless of CCI score (low CCI: 17.6% vs 54.3%, p<0.001; high CCI: 33.7% vs 62.8%, p<0.001).

CONCLUSIONS: CCI is a significant predictor of in-hospital composite adverse events in AS patients undergoing AVR. TAVR may be preferred over SAVR for patients aged ≥65 years, irrespective of comorbidity burden, to minimise composite events risk. These findings underscore the importance of considering comorbidity burden in treatment decision-making for AS patients.

TRIAL REGISTRATION NUMBER: NCT05797402.

PMID:40527568 | PMC:PMC12182039 | DOI:10.1136/bmjopen-2023-083677

Eur J Nucl Med Mol Imaging. 2025 Jun 17. doi: 10.1007/s00259-025-07406-9. Online ahead of print.

ABSTRACT

PURPOSE: In patients with valvular heart disease (VHD), fibroblast activation induced by pressure or volume overload can be identified by molecular imaging with fibroblast activation protein inhibitor (FAPI). The study sought to explore the potential of serial FAPI imaging for monitoring the reverse myocardial remodeling triggered by valve replacement.

METHODS: A cohort of 31 VHD patients scheduled for transcatheter or surgical valve replacement underwent 99mTc-FAPI SPECT/CT imaging and echocardiography. All patients repeated echocardiography and 22 of them completed repeat FAPI scans at 3-month follow-up. Cardiac FAPI uptake was quantified as maximum standardized uptake value (SUVmax), maximum of myocardial-to-blood ratio (TBRmax), and fibroblast activation volume (FAV). Myocardial remodeling patterns were evaluated through a comprehensive analysis of left ventricular geometric parameters derived from echocardiography.

RESULTS: Myocardial FAPI uptake showed heterogeneous among VHD patients (range: SUVmax 0.67-8.33; TBRmax 1.13-7.50; FAV 0-597 mL). FAPI uptake significantly correlated with levels of circulating N-terminal prohormone of brain natriuretic peptide and left ventricle mass index before valve replacement. Following relief of overload, 22 patients who underwent repeat FAPI imaging demonstrated significant reductions in TBRmax (3.31 [1.73-4.87] vs. 2.43 [1.63-4.23], p = 0.029) and FAV (31.5 [0-227] vs. 12.0 [0-144] mL, p = 0.004). Follow-up echocardiography revealed that 9 out of 31 patients transitioned to normal geometry from concentric or eccentric hypertrophy, achieving complete reverse remodeling. Multivariable regression suggested baseline FAPI uptake intensity TBRmax significantly associated with complete reverse remodeling post-intervention after adjustment (OR: 0.288 [0.097-0.852], p = 0.024).

CONCLUSION: 99mTc-FAPI SPECT/CT imaging is feasible to quantitatively track dynamics of fibroblast activation following valve replacement. Patients with lower preprocedural fibrotic activity identified by FAPI imaging may have greater potential for complete reverse remodeling.

PMID:40526127 | DOI:10.1007/s00259-025-07406-9

Hemodial Int. 2025 Jun 16. doi: 10.1111/hdi.13272. Online ahead of print.

ABSTRACT

BACKGROUND: It has been suggested that ventricular strain measurements may be impaired in chronic hemodialysis patients despite having no history of heart disease. The aim of this study is to investigate whether ventricular strain parameters can be used to detect subclinical cardiac dysfunction in hemodialysis patients.

METHODS: In our study, 47 patients under the age of 65 years with no known history of cardiac or valvular disease and receiving chronic hemodialysis treatment for at least 1 year were compared with an age- and sex-matched control group of 29 healthy individuals. Transthoracic echocardiography was used to evaluate parameters such as global longitudinal strain, right ventricular global longitudinal strain, and left ventricular diastolic diameter. Differences between groups were analyzed by Student's t-test and Mann-Whitney U test.

RESULTS: The global longitudinal strain values of the hemodialysis group were significantly lower than those of the control group (-13.2 ± 3.91 vs. -22.1 ± 1.59, p < 0.001). Right ventricular global longitudinal strain (RV GLS) and left ventricular diastolic diameter were also significantly impaired in the hemodialysis group (p < 0.05). These results indicate the presence of subclinical cardiac dysfunction in hemodialysis patients.

CONCLUSIONS: Ventricular strain measurements may be impaired in chronic hemodialysis patients without a history of cardiovascular disease. Therefore, it is considered that ventricular strain measurements can be a useful method for the early detection of cardiac dysfunction in hemodialysis patients.

PMID:40524351 | DOI:10.1111/hdi.13272

Clin Nurse Spec. 2025 Jul-Aug 01;39(4):180-184. doi: 10.1097/NUR.0000000000000904.

ABSTRACT

BACKGROUND: Cardiopulmonary bypass use during surgery disrupts microcirculation, which can contribute to lung injury, particularly in patients with pulmonary comorbidities. Continuous transcutaneous carbon dioxide (CO2) monitoring assists clinicians to trend values related to metabolic and respiratory status between intermittent arterial blood gas measurements. We sought to review the literature to support adoption of this technology to optimize weaning in patients with pulmonary comorbidities following open heart surgery.

METHODS: Multiple databases were reviewed. Inclusion criteria were limited to results of peer-reviewed articles in English published within the past 5 years. The findings were presented to relevant levels of hospital leadership, who approved adoption of the technology for this population. From there, monitors were positioned in 4 surgical intensive care unit rooms for monitoring of patients up to the point of extubation.

RESULTS: The literature review yielded 12 articles, with a majority deeming transcutaneous monitoring feasible and appropriate in the postoperative patient, including those having cardiopulmonary bypass. Clinical interventions and trending were valuable additions to improve patient outcomes and nursing autonomy. During the fiscal quarter following adoption of the technology, mean time spent on the ventilator dropped 30%, reintubation dropped 4%, and mortality decreased by 24%.

CONCLUSIONS: Transcutaneous monitoring of CO2, with improved specificity over end-tidal CO2 monitoring, offers meaningful trending to inform clinician decision-making around readiness to wean. Additionally, transcutaneous monitoring allows for noninvasive, reliable continuous metabolic monitoring to serve as an early clinical indicator for at-risk patients.

PMID:40526768 | DOI:10.1097/NUR.0000000000000904

Turk J Anaesthesiol Reanim. 2025 Jun 17. doi: 10.4274/TJAR.2025.251926. Online ahead of print.

ABSTRACT

Advanced hemodynamic monitoring has revolutionized perioperative medicine and critical care by providing comprehensive insights into cardiovascular physiology and facilitating precise assessment and management of complex parameters such as cardiac output, systemic vascular resistance, fluid responsiveness, and tissue perfusion. These technologies enhance the capacity of clinicians to detect subtle physiological alterations, enabling timely interventions and individualized therapeutic strategies, particularly for critically ill patients and those undergoing major surgical procedures. This two-part review offers a comprehensive analysis of hemodynamic monitoring. Part I examined the fundamental principles of macrohemodynamics and microhemodynamics. Part II focuses on advanced hemodynamic monitoring tools, tracing the evolution of cardiac output measurement techniques from Fick's oxygen consumption method in 1870 to contemporary innovations, such as pulse contour analysis, bioimpedance/bioreactance, and real-time non-invasive modalities like advanced echocardiography. By examining the underlying principles, devices, invasiveness, clinical applications, advantages, and limitations of various monitoring techniques, this review elucidates the clinical utility of advanced tools in addressing the limitations of standard monitoring and optimizing patient outcomes in modern anaesthesia and critical care practices.

PMID:40526033 | DOI:10.4274/TJAR.2025.251926

A A Pract. 2025 Jun 17;19(6):e02000. doi: 10.1213/XAA.0000000000002000. eCollection 2025 Jun 1.

ABSTRACT

The serratus posterior superior intercostal plane block (SPSIPB) is a novel regional anesthesia technique providing broad dermatomal coverage. We present 2 patients who underwent coronary artery bypass grafting via median sternotomy and received bilateral SPSIPB for postoperative analgesia. Both patients exhibited effective pain control with low numeric rating scale scores and minimal morphine consumption (8 mg and 10 mg, respectively) within the first 24 postoperative hours, without any complications. These findings support the potential role of SPSIPB as a safe and effective component of multimodal analgesia in cardiac surgery, particularly in patients at increased risk for neuraxial techniques. .

PMID:40525732 | DOI:10.1213/XAA.0000000000002000

Free Radic Biol Med. 2025 Jun 14;237:542-557. doi: 10.1016/j.freeradbiomed.2025.06.017. Online ahead of print.

ABSTRACT

Myocardial ischemia-reperfusion injury (MI/RI) is a major contributor to poor outcomes after revascularization in patients with myocardial infarction, largely due to the absence of targeted therapies. Phillygenin (PHI), a bioactive compound isolated from Forsythia suspensa, has been found to confer various pharmacological properties, including anti-inflammatory, hepatoprotective, and renal protective effects. However, the specific role of PHI in MI/RI remains largely unclear. Thus, this study aims to investigate whether PHI exerted cardioprotective effects against MI/RI, and if so, to elucidate the underlying molecular mechanisms. Hypoxia/reoxygenation (H/R) models in H9c2 cardiomyocytes and MI/RI mouse models were established. PHI intervention markedly improved cardiac function, reduced myocardial infarct size, and attenuated cardiomyocyte damage in MI/RI mice. PHI treatment significantly reversed H/R-induced cellular injury and mitochondrial dysfunction in cultured cardiomyocytes. Notably, PHI administration significantly mitigated myocardial cuproptosis, rather than pyroptosis and ferroptosis. Specifically, PHI reduced cardiomyocyte cuproptosis by downregulating the protein expression of ferredoxin 1 (FDX1) and lipoyl synthase (LIAS), and suppressing copper accumulation. Induction of cuproptosis abolished the cardiac benefits of PHI in vivo and in vitro. Mechanistically, PHI promoted the lysosomal localization and degradation of the copper transporter 1 (CTR1), thus alleviating cuproptosis, inflammation, oxidative stress, and mitochondrial injury in cardiomyocytes. Overall, PHI may be a promising therapeutic agent for the alleviation of MI/RI-induced cardiac dysfunction through the inhibition of cuproptosis via facilitating the transfer of CTR1 to the lysosome for degradation.

PMID:40523538 | DOI:10.1016/j.freeradbiomed.2025.06.017

J Extra Corpor Technol. 2025 Jun;57(2):74-81. doi: 10.1051/ject/2025001. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: Minimally invasive extracorporeal circulation (MiECC) has been introduced to mitigate the inflammatory response and reduce blood transfusion needs compared to conventional cardiopulmonary bypass (CPB) perioperatively. A hybrid system (HS) that merges aspects of both traditional CPB and MiECC aims to optimize patient perioperative outcomes. This study focuses on comparing the postoperative transfusion rates, intensive care unit (ICU) course, and biochemical parameters between the HS and MiECC.

MATERIALS AND METHODS: This prospective, randomized, controlled, single-center study was conducted at Koşuyolu High Specialization Education and Research Hospital, Istanbul from February 2024 to June 2024. Forty patients undergoing isolated coronary artery bypass grafting (CABG) were included, with 20 patients in the HS-group and 20 in the MiECC-group. Data on oxygen delivery management, hemoglobin and platelet values trends, biochemical parameters, the number of red blood cells and platelet units transfused postoperatively, and ICU stay duration were collected.

RESULTS: The CPB time was not significantly shorter in the HS group compared to the MiECC group (93.35 ± 33.06 min vs. 108.65 ± 30.02 min, p = 0.134). Hemoglobin levels did not differ significantly between the groups preoperatively, perioperatively, or postoperatively at 6, 12, and 24 h no difference in red blood cells unit transfusion. Indexed oxygen delivery did not differ significantly between the HS and MiECC groups (311.60 ± 28.29 mL/min/m2 vs. 332.25 ± 57.04 mL/min/m2, p = 0.275). Partial pressure of oxygen was higher in the MiECC group (210.90 ± 49.64 mmHg vs. 177.70 ± 70.41 mmHg, p = 0.093), but this difference was also not statistically significant. Biochemical parameters showed notable differences. Postoperative lactate levels were significantly lower in the HS group (2.85 ± 1.20 mmol/L vs. 4.04 ± 1.40 mmol/L, p = 0.009). Conversely, Lactate Dehydrogenase levels during and after CPB were, lower in the MiECC group. Postoperative 6th-hour troponin levels were significantly lower in the HS group (3.188 ± 2.684 ng/mL vs. 4.645 ± 3.422 ng/mL, p = 0.038). Mechanical ventilation duration, ICU stay, and hospital stay were comparable between the two groups, with no significant differences observed.

CONCLUSIONS: The hybrid system demonstrated comparable results to the MiECC in patients undergoing isolated CABG. No significant differences were observed in CPB time or postoperative blood transfusion requirements. However, the HS group showed favorable biochemical parameters, including significantly lower postoperative lactate levels and troponin levels at 6 h. Indexed oxygen delivery and partial pressure of oxygen were similar between groups, and ICU and hospital stay durations were comparable. These findings suggest that the hybrid system offers outcomes on par with the MiECC approach, with potential benefits in terms of biochemical markers. Further studies with larger sample sizes are needed to validate these results and explore possible advantages in broader clinical settings.

PMID:40523134 | PMC:PMC12169718 | DOI:10.1051/ject/2025001

Nurs Crit Care. 2025 Jul;30(4):e70081. doi: 10.1111/nicc.70081.

ABSTRACT

BACKGROUND: Understanding the factors influencing alterations in arterial blood gas (ABG) is essential for enhancing patient results, averting complications tied to abnormal blood gas levels and, in turn, elevating the quality of care in cardiac surgery.

AIMS: This research aims to evaluate the longitudinal change trends in ABG values and their associated factors in the post-operative phase for individuals undergoing coronary artery bypass graft (CABG) and cardiac valve replacement procedures.

STUDY DESIGN: In this retrospective cohort study, we enrolled all patients who underwent CABG and cardiac valve replacement surgeries in a cardiac hospital in Tehran, Iran from March 2021 to March 2022. We used the multivariate generalized linear mixed model (MGLMM) for assessing the ABG parameter change trends and its associated factors.

RESULTS: Out of 254 included patients, 92 (36.20%) were female and 162 (63.80%) were male. The standard errors of the parameter estimates in the MGLMM were smaller than those in the GLMM. So, the results of the MGLMM showed that the variables of age (p < 0.001), gender (p < 0.001) and ejection fraction (EF) (p = 0.032) had a significant association with the mean changes of pH; the variables of age (p = 0.031), chest-tube type placement (p = 0.014) and type of surgery (p = 0.007) with PaCO2; the variables of age (p < 0.001) and chest-tube type placement (p = 0.034) with pO2; the variables of age (p < 0.001), BMI (p = 0.017), chest-tube type placement (p = 0.015), smoking (p = 0.038) and having pulmonary disease (p < 0.001) with sO2; the variables of age (p = 0.008), gender (p = 0.001) and aorta clamp time duration (p = 0.020) with BE; and the variables of gender (p = 0.044) and aorta clamp time duration (p = 0.041) with HCO3 (p-value < 0.05).

CONCLUSION: Post-operative ABG results were significantly affected by a variety of factors, including age, gender, left ventricular EF, chest-tube placement, surgical techniques and some other patient-specific and medical care-related variables. The research findings emphasize the need for individualized monitoring and assessment of ABG levels based on patient-specific factors.

RELEVANCE TO CLINICAL PRACTICE: This study highlights the dynamic changes in ABG parameters following cardiac surgery and its determinants simultaneously. Our findings can also help nurses to predict the occurrence of acid-base disorders. Appropriate planning will be possible to prevent or obstruct their progression and provide better care.

PMID:40522184 | DOI:10.1111/nicc.70081

Catheter Cardiovasc Interv. 2025 Jun 16. doi: 10.1002/ccd.31679. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic impact of complete revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain.

AIMS: This study aimed to compare clinical outcomes between complete and incomplete revascularization in NSTEMI patients with MVD, assessing the optimal timing and strategy for revascularization.

METHODS: We analyzed 2460 consecutive NSTEMI patients with MVD enrolled across five institutions between January 2021 and December 2022. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs: all-cause death, recurrent myocardial infarction, heart failure, stroke, and urgent revascularization) and major adverse cardiac events (MACEs: cardiovascular death, recurrent myocardial infarction, heart failure, and urgent revascularization). Multivariable Cox proportional hazards regression analysis was conducted to adjust for important clinical characteristics, and adjusted hazard ratio (aHR) with a 95% confidence interval (CI) was calculated to assess the risk of clinical outcomes. Inverse probability weighting analysis was performed to verify the robustness of the results.

RESULTS: Over a median 528-day follow-up, complete revascularization was associated with a significantly lower risk of MACCEs (aHR 0.48, 95% CI 0.36-0.64) and MACEs (aHR 0.45, 95% CI 0.33-0.60) compared to incomplete revascularization. Single-stage and multistage complete revascularization showed comparable outcomes (MACCEs: aHR 0.93, 95% CI 0.47-1.85; MACEs: aHR 0.89, 95% CI 0.44-1.82). However, compared to delayed multistage complete revascularization, early multistage complete revascularization significantly reduced the risk of MACCEs (aHR 0.05, 95% CI 0.01-0.28) and MACEs (aHR 0.03, 95% CI 0.01-0.27). These results were consistent after confounder adjustment by inverse probability weighting analysis.

CONCLUSION: Complete revascularization is an effective treatment strategy for reducing the risk of adverse clinical outcomes in NSTEMI patients with MVD. Moreover, an early multistage complete revascularization may be a better option.

PMID:40521697 | DOI:10.1002/ccd.31679