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J Card Fail. 2025 Sep 23:S1071-9164(25)00449-X. doi: 10.1016/j.cardfail.2025.09.025. Online ahead of print.

ABSTRACT

The United States national organ transplant program was established > 50 years ago, founded on the tenets of fairness, equity, and safety. Public trust is paramount to the success of every aspect of organ transplant including donor registration, organ procurement organization practices, donor hospital partnerships and allocation policy. This perspective evaluates the status of public trust in organ transplant in the context of new and concerning developments in US practices, and government responses. Our focus is on the potential impacts on heart transplantation, specifically on waitlist mortality, especially for patients without an alternative option in durable mechanical circulatory support.

PMID:40997990 | DOI:10.1016/j.cardfail.2025.09.025

BMJ Case Rep. 2025 Sep 25;18(9):e266133. doi: 10.1136/bcr-2025-266133.

ABSTRACT

Congenital heart block is a rare disorder of neonates. It is generally diagnosed in the antenatal period or at birth and is commonly associated with transplacental passage of anti-Ro and/or anti-La antibodies to the fetus. It has a high mortality rate if left untreated. A pacemaker is considered as the treatment of choice, but the expertise for pacemaker implantation is available at only a few centres in India. We present a case of a late preterm neonate with antenatally diagnosed heart block due to anti-Ro antibody in the mother. The baby required delivery room resuscitation and mechanical ventilation. Postnatal ECG was also suggestive of third degree heart block and the baby landed into shock soon after birth. The baby was managed initially with ionotropic agents and an epicardial pacemaker was implanted within 6 hours of life. The baby was discharged successfully with stable vitals.

PMID:40998533 | DOI:10.1136/bcr-2025-266133

Int J Surg Case Rep. 2025 Sep 22;136:111977. doi: 10.1016/j.ijscr.2025.111977. Online ahead of print.

ABSTRACT

INTRODUCTION: Scoliosis is a complex spinal deformity with diverse etiologies, requiring tailored management strategies based on its classification as congenital, neuromuscular, or idiopathic.

PRESENTATION OF CASE: We present the case of a 14-year-old girl with severe sagittal imbalance and gait impairment following spinal fusion surgery for adolescent idiopathic scoliosis (AIS). Postoperative investigations revealed an undiagnosed core myopathy characterized by cervical flexor weakness, confirmed through electromyography and muscle biopsy, which contributed to her sagittal imbalance by necessitating compensatory cervical hyperextension and thoracic flexion.

DISCUSSION: This misdiagnosis of her scoliosis as idiopathic rather than neuromuscular underscores the importance of comprehensive preoperative evaluations, including neuromuscular assessments, in patients with atypical presentations. Avoiding further surgical intervention, the patient was managed conservatively with occupational therapy, resulting in partial functional improvement.

CONCLUSION: This case emphasizes the need for multidisciplinary approaches and vigilance in recognizing underlying conditions that may complicate scoliosis treatment.

LEVEL OF EVIDENCE: Level IV (Case Report).

PMID:40997629 | DOI:10.1016/j.ijscr.2025.111977

JACC Adv. 2025 Sep 24;4(11 Pt 1):102144. doi: 10.1016/j.jacadv.2025.102144. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiac surgery is associated with postsurgical inflammatory conditions, including postoperative pericarditis, that confer morbidity and are understudied in the adult congenital heart disease (ACHD) population.

OBJECTIVES: The purpose of this study was to evaluate the incidence and risk factors for developing postoperative pericarditis in ACHD surgical operations.

METHODS: Retrospective study of ACHD patients who underwent cardiac surgery between 2015 and 2023 at a major New York medical center. Pericarditis diagnosis required: 1) no prior history of pericarditis; 2) at least 2/4 criteria for acute pericarditis (chest pain, friction rub, nonlocalizing ST-segment elevations or PR depressions, new/worsening pericardial effusion); and 3) treatment of pericarditis (nonsteroidal anti-inflammatory drugs, colchicine, steroids, interleukin 1 inhibition). Surgical data and patient characteristics were collected. Logistic regression was used to determine baseline variables associated with pericarditis after atrial septal defect (ASD) repair.

RESULTS: Among 214 ACHD patients undergoing cardiac surgery (median age 36 years [Q1-Q3: 26-53 years], 48.5% male), 47 patients (22.0%) developed postoperative pericarditis and were more commonly Asian or Black. The majority (37/47, 78.7%) of cases occurred within the first 7 days, with clinical resolution within 2 to 4 weeks, except for 4 patients (8.5%) who developed recurrent pericarditis. None developed tamponade or required pericardial drainage. Pericarditis occurred most frequently with shunt repair operations (27/47, 57.4%), in particular after ASD repair (24/29, 82.7%) using autologous pericardium (15/33, 45.4%) and aortic valve replacements (10/29, 34.4%). Logistic regression analysis of ASD repairs identified younger age, male sex, and Asian race as independent risk factors for pericarditis.

CONCLUSIONS: Roughly one in five ACHD cardiac surgical cases develop postoperative pericarditis, most frequently after ASD repairs using autologous pericardium or aortic valve replacement, yet only rarely had long-lasting complications.

PMID:40997554 | DOI:10.1016/j.jacadv.2025.102144

Bol Med Hosp Infant Mex. 2025;82(5):304-313. doi: 10.24875/BMHIM.24000099.

ABSTRACT

BACKGROUND: Invasive medical procedures in children with congenital heart disease (CHD) increase parental anxiety and stress with a negative impact on the disease and children's coping. Parental psychoeducational programs promote their mental health and positive impact on pediatric health. The objective was to evaluate the efficacy of an online psychoeducational program to promote the mental health of parents of children with CHD who are about to undergo an invasive medical procedure.

METHODS: Forty-three mothers and fathers of children with CHD about to undergo catheterization or cardiac surgery belonging to the Live Longer Mexico Foundation participated, divided alternately into two groups: 1) online psychoeducational program (n = 22), and 2) control (n = 21). Mental health was evaluated based on three indicators: parental stress, state/trait anxiety and worry before the procedure. The PSI-SF Parental Stress Index, the Parental Worry about Surgery Questionnaire and the Trait-State Anxiety Inventory were used.

RESULTS: The group with the psychoeducational program showed a statistically significant decrease in state anxiety and worry about the medical procedure. Additionally, state anxiety and worry about the medical procedure are significantly lower in the group that received the psychoeducational program compared to the control. Parental stress had no significant intra- and inter-group changes.

CONCLUSIONS: The online psychoeducational program is effective in favoring parental mental health, specifically on state/trait anxiety and worry about surgery in parents of children with CC nearing catheterization or cardiac surgery.

PMID:40997336 | DOI:10.24875/BMHIM.24000099

Kyobu Geka. 2025 Sep;78(9):693-696.

ABSTRACT

A 74-year-old woman was diagnosed with obstructive hypertrophic cardiomyopathy and symptoms of heart failure. Transthoracic echocardiography and other imaging examinations revealed an apical-basal muscle bundle caused by a left ventricular outflow tract(LVOT) obstruction. The peak velocity was 6.1 m/s, recorded during the Valsalva maneuver, and mitral regurgitation progressed from trivial to moderate. The course of operative treatment consisted of surgical intervention in the mitral valve. The LVOT revealed an apical-basal muscle bundle, approximately 6 mm in diameter;however, this was excluded. Extended septal myectomy and intraoperative transesophageal echocardiography were performed, the latter to verify the systolic anterior motion of the mitral valve;however, mitral regurgitation was not detected. The post-operative peak velocity improved to 2.5 m/s. In conclusion, surgical treatment of obstructive hypertrophic cardiomyopathy and LVOT obstruction associated with an apical-basal muscle bundle was performed with accurate diagnosis, thus avoiding valvular surgery.

PMID:40998368

Kyobu Geka. 2025 Sep;78(9):677-683.

ABSTRACT

PURPOSE: Our objective is to develop a new device for the treatment of mitral regurgitation by transapical chordal implantation, allowing procedures to be conducted while the heart is beating, thus eliminating the need for extracorporeal circulation. This approach promises both simpler and more reliable procedure than existing devices.

METHODS: The target disease is mitral valve prolapse, where adequate coaptation of the anterior and posterior leaflets can be achieved solely through chordal implantation. Our treatment approach involves accessing the mitral valve via the left ventricular apex, attaching an artificial chorda tendineae to the prolapsed mitral valve leaflet, and pulling it to an appropriate length towards the left ventricular apex. We propose the design and operational mechanism of a device to facilitate this procedure.

RESULTS: The device utilizes a grasper with a hollow structure to catch the prolapsed valve leaflet and then attaches the artificial chordae tendineae to the valve leaflet by using a clip within the hollow structure. This structure enables visual confirmation of the procedure using a fiber scope, thus ensuring greater procedural reliability.

CONCLUSION: This device represents a conceptual breakthrough, although several considerations remain, such as the durability of the materials used and their compatibility with tissue.

PMID:40998366

Kyobu Geka. 2025 Sep;78(10):787-792.

ABSTRACT

While it may seem that there have been no significant changes in the field of cardiopulmonary bypass (CPB) over the past decade, there have been advances in management concepts, such as coagulation management strategies and the use of oxygen delivery index (DO2i) and carbon dioxide (CO2)-derived variables during CPB. It will be important to examine what changes in outcomes are observed as a result of advances in management methods. The development of a variety of monitoring devices is expected if better outcomes are observed as a result of advances in CPB management. In addition, the introduction and study of different perfusion-assist functions are hoped to lead to the automation of operations in CPB.

PMID:40998341

Anesthesiology. 2025 Sep 25. doi: 10.1097/ALN.0000000000005776. Online ahead of print.

ABSTRACT

BACKGROUND: Randomized controlled trials (RCTs) are designed to achieve balanced distribution of baseline characteristics across study arms through random allocation, rendering null-hypothesis significance testing on these characteristics unnecessary and potentially misleading. Despite longstanding guidance discouraging this practice, its prevalence and patterns within anesthesiology and pain medicine literature remain unclear.

METHODS: We conducted a meta-research study of parallel-group RCTs published from 1996 to 2025 across 101 journals indexed under the "Anesthesiology and Pain Medicine" category in Scopus. Data extraction included study characteristics, reporting of baseline testing, number of variables tested, and statistical significance. Multivariable logistic regression was used to identify factors associated with baseline testing, and a binomial test assessed whether the observed rate of significant findings exceeded the expected false-positive rate under the null hypothesis.

RESULTS: Of 2453 eligible RCTs, 1186 (48.3%) reported statistical testing of baseline characteristics. Among studies performing such testing, 228 (19.2%) reported at least one statistically significant difference, and 58 (25.4%) discussed it as a study limitation. A total of 11516 variables were tested, with 424 (3.7%) reported as statistically significant-below the 5% expected by chance (p < 0.001). Larger author teams were associated with lower odds of baseline testing (OR 0.95; 95% CI 0.93-0.97), while a higher number of variables tested increased the odds of finding at least one significant difference (OR 1.10; 95% CI 1.07-1.12).

CONCLUSIONS: Despite methodological guidance and CONSORT recommendations, statistical testing of baseline characteristics remains common in anesthesiology RCTs and has not declined over time. This practice likely reflects persistent misunderstanding of randomization and may lead to misinterpretation of study validity. Education and stronger editorial policies are needed to align reporting behavior with best practices and improve trial transparency.

PMID:40997084 | DOI:10.1097/ALN.0000000000005776

Saudi J Anaesth. 2025 Oct-Dec;19(4):643-645. doi: 10.4103/sja.sja_38_25. Epub 2025 Sep 3.

ABSTRACT

This case report presents the significant enlargement of the left internal jugular vein (IJV) detected during ultrasound (US)-guided central venous catheterization (CVC) in an adult patient undergoing cardiac surgery. An 81-year-old female patient who had severe mitral valve regurgitation, severe tricuspid valve regurgitation, and pulmonary hypertension was scheduled for Mitral Valve Replacement and DeVega Tricuspidoplasty. The patient had many comorbidities, so she was on antihypertensive (nebivolol), antithrombotic (rivaroxaban), and antidiabetic (insulin) medications. After anesthesia induction, the patient was positioned for CVC. Ultasound guidance showed that the anteroposterior diameter of the right IJV was small and the degree of overlapping of carotid artery (CA) was high. Left side was evaluated before starting the procedure. Marked enlargement of the left IJV and less overlapping of CA was observed. Left IJV catheterization was decided and performed without any complication. The surgery lasted for 3 hours and was completed uneventfully. Although right IJV is usually preferred for CVC where central intravenous access is required, it is advisable to evaluate the left IJV when the right one has a small diameter and there is a significant overlapping of right CA. In these cases, the choice for CVC side should be based on the data which is obtained from both sides.

PMID:40994495 | PMC:PMC12456641 | DOI:10.4103/sja.sja_38_25

Front Pharmacol. 2025 Sep 9;16:1624595. doi: 10.3389/fphar.2025.1624595. eCollection 2025.

ABSTRACT

BACKGROUND: Research has underscored the significance of targeting energy metabolic remodeling in heart failure (HF) as a crucial therapeutic avenue in recent years. Following the onset of heart failure, dysregulated energy metabolism induces multiple adverse effects, exemplified by the reduced expression of connexin 43 (Cx43)-a gap junction protein requiring substantial ATP for phosphorylation modification-in rats with post-myocardial infarction (MI) heart failure. In this study, we report that Wenxin Keli (also known as Wenxin granule), a clinically available Chinese patent medicine used for preventing and treating heart failure-related arrhythmias, modulates energy metabolism and improves Cx43 function by activating AMPK/SIRT1/PGC-1α signaling pathway. However, the pathological alterations after heart failure are intricate, and the underlying mechanism through which Wenxin Keli exerts its therapeutic effect on heart failure remains to be further elucidated.

METHODS: A post-myocardial infarction heart failure rat model was established via left anterior descending coronary artery ligation. Cardiac function was evaluated 4 weeks later using echocardiography, HE, and Masson trichrome staining. ELISA was employed to detect energy metabolism-related indices, while WB analysis was used to quantify the expression levels of proteins, including SIRT1, PGC-1α, and Cx43. IHC was further utilized to assess Cx43 protein content in tissue sections. Ventricular fibrillation (VF) was induced to determine the VF threshold, providing insights into arrhythmogenic susceptibility.

RESULTS: Wenxin Keli enhances energy metabolism and improves Cx43 function in post-MI heart failure rats by activating the AMPK/SIRT1/PGC-1α signaling pathway. Specifically, Wenxin Keli stimulates the SIRT1/PGC-1α axis, promoting interaction between PGC-1α and PPARs and ERRs. This dual mechanism addresses the combined impairments in fatty acid oxidation and glucose utilization after heart failure, restoring mitochondrial oxidative phosphorylation and increasing ATP production through the TCA cycle. Furthermore, Wenxin Keli boosts the positive regulatory effect of SIRT1 on PGC-1α by upregulating AMPK phosphorylation, thereby further activating the AMPK/SIRT1/PGC-1α signaling pathway and creating a positive feedback loop.

CONCLUSION: Wenxin Keli exhibits multi-target regulation of energy metabolic disorders in post-myocardial infarction heart failure while protecting Cx43. Its core mechanism is activating the AMPK/SIRT1/PGC-1α signalling pathway and its downstream regulatory network.

PMID:40994651 | PMC:PMC12455355 | DOI:10.3389/fphar.2025.1624595

Pediatr Cardiol. 2025 Sep 25. doi: 10.1007/s00246-025-04025-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are utilized in pediatric heart failure (HF) with little data on dosing or safety profile. Our aim is to report on dosing and adverse events associated with SGLT2i use in pediatric HF.

METHODS: A retrospective study was performed utilizing the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) pediatric heart failure registry. Patient demographics, medical regimen, echocardiographic data, laboratory data, adverse events, and relevant heart failure outcomes were collected at SGLT2i initiation and last follow-up.

RESULTS: At time of database query, data from 278 patients from 19 institutions were common. The most common SGLT2i prescribed was dapagliflozin (244) followed by empagliflozin (34). Median age at initiation was 15.1 years (IQR 10.7-18.2), 106 had DCM, 54 had Fontan physiology, and 67% of patients were initiated in the outpatient setting. For all patients prescribed dapagliflozin, the median mg/kg/dose at initiation was 0.11 (IQR 0.08-0.14). The median follow-up was 195 days (IQR 90-450, n = 180). In the follow-up cohort, 32 patients discontinued SGLT2i with 15 due to drug intolerance. 28 patients had a total of 34 adverse events (AE) reported. The most common AE was UTI (11) followed by AKI (10). After SGLT2i initiation, 13% of patients had a subsequent HF admission, 5% had a VAD, and 9% underwent heart transplantation.

CONCLUSION: In pediatric HF, SGLT2is are being utilized in a diverse patient population. AKI and UTI were the most common reported AE. Typical initiation dose is approximately 0.1mg/kg/dose. Prospective studies are needed to help determine efficacy.

PMID:40996542 | DOI:10.1007/s00246-025-04025-x

JACC Case Rep. 2025 Sep 25:105537. doi: 10.1016/j.jaccas.2025.105537. Online ahead of print.

ABSTRACT

BACKGROUND: Atrioventricular (AV) block is a potential complication of orthotropic heart transplantation (OHT). The optimal cardiac pacing method is largely unexplored in patients after OHT.

CASE SUMMARY: We present a patient with AV block after OHT in whom right ventricular pacing resulted in pacing-induced cardiomyopathy (PICM). Left ventricular function was restored with left bundle branch pacing.

DISCUSSION: AV block is an uncommon complication after OHT that requires ventricular pacing. Ventricular dyssynchrony induced by right ventricular pacing may be associated with increased risk for PICM in OHT recipients. Cardiac physiologic pacing should be considered as the primary pacing strategy in this population.

TAKE-HOME MESSAGES: OHT recipients may be at increased risk for PICM. Left bundle branch pacing is an effective strategy for both prevention and treatment of PICM.

PMID:40996402 | DOI:10.1016/j.jaccas.2025.105537

J Am Heart Assoc. 2025 Sep 25:e040914. doi: 10.1161/JAHA.124.040914. Online ahead of print.

ABSTRACT

BACKGROUND: The Stroke Preclinical Assessment Network tested 6 therapeutic interventions initiated at the time of reperfusion after focal ischemic stroke in young mice, aging mice, obese mice, and spontaneously hypertensive rats. This randomized, controlled trial was conducted across 6 sites with concealed treatment and blinded neurobehavior assessments. The trial had an adaptive design with preset levels of efficacy and futility interrogated after each of 4 stages. The primary outcome was turning preference on the corner test at 1 month. The PARP (poly(ADP-ribose) polymerase) inhibitor, veliparib, was considered futile after the second stage when pooling all animal models (n=231 veliparib; n=344 placebo).

METHODS: A secondary analysis was performed to evaluate veliparib treatment on primary and secondary outcomes in individual subgroup models.

RESULTS: Intravenous injection of veliparib at reperfusion failed to show a benefit on the corner test at 7 or 30 days of recovery in young mice, obese mice, or spontaneously hypertensive rats. However, in aging mice (15-18 months old), veliparib significantly improved performance on the corner test at 7 (P=0.007) and 30 (P=0.03) days and reduced foot-faults on the grid walk test at 7 (P=0.024) and 30 (P=0.008) days. These effects were independent of sex. Treatment had no effect on magnetic resonance imaging-determined lesion volume. The survival was similar with placebo and veliparib treatments across subgroups, although mortality was high in aging mice.

CONCLUSIONS: Veliparib improved functional outcome in aging mice. Because ischemic stroke predominantly occurs in the aging population, further research into the benefit of PARP inhibitors in aged animal models of stroke is warranted.

PMID:40996065 | DOI:10.1161/JAHA.124.040914

J Am Heart Assoc. 2025 Sep 25:e038892. doi: 10.1161/JAHA.124.038892. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies have reported conflicting evidence on racial disparities in heart transplant outcomes, often focusing only on short-term mortality rates. We assessed longer-term survival and a broader range of post-heart transplant outcomes by race.

METHODS: We analyzed adult heart transplant recipients from 2017 to 2022 in the SRTR (Scientific Registry for Transplant Recipients), categorizing race as Black, non-Hispanic White, or Other. The primary outcome was graft failure at 1 and 3 years. Secondary outcomes included acute rejection, renal dysfunction, and posttransplant diabetes. χ2 tests and Kaplan-Meier/logistic regression analyses were used.

RESULTS: Among 15 873 recipients (63% White, 23% Black, 14% Other), Black recipients were more likely female, publicly insured, and less likely to be college educated. They also had higher use of durable ventricular assist devices and intra-aortic balloon pump at transplant. One-year graft survival was similar across groups (91.8% Black versus 91.1% non-Black), but 3-year survival was lower among Black individuals (83.4% versus 85.7%, P=0.006). After adjusting for socioeconomic and clinical factors, Black recipients had a higher risk of graft failure at 3 years (odds ratio, 1.22 [95% CI, 1.07-1.39]). Black patients also experienced higher rates of acute rejection (12.4% versus 10.2%), diabetes (10.8% versus 7.1%), and renal dysfunction progression (40.9% versus 37.1%) at 3 years (P<0.05 for all).

CONCLUSIONS: Racial disparities in heart transplant outcomes persist, particularly in longer-term survival. These disparities may be partially mediated by differences in posttransplant complications such as rejection, renal dysfunction, and diabetes.

PMID:40996058 | DOI:10.1161/JAHA.124.038892

J Am Heart Assoc. 2025 Sep 25:e045280. doi: 10.1161/JAHA.125.045280. Online ahead of print.

NO ABSTRACT

PMID:40996047 | DOI:10.1161/JAHA.125.045280

J Am Heart Assoc. 2025 Sep 25:e040636. doi: 10.1161/JAHA.124.040636. Online ahead of print.

ABSTRACT

BACKGROUND: Heart transplant (HT) recipients tend to develop unfavorable ventricular-arterial interactions, yet the prognostic implications of this altered physiology remain unclear. We aimed to identify the presence of afterload mismatch (AM) after heart transplantation, its determinants, and its impact on long-term cardiac mortality.

METHODS: An observational, single-center study was conducted on the historical cohort of patients who received HT at our institution. Patients survived the first year after HT with a LVEF ≥50%, cardiac allograft vasculopathy grades 0 to 1, and acute cellular rejection grades 0 to 1R. Arterial elastance and ventricular elastance were calculated noninvasively using blood pressure, end-systolic volume, and end-diastolic volume. Patients were grouped as follows: low afterload (LA- arterial elastance <median), matched high afterload (MHA- arterial elastance ≥median, ventricular elastance ≥median), and AM (arterial elastance ≥median, ventricular elastance <median).

RESULTS: Overall, 345 patients who received HT were enrolled. Left ventricular ejection fraction was lower in AM (57%) than in LA and MHA (63% and 64%, respectively; P<0.0001); stroke volume was lower in AM than in LA but comparable between AM and MHA (27, 35, and 26 mL/m2 for AM, LA, and MHA, respectively; P=0.0001). Predictors of AM were male recipient/male donor (β=0.15, P=0.0067) and male recipient/female donor (β=0.6, P=0.0078). After a median of 11.3 years, 59 recipients had died. Cardiac mortality was higher in the group with AM (AM median survival: 17.2, 27.8, and 24.1 years for AM, LA, and MHA, respectively; log-rank P=0.005). After adjusting for confounding variables, AM was associated with cardiac mortality (hazard ratio [HR], 2.26 [95% CI, 1.18-4.35]; P=0.0143)as were male recipient/female donor (HR, 2.94 [95% CI], 1.18-4.35; P=0.0358).

CONCLUSION: Three phenotypes of patients who received HT were identified, and AM resulted as an independent predictor of cardiac mortality.

PMID:40996038 | DOI:10.1161/JAHA.124.040636

J Am Heart Assoc. 2025 Sep 25:e045281. doi: 10.1161/JAHA.125.045281. Online ahead of print.

NO ABSTRACT

PMID:40996029 | DOI:10.1161/JAHA.125.045281

Front Cardiovasc Med. 2025 Sep 9;12:1591208. doi: 10.3389/fcvm.2025.1591208. eCollection 2025.

ABSTRACT

OBJECTIVES: Stroke is a severe complication in patients with left ventricular assist devices (LVAD), significantly affecting quality of life and potentially leading to death. This study aimed to illustrate the clinical features, outcomes, and risk factors associated with stroke in LVAD patients, with the goal of identifying potential treatment targets.

METHODS: In a study of 249 consecutive patients who underwent LVAD implantation, detailed evaluations were conducted regarding clinical characteristics, perioperative management, cardiovascular risk factors, comorbidities, and brain imaging. The etiology, treatment, and outcomes were subsequently assessed in individuals who encountered a stroke.

RESULTS: Eighty-three cerebrovascular events (CVE) occurred in 54/249 patients during a median study period of 2.2 years (0.4-3.5) with 53 ischemic events and 22 intracranial hemorrhages (ICH). Early peri- or postoperatively CVE in context to the LVAD implantation were identified in 31 patients. Competing risks regression analysis revealed that postoperative dialysis was associated with higher risk for CVE, considering death as competing risk event (HR 3.617; 95%-CI: 1.78-7.35; p ≤ 0.001). Modified Rankin Scale at outpatient visit did not differ in early CVE [3 (IQR 2-5) vs. 3 (IQR2-4), p = 0.146]. Late CVE frequently occurred during hospitalization for sepsis or in cardiac rehabilitation [n = 16/41 events (39%)]. Competing risk analysis treating death and heart transplantation as competitors identified history of stroke as associated factor [HR 3.564; 95%-CI (1.67-7.169); p = 0.001]. Mortality was not associated with CVE [with n = 27/54 (50%) vs. without CVE 94/195 (48.2%) p = 0.183].

CONCLUSION: Patients who require postoperative dialysis face a heightened risk for early cerebrovascular events (CVE) during and after LVAD implantation. Additionally, a history of stroke and complicated clinical courses should increase awareness regarding the potential for impending CVE in the long term.

PMID:40994916 | PMC:PMC12454346 | DOI:10.3389/fcvm.2025.1591208

Front Psychol. 2025 Sep 9;16:1646086. doi: 10.3389/fpsyg.2025.1646086. eCollection 2025.

ABSTRACT

INTRODUCTION: Patients in intensive care units require advanced clinical care as well as attention to psychological social and emotional needs, often overlooked. Heart and lung transplant recipients experience a particularly complex postoperative journey, marked by physical fragility, emotional vulnerability, and identity transformation. Communication barriers caused by sedation, intubation, and disorientation, combined with a focus on physiological stability, hinder understanding of their lived experience. A lack of qualitative research in this topic limits the development of person-centered care and mismatches between professional priorities and patient needs may lead to depersonalization and dissatisfaction. This study aimed to explore ICU experiences of transplant patients through the richness and complexity of their individual journey.

METHODS: A descriptive phenomenological study was conducted at IRCCS University Hospital of Bologna. Semi-structured interviews were performed with 21 heart (average ICU stay: 6 days) and lung (average ICU stay: 13 days) transplant recipients, 2-4 days post-ICU discharge. Interviews aimed to capture patients' recollections while ensuring clinical stability. Thematic content analysis was used to identify key themes.

RESULTS: Six main themes emerged: (1) care environment, (2) sensory perceptions, (3) person's empowerment, (4) lived experiences, (5) transplant path, and (6) quality of care. Patients reported feelings of isolation, disorientation, frustration and impaired communication due to sedation and intubation. Emotional experiences ranged from fear and loneliness to hope and gratitude. Reflections on the donor revealed ambivalent emotions including guilt and appreciation. Personalized care, empathetic communication, and supportive relationships with healthcare professionals were seen as essential for emotional well-being and recovery.

DISCUSSION: Heart and lung transplantation is a deeply transformative experience. Beyond clinical care, patients need emotional and psychological support. Personalized, empathetic interventions and improved communication strategies are crucial to enhancing both recovery outcomes and the overall ICU experience.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT06773052.

PMID:40994850 | PMC:PMC12454062 | DOI:10.3389/fpsyg.2025.1646086