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Multimed Man Cardiothorac Surg. 2025 Jun 2;2025. doi: 10.1510/mmcts.2025.028.

ABSTRACT

The patient presents with a genetic condition named Li-Fraumeni syndrome, which predisposes her to multiple neoplasms during her lifespan. Due to the chemotherapeutic treatment of an osteosarcoma, the patient presents with cardiotoxicity secondary to doxorubicin that is refractory to conventional management. The patient is initially stabilized with a peripheral veno-arterial extracorporeal membrane oxygenation device, with no improvement after 14 days of support. Later she was assisted with a HeartMate 3 mechanical circulatory device as a bridge to candidacy or as a destination therapy. She is the first paediatric patient in Spain to be assisted with long-term circulatory support using the HeartMate 3 device.

PMID:40454942 | DOI:10.1510/mmcts.2025.028

Front Immunol. 2025 May 16;16:1583460. doi: 10.3389/fimmu.2025.1583460. eCollection 2025.

ABSTRACT

INTRODUCTION: Extracorporeal photopheresis (ECP) is a viable treatment that slows the progression of chronic lung allograft dysfunction. Despite its immunoregulatory potential, data on extracorporeal photopheresis as an induction therapy remain rather limited.

METHODS: We conducted a pilot randomized controlled study on ECP as induction therapy in cystic fibrosis patients undergoing primary lung transplantation. Primary endpoints included safety, assessed based on the incidence of adverse events, treatment-related toxicity, and procedure-related complication rates; and feasibility, evaluated through the completion rate of scheduled ECP sessions, patient tolerability, and treatment discontinuation rates. Secondary endpoint consisted of an exploratory assessment of efficacy, using a composite measure that included three key components: freedom from biopsy-proven acute rejection within the first 12 months, absence of chronic lung allograft dysfunction at 36 months, and optimal graft function, defined as a predicted forced expiratory volume in the first second ≥ 90% at 36 months. Finally, exploratory endpoints included cell phenotypic and functional analyses, secreted immune protein profiling, and gene expression analysis for mechanistic insights. Patients were randomly assigned to receive either standard immunosuppressive therapy alone or standard therapy plus six sessions of extracorporeal photopheresis, with a follow-up period of 36 months.

RESULTS: Among 36 cystic fibrosis patients who underwent lung transplantation between 2018 and 2021 and met the eligibility criteria, 21 were randomized (9 to the study group and 12 to the control group). No patients in the treatment group experienced adverse events. The enrollment rate was 61%, and the treatment discontinuation rate was 22%. The clinical composite endpoint was achieved by 28.6% of patients in the treatment group and 16.7% in the control group. Exploratory endpoint analyses revealed significant decreases in pro-inflammatory cytokines, degranulating CD8+ T lymphocytes, and NK cells in the treatment group. Moreover, significant increases in Treg lymphocytes, IL-10-producing NK cells, and anti-inflammatory cytokines appeared to be associated with improved pulmonary function in the treatment group.

CONCLUSIONS: Induction therapy with extracorporeal photopheresis is safe and feasible in lung transplantation for cystic fibrosis. Some clinical benefits appear to persist for the first 36 months of follow-up. Interestingly, a correlation between immunological modulation induced by extracorporeal photopheresis and pulmonary function was observed.

CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT03500575?cond=NCT03500575&rank=1, identifier NCT03500575.

PMID:40453071 | PMC:PMC12122324 | DOI:10.3389/fimmu.2025.1583460

J Am Soc Echocardiogr. 2025 May 30:S0894-7317(25)00273-1. doi: 10.1016/j.echo.2025.05.013. Online ahead of print.

ABSTRACT

Carcinoid heart disease (CaHD) is a complication that occurs in patients with metastatic neuroendocrine tumors (usually to the liver) and carcinoid syndrome. Hormonal release causes endocardial thickening, typically affecting right-sided cardiac valves. Symptomatic patients with CaHD have a poor prognosis, and management of valvular heart disease is complicated by metastasis and other associated conditions and carries a higher risk than management of other acquired valve disease. Clinical and biomarker assessment are used for screening and echocardiography is the diagnostic imaging backbone used for identification of CaHD, as well as grading of severity of valvular lesions and associated chamber dysfunction. Echocardiography is critical in the evaluation for surgical intervention, as well as in guiding surgery and postoperative surveillance. This article reviews in detail applications of echocardiography in patients with CaHD.

PMID:40451471 | DOI:10.1016/j.echo.2025.05.013

J Clin Anesth. 2025 May 30;105:111888. doi: 10.1016/j.jclinane.2025.111888. Online ahead of print.

ABSTRACT

BACKGROUND: Superficial and deep parasternal intercostal plane (S-PIP and D-PIP, respectively) blocks provide effective analgesia following median sternotomy; however, data regarding their sensory distribution and regression patterns are scarce. Therefore, we compared the extent of sensory blockade 30 min following the administration of the blocks and evaluated its regression over 24 h.

METHODS: Patients who underwent open cardiac surgery under the S-PIP or D-PIP block were included in this single-center, prospective study. Sensory assessment using cold stimulation and dermatomal mapping was conducted 30 min, 12 h, and 24 h following the administration of the blocks. The primary outcome was the proportion of the blocked thoracic area at 30 min. Opioid consumption and pain scores at 12 and 24 h were the secondary outcomes.

RESULTS: Thirty patients were included in this study (n = 15 per group). The total blocked area at 30 min in the S-PIP and D-PIP groups was similar (48.48 ± 9.50 % vs. 46.51 ± 10.01 %, p = 0.584). Both blocks provided consistent coverage of the T2-T6 nerves, with additional involvement of T1 and T7 in some patients. Significant sensory blockade persisted at 12 h and partially regressed after 24 h. No significant differences were observed between the groups in terms of postoperative opioid consumption (10 [5] mg vs. 9 [3] mg, p = 0.121) or pain scores.

CONCLUSION: The S-PIP and D-PIP blocks provided comparable and extensive sensory coverage of the anterior thorax. Consistent dermatomal involvement between T2 and T6 was observed, with occasional spread to T1 and T7.

PMID:40449315 | DOI:10.1016/j.jclinane.2025.111888

Int J Cardiol. 2025 Oct 1;436:133428. doi: 10.1016/j.ijcard.2025.133428. Epub 2025 May 28.

ABSTRACT

BACKGROUND: The self-expanding aortic valve prosthesis ACURATE neo2 features an extended external sealing skirt aiming to reduce postprocedural paravalvular leak (PVL). There is limited knowledge if PVL can be further reduced by dedicated implantation techniques. We aim to examine predictors of PVL after implantation of the ACURATE neo2 with focus on implantation technique.

METHODS: Patients undergoing ACURATE neo2 transcatheter aortic valve replacement (TAVR) at 3 centers were included in a retrospective registry. Patients were analyzed in 2 groups: PVL none/trace and PVL ≥ mild.

RESULTS: A total of 901 patients (mean age 81 ± 6 years, 57 % women) were included. On echocardiography before discharge, PVL was graded as none/trace, mild and moderate in 599 (67 %), 291 (32 %) and 6 (1 %), respectively. Implantation depth (OR 0.93 per mm, 95 % CI 0.88-0.99, p = 0.032) and commissural misalignment (>45°; OR 9.6, 95 % CI 1.9-48.6, p = 0.006) significantly predicted PVL ≥ mild. Other, non-modifiable predictors for PVL included LVOT calcification severity (OR 1.98, 95 % CI 1.24-3.16, p = 0.002), larger sinotubular junction diameter and sinus of valsalva diameter (OR 1.08 per mm, 95 % CI 1.02-1.13, p = 0.004 and OR 1.07 per mm, 95 % CI 1.04-1.12, p = 0.003, respectively).

CONCLUSIONS: A high implantation and commissural misalignment were associated with PVL ≥ mild after implantation of the ACURATE neo2. These findings may help to guide implantation technique and further improve clinical outcomes.

PMID:40446851 | DOI:10.1016/j.ijcard.2025.133428

Trials. 2025 May 30;26(1):181. doi: 10.1186/s13063-025-08895-7.

ABSTRACT

BACKGROUND: Cardiac procedures, particularly those requiring cardiopulmonary bypass (CPB), are associated with the development of cardiac surgery-associated acute kidney injury (CSA-AKI). Development of CSA-AKI occurs as a result of inflammation, uncontrolled complement activation, and kidney cell damage. In patients with preoperative renal impairment, such as those with chronic kidney disease (CKD), there is an increased risk of both CSA-AKI and poorer clinical outcomes. Currently, there are limited effective, targeted pharmacological interventions for the prevention or treatment of CSA-AKI, although emerging therapies are being investigated, particularly in patients with existing CKD. The ARTEMIS (RAvulizumab to PRotect PaTients with Chronic Kidney DisEase froM CSA-AKI and Subsequent Major Adverse Kidney Events) trial will assess the efficacy and safety of ravulizumab (a complement C5 inhibitor) in reducing the risk of major adverse kidney events (MAKE) in patients with preoperative CKD undergoing non-emergent cardiac surgery with CPB.

METHODS: This trial is currently recruiting patients with CKD who have planned cardiac surgery requiring CPB including coronary artery bypass grafting, valve replacement or repair, or combined procedures. This is a phase 3, randomized, double-blind, placebo-controlled, global study assessing the efficacy and safety of a single preoperative dose of ravulizumab. These outcomes will be assessed using the occurrence of MAKE and its components, as well as the occurrence and severity of CSA-AKI throughout the study period.

DISCUSSION: Complement activation is known to occur during and after cardiac procedures as a result of CPB and ischemia-reperfusion injury, leading to a cycle of cell damage and death. Therefore, it is hypothesized that preoperative administration of ravulizumab will provide immediate and complete complement inhibition, which will be sustained throughout the surgical period, preventing the uncontrolled complement activation associated with the development of CSA-AKI, thus minimizing poor outcomes for patients.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05746559. Registered on February 27, 2023.

PMID:40448185 | PMC:PMC12125780 | DOI:10.1186/s13063-025-08895-7

Braz J Cardiovasc Surg. 2025 May 30;40(3):e20240244. doi: 10.21470/1678-9741-2024-0244.

ABSTRACT

INTRODUCTION: Blood transfusion is associated with adverse clinical and surgical outcomes. Strategies like the Patient Blood Management program, which includes blood cell salvage, contribute to reducing the use of blood components. Blood cell salvage is very useful in heart surgeries where the patient's blood loss can be massive.

OBJECTIVE: The present study aimed to evaluate the impact of using the blood cell salvage in the intraoperative and postoperative periods (up to 24 hours) on the hemoglobin and hematocrit values, transfusion of red blood cells, infection rates, and postoperative length of stay in patients undergoing cardiac surgery with cardiopulmonary bypass.

METHODS: Forty-one patients who underwent cardiac surgery with cardiopulmonary bypass according to the inclusion criteria were selected in an observational study and separated into two groups: with the use of the blood cell salvage group (BCS, n = 21) and without the use of the blood cell salvage (WBCS, n = 20).

RESULTS: Patients in the group using blood cell salvage had higher postoperative hemoglobin (P = 0.018) and postoperative hematocrit levels (P = 0.009), lower consumption of red blood cells in the postoperative period and hospital discharge (P < 0.001), shorter postoperative length of stay (P = 0.020), and lower infection rates (P = 0.009).

CONCLUSION: Patient Blood Management strategies, particularly the use of blood cell salvage in the intraoperative and immediate postoperative periods of patients undergoing cardiac surgery with cardiopulmonary bypass, are associated with less use of blood components and consequently better clinical outcomes.

PMID:40445084 | PMC:PMC12124749 | DOI:10.21470/1678-9741-2024-0244

Braz J Cardiovasc Surg. 2025 May 30;40(3):e20240071. doi: 10.21470/1678-9741-2024-0071.

ABSTRACT

INTRODUCTION: Cardioplegia solution, also called the del Nido solution, has been widely used in pediatric cardiac surgeries, and has recently started to be used in adult cardiac surgeries. In this context, this study aimed to investigate the relationship between the use of del Nido and blood cardioplegia solutions and postoperative atrial fibrillation rates in our clinic.

METHODS: The study sample comprised 140 patients who underwent coronary artery bypass grafting. The del Nido and blood cardioplegia solutions were used in 70 (50%) patients. The postoperative atrial fibrillation rates of both groups were compared. Additionally, patients' preoperative, intraoperative, and postoperative data were evaluated.

RESULTS: The cardiopulmonary bypass duration and defibrillation rate were lower in the del Nido cardioplegia group than in the blood cardioplegia group (P < 0.001). Atrial fibrillation rates on postoperative days one, five, and 30 were significantly lower in the del Nido cardioplegia group than in the blood cardioplegia group (P < 0.001, P < 0.001, and P = 0.007, respectively).

CONCLUSION: The postoperative atrial fibrillation rate was significantly lower in the del Nido cardioplegia group than in the blood cardioplegia group. In addition, the del Nido cardioplegia solution did not interrupt the surgical flow, thus resulting in less total perfusion, shorter cross-clamping durations, and fewer defibrillation needs. In conclusion, the del Nido cardioplegia solution can be used safely and effectively in coronary artery bypass grafting surgeries.

PMID:40445078 | PMC:PMC12131428 | DOI:10.21470/1678-9741-2024-0071

ASAIO J. 2025 May 30. doi: 10.1097/MAT.0000000000002467. Online ahead of print.

ABSTRACT

Extracorporeal circulation (ECC) procedures, including extracorporeal membrane oxygenation (ECMO), provide essential support for critically ill patients, but complications such as hemolysis and thromboembolic events remain significant concerns. This study evaluates the hemocompatibility of the CBM LifeMotion centrifugal ECMO pump, designed with a low priming volume and shrouded impeller, comparing its performance to three commercially available pumps (Maquet, Sorin, and Novalung). Human blood was used in a simulated ECC model, following American Society for Testing and Materials (ASTM) testing protocols, to evaluate hemolysis and white blood cell damage. The CBM pump demonstrated hemolysis levels similar to the Maquet and Sorin pumps, all of which exhibited low hemolysis compared to the Novalung pump, which showed the highest hemolysis. A numerical analysis further assessed the CBM pump's performance under low-flow conditions, revealing reduced fluid shear stress due to the lower rotor speed, whereas the blood's exposure time to this shear stress increased. Despite these differences, the overall hemolytic potential under low-flow conditions was comparable to ASTM conditions. These results suggest that the CBM LifeMotion pump, with its reduced priming volume and favorable hemocompatibility, shows promise for ECMO applications. Further clinical research is required to validate these findings in real-world settings.

PMID:40444779 | DOI:10.1097/MAT.0000000000002467

Pediatr Int. 2025 Jan-Dec;67(1):e70098. doi: 10.1111/ped.70098.

ABSTRACT

BACKGROUND: Postoperative oral feeding difficulties in infants with congenital heart disease (CHD) are associated with prolonged hospital stays, increased readmission rates, and decreased patients' and their family's quality of life. They have recently been recognized as part of post-intensive care syndrome in pediatrics. The purpose of this study was to identify the risk factors for acquired feeding difficulties after surgery for CHD in infants. We hypothesized that infants who underwent more complex surgical procedures would be at higher risk.

METHODS: We conducted a retrospective observational cohort study in a PICU with 20 beds. Included were 124 eligible patients aged 1-11 months, who had established oral feeding preoperatively and underwent surgery under cardiopulmonary bypass between 2018 and 2022. The primary outcome was the duration from surgery to the re-establishment of oral feeding. We classified the patients into two groups according to the Society of Thoracic Surgeons - European Association for CardioThoracic Surgery (STAT) mortality category.

RESULTS: Eighty-one patients were classified as STAT 1-2 (low) and 43 as STAT 3-5 (high). The duration from surgery to re-establishment of oral feeding was significantly longer in the high-STAT group in one minus Kaplan-Meier curve estimate (p = 0.016). In a multivariable Cox proportional hazards model analysis, longer operative time (HR 0.83, 95% CI 0.72-0.95, p = 0.005) and higher STAT (HR 0.56, 95% CI 0.32-0.95, p = 0.032) were identified as significant risk factors for delayed oral feeding.

CONCLUSIONS: Longer operative times and procedures with higher STAT categories may be associated with acquired feeding difficulties after surgery for CHD in infants.

PMID:40444535 | DOI:10.1111/ped.70098

Clin Neurophysiol. 2025 Jul;175:2110769. doi: 10.1016/j.clinph.2025.2110769. Epub 2025 May 25.

ABSTRACT

OBJECTIVE: This study aims to utilize HFO analysis to enhance existing SSEP modality and develop it as a bedside diagnostic tool for acute brain injury (ABI) detection in Extracorporeal Membrane Oxygenation (ECMO) patients.

SIGNIFICANCE: Timely diagnosis of ABI in ECMO patients is challenging due to logistical complexities with computed tomography (CT) and magnetic resonance imaging (MRI). Integrating time-frequency analysis into routine SSEP monitoring for early ABI detection can facilitate timely medical decisions.

METHOD: Consecutive SSEP data were collected from Johns Hopkins Intensive Care Units (ICUs), including 31 ECMO and 45 non-ECMO patients from 2016 to 2022. ABIs were determined using CT and MRI as clinically indicated. Using wavelet techniques, two SSEP-HFO components were quantified: HFOL (80-200 Hz) and HFOH (200-600 Hz), which were later fed to a Support Vector Machine (SVM) with a linear kernel.

RESULT: ECMO patients with ABI (N = 22) exhibited suppressed HFOH (Median = -9.09, Interquartile Range (IQR) = [ -13.5; -4.73] dB) compared to patients without (N = 9, Median = -4.39, IQR = [-6.35; -3.28] dB, P = 0.035). The SVM classifier achieved an accuracy of 75 % and a sensitivity of 82 % for detecting ABI, outperforming SSEP-N20.

CONCLUSION: SSEP-HFO can potentially improve early detection of ABI in ECMO patients at the bedside.

PMID:40440954 | DOI:10.1016/j.clinph.2025.2110769

REC Interv Cardiol. 2025 Jan 2;7(2):75-81. doi: 10.24875/RECIC.M24000492. eCollection 2025 Apr-Jun.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Infective endocarditis (IE) is a rare but serious complication in patients with aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). The spread of this technique to lower risk patients means that this complication may increase. The objective of this study was to analyze the incidence and mortality of IE in TAVI patients vs patients undergoing surgical aortic valve replacement (SAVR).

METHODS: We conducted an observational, single-center, retrospective cohort study that included all cases of IE diagnosed consecutively in a Spanish reference center from 2008 through 2022 in patients with TAVI vs SAVR.

RESULTS: The study included a total of 10 cases of IE in 778 patients treated with TAVI, with an incidence rate of 0.09/100 patients/year vs an incidence rate of 0.12/100 patients/year in surgical bioprostheses with 24 cases in 1457 patients (P = .64) (median follow-up of 49 months (p25-p75: 29-108). Clinical features were very similar, with 50% of TAVI patients having cardiac complications vs 33% of SAVR patients (P = .33). Although 40% of the patients from the TAVI group had a surgical indication for IE and 50% for SAVR, P = .49), only half of them underwent surgery in both groups (20% TAVI vs 25% SAVR; P = .93). No differences were reported in the 1-year mortality rate (30% TAVI vs 29% SAVR; P = .56).

CONCLUSIONS: The incidence rate of IE in this long series of TAVI patients was low and despite the worse clinical profile of TAVI patients, no significant mortality differences were found compared with the group of patients with surgical bioprosthesis.

PMID:40438644 | PMC:PMC12118561 | DOI:10.24875/RECIC.M24000492

BMC Anesthesiol. 2025 May 29;25(1):271. doi: 10.1186/s12871-025-03148-1.

ABSTRACT

OBJECTIVE: In this study, we aimed to compare the effects of two different local anesthetics with different baricity used in spinal anesthesia on thermoregulation.

MATERIALS AND METHODS: Our study was conducted on forty full-term pregnant women scheduled for elective cesarean sections under spinal anesthesia. At an operating room temperature of twenty-four degrees Celsius, peripheral body temperature was measured using temperature probes attached to the lower medial parts of the same side's lower and upper extremities, and central body temperature was measured with a tympanic thermometer. Isobaric levobupivacaine and hyperbaric bupivacaine were used in spinal anesthesia applications. After spinal anesthesia, tympanic temperature, arm and leg temperatures, mean arterial pressure, heart rate, and oxygen saturation were measured and recorded at baseline, the first, third, and fifth minutes, and every five minutes thereafter until the end of surgery.

RESULTS: In the bupivacaine group, a decrease in tympanic temperature was observed at the third minute and an increase in leg skin temperature at the fifth minute compared to baseline values. In the levobupivacaine group, a decrease in tympanic temperature was observed at the fifth minute, and an increase in leg skin temperature was observed at the third minute. In both groups, within-group comparisons showed a continued decrease in tympanic temperature and increase in leg temperature at all subsequent time points compared to baseline. No statistically significant difference was observed in arm skin temperatures within groups in either group.

CONCLUSION: We observed that the effects of hyperbaric bupivacaine and isobaric levobupivacaine used in spinal anesthesia on thermoregulation were similar.

PMID:40442613 | PMC:PMC12121188 | DOI:10.1186/s12871-025-03148-1

Mol Biol Rep. 2025 May 28;52(1):511. doi: 10.1007/s11033-025-10580-6.

ABSTRACT

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, with myocardial infarction (MI) and subsequent heart failure (HF) posing significant clinical challenges. Despite advancements in pharmacological and surgical interventions, the limited regenerative capacity of the adult human heart necessitates innovative therapeutic strategies. Stem cell-based therapies have emerged as a promising approach to cardiac regeneration, aiming to restore damaged myocardial tissue through cell replacement and paracrine-mediated repair mechanisms. This review provides a comprehensive overview of the current landscape of stem cell therapies for cardiac regeneration, focusing on the molecular mechanisms, cell types, delivery techniques, and recent clinical advancements. We highlight the roles of key signaling pathways, including NOTCH, PI3K/Akt, Wnt/β-catenin, Hippo/YAP, and MAPK, in regulating cardiomyocyte proliferation, angiogenesis, fibrosis, and inflammation. Additionally, we discuss the therapeutic potential of various stem cell types, such as mesenchymal stem cells (MSCs), cardiac progenitor cells (CPCs), induced pluripotent stem cells (iPSCs), and embryonic stem cells (ESCs), in promoting cardiac repair. Despite promising preclinical results, challenges such as low cell retention, immune rejection, and inconsistent clinical outcomes persist. Recent advancements in genetic engineering, and innovative delivery methods, including transendocardial and intracoronary injections, offer new avenues for enhancing therapeutic efficacy. This review underscores the need for further research to optimize stem cell-based therapies, improve clinical trial design, and translate these innovative approaches into effective treatments for heart disease. By addressing these challenges, stem cell therapy holds the potential to revolutionize cardiac regeneration and improve outcomes for patients with ischemic heart disease and heart failure.

PMID:40434692 | DOI:10.1007/s11033-025-10580-6

Biomolecules. 2025 May 3;15(5):662. doi: 10.3390/biom15050662.

ABSTRACT

HDAC11, the only class IV histone deacetylase, primarily functions as a fatty acid deacylase and has been implicated in metabolic regulation, cancer stemness, and muscle regeneration. However, its role in cardiac mesenchymal stem cells (CMSCs) remains unexplored. To investigate the effects of HDAC11 overexpression on the gene regulatory networks in CMSCs, we treated mouse CMSCs with an adenoviral vector encoding human HDAC11 (Ad-HDAC11) versus adenoviral GFP (Ad-GFP) as a control. Gene expression and pathway enrichment were assessed using RNA sequencing (RNA-seq), and HDAC11 overexpression was validated at the RNA and protein levels through qRT-PCR and Western blot. RNA-seq and Gene Ontology (GO) analysis revealed that HDAC11 overexpression activated cell cycle pathways while suppressing nucleotide transport and phagolysosome-related processes. Furthermore, pHH3 protein level was increased, suggested enhanced proliferation in HDAC11-overexpressed CMSCs. qRT-PCR also confirmed the downregulation of GM11266, a long non-coding RNA, in HDAC11-overexpressing CMSCs. In summary, HDAC11 overexpression promotes transcriptional reprogramming, cell cycle progression, and CMSC proliferation, underscoring its potential role in regulating CMSC growth and division.

PMID:40427555 | PMC:PMC12109384 | DOI:10.3390/biom15050662

Biomedicines. 2025 May 16;13(5):1209. doi: 10.3390/biomedicines13051209.

ABSTRACT

Myocardial infarction (MI) is a leading cause of morbidity worldwide, resulting from ischemic damage and necrosis to cardiomyocytes. While the standard treatment regimen for MI can be successful in restoring coronary perfusion, it typically does not resolve myocardial damage, which can leave patients particularly vulnerable to complications such as heart failure or electrical conduction abnormalities. Stem cell therapies offer a promising novel approach aimed at restoring cardiac function and decreasing the incidence of functional complications after an MI. This review used a literature search to evaluate the current landscape of stem cell therapy for post-MI recovery and focuses on the stem cell candidates for MI recovery therapy, delivery methods of such treatment, and their effectiveness. Both preclinical and clinical trials have demonstrated the safety of stem cells, but have struggled with limited cell retention, inconsistent efficacy, and survival. Mechanisms are employed by stem cells to promote regeneration, such as paracrine signaling, angiogenesis, and structural remodeling, in addition to the various stem cell delivery methods, including intracoronary infusion, direct myocardial injection, and intravenous administration. Furthermore, some strategies to combat past challenges in this field are discussed; for instance, extracellular vesicles, bioengineered patches, hydrogels, gene editing, and bioprinting. This article will provide a framework for future research in stem cell therapies and highlight the current progress in the field.

PMID:40427036 | PMC:PMC12109359 | DOI:10.3390/biomedicines13051209

J Robot Surg. 2025 May 28;19(1):245. doi: 10.1007/s11701-025-02370-w.

ABSTRACT

Adoption of robot-assisted coronary artery bypass grafting (RA-MIDCAB) remains limited due to concerns about learning curves, outcomes, and patient-specific anatomic challenges. This study evaluates our initial single-center experience with RA-MIDCAB. Between December 2022 and June 2024, 52 patients underwent RA-MIDCAB. Inclusion criteria comprised isolated left anterior descending artery (LAD) stenosis or LAD revascularization as part of a hybrid valvular/coronary strategy. Primary endpoints were 30-day mortality, conversion to sternotomy, and graft injury. Operative times and biometric indices (body indices such as body mass index [BMI], Haller Index, and Cardiothoracic Ratio) were analyzed for correlation with learning curve progression and surgical outcomes. Mean age was 68.5 ± 11.5 years, and 82.7% (43/52) were males. Robotic LITA harvesting was successfully completed in 98.1% (51/52) of patients (one patient had a graft injury), with no perioperative mortality. Postoperative complications occurred in 38.5% (20/52), mostly due to atrial fibrillation (19.2%, 10/52) and acute kidney injury (13.5%, 7/52) with no correlation with operative times at logistic regression. According to thoracic indexes, no correlation was found between chest complexity and postoperative complications. Neither EuroSCORE II, BMI nor thoracic indices significantly impacted operative times. Linear regression demonstrated significant reductions in overall surgical and graft-harvesting times across the experience, suggesting improved efficiency. RA-MIDCAB is feasible and safe, even in patients with challenging thoracic anatomy. This early experience demonstrated promising outcomes and significant learning curve improvements, supporting the potential for broader adoption of this technique even in patients unlikely deemed suitable for minimally invasive cardiac revascularization surgery.

PMID:40434502 | PMC:PMC12119776 | DOI:10.1007/s11701-025-02370-w

J Clin Med. 2025 May 16;14(10):3499. doi: 10.3390/jcm14103499.

ABSTRACT

Since Dr. Charles Hufnagel introduced the first ball-in-cage valve prosthesis in 1952 to treat a patient with aortic regurgitation, the field of valvular heart disease has undergone remarkable evolution in both prosthetic valve development and patient management. Over the past 73 years, a wide range of valvular prostheses have been developed, each offering distinct advantages in terms of durability, thrombogenicity, and hemodynamics. This review aims to provide a detailed discussion of commonly known and used valvular heart prostheses, along with a review of newer endovascular prostheses. As ongoing research and innovation continue to shape the field, we can expect further improvements in hemodynamics, clinical outcomes, cost, ease of operation, and patient quality of life.

PMID:40429493 | PMC:PMC12112632 | DOI:10.3390/jcm14103499

J Clin Med. 2025 May 15;14(10):3471. doi: 10.3390/jcm14103471.

ABSTRACT

Objective: Aortic valve stenosis is the most common valvular heart disease in the elderly, and its treatment may be either surgical (SAVR) or transcatheter (TAVI). Although age is one of the main determinants of the therapeutic choice, current guidelines leave a "discrepancy area" between 65 and 75 years, with the American guidelines allowing TAVI for patients older than 65 years, while the European guidelines consider TAVI for patients older than 75 years. The present study addresses the outcomes of SAVR vs. TAVI in a real-world population aged 65 to 80 years, that is, one largely inclusive of the discrepancy area. Methods: This is a retrospective registry study based on data retrieved from administrative health databases of two large Italian regions (Lombardy and Puglia). Patients aged 65 to 80 years receiving either SAVR or a TAVI between 2018 and 2021 were selected. SAVR and TAVI outcomes (death, cardiac and non-cardiac events) were compared using a propensity-matching analysis, with a follow-up of 2 to 5 years and mortality as the primary outcome. Results: After propensity matching, two groups of 786 patients were compared in Lombardy and two groups of 321 patients were compared in Puglia. In both regions, at the end of follow-up, mortality was significantly (p < 0.001) lower in SAVR vs. TAVI (24.6% vs. 47.2% in Lombardy and 18.1% vs. 44.1% in Puglia). Conclusions: Our results are in contrast with the randomized controlled trials showing equivalence or even the superiority of TAVI vs. SAVR, but in agreement with other registry studies based on real-world data. With respect to the randomized controlled trials, the main difference is a better outcome in SAVR. Caution should be applied in addressing patients < 80 years with TAVI unless SAVR is contraindicated.

PMID:40429465 | DOI:10.3390/jcm14103471

Medicina (Kaunas). 2025 Apr 22;61(5):778. doi: 10.3390/medicina61050778.

ABSTRACT

Background and Objectives: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, associated with increased morbidity and prolonged hospital stays. Oxidative stress has been implicated in POAF pathogenesis, with malondialdehyde (MDA), a marker of lipid peroxidation, proposed as a potential biomarker. However, conflicting evidence exists regarding its predictive value. This study aimed to assess the association between serum MDA levels and POAF incidence in patients undergoing cardiac surgery. Materials and Methods: This prospective observational study included 99 consecutive patients undergoing elective on-pump cardiac surgery. Patients with preoperative atrial fibrillation, chronic kidney disease requiring dialysis, or emergency surgery were excluded. Blood samples for MDA measurement were collected at six perioperative time points: preoperatively, intraoperatively after aortic clamp release, and at 8, 24, 48, and 72 h postoperatively. Patients were monitored for new-onset POAF during the first three postoperative days. Statistical analyses included independent samples t-tests, Mann-Whitney U-tests, and Fisher's exact tests, with significance set at p < 0.05. Results: POAF occurred in 33 (33%) patients. Patients who developed POAF were significantly older (p = 0.017) and had higher EuroSCORE II values (p = 0.019). No significant differences were observed in serum MDA concentrations between POAF and non-POAF patients at any measured time point. The incidence of POAF was higher in patients undergoing valvular surgery (p = 0.014). Conclusions: Serum MDA levels were not associated with POAF development, suggesting that lipid peroxidation alone may not play a central role in POAF pathogenesis. These findings challenge the predictive value of MDA for POAF risk stratification. Future research should explore alternative oxidative stress markers and their potential therapeutic implications in POAF prevention.

PMID:40428736 | PMC:PMC12113208 | DOI:10.3390/medicina61050778