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Cureus. 2025 Apr 18;17(4):e82515. doi: 10.7759/cureus.82515. eCollection 2025 Apr.

ABSTRACT

Cardiac arrhythmias are common in post-coronary artery bypass graft (CABG) settings. It is a common practice to use temporary epicardial pacing wires at the end of cardiac surgery to prevent fatal arrhythmias (e.g., bradycardia,atrioventricular (AV) block, and asystole). It may also be used for sequential atrio-ventricular pacing for improved cardiac output in patients with poor ejection fraction. Epicardial wires are usually implanted around the right atrium and ventricle. Not every patient requires temporary epicardial pacing. However, certain risk factors may predispose patients to life-threatening AV blocks and ventricular tachyarrhythmias. These risk factors include advancing age, valvular surgery, poor left ventricular function, structural heart disease, diabetes mellitus, preoperative beta-blocker or digoxin use, and pre-existing history of arrhythmias. Only a handful of cases have been described in the literature where this seemingly lifesaving measure can trigger life-threatening events. Here, we describe a case where epicardial pacing wires trigger ventricular arrhythmias due to improper sensing.

PMID:40385734 | PMC:PMC12085962 | DOI:10.7759/cureus.82515

PLoS One. 2025 May 19;20(5):e0323795. doi: 10.1371/journal.pone.0323795. eCollection 2025.

ABSTRACT

OBJECTIVE: Cardiac arrest happens in 0.7%-5.2% patients after cardiovascular surgery, and cases with asystole or severe bradycardia need timely temporary pacing. However, routine temporary pacing wire insertion in cardiopulmonary bypass (CPB)-assisted cardiovascular surgery has been questioned for its noteworthy complications. This study aimed to quantify the risk of temporary pacing for cardiac arrest after CPB-assisted cardiovascular surgery.

METHODS: 2326 patients undergoing CPB-assisted cardiovascular surgery were enrolled. Age, sex, body mass index, preoperative rhythm, operation type, ablation, CPB pump, cardioplegia type and volume, hypothermia, circulation, CPB time, aortic clamping time were compared between patients having and not having temporary pacing according to the indications by multiple logistic regression (MLR). A scoring system was developed based on the β parameters of identified independent risk factors in MLR analyses. The score cutoff was determined by the negative likelihood ratio to exclude the need of temporary pacing.

RESULTS: 108 patients (4.6%) had temporary pacing. Old age (per year) (P < 0.001), preoperative atrial fibrillation (P < 0.001), long CPB time (per minute) (P = 0.017) contributed to the risk of cardiac arrest. Having mitral valve replacement (MVR) (P = 0.033), double valve replacement (DVR), MVR+tricuspid valvuloplasty (TVP) (P = 0.009), coronary artery bypass grafting (CABG)+MVR (P = 0.0495) (versus CABG) were independent risk factors. The scoring system, score = age (year)/40 + CPB time (min)/350+ [preoperative atrial fibrillation]×1, can quantitatively assess the associated risk with an area under receiver of characteristic (ROC) curve (AUC) of 0.74 (95% confidential interval 0.69-0.79) (P < 0.001). The negative likelihood ratio was < 0.1 when score≤1.138. Therefore, the cutoff of excluding temporary pacing was set as ≤1, which achieved a 0% false negative rate in our cases.

CONCLUSION: To minimize iatrogenic complications caused by unnecessary temporary pacing wire insertion, while ensuring patients with risks of asystole or severe bradycardia receive timely pacing, surgeons may identify cases with negligible risks of cardiac arrest through the scoring system.

PMID:40388430 | PMC:PMC12088002 | DOI:10.1371/journal.pone.0323795

Perfusion. 2025 May 19:2676591251340976. doi: 10.1177/02676591251340976. Online ahead of print.

ABSTRACT

ObjectiveThis study aims to evaluate the operational feasibility of a self-designed minimally invasive extracorporeal circulation integrated circuit (miECC) type IV system and to assess the effectiveness of the venous gas filter and automatic exhaust mechanism.MethodsA blood recycler was utilized in place of a heart to connect the arteriovenous line, venous gas filter, centrifugal pump head, and integrated membrane-lung connection, thereby establishing a loop circulation model for the miECC IV system. The venous gas filter was linked to a negative pressure suction device positioned at its top. During operation, gas was introduced from the venous end to determine the maximum gas storage capacity of the venous gas filter, the gas removal efficiency of the negative pressure suction device, the conversion capabilities between open and closed operations, and the adequacy of the pipeline design.ResultsThe minimally invasive extracorporeal circulation integrated pipeline demonstrated stable operational performance and successfully facilitated the transition between closed and open states. The venous gas filter exhibited a gas storage capacity of less than 80 mL across various flow rates. Experimental results indicated that at flow rates of 3.0-4.5 L/min, the automatic venting device effectively removed gas when the volume did not exceed 80 mL. At flow rates of 5.0-5.5 L/min, the device also successfully vented gas under the same conditions.ConclusionThe self-designed minimally invasive extracorporeal circulation integrated pipeline operates effectively and can transition between closed and open configurations. The gas filter effectively prevents venous gas accumulation. At the same time, the enhanced automatic gas-exhausting device, utilizing negative pressure, efficiently removes gas from the venous filter, thereby improving the safety of the closed-circulation operation.

PMID:40384547 | DOI:10.1177/02676591251340976

ASAIO J. 2025 May 14. doi: 10.1097/MAT.0000000000002458. Online ahead of print.

ABSTRACT

Heart transplantation using donation after circulatory death (DCD) has recently re-emerged alongside donation after brain death (DBD). This technique can potentially increase the number of available cardiac grafts. However, its clinical outcomes remain limited. We compared data from patients who received grafts from DCD versus DBD between 2012 and 2023. During this period, 131 adult patients underwent isolated heart transplantation. Of these, 25 (19%) were DCD donors. Donation after circulatory death donors were predominantly local (66% vs. 42%; p = 0.027). Donation after circulatory death graft recipients had fewer ventricular assist devices (12% vs. 35%; p = 0.025) and were less frequently urgent (12% vs. 39%; p = 0.009). Donation after circulatory death grafts had shorter myocardial ischemia and extracorporeal circulation times than DBD grafts (70 min [63.5-91] vs. 168 [83-219]; p < 0.001); (90 min [78-103) vs. 120 [96-148], p < 0.001). We observed no significant differences in the incidence of primary graft failure (16% vs. 22%; p = 0.526) or hospital mortality (8% vs. 14%; p = 0.410) between both groups. In conclusion, cardiac DCD demonstrates hospital outcomes comparable to those of cardiac DBD. Further long-term follow-up of these patients is necessary to determine their rejection, graft vascular disease, and mortality outcomes.

PMID:40377428 | DOI:10.1097/MAT.0000000000002458

MedEdPORTAL. 2025 May 15;21:11521. doi: 10.15766/mep_2374-8265.11521. eCollection 2025.

ABSTRACT

INTRODUCTION: Extracorporeal cardiopulmonary resuscitation (eCPR) has demonstrated patient outcome-driven benefits for those with out-of-hospital cardiac arrest in refractory ventricular fibrillation/pulseless ventricular tachycardia but remains an infrequent procedure requiring hands-on training.

METHODS: We created a high-fidelity simulation utilizing a cannulation manikin to simulate cardiac arrest in a 57-year-old patient in ventricular fibrillation refractory to standard resuscitation. Participants (consisting of emergency medicine and critical care resident and attending physicians, critical care fellows, advanced practice providers, nurses, pharmacists, and respiratory therapists) were instructed to respond to the simulation by recognizing the indication for eCPR and performing ultrasound-guided percutaneous extracorporeal membrane oxygenation (ECMO) cannulation to facilitate patient transfer to the cardiac catheterization lab. Participants rated their comfort level with various aspects of eCPR on a 5-point Likert scale, both presimulation (N = 27) and postsimulation (n = 17).

RESULTS: A total of 27 participants with varied levels of training completed the simulation, with positive feedback from all respondents on the postsimulation survey. A statistically significant increase in comfort scores from pre- to postsimulation was observed across all domains, including knowledge of eCPR candidacy (p < .001), cannulation procedures (p < .001), and overall process (p = .001).

DISCUSSION: Simulation is a valuable tool for ensuring procedural competency, especially for rarely performed and high-risk procedures such as ECMO cannulation. As eCPR becomes more prevalent, it is vital that simulation models be available and practiced on a multidisciplinary level to ensure general knowledge of the indications, procedures, and overall process of eCPR.

PMID:40376250 | PMC:PMC12078624 | DOI:10.15766/mep_2374-8265.11521

Crit Care. 2025 May 16;29(1):195. doi: 10.1186/s13054-025-05437-0.

ABSTRACT

RATIONALE: The significance of the Recruitment to Inflation (R/I) ratio in identifying PEEP recruiters in patients undergoing ultra-protective lung ventilation during venovenous ECMO is not well established.

OBJECTIVES: To compare the concordance of the R/I ratio and Electrical Impedance Tomography (EIT) in determining optimum PEEP settings in severe ARDS patients on ECMO and ventilated with very low tidal volumes.

METHODS: Initially, a low-flow insufflation was performed to detect and measure the airway opening pressure (AOP). Subsequently, the R/I ratio was calculated from PEEP 15-5 cmH2O, followed by a decremental PEEP trial (20-6 cmH2O in 2 cmH2O steps) monitored by EIT. The optimum EIT-based PEEP was defined as the intersection of the collapse and overdistension curves.

MAIN RESULTS: Among 54 ECMO patients (tidal volume: 4.8 [3.0-6.0] mL/kg), 13 (24%) exhibited an airway opening pressure (AOP) of 11 (8-14) cmH2O. The cohort's median R/I ratio was 0.43 (0.28-0.61). A tertile-based analysis of the R/I ratio (≤ 0.34; 0.34-0.54; > 0.54) revealed median optimum EIT-based PEEP of 8 [8-10], 10 [8-14], and 14 [12-16] cmH2O, respectively. The R/I ratio demonstrated weak inverse correlations with lung overdistension (R2 = 0.19) and positive correlations with lung collapse (R2 = 0.26) measured by EIT (p < 0.01).

CONCLUSION: The R/I ratio is feasible during ultra-protective ventilation and provides valuable indications for guiding PEEP titration. Specifically, an R/I ratio > 0.34 may help identify patients likely to benefit from further individualized PEEP optimization using EIT. In contrast, when the R/I ratio is ≤ 0.34, a moderate PEEP level (8-10 cmH₂O) may suffice.

PMID:40380232 | PMC:PMC12084998 | DOI:10.1186/s13054-025-05437-0

Med Sci Monit. 2025 May 15;31:e948186. doi: 10.12659/MSM.948186.

ABSTRACT

BACKGROUND Propofol is the most commonly used hypnotic for laryngeal mask airway (LMA) insertion but requires high doses when used alone, potentially causing cardiorespiratory depression. Muscle relaxants are recommended, yet no study has assessed the effects of remifentanil and dexmedetomidine before propofol induction on LMA insertion conditions. This prospective study aimed to compare the outcomes of propofol administered with remifentanil versus dexmedetomidine during short-duration operations requiring LMA placement. MATERIAL AND METHODS Eighty premedicated ASA I-II patients (age 18-65 years) were randomized to receive dexmedetomidine (Group D=40) or remifentanil (Group R=40) before propofol induction. Group D received a 10-minute infusion (1 μg.kg), while Group R received remifentanil (2 μg.kg) over 60 seconds. Baseline systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index (BIS) values were recorded before induction and at intervals up to 5 minutes after LMA placement. RESULTS Group R had significantly shorter eyelash reflex loss and LMA insertion times, but longer apnea duration. Ideal LMA insertion conditions, full chin opening, and no movement were more frequent in Group R (p<0.05). In Group D, HR was significantly lower than in Group R 1 minute before and after LMA insertion, but significantly higher in the 4th and 5th minutes after insertion (p<0.05). MAP in Group R was significantly lower than in Group D at 1 minute before and all times after LMA insertion (p<0.05). CONCLUSIONS Administration of 2 μg/kg remifentanil before 2.5 mg/kg propofol induction resulted in better hemodynamics, faster LMA insertion, and higher rates of optimal conditions compared to 1 μg/kg dexmedetomidine.

PMID:40369863 | PMC:PMC12094127 | DOI:10.12659/MSM.948186

Int J Mol Sci. 2025 Apr 23;26(9):3984. doi: 10.3390/ijms26093984.

ABSTRACT

Periodontitis is a common inflammatory disease that not only damages periodontal tissues but also induces systemic effects, including cardiac dysfunction. Mesenchymal stem cells (MSCs) offer regenerative potential due to their ability to differentiate, modulate immune responses, and secrete anti-inflammatory factors. However, the relative efficacy of local versus systemic MSC administration remains unclear. This study evaluated the therapeutic effects of adipose-derived MSCs (AD-MSCs) in a rat model of experimental periodontitis, comparing local and systemic administration. AD-MSCs were characterized based on morphology, surface marker expression, and differentiation potential. Ligature-induced periodontitis was established over 60 days, after which AD-MSCs (1 × 106 cells) were administered either supraperiosteally (local group) or intravenously (systemic group). Periodontal regeneration was assessed through clinical, radiographic, and histopathological analyses, while cardiac function was evaluated using echocardiography and histopathological examinations. Results demonstrated that local AD-MSC administration provided superior therapeutic benefits compared to systemic delivery. Locally administered cells significantly enhanced bone regeneration, reduced inflammation, and improved periodontal tissue architecture. In contrast, systemic administration offered moderate benefits but was less effective in restoring periodontal integrity. Similarly, in the heart, local treatment resulted in greater improvements in systolic function, as indicated by enhanced ejection fraction and fractional shortening, along with reduced myocardial fibrosis. Although systemic administration also provided cardioprotective effects, diastolic dysfunction persisted in both treatment groups. In conclusion, local AD-MSC administration proved more effective in regenerating periodontal tissues and mitigating cardiac dysfunction, highlighting its potential as an optimized therapeutic strategy for periodontitis and its systemic complications.

PMID:40362223 | PMC:PMC12071214 | DOI:10.3390/ijms26093984

Kardiol Pol. 2025 May 14. doi: 10.33963/v.phj.105656. Online ahead of print.

NO ABSTRACT

PMID:40365895 | DOI:10.33963/v.phj.105656

Clin Cardiol. 2025 May;48(5):e70152. doi: 10.1002/clc.70152.

ABSTRACT

BACKGROUND: Left atrial appendage occlusion (LAAO) is an established therapy for stroke prevention in non-valvular atrial fibrillation (NVAF), but outcomes in Hispanic populations remain underexplored.

OBJECTIVE: The objective of our study was to evaluate the inpatient outcomes of Hispanic patients undergoing LAAO as compared to non-Hispanic white patients.

METHODS: We conducted a retrospective cohort study using the National Inpatient Sample (NIS). From 157 434 LAAO hospitalizations identified, 133 517 were non-Hispanic white and 6814 were Hispanic/Latino. The primary outcome was in-hospital mortality.

RESULTS: Unadjusted odds in the Hispanic/Latino group were higher for mortality (OR 1.78, 95% CI 1.18-2.68, p 0.006), stroke (OR 1.64, 95% CI 1.26-2.14, p < 0.001), infectious complications (OR 3.89, 95% CI 3.03-4.99, p < 0.001), major bleeding (OR 1.22, 95% CI 1.11-1.33, p < 0.001), DVT/PE (OR 2.15, 95% CI 1.58-2.93, p < 0.001), and vascular complications (OR 1.81, 95% CI 0.53-0.93, p < 0.001). After adjusting for covariates and comorbidities, Hispanic/Latino patients had still greater odds of mortality (aOR 1.20, 95% CI 0.75-1.92, p 0.445), infectious complications (aOR 3.54, 95% CI 2.62-4.55, p < 0.001), and vascular complications (aOR 1.57, 95% CI 1.22-2.03, p < 0.001). Non-Hispanic white patients had higher adjusted odds of pericardial effusion/tamponade (aOR 0.64, 95% CI 0.52-0.95, p 0.03), while Hispanic/Latino patients also had higher adjusted odds of cardiac arrest (aOR 1.99, 95% CI 1.15-3.42, p 0.46).

CONCLUSION: Hispanic/Latino patients undergoing LAAO experience higher odds of infectious and vascular complications compared to non-Hispanic white patients. These findings highlight the need to further investigate disparities in procedural outcomes.

PMID:40365821 | PMC:PMC12076124 | DOI:10.1002/clc.70152

Commun Biol. 2025 May 13;8(1):745. doi: 10.1038/s42003-025-08162-0.

ABSTRACT

Current methods for producing cardiomyocytes from human induced pluripotent stem cells (hiPSCs) using 2D monolayer differentiation are often hampered by batch-to-batch variability and inefficient purification processes. Here, we introduce CM-AI, a novel artificial intelligence-guided laser cell processing platform designed for rapid, label-free purification of hiPSC-derived cardiomyocytes (hiPSC-CMs). This approach significantly reduces processing time without the need for chronic metabolic selection or antibody-based sorting. By integrating real-time cellular morphology analysis and targeted laser ablation, CM-AI selectively removes non-cardiomyocyte populations with high precision. This streamlined process preserves cardiomyocyte viability and function, offering a scalable and efficient solution for cardiac regenerative medicine, disease modeling, and drug discovery.

PMID:40360739 | PMC:PMC12075813 | DOI:10.1038/s42003-025-08162-0

Biochem Biophys Res Commun. 2025 Jul 8;769:151933. doi: 10.1016/j.bbrc.2025.151933. Epub 2025 May 2.

ABSTRACT

Injured human hearts are fibrotic, whereas zebrafish hearts functionally regenerate following myocardial injury. The unique regeneration niche microenvironment has been extensively studied in zebrafish hearts. However whether this can be extrapolated to humans remains unclear owing to significant species differences. We xenografted human induced pluripotent stem cell-derived cardiomyocytes (hiCMs) into the cardiac region of one-day post-fertilized zebrafish embryos and established a zebrafish xenograft model of hiCMs. This model can be used to explore the behavior of hiCMs transplanted into zebrafish hearts. Fluctuations in the fluorescence intensity of the genetically encoded calcium indicator protein GCaMP indicated that the donor hiCMs were beating. We analyzed the synchronization of the GCaMP + hiCMs transplanted into the zebrafish heart. We found synchronous beating between the host and 40 % of the zebrafish hearts with beating GCaMP-hiPSCs. Our chimeric heart model has the potential to bridge the regeneration capacity gap between zebrafish and humans and has proming future applications.

PMID:40347622 | DOI:10.1016/j.bbrc.2025.151933

Stem Cell Res Ther. 2025 May 9;16(1):234. doi: 10.1186/s13287-025-04323-4.

ABSTRACT

BACKGROUND: Junctophilin-2 (JPH2) is a vital protein in cardiomyocytes, anchoring T-tubule and sarcoplasmic reticulum membranes to facilitate excitation-contraction coupling, a process essential for cardiac contractile function. Dysfunction of JPH2 is associated with cardiac disorders such as heart failure; however, prior studies using mouse models or primary human cardiomyocytes are limited by interspecies differences or poor cell viability, respectively. This study aimed to investigate JPH2's role in human cardiac function and disease using a novel stem cell-derived model, while introducing a new indicator to evaluate related cardiac impairments.

METHODS: We generated a JPH2-knockout model using human embryonic stem cell-derived cardiomyocytes (hESC-CMs) with CRISPR/Cas9. Cellular morphology, contractile function, calcium dynamics, and electrophysiological properties were assessed via transmission electron microscopy, the CardioExcyte96 system, calcium imaging with Fluo-4 AM, and multi-electrode array recordings, respectively. Wild-type JPH2 was overexpressed through lentiviral transfection to evaluate rescue effects, and two JPH2 variants-one benign (G505S) and one pathogenic (E85K)-were introduced to study mutation-specific effects.

RESULTS: JPH2 knockout disrupted excitation-contraction coupling in hESC-CMs by impairing junctional membrane complex structure, leading to heart failure-like phenotypes with reduced contractility, altered calcium dynamics, and electrophysiological irregularities. Overexpression of wild-type JPH2 restored these functions, affirming its critical role in cardiac physiology. We identified excitation-contraction coupling delay (ECCD) as a novel indicator that precisely quantified coupling impairment severity, with its applicability validated across distinct JPH2 variants (G505S and E85K).

CONCLUSIONS: This study demonstrates JPH2's essential role in sustaining excitation-contraction coupling by stabilizing the junctional membrane complex, with its deficiency driving heart failure-like cardiac dysfunction. ECCD is established as a sensitive, comprehensive indicator for assessing JPH2-related impairment severity. These findings advance our understanding of JPH2 in cardiac pathology and position ECCD as a valuable tool for research and potential clinical evaluation, with JPH2 and calcium regulation emerging as promising therapeutic targets.

PMID:40346697 | PMC:PMC12065164 | DOI:10.1186/s13287-025-04323-4

ACS Appl Bio Mater. 2025 Jun 16;8(6):4743-4755. doi: 10.1021/acsabm.5c00125. Epub 2025 May 9.

ABSTRACT

Heart failure (HF) is a major contributor to the global burden of cardiovascular disease. Current treatments for HF do not regenerate or restore cardiac muscle function, leaving cardiac transplantation as the only definitive treatment for end-stage HF. Subsequently, there is a tremendous need for alternative HF treatments as well as methods to effectively and selectively deliver those therapies to the heart. We have engineered an injectable reverse thermal gel (RTG) functionalized with carbon nanotubes (CNTs) to create a thermoresponsive conductive hydrogel or RTG-CNT. The RTG-CNT transitions from a liquid solution to a gel-based matrix upon reaching body temperature, a unique quality that allows for rapid injection of the liquid polymeric solution followed by gel localization in situ. Previously, we demonstrated the potential use of the RTG-CNT hydrogel for cardiac tissue engineering applications using three-dimensional (3D) cocultures of primary cardiac cells. Here, we performed a preclinical study to assess the biocompatibility of our RTG-CNT hydrogel in vivo by using hydrogel intracardial injection in a mouse model and in vitro by using 3D cultures of human-induced pluripotent stem cell-derived cardiomyocytes. In this report, we present compelling results that demonstrate the RTG-CNT hydrogel biocompatibility and its potential for use in cardiac tissue engineering applications.

PMID:40343469 | DOI:10.1021/acsabm.5c00125

Biofabrication. 2025 May 23;17(3). doi: 10.1088/1758-5090/add627.

ABSTRACT

Cardiac tissue engineering is a rapidly growing field that holds great promise for the development of new therapies for heart disease. While significant progress has been made in the field over the past two decades, engineering functional myocardium of clinically relevant size and thickness remains an unmet challenge. A major roadblock in this respect is the current difficulty in incorporating efficient vascularization into engineered constructs. One potential solution involves the use of microvascular fragments from adipose tissue, which have demonstrated encouraging results in improving vascularization and graft survival following transplantation. However, this method lacks precise control over the vascular architecture within the constructs. Here, we set out to investigate the use of 3D bioprinting for the fabrication of human cardiac tissue constructs composed of human induced pluripotent stem cell derivatives, while allowing for the precise control of the distribution and density of microvessel fragments within the bioprinted constructs. We carefully selected and optimized bioink compositions based on their printability, biocompatibility, and construct stability. Following transplantation into immunodeficient mice, 3D bioprinted cardiac constructs containing microvessel fragments exhibited rapid and efficient vascularization, resulting in prolonged graft survival. Overall, our studies underscore the advantages of employing engineering design and self-assembly across different scales to address current limitations of tissue engineering, and highlight the usefulness of 3D bioprinting in this context.

PMID:40341269 | DOI:10.1088/1758-5090/add627

J Cardiothorac Surg. 2025 May 9;20(1):229. doi: 10.1186/s13019-025-03453-3.

ABSTRACT

BACKGROUND: Acute myocardial infarction (AMI) induces significant myocardial damage, ultimately leading to heart failure as the surrounding healthy myocardial tissue undergoes progressive deterioration due to excessive mechanical stress.

METHODS: This study aimed to investigate myocardial regeneration in a porcine model of AMI using an acellular amniotic membrane with fibrin-termed an amnion bilayer (AB) or heart patch-as a cellular delivery system using porcine amniotic stem cells (pASCs) and autologous porcine cardiomyocytes (pCardios). Fifteen pigs (aged 2-4 months, weighing 50-60 kg) were randomly assigned to three experimental groups (n = 5): control group (AMI induction only), pASC group (pASC transplantation only), and coculture group (pASC and pCardio transplantation). AMI was induced via posterior left ventricular artery ligation and confirmed through standard biomarkers. After eight weeks, histological and molecular analyses were conducted to assess myocardial regeneration.

RESULTS: Improvement in regional wall motion abnormality (RWMA) was observed in 60% of the coculture group, 25% of the pASC group, and none in the control group. Histological analysis of the control group revealed extensive fibrosis with pronounced lipomatosis, particularly at the infarct center. In contrast, pASC and coculture groups exhibited minimal fibrotic scarring at both the infarct center and border regions. Immunofluorescence analysis demonstrated positive α-actinin expression in both the pASC and coculture groups, with the coculture group displaying sarcomeric structures-an organization absent in control group. RNA expression levels of key cardiomyogenic markers, including cardiac troponin T (cTnT), myosin heavy chain (MHC), and Nkx2.5, were significantly elevated in the treatment groups compared to the controls, with the coculture group exhibiting the highest MHC expression. The expression of c-Kit was also increased in both treatment groups relative to the control. Conversely, apoptotic markers p21 and Caspase-9 were highest in the control group, while coculture group exhibited the lowest p53 expression.

CONCLUSION: Epicardial transplantation of an acellular amniotic heart patch cocultured with cardiomyocytes and pASCs demonstrated superior cardiomyogenesis after eight weeks compared to pASC transplantation alone or control conditions. The coculture system was found to enhance the cardiac regeneration process, as evidenced by improved RWMA, distinct sarcomeric organization, reduced fibrotic scarring, and lower apoptotic gene expression.

PMID:40340905 | PMC:PMC12063456 | DOI:10.1186/s13019-025-03453-3

Reg Anesth Pain Med. 2025 May 7:rapm-2025-106591. doi: 10.1136/rapm-2025-106591. Online ahead of print.

ABSTRACT

BACKGROUND: The effects of the erector spinae plane (ESP) block on chronic postsurgical pain (CPSP) after cardiac surgery remain unclear. This study evaluated the efficacy of bilateral ESP block in reducing the incidence and severity of CPSP after cardiac surgery.

METHODS: This prospective, randomized, controlled, single-blind trial included 63 patients aged 18-80 years with American Society of Anesthesiologists physical status II-III, scheduled for elective cardiac surgery via median sternotomy. Participants received a bilateral ultrasound-guided ESP block or standard care without regional anesthesia. The primary outcome was the Brief Pain Inventory (BPI) score at 3 months postoperatively. Secondary outcomes included morphine consumption in the first 24 hours; Numerical Rating Scale (NRS) scores during rest/activity at 0, 3, 6, 12, and 24 hours; BPI scores at 6 months postoperatively; and Douleur Neuropathique 4 (DN4) and Hospital Anxiety and Depression Scale (HADS) scores at 3 and 6 months postoperatively.

RESULTS: The BPI scores of the two groups did not differ significantly at 3 months postoperatively (median (IQR): 0(26) vs 12 (31), p=0.166). However, 24 hours postoperative morphine consumption (8 mg vs 10.5 mg, p<0.001) and NRS scores at multiple time points were significantly lower in the ESP block group. No significant differences were observed between the groups in terms of the BPI, DN4, or HADS scores at three or 6 months.

CONCLUSIONS: The ESP block effectively reduced acute pain and opioid consumption; however, it had no significant effect on the incidence or severity of CPSP at 3 and 6 months.

PMID:40341013 | DOI:10.1136/rapm-2025-106591

Lancet Respir Med. 2025 May 5:S2213-2600(25)00084-0. doi: 10.1016/S2213-2600(25)00084-0. Online ahead of print.

ABSTRACT

Despite substantial advancements in the management of cardiogenic shock, mortality rates remain greater than 40%. Trials have shown that increasing survival rates in cardiogenic shock is challenging. Even the most successful trials show 5-15% reductions in mortality, and gains have been restricted to acute myocardial infarction cardiogenic shock, representing approximately 5% of the population with cardiogenic shock. Trials studying pharmacological strategies in all populations with cardiogenic shock have been consistently neutral or negative. The reasons are complex and include heterogeneity in cardiogenic shock phenotypes, timing of patient inclusion, high prevalence of multiorgan failure and cardiac arrest, and unrealistic estimated treatment effects that restrict sample size with sometimes inadequate funding leading to underpowered trials. In June, 2024, international experts from the fields of cardiology, anaesthesiology, critical care medicine, biostatistics, government regulation of trials, and patient advocacy convened at the sixth Critical Care Clinical Trialists Workshop to reflect on how to improve the design of future randomised clinical trials in cardiogenic shock. This Position Paper summarises the results of discussions regarding what an optimal randomised controlled trial on cardiogenic shock should entail in terms of population selection, primary objectives, statistical analysis, and incorporation of the patient's perspective.

PMID:40339587 | DOI:10.1016/S2213-2600(25)00084-0

Adv Drug Deliv Rev. 2025 Jul;222:115594. doi: 10.1016/j.addr.2025.115594. Epub 2025 May 5.

ABSTRACT

The transplantation of human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) and hPSC-derived cardiac progenitors (hPSC-CPs) represents a promising strategy for regenerating hearts damaged by myocardial infarction (MI). After nearly two decades of experience testing these cell populations in various small- and large-animal MI models, multiple clinical trials have recently been initiated. In this review, we consider the principal lessons learned from preclinical experience with hPSC-CMs and -CPs, focusing on three conclusions that have been supported by the majority of reported transplantation studies. First, hPSC-CMs and -CPs stably engraft in injured hearts and partially remuscularize the infarct scar, but more progress is needed to improve graft cell retention and survival. Second, the transplantation of hPSC-CMs and -CPs has been found to improve contractile function in infarcted hearts, but the mechanistic basis for these effects remains incompletely elucidated. Third, the graft tissue formed by these cells can integrate and activate synchronously with host myocardium, but this capacity for electromechanical integration has been associated with an elevated risk of graft-related arrhythmias. Here, we summarize the preclinical evidence supporting these three observations, identify the relevant gaps and barriers to translation, and summarize ongoing efforts to improve the safety and efficacy of hPSC-CM- and -CP-based regenerative therapies.

PMID:40334814 | DOI:10.1016/j.addr.2025.115594

Iran J Microbiol. 2025 Feb;17(1):122-127. doi: 10.18502/ijm.v17i1.17809.

ABSTRACT

BACKGROUND AND OBJECTIVES: SARS CoV2 has tropism for various tissues, including the respiratory tract, brain, endothelium, heart, kidney and liver. Neurological symptoms can also be seen in the clinical course of the disease, and anosmia is the most common. The main objective of our study was to examine the urinary amino acid profiles of moderately severe patients diagnosed with COVID-19 with a positive RT-PCR test and try to find metabolic changes associated with the infection. Also, it was aimed to investigate the neuroinhibitory Gamma-Aminobutyric acid (GABA) levels in order to examine the physiopathology.

MATERIALS AND METHODS: Thirty adult cases who were followed up in the infection clinic with positive SARS CoV 2 RT-PCR and diagnosed with COVID 19 disease were included in the study with consent. The amino acid profile of these patients' urine samples, 30 different amino acid levels and creatine levels were examined using the liquid chromatography-mass spectrometry (LCMS) method on the SCIEX QTRAP 4500 device.

RESULTS: The mean age of the patients is 40 ± 5. Elevated GABA in 28/30 cases, high hydroxylysine amino acid in 27/30 cases, low glycine in 30/30 cases were detected in the urine. The creatinine levels of the patients were found to be normal.

CONCLUSION: It has been thought that the height of GABA may be due to bacteria producing GABA as a result of the change in microbiota due to lactic acidosis, as well as that the virus may directly affect the brain and cause an increase in GABA.

PMID:40330059 | PMC:PMC12049756 | DOI:10.18502/ijm.v17i1.17809