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Cardiovasc Res. 2025 Oct 3:cvaf165. doi: 10.1093/cvr/cvaf165. Online ahead of print.

ABSTRACT

AIMS: T cells drive adverse cardiac inflammation and ischemia-reperfusion injury following myocardial infarction (MI). Here, we aimed to test the extent to which T cell inhibition protected cardiac function following MI in mice.

METHODS AND RESULTS: Cardiac ischemia-reperfusion injury (CIRI), mimicking MI with successful reperfusion therapy, was induced in C57BL/6J mice via temporary surgical ligation of the left anterior descending artery. T cell inhibition was achieved using abatacept, an FDA-approved CTLA-4-Ig fusion protein. Multiple treatment strategies were assessed, ranging from prolonged treatment across 4 weeks to short-term treatment, also with delayed time-to-intervention. Cardiac function was assessed using echocardiography, including strain analysis. Impacts on the cardiac and systemic immune response were assessed using flow cytometry. CIRI-induced robust CD4+ biased T cell activation in the heart within 7 days. Treatment with abatacept significantly preserved key echocardiographic metrics of cardiac function. This treatment coincided with near-complete inhibition of the cardiac T cell response, as well as reductions in innate inflammatory cells. Collectively, this demonstrated a central mechanistic role for T cell activation post-MI with reperfusion. Evaluation of short-term intervention strategies further demonstrated sustained preservation of cardiac function even where treatment was delayed by 24 h. Mechanistically, our data indicate that over 50% of lost cardiac function post-MI with reperfusion is T cell dependent.

CONCLUSION: T cell co-stimulation leading to activation is a central driver of the cardiac immune response following MI with reperfusion. The inhibition of this axis significantly protected against CIRI and preserved cardiac function. Ultimately, we highlight T cell immunomodulation and abatacept as highly promising approaches for clinical translation.

PMID:41039954 | DOI:10.1093/cvr/cvaf165

Can J Cardiol. 2025 Oct 1:S0828-282X(25)01194-8. doi: 10.1016/j.cjca.2025.09.040. Online ahead of print.

ABSTRACT

Despite major advances in short-term outcomes after heart transplantation, long-term survival remains limited by chronic allograft dysfunction, with cardiac allograft vasculopathy (CAV) being the leading cause of late graft failure and an important cause of all-cause mortality. CAV is a unique and multifactorial form of transplant coronary vasculopathy, driven by a complex interplay of alloimmune responses, innate immune activation, and traditional cardiovascular risk factors. Recent insights from deep profiling of human allograft tissue have revealed the key roles of locally sustained T- and B-cell-mediated inflammation, macrophage-natural killer cell interactions, and chronic immune activation within the graft. These discoveries challenge prior models of systemic immune monitoring and highlight the importance of spatially organized, intragraft immune processes. In parallel, the diagnostic landscape of CAV is rapidly evolving. High-resolution imaging techniques such as optical coherence tomography, and advanced non-invasive tools including coronary computed tomography angiography and positron emission tomography, not only enable earlier and more precise detection of disease but also redefine the usual landscape of CAV diagnosis. New methods for individualized risk stratification, including trajectory modeling and machine learning-enhanced biopsy analysis, are paving the way for more personalized surveillance strategies. While current management remains focused on prevention, novel therapeutic targets are emerging, informed by a deeper understanding of CAV immunopathogenesis. This review provides an up-to-date synthesis of recent advances in CAV, with a focus on pathophysiology, individualized risk assessment, diagnostic innovation, and therapeutic perspectives, underscoring a paradigm shift toward more precise and proactive care in heart transplant recipients.

PMID:41043713 | DOI:10.1016/j.cjca.2025.09.040

Eur J Pharmacol. 2025 Oct 1;1007:178210. doi: 10.1016/j.ejphar.2025.178210. Online ahead of print.

ABSTRACT

Gut microbiome is an emerging contributor to various cardiovascular diseases (CVDs) where gut dysbiosis increases the risk of development and progression of atherosclerosis, coronary artery diseases, hypertension, and heart failure. Microbiota can also affect the metabolism of medications including cardiovascular drugs, resulting in alteration of their pharmacokinetics and pharmacodynamics or producing metabolites which can interfere with response of these drugs. Importantly, CVDs require prolonged pharmacological interventions with medications which may have impacts on the diversity and composition of gut microbiota. Gut microbiota modulation using diets, prebiotics, probiotics, fecal microbiota transplantation, antibiotics, and microbial trimethylamine-lyase inhibitors, has also shown benefits in the management of CVDs where gut microbiota and their metabolites have recently been studied as potential targets for the management of these diseases. Specifically, using innovative microbiota therapies in combination with traditional pharmacological agents have been evaluated for additional benefits in various CVDs. However, assessing the interactions among host factors, gut microbiome, and drug response will be essential for the development of new therapeutic targets for cardiovascular disorders, ultimately hoping better prognosis and patient's quality of life for those affected with CVDs.

PMID:41043575 | DOI:10.1016/j.ejphar.2025.178210

Eur J Cardiothorac Surg. 2025 Oct 3:ezaf333. doi: 10.1093/ejcts/ezaf333. Online ahead of print.

ABSTRACT

OBJECTIVES: Donor-recipient size matching in patients with pulmonary fibrosis may be performed according to the actual total lung capacity (aTLC) as measured by bodyplethysmography, the corrected total lung capacity (cTLC) and the predicted total lung capacity (pTLC). However, there is still no consensus on the ideal matching total lung capacity. Therefore, we aimed to analyze posttransplant outcomes of patients with pulmonary fibrosis listed according to aTLC, cTLC or pTLC.

METHODS: Patient records were retrospectively reviewed and analyzed using Bayesian statistics. Patients with pulmonary fibrosis who underwent double lung transplantation without concomitant lung reduction surgery were included.

RESULTS: Between November 2017 and May 2023, among the 521 patients who underwent lung transplantation at our institution, 122 (24%) were included, 11 (9%) forming the aTLC-group, 21 (17%) forming the cTLC-group and 90 (74%) forming the pTLC-group. Overall patient and graft mortality was decreased in patients who were listed according to aTLC when compared to cTLC (HR 0.11; 95% CrI 0-0.99). However, Bayesian Cox multivariable analysis revealed that this was due to the higher incidence of associated pulmonary hypertension and chronic renal failure in the cTLC group. No difference was seen in incidence of biopsy confirmed rejection and chronic lung allograft dysfunction.

CONCLUSION: Our study showed that listing patients according to aTLC improved mortality when compared to listing according to cTLC, because patients listed according to cTLC had a higher preoperative morbidity.

PMID:41042926 | DOI:10.1093/ejcts/ezaf333

Am J Physiol Renal Physiol. 2025 Oct 3. doi: 10.1152/ajprenal.00259.2025. Online ahead of print.

ABSTRACT

Renal dysfunction leads to critical health conditions, including acute kidney injury (AKI) and chronic kidney disease (CKD), and is a driver of hypertension. Despite their global prevalence and impact, the pathophysiology for all kidney disease subtypes is incompletely understood, therefore, many patients progress to kidney failure, needing dialysis and transplantation. This review highlights the role of pannexins-a family of channel-forming glycoproteins-in renal physiology and pathophysiology. Compared to other organ systems such as the brain and cardiovascular system, relatively little is known about the function of pannexins in the kidney. However, recent findings indicate that pannexins may be potential therapeutic targets in the treatment of hypertension, AKI, and CKD, though further research is needed to fully understand their precise role in renal health and disease.

PMID:41042800 | DOI:10.1152/ajprenal.00259.2025

Kardiol Pol. 2025 Oct 3. doi: 10.33963/v.phj.108922. Online ahead of print.

NO ABSTRACT

PMID:41042212 | DOI:10.33963/v.phj.108922

medRxiv [Preprint]. 2025 Sep 24:2025.09.22.25336215. doi: 10.1101/2025.09.22.25336215.

ABSTRACT

INTRODUCTION: After the 2018 allocation policy change, the rate of listings and transplants with durable LVADs has decreased significantly in favor of bridging patients from temporary mechanical circulatory support to heart transplant. The Organ Procurement and Transplantation Network (OPTN) recently approved a policy, to be implemented in September 2026, stipulating that patients supported by durable LVADs for 6 and 8 years will obtain statuses 3 and 2, respectively.

METHODS: Using OPTN data, we identified all adult heart transplant candidates with a durable LVAD implanted between October 18, 2018 and May 31, 2025. We estimated the cumulative incidence of status upgrades and durable LVAD-related complications, treating transplantation and waitlist removal before experiencing complications as competing events. We also assessed how the composition of the adult heart transplant waitlist on June 1, 2025 would have changed based on the upcoming policy change.

RESULTS: During the study period, 3,881 adult patients were listed for heart transplant with a durable LVAD. 3,182 (82.0%) of the durable LVADs were Abbott HeartMate 3, 568 (14.6%) were Medtronic Heartware HVAD, and 91 (2.3%) were Abbott HeartMate II. Transplant centers submitted a total of 6,924 justifications for status upgrades due to LVAD-related complications (6.3% status 1, 34.3% status 2, and 59.4% status 3) for 1,500 (38.6%) of these patients, with a median of 3 per patient. The cumulative incidence of complications or status upgrades was 38.6% [95% CI (37.1%, 40.2%)]. Nearly all of the 2,381 patients who did not experience any complication or status upgrade during listing were removed from the waitlist by 6 years. Had the upcoming OPTN policy change been implemented on June 1, 2025, the proportion of the waitlist that would have achieved higher priority status instantaneously was 0.06%.

CONCLUSIONS: The cumulative incidence of status upgrades and complications among heart transplant candidates with durable LVADs was nearly 40% within 6 years of device implantation. The upcoming OPTN policy to escalate patients to statuses 3 and 2 after 6 and 8 years of durable LVAD support, respectively, is unlikely to make a meaningful impact on waitlist priority status.

PMID:41040709 | PMC:PMC12485994 | DOI:10.1101/2025.09.22.25336215

J Soc Cardiovasc Angiogr Interv. 2025 Aug 19;4(9):103804. doi: 10.1016/j.jscai.2025.103804. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Although adverse events (AEs) are common during congenital cardiac catheterization procedures, many have little impact beyond the catheterization laboratory. We sought to identify factors that are associated with an increased length of stay (LOS).

METHODS: A total of 10,882 cases from the C3PO-quality improvement registry dataset from January 2014 to December 2017 admitted electively on the same day of cardiac catheterization were analyzed and independent risk factors for a prolongation of LOS were identified.

RESULTS: Length of stay ranged from 0 to 305 days. The incidence of higher severity AE was significantly higher for cases that had a hospital stay of 2 days or more, compared to those discharged the same day or day 1 after the procedure (15% vs 2%, P < .001). Seven percent of patients without any AE in the cardiac catheterization laboratory had a prolonged LOS of 2 days or more. Significant independent risk factors for a prolongation of LOS included age <1 year, single ventricle diagnosis, cardiac surgery within the last 90 days, a higher hemodynamic vulnerability score, a higher PREDIC3T risk category, a prolonged procedure time, contrast usage >6 mL/kg, operators experience of either <5 or ≥25 years, and operator case volume >200 cases/y. The presence of any level 3bc, 4, or 5 AE had the highest associated odds of an increased LOS (OR, 5.9; 95% CI, 4.6-7.6).

CONCLUSIONS: Prolonged admission after outpatient catheterization is a potential alternative measure of safety after pediatric or congenital cardiac catheterization. It is independently associated not only with patient, procedure, and operator factors that have previously been described to be associated with the risk of AE but also with other factors such as the presence of single ventricle physiology. Further studies are needed to further evaluate its utility.

PMID:41040445 | PMC:PMC12485507 | DOI:10.1016/j.jscai.2025.103804

Innovations (Phila). 2025 Oct 3:15569845251375996. doi: 10.1177/15569845251375996. Online ahead of print.

NO ABSTRACT

PMID:41040037 | DOI:10.1177/15569845251375996

Expert Opin Drug Discov. 2025 Oct 3:1-13. doi: 10.1080/17460441.2025.2562020. Online ahead of print.

ABSTRACT

INTRODUCTION: Cancer cachexia (CC) is a multifactorial syndrome characterized by progressive weight loss, anorexia, and loss of skeletal muscle and fat mass, resulting in reduced quality of life and poor prognosis. Currently, there are no approved pharmacological treatments for CC, highlighting the urgent need for developing novel experimental models.

AREA COVERED: This review covers recent advancements in preclinical models of CC, highlighting their implications for drug discovery and therapeutic development. The literature search was conducted in PubMed up to April 2025.

EXPERT OPINION: CC remains clinically challenging and requires improved translational research and therapeutic strategies. Improved preclinical models, such as personalized patient-derived xenograft models incorporating patient-specific immune profiles and microbiota, hold promise for precision medicine. Identification of standardized extracellular vesicle (EV) derived biomarkers and effective targeting of EV signaling pathways are critical research directions. In addition, clinical validation of appetite regulators such as glucagon-like peptide-1 and growth differentiation factor-15, along with comprehensive approaches integrating diet, exercise, and targeted pharmacological interventions, will be pivotal. Finally, multidisciplinary collaboration is essential to translate these findings into meaningful therapies that will ultimately improve patient prognosis and quality of life.

PMID:41039997 | DOI:10.1080/17460441.2025.2562020

J Hypertens. 2025 Sep 15. doi: 10.1097/HJH.0000000000004151. Online ahead of print.

ABSTRACT

OBJECTIVE: Rarefaction in capillary density is a hallmark of hypertension-mediated microvascular damage. This study aimed to assess the association between clinically accessible inflammatory markers, including the systemic immune-inflammation index (SII), and retinal capillary density, as well as other indicators of microvascular damage.

METHODS: We conducted a cross-sectional analysis of data from 132 consecutive patients with established primary hypertension at the Royal Perth Hospital's tertiary hypertension clinic. All patients underwent noninvasive optical coherence tomographic angiography (OCT-A) for the assessment of retinal capillary density in the foveal region (CDF) and blood sampling for inflammatory markers. We examined the association of the SII - calculated as the product of the neutrophil-lymphocyte ratio and platelet count - and its individual components with retinal capillary rarefaction and other markers of microvascular damage, such as the urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). The results were adjusted for relevant co-variates, including age, sex, 24-h SBP, BMI, antihypertensive medications, lipid levels, and diabetes status.

RESULTS: Retinal capillary rarefaction was associated with increased white cell count, particularly neutrophils, and the SII. Through predictive margin analysis, an optimal cut-off value of 600 x 109/l for SII was determined for median CDF of 34.1 mm2. The analysis showed a reduction in CDF of 1.3 mm2 for every 250 x 109/l increase in SII. Additionally, higher SII levels (≥ 600 x 109/l) were associated with elevated high-sensitivity C-reactive protein (hs-CRP) levels and markers of microvascular damage, such as increased UACR and reduced eGFR.

CONCLUSION: In patients with primary hypertension, SII and related inflammatory markers were associated with retinal rarefaction and renal indices of microvascular damage. SII may serve as a useful clinical marker of microvascular damage in the retinal and renal vascular bed.

PMID:41039760 | DOI:10.1097/HJH.0000000000004151

Perfusion. 2025 Oct 3:2676591251386601. doi: 10.1177/02676591251386601. Online ahead of print.

ABSTRACT

BackgroundMaintaining optimal anesthetic depth during cardiopulmonary bypass (CPB) in pediatric patients is challenging due to altered physiology and unreliable conventional monitoring. Entropy, a processed electroencephalogram metric, offers a potential solution. This study aimed to evaluate the relationship between end oxygenator sevoflurane concentration and entropy values during pediatric CPB using fixed-dose versus entropy-guided sevoflurane administration.MethodologyA prospective, randomized study was conducted on 62 pediatric patients undergoing congenital heart surgery with CPB. Patients were allocated into two groups: Group A received fixed-dose sevoflurane (1% v/v), and Group B received sevoflurane titrated to maintain entropy values between 40 and 60. Parameters such as end oxygenator sevoflurane concentration, entropy (Response and State entropy, RE and SE), and sevoflurane consumption were recorded intraoperatively. Postoperative hemodynamic data, length of stay, and complication rates were assessed.ResultsEntropy-guided patients showed significantly higher end oxygenator sevoflurane concentrations [1.64 (1.51-1.85)% versus 1.0%, p = .001] and sevoflurane consumption (1.26 ± 0.12 vs 0.645 ± 0.03 mL/min, p = .001). RE and SE values were significantly lower in the entropy group (p = .001), indicating better anesthetic depth control. A negative correlation was found between entropy and sevoflurane concentration (r = -0.6987, p = .02). Despite higher postoperative inotropic scores in the entropy group (p = .001), no significant differences were found in length of stay, mechanical ventilation duration, or morbidity and mortality rates between groups.ConclusionEntropy-guided sevoflurane administration during pediatric CPB provides improved anesthetic depth control at the cost of higher anesthetic and inotropic requirements. However, it does not adversely affect clinical outcomes, supporting its safety and potential utility in refining pediatric anesthesia practices.

PMID:41043805 | DOI:10.1177/02676591251386601

Anesthesiology. 2025 Oct 3. doi: 10.1097/ALN.0000000000005783. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with congenital heart disease (CHD) remain at high risk for morbidity and mortality when undergoing noncardiac procedures. Existing studies have utilized national databases focusing on mortality or are limited by small data sets from single institutions. Through a multi-institutional registry study, the primary aim is to describe the incidence of intraoperative cardiac events in patients with CHD undergoing noncardiac procedures. The secondary aim is to describe the risk factors associated with the events.

METHODS: Patients with CHD from birth to 21 years undergoing noncardiac procedures between January and December 2021, were identified at all participating centers. The primary outcome was occurrence of an intraoperative cardiac event at each encounter, defined as the composite of intraoperative hemodynamic instability, cardiac arrest, and pulmonary hypertensive crisis.

RESULTS: The final analysis involved 4,343 unique patients at 7 centers undergoing 6455 procedures. Among the cohort, 335 of 6455 procedures involved an intraoperative cardiac event (5.2%) in 296 unique patients. The most common event was hypotension (n=315, 4.9%); there were 12 occurrences of cardiac arrest (0.2%). Univariate analysis showed multiple factors associated with the increased likelihood of an intraoperative cardiac events including patient and procedure characteristics, cardiac disease, and anesthetic management. Examples of patient characteristics include prematurity (OR1.34,95%CI 1.02-1.76, P=0.038), chronic medical conditions (gastrointestinal (OR1.51, 95%CI 1.15-1.99,P=0.003), respiratory (OR2.12, 95%CI 1.62,2.76,P<0.001)), preoperative ventilatory support (OR3.88, 95%CI2.8,5.38, P<0.001), concurrent respiratory illness (OR 2.18, 95% CI 1.47,3.2, P<0.001), major cardiac disease (OR2.09, 95%CI 1.54,2.83, P<0.001), and severe CHD (OR3.48, 95%CI 2.47,4.91, P<0.001).

DISCUSSION: Pediatric patients with severe CHD, those undergoing emergency procedures, and those undergoing surgical interventions were at higher risk of not only mortality as shown previously, but also hemodynamic instability. These are established risk factors for intraoperative cardiac events and should be considered when planning risk mitigation strategies.

PMID:41043169 | DOI:10.1097/ALN.0000000000005783

Pediatr Dev Pathol. 2025 Oct 3:10935266251366015. doi: 10.1177/10935266251366015. Online ahead of print.

ABSTRACT

Left pulmonary artery (LPA) sling is a rare congenital anomaly in which the LPA abnormally originates from the right pulmonary artery (RPA) and courses between the trachea and esophagus to reach the left pulmonary hilum. This anomaly is frequently associated with tracheobronchial and other cardiovascular anomalies and patients may manifest with varying airway and cardiovascular symptoms. Surgical repair is often required for symptomatic patients. Clinical outcomes largely depend on the extent and severity of coexisting anomalies, particularly tracheobronchial abnormalities. We report 2 autopsy cases of LPA sling, 1 pre- and 1 post-surgical repair. Comprehensive autopsy examination was crucial for confirmation of the clinical diagnoses and identification of a rare surgical complication.

PMID:41042052 | DOI:10.1177/10935266251366015

JAMIA Open. 2025 Oct 1;8(5):ooaf106. doi: 10.1093/jamiaopen/ooaf106. eCollection 2025 Oct.

ABSTRACT

OBJECTIVES: Accurate characterization of patients with congenital heart disease is fundamental to research, outcomes reporting, quality improvement, and clinical decision-making. Here we present an approach to computing the anatomy of patients with congenital heart disease based on the whole of their diagnostic and surgical codes.

MATERIALS AND METHODS: All diagnostic and procedure codes for patients cared for between 1981 and 2020 at Boston Children's Hospital were extracted from a database containing diagnostic codes from echocardiograms, and procedural codes from surgical and catheterization procedures. The pipeline sequentially (1) mapped each of the 7500 native codes to algorithm codes; (2) computed the parent anatomy for each study using a pre-defined hierarchy; (3) computed the parent anatomy for the patient, based on highest ranking parent anatomy; and (4) computed the subcategories and mandatory co-variate findings for each patient. Thereafter, diagnostic accuracy of 500 unseen patients was adjudicated against clinical documentation by clinical experts.

RESULTS: A total of 514 541 echocardiograms on 161 735 patients were available for this study. Phenotypes of congenital cardiac diseases were assigned in 84 285 patients (52%), and the remainder were computed to have normal anatomy. Clinicians agreed with algorithm assignments in 96.4% (482 of 500 patients), with disagreements most often representing definitional differences. An interactive dashboard enabled by the output of this algorithm is presented.

CONCLUSIONS: The computation of detailed congenital heart defect phenotypes from raw diagnostic and procedure codes is possible with a high degree of accuracy and efficiency. This framework may enable tools to support interactive outcomes reporting and clinical decision support.

PMID:41041623 | PMC:PMC12486236 | DOI:10.1093/jamiaopen/ooaf106

J Soc Cardiovasc Angiogr Interv. 2025 Aug 19;4(9):103804. doi: 10.1016/j.jscai.2025.103804. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Although adverse events (AEs) are common during congenital cardiac catheterization procedures, many have little impact beyond the catheterization laboratory. We sought to identify factors that are associated with an increased length of stay (LOS).

METHODS: A total of 10,882 cases from the C3PO-quality improvement registry dataset from January 2014 to December 2017 admitted electively on the same day of cardiac catheterization were analyzed and independent risk factors for a prolongation of LOS were identified.

RESULTS: Length of stay ranged from 0 to 305 days. The incidence of higher severity AE was significantly higher for cases that had a hospital stay of 2 days or more, compared to those discharged the same day or day 1 after the procedure (15% vs 2%, P < .001). Seven percent of patients without any AE in the cardiac catheterization laboratory had a prolonged LOS of 2 days or more. Significant independent risk factors for a prolongation of LOS included age <1 year, single ventricle diagnosis, cardiac surgery within the last 90 days, a higher hemodynamic vulnerability score, a higher PREDIC3T risk category, a prolonged procedure time, contrast usage >6 mL/kg, operators experience of either <5 or ≥25 years, and operator case volume >200 cases/y. The presence of any level 3bc, 4, or 5 AE had the highest associated odds of an increased LOS (OR, 5.9; 95% CI, 4.6-7.6).

CONCLUSIONS: Prolonged admission after outpatient catheterization is a potential alternative measure of safety after pediatric or congenital cardiac catheterization. It is independently associated not only with patient, procedure, and operator factors that have previously been described to be associated with the risk of AE but also with other factors such as the presence of single ventricle physiology. Further studies are needed to further evaluate its utility.

PMID:41040445 | PMC:PMC12485507 | DOI:10.1016/j.jscai.2025.103804

Front Cardiovasc Med. 2025 Sep 17;12:1615697. doi: 10.3389/fcvm.2025.1615697. eCollection 2025.

ABSTRACT

BACKGROUND: Cardiopulmonary bypass (CPB) in paediatric open-heart surgery is challenging, especially in neonates and aortic arch surgery. It induces a systemic inflammatory response that can lead to significant postoperative complications, including multiorgan dysfunction, prolonged mechanical ventilation, and intensive care unit (ICU) stay. Blood purification with hemoadsorbers integrated into CPB has been proposed as a strategy to reduce these side effects. These devices adsorb cytokines from the bloodstream, trying to modulate their negative systemic effect.

METHODS: This retrospective study evaluates 33 neonates who underwent complex cardiac surgeries between January 2022 and January 2025 at Regina Margherita Children's Hospital. 17 of them had been treated with Jafron HA60 hemoadsorber during CPB. Biomarkers of organ damage (creatinine, lipase, aspartate transaminase, and alanine transaminase), C-reactive protein, lactates, inotropic drugs doses and a wide range of pro- and anti-inflammatory cytokines were analysed during surgery and in the intensive care unit.

RESULTS: The results showed a decrease in biomarkers of organ damage and inflammation, accompanied by a tendency toward reduction in the required dose of inotropes, ICU stays, days of mechanical ventilation, and duration of required open chest time in the treated group. A similar downward pattern was observed in cytokine levels.

CONCLUSIONS: Hemoadsorption may be associated with improved clinical parameters in neonates undergoing high-risk cardiac surgery. Further large-scale studies are needed to explore these observations.

PMID:41040072 | PMC:PMC12484163 | DOI:10.3389/fcvm.2025.1615697

Innovations (Phila). 2025 Oct 3:15569845251375996. doi: 10.1177/15569845251375996. Online ahead of print.

NO ABSTRACT

PMID:41040037 | DOI:10.1177/15569845251375996

Cardiovasc Revasc Med. 2025 Oct;79:41-44. doi: 10.1016/j.carrev.2025.03.002. Epub 2025 Mar 5.

ABSTRACT

BACKGROUND: The effect of ejection fraction on outcomes after transcatheter aortic valve replacement (TAVR) in heart failure (HF) patients remains unclear.

METHODS: Using the National Readmission Database (2016-2020), adult HF patients who underwent TAVR were identified, and outcomes were compared between those with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The primary outcome was all-cause inpatient mortality, while secondary outcomes included major bleeding, packed red blood cell (pRBC) transfusion, acute kidney injury (AKI), ischemic cerebrovascular accidents (CVA), valvular complications, conversion to open surgery, length of stay, and total charges.

RESULTS: Among 231,092 HF patients who underwent TAVR, 89,782 had HFrEF. Compared to HFpEF patients, HFrEF was associated with higher inpatient mortality (adjusted odds ratio [aOR] 1.97, 95 % CI 1.78-2.19, P < 0.001), major bleeding (aOR 1.49, 95 % CI 1.36-1.63, P < 0.001), pRBC transfusion (aOR 1.28, 95 % CI 1.19-1.38, P < 0.001), AKI (aOR 1.89, 95 % CI 1.79-1.99, P < 0.001), valvular complications (aOR 1.41, 95 % CI 1.21-1.64, P < 0.001), and conversion to open surgery (aOR 1.72, 95 % CI 1.28-2.34, P < 0.001), with no significant difference in ischemic CVA (aOR 1.12, 95 % CI 0.97-1.29, P = 0.13). HFrEF was also associated with longer hospital stays (adjusted mean difference [aMD] 2.06 days, 95 % CI 1.93-2.18, P < 0.001) and higher total charges (aMD $29,783, 95 % CI 25,106-34,460, P < 0.001).

CONCLUSION: Patients with HFrEF undergoing TAVR experienced worse outcomes compared to those with HFpEF. These findings underscore the need for meticulous patient selection and risk evaluation before performing TAVR in HF patients.

PMID:41043945 | DOI:10.1016/j.carrev.2025.03.002

Europace. 2025 Oct 3:euaf251. doi: 10.1093/europace/euaf251. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The direct oral anticoagulant (DOAC) score was recently developed to predict bleeding risk in patients with atrial fibrillation (AF) receiving oral anticoagulants. However, limited data show inconsistent results comparing its performance to the conventional HAS-BLED score in Asian populations with non-valvular AF receiving DOACs.

METHODS: We enrolled 21,142 patients with non-valvular AF receiving DOACs from a multicenter database in Taiwan (June 2012-December 2021). The primary endpoint was major bleeding events. Major bleeding events were defined according to the ISTH criteria. Areas under receiver operating characteristic curves (AUCs) were calculated for each score, with differences assessed using DeLong test.

RESULTS: A total of 21,142 AF patients (mean age 75.9±11.0 years; 41% female) treated with DOAC were included in the analysis. Major bleeding events occurred in 681 patients in one-year follow-up (3.66%/year). There were 82(0.43%/year) intracranial hemorrhage event occurred. Both the DOAC and HAS-BLED scores are associated with a significant risk of major bleeding event, with only modest predictive performance (AUC <0.7). The DOAC score showed a slightly but statistically significantly higher AUC compared with the HAS-BLED score (AUC:0.670, [95 %CI:0.650-0.689]) vs. 0.642, [0.623-0.663]; P<.001). Results from several reclassification analyses favored the DOAC score. Both the two scores showed a good calibration for the low to intermediate risk categories, while the two bleeding risk scores both overestimate the risk of major bleeding risk for the high risk categories. Subgroup analyses indicated that the superiority of DOAC score over HAS-BLED score is primarily driven by elderly patients (≥75 years) and prediction in risk of gastrointestinal bleeding.

CONCLUSIONS: The DOAC score, which employs a more granular scoring system compared to the HAS-BLED score, may enable finer bleeding risk discrimination among Asian patients with non-valvular AF receiving DOAC therapy.

PMID:41043006 | DOI:10.1093/europace/euaf251