Front Cardiovasc Med. 2025 Sep 10;12:1577847. doi: 10.3389/fcvm.2025.1577847. eCollection 2025.
ABSTRACT
BACKGROUND: Levosimendan is a calcium-sensitizing inotrope with vasodilatory properties, shown to improve cardiac output and reduce mortality in adults with advanced heart failure. However, data on its safety and efficacy in neonatal cardiac surgery are limited.
OBJECTIVE: To evaluate the intraoperative use of levosimendan in neonates with complex congenital heart defects (CHDs) undergoing open-heart surgery.
METHODS: We conducted a retrospective observational study of 59 neonates aged 2-30 days who underwent surgical correction of complex CHDs with cardiopulmonary bypass. Levosimendan was administered intracoronarily as part of the blood cardioplegia protocol in doses of 25-45 mcg/kg.
RESULTS: Compared to historical controls, the levosimendan group demonstrated a significant reduction in postoperative catecholamine requirements, including adrenaline and norepinephrine. In 12% of cases, surgery was completed without the use of any catecholamines. No rhythm disturbances were observed. The positive inotropic effect lasted up to 72 h without systemic hypotension. Median adrenaline doses were significantly lower (p < 0.05), and norepinephrine use was reduced from 12% to 5%.
CONCLUSIONS: Intracoronary administration of levosimendan during neonatal cardiac surgery appears to reduce catecholamine dependence and support myocardial recovery without causing rhythm disturbances or hypotension. Further randomized controlled trials are needed to validate these findings.
PMID:41000533 | PMC:PMC12457408 | DOI:10.3389/fcvm.2025.1577847
Ann Cardiol Angeiol (Paris). 2025 Sep 25;74(5):101954. doi: 10.1016/j.ancard.2025.101954. Online ahead of print.
ABSTRACT
BACKGROUND: Severe calcific aortic stenosis (AS) is the most common valvular heart disease in the elderly and carries a poor prognosis without intervention. The introduction of transcatheter aortic valve implantation (TAVI) in 2002 profoundly reshaped therapeutic strategies. This study aimed to evaluate changes in patient management and outcomes at the Departmental Hospital Center of La Roche‑sur‑Yon over three time periods: 2005 (pre‑TAVI era), 2015 (early TAVI integration), and 2022 (TAVI‑dominant era).
METHODS: We conducted a retrospective, single-center observational study including all patients hospitalized for symptomatic severe AS or reduced left ventricular ejection fraction. Clinical characteristics, operative risk scores, management strategies, and one-year outcomes were analyzed.
RESULTS: Between 2005 and 2022, the number of patients managed for SAS increased by 158% (65 in 2005, 136 in 2015, 168 in 2022). Mean age (79 years in 2022) and male proportion (60%) remained stable. Therapeutic strategies shifted markedly (p < 0.001): surgery predominated in 2005 (67%), whereas TAVI became the most frequent treatment in 2022 (55%), followed by surgery (21%) and medical therapy (24%). Surgically treated patients were increasingly selected, with a median EuroSCORE II falling from 3,95 % (2005) to 1.1% (2022). One-year all-cause mortality in 2022 was 0% after surgery, 5.9% after TAVI (down from 28.8% in 2015, p = 0.008), and 68% with medical therapy (p < 0.001). Heart failure rehospitalizations were also more frequent in the medical group (33% vs 6% after TAVI and 2% after surgery; p = 0.016). The proportion of patients not presented at the heart team meeting declined significantly (17% in 2022 vs 35% before 2015; p < 0.001). The waiting times nevertheless remained significant (median of 70 days between admission and the MDT meeting, plus 41 days before the procedure).
CONCLUSIONS: Integration of TAVI has profoundly transformed AS management in our center, now the dominant strategy with significantly improved one-year prognosis. Medically treated patients still experience poor outcomes, underscoring the need to reduce delays and streamline the care pathway.
PMID:41004876 | DOI:10.1016/j.ancard.2025.101954
Med Sci (Basel). 2025 Jun 20;13(3):81. doi: 10.3390/medsci13030081.
ABSTRACT
Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ significantly, with primary MR requiring direct valvular intervention and SMR necessitating a comprehensive approach incorporating guideline-directed medical therapy (GDMT), revascularization, and resynchronization strategies. The MitraClip, a transcatheter edge-to-edge repair (TEER) device, has emerged as a recommended intervention for symptomatic severe SMR despite optimal GDMT. Objectives: This study aims to evaluate national trends in MitraClip placements in the U.S. from 2016 to 2021 and to assess 90-day readmission events following the procedure. Additionally, we analyze patient and socioeconomic factors associated with heart failure readmissions post-MitraClip placement to optimize patient selection criteria. Methods: The study utilized data from the National Inpatient Sample (NIS) for the years 2016-2021 and the National Readmissions Database (NRD) for 2021. Patients who underwent MitraClip placement were identified using ICD-10 code 02UG3JZ. We stratified the population based on demographics, hospital resource utilization, and comorbidities. Index admissions were classified based on the presence or absence of heart failure remissions within 90 days post-procedure. Statistical analyses, including ANOVA and logistic regression, were conducted to identify factors associated with readmissions. Results: MitraClip utilization demonstrated a rising trend from 2016 to 2021, with total annual procedures increasing from 869 to 2488. Mean patient age remained stable at 76-79 years, with a nearly equal sex distribution. In-hospital mortality remained low (1-3%) throughout the study period. A steady increase in hospital charges was observed, alongside a decline in the mean length of stay. Analysis of 4918 index admissions for MitraClip placement in 2021 identified 780 total readmissions within 90 days, with 206 (26.4%) attributed to heart failure. Factors significantly associated with increased risk of heart failure readmissions included atrial fibrillation (OR 3.77, CI 1.82-4.23), pulmonary hypertension (OR 3.96, CI 1.49-5.55), and chronic lung disease (OR 1.91, CI 1.32-2.77). Conclusions: The increasing adoption of MitraClip underscores its growing role in managing SMR. However, heart failure readmissions remain a significant concern. Identifying high-risk patient profiles can refine selection criteria and enhance post-procedural management strategies to improve clinical outcomes. Further research is needed to optimize patient selection and refine risk stratification for MitraClip interventions.
PMID:41003149 | PMC:PMC12471826 | DOI:10.3390/medsci13030081
Cureus. 2025 Aug 25;17(8):e90972. doi: 10.7759/cureus.90972. eCollection 2025 Aug.
ABSTRACT
Native valve infective endocarditis (IE) refers to infection resulting from the seeding of bacteria onto the heart valves, usually in patients with one or more risk factors such as intravenous drug use, poor dentition or recent dental surgery, prior structural or valvular heart disease, or indwelling cardiac devices. Although viridans group streptococci (VGS) are a common cause of aortic valve endocarditis, it is uncommon for the infection to result from bacterial translocation across the intestinal mucosa during gastroenteritis. This case involves a 64-year-old female who presented with an acute onset of shortness of breath, weakness, nausea, vomiting, rigors, and night sweats lasting two to three weeks. She also reported a week of nonbloody diarrhea that has since resolved. A CT pulmonary angiogram revealed an acute pulmonary embolism (PE) in the right upper lobe without evidence of right heart strain. A transthoracic echocardiogram, obtained during the work-up for her PE, showed a mobile density on the right coronary cusp concerning for vegetation. Transesophageal echocardiogram confirmed a mobile density on the right coronary cusp of the aortic valve, consistent with a vegetation larger than 10 mm. Blood cultures grew Streptococcus oralis/mitis, and the patient was diagnosed with IE. She subsequently underwent early aortic valve replacement with cardiothoracic surgery. The source of the IE in this patient remains unclear. However, based on her history of a week of profuse, nonbloody diarrhea prior to any other symptom onset, it is likely that bacterial translocation from the gut during an acute episode of gastroenteritis was the source of the bacteremia leading to vegetation. While VGS are typical causes of IE, the infection usually originates from the oral cavity and less commonly from the lower GI tract. This patient had no recent dental procedures and no dental issues to suggest an oral route of infection. Her presentation with acute PE and subsequent diagnosis of native aortic valve endocarditis secondary to gastroenteritis was atypical, particularly as it occurred in a native valve without underlying risk factors.
PMID:41001307 | PMC:PMC12459982 | DOI:10.7759/cureus.90972
J Cardiovasc Dev Dis. 2025 Sep 18;12(9):365. doi: 10.3390/jcdd12090365.
ABSTRACT
Cardiopulmonary bypass (CPB) is one of the most groundbreaking medical innovations in history, enabling safe and effective heart surgery by temporarily replacing the function of the heart and lungs. This review starts with ancient concepts of cardiopulmonary function and then traces the evolution of CPB through important physiological and anatomical discoveries, culminating in the development of the modern heart-lung machine. In addition to examining the contributions of significant figures like Galen, Ibn al-Nafis, William Harvey, and John Gibbon, we also examine the ethical and technical challenges faced in the early days of open heart surgery. Modern developments are also discussed, such as miniature extracorporeal systems, off-pump surgical techniques, and the increasing importance of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS), while the evolving role of perfusionists in diverse cardiac teams and the variations in global access to CPB technology are also given special attention. We look at recent advancements in CPB, including customized methods, nanotechnology, artificial intelligence-guided perfusion, and organ-on-chip testing, emphasizing CPB's enduring significance as a technological milestone and a living example of the cooperation of science, medicine, and human inventiveness because it bridges the gap between the past and the future.
PMID:41002644 | PMC:PMC12471178 | DOI:10.3390/jcdd12090365
Crit Care. 2025 Sep 25;29(1):404. doi: 10.1186/s13054-025-05636-9.
ABSTRACT
BACKGROUND: ECMO outcomes in COVID-19-related respiratory failure among solid organ transplant (SOT) and hematopoietic stem-cell transplant recipients (HSCT) are poorly described. We investigated: (1) whether transplant patients (SOT/HSCT) with COVID-19 have worse outcomes than non-immunocompromised (IC) COVID-19 patients, and (2) whether among transplant recipients (SOT/HSCT), those with COVID-19 have worse outcomes than those with non-COVID-19-related respiratory failure. Additionally, we aimed to identify factors independently associated with mortality among COVID-19 transplants.
METHODS: Retrospective analyses of the Extracorporeal Life Support Organization Registry from 1/1/2017 to 31/07/2023. Two comparisons were made: (1) transplant COVID-19 versus non-IC COVID-19, and (2) transplant COVID-19 versus transplant non-COVID-19 patients. Outcomes were analyzed using propensity score (PS)-adjusted, multivariable, and PS-matched analyses, adjusting for a priori identified confounders. Primary outcome was in-hospital mortality.
RESULTS: Among 38,270 runs, 146 transplant COVID-19, 12,552 non-IC-COVID-19 and 886 transplant non-COVID-19 runs were identified. In-hospital mortality in transplant COVID-19 patients was 75.3% and the risk was invariably increased compared to non-IC-COVID-19 (PS-adjusted OR: 2.36 [95%CI:1.61-3.46], p < 0.001, multivariable OR:2.35 [95%CI:1.59-3.49], p < 0.001, and PS-matched analysis OR: 1.89 [95%CI:1.21-2.95], p < 0.005) and transplant non-COVID-19 patients (PS-adjusted OR: 4.20 [95%CI:2.74-6.44], p < 0.001, multivariable OR: 3.79 [95%CI:2.51-5.74], p < 0.001, and PS-matched analyses OR: 3.17 [95%CI:1.90-5.28], p < 0.001). Mortality difference remained stable over time. Older age independently associated with higher mortality. This was accompanied by higher need for renal replacement therapy compared to non-IC-COVID-19 patients. Compared to transplant non-COVID-19 patients, ECMO runs and time-to-live discharge were invariably prolonged. Hemorrhagic, metabolic, pulmonary and infectious complications consistently occurred more frequently.
CONCLUSIONS: Mortality was high in COVID-19 transplant ECMO patients, warranting cautious use of ECMO in this population.
PMID:40999467 | PMC:PMC12465718 | DOI:10.1186/s13054-025-05636-9
Bull Exp Biol Med. 2025 Jul;179(3):305-311. doi: 10.1007/s10517-025-06479-8. Epub 2025 Sep 25.
ABSTRACT
Class III antiarrhythmic drugs used for the treatment of supraventricular tachyarrhythmias can induce polymorphic ventricular tachycardia known as "torsade de pointes" (TdP). This adverse side effect of antiarrhythmic drugs is more pronounced in impaired ventricular perfusion and limits the use of the drugs. In this work, the effects of the antiarrhythmic drug cavutilide were studied in a model of phenylephrine-induced potentiation of TdP. Cavutilide was administered acutely in combination with phenylephrine in non-anesthetized rabbits under continuous ECG monitoring. Cavutilide in the presence of phenylephrine induced pronounced ventricular extrasystoles almost without episodes of ventricular tachycardia or TdP paroxysms. The reference antiarrhythmic drug dofetilide under the same model conditions caused prolonged, multiple episodes of monomorphic ventricular tachycardia and frequent, repetitive paroxysms of high-frequency TdP. Thus, cavutilide demonstrates very low tendency to induce TdP under conditions of impaired myocardial perfusion, which can be explained by direct type of the dependence of its effect on the frequency of myocardium activation.
PMID:40996652 | DOI:10.1007/s10517-025-06479-8
Ann Vasc Surg. 2025 Sep 23:S0890-5096(25)00636-3. doi: 10.1016/j.avsg.2025.09.031. Online ahead of print.
ABSTRACT
BACKGROUND: High cervical carotid lesions increase intraoperative complexity in carotid endarterectomy (CEA) due to the challenge in obtaining a clean distal clamp site. For these cases, transcarotid artery revascularization (TCAR) may offer an alternative. Our aim was to compare outcomes of CEA and TCAR in patients with high cervical lesions.
METHODS: Demographics and outcomes of CEA and TCAR procedures were retrospectively captured at two high-volume institutions between 2003 and 2023. Patients with high cervical lesions, defined as target clamp sites above the C2 vertebra, were included. Patients were dichotomized according to surgical procedure. Univariate analysis was performed comparing baseline characteristics and outcomes in both groups at an α < 0.05.
RESULTS: 2,250 patients were reviewed, of which 106 lesions (5%) were classified as above C2, of which 73 (69%) underwent TCAR and 33 (31%) underwent CEA. TCAR patients were more likely symptomatic, whereas CEA patients were more likely to have coronary artery disease. Perioperative (30-day) morbidity was similar (ipsilateral stroke was 2.7% vs. 6.1%, p=0.406, myocardial infarction was 1.4% vs. 0%, p=0.499, cranial nerve injury was 1.4% vs. 6.1%, p=0.406, and mortality was 1.4% vs. 0%, p=0.499). Operative time and estimated blood loss were higher with CEA (72.9 ± 31.8 minutes vs. 132.5 ± 53.2 minutes, p <0.001, and 47.1 ± 57.3 mL vs. 214.2 ± 285.7 mL, p < 0.001).
CONCLUSION: This retrospective study demonstrates similar outcomes between CEA and TCAR. However, TCAR was associated with a shorter operative time, suggesting that this may be an advantageous approach.
PMID:40998248 | DOI:10.1016/j.avsg.2025.09.031
Cardiovasc Interv Ther. 2025 Sep 25. doi: 10.1007/s12928-025-01199-2. Online ahead of print.
ABSTRACT
In-stent protrusion is sometimes observed after the stent implantation to the culprit lesion of ST-segment elevation myocardial infarction (STEMI). However, it remains unclear whether additional interventions are necessary for non-obstructive in-stent protrusions. The purpose of this retrospective study was to compare clinical outcomes of patients with STEMI between with and without angiographically visible in-stent protrusions, and to evaluate the association between angiographically visible in-stent protrusions and long-term clinical outcomes in patients with STEMI. We included 639 patients with STEMI who underwent stent implantation and divided them into the protrusion group (n = 59) and the clear stent group (n = 580). In-stent protrusion was defined as an angiographically visible in-stent contrast filling defect at final angiography. The primary endpoint was major adverse cardiovascular events (MACE), which were defined as the composite of all cause death, non-fatal myocardial infarction, and ischemia-driven target vessel revascularization. During the median follow-up duration of 620 (213-1379) days, MACE were more frequently observed in the protrusion group than in the clear stent group (p = 0.002). The multivariate Cox hazard analysis revealed that in-stent protrusion was significantly associated with MACE after controlling for multiple confounding factors (HR 2.373, 95% CI 1.311-4.294, p = 0.004). In conclusion, angiographically visible in-stent contrast filling defect at final angiography is a marker for worse clinical outcomes in primary PCI. When interventional cardiologists recognize visible irregular protrusion after stent implantation for STEMI, additional intervention or careful clinical follow up may be needed.
PMID:40996679 | DOI:10.1007/s12928-025-01199-2
Circulation. 2025 Sep 25. doi: 10.1161/CIRCULATIONAHA.125.074198. Online ahead of print.
ABSTRACT
BACKGROUND: The clinical significance and outcome predictors of anomalous aortic origin of a coronary artery (AAOCA) in adults remains unclear. Therefore, the aim of this study was to analyze the clinical and prognostic implications of AAOCA in a large cohort of patients undergoing coronary computed tomography angiography (CCTA) in an Italian tertiary referral center.
METHODS: Consecutive adults with AAOCA identified through CCTA from September 2004 to September 2024 were included. Data on clinical indications of CCTA, AAOCA subtypes, evidence of inducible myocardial ischemia, and concomitant coronary atherosclerotic disease were collected. Patients were followed up for the end points of all-cause mortality and major adverse cardiac events (nonfatal acute coronary syndromes, revascularization procedures, and heart failure hospitalization). Outcomes were compared with matched controls with normal coronary artery anatomy.
RESULTS: Among 17 454 CCTAs performed over a span of 20 years, AAOCA was detected in 173 patients (62±15 years of age, n=58 women [34%]). Chest pain (34%) was the most common indication of CCTA. Obstructive coronary atherosclerotic disease was present in 36 patients (21%), and myocardial ischemia was detected in 60% of those (n=62) who underwent functional imaging testing. AAOCA repair was performed in 10 patients (6%), whereas the majority of patients were treated conservatively. After a median 37-month follow-up (17 to 69 months), mortality (P=0.321) and major adverse cardiac events (P=0.392) were similar between patients with AAOCA and controls. Only obstructive coronary atherosclerotic disease was associated with a higher event rate during follow-up, whereas AAOCA subtype and ischemia were not.
CONCLUSIONS: In adults with AAOCA, concomitant obstructive coronary atherosclerotic disease is the primary determinant of adverse events. Given the low prevalence of AAOCA and event rates, multicenter registries are needed to refine risk stratification and management of these patients.
PMID:40995628 | DOI:10.1161/CIRCULATIONAHA.125.074198
Res Pract Thromb Haemost. 2025 Aug 13;9(6):103005. doi: 10.1016/j.rpth.2025.103005. eCollection 2025 Aug.
ABSTRACT
BACKGROUND: Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare hematologic disorder with improved survival due to advancements in treatment. However, long-term cardiovascular morbidity and mortality remain significant. Established cardiovascular risk calculators, such as the 2008 Framingham Heart Study (FHS) global cardiovascular disease (CVD) and the American College of Cardiology/American Heart Association (ACC/AHA) atherosclerotic CVD (ASCVD) risk estimators, may not adequately account for the elevated and unique cardiovascular risks in iTTP survivors.
OBJECTIVES: To evaluate the discrimination and calibration of the ACC/AHA ASCVD and FHS global CVD models in predicting major adverse cardiovascular events (MACEs) among iTTP survivors.
METHODS: This retrospective study analyzed 135 iTTP survivors from Johns Hopkins University (1994-2024). Presence of MACEs, including myocardial infarction, stroke, and cardiac revascularization, was the primary outcome and was assessed during clinical remission. Discriminatory ability of the model was assessed using c-statistics, while calibration was evaluated with Hosmer-Lemeshow tests and calibration plots. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated.
RESULTS: MACEs occurred in 37.8% of the cohort over a median follow-up of 3.8 years. The ASCVD and FHS models demonstrated poor discrimination (c-statistics, 0.54 and 0.52, respectively) and poor calibration, with observed MACE rates exceeding predicted probabilities (Hosmer-Lemeshow P < .05). The ASCVD model showed sensitivity of 56.5%, specificity of 49.4%, PPV of 36.6%, and NPV of 64.9%, while the FHS model showed sensitivity of 69.6%, specificity of 39.3%, PPV of 37.2%, and NPV of 67.9%.
CONCLUSION: Standard cardiovascular risk models inadequately predict MACE risk in iTTP survivors, underscoring the need for tailored tools that incorporate iTTP-specific factors to improve cardiovascular risk stratification and management.
PMID:40994890 | PMC:PMC12454890 | DOI:10.1016/j.rpth.2025.103005
Health Sci Rep. 2025 Sep 22;8(9):e71254. doi: 10.1002/hsr2.71254. eCollection 2025 Sep.
ABSTRACT
BACKGROUND AND AIMS: COVID-19 is an independent risk factor for cardiovascular disease. We investigated undiagnosed COVID-19 and its effect on recurrent adverse cardiovascular events among patients with acute myocardial infarction (AMI).
METHODS: We enrolled patients with either ST-segment elevation (STEMI) or non ST-segment elevation myocardial infarction (NSTEMI) presenting at the National Institute of Cardiovascular Disease, Dhaka, from June 28 to August 11, 2020. Nasopharyngeal swabs were collected for SARS-CoV-2 testing by rRT-PCR at enrolment. We followed all patients from admission until February 7, 2021, before the COVID-19 vaccination in Bangladesh, to register clinical endpoints (all-cause death, new AMI, heart failure, or new revascularization). Demographic information, cardiovascular risk factors, and clinical data were registered. Incidence rate (IR) per 100 person-years follow-up was calculated for clinical endpoints. Poisson regression was employed to estimate the incidence rate ratio (IRR) for SARS-COV-2 infection, adjusting for age.
RESULTS: We enrolled 280 patients with a mean age of 54.5 ( ± SD,11.8) years, and 78.6% were males. Of them, 12.9% had undiagnosed SARS-CoV-2 infection and were diagnosed with STEMI (n = 140, 50.0%) and NSTEMI (n = 140, 50.0%). We found that the IR per 100 person-years of all cause death was 35.2, 95% CI: 25.6 to 48.5; recurrent AMI was 18.5, 95% CI: 12.1 to 28.2; heart failure was 6.7, 95% CI: 3.3 to 13.5; and revascularization was 23.5, 95% CI: 16.1 to 34.3. Patients with COVID-19 had numerically higher IRRs for heart failure (2.40, 95% CI: 0.47 to 12.09, p = 0.290) and revascularization (1.11, 95% CI: 0.37 to 3.3, p = 0.853) compared to those without COVID-19, though these differences were not statistically significant.
CONCLUSION: This study provides updated data on undiagnosed cases among AMI patients during the first wave of the COVID-19 pandemic. Our findings emphasize the need for further research to explore the impact of COVID-19 on AMI patients in resource-limited settings like Bangladesh.
PMID:40994781 | PMC:PMC12453963 | DOI:10.1002/hsr2.71254
Physiol Rep. 2025 Sep;13(18):e70580. doi: 10.14814/phy2.70580.
ABSTRACT
This study investigated the effects of high-intensity interval training (HIIT) on endoplasmic reticulum (ER) stress, ferroptosis, and iron deposition in rats with heart failure (HF). HF was induced by intraperitoneal injection of isoprenaline (130 mg/kg/day) for 4 days. Afterward, rats were divided into control healthy (Control), HF sedentary (HF-Sed), and HF HIIT (HF-HIT) groups. The HF-HIT group underwent HIIT (5 intervals of 4 min at 85%-90% VO2max, separated by 2 min at 50%-60% VO2max) for 8 weeks. Biomarkers of ER stress, ferroptosis, and oxidative stress, along with cardiac function, were measured post-intervention. HIIT reduced cardiac fibrosis and iron deposition while increasing cystine/glutamate transporter (SLC7A11), glutathione peroxidase 4 (GPX4), and SOD levels. Additionally, protein levels of glucose-regulated protein 78 (GRP78), protein kinase RNA-activated-like ER kinase (PERK), and activating transcription factor 4 (ATF4) decreased after HIIT. These findings suggest that HIIT alleviates ferroptosis and ER stress via the PERK/ATF4/SLC7A11/GPX4 pathway, offering protective effects against HF.
PMID:40999314 | PMC:PMC12463575 | DOI:10.14814/phy2.70580
Kyobu Geka. 2025 Sep;78(10):775-780.
ABSTRACT
Transesophageal echocardiography (TEE) is a valuable diagnostic and intraoperative tool that allows high-resolution, real-time imaging of deep cardiovascular structures without interfering with surgery. It offers dynamic information similar to computed tomography (CT) or magnetic resonance imaging (MRI) but without radiation exposure, making repeated assessments feasible. During cardiovascular surgery, TEE guides cannula placement, monitors myocardial protection, detects complications like air embolism and intraoperative aortic dissection, and facilitates real-time surgical navigation. Its utility extends to postoperative intensive care unit (ICU) care and emergency settings, where it helps diagnose complications when CT is not feasible. In thoracic surgery, TEE aids in assessing tumor invasion into cardiovascular structures. However, TEE's effectiveness heavily relies on the operator's skill, unlike the objectivity of radiologic modalities. Thus, fostering collaboration between anesthesiologists and surgeons is essential. As a critical part of perioperative management, TEE proficiency is now a requirement for board certification in cardiovascular anesthesia in Japan. Supporting anesthesiologists in developing TEE skills enhances surgical outcomes and institutional capability.
PMID:40998339
PLoS One. 2025 Sep 25;20(9):e0333027. doi: 10.1371/journal.pone.0333027. eCollection 2025.
ABSTRACT
OBJECTIVE: The aim of this study was to explore the differentially expressed miRNAs in the hearts of rats protected from early spontaneous hypertension by blood flow-restricted resistance training and to elucidate the effects of blood flow-restricted resistance training on the expression of these genes.
METHODS: Four-week-old SHRs and WKY rats were used and randomly divided into five groups: the normal group (WKY), SHR control group (SHR-SED), high-intensity resistance training group (HIRT), medium-intensity resistance training group (MIRT), and blood flow-restricted medium-intensity resistance training group (BFRT). During the experiment, the body weight, cardiac function and hemodynamic parameters of the rats were measured. After training, total RNA was extracted from the left ventricular myocardium of rats in the SHR-SED group and the BFRT group, miRNAs were sequenced, followed by GO enrichment and KEGG pathway analyses, and the differentially expressed miRNAs were subsequently validated via qRT‒PCR.
RESULTS: 1) Hemodynamic tests revealed that the blood pressure of SHRs in the BFRT decreased significantly and that the blood pressure level of SHRs in the BFRT decreased more significantly than that of the simple resistance training groups did (P < 0.05). 2) Cardiac function tests revealed that the EF, FS, and MV E/A of SHRs in the BFRT significantly increased, whereas the HR, IVSd, IVSs, LVIDd, LIVDs, LVPWd, LVPWs and LV mass significantly decreased (P < 0.05). 3) Transcriptome sequencing revealed 9 differentially expressed miRNAs in the BFRT group compared with the SHR-SED group (2 miRNAs were significantly upregulated, and 7 miRNAs were significantly downregulated), with P < 0.05 and |log2FoldChange| ≥ 1 used as the criteria for differential significance. The most prominent differentially expressed miRNA was miR-200b-3p (P = 0.00, |log2FoldChange| = 2.45). 4) The miRNA validation results revealed that BFRT significantly reduced the expression of miR-200a-3p, miR-200b-3p, miR-342-3p, miR-350, miR-429, miR-1249, miR-1949 in SHR myocardium, and increased the expression of miR-31a-5p and miR-224-5p (P < 0.01).
CONCLUSION: Eight weeks of blood flow-restricted medium-intensity resistance training could lower SHR blood pressure, and it might also improve early SHR cardiac function by regulating the expression of miR-224-5p, miR-31a-5p, miR-200b-3p, miR-200a-3p, miR-342-3p, miR-429, miR-1949, miR-1249, and miR-350, with the differential expression of miR-200b-3p being particularly significant.
PMID:40997050 | PMC:PMC12463276 | DOI:10.1371/journal.pone.0333027
Ann Intensive Care. 2025 Sep 25;15(1):139. doi: 10.1186/s13613-025-01560-x.
NO ABSTRACT
PMID:40999100 | PMC:PMC12463790 | DOI:10.1186/s13613-025-01560-x
Bull Cancer. 2025 Sep 24:S0007-4551(25)00388-1. doi: 10.1016/j.bulcan.2025.07.015. Online ahead of print.
ABSTRACT
The use of haploidentical Hematopoietic Stem Cell Transplants (Haplo-HSCT) in adults has increased due to improved procedures that lower the risk of graft-versus-host disease (GvHD) and Transplant-Related Mortality (TRM). In pediatrics, haploidentical transplants, whether performed with in vivo or in vitro T-cell depletion, are considered an alternative to conventional transplants from genoidentical or phenoidentical donors with bone marrow (BM), peripheral stem cell (PBSC). This review synthesizes current knowledge, highlighting a thorough analysis of pediatric data from Haplo-HSCT for malignancies. In brief, donor selection criteria are the same as those published for adults, and the conditioning used is primarily myeloablative. The incidence of severe GvHD is lower as compared to adults, but other complications, such as hemorrhagic cystitis, veno-occusive disease and cardiac toxicity are present, and long-term follow-up data is lacking. We provide comprehensive recommendations for transplant preparation in treating pediatric AML and ALL, focusing on the "in vivo" T-cell depletion approach with high-dose post-transplant cyclophosphamide (PT-Cy).
PMID:40998674 | DOI:10.1016/j.bulcan.2025.07.015
Kyobu Geka. 2025 Sep;78(10):838-842.
ABSTRACT
Drug-resistant severe heart failure significantly impairs cardiac pump function, affecting both prognosis and quality of life (QOL). When conventional treatments are ineffective, a ventricular assist device (VAD) can support heart function. Heart transplantation remains the ultimate treatment, but donor shortages and eligibility constraints limit access. The left ventricular assist device (LVAD) is a crucial option, serving as a bridge to transplantation (BTT) or a permanent destination therapy (DT) for ineligible patients. In Japan, DT was covered by insurance in 2021, expanding from 7 to 19 facilities by 2023. Key differences between BTT and DT include the removal of the age limit (65 years) and reduced caregiver requirements. LVAD technology has advanced, with miniaturization improving implantation feasibility and reducing surgical burden. Pump designs have evolved from pulsatile to continuous-flow types, with axial and centrifugal models enhancing efficiency. Innovations in biocompatibility and wireless power transmission aim to reduce complications and improve long-term outcomes. BiVACOR, a fully implantable total artificial heart using magnetic levitation, was first clinically tested in 2024. While currently limited to temporary use before transplantation, further advancements may lead to broader applications, enhancing patient survival and QOL.
PMID:40998349
J Heart Lung Transplant. 2025 Sep 23:S1053-2498(25)02279-X. doi: 10.1016/j.healun.2025.09.011. Online ahead of print.
ABSTRACT
The use of organs between donors and recipients with HIV in solid organ transplantation is an area of growing interest. We conducted a single center observational study to compare early outcomes after heart transplantation (HTx) in HIV-positive recipients using HIV-positive or HIV-negative donors. Overall, 10 HIV-positive recipients underwent HTx, with 4 receiving HIV-positive and 6 receiving HIV-negative organs. At 3 months, both groups had similar survival (100% vs 100%, p=1.00), episodes of rejection (0, 0-0.5 vs 0, 0-1, p=0.39) and infection (0, 0-2.5 vs 1, 1-1, p=0.31) per patient, HIV suppression with antiretroviral therapy (VL <20 copies/ml or undetectable: 100% vs 100%, p=1.00) and donor derived cell free DNA (0.14, 0.06-0.22% vs 0.36, 0.12-0.59%, p=0.35). These data provide early evidence supporting the feasibility of utilizing organs from donors with HIV for HTx in recipients with HIV.
PMID:40998274 | DOI:10.1016/j.healun.2025.09.011
Am J Transplant. 2025 Sep 23:S1600-6135(25)02997-1. doi: 10.1016/j.ajt.2025.09.017. Online ahead of print.
ABSTRACT
Historically, liver transplant candidates with HIV have experienced high waitlist mortality. Since the HOPE Act expands access to organs from donors with HIV, we assessed the impact of HOPE on liver transplant rate and wait time for this population. We linked data from a multicenter HOPE in Action study to SRTR (2/21/2019-6/1/2024) and used Poisson regression to compare transplant rates among 99 candidates willing to accept HOPE donors (HOPE candidates) to 13495 candidates with or without HIV not listed as willing to accept HOPE donors (non-HOPE candidates) matched on transplant center. The median time to any deceased donor liver transplant (DDLT) was 2.3 months for HOPE and 1.1 years for non-HOPE candidates. Within two years of listing, 90.9% of HOPE versus 58.5% of non-HOPE candidates received a DDLT (p<0.001). HOPE was associated with an overall 3.11-fold higher DDLT incident rate ratio (IRR) (95% CI 2.48-3.88, p<0.001). Stratified by Model for End-Stage Liver Disease (MELD) score categories 6-14, 15-24, 25-34 and 35-40/Status 1, HOPE candidates had 10.12-fold, 5.31-fold, 1.41-fold and 2.90-fold higher DDLT rates, respectively. Willingness to accept livers from donors with HIV improves access to liver transplantation for candidates with HIV.
PMID:40998052 | DOI:10.1016/j.ajt.2025.09.017