Catheter Cardiovasc Interv. 2025 Jun 11. doi: 10.1002/ccd.31680. Online ahead of print.
ABSTRACT
BACKGROUND: Even after complete revascularization (CR), patients with acute myocardial infarction (AMI) still face significant risks of adverse events, frequently linked to vulnerable plaque progression in nonsignificant stenosis.
AIMS: To investigate the relationship between the radial wall strain (RWS) of nonsignificant stenosis lesions and major adverse cardiac events (MACE) in patients with AMI following CR.
METHODS: This cohort study included patients with AMI who received CR of all culprit and non-culprit lesions with diameter stenosis (DS%) > 70% during index or staged percutaneous coronary intervention within 45 days, with at least one de novo native lesion (DS% of 30%-70%) for RWS analysis. The primary outcome was MACE comprising cardiovascular death, nonfatal myocardial infarction, unstable angina, and heart failure.
RESULTS: During a median follow-up of 3.6 years, 55 among 225 patients (24.4%) experienced MACE, mainly driven by unstable angina. Maximum RWS (RWSmax) was predictive of MACE with an area under the curve of 0.84 (95% CI: 0.78-0.90; p < 0.001) and an optimal cutoff > 14.5%. In the multivariable Cox regression model, RWSmax > 14.5% was an independent predictor for MACE among patients with AMI after CR (HR: 8.06; 95% CI: 3.98-16.35; p < 0.001). In patients with Murray law-based quantitative flow ratio (μQFR) > 0.8, the prognostic impact of RWSmax on MACE was comparable to that observed in patients with μQFR < 0.8 (P for interaction = 0.236).
CONCLUSIONS: Among patients with AMI who received CR, a high-strain pattern detected by RWS analysis in nonsignificant stenosis lesions was associated with a worse clinical outcome.
PMID:40495557 | DOI:10.1002/ccd.31680
Cardiovasc Drugs Ther. 2025 Jun 11. doi: 10.1007/s10557-025-07721-1. Online ahead of print.
ABSTRACT
PURPOSE: This study investigates the therapeutic effects of extracellular vesicles (EVs) derived from bone marrow mesenchymal stem cells (BMSCs) on heart failure in rats through intrapericardial injection.
METHODS: Initially, doxorubicin was used to induce apoptosis in H9C2 cells, and the protective effects of EVs on these cells were evaluated. EVs were injected into the pericardial cavity of rats with heart failure, followed by real-time in vivo imaging and immunofluorescence detection to confirm the implantation of EVs in the myocardium. Cardiac function was assessed via echocardiography after the pericardial injection. Immunohistochemical techniques were employed to measure the expression of BNP, IL-6, CD31, and VEGFA in rat heart tissue. Additionally, the collagen fiber content in the heart tissue was detected using Masson staining.
RESULTS: The results showed that EVs derived from BMSCs at a concentration of 100 μg/ml most effectively promoted the proliferation of H9C2 cells and protected them from doxorubicin-induced damage. Compared to the heart failure group, EV treatment significantly increased LVEF, LVFS, and CO. Following intrapericardial injection of BMSCs, in vivo imaging revealed high-intensity fluorescence signals in the cardiac region, and immunofluorescence confirmed the implantation of EVs in the myocardium. Post-EV treatment, the expression levels of BNP and IL-6 and collagen content in myocardial tissue were significantly reduced, whereas the levels of CD31 and VEGFA were significantly increased.
CONCLUSION: EVs derived from BMSCs, when injected into the pericardial cavity, significantly improved cardiac function in heart failure rats through anti-inflammatory and pro-angiogenic mechanisms.
PMID:40498225 | DOI:10.1007/s10557-025-07721-1
Cells. 2025 May 31;14(11):820. doi: 10.3390/cells14110820.
ABSTRACT
Congenital Heart Diseases (CHDs) are a heterogeneous group of structural abnormalities affecting the heart and major arteries, which are present in at least 1% of births worldwide. Studies have linked CHD to both genetic and environmental factors. In this regard, it has been demonstrated that changes in the epigenetic pattern impact the expression of key genes involved in proper cardiac development. Therefore, it is suggested that aberrant epigenetic mechanisms may contribute to the development of these pathologies. Here, we review and summarize the main epigenetic mechanisms involved in CHD. Moreover, cardiac development and the importance of the environment and CHD are also addressed.
PMID:40497996 | PMC:PMC12154987 | DOI:10.3390/cells14110820
Heart Lung. 2025 Jun 10;74:1-11. doi: 10.1016/j.hrtlng.2025.05.016. Online ahead of print.
ABSTRACT
BACKGROUND: An increasing number of studies have recently suggested a relationship between sleep duration and cardiovascular disease (CVD). However, a correlation between the two has not been studied.
OBJECTIVE: The aim of this study was to investigate a correlation between sleep duration and CVD.
METHODS: This study is based on summary data from genome-wide association studies (GWAS), across various races, regarding sleep duration and 12 major cardiovascular diseases. We utilized two-sample Mendelian randomization (MR), a method specifically designed to analyze correlation, to investigate whether sleep duration directly affects risk of developing CVD. Our primary analysis used the inverse variance weighting (IVW) method to examine the effect of sleep duration on multiple cardiovascular conditions. Additionally, we employed maximum likelihood, MR-Egger regression, weighted median, and weighted mode methods to ensure the robustness of our findings.
RESULTS: This study revealed a correlation between over-sleeping and three cardiovascular conditions (valvular heart disease, myocardial infarction, and heart failure) with significant negative correlations (P < 0.05). No significant correlation was found with the remaining nine cardiovascular conditions (P > 0.05). Furthermore, we found that under-sleeping had a correlation with four cardiovascular conditions (non-ischemic cardiomyopathy, cardiac arrhythmias, valvular heart disease, and atrial fibrillation) with significant positive correlations (P < 0.05) butnot with the remaining eight cardiovascular conditions (P > 0.05).
CONCLUSION: Over-sleeping was negatively correlated with several cardiovascular diseases, whereas under-sleeping was positively correlated with others, suggesting that lack of sleep may increase the risk of certain cardiovascular conditions.
PMID:40499503 | DOI:10.1016/j.hrtlng.2025.05.016
Eur J Cardiothorac Surg. 2025 Jun 11:ezaf191. doi: 10.1093/ejcts/ezaf191. Online ahead of print.
ABSTRACT
AIMS: Aortic stenosis (AS) and mitral regurgitation (MR) are rare in heart transplant (HTx) recipients, but their incidence increases with extended post-transplant survival. This study assesses the safety, efficacy, and outcomes of transcatheter interventions in this high-risk population.
METHODS: An institutional series of HTx patients undergoing transcatheter aortic valve implantation (TAVI) or mitral transcatheter edge-to-edge repair (M-TEER) from March 2015 to April 2024 was retrospectively analysed. Both, elective cases and patients in cardiac decompensation/cardiogenic shock, were included. There were no exclusion criteria. Primary outcomes were echocardiographic allograft function and Valve Academic Research Consortium-3 (VARC-3)/Mitral Valve Academic Research Consortium (M-VARC) success and safety composite end-points. Secondary outcomes included symptom change, complications, and survival.
RESULTS: A total of 15 consecutive patients were included in the analysis. Nine patients underwent TAVI and six M-TEER. The median age was 56 years, with a median of 17 years from HTx to valve intervention. 53.3% (7/15) of procedures were urgent/emergent. Improvements were noted in left ventricular ejection fraction, systolic pulmonary artery pressure, and tissue Doppler peak contraction velocity. The VARC-3/MVARC technical success was 100%, device success for TAVI was 93.3% and 83.3% for M-TEER. VARC-3 early safety was 66.7% for TAVI and MVARC procedural success was 83.3% for M-TEER. 86.7% showed improvement of functional status. Median survival was 800 days.
CONCLUSIONS: TAVI and M-TEER were feasible and efficient in improving echocardiographic allograft function. Elective procedures were associated with a median survival of over two years. Survival outcomes varied based on procedure urgency. Close monitoring of AS/MR seems crucial in HTx patients, with timely intervention prior decompensation/shock. Further multicentre studies are needed to establish management guidelines for AS/MR in HTx recipients.
PMID:40498548 | DOI:10.1093/ejcts/ezaf191
J Perianesth Nurs. 2025 Jun 11:S1089-9472(25)00048-6. doi: 10.1016/j.jopan.2025.02.010. Online ahead of print.
ABSTRACT
PURPOSE: This study aimed to evaluate the effect of suprazygomatic maxillary nerve block (SMB) in patients undergoing septoplasty surgery.
DESIGN: Randomized controlled trial.
METHODS: A total of 60 patients who met the inclusion criteria were enrolled in this prospective, randomized controlled study. The patients were divided into two groups: group C (control group) and group B (block group). The groups were compared in terms of demographic variables, American Society of Anesthesiologists scores, hemodynamic parameters (mean arterial pressure and heart rate), visual analog scale (VAS) pain scores, postoperative recovery quality (QoR-15 scores) (Quality of recovery-15 (QoR-15)), and the need for rescue analgesics.
FINDINGS: There were no statistically significant differences between the groups regarding age, gender, or American Society of Anesthesiologists scores (P > .05). Baseline hemodynamic parameters were similar between the groups (P > .05). However, mean arterial pressure and heart rate were significantly lower in group B at 15, 30, 45, and 60 minutes postoperatively (P < .05). Visual analog scale scores at 0, 2, 6, and 12 hours were significantly lower in group B (P < .05). QoR-15 scores were also significantly higher in group B (P < .05), while the patients need rescue analgesics was lower in this group (P < .05). There was no significant difference in the total number of postoperative analgesic doses between the two groups (P > .05).
CONCLUSIONS: The application of SMB during septoplasty surgery provides improved perioperative hemodynamic stability, reduced postoperative pain, and enhanced recovery quality. The SMB can be considered a valuable component of a multimodal analgesic approach in septoplasty surgeries.
PMID:40498428 | DOI:10.1016/j.jopan.2025.02.010
J Stroke. 2025 May;27(2):228-236. doi: 10.5853/jos.2025.00409. Epub 2025 May 31.
ABSTRACT
BACKGROUND AND PURPOSE: The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90-110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear.
METHODS: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death.
RESULTS: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45-1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09-0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60-2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis.
CONCLUSION: In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.
PMID:40494581 | PMC:PMC12152449 | DOI:10.5853/jos.2025.00409
Sleep Med. 2025 May 19;133:106587. doi: 10.1016/j.sleep.2025.106587. Online ahead of print.
ABSTRACT
OBJECTIVE/BACKGROUND: Limited research assesses cardiovascular risk in people with idiopathic hypersomnia. This study compared cardiovascular conditions or events among individuals with idiopathic hypersomnia with those among matched non-idiopathic hypersomnia controls.
PATIENTS/METHODS: Claims from Merative™ MarketScan® Research Databases (12/2013-2/2020) were analyzed. Eligible individuals with idiopathic hypersomnia were ≥18 years of age upon cohort entry, continuously enrolled for 365 days before and after cohort entry (gaps ≤30 days allowed), and without cataplexy. Individuals with idiopathic hypersomnia entered the cohort upon their earliest medical claim with an idiopathic hypersomnia diagnosis code. Controls were matched 5:1, without replacement, to individuals with idiopathic hypersomnia using demographic characteristics. Odds of prevalent cardiovascular conditions or events during the 2-year assessment period (365 days before and after cohort entry date) were compared using unconditional logistic regression. Results were reported as odds ratios (ORs) with 95 % confidence intervals (CIs).
RESULTS: Final cohorts included 11,412 individuals with idiopathic hypersomnia and 57,058 matched controls. Odds (OR, 95 % CI) of cardiovascular disease (2.26, 2.14-2.38), major adverse cardiovascular event (2.08, 1.89-2.30), stroke (2.07, 1.87-2.29), hypertension diagnosis or antihypertensive use (2.02, 1.93-2.12), heart failure (1.97, 1.76-2.20), atrial fibrillation (1.91, 1.66-2.20), myocardial infarction (1.74, 1.42-2.12), and coronary revascularization (1.58, 1.12-2.17) were higher in individuals with idiopathic hypersomnia than matched controls.
CONCLUSIONS: Individuals with idiopathic hypersomnia had higher odds of prevalent cardiovascular conditions or events than matched controls. These results reinforce that clinicians should be aware of patients' cardiovascular risk profiles when selecting idiopathic hypersomnia treatments.
PMID:40494110 | DOI:10.1016/j.sleep.2025.106587
Basic Res Cardiol. 2025 Jun 10. doi: 10.1007/s00395-025-01117-w. Online ahead of print.
ABSTRACT
Ischemic heart disease is one of the leading causes of heart failure and death worldwide. The loss of cardiomyocytes following a myocardial infarction drives the remodeling process, which, in most cases, ultimately leads to heart failure. Since the available treatment options only slow down the remodeling process without tackling the causes of heart failure onset (i.e., cardiomyocyte loss and inability of the remaining cardiomyocytes to enter the cell cycle and regenerate the heart), in the last two decades, cardiovascular research focused on finding alternative solutions to regenerate the heart. So far, the investigated approaches include a variety of methods aiming at manipulation of non-coding RNAs, such as long non-coding RNA (lncRNA), circular RNA (circRNA), and microRNA (miRNA), and growth factors to enable the cardiomyocytes to re-enter the cell cycle, direct reprogramming of fibroblasts into cardiomyocytes (CM), and CM replacement therapy, all of them with the main goal to replace the loss of cardiomyocytes and restore the heart function. The development of reprogramming protocols from somatic cells to induced pluripotent stem cells (iPSCs) by Yamanaka and Takahashi, along with advancements in differentiation protocols to generate almost pure populations of induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs), has fostered optimism in cardiac regenerative medicine. Despite these advancements, critical concerns arose regarding the survival and retention of the engrafted cells, arrhythmogenicity, and immune response. Over time, much effort has been put into enhancing iPSC-CM therapy with different methods, ranging from anti-apoptotic small molecule-based approaches to tissue engineering. In this review, we discuss the evolution of cardiac cell therapy, highlighting recent advancements and the remaining challenges that must be overcome to translate this promising approach into clinical practice.
PMID:40493218 | DOI:10.1007/s00395-025-01117-w
Am J Med Genet A. 2025 Jun 9:e64148. doi: 10.1002/ajmg.a.64148. Online ahead of print.
ABSTRACT
Cardiac involvement in Gaucher disease (GD) is an uncommon feature, most often associated with the homozygous Asp448His (D409H) variant in GBA1 and typically presents with valvular and pericardial calcifications or myocardial infiltration. To date, approximately 132 individuals with this cardiovascular phenotype (GDIIIc) have been reported, with limited representation from the Middle East. This study reports the first cohort from Kuwait, involving five individuals from three unrelated Middle Eastern families, all with molecularly confirmed homozygous Asp448His variants. All individuals demonstrated early-onset cardiac valvular disease requiring surgical intervention, in addition to organomegaly, skeletal manifestations, and neurological symptoms. Despite corrective surgeries, four individuals died, with only one adult female currently alive and stable. Remarkably, this surviving patient is the first reported individual with GDIIIc to have successfully conceived and delivered a healthy child prior to her diagnosis, initiation of enzyme replacement therapy, or cardiac surgery. She later developed a broad spectrum of neuropsychiatric symptoms, including phobias, hallucinations, obsessive thoughts, anxiety, and delusions of persecution, as well as resting tremors and dysphagia. Brain MRI revealed granular ependymitis and cerebral microbleeds-neuroradiological features not previously described in GDIIIc-making her case uniquely informative. These findings broaden the phenotypic spectrum of GDIIIc and highlight the importance of recognizing cardiac and neuropsychiatric manifestations in individuals with the Asp448His variant. Early identification and multidisciplinary management may improve outcomes in this ultra-rare but severe disease.
PMID:40491257 | DOI:10.1002/ajmg.a.64148
Kyobu Geka. 2025 Apr;78(4):301-306.
ABSTRACT
Although our hospital is not a heart transplant facility, we accept many patients requiring temporary mechanical circulatory support (T-MCS), such as extracorporeal membrane oxygenation (ECMO), as part of our role as a destination therapy (DT) facility. From May 2021 to December 2024, we performed 17 cases of DT using HeartMate 3. The patients' average age was 58±7 years. The underlying conditions included ischemic heart disease (nine cases), idiopathic dilated cardiomyopathy (seven cases), and drug-induced cardiomyopathy( one case). The average J-HeartMate risk score was 1.52. In this paper, we discuss the current status and challenges of DT at non-heart transplant facilities and present our unique approach to T-MCS strategies and patient education.
PMID:40494527
Acta Anaesthesiol Scand. 2025 Jul;69(6):e70073. doi: 10.1111/aas.70073.
ABSTRACT
INTRODUCTION: Cardiac surgery in infants often triggers a severe inflammatory response. The role of biomarkers in predicting clinical outcomes in this group of patients has been debated in the literature. This study aimed to investigate the predictive value of 20 inflammatory biomarkers, in combination with clinical data, for acute kidney injury, ventilator support duration, and inotropic score following infant cardiac surgery by developing and comparing three models: Clinical-Data-Only, Biomarker-Only, and Combined.
METHODS: This secondary analysis of the MiLe-1 study included infants undergoing surgery with cardiopulmonary bypass. Biomarkers were measured before and after CPB. Using BIC-guided logistic regression, we developed and compared three multivariable models-Clinical-Data-Only, Biomarker-Only, and Combined-for each outcome. Model performance was assessed using c-statistics and p-contrast tests.
RESULTS: Regarding AKI risk prediction, the c-statistics for Biomarker-Only, Clinical-Data-Only, and Combined Model were 0.79, 0.60, and 0.78 respectively. The difference in performance between the Combined and Clinical-Data-Only Models was statistically significant (p < 0.001). Concerning ventilator support time prediction, the c-statistics were 0.80, 0.72, and 0.77 for the models respectively (p-contrast = 0.10). As for inotropic score prediction, the c-statistics were 0.83, 0.77, and 0.85 for the models (p-contrast = 0.007).
CONCLUSION: Inflammatory biomarkers may enhance risk stratification for postoperative outcomes in infant cardiac surgery. However, given the exploratory nature of this study, further validation in larger and more diverse cohorts is needed.
PMID:40492379 | PMC:PMC12150254 | DOI:10.1111/aas.70073
Front Cardiovasc Med. 2025 May 26;12:1588088. doi: 10.3389/fcvm.2025.1588088. eCollection 2025.
ABSTRACT
INTRODUCTION: Cardioplexol™ was recently proven effective and non-inferior to Buckberg's solution in a pivotal Phase-3 clinical trial. We hypothesized here that a standardized training program for surgeons without prior experience of Cardioplexol™ could increase its administration reliability and participate to its overall benefit.
METHODS: Open label, single group, observational study involving 29 surgeons from 7 centers in 3 countries. The training program included a theoretical part, and two surgical procedures performed under trainer supervision. In a subsequent evaluation part, surgeons operated on 4 additional patients. The number of major deviations from the pre-defined administration protocol (incorrect volume of initial/second/third/fourth dose, incorrect duration of injection of initial dose, incorrect timing of application of initial/second/third/fourth dose) was set as primary endpoint.
RESULTS: A total of 171 patients were screened of which 157 were operated on (57 in the training part and 100 in the evaluation part). No major deviations were observed. Other outcomes, including postoperative TnT and CK-MB profiles, cumulative inotropic support provided during the first 24 h after myocardial reperfusion, cardiac conversion rate, ICU length of stay, were all similar to or better than the results observed in the previous pivotal study.
CONCLUSION: Cardiac surgeons not familiar to Cardioplexol™ benefit from a structured and supervised training. This kind of training contributes to improve the efficiency and safety of a new cardioplegic solution such as Cardioplexol™.
TRIAL REGISTRATION: [ClinicalTrials.gov]: identifier [NCT03823521, and EudraCT No: 2018-002311-10].
PMID:40491721 | PMC:PMC12146177 | DOI:10.3389/fcvm.2025.1588088
Emerg Med Australas. 2025 Jun;37(3):e70071. doi: 10.1111/1742-6723.70071.
ABSTRACT
Extracorporeal cardiopulmonary resuscitation (ECPR) has gained increasing traction worldwide as a strategy to improve survival in carefully selected patients experiencing refractory cardiac arrest. Historically, New Zealand (NZ) stood at the forefront of extracorporeal membrane oxygenation (ECMO) use in the early 2000s, establishing one of the first national retrieval services in the world. Despite limited evidence and the nascent state of ECMO technology, this made NZ a pioneer. Over the following two decades, international guidelines evolved, ECMO systems became more streamlined, and research demonstrated the clinical and economic viability of ECPR in selected patient cohorts. However, NZ persisted with a single-provider framework, seemingly reluctant to adapt to global developments. Recent initiatives are addressing this by decentralising access to ECMO and formalising governance structures. This paper focuses on ECPR specifically, examining equity gaps in access and outcomes, discussing the country's position relative to global standards and proposing directions for the future.
PMID:40490422 | DOI:10.1111/1742-6723.70071
Front Pharmacol. 2025 May 23;16:1541131. doi: 10.3389/fphar.2025.1541131. eCollection 2025.
ABSTRACT
OBJECTIVES: To better understand nafamostat mesylate (NM) dose requirements during extracorporeal membrane oxygenation (ECMO), this study investigated its pharmacokinetic/pharmacodynamic (PK/PD) properties by comparing samples from the systemic circulation of patients and from the ECMO circuit. It specifically examined the relationship between NM concentration and activated partial thromboplastin time (aPTT) changes, aiming to provide a foundation for future dosing optimization.
METHODS: In this prospective study, 24 ECMO patients received a continuous infusion of NM through a dedicated stopcock located before the ECMO pump. This placement targets the anticoagulant effects of NM specifically to the ECMO circuit without substantially affecting the patient's overall coagulation status. The starting dose was 15 mg/h, adjusted to keep the aPTT within a target range of 40-80 s. Blood samples were collected from both the patient's central venous catheter and the ECMO circuit for PK/PD analysis using a nonlinear mixed effects model.
RESULTS: The PK profiles of NM, derived from samples taken from both the patient's catheter and the ECMO circuit, were best described by a two-compartment model. In the PK/PD models, the effect of NM on prolonging aPTT was described using a turnover model. NM was shown to inhibit the decrease in aPTT in the turnover model. In the patient model, the maximum inhibitory effect (Imax) of NM on the reduction of aPTT was 35.5%, and the concentration of NM required to achieve half of this maximum effect (IC50) was 350 μg/L. On the other hand, in the ECMO model, the Imax for aPTT reduction was 43.6%, with an IC50 of 581 μg/L.
CONCLUSION: The PK/PD models developed from samples collected from both the patient and the ECMO circuit indicate significant differences in PD. Given the observed variability and the high risk of bleeding in ECMO patients, a predictive model incorporating these differences and patient-specific variables could significantly improve anticoagulation management.
PMID:40487408 | PMC:PMC12141017 | DOI:10.3389/fphar.2025.1541131
Ann Med Surg (Lond). 2025 May 21;87(6):3819-3822. doi: 10.1097/MS9.0000000000002837. eCollection 2025 Jun.
ABSTRACT
INTRODUCTION: Over the last half-century, mortality from renal cell carcinoma (RCC) has seen a dramatic reduction, while 5-year survival rates have reached an all-time high (34% to 75%).
CASE PRESENTATION: A 77-year-old female with Stage 4 RCC (cT3c, cN1, cM1) presented with acute onset chest and back pain. Imaging revealed interval enlargement of a left renal mass with propagation of tumor thrombus (TT) throughout the left renal vein, intrahepatic and suprahepatic inferior vena cava (IVC) with extension into the right atrium (RA). The patient successfully underwent a high-risk open left nephrectomy with caval thrombectomy, retroperitoneal lymph node dissection, and atrial thrombectomy.
DISCUSSION: Approximately, 1% of RCC cases involve the right atrium, and radical nephrectomy with vena caval thrombectomy remains the most effective treatment for cavoatrial TT, with 5-year survival rates between 30% and 72%. While patients with renal vein involvement have better survival rates than those with IVC involvement, advanced TT cases (Types III and IV) often require extracorporeal circulation. Though the patient understood the prognosis of her RCC, discussing the risks of a complex procedure versus not intervening was challenging. Despite a typical median survival of 12 months for level IV tumor thrombus (TT), she remains stable 28 months post-surgery.
CONCLUSION: Although the 5-year survival rate for renal cell carcinoma (RCC) has increased from 34% to 75%, the disease still adversely affects patients' quality of life. A multidisciplinary approach is essential when managing metastatic RCC, particularly involving the heart. Despite the associated risks, surgical intervention is more effective in prolonging life by preventing sudden cardiac death due to embolic events.
PMID:40486613 | PMC:PMC12140791 | DOI:10.1097/MS9.0000000000002837
World J Pediatr Congenit Heart Surg. 2025 Jun 9:21501351251338834. doi: 10.1177/21501351251338834. Online ahead of print.
ABSTRACT
ObjectivesReview our clinical experience with eight patients at the University of Florida undergoing En-bloc combined heart+liver transplantation (ECH + LTX).MethodsContinuous variables are reported as median (interquartile range = IQR) and categorical variables are reported as N (%).ResultsEight patients underwent ECH + LTX between August 2020 and May 2023 at the University of Florida, with triple heart+liver+kidney transplantation performed in 2/8 = 25%. Median age at ECH + LTX was 47.34 years (IQR = 33.66-53.37), and all eight patients were >18 years of age. Six out of eight patients (75%) had congenital heart disease (CHD): one had biventricular CHD and five had functionally univentricular circulation and Fontan failure. Two out of eight patients (25%) had structurally normal hearts and acquired heart disease: one patient with hemochromatosis and combined cardiac and hepatic failure with nonischemic restrictive cardiomyopathy and one patient with nonischemic cardiomyopathy and alcoholic cirrhosis. Median wait list time was 93 days (IQR = 27.50-176.25). Three patients (3/8 = 37.5%) were supported with an intra-aortic balloon pump prior to ECH + LTX, and two of these three patients were subsequently also supported with extracorporeal membrane oxygenation secondary to progressive decompensation prior to ECH + LTX. Median hospital length of stay was 147 days. Median posttransplant length of stay was of 29 days. Seven of eight patients survived ECH + LTX and are alive today. One patient died two days after ECH + LTX. Mean length of follow-up after ECH + LTX of seven surviving patients (years) is 3.60 ± 0.38 (median = 3.79, IQR = 3.05-4.38, range = 1.91-4.64).ConclusionEn-bloc heart-liver transplantation is an effective treatment option for patients with combined heart and liver failure.
PMID:40485338 | DOI:10.1177/21501351251338834
Medicine (Baltimore). 2025 Jun 6;104(23):e42641. doi: 10.1097/MD.0000000000042641.
ABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional procedure that is often performed under sedation anesthesia and that is used in the diagnosis and treatment of hepatopancreaticobiliary diseases. The objective of this study was to compare the efficacy of hypnosis in conjunction with sedoanalgesia and sedoanalgesia alone in the context of outpatient anesthesia prior to ERCP. Patients undergoing ERCP in the endoscopy unit between March and May 2021 were randomly assigned to 1 of 2 groups: group 1 received hypnosis and sedoanalgesia, and group 2 received sedoanalgesia alone. Both groups were administered 0.5 to 0.6 mg/kg intravenous pethidine hydrochloride (HCl), 1 to 3 mg intravenous midazolam, and 1 to 2 mg/kg intravenous propofol. The first group also received hypnotic induction before the procedure and anesthetic agents. In the event of patients exhibiting movement during the procedure, an anesthesiologist was unaware of the patient's allocation and administered additional propofol and/or pethidine HCl. A statistical comparison was conducted between the 2 groups regarding demographic data, vital parameters, medication requirements, and satisfaction scales. Thirty patients were included in both groups. Following the procedure, the administration of propofol and pethidine HCl was reduced in group 1 (P = .031 and P = .009, respectively). The 5-minute heart rate, baseline peripheral oxygen saturation at 3 and 10 minutes were lower in group 2 (P = .008, P = .011, P = .017, and P = .031, respectively). Although the dose of anesthetic drugs were lower, no significant difference was observed neither in the patient satisfaction scores, nor in patient movements. The use of hypnosis during ERCP enhances the efficacy of sedoanalgesia. Hypnotic anesthesia may be employed as an alternative method in cases where high-dose administration of these agents is contraindicated.
PMID:40489869 | PMC:PMC12150974 | DOI:10.1097/MD.0000000000042641
Crit Care Clin. 2025 Jul;41(3):555-572. doi: 10.1016/j.ccc.2025.02.006. Epub 2025 Apr 12.
ABSTRACT
Ultrasonography is essential in intensive care units for rapid, real-time assessment and management of various organ systems, particularly for patients with mechanical circulatory support (MCS) devices. It aids in the diagnosis, safe placement, and monitoring of MCS devices such as extracorporeal membrane oxygenation, Impella, and implantable left ventricular assist devices, used for conditions like cardiogenic shock and severe respiratory failure. Ultrasonography ensures precise device positioning, identifies complications, and facilitates weaning. Future advancements in AI, portable devices, and advanced imaging techniques will enhance diagnostic accuracy and patient care.
PMID:40484621 | DOI:10.1016/j.ccc.2025.02.006
J Cardiothorac Vasc Anesth. 2025 May 21:S1053-0770(25)00406-9. doi: 10.1053/j.jvca.2025.05.024. Online ahead of print.
NO ABSTRACT
PMID:40484793 | DOI:10.1053/j.jvca.2025.05.024