Trasplante cardíaco

Front Pharmacol. 2025 Jun 18;16:1600604. doi: 10.3389/fphar.2025.1600604. eCollection 2025.

ABSTRACT

Cardiac tissue injury and repair have always been a research hotspot in the field of cardiovascular disease. Limited and lost myocardial cells are non-renewable, and the current clinical treatment effect is still poor. The stem cells-based treatment strategy for cardiomyopathy is expected to solve the current treatment pain points. A variety of stem cells have the potential to differentiate into cardiomyocytes and form cardiac tissue, and the strong paracrine activity of stem cells also plays an important role in the regulation of inflammation, oxidative stress and cardiomyocyte apoptosis in cardiac tissue. Limited by the survival rate and stem cells activity after stem cells transplantation, the effect of stem cells therapy on cardiomyopathy is still not ideal. Pretreatment of stem cells or genetic modification to enhance the adaptability of stem cells to the environment, or the use of new biomaterials to assist stem cells transplantation is an effective optimization scheme and significantly enhances the therapeutic effect of stem cells therapy for cardiomyopathy. In this review, the types of stem cells widely studied in the treatment of cardiomyopathy, the role of stem cells in the treatment of cardiomyopathy, and how to efficiently use stem cells to treat cardiomyopathy are described in detail, which provides a theoretical basis for promoting the preclinical research and clinical transformation of stem cell therapy for cardiomyopathy.

PMID:40606613 | PMC:PMC12213730 | DOI:10.3389/fphar.2025.1600604

BME Front. 2025 Jul 2;6:0151. doi: 10.34133/bmef.0151. eCollection 2025.

ABSTRACT

Objective and Impact Statement: We present a panel of virtual staining neural networks for lung and heart transplant biopsies, providing rapid and high-quality histological staining results while bypassing the traditional histochemical staining process. Introduction: Allograft rejection is a common complication of organ transplantation, which can lead to life-threatening outcomes if not promptly managed. Histological examination is the gold standard method for evaluating organ transplant rejection status, as it provides detailed insights into rejection signatures at the cellular level. Nevertheless, the traditional histochemical staining process is time-consuming, costly, and labor-intensive since transplant biopsy evaluations typically necessitate multiple stains. Furthermore, once these tissue slides are stained, they cannot be reused for other ancillary tests. More importantly, suboptimal handling of very small tissue fragments from transplant biopsies may impede their effective histochemical staining, and color variations across different laboratories or batches can hinder efficient histological analysis by pathologists. Methods: To mitigate these challenges, we developed a panel of virtual staining neural networks for lung and heart transplant biopsies, which digitally convert autofluorescence microscopic images of label-free tissue sections into their bright-field histologically stained counterparts-bypassing the traditional histochemical staining process. Specifically, we virtually generated hematoxylin and eosin (H&E), Masson's Trichrome (MT), and elastic Verhoeff-Van Gieson stains for label-free transplant lung tissue, along with H&E and MT stains for label-free transplant heart tissue. Results: Blind evaluations conducted by 3 board-certified pathologists confirmed that the virtual staining networks consistently produce high-quality histology images with high color uniformity, closely resembling their well-stained histochemical counterparts across various tissue features. The use of virtually stained images for the evaluation of transplant biopsies achieved comparable diagnostic outcomes to those obtained via traditional histochemical staining, with a concordance rate of 82.4% for lung samples and 91.7% for heart samples. Moreover, virtual staining models create multiple stains from the same autofluorescence input, eliminating structural mismatches observed between adjacent sections stained in the traditional workflow, while also saving tissue, expert time, and staining costs. Conclusion: The presented virtual staining panels provide an effective alternative to conventional histochemical staining for transplant biopsy evaluation. These virtual staining panels have the potential to enhance the clinical diagnostic workflow for organ transplant rejection and improve the performance of downstream automated models for the analysis of transplant biopsies.

PMID:40606521 | PMC:PMC12217214 | DOI:10.34133/bmef.0151

JHLT Open. 2025 May 27;9:100301. doi: 10.1016/j.jhlto.2025.100301. eCollection 2025 Aug.

ABSTRACT

Post-operative care for children and adolescents who undergo lung transplantation is a challenge because of the potential for numerous complications during this period, which can considerably impact the short- and long-term outcomes. The immediate post-operative phase is particularly critical, and complications are frequent; therefore, knowledge, early recognition, and appropriate treatment of these complications are imperative and can only be achieved through close collaboration between a wide range of medical specialties. The aim of this review is to provide an abbreviated overview of the optimal post-operative management of children in an intensive care unit, as well as to describe frequently occurring complications and their treatment.

PMID:40606299 | PMC:PMC12219461 | DOI:10.1016/j.jhlto.2025.100301

JHLT Open. 2025 Jun 3;9:100278. doi: 10.1016/j.jhlto.2025.100278. eCollection 2025 Aug.

ABSTRACT

INTRODUCTION: Ventricular septal rupture (VSR) is a devastating complication of myocardial infarction (MI), with high mortality, particularly in cardiogenic shock (CS). Heart transplantation (HT) has emerged as a potential alternative to surgery or transcatheter closure (TCC). This study evaluates contemporary trends and outcomes of HT in post-MI VSR using the National Inpatient Sample (NIS) database.

OBJECTIVES: To assess in-hospital mortality and resource utilization of HT compared to surgical repair or TCC for post-MI VSR with CS.

METHODS: We analyzed NIS data (2016-2021) for MI-VSR hospitalizations with CS. Patients undergoing HT were compared to those receiving surgical repair or TCC. Primary and secondary endpoints included in-hospital mortality (IHM), total hospital charges (TOTCHG), and length of stay (LOS). Multivariable logistic regression adjusted for age, sex, race, comorbidities, and hospital characteristics, with surgical repair as the control.

RESULTS: Of 2,514,025 acute MI hospitalizations, 4765 (0.20%) had VSR. IHM was 82% with CS vs. 60% without. Among VSR-CS patients, 30 (1.2%) underwent HT, 600 (24.1%) surgical repair, 225 (9.2%) TCC, and 1635 (65%) medical therapy. IHM was 0% for HT vs. 66% (surgery), 75% (TCC), and 97% (medical therapy). All HT patients received mechanical circulatory support [IABP (50%), Impella (27%), ECMO ± Impella (10%), ECMO (13%)].). Patients undergoing HT had an average LOS approximately 20 days longer than those treated surgically (p = 0.004; 95% CI: 13.78-47.29) and 15 days longer with TCC (p = 0.008; 95% CI: 19.32-54.23). Similarly, mean total hospital charges (TOTCHG) were higher for HT patients ($1,456,693) compared to surgical repair ($325,032; p = 0.001; 95% CI: $145,002-$634,293) and TCC ($210,032; p = 0.001; 95% CI: $119,230-$542,200).

CONCLUSIONS: From 2016 to 2021, among VSR-CS admissions in the United States, patients who underwent HT had no in-hospital mortality, in contrast to the high in-hospital-mortality observed with surgical or transcatheter closure. Despite inherent selection biases, including survival to transplantation, HT was associated with favorable outcomes compared to surgical repair. While promising, these findings are preliminary due to the small sample size and selective nature of the patient cohort. Further studies are required before HT can be broadly recommended as a primary treatment option.

PMID:40606297 | PMC:PMC12219360 | DOI:10.1016/j.jhlto.2025.100278

JHLT Open. 2025 May 30;9:100306. doi: 10.1016/j.jhlto.2025.100306. eCollection 2025 Aug.

ABSTRACT

This study evaluates global practices for managing explanted hearts, with a focus on tissue collection and biobanking protocols. A survey conducted through the International Society for Heart and Lung Transplantation (ISHLT) assessed responses from centers across Europe, North America, and Other Countries. Results demonstrated significant variability in tissue sampling, grossing protocols, and storage practices. While 78.8% of centers had grossing protocols, fewer (73.1%) adapted sampling based on pathology. Fresh tissue collection was prevalent in 63.5% of centers, but volumes varied: North America led with higher sampling rates (10-25 samples per heart), while Europe and Other Countries collected fewer samples. Coronary artery sampling also showed regional differences. Fresh tissues enable advanced molecular studies, while fixed tissues remain fundamental for histopathology. Standardized global protocols for sampling, storage, and reporting could enhance the clinical and research value of explanted hearts, optimizing post-transplant care and driving innovation in cardiac medicine.

PMID:40606294 | PMC:PMC12219514 | DOI:10.1016/j.jhlto.2025.100306

JHLT Open. 2025 Jun 2;9:100312. doi: 10.1016/j.jhlto.2025.100312. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: In 2018, changes in the United Network for Organ Sharing (UNOS) allocation system led to a shift in practices, making durable left ventricular assist devices less desirable as a bridge to transplantation compared to temporary mechanical circulatory support. This study compares the composite outcome of waitlist mortality and delisting incidence at 1 year between these two support types.

METHODS: All actively listed adult patients on mechanical circulatory support listed for heart transplantation under the current UNOS system from October 2018 to October 2021 were included, excluding those with right ventricular devices, biventricular devices, total artificial hearts, and extracorporeal membrane oxygenators. The primary outcome was the composite of waitlist mortality and delisting due to clinical deterioration at 1 year. Survival analysis was conducted using Kaplan-Meier curves and multivariable Cox regression.

RESULTS: A total of 4,569 patients were included, with 1,877 on temporary mechanical circulatory support and 2,692 on left ventricular assist devices. Propensity-score matching was performed on 660 patients divided into two groups. The event rate was lower in the left ventricular assist device group compared to the temporary mechanical circulatory support group (15.9% vs 35.2%, p < 0.001). Temporary mechanical circulatory support had a significantly higher multivariable hazard ratio (HR) for outcome events (HR 3.37, p < 0.001). The HeartMate 3 (HM3) had the best outcomes compared to all other device types.

CONCLUSION: In this propensity-score-matched analysis, durable mechanical circulatory support had better outcomes than temporary mechanical circulatory support. HM3 had the lowest risk of composite outcomes.

PMID:40606293 | PMC:PMC12221459 | DOI:10.1016/j.jhlto.2025.100312

JHLT Open. 2025 May 31;9:100308. doi: 10.1016/j.jhlto.2025.100308. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: In healthy hearts, left ventricular atrioventricular plane displacement (LVAVPD) measured by cardiac magnetic resonance (CMR) contributes to ∼60% of stroke volume. LVAVPD has been shown to correlate with maximal cardiac output and exercise capacity and is an independent predictor of outcomes in patients with heart failure. We aimed to assess if longitudinal pumping is altered, if LVAVPD is associated with exercise capacity, and if any difference in longitudinal pumping could be explained by the presence of a right bundle branch block (RBBB) in heart-transplanted patients.

METHOD: This single-center study included 34 heart-transplanted patients who had undergone CMR and a cardiopulmonary exercise test as part of a clinical post-transplant surveillance program. Data was compared to 34 healthy sex- and age-matched controls.

RESULTS: Heart-transplanted patients had decreased LVAVPD (10.3 vs 13.7 mm, p < 0.01), lower longitudinal contribution (46% vs 53%, p < 0.01), and lower septal contribution (-3% vs 8%, p < 0.01) to stroke volume compared to controls. Furthermore, the lateral contribution was increased (44% vs 28%, p < 0.01) in the heart-transplanted patients. Longitudinal contribution to stroke volume was neither associated with exercise capacity (p = 0.20) nor cardiac output at rest (p = 0.62). There was no difference in LVAVPD in patients with and without RBBB (p = 0.81).

CONCLUSION: Heart-transplanted patients have decreased left ventricular longitudinal function compared to healthy controls, in part compensated by an augmented lateral function. Longitudinal function is not associated with cardiac output at rest or exercise capacity in this patient group. Whether the altered pumping mechanics seen are associated with outcome remains to be investigated.

PMID:40606292 | PMC:PMC12221465 | DOI:10.1016/j.jhlto.2025.100308

Eur Heart J Case Rep. 2025 Jun 5;9(7):ytaf279. doi: 10.1093/ehjcr/ytaf279. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Primary cardiac lymphoma (PCL) involves the heart almost exclusively although it can extend to surrounding structures including the pericardium. Most PCLs in adults are of B-cell origin and their signs and symptoms are generally non-specific and depend on their location and size. In general, cancer patients usually have a slim chance of receiving heart transplantation (OHT), although it's not an absolute contraindication depending on the decision of the multidisciplinary team and the experience of each institution.

CASE SUMMARY: A 48-year-old man, with an ultimate diagnosis of primary cardiac follicular B-cell lymphoma presented to our hospital mimicking hypertrophic cardiomyopathy. He initially presented with worsening heart failure and ventricular tachycardia storm (VT-S) that required urgent cardiac OHT. The final pathological analysis of the explanted heart revealed the presence of a PCL without extra-cardiac extension. In addition to initial immunosuppression with mycophenolate mophethyl, corticosteroids, and tacrolimus, he was switched to Everolimus and dose reduction of Tacrolimus. Rituximab + Bendamustine was initiated to reduce the risk of cardiotoxicity and myelotoxicity associated to R-CHOP. The follow-up body PET-CT, trans-thoracic echocardiogram, cardiac magnetic resonance imagings and biopsies were normal. During a regular follow-up heart biopsy procedure to ascertain rejection, the patient developed torrential tricuspid regurgitation and required surgical valve replacement.

DISCUSSION: After 5.5 years of follow-up, the patient remains asymptomatic, with normal graft function, in NYHA FC I, and without oncological relapses despite receiving a modified chemotherapy regimen. Selected patients with a PCL can be managed with OHT and a modified chemotherapy regimen. They could also be followed up using a non-invasive approach to monitor rejection.

PMID:40606016 | PMC:PMC12210231 | DOI:10.1093/ehjcr/ytaf279

Adv Sci (Weinh). 2025 Jul 3:e07627. doi: 10.1002/advs.202507627. Online ahead of print.

ABSTRACT

Cardiac fibroblasts (CFs) secrete exosomes, and their cargo represents a new means of cellular communication in cardiovascular diseases, including atrial fibrillation (AF). We aimed to explore the contribution of atial CFs (ACFs)-derived exosomes to AF development. Cultured primary human ACFs (hACFs) and rat ACFs are treated with angiotensin II, and the secreted exosomes are transferred to rats. Action potential duration and L-type calcium current (ICa) are tested. Global microRNA-224-5p knock-in and fibroblast-specific microRNA-224-5p knock-in (FMKI) mice underwent an inducible AF test. Transferred exosomes of Ang II-induced hACFs and primary adult rat ACFs increased AF incidence and prolonged AF duration. The inhibitor of exosomes and knockdown of Dicer rescued the AF phenotype. MicroRNA array suggested upregulated microRNA-224-5p level in both primary adult rat ACFs and ACFs-secreted exosomes. microRNA-224-5p agonist shortened atrial effective refractory period (AERP) and promoted AF. Mechanistically, microRNA-224-5p bound to CACNA1C and inhibited its transcription. Moreover, global microRNA-224-5p knock-in and FMKI mice exhibited increased inducible AF incidence, accompanied by diminished ICa current in ACMs. Exosome microRNA-224-5p is enhanced in ACFs isolated from atria and plasma of AF patients, and positively correlated with recurrence after radiofrequency ablation. In summary, ACFs-derived exosome microRNA-224-5p contributes to AF by inhibiting CACNA1C to drive atrial electrical remodeling.

PMID:40605550 | DOI:10.1002/advs.202507627

Eur J Med Res. 2025 Jul 2;30(1):552. doi: 10.1186/s40001-025-02776-0.

ABSTRACT

Pulmonary arterial hypertension (PAH) is currently an irreversible disease, with many patients eventually progressing to right heart failure, severely affecting their quality of life and posing a life-threatening risk. Percutaneous atrial septostomy was first performed in infants with transposition of the great arteries in 1966. Since then, it has been used as a palliative treatment for patients with end-stage PAH, significantly improving their quality of life and providing a buffer period while waiting for lung transplantation. However, this method does not fundamentally alter the malignant outcomes of patients with PAH. This study reviews the development and evolution of atrial septostomy, summarises various emerging technologies, and systematically explains the mechanisms, efficacy, and prognosis of palliative treatment in patients with PAH. Furthermore, new ideas for this treatment approach are proposed with the hope that it will bring more benefits to patients with PAH in the future and be more fully utilised.

PMID:40604947 | DOI:10.1186/s40001-025-02776-0

BMC Complement Med Ther. 2025 Jul 2;25(1):216. doi: 10.1186/s12906-025-04945-4.

ABSTRACT

BACKGROUND: The patterns of Chinese medicine prescriptions, corresponding diagnoses, co-morbidities, and Western medication (WM) use among patients with cardiac or vascular-related diseases are uncertain. This research aimed to examine the patterns of Chinese medications (CMs, specifically in terms of extract granules), corresponding diagnoses, co-morbidities, and the use of WMs within specified follow-up periods among patients with potential of recurrent cardiac or vascular-related diseases and relevant outcomes.

METHODS: We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database. We enrolled patients with newly diagnosed cardiac or vascular-related diseases without cancer(s), transplantation, bleeding diagnoses, or catastrophic illness during the 2-year period prior to the corresponding diagnosis. Prior and non-prior CM users were matched based on their propensity scores. Finally, we compared the CM and WM patterns prescribed by physicians, and co-morbidities in the 6 months following the diagnosis and the secondary cardiac or vascular-related events in the 2 years following the diagnosis between the two groups using the standardized mean difference.

RESULTS: Of 191,025 patients with newly diagnosed cardiac or vascular-related diseases, 39,341 (20.60%) were prescribed CMs. Moreover, after propensity score matching, we identified 39,168 prior CM users and 39,168 non-prior CM users. Regardless of prior CM use, both groups had a relatively high rate of comorbidities; CM or specific WM use; and incidence of severe cardiovascular, cerebrovascular, or thromboembolic events (33.81% vs. 31.97%) and severe bleeding (18.32% vs. 16.57%). Only CM exposure within 6 months after the index date differed significantly between the groups (73.51% vs. 30.34%).

CONCLUSION: We found that over 30% of patients with newly diagnosed cardiac or vascular disease initiated CM use, while 73.5% of prior CM users continued. This finding highlights the need for healthcare professionals to carefully assess the risk-to-benefit ratio of CM use alongside WMs for patients with cardiac or vascular-related diseases.

PMID:40604744 | DOI:10.1186/s12906-025-04945-4

BMC Pediatr. 2025 Jul 2;25(1):508. doi: 10.1186/s12887-025-05866-4.

ABSTRACT

Restrictive cardiomyopathy (RCM) is a rare cardiac disease characterized by the predominance of severe diastolic dysfunction, normal or mildly increased ventricular wall thickness, and either normal or mildly reduced ejection fraction. All known RCM genes are localized on autosomes. In most cases, the mutations are inherited in an autosomal dominant mode or appear as de novo mutations. The present report describes a case with early-onset RCM and life-threatening arrhythmia, which was inherited in an autosomal recessive manner. The child developed ventricular arrhythmia at one month of age, and a mixed phenotype dominated by restrictive cardiomyopathy with coexistent hypertrophic cardiomyopathy (RCM - HCM) at one year of age. and required hospitalization for anti - heart failure treatment due to heart failure at three years of age. The patient suffered from ventricular fibrillation and cardiac arrest at four years of age, which was rescued by extracorporeal membrane oxygenation and subsequent heart transplantation. Whole genome sequencing of the proband revealed a novel homozygous missense variant (NM_001927.3: c.1243 C > T [p.R415W]) in the Desmin (DES) gene, which was inherited from heterozygous unaffected parents. This case further expands our knowledge of desmin-related cardiomyopathy in children.

PMID:40604581 | DOI:10.1186/s12887-025-05866-4

Ann Thorac Cardiovasc Surg. 2025;31(1). doi: 10.5761/atcs.oa.25-00075.

ABSTRACT

PURPOSE: Pericardial effusion (PE), tamponade, and atrial fibrillation are challenging complications after cardiac surgeries. This prospective randomized study was conducted to evaluate the impact of posterior pericardiotomy (PP) in the prevention of PE and cardiac tamponed after adult cardiac surgery.

METHODS: This single-center, prospective, randomized controlled trial included 330 patients undergoing open-heart surgery. They were randomly assigned to either a PP group or a control group.

RESULTS: Of 703 screened patients, 330 were enrolled from January 2022 to June 2024 (mean age: 50.2 ± 14.7 years, 64.2% males). Compared to controls, the PP group had significantly lower early and late PE (19.4% vs. 44.8%, and 4.2% vs. 17%, respectively), tamponade (2.4% vs. 11.5%), and postoperative atrial fibrillation (10.3% vs. 19.4%). PP also significantly reduced the need for surgical re-exploration, duration of mechanical ventilation, and both intensive care unit and overall hospital stays (all P <0.05). Adjusted multivariate analysis confirmed the benefits of PP after correcting for baseline imbalances in left ventricular ejection fraction and operative time. No adverse events directly attributable to PP were noted.

CONCLUSIONS: PP is a simple, safe, and effective technique for reducing postoperative PE, and cardiac tamponade after cardiac surgery.

PMID:40603058 | DOI:10.5761/atcs.oa.25-00075

Curr Probl Cardiol. 2025 Jun 30:103125. doi: 10.1016/j.cpcardiol.2025.103125. Online ahead of print.

ABSTRACT

Cardiac amyloidosis (CA) is a once underdiagnosed and often fatal condition that has evolved into a disease with expanding diagnostic and therapeutic possibilities. It is characterized by the extracellular deposition of misfolded amyloid proteins within the myocardium, leading to structural and functional impairment. Advances in understanding the pathophysiology encompassing the amyloid protein misfolding, aggregation and deposition in cardiac tissue as well as the role of genetic factors have been pivotal in driving progress in diagnosis and management. The deposition of amyloid proteins can lead to significant cardiac manifestations, including constrictive cardiomyopathy, heart failure (both preserved and reduced ejection fraction), and arrhythmias particularly atrial fibrillation, contributing to substantial morbidity and mortality. Diagnostic innovations, such as advanced imaging and novel biomarkers, have enabled early detection and precise subtype differentiation, underscoring the need for targeted therapies. Over the past decade, therapeutic advancements have introduced transformative medications that gained FDA approval for the management of transthyretin amyloidosis (ATTR) including transthyretin stabilizers and silencers. Promising strategies like gene editing, antisense oligonucleotides and monoclonal antibodies are currently under investigation. However, managing cardiac manifestations remains challenging, particularly in optimizing euvolemia and rate control in heart failure and atrial fibrillation with limitations in traditional medications. This review explores the evolving landscape of CA, from pathophysiologic insights to innovative therapies, and provides a comprehensive approach to the management of cardiac manifestations to address ongoing challenges this condition.

PMID:40602734 | DOI:10.1016/j.cpcardiol.2025.103125

Int Immunopharmacol. 2025 Jul 1;162:115155. doi: 10.1016/j.intimp.2025.115155. Online ahead of print.

ABSTRACT

BACKGROUND: Immune rejection remains a leading cause of graft loss following organ transplantation, with CD4+ T cells playing a central role in this process. The PI3K/AKT/mTOR signaling pathway is essential for the activation, proliferation, and metabolic reprogramming of CD4+ T cells, making it an attractive therapeutic target. However, the role of Idelalisib (ID), a selective PI3Kδ inhibitor, in transplant immunity remains underexplored.

METHODS: Purified CD4+ T cells from the spleens of C57BL/6 mice were cultured with ID. Activation, proliferation, differentiation and survival were evaluated. A fully mismatched skin and heart transplantation model was used to assess ID's effects on rejection. Histopathology analysis and transcriptomic sequencing were performed.

RESULTS: ID significantly suppressed CD4+ T cell activation, proliferation, and Th1 differentiation, while enhancing cell survival-contrasting with the pro-apoptotic effects observed with the mTOR inhibitor rapamycin (Rapa). In the skin and heart transplantation models, ID reduced acute rejection, extended graft survival, and decreased the proliferation of CD4+ T cells and B cells. Transcriptomic analysis revealed downregulation of genes involved in T cells activation and differentiation (e.g., Zap70, Stat4), as well as markers of glycolysis (e.g., Gapdh, Pfkm). Functional assays confirmed reduced glucose uptake and lactate production in ID-treated cells.

CONCLUSIONS: ID uniquely modulates T cell responses through PI3Kδ inhibition, providing a distinct immunosuppressive mechanism from that of mTOR inhibitors. These findings highlight the therapeutic potential of ID in preventing transplant rejection and reveal a critical link between PI3K signaling and CD4+ T cell metabolism.

PMID:40602262 | DOI:10.1016/j.intimp.2025.115155

Braz J Cardiovasc Surg. 2025 Jul 2;40(5):e20240310. doi: 10.21470/1678-9741-2024-0310.

NO ABSTRACT

PMID:40601830 | DOI:10.21470/1678-9741-2024-0310

Sci Adv. 2025 Jul 4;11(27):eadv4854. doi: 10.1126/sciadv.adv4854. Epub 2025 Jul 2.

ABSTRACT

Cardiovascular diseases are a leading cause of mortality, with limited possibilities for transplantation due to a critical shortage of donor hearts. Replacing the heart with total artificial hearts (TAHs) remains challenging, due to size constraints and energy requirements, among others. To address this, we introduce the LIMO heart, a compact TAH concept based on an efficient soft fluidic transmission system. By reducing actuator volume and enhancing energy transfer, LIMO enables a more compact and efficient design. We developed a soft ventricle prototype using thin-walled pouch actuators that achieve transmission ratios above one via circumferential shrinkage. A fast, cost-effective prototyping method accelerated testing. Experimental results showed high energy transfer efficiency (82 to 91%), and in vitro tests demonstrated promising cardiac outputs of 5.9 liters per minute against aortic pressure and 7.6 liters per minute against pulmonary pressure. These findings represent a step toward a more broadly applicable biventricular soft robotic TAH for treating end-stage heart failure.

PMID:40601721 | DOI:10.1126/sciadv.adv4854

PLoS One. 2025 Jul 2;20(7):e0325668. doi: 10.1371/journal.pone.0325668. eCollection 2025.

ABSTRACT

INTRODUCTION: Heart failure (HF) is among the most prevalent health issues worldwide and is associated with high mortality. Adequate decongestion remain the main clinical challenge in HF management. Sodium glucose cotransporter-2 inhibitors (SGLT-2i) have been recently introduced as a new treatment option in patients with HF irrespective of left ventricular ejection fraction. Although the favorable effects of SGLT-2i are profoundly evident, the underlying mechanisms are not yet well understood. The aim of this study is to provide novel insights into the effects of dapagliflozin, a SGLT-2i with proven cardiovascular benefit, on blood volume profile and vascular function in HF patients who had a recent event of acute decompensated heart failure (ADHF).

METHODS: Eighty adult patients with diagnosis of de novo or chronic HF (NYHA class II-IV), clinically stabilized after an ADHF event and with preserved renal function, who were not on treatment with SGLT-2i, are aimed to be included. The patients are randomized with 1:1 allocation to either dapagliflozin 10 mg p.o. once daily or placebo in addition to guideline-directed medical therapy. The primary outcome is the mean change in plasma volume status (PVS) in the dapagliflozin group compared to placebo. PVS is assessed via optimized carbon monoxide rebreathing technique, a reliable and safe method to measure total hemoglobin mass and to estimate blood volume profile, i.e., blood volume, plasma volume and red blood cell volume. Secondary outcomes include differences between the two study groups regarding blood volume profile, micro- and macro-vascular function assessed by retinal vessel analysis and flow-mediated vasodilation, respectively, changes in body water distribution, quality of life, exercise capacity, echocardiographic and laboratory parameters.

ETHICS AND DISSEMINATION: The study has been approved by the Cantonal Ethics Committee Zurich (BASEC-Nr.:2020-01920, Swissmedic-Nr.:2020DR4175) and has been registered at www.ClinicalTrials.gov‌ (NCT04869124). The results will be published in a peer-reviewed medical journal.

PMID:40601599 | DOI:10.1371/journal.pone.0325668

Eur J Epidemiol. 2025 Jul 2. doi: 10.1007/s10654-025-01258-1. Online ahead of print.

ABSTRACT

The TransplantLines Biobank and Cohort Study (NCT03272841) is an ongoing prospective study conducted at the University Medical Centre Groningen, The Netherlands. TransplantLines aims to identify risk factors and biomarkers associated with health problems following solid organ transplantation and donation. Additionally, the study seeks to develop new interventions to reduce symptom burden and improve long-term outcomes, including health-related quality of life, cardiovascular complications, graft failure, and mortality. It includes recipients of (combined) heart, liver, lung, kidney, pancreas, and small bowel transplants, as well as living liver and kidney donors, and deceased (multi-)organ donors. The biobank contains a wide range of biomaterials including whole blood, serum, EDTA-plasma, buffy coat, 24-h urine samples, faeces, hair, nails, and tissues. Data collection includes physical and cognitive assessments, extensive laboratory analysis, metagenomic sequencing, and questionnaires. TransplantLines, initiated in 2015, consists of 5143 participants as of October 2024, among 2312 (45%) females. The mean age was 50 (± 16) years at transplantation, 55 (± 11) years at living donation and 56 (± 15) years at deceased donation. Both cross-sectional and longitudinal biomaterials and data are included. For recipients, longitudinal biomaterials and data were collected at: pre-transplantation, at transplantation, and at 3, 6, 12, 24, and 60 months post-transplantation. For living donors, data were collected at pre-donation, donation, 3 months post-donation, and/or 5 or 10 years post-donation.

PMID:40601244 | DOI:10.1007/s10654-025-01258-1

Can J Anaesth. 2025 Jul 2. doi: 10.1007/s12630-025-02979-3. Online ahead of print.

ABSTRACT

PURPOSE: Cardiac donation after death determination by circulatory criteria (DCC) can be performed using either 1) direct procurement and perfusion of ex situ organs or 2) normothermic regional perfusion (NRP). Nevertheless, there are concerns regarding the acceptability and ethics of these procedures, particularly NRP in which the blood supply to the brain is surgically interrupted and circulation in the thorax and abdomen is restored prior to heart retrieval. We aimed to understand the perspectives on cardiac donation following DCC of Canadian clinicians who are involved in donation and transplantation.

METHODS: We performed a qualitative descriptive study of 75 clinicians to better understand the perspectives of physicians on cardiac DCC. We purposively sampled clinicians who care for organ donors (N = 51) and those who care for transplant recipients (N = 24) in Canada. We performed thematic analysis to generate themes describing participants' perspectives about cardiac DCC and its implementation in Canada.

RESULTS: We found that the broad support and interest to implement cardiac DCC among the cohort of clinicians interviewed was tempered by their anticipation that other clinicians, donor families, and the public would be less supportive. Donor clinicians were particularly concerned about potential erosion in public trust in the organ donation system as a whole. Participants identified opportunities to address anticipated challenges, including strategies for education and communication around cardiac DCC, staged/gradual introduction of cardiac DCC, and the option for stakeholders (clinicians, donor families, potential transplant recipients) to opt out of participation in cardiac DCC.

CONCLUSIONS: In this qualitative study of clinicians involved in organ donation or transplantation across Canada, we found broad support for cardiac DCC. Nevertheless, we observed several challenges with the implementation of cardiac DCC, particularly concerns of nonsupport by other stakeholders. Participants also identified opportunities to address anticipated barriers.

PMID:40601238 | DOI:10.1007/s12630-025-02979-3