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Chirurgie (Heidelb). 2025 Sep 24. doi: 10.1007/s00104-025-02371-3. Online ahead of print.

ABSTRACT

The thoracic outlet syndrome (TOS) refers to a group of clinical conditions caused by compression of nerves and blood vessels in congenital or acquired anatomical narrowing of the upper thoracic aperture. This includes the anatomical structures, such as the scalene muscles, the first rib, a possibly present cervical rib, the costoclavicular joint or the pectoralis minor muscle. Isolated venous compression is also known as thoracic inlet syndrome (TIS). The symptoms are diverse and the path to a correct diagnosis is often prolonged. In the absence of anatomical anomalies, conservative treatment is indicated, such as physical therapy and adequate pain management. Especially in young patients, TOS should be considered when embolic events in the upper extremities occur without other risk factors. Appropriate multimodal diagnostics and targeted therapy are challenging and require treatment in specialized departments. Surgical treatment is complex and over the years various procedures with a favorable outcome for the affected patients have been established.

PMID:40991022 | DOI:10.1007/s00104-025-02371-3

Pediatr Cardiol. 2025 Sep 24. doi: 10.1007/s00246-025-04021-1. Online ahead of print.

ABSTRACT

Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, frequently diagnosed prenatally. To enhance understanding, we reviewed 18 years of our institutional outcomes for patients with classic ToF. There were 410 patients of whom 233/410 (56.8%) were diagnosed prenatally. A genetic abnormality was diagnosed in 38/410 (9.3%), most commonly 22q11.2 microdeletion (43.6%). There were 10/410 (2.4%) deaths in the neonatal period prior to any cardiac intervention. Prior to complete ToF repair, 66/400 (16.5%) of patients required cardiac procedures, in 15 in the first week after birth. Babies with an antenatal diagnosis were more likely to require at least one procedure before complete ToF repair than those with a postnatal diagnosis (p = 0.039). There was a trend to shorter median length of stay in patients with RVOT stent (median 5.4 days) or duct stenting (median 4.2 days) versus BTT shunt (median 8 days). Complete ToF repair was undertaken in 396/410 at a median age of 6 months (IQR: 4.0-8.0 months), with a 30-day postoperative survival rate of 99.5%. The actuarial survival for the whole group (n = 410) of 410 patients was 98.5% at 30 days, 96.2% at 1 year, and 95.2% at 3 years of age. Following complete surgical repair, reintervention was required in 25% of cases: 3.3% at 30 days, 10.6% at 1 year, and 19.2% at 5 years. The freedom from reintervention was 89.4% after 1 year and 80.8% after 5 years. There were no deaths beyond 2.5 years post-repair. In conclusion, ToF can be repaired with a low procedural mortality rate and promising long-term survival outcomes, but there may be pre-procedural deaths and there is a likelihood of requiring reinterventions during follow-up.

PMID:40991001 | DOI:10.1007/s00246-025-04021-1

World J Pediatr Congenit Heart Surg. 2025 Sep 24:21501351251360691. doi: 10.1177/21501351251360691. Online ahead of print.

ABSTRACT

ObjectivesA minority of patients with hypoplastic left heart syndrome (HLHS) are at extremely high risk for staged palliation and can be bridged-to-heart transplantation with bilateral pulmonary artery bands, ductal stenting, and single ventricle-ventricular assist device insertion (HYBRID + sVAD). The purpose of this analysis is to assess our learning curve associated with our first ten patients with functionally univentricular ductal-dependent systemic circulation who were supported with primary HYBRID + sVAD as bridge-to-heart transplantation.MethodsPatients were temporally separated into two cohorts: the first five and second five. Demographic, perioperative, and outcome data were collected. Continuous variables are described as median [IQR](range). Categorical variables are described as N (%). P values were calculated using Fisher exact t test for categorical variables and unpaired t tests for continuous variables.ResultsTen patients underwent HYBRID + sVAD operations for HLHS (2017-2022). Patients in the initial cohort and the most recent cohort were similar in age and weight. Liver dysfunction and renal dysfunction were more common in the first five patients (2/5 = 40%) versus the next five patients (0/5 = 0%). Length of sVAD support was longer in the most recent five patients (98 days [64-138] vs 154 days [134-225], P = .08); however, no increase in sVAD-associated stroke or bleeding was seen in the most recent five patients. Despite very similar demographic and preoperative profiles, only two of the first five patients (2/5 = 40%) survived to heart transplantation, while all of the next 5 (5/5 = 100%) were successfully bridged-to-cardiac transplantation with HYBRID + sVAD and are alive today.ConclusionsOur experience with primary HYBRID + sVAD as bridge-to-heart transplantation in neonates with HLHS demonstrates an important learning curve associated with this operation and approach.

PMID:40990805 | DOI:10.1177/21501351251360691

Cardiovasc Res. 2025 Sep 24:cvaf159. doi: 10.1093/cvr/cvaf159. Online ahead of print.

ABSTRACT

AIMS: Calcific aortic valve disease (CAVD) is becoming more prevalent with the population ageing; however, there is currently no medical therapy available. During early lipid deposition, low-density lipoprotein (LDL) mediates chronic inflammation and accelerates calcification progression. However, the mechanism still needs to be further explored.

METHODS AND RESULTS: The study identified the transcription factor FOXS in human valvular interstitial cells (VICs) as a pivotal regulator in aortic valve calcification. Bulk RNA-seq and qRT-PCR analysis were conducted to establish that FOXS1 is induced by oxidized LDL (oxLDL) in VICs. To elucidate the role of FOXS1 in osteogenic differentiation, small interfering RNA and recombinant adenovirus were utilized to modulate FOXS1 expression in VICs. High-fat diet (HFD)-fed Apoe-/-Foxs1-/- mice served as an in vivo model to investigate the role of FOXS1 in aortic valve calcification. Analysis from bulk RNA-seq, qRT-PCR, and western blot indicated significant activation of FOXS1 by oxLDL in VICs, with silencing of FOXS1 inhibiting oxLDL-induced osteogenic differentiation. Deletion of FOXS1 markedly reduced aortic valve calcification in HFD-fed Apoe-/- mice, as shown by decreased calcium deposition in the aortic valve leaflets. RNA-seq and chromatin immunoprecipitation sequencing were performed to reveal the regulatory mechanisms of FOXS1, uncovering direct interactions with the promoter of BSCL2, which subsequently inhibits the expression of ABCA1 and ABCG1 via the PPARγ/LXRα axis. The study demonstrated that FOXS1 mediates VICs' cholesterol transport dysfunction through BSCL2, ABCA1, and ABCG1 using Bodipy-cholesterol and showed that intracellular cholesterol accumulation can activate the NLRP3 inflammasome, promoting osteogenic differentiation of VICs. Additionally, it was found that IMM-H007 and recombinant BSCL2 could reduce aortic valve calcification both in vitro and in vivo.

CONCLUSION: We identified that an oxLDL-induced transcription factor FOXS1 inhibits ABCA1 and ABCG1 expression via the BSCL2/PPARγ/LXRα axis and promotes cholesterol transport dysfunction and the activation of NLRP3 inflammasome in VICs, thereby accelerating the progression of CAVD.

PMID:40990096 | DOI:10.1093/cvr/cvaf159

Front Cardiovasc Med. 2025 Sep 8;12:1567533. doi: 10.3389/fcvm.2025.1567533. eCollection 2025.

ABSTRACT

BACKGROUND: Fast-track extubation is a key component of the interdisciplinary treatment concept Enhanced Recovery After Surgery (ERAS). In preparation for implementing ERAS as a comprehensive approach, we aimed to analyze the current state of fast-track extubation in the operating room, focusing on Minimally Invasive Cardiac Surgery (MICS). Specifically, we assessed the potential benefits of immediate on-table extubation compared to extubation within six hours after the completion of MICS.

METHODS: During a 4-year period from 2019-2023, a total of n = 146 patients underwent MICS at our institution. Surgical aspects were retrospectively analysed along with patients' risk profiles and relevant comorbidities. After 1:1 best neighbor propensity score matching, patients who were admitted to intensive care unit intubated but were extubated within six hours after surgery (fast-track, FT) were compared to those who were extubated in the operating room (extubation in tabula, EIT). The primary endpoint was fast-track failure (FTF), a composite of setbacks in the postoperative course: revision surgery, re-intubation, and readmission to ICU or intermediate care unit (IMC).

RESULTS: Patients had a median age of 61 years (IQR: 51.3-67.8) and were predominantly male (76.7%). The primary study endpoint occurred in 20.0% of all matched patients (FT: 26.7%, EIT: 13.3%; p = 0.289). FT patients had longer cardiopulmonary bypass times [FT 165.0 min (146.5-217.5); EIT 158.5 min (128.0-189.5); p = 0.047], but the duration of surgery was comparable. Additionally, the average length of hospital stay did not differ. A multivariate analysis was conducted and identified preoperative atrial fibrillation and intraoperative hypothermia as predictive risk factors for FTF.

CONCLUSIONS: According to our retrospective single-center analysis, extubation in the operating room is feasible and safe even outside of a structured ERAS program. However, as itself it does not impact the further hospital stay, if there is no action thereafter, e.g., same day physiotherapy.

PMID:40989110 | PMC:PMC12450875 | DOI:10.3389/fcvm.2025.1567533

Drug Des Devel Ther. 2025 Sep 18;19:8451-8462. doi: 10.2147/DDDT.S541433. eCollection 2025.

ABSTRACT

PURPOSE: Dexmedetomidine, an alpha-2 adrenergic agonist, has shown potential benefits in various surgical settings, but its impact on microcirculation and renal function in cardiac surgery patients remains unclear.

PATIENTS AND METHODS: This randomized, controlled, double-blind clinical trial was conducted at a single university hospital. Seventy patients undergoing non-emergency cardiac and aortic surgery requiring cardiopulmonary bypass were enrolled, and 68 patients were included in the final analysis. Patients were randomized to receive either dexmedetomidine (0.5 mcg/kg loading dose, followed by 0.5 mcg/kg/h) or saline. The infusion of dexmedetomidine or saline began at anesthesia induction and continued until the end of surgery. Key microcirculatory variables-total vessel density, proportion of perfused vessels, perfused vessel density, De Backer's score, microvascular flow index, and heterogeneity index-were measured at five time points: baseline, 1 hour after cardiopulmonary bypass, 1 hour after arrival in the intensive care unit, 24 hours after surgery, and 48 hours after surgery. Data were analyzed using a mixed-effects model with Tukey's Honestly Significant Difference correction. Intraoperative urine output, the incidence of postoperative acute kidney injury, and other postoperative complications were also compared.

RESULTS: Patients in the dexmedetomidine group maintained higher postoperative proportion of perfused vessels and perfused vessel density compared to the saline group, with a significant interaction effect for perfused vessel density. Baseline perfused vessel density was comparable between the two study groups (17.5 [15.9-18.6] vs 18.0 [16.1-19.8] mm/mm², p = 0.540). At 48 hours postoperatively, patients in the dexmedetomidine group had significantly higher PVD values than those in the saline group (17.0 [15.0-19.0] vs 15.6 [13.7-16.9] mm/mm²; P = 0.041). The dexmedetomidine group also had significantly higher intraoperative urine output (950 vs 605 mL, p = 0.002). Additionally, the incidence of postoperative acute kidney injury was significantly lower in the dexmedetomidine group (11.8% vs 50%, p = 0.001).

CONCLUSION: Intraoperative dexmedetomidine infusion during cardiac surgery is associated with higher postoperative microcirculatory state and a reduced incidence of acute kidney injury.

PMID:40989246 | PMC:PMC12452957 | DOI:10.2147/DDDT.S541433

Medicine (Baltimore). 2025 Sep 19;104(38):e44646. doi: 10.1097/MD.0000000000044646.

ABSTRACT

RATIONALE: Acute mitral regurgitation (MR) secondary to papillary muscle rupture is a rare but often life-threatening mechanical complication post-acute myocardial infarction (MI). The use of peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to mitral valve replacement surgery may improve outcome of such patients.

PATIENT CONCERNS: We reported the case of a 70-year old woman with past history who presented to the emergency department at People's Hospital of Rizhao with "a 5-day history of chest distress." She developed refractory cardiogenic shock, severe pulmonary edema and severe acidosis.

DIAGNOSES: Restoration of spontaneous circulation following PCI, VA-ECMO, IABP, and early mitral valve replacement.

INTERVENTIONS: After performing percutaneous coronary intervention (PCI) supported by VA-ECMO and intra-aortic balloon pump (IABP), our group performed a early mitral valve replacement for this patient.

OUTCOMES: This patient preliminarily made a good recovery after VA-ECMO and IABP discontinued.

LESSONS: This case demonstrated that VA ECMO combined with PCI, VA-ECMO, IABP and early mitral valve replacement can result in favorable outcomes, and might be viable emergency therapeutic options.

PMID:40988190 | PMC:PMC12459457 | DOI:10.1097/MD.0000000000044646

Pediatrics. 2025 Oct 1;156(4):e2025071349. doi: 10.1542/peds.2025-071349.

ABSTRACT

We present a case of infectious endocarditis in the immediate post-transplant period in a 7-year-old child. On postoperative day 6, an elevation in inflammatory markers was detected, and the echocardiogram revealed a pedunculated mass on the mitral valve. The patient underwent surgical resection on postoperative day 14, followed by a 6-week course of antibiotics. The patient demonstrated complete resolution of endocarditis and, at 5-year follow-up, has excellent allograft function without recurrence of endocarditis.

PMID:40987464 | DOI:10.1542/peds.2025-071349

Nephrology (Carlton). 2025 Sep;30(9):e70122. doi: 10.1111/nep.70122.

ABSTRACT

AIM: Contrast-associated acute kidney injury (CA-AKI) has higher mortality in coronary artery disease (CAD) with chronic kidney disease (CKD), undergoing coronary angiography ± revascularisation (CAG ± R). We conducted a clinical superiority trial with dichotomous outcomes to evaluate the impact of renal hypoxia mitigation with oxygen therapy (OT) on CA-AKI incidence.

METHODS: CKD stages 3-5 patients undergoing CAG ± R were assigned to the OT group (OTG) and the control therapy group (CTG). CTG received hydration only, whereas OTG received 2 L/min of pure oxygen in addition to hydration. The primary endpoint was the incidence of CA-AKI at 48 h. Secondary endpoints included patient and renal survival (doubling of serum creatinine or dialysis dependency) at 30 days, as well as intervention complications.

RESULTS: Of the 395 patients, 321 patients qualified for the per-protocol analysis (OTG: 160 and CTG: 161). CA-AKI incidence was 5.6%, and OTG observed an effective prevention (1.25% vs. 9.93%, CTG, p = 0.004). Renal and patient survival at 30 days was 100%. Three CTG patients required dialysis and were dialysis-independent at 30 days. The risk of CA-AKI incidence was high among ages > 65 years (p = 0.007), previous acute myocardial infarction (p = 0.02), CKD stage-3 (p = 0.01) and avoidance of OT use (p = 0.02). OTG had a favourable serum creatinine trend (p = 0.05). Absolute risk reduction of CA-AKI with OT was 8.7%, and the number needed to treat was 12. Interventional complications were zero.

CONCLUSION: Oxygen supplementation and saline hydration effectively prevented CA-AKI in CKD stages 3-5 patients undergoing elective CAG ± R. Hence, oxygen therapy should be a standard CA-AKI protective strategy during CAG ± R and radiocontrast-related procedures.

PMID:40984804 | DOI:10.1111/nep.70122

Elife. 2025 Sep 23;13:RP100248. doi: 10.7554/eLife.100248.

ABSTRACT

The Hippo pathway controls organ development, homeostasis, and regeneration primarily by modulating YAP/TEAD-mediated gene expression. Although emerging studies report Hippo-YAP dysfunction after viral infection, it is largely unknown in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we analyzed RNA sequencing data from human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) and SARS-CoV-2-infected human lung samples, and observed a decrease in YAP target gene expression. In screening SARS-CoV-2 nonstructural proteins, we found that nonstructural protein 13 (NSP13), a conserved coronavirus helicase, inhibits YAP transcriptional activity independent of the upstream Hippo kinases LATS1/2. Consistently, introducing NSP13 into mouse cardiomyocytes suppresses an active form of YAP (YAP5SA) in vivo. Subsequent investigations on NSP13 mutants revealed that NSP13 helicase activity, including DNA binding and unwinding, is crucial for suppressing YAP transactivation in HEK293T cells. Mechanistically, TEAD4 serves as a platform to recruit NSP13 and YAP. NSP13 likely inactivates the YAP/TEAD4 transcription complex by remodeling chromatin to recruit proteins, such as transcription termination factor 2 (TTF2), to bind the YAP/TEAD/NSP13 complex. These findings reveal a novel YAP/TEAD regulatory mechanism and uncover molecular insights into Hippo-YAP regulation after SARS-CoV-2 infection in humans.

PMID:40985618 | PMC:PMC12456957 | DOI:10.7554/eLife.100248

Cardiovasc Diabetol. 2025 Sep 23;24(1):364. doi: 10.1186/s12933-025-02864-9.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) patients are at high risk for micro- and macrovascular complications, and cardiovascular (CV) events are a major cause of their increased risk of early death. Despite well-established treatment guidelines for the management of CV disease in T2DM, little is known about the real-world implementation of these guidelines.

OBJECTIVES: To characterize the real-life treatment patterns of T2DM patients with an incident CV comorbidity in Germany, to establish whether treatment is in line with respective national guidelines, and to assess guideline adherence with respect to the occurrence of serious clinical outcomes.

METHODS: This was a retrospective observational study using claims data from the WIG2 benchmark database including more than 4.5 million insured individuals. T2DM-prevalent patients with an incident CV comorbidity (ischemic stroke, myocardial infarction [MI], heart failure, or coronary artery disease) were identified between 2016 and 2018. Data on patient demographics and comorbidities were collected at baseline. During follow-up, data on treatment patterns and medical outcomes (all-cause mortality, modified 3P-MACE [composite endpoint of all-cause death or inpatient diagnosis of MI or stroke]) were captured. Guideline adherence was assessed using the medication possession ratio and was categorized as completely, partly or non-adherent.

RESULTS: Overall, 17,175 T2DM patients with a mean age of 71.1 years experiencing an incident CV comorbidity during the study period were identified. The most frequently prescribed CV treatments during follow-up were renin-angiotensin-aldosterone system inhibitors (83.9%), diuretics (72.6%) and beta-blocking agents (71.8%). Around 40% of the study population were treated completely adherent to the respective CV guidelines. These patients had a significantly higher chance of survival compared to patients not treated in line with the guidelines (90.8% vs. 82.6% survival within 12 months follow-up). Patients not treated according to CV guidelines had a higher mortality and 3P-MACE risk vs. patients completely adherent to guidelines (HR 1.93, 95% CI 1.65-2.25 and HR 1.49, 95% CI 1.31-1.69, respectively).

CONCLUSIONS: The results from this claims database study provide important insights into real-world management of CV comorbidities in T2DM patients in Germany and underline that inconsistent guideline adherence is a major unmet challenge to healthcare providers.

PMID:40988027 | PMC:PMC12455844 | DOI:10.1186/s12933-025-02864-9

Sci Rep. 2025 Sep 23;15(1):32664. doi: 10.1038/s41598-025-19853-3.

ABSTRACT

The therapeutic efficacy of anthracycline antibiotic, doxorubicin (DOX), is hampered due to cardiotoxicity. The objective of the study was to explore the counteraction of blueberry (BB) extract and Dexrazoxane (DEX) in Dox-induced cardiotoxicity in Wistar rats. Screening of BB extract as well as DEX for protection the myocardium from Dox-induced oxidative stress was performed on seven groups (8 rats each): Control (normal diet for 14 days and IP injection of normal saline (10 ml/kg) on the 11th day), DOX control (normal diet for 14 days with a single DOX injection of 18 mg/kg on the 11th day), BB extract control (80 mg/kg), DEX (180 mg/kg on the 11th day), BB + DOX (80 mg/kg BB extract for 14 days with DOX on the 11th day, 18 mg/kg), DEX + DOX (180 mg/kg DEX 30 min before 18 mg/kg DOX on the 11th day), and a combined group BB + DOX + DEX. A significant increase in serum biomarkers cTnT, NT-proBNP, MPO and cardiac MDA, TOP II, and a significant decrease in GSH and SOD contents were observed in the cardiotoxic (DOX control) group. All these parameters were reversed significantly in all treated groups in comparison to cardiotoxic groups. The cardiotoxic group showed significant upregulation of miR-140-5p expression and significant downregulation of Sirt2 and Nrf2 expression reversed in all treated groups except miR-140-5p which showed unsignificant difference. The best ameliorative effect was observed in the combined group. The histopathological assessment of myocardial damage provided supportive evidence for the biochemical results obtained. In conclusion, the BB extract (80.0 mg/kg) can attenuate the DOX-induced oxidative stress, and it has the potential to be developed as an adjunct against DOX-induced cardiotoxicity in cancer patients who undergo anthracycline chemotherapy.

PMID:40987807 | PMC:PMC12457682 | DOI:10.1038/s41598-025-19853-3

Basic Res Cardiol. 2025 Sep 23. doi: 10.1007/s00395-025-01140-x. Online ahead of print.

ABSTRACT

Cardiovascular diseases (CVD) include a wide range of disorders affecting the heart and blood vessels, many of which are associated with atherosclerosis. Atherosclerosis is the main underlying cause of CVDs and represents a chronic inflammatory disease of the large arteries involving the build-up of plaques within the arterial wall. B cells play a dual role in CVD, particularly in the context of atherosclerosis, by producing antibodies and secreting cytokines that modulate inflammation. Depending on their subtype (B1 vs. B2 cells) and the specific context, B cells can have both protective and harmful effects on the cardiovascular system. B1 cells, which arise predominantly during fetal development, are found in body cavities, such as the perivascular adipose tissue (PVAT) and peritoneum. Guided by CXCL13 and CCR6, they migrate to sites, where they produce IgM and IgG3, contributing to immune regulation and pathogen defense. In contrast, B2 cells-central players in adaptive immunity-originate in the bone marrow and mature in secondary lymphoid organs. Within this subset, marginal-zone (MZ) B cells provide rapid, low-affinity IgM responses to blood-borne antigens, while follicular (FO) B cells mediate high-affinity, T-cell-dependent antibody production. For all of the latter chemokine-guided migration is essential for B-cell function, from immune surveillance to antibody secretion. Receptors such as CXCR4, CXCR5, and ACKR3 not only direct B-cell trafficking but also influence their phenotype in cardiovascular disease. Understanding how these chemokine-receptor interactions shape B-cell-mediated immunity in CVD may allow for developing targeted therapies for atherosclerosis, myocardial infarction, and stroke.

PMID:40986007 | DOI:10.1007/s00395-025-01140-x

Cureus. 2025 Aug 22;17(8):e90748. doi: 10.7759/cureus.90748. eCollection 2025 Aug.

ABSTRACT

Cardiac procedures carry a higher perioperative risk than other operations for major adverse cardiovascular events and kidney injury, especially since patients with multiple comorbidities have been accepted as candidates for undergoing surgical treatment. Dexmedetomidine (DEX) is an alpha-2 agonist and has been widely used as an adjuvant anesthetic in clinical anesthesia for many different types of operations, including cardiac surgery. While it can be associated with bradycardia as well as hypotension in hypovolemic patients, DEX has been shown to reduce surgical complications like atrial fibrillation (Afib) and acute kidney injury (AKI), and is associated with an improved survival rate. In this review, we discuss the effect of using perioperative DEX on hemodynamics, arrhythmia, AKI, cognitive function, and surgical outcome in patients undergoing cardiac surgery both with and without cardiopulmonary bypass (CPB), and we review the mechanisms.

PMID:40984901 | PMC:PMC12450391 | DOI:10.7759/cureus.90748

Nephrology (Carlton). 2025 Sep;30(9):e70122. doi: 10.1111/nep.70122.

ABSTRACT

AIM: Contrast-associated acute kidney injury (CA-AKI) has higher mortality in coronary artery disease (CAD) with chronic kidney disease (CKD), undergoing coronary angiography ± revascularisation (CAG ± R). We conducted a clinical superiority trial with dichotomous outcomes to evaluate the impact of renal hypoxia mitigation with oxygen therapy (OT) on CA-AKI incidence.

METHODS: CKD stages 3-5 patients undergoing CAG ± R were assigned to the OT group (OTG) and the control therapy group (CTG). CTG received hydration only, whereas OTG received 2 L/min of pure oxygen in addition to hydration. The primary endpoint was the incidence of CA-AKI at 48 h. Secondary endpoints included patient and renal survival (doubling of serum creatinine or dialysis dependency) at 30 days, as well as intervention complications.

RESULTS: Of the 395 patients, 321 patients qualified for the per-protocol analysis (OTG: 160 and CTG: 161). CA-AKI incidence was 5.6%, and OTG observed an effective prevention (1.25% vs. 9.93%, CTG, p = 0.004). Renal and patient survival at 30 days was 100%. Three CTG patients required dialysis and were dialysis-independent at 30 days. The risk of CA-AKI incidence was high among ages > 65 years (p = 0.007), previous acute myocardial infarction (p = 0.02), CKD stage-3 (p = 0.01) and avoidance of OT use (p = 0.02). OTG had a favourable serum creatinine trend (p = 0.05). Absolute risk reduction of CA-AKI with OT was 8.7%, and the number needed to treat was 12. Interventional complications were zero.

CONCLUSION: Oxygen supplementation and saline hydration effectively prevented CA-AKI in CKD stages 3-5 patients undergoing elective CAG ± R. Hence, oxygen therapy should be a standard CA-AKI protective strategy during CAG ± R and radiocontrast-related procedures.

PMID:40984804 | DOI:10.1111/nep.70122

Hum Immunol. 2025 Sep 22;86(6):111587. doi: 10.1016/j.humimm.2025.111587. Online ahead of print.

ABSTRACT

Studies have demonstrated that the liver acts as an immunologic sink when transplanted with another organ from the same donor. In this work, we review evidence of this phenomenon in kidney-liver and heart-liver transplantation. We then explore the pros and cons of this strategy as a way of helping to transplant end stage heart failure patients who are highly allosensitized but do not have severe liver disease. By considering this strategy in the context of alternative therapies, we explain the types of patients who may benefit from it.

PMID:40987086 | DOI:10.1016/j.humimm.2025.111587

Hepatology. 2025 Sep 23. doi: 10.1097/HEP.0000000000001524. Online ahead of print.

ABSTRACT

BACKGROUND AIMS: Point-of-care ultrasound(POCUS) helps in assessing volume status and cirrhotic cardiomyopathy(CCM). We evaluated POCUS-guided volume management and explored clinical predictors, including CCM, of acute kidney injury(AKI) reversal and need for renal replacement therapy(RRT), and survival, in cirrhosis and AKI between January 2023 and November 2024. Exclusions were patients with structural cardiac disease, portopulmonary hypertension, acute variceal bleeding, and septic shock.

METHODS: POCUS was performed at ICU admission(Timezero), 24h,48h,72h, and as needed to guide volume management, and determine inferior vena cava(IVC) indices and cardiac index. CCM was defined by ≥3 of 4 variables(septal e' velocity, E/e' integral, left atrial volume index, tricuspid regurgitant velocity); clinical data were collected.

RESULTS: 372 patients with AKI [84.7% men, aged 50.3±12 years, MELD-Na 23.9±5.1]; 296(79.6%), 42(11.3%), and 34(9.1%) were classified as hypovolemic, euvolemic, and hypervolemic at Timezero. Following POCUS-guided volume management, 231(62%) had pre-renal AKI; 61(16.4%) hepatorenal syndrome(HRS-AKI); 25(6.7%) HRS-AKD; 32(8.6%) HRS-CKD, while 23(6.2%) had a multifactorial etiology. CCM was diagnosed in 34.7%; 32.9% of pre-renal AKI, 75.4% in HRS-AKI, and 28% in HRS-AKD(p<0.001). Higher MAP0h (aHR1.9, 95%CI:1.96-2, p=0.039) and cardiac index0h(aHR1.2,95%CI:1.1-1.3,p=0.005) predicted AKI reversal at Day-7;53/372(14.2%) underwent RRT. Pulmonary edema developed in 4.8% overall; in 5.4% with CCM. Overall mortality was 46(12.4%) and 107(28.8%) at 90-days and 1-year. CCM predicted mortality at 90-days(aHR 8.9,95%CI:3.9-20.4,p<0.001) and one year(aHR1.7,95%CI:1.2-2.5,p=0.007). Cardiac index (aHR0.6,95%CI:0.4-0.9,p=0.005), and septal e' velocity(aHR 0.5,95% CI:0.3-0.7,p=0.010) predicted need for RRT.

CONCLUSIONS: POCUS facilitates volume management and AKI reversal in cirrhosis. CCM predicts poor outcomes in HRS-AKI, need for RRT, and mortality.

PMID:40986890 | DOI:10.1097/HEP.0000000000001524

Transplantation. 2025 Sep 23. doi: 10.1097/TP.0000000000005503. Online ahead of print.

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter inhibitors (SGLTi) slow chronic kidney disease progression and reduce kidney failure events. Kidney transplant recipients (KTRs) remain at high risk for these outcomes. SGLTi cause an initial and sustained decline in estimated glomerular filtration rate (eGFR) and have a higher risk of urogenital infection, both of which are major concerns for KTRs. We sought to (1) assess the reversibility of eGFR changes and (2) explore safety and tolerability using sotagliflozin, a dual SGLT1/2 inhibitor.

METHODS: We enrolled stable KTRs in a 16-wk open-label trial of sotagliflozin (12 wk on-drug and 4 wk off-drug) to assess the reversibility of eGFR changes. We assessed whether patient awareness of eGFR changes altered rates of withdrawal by randomizing participants to either (1) unlimited access to all study-related eGFR measurements or (2) limited access, that is, only when eGFR declined to >25% from baseline.

RESULTS: Forty patients were randomized. The mean age was 56 ± 15 y; the mean baseline eGFR was 64 ± 21 mL/min/1.73 m2. After 1 wk, change in eGFR from baseline was -4.6 ± 6.5 mL/min/1.73 m2 (-6.9 ± 9.5%). After washout, eGFR improved to -2.0 ± 6.3 mL/min/1.73 m2 (-2.4 ± 11%), with 73% of patients within 10% of baseline eGFR or higher. Limited versus unlimited access to eGFR measurements did not affect protocol completion (P = 0.34). Sotagliflozin was generally well tolerated, but 4 patients were withdrawn due to adverse events, with none due to decline in eGFR.

CONCLUSIONS: Among stable KTRs, sotagliflozin caused an initial decline in eGFR of similar magnitude to patients with chronic kidney disease, with reversibility upon withdrawal. Access to follow-up eGFR measurements did not affect study adherence.

PMID:40986618 | DOI:10.1097/TP.0000000000005503

Eur J Cardiothorac Surg. 2025 Sep 23:ezaf318. doi: 10.1093/ejcts/ezaf318. Online ahead of print.

ABSTRACT

OBJECTIVES: Bilateral transverse thoracosternotomy ('clamshell') is widely used for (heart-)lung transplantations but postoperative sternal complications are a significant challenge. The primary objective of this systematic review was to evaluate the prevalence of sternal complications after clamshell surgery in (heart-)lung transplantation patients.

METHODS: A systematic literature review was conducted. On April 4, 2025, PubMed and Embase databases were searched. Original studies reporting sternal complications after clamshell surgery in adults for bilateral lung or heart-lung transplantation were included. Studies including <10 patients were excluded. Study quality was assessed using the National Institutes of Health assessment tool. The total and range of sternal complication prevalence was provided. Meta-analysis of sternal complication prevalence was not performed due to significant heterogeneity across studies.

RESULTS: The database searches yielded 945 eligible articles. 18 studies were included, including 828 patients who underwent a total of 830 bilateral lung or heart-lung transplantations through clamshell surgery. All included studies were cohort studies with poor (n = 15), fair (n = 1), or good (n = 2) quality. In total, 286 sternal complications were reported (0.34 event per clamshell surgery; range 0.02 to 1.35 in individual studies) and 90 sternal reoperations were conducted (0.14 reoperation per clamshell surgery; range 0.02 to 0.29 in individual studies).

CONCLUSIONS: Despite limitations in study quality and heterogeneity, this review highlights the high prevalence and relevance of sternal complications following clamshell surgery for (heart-)lung transplantation. Future studies should focus on patient selection, risk stratification, development of modified sternal closure techniques, and implementation of alternative surgical approaches to (heart-)lung transplantation.

PMID:40986383 | DOI:10.1093/ejcts/ezaf318

Nutr Clin Pract. 2025 Sep 23. doi: 10.1002/ncp.70037. Online ahead of print.

ABSTRACT

BACKGROUND: Our objective was to characterize enteral nutrition safety practices and education for pediatric solid organ transplant recipients and compare practices with the 2017 American Society for Parenteral and Enteral Nutrition (ASPEN) Safe Practices for Enteral Nutrition Therapy.

METHODS: A 43-question electronic survey was distributed through the national registered dietitian pediatric transplant listserv. Questions reviewed formula hang-time, preparation, storage during initial transplant admission, and discharge education.

RESULTS: Sixty-six of 216 (31%) individuals completed at least one survey section. Forty-one of 47 (87%) reported a standard inpatient policy, and 40/40 (100%) reported ASPEN Safe Practices compliance for nonsterile powder formula with or without additives or unfortified and fortified human milk, whereas 33/39 (85%) complied for sterile liquid formula in an open system. Hospital size, type, and location did not predict compliance practices. Discharge education was primarily provided by dietitians (98%) and nurses (37%). Four-hour hang-time education was provided by 18/42 (43%) respondents for sterile formula in an open system, 31/42 (74%) for nonsterile powder formula in an open system, and 35/42 (83%) for nonsterile formula with additives. Educator type (dietitian vs non-dietitian or nurse vs non-nurse) did not predict compliance for sterile liquid in open system or nonsterile powder formula in an open system.

CONCLUSION: Inpatient policies for formula hang-time are highly compliant with 2017 ASPEN recommendations. However, formula hang-time discharge education varied, particularly for sterile liquid formula in an open system. Standardizing enteral nutrition safety education for transplant patients is critical for minimizing infection risk within this immunocompromised population.

PMID:40985927 | DOI:10.1002/ncp.70037