Agregador de feeds

JACC CardioOncol. 2025 Jun;7(4):382-392. doi: 10.1016/j.jaccao.2025.05.002.

ABSTRACT

BACKGROUND: Postural orthostatic tachycardia (POTS) and orthostatic hypotension (OH) commonly occur after hematopoietic stem cell transplantation (HSCT).

OBJECTIVES: This study sought to determine the prevalence of POTS and OH before HSCT and the incidence of new cases after HSCT.

METHODS: In this single-center, prospective study, patients were evaluated 30 days before and 30 and 100 days after HSCT. Blood pressure, heart rate, and plasma norepinephrine levels were measured in the supine position and after a 10-minute active stand test to assess for POTS or OH. After HSCT, adrenergic receptor (AR)-modulating autoantibody activity was measured in 8 subjects with POTS and 8 without.

RESULTS: Among 46 patients, 40 (87.0%) underwent autologous and 6 (13.0%) allogeneic HSCT. Multiple myeloma was the most common indication (67.4%). Before HSCT, the prevalence of both POTS and OH was 4.3%. At 30 days after HSCT, POTS was present in 10 (25.6%) of 39 patients, including 9 (23.1%) new cases, and OH in 6 (15.4%), including 5 (12.8%) new cases. Patients with POTS at 30 days showed a significantly greater increase in norepinephrine levels upon standing (median 231% [Q1-Q3: 179%-343%]) compared with before HSCT (median 100% [Q1-Q3: 62%-183%]) (P = 0.005), which positively correlated with heart rate changes. AR-modulating autoantibody activity was also higher in patients with POTS vs those without and directly correlated with heart rate changes.

CONCLUSIONS: Approximately 1 in 4 patients developed POTS after HSCT, characterized by exaggerated increases in norepinephrine upon standing and elevated AR-modulating autoantibody activity.

PMID:40537187 | DOI:10.1016/j.jaccao.2025.05.002

J Mol Med (Berl). 2025 Jun 19. doi: 10.1007/s00109-025-02564-7. Online ahead of print.

ABSTRACT

Tumor necrosis factor-α-inducible protein 8-like 2 (TIPE2) is a novel regulatory factor involved in innate and adaptive immunity that negatively regulates the functions of toll-like receptors and T-cell receptors. Its selective expression within the immune system serves to inhibit inflammatory responses and maintain immune homeostasis. Inflammation and immune cell signaling initiate the innate immune response in the cardiovascular system through intricate acute and chronic adaptation processes, resulting in tissue damage and significantly contributing to the onset and progression of cardiovascular diseases. Consequently, TIPE2 presents a potential target for the diagnosis and treatment of various cardiovascular diseases. This paper reviews the structural characteristics and biological functions of TIPE2, as well as its role in the onset and progression of cardiovascular diseases, providing new strategies for prevention and treatment.

PMID:40536707 | DOI:10.1007/s00109-025-02564-7

J Biosci. 2025;50:49.

ABSTRACT

Inhalation burns, especially when combined with thermal burns, can be fatal and significantly increase mortality rate through inhaling hazardous gas. However, there is no specific treatment for inhalation burns except for relieving bronchospasm and cleaning the airways. In particular, inhaled sulfur dioxide (SO2), a major component of inhalation burns, can easily be hydrated in the respiratory tract to produce sulfurous acid, which subsequently dissociates to form bisulfite and sulfite derivatives. In this study, we intend to assess whether human adipose-derived stem cell (ASC) exosomes rescue respiratory system-related cells damaged by exposure to SO2 derivatives. We found that the uptake of ASC exosomes was high in human respiratory systemrelated cells and they rescue decreased proliferation of cells damaged by treatment with SO2 derivatives. In human pulmonary endothelial cells (HPMECs), total tubule length was increased by pre-treatment of ASC exosomes through an in vitro angiogenesis assay. Besides, we confirmed that ASC exosomes alleviate increased expression of inflammation-related genes by treatment of SO2 derivatives in primary respiratory epithelial cells. Taken together, these results suggest that ASC exosomes have potential in regeneration of human respiratory system-related cells damaged by inhalation burns, which currently lack specific treatment methods.

PMID:40536194

Clin Transplant. 2025 Jun;39(6):e70214. doi: 10.1111/ctr.70214.

ABSTRACT

INTRODUCTION: Consensus regarding what defines acceptable heart transplant (HT) donors or recipients is lacking. This survey analyzed how risk factors guide donor and recipient selection, and how practices vary across systems.

METHODS: An online survey was conducted among adult HT centers in the US and Eurotransplant (ET) region. We aimed to represent at least 50% of the total adult HT volumes in both regions. Centers were stratified by their HT volumes. To compensate for non-responders, a safety margin was included, and centers accounting for at least 75% of the total HT volumes were contacted. Centers were queried on relative thresholds and absolute cutoffs for continuous risk factors. For other factors, their influence on donor heart acceptance or the likelihood of listing recipients was assessed.

RESULTS: Fifty-three centers from five countries participated: 39 US (accounting for 51.0% of the US HT volume), and 14 ET centers (65.0%) from four countries. ET centers more liberally considered advanced age donor hearts (threshold 64.5 [60.0-70.0] vs. 50.0 [50.0-55.0] years, p < 0.001), and hearts with abnormal echocardiography or coronary findings. Diabetes, smoking, and hypertension were rated by a quarter to more than half of US and ET centers as moderately or heavily influencing donor heart acceptance. ET centers more liberally listed candidates with chronic kidney disease (GFR 30.0 [21.5-32.5] vs. 35.0 [30.0-40.0] mL/min/1.73m2, p < 0.001). US centers, conversely, allowed for higher candidate ages (71.5 [70.0-74.0] vs. 68.0 [65.0-70.0] years, p < 0.001), and more likely (76.9%) listed candidates on ECMO support (42.9% of ET centers to less likely list, p = 0.022).

CONCLUSION: Selection practices differed distinctly between the US and ET. Further, practices appear to be driven by caution and are more conservative than current guidelines. Strengthening the evidence base to objectify and optimize donor and candidate selection could help alleviate the unmet need for donor hearts.

PMID:40536071 | DOI:10.1111/ctr.70214

Therap Adv Gastroenterol. 2025 Jun 16;18:17562848251347347. doi: 10.1177/17562848251347347. eCollection 2025.

ABSTRACT

Although radiotherapy is the second most effective cancer treatment, radiation injuries limit its use. About 80% of abdominal-pelvic radiotherapy patients develop acute radiation enteritis, with 20% discontinuing radiotherapy. The lack of effective mitigation measures restricts its clinical application. Recent studies have proposed gut microbiota as a potential biomarker for radiation injuries. However, the interaction between gut microbiota and radiation injuries remains poorly understood. This review summarizes two forms of interaction between gut microbiota and radiation injuries based on the location of the radiation field. One type of interaction, referred to as "direct interaction," involves changes in the diversity and composition of gut microbiota, alterations in microbiota-derived metabolites, disruption of the intestinal barrier, activation of inflammatory responses within the intestine, and involvement of the host's immune system. The second form, called "indirect interaction," includes the influence of the gut microbiota on various body systems, such as gut microbiota-brain axis, gut microbiota-cardiopulmonary axis, and gut microbiota-oral axis. Additionally, we examine promising interventions aimed at reshaping the gut microbiota, including the use of probiotics, prebiotics, and fecal microbiota transplantation. The interaction between radiation injuries and gut microbiota is more complex than previously understood. Therefore, further clarification of the underlying mechanisms will facilitate the application of gut microbiota in preventing and alleviating radiation injuries.

PMID:40535532 | PMC:PMC12174693 | DOI:10.1177/17562848251347347

World J Transplant. 2025 Jun 18;15(2):99992. doi: 10.5500/wjt.v15.i2.99992.

ABSTRACT

BACKGROUND: Since being declared as a pandemic on March 11, 2020, coronavirus disease 2019 (COVID-19) has profoundly influenced heart and lung transplant programs, impacting donor availability, patient management, and healthcare resources. This study offers a citation-based review of the research output on this subject, seeking to understand how the transplant community has responded to these challenges. Through a review of literature from the beginning of the pandemic to early 2023, we evaluate the shifts in academic emphasis and the emerging trends in heart and lung transplantation during the COVID-19 period.

AIM: To assess the impact of COVID-19 on heart and lung transplantation research, highlighting key themes, contributions, and trends in the literature during the pandemic.

METHODS: We conducted an extensive search of the Web of Science database on February 9, 2023. We employed the terms "transplant" and "transplantation", as well as organ-specific terms like "heart", "cardiac", and "lung", combined with COVID-19-related terms such as "COVID-19", "coronavirus", and "SARS-CoV-2". The search encompassed publications from March 11, 2020 to February 9, 2023. Data on authors, journals, countries, institutions, and publication types (articles, reviews, conference papers, letters, notes, editorials, brief surveys, book chapters, and errata) were analyzed. The data was visualized and processed with VOSviewer 1.6.18 and Excel.

RESULTS: We included 847 research items. There were 392 articles (46.3%) and 88 reviews (10.3%). The studies included were referenced 7757 times, with an average of 9.17 citations per article. The majority of the publications (n = 317) were conducted by institutes from the United States with highest citations (n = 4948) on this subject, followed by Germany, Italy, and France. The majority of papers (n = 101) were published in the Journal of Heart and Lung Transplantation.

CONCLUSION: To the fullest extent of our knowledge, this is the first bibliometric study of COVID-19's impact on heart and lung transplantation to offer a visual analysis of the literature in order to predict future frontiers and provide an overview of current research hotspots.

PMID:40535501 | PMC:PMC11886284 | DOI:10.5500/wjt.v15.i2.99992

World J Transplant. 2025 Jun 18;15(2):102384. doi: 10.5500/wjt.v15.i2.102384.

ABSTRACT

BACKGROUND: Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection. However, the risk of malignancy associated with prolonged immunosuppression remains a concern, as it can adversely affect recipients' quality of life and survival. While the link between immunosuppression and increased cancer risk is well-documented, the specific interactions between graft rejection and post-transplant malignancy (PTM) remain poorly understood. Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.

AIM: To investigate whether immunosuppression in PTM reduces rejection risk, while immune activation during rejection protects against malignancy.

METHODS: We analyzed data from the United Network for Organ Sharing's Organ Procurement and Transplantation Network database (1987-2023) on adult, first-time, single-organ transplant recipients with no prior history of malignancy (in donors or recipients). Landmark analyses at 1, 2, 3, 5, 10, 15, and 20 years post-transplant, Kaplan-Meier analyses, and time-dependent Cox proportional hazards regression models, each incorporating the temporal dimension of outcomes, assessed the association between rejection-induced graft failure (RGF) and PTM. Multivariate models were adjusted for clinical and immunological factors, including immunosuppression regimens.

RESULTS: The cohort included 579905 recipients (kidney: 386878; liver: 108390; heart: 45046; lung: 37643; pancreas: 1948) with a mean follow-up of 7.3 years and a median age of 50.6 ± 13.2 years. RGF was associated with a reduction in PTM risk across all time points [hazard ratio (HR) = 0.07-0.20, P < 0.001], even after excluding mortality cases. Kidney transplant recipients exhibited the most pronounced reduction (HR = 0.22, P < 0.001). Conversely, among recipients with PTM, RGF risk decreased across all time points up to 15 years after excluding mortality cases (HR = 0.49-0.80, P < 0.001). This risk reduction was observed in kidney, liver, heart, and lung transplants (HRs = 0.90, 0.21, 0.21, and 0.18, respectively; P < 0.001) but not in pancreas transplants.

CONCLUSION: RGF reduces PTM risk, particularly in kidney transplants, while PTM decreases RGF risk in kidney, liver, heart, and lung transplants.

PMID:40535498 | PMC:PMC11886299 | DOI:10.5500/wjt.v15.i2.102384

World J Transplant. 2025 Jun 18;15(2):99208. doi: 10.5500/wjt.v15.i2.99208.

ABSTRACT

BACKGROUND: The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant (LT).

AIM: To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.

METHODS: This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome, Italy. Cardiac contraindications for LT listing were defined after a center-specific cardiac workup, which included cardiac stress tests for most patients. The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic (AUROC) method.

RESULTS: A total of 342 LT candidates were evaluated between 2015 and 2019, with a moderate cardiovascular risk profile (37% diabetes, 34% hypertension, 22% obesity). Of these, 80 (23%) candidates underwent coronary angiography. Twenty-one (6%) candidates were given cardiac contraindications to LT listing, 48% of which were due to coronary artery disease. The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81. The optimal cut-off for sensitivity was a CAR-OLT score ≤ 23, which showed a 99% negative predictive value for cardiac contraindications to LT listing. A total of 84 (25%) LT candidates with a CAR-OLT score ≤ 23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing, with estimated costs of approximately 48000€. The estimated savings per patient was €574.70 for the Italian National Health System.

CONCLUSION: A CAR-OLT score ≤ 23 can identify LT candidates who can be safely listed without the need for cardiac stress tests, providing time and cost savings. These findings require external validation.

PMID:40535490 | PMC:PMC11886293 | DOI:10.5500/wjt.v15.i2.99208

World J Transplant. 2025 Jun 18;15(2):101005. doi: 10.5500/wjt.v15.i2.101005.

ABSTRACT

Lung transplantation (LT) is now an accepted therapy for end stage lung disease in appropriate patients. Atrial arrhythmias (AA) can occur after LT. Early AA after LT are most often atrial fibrillation, whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia. The causes of AA are multifactorial. The review begins with a brief history of LT and AA. This review further describes the pathophysiology of the AA. The risk factors, incidence, recipient characteristics including intra-operative factors are elaborated on. Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT, the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia. The strategy of rate control vs rhythm control is discussed. The pros and cons of various drug regimen, need for direct current cardioversion and catheter ablation therapies are considered. Possible methods to prevent or reduce the incidence of AA after LT are considered. The impact of AA on the short-term and long-term outcomes following LT is discussed.

PMID:40535489 | PMC:PMC11886302 | DOI:10.5500/wjt.v15.i2.101005

World J Transplant. 2025 Jun 18;15(2):99241. doi: 10.5500/wjt.v15.i2.99241.

ABSTRACT

Lung transplantation (LT) is currently a surgical therapy option for end-stage lung disease. Venous thromboembolism (VTE), which can occur after LT, is associated with significant morbidity and mortality. Because of improved outcomes, increasing numbers of patients are receiving LT as treatment. Patients on the waitlist for LT tend to be older with weakness and frailty in addition to pulmonary symptoms. These factors contribute to a heightened risk of postoperative VTE. Furthermore, patients who clinically deteriorate while on the waitlist may require extra corporeal membrane oxygenation as a bridge to LT. Bleeding and thromboembolism are common in these patients. Pulmonary embolism (PE) in a freshly transplanted lung can have significant effects leading to morbidity and mortality. PE typically leads to impairment of gas exchange and right ventricular strain. In LT, PE can affect healing of bronchial anastomosis and may even contribute to the development of chronic allograft lung dysfunction. This article discussed the incidence, clinical features and diagnosis of VTE after LT. Furthermore, the treatment modalities, complications, and outcomes of VTE were reviewed.

PMID:40535488 | PMC:PMC11886300 | DOI:10.5500/wjt.v15.i2.99241

World J Transplant. 2025 Jun 18;15(2):100460. doi: 10.5500/wjt.v15.i2.100460.

ABSTRACT

Heart transplantation (HTx) is a life-saving procedure for patients with end-stage heart failure and has undergone remarkable advancements since the first successful transplant in 1967. The introduction of cyclosporine in the 1970s significantly improved patient outcomes, leading to a global increase in transplants, including in India, where the practice has grown despite initial challenges. This review provides an extensive overview of HTx, focusing on current practices, technological advancements, and the ongoing challenges the field faces today. It explores the evolution of surgical techniques, such as minimally invasive and robotic-assisted procedures, and the management of posttransplant rejection through tailored immunosuppressive strategies, including new monoclonal antibodies and personalized therapies. The review also highlights emerging innovations such as mechanical circulatory support devices and xenotransplantation as potential solutions to donor shortages while acknowledging the ethical and logistical challenges these approaches entail. Furthermore, the analysis delves into the implications of using extended-criteria donors and the role of multidisciplinary teams in evaluating absolute and relative contraindications. Despite the progress made, the persistent issues of organ scarcity and ethical concerns underscore the need for ongoing research and innovation to further enhance the efficacy, safety, and accessibility of HTx.

PMID:40535486 | PMC:PMC11886295 | DOI:10.5500/wjt.v15.i2.100460

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):933-936. doi: 10.1007/s12055-024-01892-6. Epub 2025 Jan 7.

ABSTRACT

We describe a case of profound coagulopathy during orthotopic heart transplantation in a cyanotic single ventricle pediatric patient with an intracorporeal continuous flow ventricular assist device performed on bivalirudin for heparin-induced thrombocytopenia. This was successfully managed with central veno-arterial extracorporeal membrane oxygenation and hemofiltration as an adjunct to treat bivalirudin-induced coagulopathy due to lack of a reversal agent for bivalirudin.

PMID:40535220 | PMC:PMC12170461 | DOI:10.1007/s12055-024-01892-6

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):892-905. doi: 10.1007/s12055-025-01900-3. Epub 2025 Apr 17.

ABSTRACT

The enhanced survival rates of patients with functionally univentricular hearts can be credited to the ongoing development of surgical techniques and improved perioperative care. Hence, the population of single ventricle patients reaching the treating physician is increasing. Many of these patients go on to develop end-stage heart failure and may need a heart transplant. In this subgroup, the scarcity of donors calls for the potential necessity of employing mechanical circulatory support to facilitate heart transplantation. Ventricular assist devices are crucial in supporting the failing myocardium and improving systemic perfusion and tissue oxygenation. However, their implantation poses significant challenges due to the unique intrinsic anatomical and physiological characteristics of these patients. There is mounting evidence bolstering the use of ventricular assist devices in a subset of patients with functionally univentricular hearts. The purpose is to examine the evolution and current role of ventricular assist devices in this spectrum of patients, including its challenges and outcomes.

PMID:40535218 | PMC:PMC12170974 | DOI:10.1007/s12055-025-01900-3

Front Physiol. 2025 Jun 4;16:1579815. doi: 10.3389/fphys.2025.1579815. eCollection 2025.

ABSTRACT

Numerous reports investigating channelopathies, including Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), have successfully reproduced using cardiomyocytes (CMs) differentiated from human induced pluripotent stem cells (hiPSCs). However, the relationship between action potentials (AP) and calcium transient waveforms-especially after drug treatment-remains unclear. In this study, we simultaneously loaded a membrane potential dye FluoVolt and the new calcium indicator CalbryteTM 590 AM and optimized stimulation and detection of both dyes to successfully obtain a higher signal-to-noise (S/N) ratio than the conventional membrane potential dye-red fluorescence Ca2+ dye combination, thus enabling the simultaneous recording of both AP and calcium transient waveforms in single hiPSC-CMs, which continued even after gradual increases in drug concentration. In drug-loading experiments on CPVT1 (RyR2-I4587V) hiPSC-derived ventricular-like CMs, carvedilol and flecainide demonstrated some effectiveness, while JTV519 at 3 µM exhibited both efficacy and alterations in AP waveforms. The Ca2+/calmodulin-dependent serine-threonine protein kinase II (CaMKII) inhibitor KN-93 at 1 µM was highly effective (93%) at reducing Ca2+ transient abnormalities without altering AP waveforms.

PMID:40534641 | PMC:PMC12175672 | DOI:10.3389/fphys.2025.1579815

BMC Anesthesiol. 2025 Jun 19;25(1):296. doi: 10.1186/s12871-025-03168-x.

ABSTRACT

BACKGROUND: The aim of this study was to develop a risk calculation model for peri-operative 30-day-mortality in preterm infants in non-cardiac surgery.

METHODS: Retrospective monocentric follow-up cohort-study of 27,453 pediatric anesthesias at a German university hospital and level one perinatal center between 2008 and 2021 for non-cardiac surgeries. Inclusion criteria were age < 37 post-menstrual weeks at the time of surgery. The primary endpoint was 30-day-mortality after surgery. For statistical analysis, stepwise backwards logistic regressions were performed to identify predictors for 30-day mortality after surgery.

RESULTS: Between 2007 and 2021, 278 preterm infants underwent surgery. The 30-day-mortality was 8.6% (24/278; CI95%:5.6–12.6). A preselection of potential risk factors was based primarily on prior knowledge available from the literature and the results of previously published studies. The final prediction model using a multivariable logistic regression revealed lower post-menstrual age (odds-ratio(OR): 0.67; CI95%: 0.54–0.83) and lower body weight at the time of surgery for extremely preterm infants (OR: 0.024; CI95%: 0.003–0.22), administration of dopamine or norepinephrine or epinephrine (OR: 11.6; CI95%: 3.58–37.7), and life-threatening emergencies between 10pm-7am (OR: 10.1; CI95%: 2.36–43.5) as significant independent risk factors for 30-day-mortality. The Area-Under-The-Receiver-Operating-Characteristic-Curve (0.90; CI95%: 0.85–0.96) showed a good discrimination of the final model. The investigation of the calibration curve (p = 0.99, Spiegelhalter test) and the goodness of fit test (p = 0.85, Hosmer-Lemeshow test) indicated no significant discrepancies between estimated and observed probabilities for the peri-operative 30-day mortality.

CONCLUSIONS: Peri-operative 30-day-mortality of preterm infants during non-cardiac surgery is high. The prediction model with easily ascertainable factors as described could be a valuable tool for estimating 30-day-mortality in preterm infants and should be validated in larger populations.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-025-03168-x.

PMID:40537757 | PMC:PMC12180206 | DOI:10.1186/s12871-025-03168-x

Am J Transl Res. 2025 May 15;17(5):3546-3553. doi: 10.62347/SMEE7102. eCollection 2025.

ABSTRACT

INTRODUCTION: Spinal meningoceles are congenital anomalies characterized by meningeal herniation through vertebral defects, most commonly occurring in the lumbosacral region. Intrathoracic meningoceles are rare and are typically associated with neurofibromatosis type 1 (NF-1). True anterior thoracic meningoceles unassociated with NF-1 represent exceptionally rare clinical entities.

CASE SUMMARY: This is a retrospective case report. We report a 15-year-old female with severe kyphoscoliosis and a non-NF-1-associated anterior thoracic meningocele who presented with progressive spastic paraparesis. Imaging examinations revealed thoracolumbar scoliosis with 100-degree kyphotic angulation, midline anterior spina bifida at T7, and a well-defined cystic structure exhibiting hypointense T1 and hyperintense T2 signals (measuring 5.7×4.5 cm) anterior to the T7-T8 vertebral bodies. Surgical intervention included posterior spinal laminar decompression, T7 vertebral osteotomy, microscopic dural sac reduction, and stabilization using a pedicle screw system with autologous bone grafting. The patient was discharged without any complications 12 days after surgery, and at the 12-month follow-up, the patient achieved ambulation with a walker and leg brace.

CONCLUSION: This case underscores the necessity of tailored surgical strategies for anterior thoracic meningoceles complicated by severe spinal deformities. The integration of microsurgical techniques and 3D-printed anatomical modeling may optimize procedural safety and functional outcomes.

PMID:40535678 | PMC:PMC12170365 | DOI:10.62347/SMEE7102

J Pediatr Surg Case Rep. 2025 May;116:102989. doi: 10.1016/j.epsc.2025.102989. Epub 2025 Mar 21.

ABSTRACT

INTRODUCTION: Lipomas are typically slow-growing tumors with the highest incidence in the fourth through sixth decades of life, less commonly occurring in pediatric patients, particularly extending across multiple body compartments. Excision is often reserved for cases that cause cosmetic or compressive symptoms and, due to the slow growth pattern, is less likely to be necessary in younger patients.

CASE PRESENTATION: A 2-year-old female with congenital albinism presented with a painless but visible 3 × 4 cm non-mobile left lateral neck mass that had been present for 2 months. MRI without contrast demonstrated a lobulated lesion in the left inferolateral supraclavicular region extending into the left thoracic inlet and thoracic apex. Due to concern for developing mass effect on carotid space structures, resection of the mass was performed. Complete excision was achieved through a single lower cervical incision, requiring dissection from the brachial plexus, carotid sheath, subclavian vessels, and extrapleural thoracic apex. Final pathology revealed an adipocytic neoplasm consistent with a lipoma with a total specimen size measuring 9 × 6.5 × 5 cm. The patient was discharged on postoperative day one and was healing well without complaint at the time of follow-up.

CONCLUSION: Despite their benign nature, cases such as the one presented here demonstrate the capability of lipomas to adhere to and involve surrounding critical structures, particularly when located in the cervicothoracic region and occurring in younger patients. However, with careful surgical planning involving cross-sectional imaging, such lesions can successfully be completely resected through a single cervical incision without morbidity.

PMID:40535308 | PMC:PMC12176381 | DOI:10.1016/j.epsc.2025.102989

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):852-862. doi: 10.1007/s12055-025-01907-w. Epub 2025 Mar 6.

ABSTRACT

BACKGROUND: The efficacy and safety of off-pump relative to on-pump coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) remain unclear.

OBJECTIVES: Conduct a meta-analysis assessing the outcomes following CABG comparing off-pump CABG vs. on-pump CABG.

METHODS: MEDLINE, Cochrane, and Embase were examined for randomized controlled trials (RCTs) and observational studies that communicated outcomes after off-pump vs. on-pump CABG in patients with LMCAD. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Cochrane recommendations for quality assessment and risk of bias were performed. This study was registered in the PROSPERO platform, ID: CRD42023451467.

RESULTS: One RCT and 17 observational studies with 16,848 patients were included, 6735 (40.0%) of whom underwent off-pump CABG. In patients with LMCAD undergoing CABG, off-pump CABG was associated with a lower incidence of all-cause mortality (OR 0.52, 95% CI 0.38-0.71; p < 0.001), acute renal dysfunction (OR 0.40; 95% CI 0.27-0.59; p < 0.001), postoperative use of intra-aortic balloon pump (IABP) (OR 0.38; 95% CI 0.22-0.64; p < 0.01), and wound infection (OR 0.66; 95% CI 0.48-0.9; p = 0.01). There was no difference between the groups for myocardial infarction (OR 0.81; 95% CI 0.59-1.11; p = 0.193), stroke, or transitional ischemic attack (TIA) (OR 0.64; 95% CI 0.38-1.06; p = 0.085). The number of grafts per patient was also lower in the off-pump CABG group (mean deviation (MD) -0.32; 95% CI -0.50 to -0.14; p < 0.001). After a mean follow-up of 38.1 months, no significant difference in all-cause mortality incidence was observed between the two techniques (OR 0.72; 95% CI 0.30-1.74; p = 0.47). This underscores that the reduction in mortality rates was primarily driven by short-term outcomes.

CONCLUSION: In this meta-analysis with 16,848 patients with LMCAD undergoing CABG, off-pump CABG was associated with lower rates of all-cause mortality, acute renal dysfunction, IABP use, and wound infection compared with on-pump CABG.

GRAPHICAL ABSTRACT: On-pump versus off-pump CABG in patients with LMCAD.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-025-01907-w.

PMID:40535226 | PMC:PMC12170468 | DOI:10.1007/s12055-025-01907-w

Eur J Cardiothorac Surg. 2025 Jun 3;67(6):ezaf135. doi: 10.1093/ejcts/ezaf135.

ABSTRACT

OBJECTIVES: In the last decades, minimally invasive cardiac surgery has emerged as an alternative approach to conventional median sternotomy. However, some reports state an increased risk of iatrogenic acute aortic dissection. Evidence remains limited regarding preoperative diagnostics for risk reduction and the appropriate adjustment of surgical procedures if acute aortic dissection is detected intraoperatively.

METHODS: In this retrospective single-centre observational study, we analysed 1065 patients who underwent minimally invasive cardiac surgery via right anterolateral thoracotomy for atrioventricular valves and atrial structures with femoral cannulation for cardiopulmonary bypass from August 2009 to June 2021. Occurrence of iatrogenic acute aortic dissection was evaluated, along with patient profiles and the primary composite outcome of major adverse cardiovascular events (non-fatal stroke, myocardial infarction or cardiovascular death). An optimal perioperative strategy was subsequently described.

RESULTS: Intraoperative iatrogenic acute aortic dissection was observed in 8 patients (0.75%). It was identified at the start of cardiopulmonary bypass in 4 patients (50.0%). All patients underwent conversion to full sternotomy; 7 patients underwent additional aortic surgery with circulatory arrest thereafter. In-hospital mortality was 37.5% (n = 3), including 1 intraoperative death. Non-fatal stroke was observed in 12.5% (n = 1). A preoperative computed tomography scan was missing in 3 patients with aortic calcification (n = 1) and hostile peripheral arteries (n = 2).

CONCLUSIONS: Intraoperative aortic dissection in minimally invasive cardiac surgery remains a rare complication. Frequent major adverse cardiovascular events highlight the importance of preoperative imaging based procedure planning. Intraoperatively, early diagnosis with standardized monitoring and time- and location-specific surgical adaptations might increase safety and outcomes.

PMID:40534225 | PMC:PMC12199776 | DOI:10.1093/ejcts/ezaf135

J Am Heart Assoc. 2025 Jul;14(13):e042249. doi: 10.1161/JAHA.125.042249. Epub 2025 Jun 18.

ABSTRACT

BACKGROUND: Standardized protocols with optimal hemodynamic targets for percutaneous ventricular assist device (PVAD) management remain undefined. We aimed to evaluate the proportion of phase-specific hemodynamic criteria achieved during PVAD support and their association with outcomes in patients with cardiogenic shock.

METHODS: This multicenter retrospective study enrolled patients with cardiogenic shock requiring PVAD (Impella). Patients were evaluated at 24 hours post-PVAD, venoarterial extracorporeal membrane oxygenation weaning, and PVAD weaning. Hemodynamic criteria consisted of key targets, including mean arterial pressure ≥60 mm Hg, lactate <2.0 mmol/L, right atrial pressure <15 mm Hg, pulmonary artery wedge pressure <20 mm Hg, pulmonary artery pulsatility index ≥1.0, and cardiac power output ≥0.6 W. The primary outcome was a composite of 30-day all-cause mortality and unplanned mechanical circulatory support reintroduction.

RESULTS: A total of 501 patients were enrolled: 206 (41%) with PVAD alone and 295 (59%) with PVAD and venoarterial extracorporeal membrane oxygenation. The majority of patients were supported with Impella CP (406, 81%). Fulfillment of criteria was observed in 37%, 52%, and 45% at 24 hours post-PVAD, venoarterial extracorporeal membrane oxygenation weaning, and PVAD weaning, respectively. Patients with unfulfilled criteria at each evaluation point were at high risk for the primary outcome (hazard ratio, 3.2 [95% CI, 2.1-4.8]; hazard ratio, 2.1 [1.2-3.7]; and hazard ratio, 2.0 [95% CI, 1.1-3.6]). Hemodynamic criteria achievement consistently stratified the risk of the primary outcome across different subgroups, including shock cause, shock stage, and concomitant use of venoarterial extracorporeal membrane oxygenation.

CONCLUSIONS: Phase-specific hemodynamic criteria are often unmet and are associated with significantly higher risks of short-term fatal events.

PMID:40530483 | DOI:10.1161/JAHA.125.042249