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J Gastrointest Oncol. 2025 Aug 30;16(4):1756-1762. doi: 10.21037/jgo-2025-26. Epub 2025 Aug 8.

ABSTRACT

BACKGROUND: Carcinoid syndrome (CS) is a rare complication of neuroendocrine tumors (NETs). Characterized by cutaneous flushing, diarrhea, abdominal pain, and long-term risk for valvular heart disease, these components occur in a fraction of patients with advanced disease. Early recognition through history taking, physical and laboratory examination, and clinical imaging is paramount to successful management.

CASE DESCRIPTION: We report a case of CS in a 21-year-old male patient found to have a metastatic gastrointestinal, well differentiated (Ki67 <3%) NET. The patient presented with cutaneous flushing, diarrhea, abdominal pain, dyspnea, ascites, and peripheral edema. On imaging, he was found to have a massive left pleural effusion, innumerable enhancing hepatic lesions, mesenteric lymphadenopathy, and large-volume ascites. Cardiac imaging further showed severe tricuspid regurgitation and right heart failure. Biopsy of the enhancing hepatic lesions showed a grade 1 NET of gastrointestinal origin. Urine testing revealed markedly high serotonin metabolites. The patient was started on somatostatin analogues, which resulted in improved control of diarrhea and flushing. Thoracoscopic surgery improved pleural effusion accumulation, and recurrent abdominal ascites was treated with paracentesis when necessary. He was also referred to cardiothoracic surgery tricuspid valve replacement surgery.

CONCLUSIONS: Our case illustrates the classic characteristics of CS as well as valvular heart disease supported by clinical imaging of the syndrome's involvement of multiple organ systems. These findings are important for physicians to recognize as early recognition of CS can lower the risk of long-term complications of carcinoid heart disease. Additionally, patients with limited access to healthcare may be at risk of later CS presentation.

PMID:40950358 | PMC:PMC12432937 | DOI:10.21037/jgo-2025-26

J Coll Physicians Surg Pak. 2025 Sep;35(9):1083-1087. doi: 10.29271/jcpsp.2025.09.1083.

ABSTRACT

OBJECTIVE: To investigate the incidence of postoperative atrial fibrillation (POAF) in patients following isolated coronary artery bypass grafting (CABG), evaluate its impact on mortality and morbidity, and analyse demographic and comorbid variables associated with its onset.

STUDY DESIGN: Observational cohort study. Place and Duration of the Study: Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkiye, from June 2020 to December 2022.

METHODOLOGY: Patients who underwent isolated CABG were included in the study. Those diagnosed with valvular heart disease on echocardiography were excluded, as were those with a history of atrial fibrillation (AF).

RESULTS: Statistical analysis was conducted on data from 489 patients. Among the demographic factors examined, only age (p = 0.021) exhibited a significant correlation with the development of POAF. Chronic renal disease (p = 0.044) and reduced glomerular filtration rate (GFR) levels (p = 0.020) were significantly associated with POAF. Regarding perioperative factors, cardiopulmonary bypass (CPB) duration (p = 0.104) was not significantly related to POAF, whereas prolonged cross-clamp time was (p = 0.009). POAF was associated with postoperative complications, including acute kidney damage (p = 0.002), extended intubation (p = 0.003), infection (p <0.001), the need for intra-aortic balloon pump (IABP) or inotropic support (p = 0.004), and mortality (p = 0.001).

CONCLUSION: POAF is a common complication after isolated CABG and is significantly associated with advanced age, reduced GFR, chronic kidney disease, and prolonged cross-clamp time. Its occurrence is associated with increased postoperative morbidity and mortality. These findings emphasise the importance of perioperative risk factors in predicting adverse outcomes.

KEY WORDS: Atrial fibrillation, Coronary artery bypass, Acute kidney injury, Mortality, Morbidity, Intra-aortic balloon pumping.

PMID:40948152 | DOI:10.29271/jcpsp.2025.09.1083

J Thorac Dis. 2025 Aug 31;17(8):5561-5574. doi: 10.21037/jtd-2025-634. Epub 2025 Aug 22.

ABSTRACT

BACKGROUND: Previous studies comparing off-pump versus on-pump coronary artery bypass grafting (CABG) have shown inconsistent results, especially for left main coronary artery disease (LM CAD), largely due to variations in surgical expertise. This study evaluates outcomes from a high-volume center with considerable experience in both techniques.

METHODS: We retrospectively analyzed 1,410 patients with significant LM CAD (stenosis ≥70% or functionally significant 50-69%) who underwent isolated CABG between 2003 and 2017. The primary endpoint was a composite of death, myocardial infarction (MI), or stroke within 5 years. Analyses included Cox regression, inverse probability of treatment weighting (IPTW), and propensity score (PS) matching with adjustments for surgeon type and temporal trends.

RESULTS: Of 1,410 patients, 824 underwent off-pump and 586 underwent on-pump CABG. The off-pump group demonstrated a low conversion rate (1.0%) and high left internal mammary artery (LIMA) utilization (97.0%). The 5-year composite endpoint (death, MI, or stroke) was similar between groups [14.7% for off-pump vs. 15.0% for on-pump; unadjusted hazard ratio (HR): 0.98, 95% confidence interval (CI): 0.74-1.30], and this finding persisted after adjustments for baseline differences. Individual components showed comparable rates of death and stroke, while in-hospital composite outcomes were lower in the off-pump group (1.3% vs. 3.5%; P=0.01).

CONCLUSIONS: Our findings suggest that in a high-volume center with experienced surgeons, off-pump CABG for LM CAD can achieve long-term outcomes comparable to on-pump CABG. Larger prospective studies are warranted to confirm these findings and establish optimal patient selection criteria.

PMID:40950864 | PMC:PMC12433041 | DOI:10.21037/jtd-2025-634

J Extra Corpor Technol. 2025 Sep;57(3):160-163. doi: 10.1051/ject/2025002. Epub 2025 Sep 15.

ABSTRACT

The development of multi-organ failure resulting from cardiopulmonary bypass (CPB) is acknowledged as a significant contributor to increased morbidity and mortality rates during the postoperative period. This report discusses a patient who presents with multiple comorbidities, including renal failure, reduced ejection fraction, and a history of hypertension, and is being considered for coronary artery bypass grafting (CABG) along with aortic valve replacement surgery. The administration of CPB was customized to address the unique comorbid conditions of the patient, highlighting the critical objective of maintaining an oxygen delivery index (DO2i) exceeding 280 mL/min/m2, while also integrating pulsatile flow methodologies. The management of CPB, as previously discussed, resulted in a notable enhancement of kidney function, accompanied by a reduction in the patient's lactate levels post-surgery.

PMID:40953244 | PMC:PMC12435815 | DOI:10.1051/ject/2025002

J Extra Corpor Technol. 2025 Sep;57(3):147-152. doi: 10.1051/ject/2025018. Epub 2025 Sep 15.

ABSTRACT

BACKGROUND: The use of VA extracorporeal membrane oxygenation (ECMO) for cardiac recovery is widely adopted, with extensive publications on assessing readiness to wean from VA ECMO. Techniques to reduce ECMO support vary, including reducing flows to a low continuous cardiac index, adding bridges, temporary flow cessation, or decreasing ECMO RPMs.

METHOD: We propose an alternative method involving repeated cycles of 3-4 min of ECMO flow cessation ("clamp") followed by a 30-second return ("flash") of flow. This method requires additional anticoagulation to achieve an elevated ACT, targeting 220 s for adults and 210 s for pediatrics with heparin drip and bolus, or 240 s for adults and 225 s for pediatrics with bivalirudin drip and heparin bolus. During the clamp period, flow is stopped in adult ECMO circuits with a single venous line clamp, while in pediatric circuits, flow continues via the manifold shunt but is stopped in the arterial and venous lines with a single venous line clamp. Flashing the circuit resumes patient flow for 30 s to circulate stagnant blood.

RESULTS: This method significantly reduces support during the trial, which lasts one hour for adults and up to two hours for pediatric patients. The heart is unsupported 85-90% of the time, with an 85% decrease in cardiac support compared to low-flow trials.

CONCLUSION: Since 2011, our center has used this technique without thrombotic complications when the protocol is followed. Most patients removed from ECMO did not require reinstitution, with rare cases needing VV support or VA support due to sepsis onset.

PMID:40953242 | PMC:PMC12435822 | DOI:10.1051/ject/2025018

J Extra Corpor Technol. 2025 Sep;57(3):129-136. doi: 10.1051/ject/2025006. Epub 2025 Sep 15.

ABSTRACT

BACKGROUND: Data is limited regarding the effects of supraphysiologic blood oxygen tension in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and outcomes in pediatric patients requiring veno-arterial (VA) ECLS.

METHODS: Retrospective single-center study at an academic children's hospital that included all patients 0-18 years who required VA-ECLS between 01/2014 and 12/2019.

RESULTS: During the study period, 229 VA-ECLS runs occurred in 229 patients. The majority of patients were neonates (73.4%), with cardiac being the most common indication (48.9%). The median time from admission to cannulation was 78.5 h (IQR 14, 356) with a median ECLS duration of 111.5 h (IQR 65.5, 184.5). The overall mortality rate was 44.5%. Using a receiver operating curve, a mean PaO2 of 233 mmHg in the first 48 h of ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 36% and specificity 76%). Of the VA-ECLS cohort, 68 (29.7%) had a mean PaO2 > 233 mmHg (hyperoxia group). The hyperoxia group tended to be older (median age 4.6 vs 1.5 months, p = 0.019), had a primary cardiac indication for VA-ECLS (60% vs 44%, p = 0.0004), and had a higher mortality rate (54% vs 40%, p = 0.050). In the multivariable analysis, after adjusting for covariables, the data demonstrated increased odds of mortality (aOR 2.02, 95% CI [1.03, 3.97], p = 0.03). The odds of development of stage II or III acute kidney injury (AKI) (aOR 2.04, 95% CI [0.82, 5.50]), but that did not reach statistical significance (p = 0.120).

CONCLUSION: There is evidence that hyperoxia during the first 48 h of VA-ECLS may be associated with mortality and development of acute kidney injury, although this did not reach statistical significance. Multicenter and prospective evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.

PMID:40953240 | PMC:PMC12435806 | DOI:10.1051/ject/2025006

PLoS One. 2025 Sep 15;20(9):e0332597. doi: 10.1371/journal.pone.0332597. eCollection 2025.

ABSTRACT

Short-term mechanical circulatory supports (MCS) are used to stabilize patients with severe cardiogenic shock (CS). Catheter ablation may be an option to suppress recurrent arrhythmias preventing MCS weaning. We retrospectively analysed a dedicated registry to identify CS patients who underwent a catheter ablation between January 2020 and August 2024 for treatment resistant and hemodynamically significant arrhythmias while being on the MCS. Patients with supraventricular and ventricular tachycardias (SVT/VT) were analysed separately. Nine patients (8 males, 69 [IQR 60;74] years) were ablated for a refractory VT. Impella CP was used in 6 patients, VA ECMO in 2 patients, and 1 patient was on ECPELLA. Seven patients (78%) were successfully weaned off the MCS after the catheter ablation. 3 patients (33%) died within 30 days. The arrhythmia recurred in 5 patients (56%). Significant complications of MCS were reported in 6 patients (66%). The catheter ablation was complicated in one patient. SVT ablation was performed in 4 patients (3 males, 73 [IQR 67; 78] years, 1x VA ECMO, 2x Impella CP, 1x Impella 5.5). Three patients with atrial fibrillation were treated by a non-selective AV node ablation (pace and ablate strategy). One patient underwent an ablation of focal atrial tachycardia. The MCS was successfully explanted in all patients and no patient died in 30 days. The MCS use was complicated in one patient. Catheter ablation of refractory arrhythmias in CS patients treated by MCS is a safe and feasible approach to facilitate the MCS weaning process.

PMID:40953065 | PMC:PMC12435639 | DOI:10.1371/journal.pone.0332597

A A Pract. 2025 Sep 15;19(9):e02054. doi: 10.1213/XAA.0000000000002054. eCollection 2025 Sep 1.

ABSTRACT

Microbubbles during extracorporeal membrane oxygenation (ECMO) can cause systemic embolism. We report a 33-year-old woman in late pregnancy with COVID-19-associated myocarditis supported by veno-veno-arterial ECMO and Impella 5.5. During rapid transfusion via central venous catheter for massive hemorrhage after emergency cesarean section, transesophageal echocardiography (TEE) revealed microbubbles entering the arterial circulation. The bubbles resolved after pausing transfusion. Although the patient initially recovered without neurological deficits, she later died from unrelated intracranial hemorrhage. This case highlights the need to prevent air entrainment during transfusion and illustrates the diagnostic value of intraoperative TEE in detecting systemic microembolism under mechanical circulatory support.

PMID:40952022 | DOI:10.1213/XAA.0000000000002054

Ultrasound. 2025 Sep 11:1742271X251353722. doi: 10.1177/1742271X251353722. Online ahead of print.

ABSTRACT

BACKGROUND: Bedside ultrasound of inferior vena cava is used by clinician sonographers in intensive care units. Its data can impact clinical decision-making. Subcostal view is a standard view for this issue. A significant proportion of the intensive care unit patients have very difficult approach to this view. In these patients, an alternative view is a transhepatic view, feasible in nearly every intensive care unit patient. Limited data on the ultrasound technique exist in literature.

AIM: In this review, we discuss in detail the technical aspects of the inferior vena cava ultrasound technique assessed from the transhepatic view, ultrasound tips, and pitfalls.

METHODS: A search was performed using PubMed, Google Scholar, EMBASE, and Scopus databases with the terms "inferior vena cava ultrasound," "transhepatic view," "right mid-axillary view," "right lateral intercostal view," "ultrasound technique," "inferior vena cava pitfalls," and inferior vena cava ultrasound tips," "intensive care unit." The latest articles were reviewed and this review was written using the most current information.

DISCUSSION: A standardised ultrasound approach from mid-axillary line provides optimal image acquisition. When there are difficulties finding inferior vena cava or in obesity alternative approaches should be used. Potential pitfalls during acquisition are: misidentifying the inferior vena cava; technical issues in inferior vena cava measurements; utility of the inferior vena cava data in isolation.

CONCLUSION: Mastering the ultrasound technique from the transhepatic view offers clinicians the opportunity to perform inferior vena cava ultrasound, even in the most challenging patients. Awareness of potential pitfalls and knowledge how to avoid them is important to intensive care unit clinicians to avoid wrong decisions at the bedside.

PMID:40951908 | PMC:PMC12425945 | DOI:10.1177/1742271X251353722

Int J Stroke. 2025 Sep 13:17474930251381131. doi: 10.1177/17474930251381131. Online ahead of print.

ABSTRACT

BACKGROUND: Ischemic stroke remains a leading cause of morbidity and mortality worldwide. Cardioembolic sources account for a significant proportion of these events, necessitating accurate identification of underlying structural heart abnormalities. Traditionally, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been utilized for this purpose, although both have limitations. Cardiac computed tomography (CCTA) has emerged as a potential alternative, offering non-invasive imaging with high sensitivity and specificity for detecting intracardiac thrombi.

OBJECTIVE: This study aimed to evaluate the diagnostic yield of CCTA compared to TTE and TEE in detecting high-risk cardioaortic sources of embolism, including left ventricular (LV) thrombus, left atrial (LA) thrombus, valvular thrombus, and ulcerated aortic plaques, in patients with ischemic stroke.

METHODS: We conducted a retrospective, single-center cohort study at Mayo Clinic, Rochester, MN, including 426 ischemic stroke patients who underwent CCTA within 30 days of stroke onset between March 2019 and June 2023. We compared the diagnostic yields of CCTA, TTE, and TEE in detecting structural cardiac sources of embolism.

RESULTS: The overall diagnostic yield of CCTA for detecting high-risk cardioaortic sources was 15.5%. Specifically, CCTA identified LV thrombus in 2.3% of patients, LA thrombus in 4.0%, valvular thrombus in 2.8%, and ulcerated aortic plaques in 7.0%. In comparative analysis, CCTA demonstrated a higher yield than TTE (16.0% vs. 3.5%, P<0.001) and a comparable yield to TEE (25.3% vs. 20.7%, P=0.47) in detecting these sources.

CONCLUSIONS: CCTA proved to be a viable option for identifying high-risk structural sources of cardioembolism in ischemic stroke patients. Its non-invasive nature, coupled with the ability to perform imaging soon after stroke onset, underscores its clinical utility. However, further prospective and blinded studies are required to validate these findings and fully establish the efficacy of CCTA in this context.

PMID:40944425 | DOI:10.1177/17474930251381131

J Clin Med. 2025 Aug 27;14(17):6064. doi: 10.3390/jcm14176064.

ABSTRACT

Background: The perfusion of viscera, kidney, and spinal cord represents one of the main concerns during open repair (OR) of Thoraco-Abdominal Aortic Aneurisms (TAAAs). Passive shunting (PS) has been historically used for intraoperative distal aortic perfusion but has been progressively replaced almost entirely by partial left-sided heart or total cardiopulmonary bypass with extra-corporeal circulation (ECC). Despite several advantages of these methods, PS still has potential in mitigating some drawbacks of long extracorporeal circuits connected with centrifugal or roller pumps, such as the need for cardiac and great vessels cannulation, priming and large intravascular fluid volume shifts, high heparin dose, immunosuppressive effects, and systemic inflammatory response syndrome. Methods: This study prospectively analyzed data of a cohort of patients who underwent TAAA OR using a PS in a single institution. Outcomes of interest were mortality, rate of mesenteric, renal and spinal cord ischemia, cardiac complications, and intraoperative hemodynamic stability achieved in this setting. Our institutional bundle and a comprehensive literature review about the different configurations and applicability of PS for TAAA OR is also reported. The search was performed based on three databases (PubMed, EMBASE, and Cochrane Library) by two independent reviewers (LS and AA) from inception to 31 December 2023, and the reported clinical results (visceral, renal, and spinal cord complications and mortality) using PS during TAAAs OR were analyzed. Results: Between March 2021 and December 2023, 51 TAAA repairs were performed and eleven patients (n = 8, 73% male; mean age 67 years, range 63-79) were operated using a PS for a total of one (9%) type I, one (9%) type II, two (18%) type III, five (45%) type IV, and two (18%) type V TAAA. In our early experience, PS was indicated for limited staff resources during the COVID-19 pandemic to treat five non-deferable cases. The sixth and seventh patients were selected for PS as they already had a functioning axillo-bifemoral bypass that was used for this purpose. For the most recent cases, PS was chosen as the primary perfusion method according to a score based on clinical and anatomical factors with ECC as a bailout strategy. Selective renal perfusion with cold (4 °C) Custodiol solution was the method of choice for renal protection in all cases while antegrade perfusion of the coeliac trunk and the superior mesenteric artery was assured by PS through a loop graft (8-10mm) proximally anastomosed to the axillary artery (10 patients, 90.9%) or the descending thoracic aorta (one patient, 9%) and distally anastomosed to the infrarenal aorta (3), common iliac (3), or femoral vessels (5). In-hospital mortality was 9% as one patient died on the 10th postoperative day from mesenteric ischemia following hemodynamic instability; permanent spinal cord ischemia rate was 0% and the rate of AKI stage 3 was 9% (one patient). Bailout shifting to ECC was never required. No cardiac complications, nor a significant increase in serum CK-MB were reported in any patient. No prolonged severe intraoperative hypotension episodes (Mean Arterial Pressure < 50 mmHg) were assessed using the Software Acumen Analytics (Edwards LifeSciences, Irvine CA, USA). No peri-operative coagulopathy nor major bleeding was reported. Conclusions: Our experience showed satisfactory outcomes with the use of PS in specifically selected cases. Current data indicate that PS may represent an alternative to ECC techniques during TAAAs OR in high volume centers where assisted extracorporeal circulation could eventually be applied as a bailout strategy. However, due to the small sample size of this and previously published series, more data are needed to clearly define the potential role of such approach during TAAA OR.

PMID:40943821 | PMC:PMC12429315 | DOI:10.3390/jcm14176064

Cells. 2025 Aug 31;14(17):1357. doi: 10.3390/cells14171357.

ABSTRACT

Patients with heart failure with a reduced ejection fraction (HFrEF) are at an increased risk of developing postoperative hemodynamic instability and vasoplegia after surgery on cardiopulmonary bypass (CPB). Potentially pre-existing endothelial cell (EC) alterations due to chronic HF influence EC responses to cardiac surgery and might be responsible for the altered vascular responsiveness observed postoperatively. In this study, well-described EC activation markers were measured in blood samples collected pre- and perioperatively at four time points from HFrEF and control patients undergoing cardiac surgery on cardiopulmonary bypass (CPB). Circulating levels of Angiopoietin 2 (ANG2), von Willebrand Factor (vWF), and soluble P-selectin were measured using ELISA. Additionally, we investigated the responses of the cultured EC to patient-derived plasma through morphological profiling and mitochondrial functional assays. In total, 36 patients were included (67 (61-71) years, 78% male). HFrEF patients had higher baseline ANG2 and vWF levels when compared to controls. Both markers peaked during the first postoperative day. A pronounced increase in vWF was seen in controls after CPB. Ex vivo EC responses to patient-derived plasma showed distinct morphological differences between the two groups at baseline. A mitochondrial analysis indicated alterations in function and morphology for both groups after CPB. In conclusion, HFrEF patients exhibit a dampened EC response to cardiac surgery on CPB. Stable circulating factors in HFrEF plasma are responsible for inducing EC stress. Moreover, the mitochondrial function is highly affected postoperatively. This pre-existing mitochondrial and EC dysfunction predispose HFrEF patients to postoperative hemodynamic instability.

PMID:40940768 | PMC:PMC12428422 | DOI:10.3390/cells14171357

J Clin Med. 2025 Sep 3;14(17):6236. doi: 10.3390/jcm14176236.

ABSTRACT

Background: Spinal anesthesia is a widely used technique for pain control in surgical procedures, requiring effective drug distribution within the cerebrospinal fluid (CSF) for optimal outcomes. The distribution is influenced by injection parameters such as needle diameter and injection speed, which, if not optimized, can reduce efficacy or cause side effects. This study investigates how these parameters affect drug distribution in the CSF using computational fluid dynamics (CFD). Material Methods: An anatomically accurate three-dimensional model of the CSF space was created using MRI data. Simulations were performed using three needle tips (22 G, 25 G, 27 G) and different injection rates at the L4-L5 vertebral level. The model included physiological CSF oscillations from cardiac and respiratory cycles. Drug dispersion was analyzed in terms of spatial distribution and concentration changes over time. Results: The findings obtained show that the combination of a large-gauge needle (22G) and high injection speed provides wider distribution within the CSF and more effective transport to the cranial regions. On the other hand, with a small-gauge needle (27G) and low injection speed, the drug remained more localized, and access to the upper spinal regions was limited. Additional parameters such as injection duration, direction, and flush applications were also observed to significantly affect distribution. Conclusions: CFD modeling reveals that injection parameters significantly affect drug dispersion patterns in spinal anesthesia. Optimizing these parameters may improve therapeutic outcomes and reduce complications. The model provides a foundation for developing personalized intrathecal injection protocols.

PMID:40943995 | PMC:PMC12429119 | DOI:10.3390/jcm14176236

J Clin Med. 2025 Aug 28;14(17):6080. doi: 10.3390/jcm14176080.

ABSTRACT

Background/Objectives: Perioperative organ injury (POI) is frequently observed following hepatectomy as acute kidney injury (AKI), perioperative myocardial injury (PMI), or both. We aimed to determine the incidences of POI, PMI, and AKI, reveal the risk factors and predictive tools for POI occurrence, and evaluate the relationship between POI and patient outcomes. Methods: This was a single-center historical cohort study of consecutive patients. The primary endpoint was the occurrence of POI within 3 days following hepatectomy. Results: Out of 128 patients, POI, PMI, and AKI occurred in 48 (37.5%), 36 (28.1%), and 23 (18%) patients, respectively. Ten (7.8%) patients suffered from both PMI and AKI. The presence of chronic kidney disease or systolic/valvular heart disease, fluid balance more than 365 mL/h, and intraoperative bleeding more than 950 mL were the risk factors for POI. A tool created by using the intraoperative decline of central venous oxygen saturation and lactate value during skin closure performed well in predicting POI (area under the ROC curve: 0.79, p < 0.001). In patients with POI, the number of those who needed intensive care unit (ICU) follow-up for more than 1 day was significantly higher (21% vs. 6%, p: 0.01). The length of hospital stay for these patients was significantly longer as well (11 (8-18) vs. 9 (7-13) days, p: 0.02). Two patients (20% of 10 patients who suffered from both AKI and PMI) died in the 90-day follow-up. Conclusions: POI is a common complication following hepatectomy and is associated with longer hospital and ICU stays. Patients who suffer from both AKI and PMI have a higher risk of mortality.

PMID:40943838 | PMC:PMC12429616 | DOI:10.3390/jcm14176080

Elife. 2025 Sep 12;14:RP107148. doi: 10.7554/eLife.107148.

ABSTRACT

Tissue regeneration enhancer elements (TREEs) direct expression of target genes in injured and regenerating tissues. Additionally, TREEs of zebrafish origin were shown to direct expression of transgenes in border zone regions after cardiac injury when packaged into recombinant adeno-associated viral (AAV) vectors and introduced into mice. Future implementation of TREEs into AAV-based vectors as research tools and potential gene therapy modalities requires a deeper understanding of expression dynamics and potential off-target effects. Here, we applied in vivo bioluminescent imaging to mice systemically injected with AAV vectors containing different combinations of capsids, enhancers, and timing of delivery. Longitudinal tracking of expression directed by different TREEs revealed distinct amplitudes and durations of reporter gene expression in the injured heart. The liver-de-targeted AAV capsid, AAV.cc84, could deliver TREEs either pre- or post-cardiac injury to negate off-target expression in the liver while maintaining transduction in the heart. By screening AAV9-based capsid libraries dosed systemically in mice post-cardiac injury, we discovered a new capsid variant, AAV.IR41, with enhanced transduction in cardiac injuries and with elevated transduction of TREE-driven transgenes versus conventional AAV9 vectors. In vivo bioluminescence imaging offers insights into how enhancers and engineered capsids can be implemented to modulate spatiotemporal transgene expression for targeted therapies.

PMID:40938325 | PMC:PMC12431772 | DOI:10.7554/eLife.107148

J Physiol. 2025 Sep 12. doi: 10.1113/JP288649. Online ahead of print.

ABSTRACT

The heart functions within a complex system that adapts its function to alterations in loading via several mechanisms. For example, the baroreflex is a feedback loop that modulates the heart's function on a beat-to-beat basis to control arterial pressure. On the other hand, cardiac growth is an adaptive process that occurs over weeks or months in response to changes in left ventricular loading. In this study, we investigate the impact of a baroreflex feedback loop on left ventricular growth in simulations of valve disease. To achieve this, we integrated the effects of a baroreflex feedback loop and a growth algorithm into a beating multiscale finite element model of the left ventricle. Our integrated model replicated clinical measures of left ventricular growth in two types of valvular diseases - aortic stenosis and mitral regurgitation - at two different levels of severity for each case. Furthermore, our results showed that incorporating the effects of baroreflex control in simulations of left ventricular growth not only led to more realistic haemodynamics, but also impacted the magnitude of growth. Finally, our results suggest that the regulation of Ca2+ dynamics by the baroreflex is a crucial mechanism in adapting the myocardial cell in response to altered loading due to aortic stenosis and mitral regurgitation. KEY POINTS: The heart adapts its function in response to alterations in loading via short-term and long-term mechanisms. These mechanisms are essential for maintaining proper blood pressure in the vasculature (baroreflex) and homeostasis in the heart (ventricular growth). In this study, we investigate the impact of a baroreflex feedback loop on left ventricular growth in finite element simulations of valve disease. We showed that incorporating the effects of baroreflex control and ventricular growth not only led to more realistic haemodynamics, but also impacted the magnitude of growth. Our results suggest that the regulation of Ca2⁺ dynamics by the baroreflex is a crucial mechanism in adapting the myocardial cell in response to altered ventricular loading.

PMID:40938767 | DOI:10.1113/JP288649

Circ Rep. 2025 Jul 23;7(9):715-726. doi: 10.1253/circrep.CR-25-0098. eCollection 2025 Sep 10.

ABSTRACT

BACKGROUND: The optimal timing for mechanical circulatory support (MCS) initiation in patients with acute myocardial infarction complicated by cardiogenic shock (CS) is unknown, so in this study we analyzed whether MCS implementation before percutaneous coronary intervention (PCI) is associated with better outcomes compared to after PCI.

METHODS AND RESULTS: We conducted a systematic review and meta-analysis using a random-effects model to account for potential heterogeneity. Risk ratios and 95% confidence intervals were used for dichotomous outcomes. PubMed, Web of Science, and CENTRAL were searched up to April 30, 2023. Certainty of evidence was evaluated according to the Risk of Bias in Non-Randomized Studies of Interventions-I tool. A total of 14 observational studies met the inclusion criteria. We found that venoarterial-extracorporeal membrane oxygenation (VA-ECMO) may have little to no positive effect on short-term survival, but the evidence was very uncertain. Impella use probably increases short-term survival (moderate certainty of evidence), whereas the timing of intra-aortic balloon pump (IABP) insertion improves outcomes (very low certainty of evidence). Pre- and post-PCI MCS implementation may result in little to no difference in bleeding complications or stroke incidence across all device types (low to very low certainty of evidence).

CONCLUSIONS: Early Impella implementation before PCI may increase short-term survival, whereas the timing of ECMO or IABP implementation may have little to no effect on outcomes; however, the evidence is very uncertain.

PMID:40937035 | PMC:PMC12421136 | DOI:10.1253/circrep.CR-25-0098

J Cardiothorac Vasc Anesth. 2025 Aug 18:S1053-0770(25)00673-1. doi: 10.1053/j.jvca.2025.08.026. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of perioperative blood pressure variability (BPV) on cardiovascular outcomes and mortality in cardiac surgery patients.

METHODS: Literature searches were performed across scientific databases up to December 31, 2024. Studies reporting perioperative BPV in patients undergoing cardiac surgery and its association with mortality and clinical outcomes were included.

RESULTS: Fifteen studies with 16,407 patients were included. Increased BPV was significantly associated with higher rates of 30-day mortality, acute kidney injury (AKI), prolonged intensive care unit stay, and cognitive dysfunction. Among patients with fewer comorbidities and perioperative risk, 30-day mortality ranged from 0.2% to 0.5%, while in patients with higher risk, it increased from 42.4% to 60.7% (p < 0.001). Elevated BPV was linked to a 23.2% higher risk of AKI per unit increase in blood pressure (BP) standard deviation (SD) and a 15% increased incidence of postoperative delirium. The findings emphasize the critical need for precise perioperative BP control, with advanced metrics like BP fragmentation providing valuable insights into patient risk.

CONCLUSIONS: Perioperative BPV appears to be a crucial factor influencing postoperative outcomes in cardiac surgery patients. Effective management of BPV may help reduce complications and improve patient outcomes, highlighting the potential benefits of tailored hemodynamic strategies. However, further research is needed to establish standardized BPV thresholds and optimal management approaches.

PMID:40940247 | DOI:10.1053/j.jvca.2025.08.026

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Jul 21;33(3):321-328. doi: 10.5606/tgkdc.dergisi.2025.27656. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: In this review, we discuss the risk factors of intraabdominal hypertension developing after cardiac surgery.

METHODS: We used records from electronic databases (PubMed, Scopus, Web of Science and Ovid) between 1980 and 2025. All studies in which possible pre- and intraoperative risk factors (age, sex, hypertension, diabetes mellitus, lung disease, coronary artery bypass grafting, body mass index and, cardiopulmonary bypass duration) were recorded were included in the analysis. The results of the studies were evaluated with a random or fixed effect model depending on the presence of heterogeneity (I2 >25%).

RESULTS: A total of 4,286 articles were found from the database search. After analyzing the abstract and full texts, six articles which met the inclusion criteria and covered 696 patients were included in the analysis. The overall rate of intraabdominal hypertension was 44.68%. Age (standardized mean difference [SMD]: 0.303, 95% confidence interval [CI]: 0.123-0.484, p<0.001), hypertension (odds ratio [OR]=0.524, 95% CI: 0.087-0.960, p=0.019), body mass index (SMD: 0.532, 95% CI: 0.004-1.061, p=0.048), and cardiopulmonary bypass duration (SMD: 0.545, 95% CI: 0.184-0.907, p=0.003) were preoperative risk factors.

CONCLUSION: The patient's age, hypertension, body mass index, and duration of cardiopulmonary bypass are the risk factors for the development of intraabdominal hypertension after cardiac surgery. However, larger studies are needed to avoid heterogeneity of results.

PMID:40936981 | PMC:PMC12421560 | DOI:10.5606/tgkdc.dergisi.2025.27656

J Adv Res. 2025 Sep 9:S2090-1232(25)00694-0. doi: 10.1016/j.jare.2025.09.011. Online ahead of print.

ABSTRACT

INTRODUCTION: Aortic stenosis (AS) involves aortic obstruction, pressure overload, reduced cardiac output, and impaired organ arterial hemodynamics. Many patients remain at risk of rehospitalization or death after transcatheter aortic valve replacement (TAVR) due to unclear mechanisms. Our previous studies linked bile acids (BAs) metabolism to heart-other organ crosstalk, but the BAs-hemodynamics interplay in AS remains unclear.

OBJECTIVES: To investigate metabolic abnormalities in AS, focusing on the role of BA metabolism in AS pathogenesis and the underlying mechanisms.

METHODS: An acute canine model of AS was established via intra-aortic balloon catheter-induced transverse aortic obstruction (ITAO). Computational fluid dynamics (CFD) simulation was performed to assess the arterial hemodynamics of the aorta and other organs. Untargeted/targeted metabolomics and transcriptomics were performed in ITAO and deleting ITAO (deITAO) canines. The findings were validated in 33 controls and 30 AS patients. Metabolic predictive performance was assessed by the area under the receiver operating characteristic (AUROC) curve. Transcriptomic and western blot analyses were used to assess the effects of glycoursodeoxycholic acid (GUDCA) and glycoursodeoxycholic acid 3 sulfate sodium (GUDCA-3S) on isoproterenol (ISO)-induced myocardial remodeling.

RESULTS: ITAO replicated AS hemodynamics (reduced cardiac output, increased aortic velocity), reversed post-deITAO. CFD revealed that ITAO increased organ (e.g., liver) artery pressure, improved after deITAO. Untargeted metabolomics identified 1583 differentially abundant metabolites; transcriptomics revealed 291 DEGs enriched in BA biosynthesis. Targeted BA analysis revealed that GUDCA-3S was elevated in ITAO canines, correlated with aortic velocity (R = -0.4822, P = 0.0002) and BNP (R = 0.3836, P = 0.0019) in AS patients, and exhibited superior AS diagnostic performance (AUROC = 0.844, P < 0.001). Reduced aortic flow upregulated hepatic SULT2A1, driving GUDCA sulfonation to GUDCA-3S and weakening GUDCA's cardioprotection by impairing IL-17/NF-κB signaling inhibition in ISO-induced cardiomyocytes.

CONCLUSIONS: BA metabolism dysfunction responds to cardiac hemodynamic changes, with GUDCA-3S linking cardiac hemodynamics and BA metabolism in AS.

PMID:40934971 | DOI:10.1016/j.jare.2025.09.011