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Res Pract Thromb Haemost. 2025 Jul 29;9(5):102988. doi: 10.1016/j.rpth.2025.102988. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Antithrombotic therapy (AT) after cardiac valve surgery is complex, with guidelines often relying on limited evidence.

OBJECTIVES: This study examines real-world adherence to the European Society of Cardiology Class II, level C recommendations for AT in valve surgery, as well as the 6-month impact of AT on patient outcomes.

METHODS: This prospective, observational subanalysis of the European Society of Cardiology EURObservational Research Programme Valvular Heart Disease II survey included 6 substudies examining different valve interventions and AT regimens. Patient demographics, clinical characteristics, and 6-month outcomes were compared between groups receiving the recommended AT and those who did not.

RESULTS: Guideline adherence varied widely (39.5%-81.1%) across substudies. Factors influencing AT decisions included cardiovascular risk factors, atrial fibrillation, and prior percutaneous coronary intervention. In unadjusted analyses of 3 substudies, 6-month all-cause mortality was significantly higher in patients not receiving the recommended AT. However, no significant differences were observed in thromboembolic events, bleeding, or other complications between AT and non-AT groups across all substudies at 6 months.

CONCLUSION: This analysis reveals potential mortality benefits associated with guideline-recommended AT in some patient groups. However, the observational nature of the study limits causal inferences, emphasizing the importance of further prospective research to optimize AT strategies and improve patient outcomes in this complex clinical setting, particularly as new AT and valve types emerge.

PMID:40933058 | PMC:PMC12419113 | DOI:10.1016/j.rpth.2025.102988

REC Interv Cardiol. 2025 Apr 29;7(3):146-153. doi: 10.24875/RECICE.M25000508. eCollection 2025.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Although early discharge protocols after transcatheter aortic valve implantation (TAVI) have demonstrated to be safe in various studies, they are usually applied in high-experience centers. This study analyzes the length of stay of the first 100 patients undergoing TAVI in a center without on-site cardiac surgery, differentiating between very early (< 24 hours), early (24-48 hours), and late discharge (> 48 hours). Furthermore, the study evaluates the feasibility of an early discharge protocol during the team's learning curve.

METHODS: We conducted a prospective observational study from April 2022 through January 2024. A pre- and postoperative management protocol was implemented, including assessments in the Valvular Heart Disease Clinic, admission to the cardiac surgery intensive care unit with electrocardiographic monitoring, and specific discharge criteria in full compliance with an established protocol for the management of conduction disorders. Early follow-up evaluations were performed in the outpatiently after discharge.

RESULTS: A total of 100 patients (50% women) were included, with a mean age of 82.4 ± 5.3 years and a EuroSCORE II score of 4.38 ± 5.1%. The median length of stay was 2 days (range, 1-19). A total of 27.27% of patients were discharged in < 24 hours, 48.49% within the 24-48 hours following implantation, and 24.24% 48 hours later. The 30-day cardiovascular mortality rate was 1%. A total of 6 patients were readmitted with procedural complications within the first 30 days.

CONCLUSIONS: The implementation of a standardized care protocol allows for early and safe discharge in most patients, even during the team's learning cuve.

PMID:40933016 | PMC:PMC12418241 | DOI:10.24875/RECICE.M25000508

Circ Rep. 2025 Jul 23;7(9):784-790. doi: 10.1253/circrep.CR-25-0058. eCollection 2025 Sep 10.

ABSTRACT

BACKGROUND: Grip strength is a simple predictor of cardiovascular events and their prognosis. Early ambulation is related to an increase in functional independence, shortening of hospital stay, and a decrease in the need for readmission in patients with cardiovascular disease. However, little is known about the relationship between grip strength and early ambulation after cardiac surgery.

METHODS AND RESULTS: In this observational study, 92 patients who underwent scheduled cardiac surgery with extracorporeal circulation without unexpected complications and in whom grip strength was measured before surgery were included. We divided them into 48 low and 44 preserved grip strength groups according to the criterion for frailty and sarcopenia. Age, the percentage of females, and the New York Heart Association classification in the low grip strength group were significantly higher than in the preserved grip strength group. All of the measures of functional status were significantly low in the low grip strength group. There were no significant differences in perioperative procedures between the groups. In-hospital outcomes were poorer, step-ups of rehabilitation were significantly later and the hospitalization stays were significantly longer in the low grip strength group. In the multiple regression analysis, grip strength was an independent predictor of early ambulation.

CONCLUSIONS: The results suggest that grip strength is an independent predictor of early ambulation in patients after cardiac surgery with extracorporeal circulation.

PMID:40933486 | PMC:PMC12419942 | DOI:10.1253/circrep.CR-25-0058

Turk J Med Sci. 2025 Apr 17;55(4):868-876. doi: 10.55730/1300-0144.6039. eCollection 2025.

ABSTRACT

BACKGROUND/AIM: The aim of our study was to determine which preoperative bleeding risk scoring system is more sensitive in predicting perioperative transfusion requirement in patients undergoing open-heart surgery.

MATERIALS AND METHODS: This is a retrospective single-center cohort study. Seven scoring systems (TRACK, PAPWORTH, WILL-BLEED, CRUSADE, ACTION, TRUST, ACTA-PORT) were used to predict the likelihood of perioperative erythrocyte suspension (ES) transfusion requirement.

RESULTS: Four hundred patients were enrolled in the study. Age, creatinine level, and diagnoses of diabetes mellitus and hypertension were significantly higher in patients who required ES (p < 0.05). In addition, ejection fraction percentages and hemoglobin and hematocrit levels were significantly lower (p < 0.05). Except for PAPWORTH; ACTION, ACTA-PORT, WILL-BLEED, TRACK, TRUST, and CRUSADE scores were higher in the ES group (p < 0.05), but the most predictive scoring system for ES use was TRUST.

CONCLUSION: The ACTION and ACTA-PORT systems were also found to significantly predict ES use, but the WILL-BLEED, TRUST, and TRACK systems were found to be more predictive of bleeding and ES transfusion requirement in CABG operations. Furthermore, low EF, Hb, and Hct levels, higher creatinine levels, and the presence of DM were identified as individual risk factors for perioperative bleeding, apart from the scoring systems.

PMID:40933962 | PMC:PMC12419046 | DOI:10.55730/1300-0144.6039

Cardiol Young. 2025 Sep 11:1-7. doi: 10.1017/S1047951125109517. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the predictive accuracy of Paediatric Risk of Mortality-III, Paediatric Index of Mortality-II, and Paediatric Logistic Organ Dysfunction scoring systems for major adverse events following congenital heart surgery.

METHODS: This prospective observational study included patients under 18 years of age who were admitted to the ICU for at least 24 hours postoperatively following congenital heart surgery. Major adverse events were defined as a composite of 30-day mortality, ICU readmission, reintubation, acute neurologic events, requirement for extracorporeal membrane oxygenation, cardiac arrest requiring cardiopulmonary resuscitation, need for a permanent pacemaker, acute kidney injury, or unplanned reoperation.

RESULTS: A total of 116 patients, with a median age of 17.5 months (interquartile range: 5.4-60.0) were included in the study. Major adverse events occurred in 34 patients (29.3%). Paediatric Risk of Mortality-III (11.5 [8.0-18.8] vs. 7.0 [2.3-11.0]; p = 0.001), Paediatric Index of Mortality-II (3.8 [2.8-6.6] vs. 2.2 [1.7-2.8]; p < 0.001), and Paediatric Logistic Organ Dysfunction (12.0 [10.0-21.0] vs. 1.0 [1.0-10.0]; p < 0.001) scores were significantly higher in patients with major adverse events than in those without. The Paediatric Logistic Organ Dysfunction score (area under the curve 0.83; 95% confidence interval: 0.74-0.92) demonstrated the highest discrimination capacity compared to Paediatric Risk of Mortality-III (area under the curve 0.70; 95% confidence interval: 0.60-0.81) and Paediatric Index of Mortality-II (area under the curve 0.77; 95% confidence interval: 0.66-0.88) with good calibration (Hosmer-Lemeshow p > 0.05 for all). Based on the logistic regression model evaluation metrics, Paediatric Logistic Organ Dysfunction demonstrated better performance in predicting major adverse events compared with Paediatric Risk of Mortality-III and Paediatric Index of Mortality-II.

CONCLUSIONS: The Paediatric Logistic Organ Dysfunction score outperformed the Paediatric Index of Mortality-II and Paediatric Risk of Mortality-III scores in predicting major adverse events in paediatric patients admitted to the ICU after congenital heart surgery.

PMID:40931679 | DOI:10.1017/S1047951125109517

Mol Biol Rep. 2025 Sep 10;52(1):880. doi: 10.1007/s11033-025-11001-4.

ABSTRACT

Regenerative cardiology has emerged as a novel strategy to improve cardiac healing following ischemic injury. While stem-cell-mediated cardiac regeneration has garnered much attention as a promising strategy, its value remains debated owing to the lack of ideal stem cell source candidates. Resident/endogenous cardiac-derived stromal cells (CSCs) exhibit superior therapeutic potential due to their innate abilities to differentiate into cardiac cells, especially cardiomyocytes (CM). Emerging research has highlighted diverse endogenous CSCs phenotypes and sub-types as candidates for cardiac repair. Interestingly, CSCs promote healing through angiogenesis and regenerative paracrine signaling along with replenishing CM, and CM-like cells in the ischemic heart. Unfortunately, the clonogenic properties and translational potential of CSCs are minimally explored. This review examines the healing promise of a myriad CSCs such as c-kit + cardiac cells, Sca-1 + cells, cardiosphere-derived cells, side population cells, Bm1 + cells, cardiac atrial appendage cells, cardiac adipose cells, epicardial cells, and Isl1 + cells. Also, the review highlights the areas of improvement regarding the therapeutic applications of CSC to extrapolate into the clinical arena of cardiac management.

PMID:40928598 | PMC:PMC12423225 | DOI:10.1007/s11033-025-11001-4

EClinicalMedicine. 2025 Aug 30;88:103477. doi: 10.1016/j.eclinm.2025.103477. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: Paediatric patients who underwent surgery for mitral regurgitation (MR) have a high risk of recurrence or death; however, no prediction tool has been developed to risk-stratify this challenging subpopulation.

METHODS: In this multicentre cohort study, paediatric patients undergoing surgery for congenital MR in Shanghai Children's Medical Center in January 1st, 2009-December 31st, 2022 were included for analysis while those had a combination with infective endocarditis, anomalous left coronary artery from the pulmonary artery, rheumatic valvular disease, connective tissue disease, or single ventricle were excluded. A Cox regression model predictive of the primary outcome (a composite of mortality or mitral valve [MV] re-operation) was derived and converted to a point-based risk score. This score was externally validated in a cohort of patients undergoing MR surgeries between January 1st, 2009 and December, 31st, 2022 in eight independent hospitals in China. The Harrell's c index and Hosmer-Lemeshow test was used to quantify the discrimination and calibration of the risk score.

FINDINGS: In total, 2640 patients (female: 57% [n = 1505]) with a median age of 0.99 (IQR, 0.47-2.60) years were included. The primary outcome occurred in 262 patients (16.6%) over a median of 5.7-year follow-up in the derivation cohort (n = 1581; median age of 1.03 years [IQR, 0.47-2.67]) and in 130 (12.3%) over a median of 7.1-year follow-up in the validation cohort (n = 1059; median age of 0.93 years [IQR, 0.46-2.51]). The score variables included preoperative variables (age, the presence of primary MR, N-terminal pro-brain natriuretic peptide, left ventricular ejection fraction, and left atrium z score), perioperative changes in z scores of LA and left ventricular end-diastolic dimension, and the procedural variable (use of MV annuloplasty or not). This risk score, ranging from -22 to 10, yielded strong discrimination (Harrell's c index: 0.85, 95% CI, 0.83-0.87) and exhibited good calibration of postoperative 10-year primary outcome (Hosmer-Lemeshow; χ2 = 9.85; P = 0.33) in the derivation cohort, which maintained in the validation cohort (Harrell's c index: 0.86, 95% CI, 0.83-0.89; Hosmer-Lemeshow; χ2 = 23.80; P = 0.64). In addition, a simplified stratification of the score model (low-risk: -22 to -5, intermediate risk: -4 to 0, high risk: >0) showed good performances in predicting the primary outcome in both derivation and validation (Ps < 0.001).

INTERPRETATION: The scoring system represents a crucial step towards personalised management care for paediatric MR. However, this model has not been applied in clinical practice and require validation in large and diverse cohorts of patients. Further work should aim to incorporate other novel multi-modality metrics to optimise the PRIMARY score.

FUNDING: Chinese National Natural Science Foundation of China, Science and Technology Commission of Shanghai Municipality, Science and Technology Project of Guizhou Province.

PMID:40926901 | PMC:PMC12414831 | DOI:10.1016/j.eclinm.2025.103477

Adv Pharm Bull. 2025 Jun 16;15(2):268-283. doi: 10.34172/apb.025.45122. eCollection 2025 Jul.

ABSTRACT

PURPOSE: Myocardial infarction (MI), the leading cause of human mortality, is induced by a sudden interruption of blood supply. Among various stem cell types, endothelial progenitor cells (EPCs) are novel and valid cell sources for the restoration of vascularization in the ischemic tissue. The present study aimed to evaluate the regenerative properties of EPCs in rodent models of MI.

METHODS: A comprehensive systematic search was implemented in Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases without language limitation in Sep 2024. Of the 67 papers pooled, 42 met the inclusion criteria and were subjected to multiple analyses.

RESULTS: Compared to the MI group, the overall effect size was confirmed in the groups receiving EPC with enhanced angiogenesis (SMD: 2.02, CI 95%: 1.51-2.54, P<0.00001; I2: 82%), reduced fibrosis (SMD: -1.48; 95% CI-2.15, -0.81; P<0.0001; I2: 88%), improved ejection fraction (EF; SMD: 1.72; 95% CI-1.21, 2.23; P<0.00001; I2: 87%), and fractional shortening (FS; SMD: 1.58; 95% CI-1.13, 2.03; P<0.00001; I2: 82%). Data confirmed significant improvements in the cardiac tissue parameters after intramyocardial injection of EPCs.

CONCLUSION: These data showed that EPC transplantation is an alternative therapy to ameliorate ischemic myocardium in rodents via the stimulation of angiogenesis, reduction of fibrosis, and improvement of fractional shortening and ejection fraction.

PMID:40922747 | PMC:PMC12413962 | DOI:10.34172/apb.025.45122

Eur Heart J. 2025 Sep 9:ehaf609. doi: 10.1093/eurheartj/ehaf609. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Atrial fibrillation (AF) is a prevalent complication after cardiac surgery, worsening patient outcomes. Considering the established role of Ca2+-handling abnormalities in AF pathogenesis, this study aimed to evaluate if integrating cytosolic Ca2+-handling measurements with clinical risk factors enhances the risk prediction of post-operative AF.

METHODS: Clinical data from 558 patients undergoing cardiac surgery without pre-existing AF from two centres were analysed. From 94 of these patients, atrial cardiomyocytes were isolated from collected right atrial appendages and Ca2+ handling (L-type Ca2+ current, intracellular Ca2+ concentration) was assessed using patch-clamp. The predictive performance of combining both clinical and single-cell Ca2+ handling parameters was tested using sequential feature selection and logistic regression models.

RESULTS: Single-cell Ca2+-handling parameters through cluster analysis correlated with post-operative AF development and several cardiac diseases. Integration of Ca2+-handling parameters into a new post-operative AF risk prediction model improved its predictive accuracy by increasing the areas under the receiver operating characteristic (ROC) curves from 0.69 to 0.71 in the training and 0.76 to 0.79 in the validation cohort. Systolic Ca2+ level, along with clinical parameters such as age, left atrial dilatation, valvular heart disease, impaired renal function, and serum magnesium, was identified as an independent risk factor for post-operative AF. Additionally, a predictive score for AF occurrence at discharge and during rehabilitation has been developed, with area under the curve (AUC) values of 0.84 and 0.71, respectively. Incorporating the occurrence of AF during the immediate post-operative period as an additional predictor significantly enhanced the prediction of AF at discharge, achieving an AUC value of 0.94.

CONCLUSIONS: Integrating cellular Ca2+ handling signature with clinical predictors improves the prediction of post-operative AF, highlighting the potential of incorporating functional cellular data into clinical risk models.

PMID:40923107 | DOI:10.1093/eurheartj/ehaf609

JTCVS Open. 2025 Jun 10;26:115-121. doi: 10.1016/j.xjon.2025.05.010. eCollection 2025 Aug.

ABSTRACT

OBJECTIVES: To describe the clinical presentation of patients with gonadal neuroendocrine tumors and carcinoid heart disease (CaHD) and to evaluate long-term outcomes following valvular surgery.

METHODS: Retrospective review of patients with primary gonadal neuroendocrine tumor who were surgically treated for CaHD at our institution between 1990 and 2021.

RESULTS: Eight patients (median age, 70 years) were included in the study, 7 with ovarian tumors and 1 with testicular tumor. None of the patients had liver metastasis at the time of cardiac surgery. Three patients presented with both CaHD symptoms and carcinoid syndrome symptoms (diarrhea and flushing). Three others presented with symptoms of CaHD but without diarrhea or flushing. One patient with ovarian tumor presented with severe diarrhea and flushing without CaHD symptoms and had tumor resection but then developed severe CaHD symptoms few months later. The last patient presented initially with an asymptomatic testicular mass, which was resected, but then developed severe CaHD symptoms years later. All patients had severe tricuspid regurgitation at time of surgery, and 7 had severe pulmonary regurgitation. All were treated with replacement of affected valves. Both 5- and 10-year survival rates were 86% and were higher than a control group of patients with CaHD and nongonadal primary neuroendocrine tumor (35% and 23%, respectively).

CONCLUSIONS: Patients with primary gonadal neuroendocrine tumors can develop CaHD in the absence of liver metastasis. Some patients have delayed presentation of cardiac symptoms, emphasizing the importance of thorough assessment and regular echocardiographic follow-up. Cardiac intervention is safe and yields excellent long-term survival.

PMID:40923064 | PMC:PMC12414394 | DOI:10.1016/j.xjon.2025.05.010

Medicine (Baltimore). 2025 Sep 5;104(36):e44325. doi: 10.1097/MD.0000000000044325.

ABSTRACT

RATIONALE: Extracorporeal membrane oxygenation (ECMO) is a life-support technology for refractory cardiac arrest, but the massive blood transfusions required during treatment significantly increase the risk of transfusion-related infections. Hepatitis E virus (HEV) - traditionally linked to fecal-oral transmission - is increasingly recognized as a transfusion-transmitted pathogen, especially in emergency settings where urgent blood product infusion is common and routine HEV screening in blood banks is often lacking. However, nursing strategies for managing acute HEV infection after ECMO remain poorly defined, highlighting the need to address this clinical gap.

PATIENT CONCERNS: A 35-year-old female nurse developed sudden cardiac arrest due to idiopathic ventricular fibrillation and underwent ECMO. Post-ECMO, she received red blood cells and plasma transfusions. On postoperative day 15, she had worsening liver function (alanine aminotransferase 938 U/L, total bilirubin 69.3 μmol/L) and abnormal coagulation function (prothrombin time [PT] 14.5 seconds), along with intermittent low-grade fever (37.3-38.0°C); subsequent jaundice of the skin, sclera, and urine developed.

DIAGNOSES: Next-generation sequencing confirmed acute HEV infection. The diagnosis was further supported by typical liver function abnormalities (marked elevation of transaminases and bilirubin), abnormal coagulation (PT 14.5 seconds), and clinical manifestations of HEV infection (fever, jaundice), with no evidence of other etiologies (e.g., viral hepatitis A/B/C, drug-induced liver injury).

INTERVENTIONS: Comprehensive nursing and clinical interventions were implemented. Daily monitoring: liver function (alanine aminotransferase, aspartate aminotransferase, bilirubin), coagulation status (with focus on PT, e.g., baseline PT 14.5 seconds), and jaundice-related symptoms (skin/sclera color, pruritus, urine color); gastrointestinal management: Bacillus licheniformis (0.5 g twice daily) to regulate intestinal flora, and lactulose (15 mL twice daily) to promote bowel movement, maintaining gut-liver axis balance; personalized nutritional support: Collaboration with the nutrition department to provide a low-fat semi-liquid diet (1500-1600 kcal/d, 75-80 g branched-chain amino acid-rich protein, and adequate vitamins/minerals); and cardiac follow-up: planning and implementation of implantable cardioverter defibrillator (ICD) implantation on postoperative day 50 (after resolution of liver injury and stabilization of coagulation function).

OUTCOMES: After 49 days of hospitalization, the patient's liver function normalized (total bilirubin within normal range, albumin increased from 31.3 to 35.1 g/L), coagulation function (PT) returned to normal, and jaundice resolved. She successfully underwent ICD implantation on postoperative day 50. A 3-month follow-up showed no chronic liver damage, and serum HEV-IgM turned negative at 6 months; no malignant arrhythmias or ICD discharges were recorded during follow-up.

LESSONS: This case emphasizes 3 key lessons: Firstly, for patients receiving ECMO and blood transfusions, close monitoring of liver function, coagulation indicators (e.g., PT), and clinical signs of HEV infection (fever, jaundice) is critical for early diagnosis; secondly, multimodal interventions - combining targeted monitoring (including coagulation tracking), gut-liver axis regulation, and personalized nutrition - are effective for managing acute HEV infection post-ECMO; and thirdly, timing of ICD implantation (e.g., postoperative day 50, after liver and coagulation stabilization) and collaboration between nursing teams, nutrition departments, and cardiac specialists ensure holistic care, supporting both liver recovery and long-term cardiac safety.

PMID:40922328 | PMC:PMC12419282 | DOI:10.1097/MD.0000000000044325

Turk Kardiyol Dern Ars. 2025 Sep 8. doi: 10.5543/tkda.2025.54968. Online ahead of print.

ABSTRACT

OBJECTIVE: Management of aortic stenosis (AS) requires integrating complex clinical, imaging, and risk stratification data. Large language models (LLMs) such as ChatGPT and Gemini AI have shown promise in healthcare, but their performance in valvular heart disease, particularly AS, has not been thoroughly assessed. This study systematically compared ChatGPT and Gemini AI in addressing guideline-based and clinical scenario questions related to AS.

METHOD: Forty open-ended AS-related questions were developed, comprising 20 knowledge-based and 20 clinical scenario items based on the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines. Both models were queried independently. Responses were evaluated by two blinded cardiologists using a structured 4-point scoring system. Composite scores were categorized, and comparisons were performed using Wilcoxon signed-rank and chi-square tests.

RESULTS: Gemini AI achieved a significantly higher mean overall score than ChatGPT (3.96 +- 0.17 vs. 3.56 +- 0.87; P = 0.003). Fully guideline-compliant responses were more frequent with Gemini AI (95.0%) than with ChatGPT (72.5%), although the overall compliance distribution difference did not reach conventional significance (P = 0.067). Gemini AI performed more consistently across both question types. Inter-rater agreement was excellent for ChatGPT (κ = 0.94) and moderate for Gemini AI (κ = 0.66).

CONCLUSION: Gemini AI demonstrated superior accuracy, consistency, and guideline adherence compared to ChatGPT. While LLMs show potential as adjunctive tools in cardiovascular care, expert oversight remains essential, and further model refinement is needed before clinical integration, particularly in AS management.

PMID:40919834 | DOI:10.5543/tkda.2025.54968

Front Cardiovasc Med. 2025 Aug 22;12:1600757. doi: 10.3389/fcvm.2025.1600757. eCollection 2025.

ABSTRACT

INTRODUCTION: Left ventricular assist device (LVAD) implantation is a highly effective procedure for the management of selected advanced heart failure patients, prolonging patient life and improving quality. Additional cardiac pathologies, especially valvular regurgitation or coronary heart disease, are common in LVAD recipients, whereas reports on the surgical management of heart failure combined with aortic disease are rare.

CASE PRESENTATION: We present a case of a 60-year-old patient with an aortic sinus aneurysm, aortic regurgitation, and end-stage heart failure. LVAD implantation was performed concomitantly with the Bentall procedure and Cabrol shunt technique. The patient was discharged uneventfully on postoperative day 26. This suggests that combining LVAD implantation with additional cardiovascular procedures could be an alternative strategy for patients with complex heart failure conditions.

CONCLUSION: LVAD implantation combined with additional aortic surgery can be a feasible alternative with acceptable risk, especially for patients who have elected to pursue LVAD as destination therapy. Successful outcomes require adequate preoperative evaluation, experienced cardiac surgeons, and close postoperative care.

PMID:40918189 | PMC:PMC12411443 | DOI:10.3389/fcvm.2025.1600757

Can Respir J. 2025 Aug 28;2025:3647362. doi: 10.1155/carj/3647362. eCollection 2025.

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide, and acute exacerbations are the major health issues in COPD patients. In this study, we aimed to investigate the role of the delta neutrophil index (DNI) with other hematologic parameters in managing and guiding COPD patients admitted with acute exacerbations. Methods: In this retrospective study, COPD patients treated internally in pulmonology clinic, intensive care unit, and anesthesiology and reanimation unit with acute exacerbation between May 2021 and December 2023 were investigated. Records from daily visits were evaluated retrospectively. Patients were divided into two groups according to the causative organism: bacterial or nonbacterial. Results: Patients with cardiac failure were found to have significantly higher median DNI values (p : 0.026), whereas patients with other comorbidities that were not individually recorded have substantially lower median DNI values (p : 0.026). White blood cell (WBC), neutrophil, immature granulocyte values (both absolute value and percent), thrombocyte, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin, positive blood culture, positive systemic inflammatory response syndrome (SIRS) criteria, and sepsis were significantly higher in patients with bacterial acute exacerbation. Hospitalization duration was also significantly longer in the same group (p : 0.006). No statistically significant correlation was found between median DNI values and early mortality rate (within 28 days), readmission within 30 days and 6 months. Conclusion: In this study, we have shown that the serum procalcitonin level, WBC, NLR, and PLR measurement can be used to distinguish bacterial and nonbacterial COPD exacerbations. The DNI revealed no prognostic predictive value regarding early mortality, mechanic ventilation need, or readmission in 30 days and 6 months.

PMID:40917823 | PMC:PMC12411038 | DOI:10.1155/carj/3647362

Expert Opin Investig Drugs. 2025 Sep;34(9):675-683. doi: 10.1080/13543784.2025.2558655. Epub 2025 Sep 10.

ABSTRACT

INTRODUCTION: Ischemic heart disease (IHD) constitutes the most prevalent form of cardiac disease in the general population. Although current therapeutic interventions have significantly improved both quality of life and survival rates, no available treatment can reverse the loss of cardiomyocytes resulting from ischemic injury. Existing therapies are limited to attenuating myocardial damage, reducing its extent, and mitigating its clinical consequences.

AREA COVERED: Advances in pharmacological and biomedical research have paved the way for novel therapeutic modalities. Tissue engineering, gene therapy, microRNAs (miRNAs), small interfering RNAs (siRNAs), and stem cell-based approaches represent promising avenues for promoting myocardial regeneration. In the present review, we aim to provide a succinct yet comprehensive review of the principal areas of current scientific investigation in this evolving field.

EXPERT OPINION: Although current scientific evidence remains limited, primarily due to the lack of large-scale clinical trials in vivo, the prospects of these therapeutic strategies are highly promising, particularly for patients with limited conventional treatment options. It remains to be determined when and how these approaches may be effectively implemented in clinical practice.

PMID:40914985 | DOI:10.1080/13543784.2025.2558655

Pathol Res Pract. 2025 Sep 5;275:156193. doi: 10.1016/j.prp.2025.156193. Online ahead of print.

ABSTRACT

AIM: This study aims to evaluate the effects of bupivacaine on acute kidney injury (AKI) through kidney function parameters and cardiac tissue damage via TRPM2, HSP70, TLR4, NF-κB, and TNF-α biomarkers.

MATERIAL AND METHOD: Male Wistar albino rats were divided into 4 groups, with seven rats in each group: Control group, AKI group (kidney damage induced by glycerol), AKI + L group (group treated with bupivacaine), and L group (group treated with bupivacaine alone). At the end of the experiment, kidney and heart tissues were collected for histological analysis, and serum samples were taken for biochemical analysis. In serum samples, urea nitrogen (BUN), creatinine (Cr), troponin t, Creatine Kinase, Creatine Kinase-MB, and total oxidant levels were measured. In histological analysis, changes in heart and kidney tissues were evaluated histopathologically and immunohistochemically through KIM-1, TNF-α, TRPM2, HSP70, NF-κB, and TLR4 parameters.

RESULTS: In the AKI group, a significant increase in blood urea nitrogen (BUN) and creatinine (CR) levels was observed when compared to the control group (p < 0.05). Notably, in the AKI + Local Anesthetic (L) group, these levels were found to be elevated compared to the AKI group. KIM-1 and TNF-α immunoreactivity in kidney tissue were both significantly elevated in the AKI group compared with the Control group, and further increased in the AKI + L group compared with the AKI group. In heart tissues, significant increases in the immunoreactivity levels of TLR4, NF-κB, TNF-α, HSP70, and TRPM2 were observed in the AKI + L group relative to the AKI group (p < 0.05). Moreover, in the AKI + L group, the extent of histopathological damage was found to be more severe compared to the AKI group (p < 0.05).

CONCLUSION: This study demonstrates that bupivacaine exacerbates acute kidney injury and leads to significant histopathological changes in kidney function and heart tissue parameters. It was observed that bupivacaine might affect cardiac conduction, impairing heart functions, and lead to changes in molecular pathways such as KIM-1, TNF- α, TRPM2, HSP70, TLR4, and NF-κB. Furthermore, the increase of oxidant levels and biomarker levels suggest that bupivacaine may induce oxidative stress and inflammation, leading to damage in both kidney and heart tissues.

PMID:40915012 | DOI:10.1016/j.prp.2025.156193

Int J Artif Organs. 2025 Sep;48(9):627-635. doi: 10.1177/03913988251370227. Epub 2025 Sep 5.

ABSTRACT

Cardiovascular disease (CVD) is a leading cause of death worldwide. CVD includes conditions such as myocardial infarction (MI), arrhythmias, valvular heart disease, and cardiomyopathy. The limitations of heart treatment are related to the inability of damaged cells to regenerate, which leads to an increasing demand for new therapies. Cardiac tissue engineering (CTE) aims to efficiently regenerate damaged cardiac tissues by combining cells and biomaterials to address these diseases. Various cell types have been used in CTE research, including adult and pluripotent stem cells, the latter differentiating into functional cardiomyocytes. An ideal biomaterial promotes efficient adhesion, growth, and differentiation of cardiac cells and possesses the appropriate characteristics needed for functional cardiac cells, showing great potential for heart repair and regeneration. This review focuses on various tissue engineering approaches for the regeneration and repair of cardiac tissues following myocardial infarction.

PMID:40913305 | DOI:10.1177/03913988251370227

J Surg Res. 2025 Oct;314:657-661. doi: 10.1016/j.jss.2025.08.008. Epub 2025 Sep 4.

ABSTRACT

INTRODUCTION: Application of extracorporeal life support during cardiac arrest is termed extracorporeal cardiopulmonary resuscitation (eCPR). Mortality in pediatric patients undergoing eCPR for noncardiac conditions remains high and factors influencing survival are not well-defined. We hypothesized that eCPR survivors are more likely to have less severe electrolyte derangements prior to cannulation than nonsurvivors.

METHODS: A retrospective review of extracorporeal membrane oxygenation (ECMO) data at our free-standing children's hospital from January 2013 through December 2023 was performed. Variables evaluated included demographics, diagnosis, blood gas values, CPR time, and survival. Kruskal-Wallis test was used to compare precannulation labs and CPR duration in those who survived to the nonsurvivors.

RESULTS: We identified 21 patients who underwent CPR during ECMO cannulation over a 10-year period. The most common diagnosis was respiratory failure (n = 8, 38%). The median duration of CPR prior to successful ECMO initiation was 60 min (interquartile range 15-80). Veno-arterial ECMO (n = 20, 95%) was the most common method of cannulation. The median ECMO run time was 84 h (interquartile range 27-183). A single patient died during ECMO cannulation (n = 1, 4.7%). Eight patients survived to discharge (38%). Higher pH, partial pressure of arterial oxygen, and bicarbonate levels prior to cannulation were associated with survival (P < 0.05).

CONCLUSIONS: In this study, precannulation pH, partial pressure of arterial oxygen, and bicarbonate median values were significantly higher in those who survived compared to the nonsurvivors. Precannulation characteristics that may influence survivability can potentially assist with decision making regarding inclusion and exclusion criteria for eCPR candidates.

PMID:40912082 | DOI:10.1016/j.jss.2025.08.008

Biotechnol J. 2025 Sep;20(9):e70116. doi: 10.1002/biot.70116.

ABSTRACT

Cardiac tissue engineering (CTE) is a rapidly evolving field that combines cells, scaffolds, and biofabrication methods to repair damaged heart tissue. New technologies have made it possible to utilize AI in designing cardiac patches and 4D bioprinting to create biomaterials that respond to time. These procedures are a big step forward from traditional ones since they offer more accuracy, flexibility, and the possibility of therapies that are tailored to each patient. This review talks about the latest developments in cellular sources, biomaterials, and bioprinting platforms, as well as immunological, regulatory, and translational issues. We show a realistic way forward for using CTE in clinical settings by looking at both its strengths and weaknesses. SUMMARY: Innovative biomaterials enhance cardiac tissue regeneration. 3D bioprinting revolutionizes cardiac tissue fabrication. Patient-specific stem cell therapies offer personalized solutions. AI and 4D printing advance tissue design and clinical applications.

PMID:40911173 | DOI:10.1002/biot.70116

Clin Transl Med. 2025 Sep;15(9):e70475. doi: 10.1002/ctm2.70475.

ABSTRACT

BACKGROUND: To investigate the role of self-peripheral blood mesenchymal stem cell (PBMSC)-derived exosomes (Exos) in enhancing renal sympathetic denervation (RD)-mediated heart regeneration following myocardial infarction (MI) in a porcine model.

METHODS: Pigs (ejection fraction [EF] < 40% post-MI) were randomised to early sham RD or RD. At 2 weeks post-MI, autologous PBMSC-Exos were collected. At 30 days post-MI, pigs received either PBMSC-Exos (2 × 1013 particles) or phosphate-buffered saline and were followed until 90 days. Another cohort underwent myocardial biopsy at 14 days post-MI to assess PBMSC-Exos effects on ischaemic cardiomyocyte (CM) reprogramming, followed by adeno-associated viral therapy with miR-141-200-429 sponges or negative control sponges to explore the role of miR-141-200-429 clusters in reprogramming.

RESULTS: Two weeks post-MI, RD hearts showed increased Exos uptake and inhibited the sympathetic nervous system. By 90 days, the RD+Exos group had 11%-26% higher EF than single-treatment groups (all p < .001), with improved survival and reduced fibrosis. Exos therapy enhanced RD effects by suppressing the renin‒angiotensin‒aldosterone system and transferring the miR-141-200-429 cluster into ischaemic CMs. CMs from RD-treated hearts cocultured with PBMSC-ExosRD exhibited a more immature state, promoting reprogramming. β-Catenin overexpression further enhanced PBMSC-ExosRD effects, while miR-141-200-429 inhibition blocked RD-induced CM reprogramming and survival. Ultimately, PBMSC-ExosRD reduced dickkopf-1 (Dkk1) expression and activated GSK3β phosphorylation, thereby stimulating the Wnt/β-catenin pathway.

CONCLUSIONS: PBMSC-ExosRD enhances RD-mediated cardiac repair through miR-141-200-429 cluster-dependent activation of the Wnt/β-catenin pathway, offering a novel therapeutic strategy for MI-induced heart failure. Our findings unveil a novel therapeutic strategy, highlighting that RD maintains its efficacy and safety when integrated with complementary approaches over extended periods.

KEY POINTS: Myocardial infarction triggers cardiomyocyte depletion and sympathetic overactivation, culminating in irreversible heart failure. Renal denervation (RD) attenuates sympathetic signalling, modulating catecholamine‒B-type natriuretic peptide (BNP) homeostasis. We newly demonstrate RD-enhanced peripheral blood mesenchymal stem cell exosomal secretion enriched with miR-141-200-429 clusters. These exosomal miRNAs suppress dickkopf-1 (Dkk1), activating GSK3β/Wnt/β-catenin signalling to enhance myocardial survival and regeneration. Our findings establish a combined therapeutic paradigm wherein RD maintains durable efficacy and safety alongside complementary interventions for heart failure management.

PMID:40910352 | PMC:PMC12411928 | DOI:10.1002/ctm2.70475