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Ann Thorac Surg. 2025 Sep 3:S0003-4975(25)00844-6. doi: 10.1016/j.athoracsur.2025.08.028. Online ahead of print.

ABSTRACT

BACKGROUND: Recent advances in transcatheter valve techniques often compete with open cardiac operations in managing high-risk patients with valvular disease, especially in the elderly. This study assessed late survival and quality of life after valvular surgery in octogenarians with prior sternotomy.

METHODS: We identified octogenarians who underwent cardiac valve reoperations between 2004 and 2023. Study end points were long-term mortality, long-term self-reported physical activity, and general health status.

RESULTS: A total of 934 octogenarians (median age, 83 years; 29% women) had valve reoperations. Reoperations were isolated procedures in 72% (aortic [58%], mitral [10%], and tricuspid [4%]), multiple valve procedures in 16%, and valve + coronary artery bypass graft (CABG) in 12%. Previous operations were isolated CABG in 53%, isolated valve in 27%, valve + CABG in 17%, and others in 3%. Operative mortality was 6%. Total hospital stay was 6 days (4-9 days). Median survival was 5.6 years in this cohort compared with 5.9 years for a sex- and age-matched US population. At 1-, 3-, and 5-year follow-up, most survey respondents reported significant improvement in their general health status and physical activity levels. Renal failure (hazard ratio [HR], 2.1; P < .001), history of atrial fibrillation (HR, 1.2; P = .029), peripheral vascular disease (HR, 1.2; P = .026), cerebrovascular disease (HR, 1.2; P = .022), moderate or severe chronic lung disease (HR, 1.7; P < .001), and concomitant tricuspid valve surgery (HR, 1.5; P = .0022) were independently associated with increased late mortality.

CONCLUSIONS: Repeated valve surgery in octogenarians can be performed with excellent short- and long-term outcomes. Age alone should not be a contraindication to reoperation for patients requiring intervention for valvular disease.

PMID:40912622 | DOI:10.1016/j.athoracsur.2025.08.028

J Heart Lung Transplant. 2025 Sep 5:S1053-2498(25)01951-5. doi: 10.1016/j.healun.2025.04.015. Online ahead of print.

NO ABSTRACT

PMID:40910964 | DOI:10.1016/j.healun.2025.04.015

Cardiol Young. 2025 Sep;35(9):1824-1843. doi: 10.1017/S1047951125100565. Epub 2025 Sep 5.

ABSTRACT

OBJECTIVE: Chronic pulmonary regurgitation following tetralogy of Fallot repair burdens the right ventricle. This study evaluated early outcomes of pulmonary valve reconstruction using right atrial tissue versus standard transannular patch repair.

METHODS: A retrospective analysis of 412 tetralogy of Fallot patients (2014-2024) was conducted: Atrial Valve Group (n = 205) underwent valve reconstruction; No-Valve Group (n = 207) received standard repair. Patients were followed for 1 year with echocardiographic assessments. Outcomes included right ventricular insufficiency, ventilation duration, and ICU stay.

RESULTS: Atrial Valve Group had lower right ventricular insufficiency at 12 months (9.3% vs. 19.8%, p = 0.004, OR = 2.39, 95% CI: 1.32-4.33), shorter ventilation times (6.1 vs. 18.0 hours, p < 0.001, Cohen's d = 3.54), and reduced ICU stays (3.0 vs. 5.7 days, p < 0.001, Cohen's d = 1.87), despite longer CPB durations (47.1 vs. 40.5 minutes, p = 0.02).

CONCLUSIONS: Right atrial tissue reconstruction reduces early and intermediate-term right ventricular dysfunction post-tetralogy of Fallot repair. Long-term studies are needed.

PMID:40908924 | DOI:10.1017/S1047951125100565

RSC Adv. 2025 Sep 2;15(38):31564-31585. doi: 10.1039/d5ra05286f. eCollection 2025 Aug 29.

ABSTRACT

Myocardial infarction (MI) is one of the leading causes of heart failure and death worldwide. While conventional treatments have limitations in promoting myocardial repair and regeneration, hydrogel, as a multifunctional biomaterial, shows great potential in MI treatment due to its unique physicochemical properties and biocompatibility. This paper reviews the multifunctional applications of hydrogels in MI therapeutics, including drug delivery (miRNAs, exosomes, etc.), electrical conduction, immunomodulation, detection, tissue engineering, and microfluidic functions. In terms of drug delivery, hydrogels are able to precisely deliver drugs, stem cells and exosomes to improve the microenvironment of the infarcted area through their controlled release properties. In the field of electrical conduction, hydrogels are used as scaffolding materials that mimic the mechanical and electrical properties of myocardial tissues. The role of hydrogels in immunomodulation has also attracted much attention. In addition, the application of hydrogels in biosensing and detection functions provides new strategies for real-time monitoring of MI. In summary, hydrogels have demonstrated multifunctional advantages in MI therapy, but their clinical applications still face challenges, such as the long-term biocompatibility of the materials and the feasibility of large-scale production. Future research should focus on optimizing the design of hydrogels for more precise treatment and wider applications.

PMID:40904844 | PMC:PMC12403691 | DOI:10.1039/d5ra05286f

Front Cardiovasc Med. 2025 Aug 19;12:1634877. doi: 10.3389/fcvm.2025.1634877. eCollection 2025.

ABSTRACT

Ischemia-reperfusion injury, marked by transient blood flow disruption followed by tissue reperfusion, constitutes a unifying pathological mechanism across cerebral stroke, myocardial infarction, and acute kidney injury. Hypoxia, a central driver of ischemia-reperfusion injury progression, triggers molecular cascades that simultaneously exacerbate tissue damage and activate compensatory repair mechanisms. Notably, hypoxia-induced angiogenesis and vascular remodeling serve as critical adaptive processes for functional recovery, supporting neuronal plasticity in stroke, myocardial salvage in infarction, and tubular regeneration in renal ischemia-reperfusion injury. While these conditions exhibit organ-specific manifestations, emerging studies underscore conserved regulatory frameworks mediated by extracellular vesicles (EVs) and their molecular cargoes, which orchestrate cross-organ protective responses. In this context, mesenchymal stem cell (MSC)-derived EVs have emerged as potent therapeutic agents for mitigating ischemia-reperfusion injury-related deficits, as evidenced by preclinical and clinical studies. These EVs act as bioactive nanocarriers, delivering cargos that modulate shared pathological pathways-particularly angiogenesis, a linchpin of post-ischemic tissue repair. Accumulating evidence highlights cargos within MSC-EVs (e.g., miRNAs, proteins) as master regulators of vascular regeneration, fine-tuning endothelial proliferation, vessel maturation, and hypoxia adaptation. This review systematically examines the dual roles of MSC-EV-associated cargos in promoting or suppressing angiogenesis across cerebral, cardiac, and renal ischemia-reperfusion injury models. By dissecting their mechanisms in spatiotemporal regulation of vascular signaling networks, we aim to elucidate their translational potential as universal therapeutic targets for multi-organ ischemia-reperfusion injury management.

PMID:40904530 | PMC:PMC12403218 | DOI:10.3389/fcvm.2025.1634877

Biology (Basel). 2025 Aug 1;14(8):973. doi: 10.3390/biology14080973.

ABSTRACT

Systematic reviews are a cornerstone of evidence-based research, providing comprehensive summaries of existing studies to answer specific research questions. This article offers a detailed guide to conducting high-quality systematic reviews in biology, health and social sciences. It outlines key steps, including developing and registering a protocol, designing comprehensive search strategies, and selecting studies through a screening process. The article emphasizes the importance of accurate data extraction and the use of validated tools to assess the risk of bias across different study designs. Both meta-analysis (quantitative approach) and narrative synthesis (qualitative approach) are discussed in detail. The guide also highlights the use of frameworks, such as GRADE, to assess the certainty of evidence and provides recommendations for clear and transparent reporting in line with the PRISMA 2020 guidelines. This paper aims to adapt and translate evidence-based review principles, commonly applied in clinical research, into the context of biological sciences. By highlighting domain-specific methodologies, challenges, and resources, we provide tailored guidance for researchers in ecology, molecular biology, evolutionary biology, and related fields in order to conduct transparent and reproducible evidence syntheses.

PMID:40906182 | PMC:PMC12383630 | DOI:10.3390/biology14080973

Neurologia (Engl Ed). 2025 Sep;40(7):668-675. doi: 10.1016/j.nrleng.2025.07.009.

ABSTRACT

BACKGROUND: Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHA2DS2-VASc ≥2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously.

OBJECTIVE: To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA2DS2-VASc ≥2) and to determine adequate timing of its performance.

METHODS: This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (n=31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n=97; 75.8%), after 90 days.

RESULTS: Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHA2DS2-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9±34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group.

CONCLUSIONS: Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.

PMID:40903150 | DOI:10.1016/j.nrleng.2025.07.009

Ann Med Surg (Lond). 2025 Aug 2;87(9):5870-5877. doi: 10.1097/MS9.0000000000003662. eCollection 2025 Sep.

ABSTRACT

Rheumatic heart disease (RHD) and papillary fibroelastoma (PFE) are distinct cardiovascular disorders that can rarely occur together. RHD is a chronic condition caused by untreated streptococcal infections, primarily affecting the mitral valve and resulting in severe valvular damage. On the other hand, PFE is a benign heart tumor, usually affecting the aortic valve, and is typically asymptomatic, often discovered incidentally through imaging. The simultaneous presence of RHD and PFE, especially involving the mitral and aortic valves, has only been reported in two case studies. This review examines the pathophysiology, clinical features, diagnostic challenges, and treatment options for both conditions. Echocardiography is the primary diagnostic tool, and surgery, involving tumor removal and valve replacement, is the standard treatment for symptomatic cases. Although this dual condition is rare, the review highlights the significance of early detection, particularly in areas where RHD is common, and calls for additional research to explore the potential connections between these conditions and improve patient care.

PMID:40901114 | PMC:PMC12401350 | DOI:10.1097/MS9.0000000000003662

Eur Heart J. 2025 Sep 3:ehaf519. doi: 10.1093/eurheartj/ehaf519. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Aortic stenosis may be managed differently in women and men, but evidence remains limited. Sex-specific characteristics and outcomes of low- to intermediate-risk patients assigned to transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) from the DEDICATE-DZHK6 trial are described.

METHODS: The DEDICATE-DZHK6 trial demonstrated non-inferiority for the primary outcome of all-cause death or stroke at 1 year. Sex-specific effects were evaluated in this predefined descriptive subgroup analysis.

RESULTS: A total of 1394 patients (43.3% women) were included. Women were older (women: 74.8 ± 4.6 years vs men: 74.2 ± 4.2 years, P = .020) and at higher operative risk [median Society of Thoracic Surgeons risk score 2.1% (1.5-2.7) vs 1.5% (1.0-2.2), P < .001]. All-cause death or stroke at 1 year was 5.2% in the TAVI vs 11.5% in the SAVR group [hazard ratio (HR) 0.46; 95% confidence interval (CI) 0.25-0.82] in women and 5.4% vs 9.0% (HR 0.61; 95% CI 0.35-1.03) in men. At 1 year after TAVI vs SAVR, all-cause death occurred in 2.6% vs 6.7% (HR 0.41; 95% CI 0.17-0.90) in women and 2.6% vs 5.9% (HR 0.44; 95% CI 0.20-0.88) in men. Stroke occurred in 2.6% vs 6.2% (HR 0.43; 95% CI 0.18-0.93) in women and 3.1% vs 3.6% (HR 0.89; 95% CI 0.41-1.90) in men.

CONCLUSIONS: Among patients with severe aortic stenosis at low to intermediate risk, TAVI was non-inferior to SAVR for the primary outcome in women and men with lower event rates in patients assigned to TAVI. Women were at particular risk for early complications irrespective of the assigned treatment and at increased stroke risk after SAVR.

PMID:40900118 | DOI:10.1093/eurheartj/ehaf519

BMJ Open Respir Res. 2025 Sep 3;12(1):e002912. doi: 10.1136/bmjresp-2024-002912.

ABSTRACT

BACKGROUND: We previously demonstrated a high prevalence of transpulmonary bubble transit (TPBT) using transcranial Doppler (TCD) in patients with COVID-19 pneumonia, but these observations require confirmation.

METHODS: Patients at two academic medical centres, hospitalised with COVID-19 pneumonia and requiring any form of respiratory support, were studied. The first TCD study was performed at the time of enrolment and repeated approximately 7 and 14 days later if participants remained hospitalised.

RESULTS: 91 participants were enrolled. At the first TCD, 14 participants (15%) were receiving oxygen by nasal cannula, 41 participants (45%) were receiving oxygen by high flow nasal cannula, 8 participants (9%) were receiving non-invasive positive pressure, 28 participants (31%) were receiving mechanical ventilation and 2 participants (2%) were receiving extracorporeal membrane oxygenation. 33 participants (36%) demonstrated TPBT at the first TCD. There was evidence that the presence of TPBT and increased heart rate together was associated with in-hospital death (p=0.02). For every one-unit increase in heart rate, the odds of death increased 11% (OR 1.11, 95% CI 1.02 to 1.20, p=0.01) for those with TPBT; however, there was no evidence of this increase for those without TPBT (OR 1.01, 95% CI 0.97 to 1.05, p=0.76). For participants with subsequent TCD assessments, 55% demonstrated TPBT during the second TCD assessment, and 85% demonstrated TPBT at the third TCD assessment.

CONCLUSIONS: The prevalence of TPBT in hospitalised patients with COVID-19 pneumonia is higher than expected and the presence of TPBT increases over time in those that remained alive and hospitalised. In patients with TPBT, increased heart rate, a marker of hyperdynamic circulation, is associated with increased mortality.

PMID:40903187 | PMC:PMC12410680 | DOI:10.1136/bmjresp-2024-002912

Biochem Biophys Res Commun. 2025 Sep 30;782:152552. doi: 10.1016/j.bbrc.2025.152552. Epub 2025 Sep 2.

ABSTRACT

Reperfusion arrhythmia (RA) poses a significant risk to the prognosis of patients undergoing extracorporeal circulation cardiac surgery, and its occurrence closely linked to disturbances in myocardial electrical conduction. Our prior research indicated that ischemia-reperfusion (I/R) affects the localization of connexin 43 (Cx43) at the intercalated discs (IDs) by inducing depolymerization of microtubules, resulting in myocardial electrical conduction abnormalities in rats. Although sevoflurane preconditioning (SPC) has demonstrated considerable protective effects on ischemic myocardium, the underlying mechanisms remain inadequately understood. This prompted us to study the effect of SPC on the stability of microtubules in I/R myocardium to explore the protective mechanism of SPC based on microtubule cytoskeleton. Western blotting, immunofluorescence colocalization, and ex vivo cardiac electrophysiological mapping demonstrated that SPC attenuated myocardial I/R-induced microtubule depolymerization, recovered the distribution of Cx43 at the IDs, and improved myocardial electrical conduction and RA score in rats. Furthermore, the microtubule depolymerization agent nocodazole abolished the protective effect of SPC on microtubules and significantly inhibited the ameliorative effects of sevoflurane on Cx43 localization and electrical conduction. These findings substantiate that the ability of SPC to restore the localization of Cx43 and electrophysiological functions in I/R myocardium depends on microtubule stability. In conclusion, our study shows that SPC ensures the targeted transport of Cx43 to the IDs by stabilizing microtubule structure, thereby ameliorating myocardial electrical conduction and RA after I/R.

PMID:40902546 | DOI:10.1016/j.bbrc.2025.152552

J Multidiscip Healthc. 2025 Aug 27;18:5263-5269. doi: 10.2147/JMDH.S533452. eCollection 2025.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the myocardial protective efficacy of different myocardial protection solutions used during extracorporeal circulation in pediatric patients undergoing surgery for complex congenital heart disease. The analysis focused on the effects of these solutions on perioperative cardiac rhythm and serum sodium levels.

METHODS: A retrospective analysis was performed on clinical data from 60 pediatric patients who underwent surgery with extracorporeal circulation for complex congenital heart disease between January 2022 and October 2024. Patients were categorized into the St. Thomas cardioplegic solution group (n = 30) and the histidine-tryptophan-ketoglutarate (HTK) solution group (n = 30). Serum sodium levels and myocardial enzyme markers were monitored perioperatively. Additionally, the incidence of postoperative cardiac arrhythmia and the duration of cardiac reperfusion were recorded.

RESULTS: No significant differences in serum sodium concentrations were observed between the groups preoperatively, or at 12 and 48 hours postoperatively (p > 0.05). However, intraoperative serum sodium levels at 30 and 60 minutes were significantly lower in the HTK solution group compared to the St. Thomas cardioplegic solution group (p < 0.05). Postoperative levels of creatine kinase-MB and B-type natriuretic peptide at 12 and 48 hours were significantly lower in the HTK solution group than in the St. Thomas cardioplegic solution group (p < 0.05). Additionally, the cardiac reperfusion duration was significantly shorter in the HTK solution group (p < 0.05). No significant difference was observed in the incidence of postoperative cardiac arrhythmia between the two groups (p > 0.05).

CONCLUSION: Compared with St. Thomas cardioplegic solution, the HTK solution was associated with significant intraoperative fluctuations in serum sodium concentrations, which stabilized postoperatively. HTK solution demonstrated improved myocardial protection as evidenced by reduced cardiac reperfusion time and lower postoperative myocardial enzyme levels, without an increased risk of postoperative cardiac arrhythmias.

PMID:40900717 | PMC:PMC12400945 | DOI:10.2147/JMDH.S533452

Circ Cardiovasc Imaging. 2025 Sep;18(9):e017620. doi: 10.1161/CIRCIMAGING.124.017620. Epub 2025 Sep 3.

ABSTRACT

BACKGROUND: 2D-speckle tracking echocardiography may help detect subclinical ventricular dysfunction, but data in multisystem inflammatory syndrome in children (MIS-C) are scarce. We investigated left ventricular (LV) strain parameters in MIS-C and their association with outcomes.

METHODS: We performed an ambi-directional, 32-center cohort study on hospitalized patients with MIS-C (March 2020-November 2021) with at least 1 echocardiogram read by the Core Lab. Generalized estimating equation modeling was used to test associations between LV strain and a composite in-hospital adverse cardiovascular outcome (vasoactive support, arrhythmias, cardiac arrest, extracorporeal support, death, or heart transplant).

RESULTS: Of 349 patients (median age, 8.7 years [interquartile range, 5.3-12.9]), 35% had decreased LV ejection fraction during hospitalization, and 45% had depressed LV strain (either 4-chamber LV longitudinal strain [4CH-LVLS] or mid-ventricular LV circumferential strain [mid-LVCS]). The worst 4CH-LVLS and mid-LVCS occurred at ≈5 days of illness; 50% of abnormal LV strain normalized within 1 week, and 95% within 50 days. In-hospital adverse outcomes occurred in 35% of patients; these patients were older (P=0.003) and, at admission, had more likely abnormal troponin (P<0.001) higher C-reactive protein (P<0.001), higher indexed LV end-diastolic volume (P<0.001) and mass (P=0.015), worse LV ejection fraction (P<0.001), and worse LV strain (4CH-LVLS, P=0.002; mid-LVCS, P=0.001). Covariate-adjusted individual models for each strain parameter showed that 4CH-LVLS (adjusted odds ratio, 1.09 [95% CI, 1.07-1.12]), mid-LVCS (adjusted odds ratio, 1.06 [95% CI, 1.04-1.09]), worst LV strain Z score between 4CH-LVLS and mid-LVCS (adjusted odds ratio, 1.30 [95% CI, 1.21-1.41]), and early diastolic longitudinal strain rate (adjusted odds ratio, 1.68 [95% CI, 1.26-2.23]) at admission were found to be associated with adverse outcomes.

CONCLUSIONS: About half of patients with MIS-C had abnormal LV strain during hospitalization. 4CH-LVLS, mid-LVCS, the most abnormal strain Z score, and early diastolic longitudinal strain rate at admission were independently associated with in-hospital adverse cardiovascular outcome. These data may help early characterization and prognostication in MIS-C.

PMID:40899279 | DOI:10.1161/CIRCIMAGING.124.017620

Stem Cell Res Ther. 2025 Sep 2;16(1):485. doi: 10.1186/s13287-025-04357-8.

ABSTRACT

BACKGROUND: Myocardial infarction (MI) results in loss of cardiomyocytes leading to heart failure. Despite advancements in pharmacotherapy and interventions such as revascularization, ischemic heart failure remains a challenge. Recent advancements in stem cell therapies, genetic engineering and bioengineering have shown to improve cardiac function and quality of life.

METHODOLOGY: Following PRISMA guidelines, randomized controlled trials clinical trials from last 12 years were systematically reviewed. All the patients included in these studies had ischemic heart failure and were subjected to different types of stem cell therapies. Protocol for this meta-analysis is registered on PROSPERO (Registration no: CRD42023399263). Data extraction and Quality assessment was done according to Cochrane handbook of systematic reviews and meta-analysis. Meta-analysis was conducted using Revman, and a random-effect model was used to calculate weighted mean differences (WMD) in left ventricular ejection fraction (LVEF), scar size and Minnesota Living with Heart Failure score (MLHFQ) pre- and post-intervention.

RESULTS: The pooled mean difference (MD) for scar size reduction at 6 months follow-up was - 0.36; (95%CI [-0.63, -0.10]), I2 = 71% (p < 0.0001) and at 12 months follow-up was - 0.62; (95%CI [-1.03, -0.21]), I2 = 78% (p < 0.0001) with a positive effect direction. Weight of the studies ranged from 5.4 to 10.8% and 9.6-14.1% at 6 months and 12 months follow-up respectively. The pooled data analysis at 6 months and 12 months follow-up revealed weighted mean difference 0.44; (95% CI [0.13-0.75]), I2 = 85% (p < 0.00001) and 0.64; 95% CI [0.14-1.14], I2 = 85% (p < 0.00001) respectively. For MHLFQ score pooled weighted mean difference was calculated for 286 patients which revealed mean difference - 0.38, (95% CI [-0.71-0.05]) (p = 0.02), I2 = 69% (p < 0.002). Sensitivity analysis by excluding 'Gujjaro et al. 2016' revealed weighted mean difference - 0.49; (95% CI [-0.74-0.25]) (p < 0.0001), I2 = 72% (p = 0.09).

CONCLUSIONS: Our meta-analysis not only demonstrated consistent improvements in LVEF and reductions in scar size but also improvement in quality of life with stem cell therapies, however, the heterogeneity among studies calls for a need of standardized protocols and further research in optimizing these therapies to improve cardiomyocyte regeneration and overall cardiac repair.

PMID:40898343 | PMC:PMC12403498 | DOI:10.1186/s13287-025-04357-8

BMJ Open. 2025 Sep 2;15(9):e096823. doi: 10.1136/bmjopen-2024-096823.

ABSTRACT

INTRODUCTION: Evidence-based early rehabilitation intervention after heart valve surgery has been proven to have many benefits, but the experience of implementing nurse-led early rehabilitation combining exercise and psychology is still lacking. It is urgent to find a more acceptable and cost-effective method to provide exercise intervention and psychological support. The aim of this study is to design a nurse-led cardiac rehabilitation programme to increase the physical capacity and mental health for heart valve patient based on broaden-and-build theory.

METHODS AND ANALYSIS: A non-blinded randomised controlled trial will be conducted. A total of 86 adults diagnosed with heart valve disease will be recruited and randomly assigned to the control group and intervention group. The recovery for valvular heart disease intervention, based on the broaden-and-build theory, will be guided one-on-one by a multidisciplinary team and will consist of two main components: physical intervention and psychological intervention. The baseline assessment will be conducted 1 to 2 days after admission, and sequent evaluations will be implemented at post-intervention, 3 months after intervention and 6 months after intervention. The primary outcome is the finding of six-min walk test and mental state. Other outcomes include quality of life, 36-item short-form health survey, Short Physical Performance Battery, stress, coping modes and social support.

ETHICS AND DISSEMINATION: This study was conducted following the Helsinki Declaration and was approved by the ethics committee of the Zhong Da Hospital, Southeast University (2024ZDSYLL098-P01). The results of this study are scheduled to be published in relevant peer-reviewed journals.

TRIAL REGISTRATION NUMBER: Registered at the Chinese Clinical Trials.gov (ChiCTR2400090853).

PMID:40897479 | PMC:PMC12406905 | DOI:10.1136/bmjopen-2024-096823

Glob Heart. 2025 Aug 28;20(1):71. doi: 10.5334/gh.1462. eCollection 2025.

ABSTRACT

BACKGROUND: The clinical significance of atherosclerotic disease in more than one vascular bed, that is, polyvascular disease, in valvular heart surgery remains poorly understood. This study aims to establish the prevalence and prognostic value of polyvascular disease for long-term outcomes after valvular heart surgery.

METHODS: Patients receiving valvular heart surgery at two tertiary centres from January 1, 2010 to December 31, 2021 were identified. We examined the effect of atherosclerotic disease in three major vascular beds, including coronary artery disease (CAD), ischaemic cerebrovascular accidents (CVA) and peripheral vascular disease (PVD), on postoperative major adverse cardiac events (MACE) and all-cause mortality. Polyvascular disease was defined as atherosclerotic disease in ≥2 vascular beds.

RESULTS: Of 3843 patients (mean age 58 ± 13 years; 52% male), 1266 (33%) had atherosclerotic disease in ≥1 vascular beds, including 207 (5.4%) with polyvascular disease. Patients with vascular disease were older with more comorbidities, higher surgical risk and more aortic stenosis. Over a median follow-up of 6.37 years (IQR: 3.40-9.54), patients with polyvascular disease had the greatest long-term MACE risk [HR: 1.68 (1.35-2.10)], followed by those with monovascular disease [HR: 1.43 (1.24-1.65)]. Both monovascular and polyvascular disease independently predicted mortality and MACE. Patients with extracardiac vascular disease had independently greater long-term MACE risk than CAD [HR: 1.56 (1.27-1.92)].

CONCLUSION: Patients undergoing valvular heart surgery exhibit a high prevalence of vascular disease. The risk of adverse outcomes rises with both the presence and extent of vascular disease, and extracardiac vascular disease confers greater risk of MACE than CAD.

PMID:40894084 | PMC:PMC12396194 | DOI:10.5334/gh.1462

Acta Biomater. 2025 Aug 30:S1742-7061(25)00649-X. doi: 10.1016/j.actbio.2025.08.057. Online ahead of print.

ABSTRACT

Background Myocardial infarction leads to irreversible cardiomyocyte loss and adverse ventricular remodeling, often culminating in heart failure. Transplantation of functional cardiac patches offers a promising avenue for myocardial repair, yet current delivery methods typically require open-chest surgery and suturing of the graft, limiting their applicability in patients with severe heart failure. Methods We developed an engineered heart tissue composed of human induced pluripotent stem cell-derived cardiomyocytes, endothelial cells, and fibroblasts seeded on a durable, flexible scaffold. The scaffold was made of intertwined poly lactide-co-glycolide nano- and microfiber hybrid aerogels coated with gelatin of shape-recoverable property, ensuring mechanical resilience and flexibility for thoracoscopic delivery. Engineered heart tissues were loaded with pro-angiogenic factors including fibroblast growth factor 1 and CHIR99021. After in vitro characterization and optimization, engineered heart tissues were delivered to rats via thoracoscopy at 28 days after myocardial infarction induction. Echocardiography and histological analysis were used to assess cardiac function and heart remodeling. Results Engineered heart tissues exhibited structural integrity under mechanical compression. Thoracoscopy-based epicardial engineered heart tissue transplantation to rats with chronic myocardial infarction significantly improved left ventricular ejection fraction and fractional shortening, concomitant with reduced fibrosis, cardiomyocyte apoptosis, and inflammation, as well as enhanced vascularization. Furthermore, engineered heart tissues modulated the immune response by decreasing neutrophil and macrophage infiltration. Conclusions These findings establish the feasibility of a minimally invasive approach for delivery of engineered heart tissues, eliminating the need for suturing and offering a less invasive alternative to transplantation, thereby broadening the clinical potential of engineered heart tissue-based therapy for heart failure. STATEMENT OF SIGNIFICANCE: Transplantation of engineered heart tissues emerges as a promising approach for regenerating myocardium and improving cardiac function in preclinical models of heart failure. However, clinical translation remains challenged due to the invasive nature of current delivery methods, which often involve open-chest procedures that pose significant risks, particularly for patients with severe heart failure. This study introduces an engineered heart tissue (EHT) made from human induced pluripotent stem cells-derived cardiac cells on a flexible scaffold, and shows that EHTs can be delivered to animal models of chronic myocardial infarction using a minimally invasive, video-assisted thoracoscopic approach. This approach offers a safer alternative to open-chest surgery for EHT treatment of patients with end-stage heart failure.

PMID:40889668 | PMC:PMC12450543 | DOI:10.1016/j.actbio.2025.08.057

Nucleosides Nucleotides Nucleic Acids. 2025 Sep 1:1-29. doi: 10.1080/15257770.2025.2550969. Online ahead of print.

ABSTRACT

Heart failure (HF) is not a disease but a combination of signs and symptoms caused by the failure of the heart to pump blood to support the circulatory system at rest or during activity. HF is the potential end stage of all heart diseases in which cardiomyopathies are a diverse group of cardiac disorders with distinct phenotypes, depending on the protein and pathways affected. Cardiomyopathies represent major causes of morbidity and mortality at all ages in humans in which hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), are the most common. Among the different common diagnostic tests for heart failure such as physical examination, blood tests, chest X-rays, electrocardiogram (ECG), etc. ultrasound has also been used not only for diagnosis such as echocardiography but also for therapeutic purposes. The development of therapeutic strategies for HF aiming to improve the heart's function, delay progression of HF, and treat HF symptoms as well as to stimulate the capacity to regenerate cardiomyocytes via stem cell therapy have been under intensive research interest. This narrative review aims to present the current understanding of the pathogenesis, diagnosis, and treatment of HF. Furthermore, as a perspective, this review navigates emerging therapies for HF by emphasizing on the use of low-intensity pulsed ultrasound (LIPUS) as a noninvasive therapy for (1) stimulation of the myocardial tissue reconstruction mechanisms; and (2) exploration of the molecular mechanisms behind the mechanotransduction from the muscle LIM protein (MLP), which is believed to be involved in human HF, using its expression vector via glycosylphosphatidylinositol, GPI, anchor.

PMID:40889110 | DOI:10.1080/15257770.2025.2550969

BMC Anesthesiol. 2025 Sep 1;25(1):441. doi: 10.1186/s12871-025-03317-2.

ABSTRACT

BACKGROUND: The implantation of a Swan-Ganz catheter for invasive hemodynamic monitoring is an established measure after cardiac surgery. A rare but serious complication is the formation of a knot in the heart, which can be diagnostically challenging. We report on a patient who developed left heart failure postoperatively after quadruple bypass surgery combined with aortic valve replacement and in whom a knot formed inadvertently during monitoring using a Swan-Ganz catheter.

CASE PRESENTATION: An 82-year-old female underwent combined quadruple coronary artery bypass grafting and aortic valve replacement for severe coronary and valvular heart disease. Postoperatively, she experienced acute left ventricular dysfunction, necessitating mechanical circulatory support with an Impella device. A Swan-Ganz catheter was placed through the internal jugular vein for accurate hemodynamic monitoring. After placement, unexpected catheter immobility raised suspicion of an intracardiac knot. Initial transthoracic echocardiography did not clearly visualize the lesion; however, subsequent chest radiography and jugular vein ultrasound confirmed catheter-associated intracardiac knot formation. Considering the heightened risk for cardiac injury and thromboembolic events, interdisciplinary consensus recommended bedside surgical extraction. The catheter and associated knot were successfully removed via transcutaneous vascular incision without complications. Inspection revealed knot formation proximal to the catheter thermistor, while the balloon remained intact and functional.

CONCLUSION: Intracardiac knot formation associated with Swan-Ganz catheter placement is rare but presents significant risks. Timely interdisciplinary assessment, multimodal imaging, and surgical extraction under controlled conditions effectively mitigate potential complications, enabling safe catheter removal and favorable patient outcomes.

PMID:40890593 | PMC:PMC12403380 | DOI:10.1186/s12871-025-03317-2

Open Heart. 2025 Sep 1;12(2):e003476. doi: 10.1136/openhrt-2025-003476.

ABSTRACT

BACKGROUND: Valvular surgery for infective endocarditis (IE) can improve survival but carries substantial risk. Limited data exist on long-term outcomes for patients who survive surgery compared with a background population. We aim to compare long-term mortality and morbidity in patients with IE, who survive 90-days following valvular surgery to a matched Danish background population.

METHODS: Using Danish registries, we identified patients who survived >90 days post-valvular surgery for first-time IE (2010-2023). Each patient was matched 1:3 with controls from the background population by age, sex and selected comorbidities. All-cause mortality was assessed at 5 and 10 years using the Kaplan-Meier estimator and the multivariate Cox model. Further, we examined the time spent in hospital during the first year following the index date.

RESULTS: We identified 1050 patients (77.5% male, median age 65.8 years) surgically treated for IE and 3150 controls. The most common pathogens were: Viridans group streptococci (44.6%), Staphylococcus aureus (23.1%), Enterococci (17.9%). Patients with IE had higher absolute 5-year (20.1% vs 12.9%, p=0.001) and 10-year (38.5% vs 27.9%, p<0.001) mortality compared with controls. Adjusted 5-year and 10-year mortality rates were also higher in patients with IE (5-year HR=1.49 (95% CI 1.24 to 1.79) and 10-year HR 1.38 (95% CI 1.19 to 1.60)). Patients with IE experienced more frequent and longer hospitalisations within the first year postsurgery, as 36.8% patients with IE were hospitalised within the first year following index compared with 17.5% in the matched controls. 9.3% of patients with IE were hospitalised for >14 days compared with 3.0% in matched controls. 60 patients with IE (5.7%) died within the first year following index compared with 51 (1.6%) in the matched controls.

CONCLUSION: Patients with IE who underwent valve surgery had a higher crude mortality than their controls from the background population. After adjusting for confounders, 5-year and 10-year mortality rates remained higher in the IE patient population.

PMID:40890021 | DOI:10.1136/openhrt-2025-003476