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JAMA. 2025 Sep 23;334(12):1077-1083. doi: 10.1001/jama.2025.13580.

ABSTRACT

IMPORTANCE: Partial heart transplant, or living valve replacement, has the potential to advance surgical management of irreparable valvular disease by providing a viable option with capacity for growth.

OBJECTIVES: To describe the early experience and assess the feasibility, safety, and efficacy of partial heart transplant in patients with congenital heart valve disease.

DESIGN, SETTING, AND PARTICIPANTS: Case series of the first 19 patients to undergo partial heart transplant at a single high-volume pediatric cardiac surgery and transplant center in the US between April 2022 and December 2024. No patients were excluded or lost to follow-up.

EXPOSURES: Partial heart transplant using semilunar valves from donor hearts. Maintenance immunosuppression consisted of tacrolimus monotherapy with a trough level goal of 4 to 8 ng/mL.

MAIN OUTCOMES AND MEASURES: Efficacy was defined as growth of the transplanted valve annulus and leaflets over time. Secondary outcomes included valve dysfunction and complications related to immunosuppression.

RESULTS: Among the 19 participants with irreparable congenital heart valve dysfunction, 53% were male and 47% female. The median age at the time of transplant was 97 days. The median follow-up was 26 weeks. Three patients received partial heart transplant of both semilunar valves, 7 underwent living pulmonary valve replacement in the pulmonary position, 2 had a living aortic valve allograft in the aortic position, and 7 had a living aortic valve allograft in the pulmonary position. Nine patients constituting the initial cohort of partial heart transplant recipients had their annular diameter and valve leaflet length longitudinally analyzed for growth. All valves functioned well and demonstrated growth along appropriate z scores. Annular diameter increased from medians of 7 mm (aortic valve) and 9 mm (pulmonary valve) to 14 mm (aortic valve) and 17 mm (pulmonary valve), respectively. Leaflet length similarly increased from medians of 0.5 mm (aortic valve) and 0.49 mm (pulmonary valve) to 1 mm (aortic valve) and 0.675 mm (pulmonary valve), respectively. One patient required reoperation unrelated to the implanted valve. No significant complications related to immunosuppression were observed.

CONCLUSIONS AND RELEVANCE: Partial heart transplant appears feasible, safe, and efficacious. All transplanted valves demonstrated growth based on annular and leaflet length measurements. Careful follow-up and monitoring are crucial to support the continued expansion of this novel technique.

PMID:40864436 | PMC:PMC12457970 | DOI:10.1001/jama.2025.13580

Int J Surg Protoc. 2025 Mar 20;29(2):26-29. doi: 10.1097/SP9.0000000000000039. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Rheumatic heart disease (RHD) remains a major health challenge in Africa, where the prevalence is notably high. Valvular surgery is a crucial procedure for managing severe RHD. However, the current state and historical trend of research on this subject in African populations is not well understood. Understanding the scope, subject matter, and quality of the literature on this topic over time is essential to inform future research and clinical practice.

OBJECTIVE: This paper aims to assess the current published literature to evaluate vital outcomes such as surgical outcomes, survival rates, postoperative complications, long-term quality of life, morbidities, mortalities, and barriers to valve surgery for patients with RHD in Africa.

METHODS: This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). An extensive search will be conducted across different databases, including PubMed, Scopus, Web of Science, Cochrane Library, African Index Medicus, and African Journals Online. Studies will be identified through keyword searches and will be reviewed against predefined inclusion and exclusion criteria by two reviewers, with a third reviewer resolving any discrepancies. A narrative synthesis will be conducted to describe the findings.

CONCLUSION: The findings from this scoping review will provide an understanding of the current literature on valvular surgery for RHD in African contexts. This will help guide future research directions in this field.

PMID:40861286 | PMC:PMC12373035 | DOI:10.1097/SP9.0000000000000039

J Surg Case Rep. 2025 Aug 23;2025(8):rjaf663. doi: 10.1093/jscr/rjaf663. eCollection 2025 Aug.

ABSTRACT

Papillary fibroelastoma (PFE) is a rare, benign cardiac tumor usually arising from the heart valves, whereas non-valvular involvement is uncommon. We report herein a case of a 71-year-old Asian male who developed an ischemic stroke during hospitalization for gastrointestinal bleeding. A stroke workup led to the incidental detection of a cardiac mass in the left ventricular outflow tract, later confirmed as PFE following surgical excision without complications. This case highlights the importance of cardiac imaging in patients with cryptogenic stroke and supports early surgical excision to prevent recurrent embolic events.

PMID:40860283 | PMC:PMC12374799 | DOI:10.1093/jscr/rjaf663

Anaesthesia. 2025 Aug 26. doi: 10.1111/anae.16753. Online ahead of print.

ABSTRACT

INTRODUCTION: Peri-operative anaemia is a common problem in patients undergoing cardiac surgery. Postoperative anaemia is not well understood relative to pre-operative anaemia; limited data exist on haemoglobin recovery and mortality after discharge, especially in the era of restrictive transfusion practice. We aimed to investigate the associations of pre-operative and persistent postoperative anaemia with 1-year mortality in patients undergoing valvular heart surgery.

METHODS: We identified patients who had undergone valvular heart surgery and allocated them to one of four groups based on their pre-operative (haemoglobin ≥ 130 g.l-1 and < 130 g.l-1 in men and ≥ 120 g.l-1 and < 120 g.l-1 in women) and postoperative (measured 2 months after surgery; haemoglobin ≥ 100 g.l-1 and < 100 g.l-1 in both men and women) anaemia status. The four groups were: pre- and postoperative non-anaemia (non-anaemia-non-anaemia); pre-operative anaemia-postoperative non-anaemia (anaemia-non-anaemia); pre- and postoperative anaemia (anaemia-anaemia); and pre-operative non-anaemia-postoperative anaemia (non-anaemia-anaemia). The primary outcome was 1-year mortality.

RESULTS: Data from 2486 patients were included. Pre-operative anaemia was diagnosed in 1107 patients (44.5%) and 279 (11.9%) met the diagnostic criteria for persistent anaemia 2 months postoperatively. The overall 1-year mortality rate was 3.3%. The highest rate was observed in the anaemia-anaemia group (17.8%), followed by the non-anaemia-anaemia (13.1%), anaemia-non-anaemia (2.9%) and non-anaemia-non-anaemia (0.5%) groups. Multivariable Cox regression analysis showed that the non-anaemia-anaemia group had the highest risk of 1-year mortality (adjusted hazard ratio 14.44, 95%CI 4.88-42.69), followed by the anaemia-anaemia group (adjusted hazard ratio 10.94, 95%CI 4.41-27.16).

DISCUSSION: Our study highlights the high prevalence of persistent anaemia following valvular heart surgery. Persistent anaemia 2 months postoperatively is associated with an increased risk of 1-year mortality.

PMID:40859452 | DOI:10.1111/anae.16753

Medicine (Baltimore). 2025 Aug 22;104(34):e43695. doi: 10.1097/MD.0000000000043695.

ABSTRACT

This retrospective study evaluates the efficacy of dexmedetomidine (Dex) combined with stellate ganglion block (SGB) in cardiac valve replacement under extracorporeal circulation. A total of 93 patients with cardiopulmonary bypass heart valve replacement were included between June 2021 and June 2023. The study group (n = 46) received SGB before anesthesia induction followed by Dex infusion, while the control group (n = 47) received Dex alone. Hemodynamics, cerebral oxygen metabolism (D(a-jv)O₂ and CERO₂), serum biomarkers (S100β, neuron-specific enolase, malondialdehyde, superoxide dismutase), postoperative cognitive dysfunction (POCD), and anesthesia-related adverse events were compared. Repeated-measures ANOVA revealed significant differences in mean arterial pressure (MAP) trends between groups (P < .05). The study group exhibited higher MAP during anesthesia induction and extracorporeal circulation but lower MAP postoperatively versus controls (all P < .05). D(a-jv)O₂ and CERO₂ were significantly lower in the study group at extracorporeal circulation initiation and cessation (P < .05). At 24 hours post-surgery, the control group showed elevated S100β, neuron-specific enolase, and malondialdehyde levels (P < .05) and reduced superoxide dismutase (P < .05) compared to the study group. The incidence of POCD in the study group was significantly lower at postoperative day 3 (10.87% vs 29.79%) and day 5 (4.35% vs 14.89%) (P < .05). Anesthesia-related adverse events were reduced in the study group (15.22% vs 36.17%, P < .05). Preoperative Dex combined with SGB stabilizes hemodynamics, mitigates oxidative stress, and reduces risks of POCD and anesthesia complications in cardiac valve replacement surgery.

PMID:40859584 | PMC:PMC12385058 | DOI:10.1097/MD.0000000000043695

Medicine (Baltimore). 2025 Aug 22;104(34):e44008. doi: 10.1097/MD.0000000000044008.

ABSTRACT

RATIONALE: The long-term complications of extracorporeal membrane oxygenation (ECMO) have not been well documented, especially the rare lower extremity drop foot (LEDF). Understanding the mechanisms and management of such complications is critical to improving patient outcomes. What is the role of patient-based on user portrait and health management journey map (HMJM) for rehabilitation management of patients with post-intensive care syndrome (PICS)?

PATIENT CONCERNS: We reported a case of a patient who developed LEDF after receiving ECMO for severe heart failure. The patient's user profile revealed a 17-year-old female athlete with a past history of hypertension. After treatment with ECMO, the patient developed LEDF with loss of sensation and motor deficits resulting in third-degree burns, which were inadvertently caused by using an electric stove for heating in the winter. During her hospitalization, she experienced several medical interventions and became more sensitive to pain and dysfunction perception. After discharge from the ICU, the patient reported significant difficulties in mobility, quality of life, and mental health.

DIAGNOSES: The diagnosis of LEDF was confirmed by clinical electromyography, third-degree burns were assessed using the burn assessment criteria, and the scale confirmed PICS.

INTERVENTIONS: User portrait and HMJM provided patients with personalized integrated rehabilitation care from a multidisciplinary team. This included physical and pharmacological treatment for foot drop. A skin graft was applied to the burned area. In addition, psychotherapy was received during the peri-rehabilitation period.

OUTCOMES: Despite comprehensive interventions, the patient showed only partial recovery of foot function and required long-term rehabilitation and assistive devices for daily activities. However, mental health performance was better than before.

LESSONS: This case highlighted the importance of monitoring patients with ECMO for neuromuscular injuries, such as LEDF. The need for early intervention to prevent secondary injuries, such as burns. It also demonstrated the value of user portrait and HMJM in guiding individualized rehabilitation care plans for PICS.

PMID:40859570 | PMC:PMC12384982 | DOI:10.1097/MD.0000000000044008

Medicine (Baltimore). 2025 Aug 22;104(34):e43975. doi: 10.1097/MD.0000000000043975.

ABSTRACT

RATIONALE: Acute myocardial infarction (AMI) in young individuals has become increasingly prevalent in recent years, with the age of onset progressively declining. According to the China Acute Myocardial Infarction Registry, which included over 24,000 cases, approximately 8.5% of AMI patients were aged ≤45 years. However, AMI occurring in adolescents remains exceptionally rare. Early recognition and timely intervention in such patients pose significant clinical challenges and carry important implications for improving outcomes in this population.

PATIENT CONCERNS: We report the case of a 16-year-old previously healthy male who presented with persistent precordial pain lasting over 4 hours. On admission, an emergency electrocardiogram showed atrial fibrillation with a heart rate of 117 bpm, abnormal Q waves in leads I, aVL, V2, and V3, and ST segment elevations ranging from 0.1 to 0.8 mV in leads I, aVL, and V1-V5.

DIAGNOSES: Based on clinical presentation and ECG findings, the patient was diagnosed with acute extensive anterior and high lateral wall myocardial infarction.

INTERVENTIONS: Emergency coronary angiography revealed total occlusion of the left main coronary artery. The patient was immediately treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and received comprehensive supportive care.

OUTCOMES: Despite aggressive intervention, the patient developed catastrophic intracranial hemorrhage and subsequently died.

LESSONS: This case highlights the importance of considering AMI in the differential diagnosis of chest pain even in adolescents, and underscores the need for heightened clinical awareness, early diagnostic evaluation, and rapid therapeutic decision-making. Further research is needed to understand the underlying mechanisms and risk factors contributing to early-onset AMI in young individuals.

PMID:40859521 | PMC:PMC12384938 | DOI:10.1097/MD.0000000000043975

Medicine (Baltimore). 2025 Aug 22;104(34):e43840. doi: 10.1097/MD.0000000000043840.

ABSTRACT

BACKGROUND: Music therapy has been used in medicine to reduce patient stress and to improve mood. This study aimed to evaluate the effects of music therapy on intraoperative hemodynamics and medication requirement and postoperative pain and side effects.

METHODS: Eighty patients with American Society of Anesthesiologists I to II physical status at the ages of 20 to 60 for whom elective thyroidectomy surgery was planned were included in the study. General anesthesia was induced for patients and demographic data were recorded. The patients were randomly divided into 2 groups. The groups were determined as music group (group M) and control group (group C). The intraoperative vital signs of the patients (heart rate, blood pressure, and oxygen saturation), bispectral index values, train-of-four neuromuscular monitoring values, additional opioid and muscle relaxant requirements, and complications were recorded.At the end of the operation, extubation was performed following standard decurarization using atropine and neostigmine. The 0th hour, 3rd hour and 6th hour visual analogue scale scores of the patients were measured and recorded.

RESULTS: Intraoperative fentanyl and rocuronium consumption were found to be approximately 23% lower in group M compared to group C (P < .05).The bispectral index values of the patients were similar between the groups (P > .05). It was also observed that the postoperative pain levels of the group M were lower (P < .05). Music therapy was determined to not create a difference in terms of the blood pressure, heart rate, and saturation (SpO2) levels during recovery from anesthesia (P > .05).

CONCLUSIONS: Playing music, which is a non-pharmacological intervention, is an effective method without a side effect that not only reduces the intraoperative need for muscle relaxant and analgesic use but also causes positive effects on postoperative visual analogue scale scores.

PMID:40859508 | PMC:PMC12384971 | DOI:10.1097/MD.0000000000043840

Braz J Cardiovasc Surg. 2025 Aug 26;40(5):e20240405. doi: 10.21470/1678-9741-2024-0405.

ABSTRACT

OBJECTIVE: To evaluate the long-term performance of a bovine pericardium valve prosthesis in individuals who required valve replacement in the Brazilian public health system.

METHODS: Medical records of patients having mitral or aortic valve replacement with bovine pericardium valve prostheses between 1978 and 1994 at a Brazilian hospital were reviewed in this retrospective study. Safety was assessed through the complications and serious adverse events rates in the early and long terms. Successful valve replacement was defined by absence of complications and serious adverse events up to 30 days after surgery.

RESULTS: A total of 439 surgeries were performed in 382 patients with a mean age of 46.45 ± 13.93 years. Mean follow-up time was 6.26 years (up to 26.13 years). Rheumatic etiology was present in 83.5% of the cases. Mitral valve replacement was the most performed surgery. Five complications in five patients were recorded up to 30 days after surgery, and the rate of serious adverse events for the same period was 10.3%. Successful valve replacement rate was 90.7%. Postoperative complications were reported during the follow-up period in 29.6% of the procedures, being calcification the most common with 17.3%.

CONCLUSIONS: Despite the young age of the patients, safety outcomes were in accordance with what is reported in the literature for bioprostheses, with acceptable complication, serious adverse events, and freedom from reintervention rates.

PMID:40857581 | PMC:PMC12400614 | DOI:10.21470/1678-9741-2024-0405

Sci Rep. 2025 Aug 26;15(1):31479. doi: 10.1038/s41598-025-12560-z.

ABSTRACT

Neurological disorders are increasingly prevalent in developing countries, particularly in sub-Saharan Africa. However, data regarding the epidemiology of these conditions in Somalia remain limited. This study aims to analyze the patterns of neurological diagnoses among patients admitted to the neurology department of a tertiary referral hospital in Mogadishu, Somalia. We conducted a retrospective cross-sectional study at Somalia's largest referral hospital in Mogadishu between July 2019 and July 2024. Data were extracted from electronic medical records of adult patients admitted with neurological conditions to the neurology ward, emergency department, and general intensive care units. Pediatric and trauma-related admissions were excluded. Descriptive statistics, Pearson chi-square tests, binary logistic regression, and Kaplan-Meier survival analysis were employed to assess the distribution of neurological diagnoses and factors associated with in-hospital mortality. A total of 2,126 patients were included in the study. The mean age was 56.03 ± 19.07 years (range: 18-98 years), and the majority were male (n = 1,274; 60%). Most admissions originated from the emergency department (n = 1,741; 82%). Over half of the patients had at least one comorbidity (n = 1,329; 62.5%), with hypertension being the most common (n = 654; 31%), followed by diabetes mellitus (n = 175; 8.2%), epilepsy (n = 138; 6.5%), heart disease (n = 118; 5.6%), and previous stroke or transient ischemic attack (TIA) (n = 67; 3.2%). The leading neurological diagnoses were ischemic stroke (n = 905; 42.6%), hemorrhagic stroke (n = 552; 26%), epileptic disorders (n = 166; 7.8%), cerebral venous thrombosis (n = 138; 6.5%), non-traumatic subarachnoid hemorrhage (n = 92; 4.2%), and Guillain-Barré syndrome (n = 47; 2.2%). Intrahospital mortality was recorded in 342 patients (23%). Poor survival outcomes were significantly associated with advanced age, comorbidities, multiple diagnoses, low Glasgow Coma Scale (GCS) scores, and ICU admission, underscoring the importance of early detection and targeted interventions to reduce mortality. This study represents the first comprehensive assessment of neurological admissions in Mogadishu, Somalia-a region with limited healthcare resources. Cerebrovascular diseases and epileptic disorders were the most common diagnoses. The high in-hospital mortality rate emphasizes the urgent need to strengthen preventative and therapeutic strategies targeting non-communicable neurological diseases in low-resource settings.

PMID:40858641 | PMC:PMC12381066 | DOI:10.1038/s41598-025-12560-z

Biol Cell. 2025 Aug;117(8):e70028. doi: 10.1111/boc.70028.

ABSTRACT

Cardiac regeneration is hindered by the permanent cell cycle arrest of cardiomyocytes post-birth, leading to compensatory fibrosis and impaired cardiac function after injury. While the role of cell cycle regulatory proteins is well understood, the impact of long non-coding RNAs (lncRNAs) remains unclear. To address this gap, we reanalyzed public transcriptomic datasets comparing pre- and post-natal ventricular cardiomyocytes. In silico analysis identified differentially expressed lncRNAs, with four candidates selected for further validation. Human embryonic stem cells (hESCs) were differentiated into cardiomyocytes, and their cell cycle status was assessed on Days 10, 20, and 30. The expression of in silico-identified lncRNAs was evaluated in proliferative (Day 10) and non-proliferative (Days 20 and 30) hESC-derived cardiomyocytes, resembling pre- and post-natal ventricular cardiomyocytes. Among the candidates, STARD4-AS1 and H19 showed a permanent downregulation pattern in both in silico and in vitro assays. STARD4-AS1 and H19 lncRNAs might reside in the regulatory network of cardiomyocytes cell cycle arrest and as targets for cardiac regenerative strategies.

PMID:40851346 | DOI:10.1111/boc.70028

Sci Rep. 2025 Aug 25;15(1):31271. doi: 10.1038/s41598-025-15746-7.

ABSTRACT

Allogeneic red blood cells (RBCs) are commonly used for cardiopulmonary bypass (CPB) circuit priming in congenital heart surgery. While convection-based pre-bypass ultrafiltration (PBUF) corrects acid-base, electrolyte, and metabolite imbalances, its efficacy in removing RBC cytokines/chemokines remains unclear. In a prospective observational study, 22 children (median age: 4.1 months) undergoing congenital heart surgery were enrolled. PBUF of RBC-primed CPB circuits was conducted using bicarbonate-buffered hemofiltration solution. Cytokines/chemokines were quantified in RBC supernatants, CPB priming (before and after PBUF), preoperative patient plasma, and PBUF effluent using Luminex-based multiplex technology. 30 of 50 cytokines were detected in > 50% of RBC supernatants. RBC priming significantly elevated concentrations of 25 cytokines, with 20 further rising after PBUF. At CPB onset, eight mediators (MIF, IL-15, CCL11/Eotaxin, CCL2/MCP-1, VEGF, IL-5, VCAM-1, ICAM-1) exceeded patient plasma concentrations. PBUF filtered cytokines with different efficiencies (0.6-97%). Despite poor filtration or increased concentrations, total mediator load of 42 cytokines decreased significantly (33.3-69.1% of pre-processing levels) after PBUF. In conclusion, PBUF effectively removed multiple cytokines/chemokines released from RBC. Beyond filtration, decrease of total mediator load may be attributed to adsorption to circuit components or rebinding to RBCs. Improved washing techniques may further optimize mediator levels in RBC-primed CPB circuits.

PMID:40854943 | PMC:PMC12379243 | DOI:10.1038/s41598-025-15746-7

Braz J Cardiovasc Surg. 2025 Nov 1;40(6):e20250028. doi: 10.21470/1678-9741-2025-0028.

ABSTRACT

Cardiopulmonary bypass (CPB) in children presents challenges related to blood volume and surface area of the circuit. Conventional ultrafiltration (CUF) is used to minimize complications, but modified ultrafiltration (MUF) can optimize clinical outcomes. We propose a modification to the CPB circuit, incorporating three luer connectors and a 12 Fr extension tube, allowing for simple and safe MUF implementation. Since 2014, this technique has been applied to approximately 3,500 children weighing < 20 kg, proving to be effective and low-cost. The new configuration does not require additional pumps, facilitates volume replacement, and maintains blood temperature, thereby improving procedural safety. Results indicate that this circuit modification for MUF offers safe and efficient management strategy for pediatric patients, with low risk of complications and potential easy implementation in various cardiovascular surgery centers.

PMID:40854153 | PMC:PMC12379719 | DOI:10.21470/1678-9741-2025-0028

JAMA Netw Open. 2025 Aug 1;8(8):e2527443. doi: 10.1001/jamanetworkopen.2025.27443.

ABSTRACT

IMPORTANCE: Posttraumatic growth (PTG) refers to positive psychological changes following adversity, including deeper relationships and a greater appreciation for life.

OBJECTIVE: To assess PTG among intensive care unit (ICU) health care professionals 4 years after the COVID-19 pandemic and explore its association with resilience, anxiety, and depression.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study invited ICU health care professionals (nursing staff, medical staff [residents, interns, clinical fellows, and senior intensivists], and other professionals providing patient care) in ICUs in general or university-affiliated hospitals in France and Belgium to complete online questionnaires between March 15 and May 15, 2024.

EXPOSURES: PTG, resilience, anxiety, and depression.

MAIN OUTCOMES AND MEASURES: The primary outcome was PTG, and secondary outcomes were anxiety, depression, and resilience. Participants completed validated self-reported questionnaires, including the Posttraumatic Growth Inventory (PTGI), Hospital Anxiety and Depression Scale (HADS), and 10-item Connor-Davidson Resilience Scale (CD-RISC 10). Visual analog scales (VASs) assessed professional experiences and psychological impact. Multivariate linear regression identified factors associated with PTG.

RESULTS: Among 1371 health care professionals in 23 ICUs, 850 (62%) responded (median age, 39 years [IQR, 32-46 years]; 574 [68%] women). The median PTGI score was 50 (IQR, 33-64), with nursing staff reporting higher PTG than medical staff (51 [IQR, 34-65] vs 47 [IQR, 28-61]; P = .02), mainly in personal strength, spiritual change, and appreciation of life. Anxiety and depression symptoms were present in 492 respondents (58%) and 219 respondents (26%), respectively. Lower PTG was associated with psychological fatigue (regression coefficient, 1.43; 95% CI, 0.91-1.96; P < .001), ICU conflicts (regression coefficient, 0.62; 95% CI, 0.05-1.19; P = .03), and perceived deterioration in family-centered care (regression coefficient, -7.47; 95% CI, -1.10 to -13.80; P = .02). Higher PTG was correlated with higher resilience (Spearman correlation coefficient, 0.24; 95% CI, 0.17-0.30; P < .001) and was associated with a change in personal life since the pandemic (regression coefficient, 1.80 [95% CI, 1.13-2.47] per VAS point; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study performed 4 years after the start of the COVID-19 pandemic, ICU health care professionals, particularly nursing staff, exhibited significant PTG. Resilience, rather than psychological distress, emerged as a key driver of PTG, and deterioration in family-centered care was a major contributing factor, underscoring the need for targeted well-being and resilience-building strategies to enhance health care professionals' mental health and professional fulfillment while also improving patient and family care.

PMID:40853660 | PMC:PMC12379108 | DOI:10.1001/jamanetworkopen.2025.27443

Anesth Analg. 2025 Aug 19. doi: 10.1213/ANE.0000000000007710. Online ahead of print.

NO ABSTRACT

PMID:40853224 | DOI:10.1213/ANE.0000000000007710

J Thorac Cardiovasc Surg. 2025 Aug 22:S0022-5223(25)00636-1. doi: 10.1016/j.jtcvs.2025.07.029. Online ahead of print.

NO ABSTRACT

PMID:40848039 | DOI:10.1016/j.jtcvs.2025.07.029

Catheter Cardiovasc Interv. 2025 Oct;106(4):2637-2644. doi: 10.1002/ccd.70098. Epub 2025 Aug 21.

ABSTRACT

BACKGROUND: Data regarding the long-term outcomes of patients undergoing venoarterial extracorporeal membrane oxygenator (VA-ECMO) assisted high-risk percutaneous coronary intervention (PCI) and the impact of the operator experience is limited.

AIMS: We aimed to investigate the long-term outcomes of patients undergoing VA-ECMO-assisted PCI and the effect of the operator experience.

METHODS: The study was a retrospective cohort study that consecutively enrolled patients who were declined by the Heart Team for coronary artery bypass grafting (CABG) due to high surgical risk and treated with VA-ECMO-assisted PCI from November 1, 2016, to March 1, 2024, in Xijing Hospital, China. The primary endpoint was all-cause death at 1 year.

RESULTS: A total of 220 patients were included. The mean age ± SD was 65.6 ± 11.4 years and the median LVEF% (IQR) was 36.0 (30.0-40.0). The mean ± SD of the SYNTAX score was 34.7 ± 6.9. The median (IQR) follow-up was 1.9 (1.3-4.9) years, and the vital status of all patients was available at 1 year. The all-cause death occurred in 56 (25.5%) of patients at 1 year. Utilizing the restricted cubic spline, the threshold to categorize an experienced operator was performing > 10 cases of VA-ECMO-assisted PCI. Compared to the ≤ 10 cases group, the > 10 cases group was associated with a 44% decrease in risk of all-cause death (19.8% vs. 31.5%, HR adjusted: 0.56, 95% CI: 0.33-0.97, p = 0.039).

CONCLUSION: VA-ECMO-assisted PCI appeared to be a feasible option for patients unsuitable for CABG. Performing > 10 cases could be a threshold to categorize an experienced operator.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06713876.

PMID:40842186 | DOI:10.1002/ccd.70098

Cardiovasc Diabetol. 2025 Aug 21;24(1):344. doi: 10.1186/s12933-025-02902-6.

ABSTRACT

BACKGROUND: Metabolic Syndrome (MetS) significantly increases the risk of cardiovascular disease (CVD), with central obesity and insulin resistance as major contributors. The TyG-ABSI index is a newly proposed composite measure that combines the TyG index and ABSI, aiming to assess both insulin resistance and central obesity simultaneously. Previous studies have shown that TyG-ABSI has potential in predicting cardiovascular mortality, but its applicability in MetS populations remains unclear. This study aims to explore the association between TyG-ABSI and cardiovascular events in individuals with MetS and compare its predictive value with the traditional TyG index in this specific population.

METHODS: Participants from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 were selected, with all data weighted for sample design, clustering, and stratification to ensure national representativeness. Associations between TyG-ABSI and other TyG indices with cardiovascular mortality and all-cause mortality were assessed using weighted Cox proportional hazards models; CVD prevalence was analyzed using weighted logistic regression models. Additional analyses included Kaplan-Meier survival curves and restricted cubic spline regression. Model performance was compared between TyG-ABSI, TyG, and its derived indices using ROC curves, NRI, IDI, and DCA. E-value, subgroup analyses, and competing risks models were conducted to assess robustness.

RESULTS: This study analyzed data from 12,813 individuals with metabolic syndrome in the NHANES cohort to systematically compare the performance of TyG-ABSI and other TyG-related indices in assessing CVD and mortality. The results revealed significant associations between TyG-ABSI and CVD, cardiovascular mortality, and all-cause mortality. Specifically, for each 1-unit increase in TyG-ABSI, the risk of CVD increased by 28%, cardiovascular mortality by 25%, and all-cause mortality by 28%. These associations showed a dose-response relationship in stratified analyses based on tertiles, and TyG-ABSI outperformed the traditional TyG index in overall analysis. Compared to other TyG-related indices, TyG-ABSI demonstrated superior predictive performance in metrics such as the ROC curve, NRI, and DCA. Further analyses, including competing risks models, E-value estimation, and RCS modeling, confirmed the robustness of these associations. Subgroup analyses also supported the stability of TyG-ABSI, with limited interaction effects.

CONCLUSION: Our study highlights the value of TyG-ABSI in assessing cardiovascular disease and mortality risk in populations with MetS, providing new evidence for medical practice and public health interventions.

PMID:40841630 | PMC:PMC12372269 | DOI:10.1186/s12933-025-02902-6

Kyobu Geka. 2025 Aug;78(8):613-616.

ABSTRACT

An 82-year-old man was admitted to our hospital with chest pain as a chief complaint and diagnosed with a ruptured aortic aneurysm in the distal arch by contrast-enhanced computed tomography (CT). The patient underwent surgery using artificial heart-lung and selective cerebral extracorporeal circulation, and a semi-circumferential aortic arch incision was made around the anterior surface of the aortic arch. An open stent graft was inserted through the incision, trimmed to fit the size, and the aortic wall and the stent graft were fixed with 3-0 proline continuous sutures, and finally the incision was closed with 3-0 proline. This method was useful because it may shorten the operation time and decrease the amount of blood loss compared to the common aortic arch replacement with frozen elephant trunk.

PMID:40840883

J Med Biochem. 2025 Jul 4;44(4):854-862. doi: 10.5937/jomb0-54272.

ABSTRACT

BACKGROUND: To investigate the effects of modified ultrafiltration in extracorporeal circulation valve replacement surgery.

METHODS: A total of 62 patients with valvular disease who underwent valve replacement were included. They were randomly divided into the conventional ultrafiltration group (CUF group, n=31) and the modified ultrafiltration group (MUF group, n=31). The hematocrit (Hct) values, volume of pleural fluid drainage at 24 hours after operation, Intensive Care Unit (ICU) stay time, postoperative 24-hour blood loss, bank blood usage, postoperative 24-hour urine volume, ventilator support time, cardiac function indexes, postoperative changes of respiratory function, and levels of inflammatory factors in both groups were compared.

RESULTS: After ultrafiltration, the MUF group showed higher Hct value and reduced volume of pleural fluid drainage, blood loss, bank blood usage, urine volume and ventilator support time 24 hours after operation compared with the CUF group (P<0.05). After surgery, left ventricular ejection fraction (LVEF) levels were elevated, and those in the MUF group were higher than those in the CUF group. Left ventricular end-diastolic diameter (LVEDD) and heart rate (HR) were decreased in both groups after surgery. They were lower in the MUF group than in the CUF group (P<0.05). After ultrafiltration, the OI value in the MUF group was higher, and the alveolar-arterial oxygen partial pressure gradient (P (A-a)O2) value was lower than the CUF group (P<0.05). The plasma concentrations of interleukin 6 (IL-6) and tumour necrosis factor-alpha (TNF-a) were increased after cardiopulmonary bypass (CPB) in both groups and then decreased after ultrafiltration, and IL-6 and TNF-a levels in MUF group were lower than those in CUF group (P<0.05).

CONCLUSIONS: MUF attenuates the postoperative systemic inflammatory response, reduces the lung injury caused by CPB, and improves the lung function of patients in the early postoperative period, which benefits patient recovery after surgery and is valuable in heart valve replacement.

PMID:40837350 | PMC:PMC12363347 | DOI:10.5937/jomb0-54272