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J Cardiothorac Vasc Anesth. 2025 Jul 23:S1053-0770(25)00619-6. doi: 10.1053/j.jvca.2025.07.027. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the analgesic efficacy of anesthesiologist-performed ultrasound-guided superficial parasternal intercostal plane block (SPIPB) and surgeon-performed deep parasternal intercostal plane block (DPIPB) in patients undergoing coronary artery bypass grafting (CABG) via median sternotomy.

DESIGN: A prospective, randomized, single-blind clinical trial.

SETTING: A single, tertiary care university hospital.

PARTICIPANTS: Seventy-five participants (aged 45-80 years, ASA III-IV) scheduled for elective isolated CABG surgery.

INTERVENTIONS: Participants were randomly assigned to the SPIPB, DPIPB, or control groups. Regional blocks were performed either under ultrasound guidance after sternal closure and sterilization of the surgical site (SPIPB) or intraoperatively under direct vision (DPIPB). Postoperative pain was managed with multimodal analgesia protocols.

MEASUREMENTS AND MAIN RESULTS: Outcomes included pain scores and tramadol administration at the 1st, 4th, 12th, and 24th postoperative hours, as well as after extubation. The cumulative 24-hour tramadol administration (primary outcome) was significantly lower in the DPIPB group (95 ± 44 mg) compared with the SPIPB (141 ± 58 mg) and control groups (176 ± 61 mg) (p < 0.001). Compared with the control group, the DPIPB group had a significantly reduced likelihood of requiring high-dose tramadol (odds ratio [OR]: 0.18, 95% confidence interval [CI]: 0.06-0.56, p = 0.003). The SPIPB group showed an intermediate effect compared with control (OR: 0.52, 95% CI: 0.23-1.18, p = 0.095). When directly compared, DPIPB was associated with significantly lower tramadol use than SPIPB (OR: 0.34, 95% CI: 0.16-0.72, p < 0.001). Pain scores at all time points were significantly lower in both block groups compared with control (p < 0.05), with DPIPB showing the most pronounced effect. No block-related complications were observed.

CONCLUSIONS: Both parasternal intercostal blocks improved postoperative analgesia compared with standard care. The SPIPB was performed under ultrasound guidance, whereas the DPIPB was applied under direct vision by the surgeon. The DPIPB demonstrated superior opioid-sparing effects and improved dynamic pain control. These findings support the use of parasternal fascial plane blocks, whether performed under ultrasound guidance or direct vision, as effective components of multimodal analgesia in cardiac surgery.

PMID:40841230 | DOI:10.1053/j.jvca.2025.07.027

Intensive Care Med. 2025 Oct;51(10):1784-1796. doi: 10.1007/s00134-025-08089-4. Epub 2025 Aug 21.

ABSTRACT

PURPOSE: Inflammatory phenotypes of acute respiratory distress syndrome (ARDS) can predict patient outcomes and potentially response to treatment. The aim was to assess whether inflammatory phenotypes can be characterized over time using clinical surrogate data and used to guide therapy with corticosteroids.

METHODS: Individual patient data and biomarkers from six multicenter randomized controlled trials (development, n = 1207; validation, n = 2751) were analyzed to establish an open-source AI Clinical Classifier ( https://bostonmontpelliercare.shinyapps.io/AIClarity ) for inflammatory phenotypes of ARDS using routine clinical data. Then, patients from a retrospective cohort (investigation, n = 5578) underwent classification from baseline to day 30. A discrete-time Bayesian Markov model assessed temporal stability at 3-day intervals. A target trial emulation and longitudinal logistic regression assessed corticosteroid effect on 30-day mortality depending on phenotype.

RESULTS: The AI Clinical Classifier identified 2169 (39%) hyperinflammatory and 3409 (61%) hypoinflammatory patients. 1053 (49%) and 826 (24%) patients died within 30 days, respectively (p < 0.001). Over 30 days, 49%(1072/2169) of hyperinflammatory patients at baseline transitioned to hypoinflammatory, and 7%(229/3409) of hypoinflammatory patients at baseline transitioned to hyperinflammatory (p < 0.001). Phenotypes predicted response to corticosteroids, with lower mortality in hyperinflammatory patients (IPW-weighted hazard ratio [HR]: 0.81 [0.67-0.98], p = 0.033), and higher mortality in hypoinflammatory patients (IPW-weighted HR: 1.26 [1.06-1.50], p = 0.009). At day 3, a positive response to corticosteroids only persisted among patients who remained hyperinflammatory (adjusted odds ratio = 0.51, 95% CI 0.32-0.80, p = 0.004).

CONCLUSION: Characterization of inflammatory ARDS phenotypes using clinical surrogate data allows physicians to monitor patients throughout the course of the disease and guide clinical treatment. Corticosteroids may be beneficial in hyperinflammatory ARDS and harmful in hypoinflammatory ARDS.

PMID:40839098 | DOI:10.1007/s00134-025-08089-4

Card Electrophysiol Clin. 2025 Sep;17(3):311-326. doi: 10.1016/j.ccep.2024.12.008.

ABSTRACT

Hemodynamically significant pulmonary embolism (PE) remains a widely prevalent, underdiagnosed condition associated with mortality rates as high as 30%. The main driver of poor outcomes is acute right ventricular failure that remains clinically challenging to diagnose and requires critical care management. Treatment of high-risk (or massive) acute PE has traditionally included systemic anticoagulation and thrombolysis. Mechanical circulatory support, including both percutaneous and surgical approaches, are emerging as treatment options for refractory shock due to acute right ventricular failure in the setting of high-risk acute pulmonary embolism.

PMID:40835301 | DOI:10.1016/j.ccep.2024.12.008

Eur J Med Res. 2025 Aug 19;30(1):767. doi: 10.1186/s40001-025-03004-5.

ABSTRACT

BACKGROUND: The combination of percutaneous coronary intervention (PCI) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become a widely used approach for resuscitating patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA). Nonetheless, limited research has focused on predicting in-hospital mortality in affected patients. This study aims to identify factors associated with in-hospital mortality and develop a clinical prediction model for these patients.

METHODS: Clinical presentations of AMI patients with CA undergoing PCI supported by VA-ECMO at two hospitals in Zhengzhou were evaluated. Patients were stratified based on their survival status at discharge. A comprehensive analysis, which included univariate logistic regression, LASSO regression, and multivariate logistic regression, was conducted to identify predictors and develop a nomogram for in-hospital mortality. The nomogram's predictive performance was subsequently compared to that of existing models.

RESULTS: The study included 139 patients, of whom 84 died during hospitalization. Using factors such as age, current smoking, left main culprit vessel, lactic acid levels, and serum creatinine, a nomogram model was developed. The model demonstrated good predictive performance, with an area under the curve of 0.826 (95% CI 0.757-0.894) in the training dataset and 0.783 (95% CI 0.706-0.859) in the internal validation dataset, indicating high accuracy and stability. Clinical decision curve analysis confirmed the model's utility, particularly for risk thresholds above 20%, outperforming existing models.

CONCLUSIONS: This study identified independent predictors of in-hospital mortality in AMI patients with CA undergoing PCI supported by VA-ECMO and developed a clinically applicable prediction model.

PMID:40830896 | PMC:PMC12363090 | DOI:10.1186/s40001-025-03004-5

Medicine (Baltimore). 2025 Aug 15;104(33):e43878. doi: 10.1097/MD.0000000000043878.

ABSTRACT

The phenotype of stem cell-derived cardiomyocytes is far from that of adult cardiomyocytes. Specifically, it is characterized by spontaneous contraction, irregular morphology, and differences in sarcomere components and metabolism. Human cardiomyocyte maturation involves a shift in metabolism from glycolysis to fatty acid oxidation. This metabolic shift alters gene expression and inhibits proliferation. These findings indicate that the glucose concentration manipulates cardiomyocyte metabolism and modulates maturation. This review summarizes the main phenotypic differences, focusing on changes in myocardial cell metabolism. We also summarize the effect of the glucose concentration on maturity of stem cell-derived cardiomyocytes, and how glucose may support a novel maturation strategy.

PMID:40826763 | PMC:PMC12366996 | DOI:10.1097/MD.0000000000043878

Clin Transplant. 2025 Aug;39(8):e70283. doi: 10.1111/ctr.70283.

ABSTRACT

BACKGROUND: The new United Network of Organ Sharing (UNOS) allocation policy emphasizes those supported by mechanical circulatory support devices (MCSD). We evaluated the outcomes based on temporary mechanical circulatory support (TMCS) devices that have a timeline restriction (Status 1: Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) and Status 2: Intra-Aortic Balloon Pump (IABP) and Impella) and extension status among Status 1 and 2 patients.

METHODS: The UNOS database was used to identify adult patients (age > 17) listed for heart transplants as Status 1 or 2 at any point during their listing from October 2018 to June 2024.

RESULTS: Among Status 1 patients, extensions have stayed steady throughout the years but with significant regional variations across the UNOS region (0%-30.2%). Those extensions granted had worse waitlist outcomes but comparable post-transplant survival. Among Status 2 patients, the use of IABP and Impella has significantly increased over the years, with the use of extensions increased during our study period. The majority of the patients were supported on IABP. Again, regional variations existed with the UNOS region that ranged from 12% to 25% use of the extension. Those who were extended had better waitlist survival, with comparable post-transplant outcomes (p < 0.05).

CONCLUSION: The timeline restriction for Status 1 and 2 patients with TMCS are not seen in practice with more patients remaining in their respective status through extensions. Extension criteria as well as timeline restriction should be revisited in the UNOS heart allocation policy.

PMID:40828460 | DOI:10.1111/ctr.70283

Intensive Care Med. 2025 Oct;51(10):1749-1763. doi: 10.1007/s00134-025-08058-x. Epub 2025 Aug 19.

ABSTRACT

PURPOSE: This is the third of three parts of the clinical practice guideline from the European Society of Intensive Care Medicine (ESICM) on fluid management in adult critically ill patients. This part addresses fluid removal in the de-escalation phase of shock management.

METHODS: This guideline was formulated by an international panel of clinical experts, methodologists, and patient representatives. A literature search was conducted to identify relevant randomized controlled trials (RCTs) in adults published up to February 2025. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was applied to evaluate the certainty of evidence and to move from evidence to decision.

RESULTS: Based on data from 13 RCTs, the panel issued three conditional recommendations. The panel suggested de-escalation of fluid therapy over no de-escalation in critically ill adults after the acute phase of fluid resuscitation (low certainty evidence). They suggested protocolized fluid removal by diuretics over usual care in critically ill patients after the acute phase of fluid resuscitation (moderate certainty evidence). A conditional recommendation was issued against the routine use of ultrafiltration or extracorporeal fluid removal in critically ill adults after the acute phase of fluid resuscitation, without other indication for RRT (low certainty evidence). There was limited evidence to comment on fluid removal in specific patient cohorts.

CONCLUSIONS: This ESICM guideline provides three recommendations to inform clinicians on fluid removal during the de-escalation phase in critically ill patients with shock who no longer need fluid resuscitation.

PMID:40828463 | DOI:10.1007/s00134-025-08058-x

Am J Transl Res. 2025 Jul 15;17(7):5465-5474. doi: 10.62347/VKEY9889. eCollection 2025.

ABSTRACT

OBJECTIVE: To compare the therapeutic effects of off-pump versus conventional coronary artery bypass grafting (CABG) in elderly coronary heart disease (CHD) patients.

METHODS: This retrospective study analyzed 98 elderly CHD patients (47 conventional CABG, 51 off-pump CABG) treated between April 2019 and March 2021. Outcomes included intraoperative and postoperative indicators (distal anastomoses, mechanical ventilation time, hospital stay), graft patency, left ventricular function (LVEF, LVEDD), cardiac biomarkers (cTnI, CK, CK-MB), complication rates, 3-month quality of life (QoL), and long-term major adverse cardiovascular and cerebrovascular events (MACCE).

RESULTS: The two groups had similar distal anastomoses and graft patency rates (P>0.05). However, the off-pump group had shorter mechanical ventilation time and hospital stay than the conventional group (both P<0.05). LVEF and LVEDD showed no significant differences between the two group pre- and post-surgery. Cardiac biomarkers (cTnI, CK, CK-MB) increased postoperatively in both groups but were significantly lower in the off-pump group (P<0.05). The off-pump group had fewer complications, better QoL scores in social, mental, emotional, and overall health, and lower long-term MACCE incidence than the conventional group (all P<0.05).

CONCLUSION: Off-pump CABG reduces surgical trauma, shortens recovery time, lowers complication rates, and improves QoL compared to conventional CABG, making it a preferable option for elderly CHD patients.

PMID:40821072 | PMC:PMC12351558 | DOI:10.62347/VKEY9889

Perfusion. 2025 Aug 17:2676591251370076. doi: 10.1177/02676591251370076. Online ahead of print.

ABSTRACT

IntroductionPostoperative delirium affects up to 60% of cardiac surgical patients. No reliable gold standard method exists for preventing delirium after cardiac surgery. An example of patient-personal monitoring is cerebral autoregulation (CA). This study aims to highlight the personal monitoring of patients' cerebral autoregulation and to determine its relationship with postoperative delirium. Additionally, it seeks to test the hypothesis that the duration of CA impairment influences the onset of postoperative delirium.MethodsA prospective study was conducted in 2021-2023. After approval of the Ethics Committee and with the patient's written consent, 104 adult patients undergoing elective coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) surgery were enrolled. To diagnose possible delirium, all patients underwent a Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test. CA monitoring using transcranial Doppler was performed. CA status index - Mx was recorded.ResultsOur study found that 12.5% of patients were diagnosed with delirium after on-pump CABG surgery. The total duration of cerebral autoregulation impairment (TCAI) was longer in the delirium group, 4783.0 seconds versus 4204.5 seconds (p = .047), with a cut-off at 4380 s. Longer cardiopulmonary bypass (CPB) leads to prolonged CA impairment (p < .001). The mean arterial pressure (MAP) during CPB was 69.67 mmHg in the non-delirium group and 74.91 mmHg in the delirium group (p = .001), with a cutoff at 73.669 mmHg.ConclusionsCA impairment is crucial for delirium development after cardiac surgery. The duration of the TCAI event increases the risk of delirium.

PMID:40820307 | DOI:10.1177/02676591251370076

Methodist Debakey Cardiovasc J. 2025 Aug 12;21(4):14-25. doi: 10.14797/mdcvj.1654. eCollection 2025.

ABSTRACT

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains a critical clinical challenge associated with high morbidity and mortality. Temporary mechanical circulatory support (tMCS) devices can stabilize hemodynamics, improve cardiac output, and enhance survival, thereby continuing to be more favorable with operators. This review summarizes the pathophysiology of AMI-CS and examines the evidence informing recommendations for tMCS device implementation-specifically the intra-aortic balloon pump, Impella (Abiomed/J&J MedTech), TandemHeart™ (LivaNova, Inc.), and venoarterial extracorporeal membrane oxygenation-with a particular focus on clinical trial data and recent guideline recommendations to assist operators in implementing decision-making.

PMID:40822370 | PMC:PMC12352399 | DOI:10.14797/mdcvj.1654

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jun;37(6):595-598. doi: 10.3760/cma.j.cn121430-20250117-00066.

ABSTRACT

OBJECTIVE: To investigate the efficacy and safety of autologous blood transfusion during weaning from venous-arterial extracorporeal membrane oxygenation (VA-ECMO) under controlled rotational speed.

METHODS: A retrospective study was conducted, selecting patients who underwent extracorporeal membrane oxygenation (ECMO) and successfully weaned at the emergency and critical care medicine center of Henan Provincial Third People's Hospital from January 2023 to May 2024. General data including gender, age, body mass index (BMI), European system for cardiac operative risk evaluation (EuroScore), and disease types were collected. Vital signs at weaning [heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and peripheral oxygen saturation], parameters before and after weaning [B-type natriuretic peptide (BNP), hemoglobin (Hb), partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), arterial lactate, central venous pressure (CVP), inferior vena cava collapsibility index, left ventricular ejection fraction (LVEF), and right heart load], post-weaning inflammatory markers at 1-day and 3-day [body temperature, white blood cell count (WBC), neutrophil percentage (NEU%), C-reactive protein (CRP), procalcitonin (PCT), interleukin-10 (IL-10)], as well as complications (infection, thrombosis, renal failure, gastrointestinal bleeding) and post-weaning blood return status were recorded. Patients were divided into an observation group (with post-weaning blood return) and a control group (without post-weaning blood return) based on the presence of blood return after weaning. The changes in the aforementioned parameters were compared between the two groups.

RESULTS: A total of 62 patients were included, with 31 cases in each group. No statistically significant differences were observed between the two groups in baseline characteristics including gender, age, BMI, and EuroScore. At weaning, the observation group exhibited relatively stable vital signs, with no significant differences in heart rate, SBP, DBP, or peripheral oxygen saturation compared to the control group. After weaning, the observation group showed significantly lower levels of BNP, PaCO2, arterial lactate, CVP, and right heart load compared to pre-weaning values [BNP (ng/L): 2 325.96±78.51 vs. 4 878.48±185.47, PaCO2 (mmHg, 1 mmHg≈0.133 kPa): 35.23±3.25 vs. 40.75±4.41, arterial lactate (mmol/L): 2.43±0.61 vs. 6.19±1.31, CVP (cmH2O, 1 cmH2O≈0.098 kPa): 8.32±0.97 vs. 15.34±1.74, right heart load: 13.24±0.97 vs. 15.69±1.31, all P < 0.05], while Hb, PaO2, inferior vena cava collapsibility index, and LVEF were significantly higher than pre-weaning values [Hb (g/L): 104.42±9.78 vs. 96.74±6.39, PaO2 (mmHg): 94.12±7.78 vs. 75.51±4.39, inferior vena cava collapsibility (%): 28±7 vs. 17±3, LVEF (%): 62.41±6.49 vs. 45.30±4.51, all P < 0.05]. No statistically significant differences were found between the observation group and control group in these parameters. At 3 days post-weaning, the observation group demonstrated significantly lower levels of body temperature, WBC, NEU%, CRP, PCT, and IL-10 compared to 1 day post-weaning [body temperature (centigrade): 36.83±1.15 vs. 37.94±1.41, WBC (×109/L): 7.82±0.96 vs. 14.34±2.15, NEU%: 0.71±0.05 vs. 0.80±0.07; CRP (mg/L): 4.34±0.78 vs. 8.94±1.21, PCT (μg/L): 0.11±0.02 vs. 0.26±0.05, IL-10 (ng/L): 8.93±1.52 vs. 13.51±2.17, all P < 0.05], with no significant differences compared to the control group. No statistically significant differences were observed between the two groups in the incidence of complications including infection, thrombosis, renal failure, and gastrointestinal bleeding.

CONCLUSION: Autologous blood reinfusion during VA-ECMO weaning under controlled rotational speed is safe and effective, without increasing risks of infection or thrombosis.

PMID:40820537 | DOI:10.3760/cma.j.cn121430-20250117-00066

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jun;37(6):576-582. doi: 10.3760/cma.j.cn121430-20240329-00298.

ABSTRACT

OBJECTIVE: To observe the degree of myocardial cell injury and the changes in autophagy level in rats with myocardial ischemia/reperfusion (I/R) injury induced by cardiopulmonary bypass (CPB), and to explore the regulatory role of the long non-coding RNA-urothelial carcinoma antigen 1-microRNA-143-Notch1 axis (lncRNA-UCA1-miR-143-Notch1 axis) in myocardial I/R injury induced by CPB.

METHODS: Healthy male Sprague-Dawley (SD) rats were randomly divided into the following groups using the random number method: Sham operation (Sham) group, myocardial I/R injury model group (model group), empty lentivirus group, lncRNA-UCA1 upregulation group, miR-143 downregulation group, and lncRNA-UCA1 upregulation+miR-143 upregulation group, with 9 rats in each group. The rat model of myocardial I/R injury induced by CPB was established by thoracotomy aortic ligation under cardiopulmonary bypass support; in the Sham group, only threading was performed without ligation, and other procedures were the same. Seventy-two hours before modeling, the lncRNA-UCA1 upregulated group was injected with 100 μL of myocardial tissue-specific adeno-associated virus (AAV) overexpression vector of lncRNA-UCA1 via tail vein, the miR-143 downregulated group was injected with 100 μL of AAV short hairpin RNA (shRNA) vector of miR-143 via tail vein, the lncRNA-UCA1 upregulation+miR-143 upregulation group was injected with 100 μL of myocardial tissue-AAV overexpression vector of lncRNA-UCA1 and 100 μL of AAV overexpression vector of miR-143 via tail vein, and the empty vector lentivirus group was injected with 100 μL of AAV empty vector (virus titers were 1×109 TU/mL); the Sham group and the model group were injected with equal amounts of normal saline. The animals were euthanized 24 hours after intervention and cardiac tissue specimens were collected. After hematoxylin eosin (HE) staining, the damage of myocardial cells and the changes of muscle fiber tissue were observed under a light microscope; after dual staining with uranyl acetate and lead citrate, the ultrastructural damage of heart tissue was observed under a transmission electron microscopy; the expression of lncRNA-UCA1, miR-143, and Notch1 mRNA in myocardial tissue was detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR); the expression of microtubule 1 light chain 3-II/I (LC3-II/I) and Notch1 protein in myocardial tissue was detected by Western blotting.

RESULTS: Compared with the Sham group, the myocardial cells of rats in the model group were enlarged, the intercellular space increased, autophagosomes increased, the arrangement of myocardial fibers was disordered, mitochondrial proliferated and deformed. The expression levels of lncRNA-UCA1 and Notch1 mRNA, as well as the protein expression levels of LC3-II/I and Notch1 were significantly increased, while the expression level of miR-143 was significantly decreased. Compared with the model group, the degree of myocardial cell injury in the lncRNA-UCA1 upregulation group and miR-143 downregulation group was significantly alleviated, the expression levels of Notch1 mRNA, LC3-II/I, and Notch1 protein were significantly increased [Notch1 mRNA (2-ΔΔCt): 2.66±0.24, 2.03±0.23 vs. 1.45±0.13, LC3-II/I: 2.10±0.21, 1.92±0.19 vs. 1.39±0.14, Notch1 protein (Notch1/GAPDH): 1.72±0.16, 1.57±0.16 vs. 1.34±0.13, all P < 0.05], and the expression level of miR-143 was significantly decreased (2-ΔΔCt: 0.50±0.06, 0.52±0.06 vs.0.71±0.06, P < 0.05). The expression level of lncRNA-UCA1 in the lncRNA-UCA1 upregulated group was significantly higher than that in the model group (2-ΔΔCt: 2.47±0.22 vs. 1.43±0.14, P < 0.05), while there was no significant difference in the miR-143 downregulation group compared with the model group (2-ΔΔCt: 1.50±0.16 vs. 1.43±0.14, P > 0.05). There was no significant difference in the degree of myocardial cell injury in the empty load lentivirus group and the lncRNA-UCA1 upregulation+miR-143 upregulation group compared to the model group. There were no significant differences in the expression of miR-143, Notch1 mRNA, and the autophagy level in these two groups compared to the model group. The expression level of lncRNA-UCA1 in the lncRNA-UCA1 upregulation+miR-143 upregulation group was significantly higher than that in the model group (2-ΔΔCt: 2.47±0.20 vs. 1.43±0.14, P < 0.05).

CONCLUSIONS: Autophagy is involved in the pathological process of myocardial I/R injury induced by CPB. The lncRNA-UCA1-microRNA-143-Notch1 axis may regulate the autophagy level to participate in the I/R injury process.

PMID:40820534 | DOI:10.3760/cma.j.cn121430-20240329-00298

JACC Case Rep. 2025 Aug 13;30(23):104182. doi: 10.1016/j.jaccas.2025.104182.

ABSTRACT

BACKGROUND: Amniotic fluid embolism is a rare potential complication in the peripartum period.

CASE SUMMARY: A 27-year-old nulliparous woman presented for elective induction at 41 weeks' gestation. Due to nonreassuring fetal heart tracing, the patient underwent emergent caesarean section complicated by pulseless electrical activity arrest secondary to suspected amniotic fluid embolism after fetus delivery. Despite return of spontaneous circulation, the patient remained in cardiogenic shock with right ventricular failure. The patient was cannulated for venoarterial extracorporeal membrane oxygenation. After 5 days, she was converted to a right ventricular assist device, with ultimate complete biventricular recovery.

DISCUSSION: The use of multidisciplinary cardiogenic shock team aids in swift escalation of care in patients with refractory shock requiring mechanical circulatory support. It is crucial to initiate cardiogenic shock teams early in a patient's clinical course.

TAKE-HOME MESSAGES: Amniotic fluid embolism is a known cause of mortality in postpartum women. Severe cases can lead to cardiac arrest. Rapid initiation of mechanical circulatory support can save lives.

PMID:40816834 | PMC:PMC12462143 | DOI:10.1016/j.jaccas.2025.104182

Polymers (Basel). 2025 Jul 30;17(15):2088. doi: 10.3390/polym17152088.

ABSTRACT

Myocardial infarction (MI) remains one of the most common cardiovascular diseases and a leading cause of morbidity and mortality worldwide. In recent years, natural polymeric patches have attracted increasing attention as a promising therapeutic platform for myocardial tissue repair. This study explored the fabrication and evaluation of screen-printed electrodes (SPEs) on chitosan film as a novel platform for cardiac patch applications. Chitosan is a biodegradable and biocompatible natural polymer that provides an ideal substrate for SPEs, providing mechanical stability and promoting cell adhesion. Silver ink was employed to enhance electrochemical performance, and the electrodes exhibited strong adhesion and structural integrity under wet conditions. Mechanical testing and swelling ratio analysis were conducted to assess the patch's physical robustness and aqueous stability. Silver ink was employed to enhance electrochemical performance, which was evaluated using cyclic voltammetry. In vitro, electrical stimulation through the chitosan-SPE patch significantly increased the expression of cardiac-specific genes (GATA-4, β-MHC, troponin I) in bone marrow mesenchymal stem cells (BMSCs), indicating early cardiogenic differentiation potential. In vivo, the implantation of the chitosan-SPE patch in a rat MI model demonstrated good tissue integration, preserved myocardial structure, and enhanced ventricular wall thickness, indicating that the patch has the potential to serve as a functional cardiac scaffold. These findings support the feasibility of screen-printed electrodes fabricated on chitosan film substrates as a cost-effective and scalable platform for cardiac repair, offering a foundation for future applications in cardiac tissue engineering.

PMID:40808135 | PMC:PMC12349067 | DOI:10.3390/polym17152088

BMC Cardiovasc Disord. 2025 Aug 14;25(1):605. doi: 10.1186/s12872-025-05044-5.

ABSTRACT

BACKGROUND: The primary causes of heart failure include myocardial damage and structural abnormalities. In addition to cardiovascular disease, noncardiovascular disease can also lead to heart failure. Identifying these etiologies is critical for accurate diagnosis and timely, targeted treatment.

CASE PRESENTATION: The patient presented with a 10-month history of recurrent chest tightness and shortness of breath, with symptoms significantly worsening 6 hours before admission. She was diagnosed with acute heart failure in the decompensated phase, complicated by cardiogenic shock. Stabilization was achieved via an intra-aortic balloon pump (IABP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Further evaluation revealed pheochromocytoma as the underlying cause of acute heart failure. The patient underwent successful surgical resection of the pheochromocytoma, with no recurrence of heart failure symptoms observed during follow-up.

CONCLUSION: Acute heart failure is a rare but critical condition with rapid onset, often presenting as an emergency. Effective management necessitates life support therapy to stabilize the patient, allowing time for further diagnostic and therapeutic measures.

PMID:40813639 | PMC:PMC12355791 | DOI:10.1186/s12872-025-05044-5

Braz J Cardiovasc Surg. 2025 Nov 1;40(6):e20250906. doi: 10.21470/1678-9741-2025-0906.

ABSTRACT

Mechanical circulatory support (MCS) devices have evolved significantly over the past decades and play a vital role in managing end-stage heart failure, especially as a bridge to heart transplantation. From the pioneering heart-lung machines to third-generation ventricular assist devices (VADs), MCS technology has advanced to provide more durable, efficient, and safer options for both shortand long-term support. This review outlines the historical development of mechanical assist devices, the types of available supports - ranging from intra-aortic balloon pumps and extracorporeal membrane oxygenation to implantable devices like HeartMate 3 - and their clinical indications and complications. Special attention is given to right ventricular dysfunction, thromboembolic and hemorrhagic complications, and infections, which remain major challenges in the management of patients with MCS devices.In Brazil, despite the growing evidence supporting MCS in critically ill patients, access remains limited due to financial and systemic constraints. The review explores the current landscape of device availability in the country, national guidelines, cost-effectiveness data, and the impact of recent changes in transplant allocation criteria that prioritize patients receiving mechanical support. Notably, the approval of long-term VADs for destination therapy in the public health system in 2024 marks a significant milestone.This review offers a comprehensive perspective on MCS utilization, highlighting both global advances and Brazil-specific challenges. By identifying gaps in access and proposing future directions, it advocates for expanded use of these life-saving technologies to improve survival and quality of life in advanced heart failure patients.

PMID:40811591 | PMC:PMC12352751 | DOI:10.21470/1678-9741-2025-0906

Front Public Health. 2025 Jul 30;13:1560587. doi: 10.3389/fpubh.2025.1560587. eCollection 2025.

ABSTRACT

INTRODUCTION: This study aims to evaluate the impact of oXiris continuous renal-replacement therapy (CRRT) on the prognosis of patients with severe intra-abdominal infections (IAIs) and to analyze potential risk factors for early off-machine of oXiris CRRT during treatment.

METHODS: A total of 49 patients with severe abdominal infections admitted to the intensive care unit of the First Affiliated Hospital of Fujian Medical University from October 2020 to October 2023 were retrospectively analyzed. The patients were divided into a conventional group and an oXiris group. Heart rate, blood lactate level, mean arterial pressure, and total CRRT operation time were observed 72 h before and after CCRT treatment.

RESULTS: When comparing changes in indicators over the 72-h period between the two groups, no significant difference in survival rate was observed between the two groups. D-dimer [per 1 ng/mL increase, odds ratio (OR) = 0.930, 95% confidence interval (CI): 0.866-0.999] was identified as a risk factor for early off-machine. In contrast, prothrombin time (PT, per 1-s increase, OR = 1.117, 95% CI: 1.017-1.226), activated partial thromboplastin time (APTT, per 1-s increase, OR = 1.021, 95% CI: 1.006-1.037), and blood flow velocity (per 1 mL/min increase, OR = 1.027, 95% CI: 1.009-1.046) were found to be protective factors.

CONCLUSION: oXiris CRRT is associated with a better prognosis in the treatment of severe abdominal infections. APTT, PT, D-dimer, and blood flow velocity are associated with early off-machine during oXiris CRRT.

PMID:40809760 | PMC:PMC12343586 | DOI:10.3389/fpubh.2025.1560587

Diagnostics (Basel). 2025 Aug 5;15(15):1962. doi: 10.3390/diagnostics15151962.

ABSTRACT

Background/Objectives: Obesity is a major cause of repolarisation defects of the heart. The frontal QRS-T angle is a new parameter used for cardiac evaluation. This study aimed to evaluate the effects of a laparoscopic cholecystectomy and anaesthetic agents on the frontal QRS-T angle in individuals with obesity. Methods: A total of 91 patients who underwent a laparoscopic cholecystectomy surgery were included in this study. The patients were divided into two groups according to body mass index (BMI) < 30 (n = 68) and ≥30 (n = 23). The frontal QRS-T angle (FQRST), QT interval (QT), corrected QT, and other electrocardiography (ECG) findings were recorded at different time points. Results: In the BMI ≥ 30 group, the frontal QRS-T angle and QT interval measured during the intraoperative period were statistically higher than those of the BMI < 30 group (p < 0.001, p < 0.001). Additionally, the frontal QRS-T angle value was statistically higher in all patients postoperatively compared with the preoperative and intraoperative periods (p < 0.001). Furthermore, there was a positive correlation between the BMI and the frontal QRS-T angle. Our study found that the QRS-T angle and the QT interval duration measured during surgery in the BMI ≥ 30 group who underwent a laparoscopic cholecystectomy were significantly higher than in the BMI < 30 group. Conclusions: We recommend close haemodynamic monitoring during and after surgery for patients with obesity undergoing a laparoscopic cholecystectomy.

PMID:40804926 | PMC:PMC12346821 | DOI:10.3390/diagnostics15151962

Diagnostics (Basel). 2025 Jul 22;15(15):1839. doi: 10.3390/diagnostics15151839.

ABSTRACT

Background: Down syndrome (DS) is associated with unique anatomical and physiological characteristics that complicate the perioperative management of infants undergoing cardiac surgery. While ventricular septal defect (VSD) repair is commonly performed in this population, detailed data comparing perioperative outcomes in DS versus non-syndromic infants remain limited. Methods: This retrospective matched study analysed 100 infants (50 with DS and 50 without DS) who underwent isolated VSD closure between January 2021 and January 2025. Patients were matched by age and surgical date. Intraoperative anesthetic management, complications, postoperative outcomes, and mortality were compared between groups. Results: DS patients had lower age, weight, and height at surgery. They required significantly smaller endotracheal tube sizes, more intubation and vascular access attempts. The DS group had significantly lower rates of extubation in the operating room and experienced longer durations of mechanical ventilation and ICU stay. However, no significant differences were observed in total hospital stay or mortality between groups. Conclusions: Although DS infants present with increased anesthetic complexity and respiratory challenges, they do not exhibit higher surgical mortality following isolated VSD closure. Tailored perioperative strategies may improve respiratory outcomes in this high-risk group.

PMID:40804803 | PMC:PMC12346779 | DOI:10.3390/diagnostics15151839

Cells. 2025 Aug 1;14(15):1188. doi: 10.3390/cells14151188.

ABSTRACT

Diabetes mellitus, both type 1 (T1D) and type 2 (T2D), has become the epidemic of the century and a major public health concern given its rising prevalence and the increasing adoption of a sedentary lifestyle globally. This multifaceted disease is characterized by impaired pancreatic beta cell function and insulin resistance (IR) in peripheral organs, namely the liver, skeletal muscle, and adipose tissue. Additional insulin target tissues, including cardiomyocytes and neuronal cells, are also affected. The advent of stem cell research has opened new avenues for tackling this disease, particularly through the regeneration of insulin target cells and the establishment of disease models for further investigation. Human-induced pluripotent stem cells (iPSCs) have emerged as a valuable resource for generating specialized cell types, such as hepatocytes, myocytes, adipocytes, cardiomyocytes, and neuronal cells, with diverse applications ranging from drug screening to disease modeling and, importantly, treating IR in T2D. This review aims to elucidate the significant applications of iPSC-derived insulin target cells in studying the pathogenesis of insulin resistance and T2D. Furthermore, recent differentiation strategies, protocols, signaling pathways, growth factors, and advancements in this field of therapeutic research for each specific iPSC-derived cell type are discussed.

PMID:40801620 | PMC:PMC12345660 | DOI:10.3390/cells14151188