Phytomedicine. 2025 Sep 15;148:157260. doi: 10.1016/j.phymed.2025.157260. Online ahead of print.
ABSTRACT
BACKGROUND: Rehabilitation exercise after acute myocardial infarction is helpful for cardiac function recovery. Isatin, an endogenous indole derivative of tryptophan metabolism, exhibits anti-inflammatory and antioxidant properties, but its role in myocardial injury repair post-myocardial infarction (MI) remains unclear.
PURPOSE: This study aimed to investigate isatin's cardioprotective effects and molecular mechanisms in post-rehabilitation AMI patients through multi-omics approaches.
STUDY DESIGN: This study aimed to systematically investigate the protective effects and molecular mechanisms of isatin on cardiac injury in patients with AMI following rehabilitation, using untargeted metabolomics, HuProt™ microarray, network pharmacology (NP), surface plasmon resonance (SPR), molecular docking, molecular dynamics (MD), animal models, and cell experiments.
METHODS: Serum isatin levels were measured in STEMI patients' pre-/post-Enhanced external counterpulsation (EECP) rehabilitation using untargeted metabolomics. HuProtTM microarray and NP was used to identify the downstream targets of isatin, validated through SPR, molecular docking, and dynamics. A murine AMI model was applied to assess the protective function of isatin. H2O2-treated cardiomyocytes and LPS-treated macrophages were used to explore the potential protective mechanisms of isatin.
RESULTS: EECP elevated serum isatin in STEMI patients, correlating with better cardiopulmonary function. S100A8 was identified as the primary target by HuProt™ microarray and NP. Isatin formed a 2.1 Å hydrogen bond with S100A8-GLU41. SPR KD=57.9 μM; Docking score=-5.37 kcal/mol; MD ΔG=-15.35 ± 1.95 kcal/mol. Isatin improved cardiac function in AMI mice. Isatin enhanced HL-1 cardiomyocyte viability while reducing apoptosis, and decreased macrophage IL-1β, IL-6, IL-1α, and TNF-α secretion.
CONCLUSION: This study demonstrates that EECP enhances cardiac rehabilitation in STEMI patients by upregulating endogenous isatin, which exerts cardioprotective effects through direct targeting of S100A8, leading to improved cardiac function and reduced oxidative stress and inflammation, with the molecular mechanism confirmed by integrated multi-omics analyses.
PMID:40992064 | DOI:10.1016/j.phymed.2025.157260
Transplant Proc. 2025 Sep 23:S0041-1345(25)00442-7. doi: 10.1016/j.transproceed.2025.06.022. Online ahead of print.
ABSTRACT
BACKGROUND: Sequential adaptations to Child-Pugh (CP) and MELD have improved prediction of waitlist mortality in liver transplant (LT). Despite its widespread use as a prognosticator, the association between the MELD score and perioperative adverse events during LT has yet to be evaluated. this study seeks to evaluate whether advances in MELD score calculations correspondingly improve predictions for massive transfusion (MT) and renal failure.
METHODS: Adult patients undergoing LT at a tertiary institution between 2015 and 2023 were enrolled. MELD, MELD-Na, MELD 3.0, and CP were calculated at time of LT. Massive transfusion (MT) was >6 units of red blood cells before hepatic artery ligation. Renal failure (RF) was defined as requiring dialysis on postoperative-day one. Area-under-the-receiver-operating-characteristic curves (AUC) was estimated for each score and outcome and compared using the DeLong method. Score performance was evaluated using receiver operator curves (ROC) with a high performing assay considered as an area under the curve (AUC) >0.800.
RESULTS: Total 265 patients were included; 20 (7.6%) received MT, 31 (11.8%) had RF. For MT, scores performed similarly (CP 0.70 [95% CI: 0.58, 0.81]; MELD 0.69 [0.59, 0.80]; MELD-Na 0.71 [0.61, 0.81]; MELD 3.0 0.69 [0.59, 0.80]). For RF all MELD scores outperformed CP, and MELD-Na outperformed MELD 3.0 (0.58 [0.48, 0.68], 0.66 [0.55,0.77], 0.67 [0.56, 0.78], and 0.65 [0.53, 0.77]).
CONCLUSION: MELD 3.0 did not outperform its predecessors. MELD-Na may still have a role in assessment of perioperative complications in LT recipients as well as patients with end-stage liver disease undergoing nontransplant operations.
PMID:40992988 | DOI:10.1016/j.transproceed.2025.06.022
Transplant Proc. 2025 Sep 23:S0041-1345(25)00449-X. doi: 10.1016/j.transproceed.2025.08.018. Online ahead of print.
ABSTRACT
Combined heart-liver transplantation presents significant challenges, particularly in cases requiring extended ischemic times for managing hemodynamic instability post cardiac implantation. Advances in perfusion techniques, such as the normothermic machine perfusion pump, offer advantages over traditional static cold storage by maintaining organ viability during prolonged periods. We report the first successful combined heart-liver transplant using normothermic machine perfusion for both organs from a donation after circulatory death donor. The recipient is a 45-year-old male with ischemic cardiomyopathy-induced heart failure and end-stage liver disease secondary to congestive hepatopathy. Both organs, procured from a donation after circulatory death donor were preserved on the TransMedics Organ Care System and subsequently transplanted with total post crossclamp times of 7.75 hours for the heart and 15.25 hours for the liver. At 8 months post-transplant, the patient demonstrates stable cardiac and hepatic graft function. This case highlights the critical role of normothermic machine perfusion in optimizing organ quality and mitigating ischemic injury in multi-organ transplants involving donation after circulatory death donors. Our findings support the expanded use of normothermic machine perfusion to enhance organ utilization, particularly in complex, high-risk multi-organ transplants cases.
PMID:40992987 | DOI:10.1016/j.transproceed.2025.08.018
Am J Transplant. 2025 Sep 22:S1600-6135(25)02993-4. doi: 10.1016/j.ajt.2025.09.013. Online ahead of print.
ABSTRACT
US heart transplant candidates from socioeconomically disadvantaged communities have lower access to transplant. The place-based disadvantage index that best captures this disparity is still unknown. We sought to answer this question. We studied all adult heart transplant candidates initially listed between January 1, 2019 and December 31, 2022 using the Scientific Registry of Transplant Recipients. We used competing risk regressions to estimate the association of four place-based disadvantage indices (Social Vulnerability Metric, Social Vulnerability Index, Area Deprivation Index (ADI), and Distressed Communities Index) with transplantation and death using models adjusted for characteristics that impact access to transplantation. ADI was significantly associated with receiving a transplant over the greatest range of deciles compared to other indices. Three years after listing, ADI decile 1 patients had a cumulative incidence of 83% of receiving a transplant, compared to 65.8% of decile 10 candidates. Compared to decile 1, decile 10 patients had a 156% greater risk of dying on the waitlist. In this study, we found that ADI was associated with transplantation to a greater extent than other indices studied. The forthcoming continuous distribution provides an opportunity to incorporate ADI to address disparities in heart transplantation.
PMID:40992603 | DOI:10.1016/j.ajt.2025.09.013
Pediatr Res. 2025 Sep 24. doi: 10.1038/s41390-025-04437-8. Online ahead of print.
ABSTRACT
BACKGROUND: Children with complex congenital heart disease (CCHD) are at high risk for early neurodevelopmental delays across all domains. Neuromotor delay often emerges first and may impact broader development. Identifying early biomarkers of motor function could capture a critical window for intervention. We assessed the prognostic value of neuron-specific enolase (NSE) and S100B in predicting 4-month motor outcomes in newborns undergoing cardiac surgery with cardiopulmonary bypass (CPB).
METHODS: Between December 2021 and October 2024, we conducted a prospective, single-centre study including term neonates with (CCHD) who required cardiac surgery within the first two months of life. NSE and S100B levels were measured at five perioperative time points. Blinded Alberta Infant Motor Scale (AIMS) assessment at four months evaluated motor outcomes.
RESULTS: Of 35 newborns, 27 completed follow-up. Preoperative NSE levels were significantly higher in infants with AIMS scores below the 10th percentile (32.7 vs. 20.9 ng/mL, p = 0.044) and negatively correlated with AIMS percentiles (ρ = -0.617, p = 0.006. There was no significant association between motor outcomes, MRI findings or S100B levels.
CONCLUSIONS: Higher preoperative NSE levels predict poor early motor outcomes in CCHD and may be a marker for early risk stratification and intervention.
IMPACT: Neuron-specific enolase (NSE) may serve as an early biomarker of neuromotor development in newborns with complex congenital heart disease (CCHD). Elevated preoperative NSE levels were associated with poorer motor outcomes at four months. NSE may serve as an additional biomarker within a multimodal risk stratification strategy, complementing clinical, imaging, and electrophysiological assessments to refine prognostic evaluation. These findings highlight the prognostic value of perioperative biomarkers for predicting early motor outcomes and support earlier identification of at-risk newborns, enabling targeted neurodevelopmental interventions. This work adds new evidence to limited literature on biological predictors of motor development after neonatal cardiac surgery.
PMID:40993357 | DOI:10.1038/s41390-025-04437-8
Int J Surg Case Rep. 2025 Sep 22;136:111963. doi: 10.1016/j.ijscr.2025.111963. Online ahead of print.
ABSTRACT
INTRODUCTION: Laubry-Pezzi syndrome is a rare congenital heart disease characterized by the association of a ventricular septal defect (VSD) and aortic regurgitation (AR) due to valvular prolapse. The natural course of this condition may lead to severe valvular damage and aortic root dilatation, particularly in cases of delayed diagnosis.
PRESENTATION OF CASE: We report two adult cases of Laubry-Pezzi syndrome managed surgically in Benin. The first patient, a 49-year-old man, presented with severe AR, a large subaortic VSD, and an ascending aortic aneurysm. He underwent VSD closure and a mechanical Bentall procedure. Postoperatively, he developed complete atrioventricular block requiring pacemaker implantation, with no further complications over 24 months. The second patient, a 19-year-old man, had severe AR, a 16 mm VSD, and dilated sinus of Valsalva. He underwent VSD closure, mechanical aortic valve replacement, and tricuspid annuloplasty. Recovery was uneventful, with favorable outcomes at the four-month follow-up, and ongoing surveillance is planned.
DISCUSSION: These two cases demonstrate the clinical progression of untreated Laubry-Pezzi syndrome in adults, highlighting challenges related to delayed diagnosis. Despite complex anatomical findings, surgical repair including Bentall and valve replacement was successfully performed in a resource-limited setting. Findings align with global literature in terms of pathology and outcomes, supporting the feasibility of advanced cardiac surgery in sub-Saharan Africa.
CONCLUSION: Early detection and intervention are critical to prevent severe valve and aortic complications in Laubry-Pezzi syndrome. This case report illustrates that, even in low-resource contexts, successful surgical outcomes are achievable through adapted techniques and interdisciplinary collaboration.
PMID:40992295 | DOI:10.1016/j.ijscr.2025.111963
Int J Surg Case Rep. 2025 Sep 22;136:111963. doi: 10.1016/j.ijscr.2025.111963. Online ahead of print.
ABSTRACT
INTRODUCTION: Laubry-Pezzi syndrome is a rare congenital heart disease characterized by the association of a ventricular septal defect (VSD) and aortic regurgitation (AR) due to valvular prolapse. The natural course of this condition may lead to severe valvular damage and aortic root dilatation, particularly in cases of delayed diagnosis.
PRESENTATION OF CASE: We report two adult cases of Laubry-Pezzi syndrome managed surgically in Benin. The first patient, a 49-year-old man, presented with severe AR, a large subaortic VSD, and an ascending aortic aneurysm. He underwent VSD closure and a mechanical Bentall procedure. Postoperatively, he developed complete atrioventricular block requiring pacemaker implantation, with no further complications over 24 months. The second patient, a 19-year-old man, had severe AR, a 16 mm VSD, and dilated sinus of Valsalva. He underwent VSD closure, mechanical aortic valve replacement, and tricuspid annuloplasty. Recovery was uneventful, with favorable outcomes at the four-month follow-up, and ongoing surveillance is planned.
DISCUSSION: These two cases demonstrate the clinical progression of untreated Laubry-Pezzi syndrome in adults, highlighting challenges related to delayed diagnosis. Despite complex anatomical findings, surgical repair including Bentall and valve replacement was successfully performed in a resource-limited setting. Findings align with global literature in terms of pathology and outcomes, supporting the feasibility of advanced cardiac surgery in sub-Saharan Africa.
CONCLUSION: Early detection and intervention are critical to prevent severe valve and aortic complications in Laubry-Pezzi syndrome. This case report illustrates that, even in low-resource contexts, successful surgical outcomes are achievable through adapted techniques and interdisciplinary collaboration.
PMID:40992295 | PMC:PMC12494551 | DOI:10.1016/j.ijscr.2025.111963
PLoS One. 2025 Sep 24;20(9):e0328954. doi: 10.1371/journal.pone.0328954. eCollection 2025.
ABSTRACT
BACKGROUND: Chronic postsurgical pain (CPSP) after cardiac surgery is significant. Despite the known association between acute pain and CPSP, advanced pain management strategies have not reduced its incidence. Preventing CPSP requires optimizing acute pain control and disrupting central sensitization. The side effects and risks associated with chronic use of current opioid-based cardiac anesthesia necessitate the adoption of multimodal analgesia. Regional anesthesia is a promising alternative, though existing techniques in cardiac surgery have notable limitations. The intertransverse process block (ITPB) is a novel regional technique that offers potential somatic and visceral analgesia. Recent studies demonstrate consistent local anesthetic spread to the intercostal, paravertebral, and epidural spaces, suggesting broader pain control. ITPB may provide a simpler, safer approach in cardiac surgery, reducing the risks of pleural puncture and bleeding. We hypothesize that ITPB will improve quality of recovery, pain control, and health-related quality of life, thereby mitigating chronic postsurgical pain.
METHODS: This is a single-center, randomized, double-blinded, placebo-controlled trial with intention-to-treat analysis. Elective patients awaiting coronary artery bypass grafting, with or without valvular repair or replacement, will be recruited. Ninety-six participants will be randomly assigned to either ITPB or control group. The ITPB group will receive bilateral ITPBs with 20 ml 0.25% levobupivacaine on each side at the T4-5 level under ultrasound guidance, administered before anesthesia induction. Sham blocks, with equal volume of normal saline, will be performed in the control group. The primary outcome is the quality of recovery, assessed using the 15-item Quality of Recovery questionnaire, at 24 hours after tracheal extubation. Secondary outcomes include Numerical Rating Scale pain scores, patient satisfaction, and opioid consumption within 72 hours post-extubation, duration of mechanical ventilation, length of stay in the ICU and hospital, and opioid-related side effects. The incidence of CPSP at 3, 6, and 12 months will be measured, along with pain interference via the Brief Pain Inventory and the Short-Form McGill Questionnaire-2.
DISCUSSION: Current pain management strategies often rely heavily on opioids, which can have significant side effects and may not adequately address chronic postsurgical pain. This study investigates the efficacy of the intertransverse process block, a novel regional anesthesia technique, in reducing both acute and chronic postsurgical pain in cardiac surgery. Randomized controlled trials on intertransverse process block in cardiac surgery are limited. The results of this study will help define the role of intertransverse process block on the recovery process, and generate vital preliminary data on its potential long-term benefits in reducing chronic postsurgical pain in cardiac surgical population.
CLINICAL TRIAL REGISTRATION: This trial has been prospectively registered at clinicaltrials.gov: NCT06946290.
PMID:40991544 | PMC:PMC12459764 | DOI:10.1371/journal.pone.0328954
Cardiovasc Toxicol. 2025 Sep 24. doi: 10.1007/s12012-025-10062-y. Online ahead of print.
ABSTRACT
Ventricular aneurysm is a serious complication following myocardial infarction. Increasing evidence suggests that exercise-based cardiac rehabilitation plays a protective role in cardiovascular disease. However, the effects of exercise on ventricular aneurysm and the underlying mechanisms remain poorly understood. Therefore, this study aimed to establish a murine model of ventricular aneurysm and investigate the impact of exercise on this condition, along with its potential mechanisms. In this study, using proximal coronary artery ligation, a murine cardiac ventricular aneurysm model was established and evaluated by real-time myocardial contrast echocardiography. Wild-type male C57BL/6 mice with ventricular aneurysms were randomly assigned to three groups: a Sedentary group (no exercise, n = 7), a moderate-intensity exercise group (5 m/min adaptive exercise for 2 weeks, followed by 12-m/min moderate-intensity exercise for 8 weeks, n = 9), and a high-intensity exercise group (5-m/min adaptive exercise for 2 weeks, followed by 18-m/min high-intensity exercise for 8 weeks, n = 7). After 8 weeks of exercise intervention, moderate-intensity exercise was found to significantly enhance cardiac function, reduce myocardial fibrosis, and inhibit fibroblast activation. In contrast, high-intensity exercise resulted in deteriorated cardiac function and aggravated cardiac injury. Mechanistically, this paradoxical effect was linked to the regulation of PTEN stability and subsequent modulation of Smad2/3 signaling pathway. This study provides a theoretical foundation for the role of exercise in managing ventricular aneurysms and offers insights into optimal exercise intensity levels.
PMID:40991159 | DOI:10.1007/s12012-025-10062-y
J Inflamm Res. 2025 Sep 17;18:12929-12948. doi: 10.2147/JIR.S527105. eCollection 2025.
ABSTRACT
PURPOSE: To investigate the synergistic protective effects and underlying mechanisms of combining Acorus gramineus rhizoma volatile oil (VOA), known for its "Cardiotropic-channel-directing" properties, with Crebanine (Cre) in MIRI.
PATIENTS AND METHODS: An MIRI model was established in Sprague-Dawley rats to evaluate the synergistic cardioprotective effects of VOA combined with Cre. Myocardial injury was assessed by measuring the infarct size, apoptotic cardiomyocytes, myocardial injury biomarkers, and histopathological changes. Proinflammatory mediators and oxidative stress markers and results of Western blotting were analyzed to determine the underlying cardioprotective mechanisms of Cre and VOA. In addition, metabolomic analysis was conducted to identify alterations in relevant metabolic pathways.
RESULTS: Cre and VOA alleviated MIRI in rats by reducing infarct size, lowering the levels of myocardial injury biomarkers (Lactate dehydrogenase (LDH), cardiac troponin I (cTnI), creatine kinase (CK), and creatine kinase-myocardial band (CK-MB)), and ameliorating histopathological damage. Mechanistically, Cre and VOA attenuated oxidative stress by enhancing the activity of the antioxidant enzyme superoxide dismutase (SOD) and suppressing the expression of the oxidative stress marker malondialdehyde (MDA). In addition, they downregulated proinflammatory cytokines (interleukin-6 (IL-6) and interleukin-1β (IL-1β)) by inhibiting the MAPK/NF-κB/TNF-α signaling pathway. They mitigated endoplasmic reticulum (ER) stress and apoptosis by modulating the GRP78-PERK/ATF6-CHOP pathway. Metabolomic analysis identified 13 potential biomarkers, and glutamic, pantothenic, and oleic acids were the key metabolites. The glycine, serine, and threonine metabolism pathway, glutathione metabolism, the pentose phosphate pathway, and the biosynthesis of unsaturated fatty acids were the most relevant metabolic pathways involved in the cardioprotective effects of Cre and VOA.
CONCLUSION: Cre and VOA may alleviate MIRI by modulating energy metabolism and suppressing apoptosis and inflammatory responses triggered by oxidative and ER stress. This effect is mediated by GRP78-PERK/ATF6-CHOP and MAPK-NF-κB-TNF-α signaling pathways. Moreover, the volatile oil of Acorus tatarinowii significantly enhanced the cardioprotective effects of Cre against ischemia-reperfusion injury.
PMID:40989754 | PMC:PMC12451010 | DOI:10.2147/JIR.S527105
Open Life Sci. 2025 Sep 8;20(1):20251163. doi: 10.1515/biol-2025-1163. eCollection 2025.
ABSTRACT
Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia. A key pathological feature of AF is atrial fibrosis, which promotes arrhythmogenic remodeling. While myocardial fibrosis has been widely observed in AF models, the underlying molecular mechanisms driving fibrotic progression remain incompletely understood. AF rats were modeled using acetylcholine, followed by treatment with different concentrations of dapagliflozin (DAPA) or positive control amiodarone. To elucidate the role of the high-mobility group box 1 (HMGB1)/receptor for advanced glycation end products (RAGE) pathway in AF, lipopolysaccharide (LPS; an HMGB1/RAGE pathway activator) and FPS-ZM1 (a RAGE inhibitor) were employed. Cardiac function, myocardial fibrosis, and inflammation-related proteins were assessed using echocardiography, enzyme-linked immunosorbent assay, histological staining, Western blotting, and reverse transcription quantitative polymerase chain reaction. AF rats exhibited marked cardiac dysfunction, fibrosis, and increased expression of inflammatory markers. DAPA restored cardiac function, attenuating fibrosis and inflammation. LPS aggravated cardiac injury, while DAPA attenuated the damage, with the greatest protective effects observed in the LPS + DAPA + FPS-ZM1 group. DAPA attenuates atrial fibrosis and cardiac dysfunction in AF rats by inhibiting the HMGB1/RAGE pathway. This study suggests the potential of DAPA as a therapeutic option for AF.
PMID:40989585 | PMC:PMC12451426 | DOI:10.1515/biol-2025-1163
Circulation. 2025 Sep 24. doi: 10.1161/CIRCULATIONAHA.124.072312. Online ahead of print.
ABSTRACT
BACKGROUND: PYGM (muscle glycogen phosphorylase), the rate-limiting enzyme in glycogenolysis, plays an indispensable role in maintaining cardiac energy metabolism. However, the role of PYGM in the pathogenesis of myocardial infarction (MI) remains unclear.
METHODS: The expression profiles of PYGM in cardiac tissues and plasma samples from subjects with MI were assessed using immunoblotting. The role of PYGM in MI was determined by evaluating the effects of PYGM deficiency and its replenishment through adeno-associated virus-mediated PYGM expression in mice with MI.
RESULTS: We found that circulating PYGM levels and their cardiac contents were significantly decreased in patients with MI, which was associated with impaired cardiac function. Loss of PYGM significantly exacerbated MI-induced cardiac dysfunction and damage in mice, and replenishment of PYGM profoundly reversed these adverse effects. Mechanistically, PYGM enhanced glycogenolysis by activating glycolysis and the pentose phosphate pathway, thereby improving cardiac energy homeostasis and mitigating oxidative stress. In addition, PYGM improved MI-induced autophagic flux obstacles and alleviated MI-induced cardiac damage by suppressing the expression of Thbs1 (thrombospondin-1). Moreover, genetic deficiency or pharmacological blockage of autophagy attenuated the protective effects of PYGM against MI-induced cardiac injury, and cardiac-specific knockdown of Thbs1 substantially improved the adverse impact of MI on cardiac dysfunction and damage in PYGM-null mice.
CONCLUSIONS: PYGM safeguards against MI-induced myocardial injury by stimulating glycogenolysis and promoting autophagic flux, thus preserving myocardial energy homeostasis.
PMID:40988610 | DOI:10.1161/CIRCULATIONAHA.124.072312
World J Pediatr Congenit Heart Surg. 2025 Sep 24:21501351251361497. doi: 10.1177/21501351251361497. Online ahead of print.
ABSTRACT
Coral reef aorta (CRA) is a rare, calcified aortic lesion observed primarily in adults and elderly patients. This condition can lead to resistant hypertension and impaired organ perfusion. Although surgical treatment remains the predominant approach, endovascular intervention is emerging as an alternative for suitable cases. We present a 16-year-old male patient with a history of kidney transplantation who was admitted due to hypertension. Imaging revealed severe stenosis at the isthmus level caused by a calcific lesion characteristic of CRA. Given the complexity of the lesion and the surgical challenges, an endovascular approach was chosen. A covered stent was successfully implanted, resulting in significant hemodynamic improvement. At the sixth month follow-up, the patient remained normotensive, and antihypertensive medications were discontinued. To our knowledge, this case represents the first pediatric patient reported to have undergone endovascular treatment for severe aortic coarctation associated with CRA. Our findings suggest that endovascular intervention using a covered stent may provide a viable alternative to surgery in selected pediatric cases, minimizing morbidity and mortality. Further studies are needed to assess the long-term outcomes of this approach.
PMID:40990816 | DOI:10.1177/21501351251361497
World J Pediatr Congenit Heart Surg. 2025 Sep 24:21501351251360691. doi: 10.1177/21501351251360691. Online ahead of print.
ABSTRACT
ObjectivesA minority of patients with hypoplastic left heart syndrome (HLHS) are at extremely high risk for staged palliation and can be bridged-to-heart transplantation with bilateral pulmonary artery bands, ductal stenting, and single ventricle-ventricular assist device insertion (HYBRID + sVAD). The purpose of this analysis is to assess our learning curve associated with our first ten patients with functionally univentricular ductal-dependent systemic circulation who were supported with primary HYBRID + sVAD as bridge-to-heart transplantation.MethodsPatients were temporally separated into two cohorts: the first five and second five. Demographic, perioperative, and outcome data were collected. Continuous variables are described as median [IQR](range). Categorical variables are described as N (%). P values were calculated using Fisher exact t test for categorical variables and unpaired t tests for continuous variables.ResultsTen patients underwent HYBRID + sVAD operations for HLHS (2017-2022). Patients in the initial cohort and the most recent cohort were similar in age and weight. Liver dysfunction and renal dysfunction were more common in the first five patients (2/5 = 40%) versus the next five patients (0/5 = 0%). Length of sVAD support was longer in the most recent five patients (98 days [64-138] vs 154 days [134-225], P = .08); however, no increase in sVAD-associated stroke or bleeding was seen in the most recent five patients. Despite very similar demographic and preoperative profiles, only two of the first five patients (2/5 = 40%) survived to heart transplantation, while all of the next 5 (5/5 = 100%) were successfully bridged-to-cardiac transplantation with HYBRID + sVAD and are alive today.ConclusionsOur experience with primary HYBRID + sVAD as bridge-to-heart transplantation in neonates with HLHS demonstrates an important learning curve associated with this operation and approach.
PMID:40990805 | DOI:10.1177/21501351251360691
Curr Opin Organ Transplant. 2025 Sep 25. doi: 10.1097/MOT.0000000000001251. Online ahead of print.
ABSTRACT
PURPOSE OF REVIEW: Transplantation in candidates with psychotic disorders has been a controversial topic for over 40 years. Reviewing the outcomes of these candidates may inform decisions going forward, though it is unclear whether outcomes with kidney recipients is generalizable to other organs, which are life-sparing not mainly life-enhancing.
RECENT FINDINGS: Outcomes in recipients with psychotic disorders after kidney transplants were described in three studies. Outcomes with heart, lung, pancreas, and small bowel or multivisceral transplants is sparse to nonexistent. There were 26 cases and 8 case series published, mostly highly selected patients, with small sample size, and the majority had less than 3-year follow-up. Guidelines were proposed for this population based on a survey of 12 centers.
SUMMARY: More systematic study is needed on the risks and barriers to transplantation in these candidates. More data is needed regarding outcomes in those recipients with life-sparing transplants for whom there is not a rescue plan in case the graft is lost. Candidates should be evaluated on an individual basis based on known risk factors in accordance with the ethical principles of beneficence, justice, and utility in the face of scarce resources.
PMID:40990665 | DOI:10.1097/MOT.0000000000001251
Curr Opin Nephrol Hypertens. 2025 Sep 25. doi: 10.1097/MNH.0000000000001114. Online ahead of print.
ABSTRACT
PURPOSE OF REVIEW: Postoperative acute kidney injury (PO-AKI) is a common complication associated with increased morbidity and mortality. Despite its frequency, guidelines for the prevention of PO-AKI are relatively recent and still based on weak or contradictory evidence. This review aims to summarize large recent studies published in the past 2 years that have attempted to address these gaps.
RECENT FINDINGS: While the POST-CABGDM and Stop-or-Not trials have provided additional evidence on the preoperative prescription of RAAS and SGLT2 inhibitors in selected surgical settings, future research must integrate preoperative risk profiling to personalize therapy. Likewise, although the POISE-3 trial seems to suggest that maintaining a mean arterial pressure of at least 60 mmHg is crucial in noncardiac surgery, it does not explore how targets might be personalized. In cardiac surgery, both the SIRAKI02 trial (i.e., extracorporeal blood purification membrane connected to the cardiopulmonary bypass) and the PROTECTION trial (i.e., intraoperative amino-acid infusion) demonstrated benefit only for mild AKI, raising questions about their mechanistic basis and clinical significance.
SUMMARY: "Prevention is better than cure," a principle that holds particularly true for PO-AKI, a common complication that still lacks effective curative treatments. Although the recent abovementioned trials have yielded important findings, they concurrently underscore the significant obstacles in conducting clinical trials on PO-AKI and in formulating robust recommendations based on their outcomes.
PMID:40990657 | DOI:10.1097/MNH.0000000000001114
Kardiol Pol. 2025 Sep 24. doi: 10.33963/v.phj.108672. Online ahead of print.
NO ABSTRACT
PMID:40990557 | DOI:10.33963/v.phj.108672
Clin Kidney J. 2025 Jul 12;18(8):sfaf222. doi: 10.1093/ckj/sfaf222. eCollection 2025 Aug.
ABSTRACT
BACKGROUND: Emerging evidence suggests that ambient air pollution may adversely affect long-term outcomes in kidney transplant recipients; however, quantitative estimates across clinical endpoints remain limited. This meta-analysis aimed to systematically evaluate the association between air pollution exposure and mortality, graft failure, and rejection risk in kidney transplant populations.
METHODS: A systematic database search was carried out across the databases of the Cochrane Library, Web of Science, Scopus, and PubMed until the 1 May 2025. Research that evaluated the impact of air pollution, particularly PM₂.₅, PM₁₀, NO₂, O₃, and other ambient pollutants, on graft survival in kidney transplant recipients were evaluated. Hazard ratios (HR) were extracted or recalculated for all-cause mortality, death-censored graft failure, and graft rejection per 10 µg/m³ increase in particulate matter concentration.
RESULTS: After screening 6209 records, a total of six studies involving populations of adult kidney transplant recipients from the USA, UK, South Korea, and Taiwan were included in the meta-analysis. Exposure to ambient air pollution was significantly associated with increased all-cause mortality among kidney transplant recipients [pooled HR 1.61; 95% confidence intervals (CI) 1.01-2.58], as well as higher risks of death-censored graft failure (HR 1.25; 95% CI 1.04-1.50) and graft rejection (HR 1.35; 95% CI 1.09-1.69) per 10 µg/m³ increment in particulate matter concentration. Substantial heterogeneity was observed across studies, particularly for mortality (I² = 99%) and graft rejection (I² = 91%). No significant associations were found between air pollution exposure and cardiovascular disease or coronary heart disease mortality.
CONCLUSION: Ambient air pollution exposure is associated with increased risks of mortality, graft failure, and rejection in kidney transplant recipients, highlighting air pollution as a modifiable environmental risk factor that may have important implications for long-term transplant outcomes.
PMID:40989710 | PMC:PMC12451696 | DOI:10.1093/ckj/sfaf222
Circ Heart Fail. 2025 Sep 24:e012592. doi: 10.1161/CIRCHEARTFAILURE.124.012592. Online ahead of print.
ABSTRACT
BACKGROUND: Dilated cardiomyopathy (DCM) is a genetically heterogeneous disease, presenting diverse clinical phenotypes and outcomes based on the underlying gene affected. The influence of sex on the gene-specific long-term prognosis of patients with genetic DCM remains unclear. This study aims to determine the effect of sex on the long-term prognosis per underlying genogroup.
METHODS: A retrospective cohort study was conducted using data from 4 international referral centers. Baseline and longitudinal clinical data of patients with DCM, with a median follow-up of 6.7 years (interquartile range, 3.5-11.9 years), were collected. The study included men and women with DCM who had undergone genetic testing. Patients were categorized into 7 genotype groups: cytoskeletal/Z-disk, desmosomal, nuclear envelope, motor sarcomeric, TTN, other genetic, and genotype negative. The main outcomes measured were left ventricular reverse remodeling, mortality, heart failure hospitalization, heart transplantation, and malignant ventricular arrhythmias.
RESULTS: Among 1716 patients, 1130 (66%) were men and 510 (30%) had a (likely) pathogenic variant. Ventricular remodeling was gene-dependent in women, with TTN patients exhibiting the highest rate (P=0.003) and desmosomal patients the lowest (P=0.04) compared with the genotype-negative group. After a median follow-up of 6.7 years, 334 men (29%) and 140 women (24%) reached the primary end point. Men with a (likely) pathogenic variant had the poorest prognosis, showing a higher rate of major adverse events (adjusted hazard ratio, 1.48 [95% CI, 1.12-1.95]; P=0.02) and malignant ventricular arrhythmias (adjusted hazard ratio, 1.83 [95% CI, 1.16-2.88]; P=0.009) compared with genotype-negative women. Prognosis varied by gene in men (log-rank P<0.0001) but not in women (log-rank P=0.1). The cytoskeletal/Z-disk, desmosomal, and nuclear envelope groups had the worst prognosis in men.
CONCLUSIONS: The genetic architecture and sex are critical predictors of left ventricular reverse remodeling and long-term prognosis in DCM. These factors should be integrated into individualized risk prediction models to enhance clinical outcomes in patients with DCM.
PMID:40988625 | DOI:10.1161/CIRCHEARTFAILURE.124.012592
Interdiscip Cardiovasc Thorac Surg. 2025 Sep 24:ivaf214. doi: 10.1093/icvts/ivaf214. Online ahead of print.
ABSTRACT
OBJECTIVES: Many models of bioprosthesis are available for pulmonary valve replacement in adults with congenital heart disease but there is a lack of randomized evidence to guide practice. We surveyed congenital cardiac surgeons to establish current practice and willingness to change within a clinical trial.
METHODS: An online survey was sent to all consultant congenital cardiac surgeons in adult congenital centres in UK and Ireland. Information was sought on preferred prostheses, factors influencing decision-making, implant technique, postoperative anticoagulation, practice variations in adolescents, and willingness to randomise patients to different prostheses within a trial.
RESULTS: Responses were obtained from 27 (69%) surgeons. 19 (70%) preferred an Edwards bovine pericardial valve, most commonly the Inspiris Resilia (7, 26%). Only 2 (7%) favoured the Hancock II valve, the remaining 6 (22%) preferred pulmonary homografts. Data regarding long-term freedom from reintervention (23, 85%) was the most important factor influencing prosthesis choice. 22 (81%) surgeons were willing to randomise adult patients to either a bovine pericardial valve or porcine xenograft in a clinical trial, with Perimount Magna Ease and Hancock II the most acceptable, respectively. Willingness to randomise dropped to 11 (41%) surgeons for adolescent patients.
CONCLUSIONS: This survey demonstrates heterogeneity in the choice of pulmonary valve prosthesis. Combined with a lack of evidence from clinical trials, our findings support the presence of clinical equipoise. Most surgeons are willing to change practice suggesting that a pragmatic, multicentre, randomized controlled trial comparing bovine pericardial versus porcine xenograft for pulmonary valve replacement in adults is feasible.
PMID:40991337 | DOI:10.1093/icvts/ivaf214