Eur Heart J. 2025 Sep 1:ehaf674. doi: 10.1093/eurheartj/ehaf674. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: While surgical left atrial appendage occlusion (SLAAO) reduces stroke in atrial fibrillation (AF) patients, its efficacy in patients without pre-operative AF but with CHA₂DS₂-VASc ≥2 remains uncertain despite their high post-operative AF risk (15-54%). The aim of this study was to evaluate whether prophylactic SLAAO reduces post-operative thrombo-embolic events in valvular surgery patients.
METHODS: The OPINION was a multicentre, open-label, randomized, superiority trial conducted at three cardiac surgery centres in China. Eligible non-AF patients with CHA₂DS₂-VASc ≥2 and an indication for valve repair or replacement due to mitral or aortic valve lesions were randomly assigned (1:1) to undergo SLAAO (intervention arm) or not undergo SLAAO (control arm) during surgery. The primary outcome was a composite of ischaemic stroke, transient ischaemic attack (TIA), or cardiovascular mortality assessed at 1 year. The primary analysis was done in the intention-to-treat population.
RESULTS: Between April 2021 and June 2024, a total of 2157 patients were enrolled and randomized. After exclusion of 39 patients who withdrew informed consent, 2118 participants were included in the intention-to-treat population (1062 in the SLAAO group and 1056 in the control group). Baseline characteristics were well-balanced between the SLAAO group and control group (mean age 55.5 [11.4] vs 55.6 [11.5] years, P = .65; female 32.9% vs 32.3%, P = .78; CHA2DS2-VASc score 2.88 [0.98] vs 2.87 [0.96], P = .83; median EuroSCORE II 1.58% [1.42%] vs 1.56% [1.28%], P = .74). The 1-year primary endpoint occurred in 73 (6.9%) patients in the SLAAO group and in 87 (8.2%) patients in the control group (hazard ratio 0.83; 95% confidence interval 0.61-1.14; P = .25).
CONCLUSIONS: For valvular surgery patients with CHA₂DS₂-VASc scores ≥2 but no pre-operative AF, routine prophylactic left atrial appendage closure did not significantly reduce the incidence of the primary composite endpoint (ischaemic stroke, TIA, and cardiovascular mortality) at 1-year follow-up.
TRIAL REGISTRATION: ChiCTR.org registry ChiCTR2100042238.
PMID:40888584 | DOI:10.1093/eurheartj/ehaf674
Circ Cardiovasc Interv. 2025 Sep;18(9):e015702. doi: 10.1161/CIRCINTERVENTIONS.125.015702. Epub 2025 Sep 1.
ABSTRACT
BACKGROUND: Transcatheter tricuspid valve annuloplasty (TTVA) with the Cardioband system is a safe and effective option for high-risk patients with symptomatic severe tricuspid regurgitation (TR). Hemodynamics play a crucial role in these patients. However, it remains unclear if hemodynamic changes after TTVA are linked to clinical outcomes.
METHODS: Consecutive patients with severe functional TR who underwent TTVA between 2019 and 2022 were retrospectively analyzed. Right heart catheterization was performed before and after cinching to assess hemodynamic parameters, including XV height (difference between the V-wave and the nadir of right atrial pressure). The primary end point was 2-year survival.
RESULTS: Fifty-eight patients with complete hemodynamic assessment were included. All patients presented with torrential (40%), severe (38%), or massive (22%) TR. TR was reduced by ≥2 grades in 83% and by ≥1 grade in 97%. Hemodynamics following TTVA showed significant increases in median cardiac index (2.4-2.8 L/[min·m²]), pulmonary artery pulsatility index (1.73-2.13), and right ventricle cardiac power index (0.15-0.21 W/m²). Right atrial pressure (mean/V-wave) decreased significantly, with the most notable change in XV height (12.5 to 7 mm Hg; P<0.001). Lower postprocedural XV height independently predicted 2-year survival (P=0.002) and was significantly associated with lower TR grade at follow-up (P=0.002) and right ventricle reverse remodeling (P<0.001). Immediate right ventricle remodeling was also associated with 2-year survival (P=0.024).
CONCLUSIONS: Postprocedural XV height was independently associated with 2-year survival and linked to TR reduction and right ventricle remodeling. TTVA improves hemodynamics even in advanced TR, and hemodynamic markers may support risk stratification.
PMID:40888413 | DOI:10.1161/CIRCINTERVENTIONS.125.015702
World J Transplant. 2025 Sep 18;15(3):102768. doi: 10.5500/wjt.v15.i3.102768.
ABSTRACT
Heart transplantation is a life-saving procedure for many people throughout the world. Data shows that in 2024, there was an increase in the volume of adult heart transplantation in the United States even as there was a decrease in the volume of pediatric heart transplantation to the lowest volume in a decade. Organ availability remains a major limiting factor affecting transplant volume. This mandates that innovation must take place to increase the supply of donor organs. While some strategies such as donation after cardiac death, hepatitis C virus + transplantation, and ABO-incompatible transplantation have increased the pool for donation, it still falls short of meeting the demand. Other proposed strategies include splitting the donor heart to provide multiple partial heart transplants, domino partial heart transplantation, changes in legislation including opt-out legislation, and xenotransplantation. Further evolution and refinement of these strategies will make a meaningful impact on patients awaiting life-saving heart transplants.
PMID:40881767 | PMC:PMC12038578 | DOI:10.5500/wjt.v15.i3.102768
J Am Heart Assoc. 2025 Sep 2;14(17):e041907. doi: 10.1161/JAHA.125.041907. Epub 2025 Aug 29.
ABSTRACT
BACKGROUND: The association of outcomes with initial clip selection has not been investigated in patients undergoing transcatheter edge-to-edge repair with the MitraClip G4.
METHODS: We analyzed 2257 patients receiving the MitraClip G4 according to the initial clip type: short (NT/NTW) versus long (XT/XTW) and narrow (NT/XT) versus wide (NTW/XTW). We performed a propensity-matched analysis of baseline anatomical features in patients with primary and secondary mitral regurgitation (MR).
RESULTS: The proportions of the initial clip types were as follows: NT, 18.9%; NTW, 41.7%; XT, 5.1%; and XTW, 34.3%. The proportions of the MR severity ≤1+ at discharge and 1 year were not significantly different among the 4 clip types. The incidence of death or heart failure hospitalization was not significantly different between the initial long and short clip groups and between the initial wide and narrow clip groups. After propensity matching, in patients with primary MR, long clips were significantly associated with a greater MR reduction (2.87±0.89 versus 2.62±0.99, P=0.04) and a higher proportion of the MR severity ≤1+ at 1 year (68.2% versus 48.6%, P=0.04) than short clips. In patients with secondary MR, long or wide clips had a similar MR severity at discharge and 1 year as short or narrow clips.
CONCLUSIONS: Residual MR severity and outcomes were not different regardless of the initial clip type, indicating the optimal clip selection in the real-world settings with the MitraClip G4. In patients with primary MR, greater and more durable MR reduction may be expected by using the initial long clips.
REGISTRATION: URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN-ID: UMIN000023653.
PMID:40879026 | DOI:10.1161/JAHA.125.041907
Eur Heart J. 2025 Aug 29:ehaf194. doi: 10.1093/eurheartj/ehaf194. Online ahead of print.
NO ABSTRACT
PMID:40878295 | DOI:10.1093/eurheartj/ehaf194
Eur J Cardiothorac Surg. 2025 Aug 2;67(8):ezaf276. doi: 10.1093/ejcts/ezaf276.
NO ABSTRACT
PMID:40878291 | DOI:10.1093/ejcts/ezaf276
BMC Pediatr. 2025 Aug 29;25(1):664. doi: 10.1186/s12887-025-06083-9.
ABSTRACT
BACKGROUND: We analyzed the perioperative metabolomic alterations in children undergoing ventricular septal defect (VSD) repair under cardiopulmonary bypass (CPB), identified evidence of postoperative injury, and explored strategies to mitigate such injuries.
METHODS: We conducted an untargeted metabolomic analysis of serum at three distinct time points (preoperative (Tp), immediate postoperative (T0), and 24 h postoperative (T24)) in eight children undergoing VSD repair under CPB. Subsequently, we identified the key enzymes associated with perioperative injury for molecular docking prediction studies.
RESULTS: We identified 623 metabolites in serum samples with VIP scores exceeding 1 in all three groups; 37 of these metabolites exhibited significant differences throughout the study phases. Three metabolic pathways-glycerophospholipid metabolism, arginine and proline metabolism, and retrograde endogenous cannabinoid signaling recurred in various comparisons between the two groups. Molecular docking predictions confirmed that arginine-glycine amidinotransferase may possess binding sites for bosentan and AdipoRon.
CONCLUSION: The perioperative metabolic profiles in children undergoing VSD repair under CPB were significantly altered, presumably because of the inflammatory response and endothelial cell dysfunction induced by CPB. Molecular docking predictions suggested that bosentan and AdipoRon may be potent compounds that influence perioperative damage.
PMID:40883731 | PMC:PMC12395897 | DOI:10.1186/s12887-025-06083-9
J Am Heart Assoc. 2025 Sep 2;14(17):e042734. doi: 10.1161/JAHA.125.042734. Epub 2025 Aug 29.
ABSTRACT
BACKGROUND: Selecting appropriate patients for extracorporeal cardiopulmonary resuscitation (ECPR) in cases of out-of-hospital cardiac arrest remains challenging, particularly for those with initial nonshockable rhythms. Our aim is to develop a prediction score to identify suitable ECPR candidates in patients with initial nonshockable rhythm.
METHODS: The data were sourced from the SAVE-J II (Study of Advanced Life Support for Ventricular Fibrillation With Extracorporeal Circulation in Japan II) study, a retrospective multicenter observational study in Japan. Included were adult patients with out-of-hospital cardiac arrest who underwent ECPR with initial pulseless electrical activity or asystole. The primary outcome was survival to hospital discharge. We developed a prediction score, employing logistic regression analysis and internally validating it with 1000 bootstrap samples. The performance of the score in predicting a favorable neurological outcome at discharge was also evaluated.
RESULTS: Among 648 eligible patients, 86 (13.3%) survived to hospital discharge. The median age was 60.5 years, 75.9% (492) were male, and 74.4% (482) had pulseless electrical activity as the initial rhythm. Three clinical predictors for the START-ECPR Score (Signs of Life, Transient ROSC, Not Asystole Rhythm to ECPR Score) were identified: shockable rhythm or pulseless electrical activity at hospital arrival, transient return of spontaneous circulation before hospital arrival, and signs of life at hospital arrival. Survival rates were 4.4% (7/159) for a score of 0, 10.7% (38/356) for a score of 1, and 30.8% (39/130) for scores of 2 to -3. The bias-corrected C-index for the score was 0.696. For predicting favorable neurologic outcomes at discharge, the C-index was 0.761.
CONCLUSIONS: We developed a straightforward 3-factor prediction score for predicting survival to hospital discharge and favorable neurologic outcomes in patients with out-of-hospital cardiac arrest with initial nonshockable rhythms receiving ECPR.
PMID:40878992 | DOI:10.1161/JAHA.125.042734
Int J Mol Sci. 2025 Aug 21;26(16):8100. doi: 10.3390/ijms26168100.
ABSTRACT
Renocardiac syndrome type 4 (RCS4) is a common comorbid pathology, but the mechanisms of kidney dysfunction-induced cardiac remodeling and the involvement of cardiac progenitor cells (CPCs) in this process remain unclear. The aim of this study was to investigate the structural and functional changes in the cardiac muscle in RCS4 induced by unilateral ureteral obstruction (UUO) and the role of nestin+ CPCs in these. Heart function and localization of nestin+ cells in the myocardium were assessed using nestin-GFP transgenic mice subjected to UUO for 14 and 28 days. UUO resulted in cardiac hypertrophy, accompanied by an elongation of the QRS wave on the ECG, decreased expression of Cxcl1, Cxcl9, and Il1b, reduced the number of CD11b+ cells, and increased in titin isoform parameters, such as T1/MHC and TT/MHC ratios, without changes in fibrosis markers. The number of nestin+ cells increased in the myocardium with increased duration of UUO and displayed an SCA-1+TBX5+ phenotype, consistent with CPCs. Thus, cardiac pathology in RCS4 was manifested by cardiomyocyte hypertrophy with changes in the electrophysiological phenotype of the heart, not accompanied by fibrosis or inflammation. Nestin+ cardiac cells retained the CPC phenotype during UUO, and their number increased, which suggests their participation in regenerative processes in the heart.
PMID:40869420 | PMC:PMC12386493 | DOI:10.3390/ijms26168100
Yonsei Med J. 2025 Sep;66(9):529-536. doi: 10.3349/ymj.2024.0455.
ABSTRACT
PURPOSE: The morphological and functional characteristics and clinical significance of the left atrial appendage (LAA) are well established in patients with non-valvular atrial fibrillation (AF). However, data on the LAA characteristics in patients with mitral valve (MV) disease are limited. This study aimed to identify the LAA characteristics in AF patients with severe MV disease.
MATERIALS AND METHODS: A total of 506 AF patients who underwent cardiac computed tomography (CT) as preoperative evaluations for MV surgery were retrospectively analyzed. The prevalences of different LAA morphologies (cactus, cauliflower, windsock, chicken wing), LAA ostium diameter, LAA volume, and LAA flow stasis or thrombus were assessed. The LAA variables were compared according to the predominant MV dysfunction.
RESULTS: The most common LAA morphology was cactus (n=211, 41.7%), followed by cauliflower (n=143, 28.3%), windsock (n=90, 17.8%), and chicken wing (n=60, 11.9%). The average LAA ostium maximal diameter and LAA volume were 35.3±8.0 mm and 22.1±15.1 mL, respectively. LAA stasis was found in 215 patients (42.5%) and LAA thrombus in 93 patients (18.4%). Patients with mitral stenosis predominance showed significantly smaller LAA volume compared to those with mitral regurgitation predominance (17.8±11.7 mL vs. 26.9±16.8 mL, p<0.001). However, LAA flow stasis [190 (71.7%) vs. 25 (10.4%), p<0.001] and thrombus [89 (33.6%) vs. 4 (1.7%), p<0.001] were remarkably prevalent in these patients.
CONCLUSION: Due to advanced LAA remodeling in AF patients with severe MV disease, the morphologic distribution of LAA types differs from that established in patients without MV disease.
PMID:40873139 | PMC:PMC12394754 | DOI:10.3349/ymj.2024.0455
Eur J Med Res. 2025 Aug 29;30(1):818. doi: 10.1186/s40001-025-03096-z.
ABSTRACT
BACKGROUND: Critical gaps persist in clinical guidelines and resuscitation strategies for induction and maintenance phase peri-anesthetic cardiac arrest (IM-PACA), urgently necessitating exploration of feasible solutions during anesthesia induction and maintenance periods. This study evaluates a modified cardiopulmonary bypass (CPB) strategy for managing IM-PACA in valvular heart disease (VHD) surgical patients.
METHODS: A retrospective analysis was performed on IM-PACA patients (n = 21) from 1,043 cardiac valve surgeries between March 2019 and January 2022 as the cardiac arrest-resuscitation group (CAR group). Patients who completed normal cardiac valve surgery (n = 84) were randomly selected from the medical record database as the Routine Surgery group (RS group), serving as a benchmark control for the standard efficacy of routine surgery. The CAR group completed surgery after modified cardiopulmonary bypass strategy; the RS group completed surgery as planned. This study reviewed the possible causes of cardiac arrest in the CAR group and performed statistical analysis on surgical time-related metrics (total surgical duration, cardiopulmonary bypass duration, etc.) and postoperative follow-up data (paravalvular leak, cardiac-related complications, etc.) using SPSS 26.0.
RESULTS: The short-term postoperative survival rate was 95.24% in the CAR group and 100% in the RS group. Baseline characteristics including gender, age, and smoking history showed no significant differences between the two groups (P > 0.05). The CAR group showed a significantly shorter pericardiotomy-to-CPB time (250.00 (205.00-269.50) vs. 512.50 (459.25-563.00) s; P < 0.001), but longer rewarming time (68.00 (63.50-74.50) vs. 48.00 (35.25-61.75) min; P < 0.001), ventilator duration (980.00 (619.00-1106.50) vs. 900.00 (630.00-1103.75) min; P = 0.002), and higher day 2 drainage (190 (157.50-215.00) vs. 105 (71.25-150.00) ml; P < 0.001) compared to the RS group. Other intraoperative and postoperative parameters revealed no statistically significant differences when compared with the RS group (P > 0.05).
CONCLUSIONS: For IM-PACA patients undergoing cardiac valve surgery, the modified cardiopulmonary bypass strategy is an effective rescue method, and the strategy of continuing surgery after resuscitation is completely feasible.
PMID:40877919 | PMC:PMC12395764 | DOI:10.1186/s40001-025-03096-z
Biomedicines. 2025 Jul 30;13(8):1856. doi: 10.3390/biomedicines13081856.
ABSTRACT
Background: The prevalence of cardiogenic shock (CS) resulting from the progression of heart failure (PHF) is increasing and remains associated with high mortality. This study aimed to compare the clinical characteristics and outcomes of patients who developed CS due to PHF versus those whose CS was caused by other aetiologies (non-PHF). Methods: We retrospectively analysed 280 patients admitted to a Polish tertiary care centre between January 2021 and April 2024. The cohort was divided into two groups: PHF (n = 84, 30%) and non-PHF (n = 196, 70%). Results: Compared to the non-PHF group, PHF patients more frequently had chronic kidney disease (30% vs. 15%, p < 0.01), and significant valvular disease (30% vs. 13%, p < 0.01). PHF patients exhibited significantly lower white blood cell counts (9.4 [6.9-16.4] vs. 13.3 [10.4-17.6], p < 0.01) and troponin T levels (188 [61-1392] vs. 10,921 [809-45,792], p < 0.01). In-hospital mortality was significantly lower among PHF patients (52% vs. 65%, p = 0.04). Although the overall use of mechanical circulatory support (MCS) did not differ between groups, significant differences in the types of MCS applied were observed (p < 0.01). Additionally, PHF patients underwent fewer coronary revascularisation procedures (15% vs. 70%, p < 0.01). Conclusions: Patients with PHF-related CS exhibit distinct clinical profiles and may experience lower in-hospital mortality when appropriately diagnosed and treated with a personalised approach. Further prospective, multicentre studies are warranted to optimize the management of this growing subgroup of CS patients.
PMID:40868111 | PMC:PMC12383962 | DOI:10.3390/biomedicines13081856
Radiol Cardiothorac Imaging. 2025 Aug;7(4):e240218. doi: 10.1148/ryct.240218.
ABSTRACT
Left ventricular assist devices (LVADs) are used for short-term support, as a bridge to transplant, or as destination therapy in patients with end-stage systolic heart failure. Imaging plays a crucial role in assessing the anatomic suitability for implantation and in detecting complications following both implantation and explantation. LVAD-associated complications can affect the pump, inflow cannula, outflow graft, or driveline. Echocardiography is effective for evaluating inflow cannula position and certain parameters, such as inflow and outflow velocities, valvular regurgitation, and ventricular dilatation; however, its ability to visualize the interiors of the inflow and outflow cannulas is limited. MRI is contraindicated for patients with LVADs. Contrast-enhanced chest CT imaging has become the preferred diagnostic modality for evaluating outflow graft complications. This imaging essay describes the CT findings and complications associated with LVADs, particularly the commercially available HeartMate II and HeartMate 3 devices (Abbott Laboratories). The HeartWare device (Medtronic), although recalled by the U.S. Food and Drug Administration, will also be mentioned. Keywords: Cardiac Assist Devices, CT Imaging Supplemental material is available for this article. © RSNA, 2025.
PMID:40874839 | DOI:10.1148/ryct.240218
Echocardiography. 2025 Sep;42(9):e70279. doi: 10.1111/echo.70279.
ABSTRACT
BACKGROUND: Transcatheter edge-to-edge mitral valve repair (TEER) is an effective and safe method for treating high-risk patients with severe mitral regurgitation (MR). Two approved devices, MitraClip (Abbott Vascular) and PASCAL (Edwards Lifesciences), use leaflet approximation to reduce MR and may also influence annular dimensions via leaflet tension. The purpose of this study is to analyze the acute mitral annular dimensional changes following PASCAL implantation and correlate with long-term results.
METHODS: A retrospective analysis was conducted on 115 high-risk patients (mean age 76 ± 11 years) with moderate-to-severe and severe MR (grade 3.9 ± 0.3, EROA 49± 23 mm2, LV ejection fraction 47% ± 14%). All patients had elevated surgical risk scores (logistic EuroSCORE 23.6% ± 11.5%, EuroSCORE II 6.9% ± 5%, STS Score 5.5± 4.2). Intraprocedural transesophageal echocardiography (TOE) was post-analyzed using specialized software to assess mitral annular geometry.
RESULTS: PASCAL effectively reduced MR (grade 3.9 ± 0.3 to 1.2 ± 0.5, p < 0.001) in all patients. Significant reductions in 3D annulus area (15 ± 4cm2 to 13.9 ± 4cm2, 7.1% ± 9.9%, p < 0.001) and perimeter (14 ± 1.7 cm to 13.5 ± 1.8 cm, 3.2% ± 5.9%, p < 0.001) were observed in 77.4% of our cohort immediately after TEER. Anterior-posterior (AP) diameter showed greater reduction (4.1 ± 0.6 cm to 3.8 ± 0.6 cm, p < 0.001, 6.3% ± 7.8%) compared to medial-lateral diameter (4.3 ± 0.5 cm to 4.2 ± 0.6 cm, p < 0.001, 3.2% ± 8%), and these changes resulted in a more elliptic valve at the end of the procedure (ellipticity from 105% ± 8% to 109% ± 10%, p = 0.001). The reduction of the annulus dimensions correlated with the residual MR at discharge (p = 0.001), while these patients also achieved optimal long-term echocardiographic results with mild MR (p = 0.019).
CONCLUSIONS: TEER with PASCAL acutely reduces mitral annular dimensions, favoring a more elliptic valve shape, particularly through AP diameter reduction. These changes correlate with sustained MR improvement.
PMID:40873407 | DOI:10.1111/echo.70279
Eur J Med Res. 2025 Aug 29;30(1):818. doi: 10.1186/s40001-025-03096-z.
ABSTRACT
BACKGROUND: Critical gaps persist in clinical guidelines and resuscitation strategies for induction and maintenance phase peri-anesthetic cardiac arrest (IM-PACA), urgently necessitating exploration of feasible solutions during anesthesia induction and maintenance periods. This study evaluates a modified cardiopulmonary bypass (CPB) strategy for managing IM-PACA in valvular heart disease (VHD) surgical patients.
METHODS: A retrospective analysis was performed on IM-PACA patients (n = 21) from 1,043 cardiac valve surgeries between March 2019 and January 2022 as the cardiac arrest-resuscitation group (CAR group). Patients who completed normal cardiac valve surgery (n = 84) were randomly selected from the medical record database as the Routine Surgery group (RS group), serving as a benchmark control for the standard efficacy of routine surgery. The CAR group completed surgery after modified cardiopulmonary bypass strategy; the RS group completed surgery as planned. This study reviewed the possible causes of cardiac arrest in the CAR group and performed statistical analysis on surgical time-related metrics (total surgical duration, cardiopulmonary bypass duration, etc.) and postoperative follow-up data (paravalvular leak, cardiac-related complications, etc.) using SPSS 26.0.
RESULTS: The short-term postoperative survival rate was 95.24% in the CAR group and 100% in the RS group. Baseline characteristics including gender, age, and smoking history showed no significant differences between the two groups (P > 0.05). The CAR group showed a significantly shorter pericardiotomy-to-CPB time (250.00 (205.00-269.50) vs. 512.50 (459.25-563.00) s; P < 0.001), but longer rewarming time (68.00 (63.50-74.50) vs. 48.00 (35.25-61.75) min; P < 0.001), ventilator duration (980.00 (619.00-1106.50) vs. 900.00 (630.00-1103.75) min; P = 0.002), and higher day 2 drainage (190 (157.50-215.00) vs. 105 (71.25-150.00) ml; P < 0.001) compared to the RS group. Other intraoperative and postoperative parameters revealed no statistically significant differences when compared with the RS group (P > 0.05).
CONCLUSIONS: For IM-PACA patients undergoing cardiac valve surgery, the modified cardiopulmonary bypass strategy is an effective rescue method, and the strategy of continuing surgery after resuscitation is completely feasible.
PMID:40877919 | PMC:PMC12395764 | DOI:10.1186/s40001-025-03096-z
Medicina (Kaunas). 2025 Aug 6;61(8):1420. doi: 10.3390/medicina61081420.
ABSTRACT
Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes-including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support-were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90-120, 120-150, 150-180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120-150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity.
PMID:40870465 | PMC:PMC12388088 | DOI:10.3390/medicina61081420
Pharmaceuticals (Basel). 2025 Aug 8;18(8):1173. doi: 10.3390/ph18081173.
ABSTRACT
Background: Remifentanil, an ultra-short-acting μ-receptor agonist, is used with propofol or thiopental for tracheal intubation without muscle relaxants. While effective with both, its combination with thiopental provides better hemodynamic stability. Thiopental has long been a standard intravenous agent for anaesthesia induction and remains a cost-effective alternative to propofol in resource-limited settings. To date, no study has directly compared the effects of thiopental-remifentanil and propofol-remifentanil combinations on LMA insertion conditions. This study aims to compare the effects of thiopental or propofol with 2 µg·kg-1 remifentanil on laryngeal mask airway (LMA) insertion conditions and success in a prospective, randomised double-blind study. Method: The study included 80 premedicated ASA I-II patients, aged 18-65, randomised into Group P (propofol) and Group T (thiopental). Anaesthesia induction was with 2 μg·kg-1 remifentanil, followed by 5 mg·kg-1 thiopental or 2.5 mg·kg-1 propofol. LMA insertion occurred 90 s post-induction. LMA insertion conditions were evaluated using a six-variable scale. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index monitor (BIS) values were recorded at baseline, 1 min pre-insertion, and at 1, 2, 3, 4, and 5 min after insertion. Apnoea duration, loss of eyelash reflex duration, insertion duration, number of attempts, and perioperative complications were also documented. Results: Demographic data were similar. Group P showed significantly shorter eyelash reflex loss and LMA insertion durations, longer apnoea duration, and higher rates of full mouth opening, excellent LMA insertion condition, and hypotension or bradycardia compared to Group T (p < 0.05). Group P had significantly lower HR, SAP, DAP, and MAP at various time points (p < 0.05). There were no significant differences in blood presence on LMA, sore throat, or dysphagia (p > 0.05). Conclusions: In our study, administration of 2 μg·kg-1 remifentanil before induction along with thiopental or propofol was shown to provide acceptable LMA insertion conditions at comparable levels. As hemodynamic parameters were less affected, we believe the remifentanil-thiopental combination may be a suitable alternative.
PMID:40872564 | PMC:PMC12389158 | DOI:10.3390/ph18081173
Life (Basel). 2025 Aug 14;15(8):1292. doi: 10.3390/life15081292.
ABSTRACT
Intubated critically ill patients are susceptible to secretion accumulation because of compromised airway clearance. Various airway clearance interventions are employed to prevent complications arising from mucus retention. This Delphi study aims to collect global opinions in an international expert panel of ICU professionals on the usefulness of these various airway clearance interventions. A steering committee performed a literature search informing the formulation of statements. Statements are grouped into two distinct parts: (1) Humidification and Nebulization, and (2) Suctioning and Mucus mobilization techniques. For each part, a diverse panel of 30-40 experts will be selected, with concerted effort to involve experts from various medical specialties involved in airway clearance methods. Multiple choice questions (MCQs) or 7-point Likert-scale statements will be used in the iterative Delphi rounds to reach consensus on various airway clearance interventions. Rounds will continue until stability is achieved for all statements. Consensus will be deemed achieved when a choice in MCQs or a Likert-scale statement achieves ≥75% agreement or disagreement. Starting from the second round of the Delphi process, stability will be assessed using non-parametric χ2 tests or Kruskal-Wallis tests. Stability will be defined by a p-value of ≥0.05.
PMID:40868940 | PMC:PMC12387527 | DOI:10.3390/life15081292
Int J Cardiol. 2025 Aug 25;442:133826. doi: 10.1016/j.ijcard.2025.133826. Online ahead of print.
ABSTRACT
BACKGROUND: The long-term natural history of moderate tricuspid regurgitation (TR) patients with preserved left-ventricular ejection fraction (LVEF) and without severe left-sided valvular heart disease (VHD) remains ambiguous. We aimed to assess the outcomes of patients with moderate TR, preserved LVEF and without concomitant severe left-sided VHD.
METHODS: We evaluated patients diagnosed with moderate TR in our centers between 2012 and 2020. The primary outcome was all-cause death, the secondary outcome was the composite of all-cause death+heart failure (HF) hospitalization, also accounting for pulmonary artery systolic pressure (PASP) values and concomitant moderate left-sided VHD.
RESULTS: Among 1198 moderate TR patients, 53 % had New York Heart Association class ≥II and mean LVEF was 58 ± 5 %. After a median follow-up of 2.9 years, 3-year survival was 69 % (95 % confidence interval [CI]: 66 %-72 %), significantly worse than an age- and gender-matched population (p < 0.001), and 3-year survival free from the secondary composite outcome was 63 % (95 % CI: 60-67 %). At secondary analysis, increasing PASP values were associated with worse adjusted prognosis, and in patients with PASP <35 mmHg 3-year survival free from the primary and secondary outcome was 85 % (95 % CI: 80 %-89 %) and 80 % (95 % CI: 75 %-86 %), respectively. Finally, among patients with concomitant moderate left-sided VHD groups, the group with moderate aortic stenosis+moderate TR presented the worst adjusted prognosis, and patients with isolated moderate TR had a yearly mortality of 8.9 % (95 % CI: 6.0 %-11.0 %).
CONCLUSIONS: Our cohort of moderate TR patients, despite having preserved LVEF and no concomitant severe left-sided VHD, presented significant risk of death and of HF hospitalization.
PMID:40865733 | DOI:10.1016/j.ijcard.2025.133826
G Ital Cardiol (Rome). 2025 Sep;26(9):656-665. doi: 10.1714/4542.45430.
ABSTRACT
Atrial secondary tricuspid regurgitation (A-STR) is a complex and increasingly recognized form of valvular heart disease that arises primarily due to right atrial and tricuspid annular dilation in the absence of intrinsic leaflet pathology. Unlike ventricular secondary tricuspid regurgitation, which is driven by right ventricular remodeling, A-STR is predominantly associated with atrial fibrillation, heart failure with preserved ejection fraction, and other conditions that lead to chronic right atrial remodeling. This condition has been underappreciated despite its significant prevalence and impact on patient morbidity and mortality. Echocardiography is the primary diagnostic tool for diagnosing and assessing patients with A-STR. The natural history of A-STR is unfavorable, with potential worsening over time, particularly if the underlying conditions are not properly treated. Treatment options include cardioversion of atrial fibrillation and medical treatment of heart failure with preserved ejection fraction, which may promote reverse remodeling of the right heart structures and reduce STR severity in some cases. Surgical tricuspid valve annuloplasty remains the gold standard for severe cases, but transcatheter interventions are emerging as potential alternatives. This review provides a comprehensive overview of A-STR, encompassing its epidemiology, pathophysiology, diagnostic approaches, and treatment strategies. By synthesizing current evidence and highlighting gaps in knowledge, this paper aims to guide clinicians in the management of this challenging condition and to inspire future research.
PMID:40864484 | DOI:10.1714/4542.45430