Heart transplant evaluation in adults with congenital heart disease presenting with advanced heart failure.

School attendance is associated with increased quality of life in chronically ill pediatric patients and has a profound impact on child development[ 1, 2, 3, 4, 5, 6, 7, 8 ]. Despite the importance of school attendance, little research has been done to identify which pediatric transplant recipients are at risk for delayed school attendance due to morbidity. We conducted univariate and multivariate analysis on 5355 pediatric heart transplant recipients using the UNOS database. Recipients were split into two age groups, ≤ 4year and 5-16years. The outcome of interest was returning to school at age 6 for ≤ 4years, and within 2years post-transplant for 5-16years. School attendance after transplant (SAAT scores) were generated via weighting significant variables (p < 0.05) based on odds ratio. We found 20 significant factors combined across both cohorts. The most significant protective factors included having a VAD/TAH, age, and transplantation with an ABO incompatible organ. The most significant risk factors included low-medium functional status, age, and elevated total bilirubin. The indices for each age group had Area Under the Receiver Operating Curve (AUROC) indicating high predictive value, at 0.81 (≤ 4years) and 0.72 (5-16years). In this study, we created SAAT scores to predict time to school attendance in both infants and children with the intention of identifying patients at risk for delayed school attendance who may benefit from targeted interventions including Enhanced Recovery Programs.

Myocardial infarction (MI) is one of the leading causes of death worldwide. MI is associated with cardiac structural and functional alterations. Among these, cardiac fibrosis may be significantly influenced by mitochondrial dysfunction. We sought to evaluate whether the injection of functional mitochondria from healthy muscle could improve the detrimental consequences of MI. Male Wistar rats were submitted to MI through the ligature of the left anterior descending coronary artery. Animals subjected to a sham operation (the same surgical procedure without fastening of the suture that passes through the LAD) were included as a reference group (Sham). At the time of surgery, either vehicle (PBS) or isolated mitochondria (equivalent to 180 μg of mitochondrial protein in 75 μL of vehicle) were directly injected into the myocardium around the ligation to half of the animals in each group. Animals were sacrificed 4 weeks after both MI induction and the evaluation of cardiac and systolic functions. Cardiac mitochondrial transplantation was able to prevent the decrease in systolic function and the development of cardiac fibrosis in MI rats. These beneficial effects were accompanied by a reduction in cardiac hypertrophy, oxidative stress, endoplasmic reticulum stress activation, and inflammatory markers. We also evaluated the effects of mitochondrial transplantation by a proteomic analysis. In addition, cardiac mitochondrial transplantation was able to prevent the development of renal alterations observed in MI rats. The data reveal novel mechanisms of mitochondrial transplantation effects and emerge as a novel therapeutic strategy under chronic diseases such as MI.

Noteworthy in Cardiothoracic Surgery 2025 highlights several of the most influential trials and emerging trends shaping cardiothoracic surgical practice. In structural heart disease, new randomized data have expanded consideration of transcatheter aortic valve replacement to asymptomatic patients while reinforcing the importance of longer-term durability and lifetime valve management in lower-risk populations. In heart transplantation, advances in minimally invasive and robotic techniques, alongside growing international experience with donation after circulatory death, underscore both the promise of innovation and the need for disciplined management of ischemic and preservation times. Endovascular management of complex thoracic aortic disease continues to evolve with broader use of branched devices. In thoracic oncology, practice changing trials support a shift towards perioperative chemotherapy and immunotherapy for resectable esophageal, gastroesophageal junction, and lung cancers, redefining surgical timing, coordination, and multidisciplinary care. Finally, continued adoption of minimally invasive and robotic approaches reflects a broader trend toward reducing surgical morbidity while maintaining oncologic and transplant outcomes.

Xenotransplantation: Promise, progress, and risks.

Studies on multiple serially measured blood biomarkers and adverse outcomes in patients with heart failure (HF) are scarce and restricted to research settings. Prognostic estimates based on serial measurements could provide a scientifically substantiated, uniform approach to risk stratification and timing of treatment. We use an exploratory and hypothesis-generating approach to assess the predictive ability of serially measured biomarkers, commonly collected during usual care, for adverse events in a real-world population of ambulant patients with HF with reduced ejection fraction (HFrEF) and HF with mildly reduced ejection fraction (HFmrEF). We included ambulatory HFrEF-HFmrEF patients who attended an outpatient hospital visit between 2017 and 2022. Data on blood biomarkers, clinical characteristics and clinical outcome were extracted from electronic health records. Joint modelling was applied to investigate associations between time-varying blood biomarkers and the composite endpoint of mortality, LVAD implantation and heart transplant. We included 1353 patients; 66.8% men; median (P25, P75) age 62 (51, 71) years. During a median follow-up of 3.30 (1.62, 4.65) years, 387 (28.6%) experienced the endpoint. Temporal trajectories of 30 blood biomarkers were significantly associated with the endpoint. After correcting for clinical characteristics, associations persisted in multiple-biomarker models for serially measured NT-proBNP, hs-TnT, and CRP, as well as liver biomarkers, kidney biomarkers, and blood count parameters. Serial measurements increased model performance compared to baseline measurements, with AUCs up to 0.83 for multiple-biomarker models. Real-life, serially measured laboratory data predict adverse events in an ambulatory HFrEF-HFmrEF population, with good internal model performance. Thus, making use of laboratory values already present in electronic medical records, could inform risk stratification without any extra effort.

Incremental prognostic value of left atrial strain for heart failure-related events following ST-Segment elevation myocardial infarction.

Impact of immunosuppressive therapy on non-melanoma skin cancer after solid organ transplantation: A critical systematic review.

Phosphatidylserine nanobubbles: A macrophage-targeted ultrasound contrast agent - promising approach for the early detection of acute cardiac rejection.

The ISHLT Consensus Statement on the Perioperative Use of ECLS in Lung Transplantation: Highlights and Perioperative Implications.

Non-ABO red blood cell antibodies in transplant patients.

An ensemble learning approach for predicting hospital stay in transplant patients

Protocol for partial heart transplantation of the pulmonary valve in a swine model: surgical technique, postoperative care, assessments and outcomes.

Interleukin-1β Drives Disease Progression in Arrhythmogenic Cardiomyopathy.

Permanent pacemaker (PPM) implantation after heart transplantation (HT) is common, but contemporary data regarding utilization, outcomes, and emerging pacing technologies are limited. We studied PPM placement among 1225 bicaval HT recipients (28% women) treated at our institution from 2010 to 2025 and compared PPM recipients with HT patients without PPMs matched on sex, age, and transplant year. Median age at HT was 58 years (interquartile range, 48-65 years). Sixty-six (5%) patients received a PPM, with stable implantation rates over time. Median HT-to-PPM time was 4.3 months (interquartile range, 2 weeks to 4.8 years). The main indications were sinus node dysfunction (41 patients, 62%) or atrioventricular block (19 patients, 29%). Median post-HT survival was similar between PPM and non-PPM recipients (12.8 versus 11.5 years, P=0.14). Older organ donor age independently predicted PPM placement (odds ratio, 1.75; P=0.04). After 3.2 years of median follow-up, 1 transvenous PPM had a major complication requiring device extraction. Thirteen (20%) patients received leadless PPMs, including 3 atrial leadless PPMs and 1 dual-chamber leadless PPM. Leadless PPMs had no short-term complications over 1 year of median follow-up. Post-HT PPM implantation rates were low and unchanged since 2010. Most devices were implanted for sinus node dysfunction, with 44% implanted within 1 month post-HT. PPM placement was not associated with post-HT survival. Advanced organ donor age was associated with risk of PPM placement. Transvenous PPM complication rates were comparable to rates described in general populations. Leadless PPMs accounted for a substantial minority of PPM placements since their introduction in 2018, with no complications to date. Longer follow-up is needed to establish their long-term outcomes and safety in patients with HT.

Recurrence of acute myocarditis (AM) is challenging. The management and natural history of patients who experience a recurrence of AM (Re-AM) remain poorly characterized. The aim of this study is to investigate clinical characteristics and outcomes of patients with Re-AM. In this international multicenter study, 141 consecutive patients with biopsy-proven or cardiac magnetic resonance-proven Re-AM (35 [26-45] years, 77% male, median left ventricular ejection fraction 55%) were investigated and compared with 372 consecutive patients with single acute myocarditis (S-AM). The primary outcome was a composite of all-cause mortality, heart transplant and major ventricular arrhythmias. Patients with Re-AM had more frequently a family history of cardiomyopathy (19% in Re-AM versus 2.8% in S-AM, P<0.001) and a diffuse late gadolinium enhancement compared with patients with S-AM (46% in Re-AM versus 34% in S-AM, P=0.019). The extent of late gadolinium enhancement also increased between the first and the second AM episode in patients with Re-AM (P=0.001). During a median follow-up of 33 months (interquartile range, 23-52) patients with Re-AM had a higher risk of primary outcome (P=0.001) compared with patients with S-AM, as well as a significantly elevated competing risk of major ventricular arrhythmias (P<0.001), which remained independently associated even after adjustment (hazard ratio, 2.15 [95% CI, 1.15-4.04], P=0.017). A family history of cardiomyopathy, autoimmune diseases, and ring-like late gadolinium enhancement was independently associated with a higher risk of recurrent AM. Re-AM is a distinct clinical subgroup of AM associated with generally worse prognosis and a specific increased arrhythmic risk compared with S-AM.

Whether the increased use of temporary mechanical circulatory support (tMCS) as a bridge to heart transplantation following the 2018 UNOS policy change has translated to a different risk of treated rejection episodes is unknown. We included adult heart transplant recipients listed and transplanted between November 1, 2010 to October 31, 2020 from the UNOS registry.Multinomial logistic regression analysis was performed to determine the odds of post-transplant treated rejection compared to the non-MCS cohort. A total of 22,634 patients were stratified by tMCS type [intra-aortic balloon pump, percutaneous device, extracorporeal membrane oxygenation, and surgically implanted dischargeable or non-dischargeable ventricular assist devices]. Odds were higher for treated rejection relative to being alive and untreated for rejection for the IABP cohort compared to the non-MCS cohort in the pre era [OR: 1.47 (1.25, 1.72); p<0.001]. However, there was no difference in the odds of treated rejection [OR: 1.05 (0.85, 1.28); p=0.66] for IABP versus non-MCS patients in the post era. For other bridge-to-transplant therapies compared to the non-MCS cohort, the odds for treated rejection were not different based on policy era or tMCS sub-type. The policy change was associated with an attenuated risk of treated rejection amongst IABP-bridged recipients compared to the non-MCS cohort.

This manuscript reviews the clinical spectrum and management of Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE), examining how chronic venous hypertension leads to multisystem injury. Liver fibrosis is now recognized as an early and nearly universal complication after the Fontan procedure, with cirrhosis affecting approximately 43% of patients by 30years post-operation. Although post-2001 survival exceeds 90%, standard biomarkers and imaging frequently underestimate disease severity, as liver stiffness measurements are confounded by hepatic congestion. Liver biopsy remains the gold standard for staging. FALD is an inevitable consequence of Fontan physiology, characterized by sinusoidal congestion and progressive fibrosis, while PLE results from multifactorial gastrointestinal protein loss. The key clinical implication is the importance of a multidisciplinary approach, particularly when considering transition from isolated heart transplantation to combined heart-liver transplantation in advanced disease. Future research should prioritize standardized staging systems and targeted therapies to reduce lymphatic dysfunction and fibrosis progression.

Dilated cardiomyopathy, defined by left ventricular dilatation and systolic dysfunction, is a major cause of heart failure, heart transplantation and sudden cardiac death, especially in young and middle-aged adults. Dilated cardiomyopathy of non-ischaemic aetiology is more common than once thought, with current prevalence estimated at around 1 in 220 based on cardiac magnetic resonance imaging studies, and the prevalence is twice as high in men than in women. However, the true prevalence could be even higher when early or subclinical forms of the disease are considered. Advances in genetic technologies over the past three decades have led to improved understanding of the genetic basis of non-ischaemic dilated cardiomyopathy and the identification of pathogenic variants in 30-40% of patients. The genetic architecture of this disease is complex and heterogeneous. Rather than being a strictly monogenic disorder, dilated cardiomyopathy results from a combination of monogenic and polygenic factors, along with gene-environment interactions as critical modifiers of disease penetrance and phenotype. A deeper understanding of the genetic factors and epidemiological landscape of dilated cardiomyopathy is crucial for improving clinical management and optimizing screening protocols and public health strategies.

Artificial intelligence-enhanced electrocardiogram findings before and after heart transplantation in cardiac amyloidosis