Pub Date : 2024-03-13DOI: 10.20517/2574-1209.2023.68
Alberto Barioli, Emanuele Visco, N. Pellizzari, Filippo Marzot, Davide Lanzellotti, Luca Favero, C. Cernetti
Coronary artery aneurysms and coronary ectasia are defined as focal or diffuse dilation of the coronary arteries, respectively. Although frequently silent and detected as incidental findings at coronary angiography or computed tomography, coronary aneurysms have been associated with different clinical conditions, including silent ischemia and acute coronary syndromes, and with poor clinical outcomes. The optimal management still remains unsettled, as randomized data are lacking and treatment with either surgical or percutaneous procedures faces significant challenges. This review aims to provide an update on the classification, etiopathogenesis, diagnostic workup, and treatment of aneurysmal coronary disease.
{"title":"Diagnostic workup and treatment options for aneurysmal coronary artery disease","authors":"Alberto Barioli, Emanuele Visco, N. Pellizzari, Filippo Marzot, Davide Lanzellotti, Luca Favero, C. Cernetti","doi":"10.20517/2574-1209.2023.68","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.68","url":null,"abstract":"Coronary artery aneurysms and coronary ectasia are defined as focal or diffuse dilation of the coronary arteries, respectively. Although frequently silent and detected as incidental findings at coronary angiography or computed tomography, coronary aneurysms have been associated with different clinical conditions, including silent ischemia and acute coronary syndromes, and with poor clinical outcomes. The optimal management still remains unsettled, as randomized data are lacking and treatment with either surgical or percutaneous procedures faces significant challenges. This review aims to provide an update on the classification, etiopathogenesis, diagnostic workup, and treatment of aneurysmal coronary disease.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140247727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute type A aortic dissection (ATAAD) is a surgical emergency with a nonoperative mortality rate of up to 1% per hour and an operative mortality rate as high as 24%. Therefore, evaluation of comorbidities and patient presentation characteristics prompts a pause for risk stratification before proceeding to the operating room, as emergent surgery may not always be the optimal approach. This comprehensive review explores key considerations in ATAAD management, emphasizing the need for nuanced decision making, by considering medical management and delayed surgery as an alternative management approach for high-risk populations such as the frail or patients who have a history of cardiac surgery. Beyond the immediate threat of aortic rupture, organ malperfusion stands out as the most feared complication of ATAAD, also elevating perioperative risk significantly. In such cases, careful assessment of patient’s hemodynamic status is paramount. For stable patients, a thorough preoperative strategy and multidisciplinary discussions are encouraged. Notably, the advent of endovascular techniques provides viable lower-risk alternatives to the traditional open approach. The consequences of ATAAD surgical intervention extend beyond the immediate procedural concerns, with a substantial impact on the patient’s overall function. Prioritizing patient-centered care becomes imperative in aligning management with individual goals of care. This review seeks to provide insights into these considerations by offering a stepwise approach to patient-centered decision-making in ATAAD management.
{"title":"Acute type a aortic dissection: when not to operate, a review","authors":"Thais Faggion Vinholo, Jake Awtry, Robert Semco, Paige Newell, Ashraf Sabe","doi":"10.20517/2574-1209.2023.150","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.150","url":null,"abstract":"Acute type A aortic dissection (ATAAD) is a surgical emergency with a nonoperative mortality rate of up to 1% per hour and an operative mortality rate as high as 24%. Therefore, evaluation of comorbidities and patient presentation characteristics prompts a pause for risk stratification before proceeding to the operating room, as emergent surgery may not always be the optimal approach. This comprehensive review explores key considerations in ATAAD management, emphasizing the need for nuanced decision making, by considering medical management and delayed surgery as an alternative management approach for high-risk populations such as the frail or patients who have a history of cardiac surgery. Beyond the immediate threat of aortic rupture, organ malperfusion stands out as the most feared complication of ATAAD, also elevating perioperative risk significantly. In such cases, careful assessment of patient’s hemodynamic status is paramount. For stable patients, a thorough preoperative strategy and multidisciplinary discussions are encouraged. Notably, the advent of endovascular techniques provides viable lower-risk alternatives to the traditional open approach. The consequences of ATAAD surgical intervention extend beyond the immediate procedural concerns, with a substantial impact on the patient’s overall function. Prioritizing patient-centered care becomes imperative in aligning management with individual goals of care. This review seeks to provide insights into these considerations by offering a stepwise approach to patient-centered decision-making in ATAAD management.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"46 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140252989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-28DOI: 10.20517/2574-1209.2023.142
Sahil Jain, S. Sangle, Sangmi Kim, Susan John, David D’Cruz
Antimalarial agents have been used to treat various autoimmune rheumatic diseases for over a century. Hydroxychloroquine is a safe, effective and inexpensive antimalarial drug with additional antithrombotic, cardioprotective, antimicrobial, and anti-neoplastic benefits. It has been used extensively in various diseases, especially systemic lupus erythematosus and rheumatoid arthritis; however, it has not been used in anti-neutrophil cytoplasmic antibody associated vasculitides (AAVs). There exists a significant unmet need for safe and inexpensive treatments for non-severe AAV or those with low-grade “grumbling” disease activity who do not warrant significant escalation of therapy but who remain at risk of disease flares and damage accumulation. Hydroxychloroquine may be an option to help fill this void. Although the mechanisms of action of Hydroxychloroquine are not fully understood, it interacts with various inflammatory mediators involved in the pathogenesis of AAV. Based on these benefits, along with the unmet need in AAV, we present evidence to support the use of Hydroxychloroquine as a potential therapy for AAV.
{"title":"Hydroxychloroquine as a potential therapy for ANCA-associated vasculitis","authors":"Sahil Jain, S. Sangle, Sangmi Kim, Susan John, David D’Cruz","doi":"10.20517/2574-1209.2023.142","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.142","url":null,"abstract":"Antimalarial agents have been used to treat various autoimmune rheumatic diseases for over a century. Hydroxychloroquine is a safe, effective and inexpensive antimalarial drug with additional antithrombotic, cardioprotective, antimicrobial, and anti-neoplastic benefits. It has been used extensively in various diseases, especially systemic lupus erythematosus and rheumatoid arthritis; however, it has not been used in anti-neutrophil cytoplasmic antibody associated vasculitides (AAVs). There exists a significant unmet need for safe and inexpensive treatments for non-severe AAV or those with low-grade “grumbling” disease activity who do not warrant significant escalation of therapy but who remain at risk of disease flares and damage accumulation. Hydroxychloroquine may be an option to help fill this void. Although the mechanisms of action of Hydroxychloroquine are not fully understood, it interacts with various inflammatory mediators involved in the pathogenesis of AAV. Based on these benefits, along with the unmet need in AAV, we present evidence to support the use of Hydroxychloroquine as a potential therapy for AAV.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"32 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140419204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.20517/2574-1209.2023.80
I. Chinyere, Shumpei Mori, Mathew D. Hutchinson
The clinical use of irreversible electroporation in invasive cardiac laboratories, termed pulsed field ablation (PFA), is gaining early enthusiasm among electrophysiologists for the management of both atrial and ventricular arrhythmogenic substrates. Though electroporation is regularly employed in other branches of science and medicine, concerns regarding the acute and permanent vascular effects of PFA remain. This comprehensive review aims to summarize the preclinical and adult clinical data published to date on PFA’s effects on pulmonary veins and coronary arteries. These data will be contrasted with the incidences of iatrogenic pulmonary vein stenosis and coronary artery injury secondary to thermal cardiac ablation modalities, namely radiofrequency energy, laser energy, and liquid nitrogen-based cryoablation.
{"title":"Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation","authors":"I. Chinyere, Shumpei Mori, Mathew D. Hutchinson","doi":"10.20517/2574-1209.2023.80","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.80","url":null,"abstract":"The clinical use of irreversible electroporation in invasive cardiac laboratories, termed pulsed field ablation (PFA), is gaining early enthusiasm among electrophysiologists for the management of both atrial and ventricular arrhythmogenic substrates. Though electroporation is regularly employed in other branches of science and medicine, concerns regarding the acute and permanent vascular effects of PFA remain. This comprehensive review aims to summarize the preclinical and adult clinical data published to date on PFA’s effects on pulmonary veins and coronary arteries. These data will be contrasted with the incidences of iatrogenic pulmonary vein stenosis and coronary artery injury secondary to thermal cardiac ablation modalities, namely radiofrequency energy, laser energy, and liquid nitrogen-based cryoablation.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"514 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140472668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-10DOI: 10.20517/2574-1209.2023.77
Wilhelm Mistiaen
Fungal infective endocarditis is a rare but highly lethal condition. Its diagnosis is often delayed due to nonspecific symptoms, inconclusive medical imaging, and negative blood cultures. Recent reviews of cases and series over the last 5 years indicate that the condition remains rare and lethal. If fungi are identified as the causative agents in more than 5% of patient cases with infective endocarditis, it is likely that risk factors such as immune suppression or cardiac implants are probably involved. A series derived from recent case reports indicates that Candida and Aspergillus are still the main causative infectious agents, with. C parapsilosis on the rise. From these cases, diagnostic clues (frequent embolisms, ophthalmic involvement, large, mobile and friable vegetation, non-valvular cardiac manifestations) are pointing towards fungal IE. These reports, however, are not standardized and a publication bias towards rare microorganisms or towards a favorable outcome might exist. Complications might be underreported, and important data such as diagnostic delay are absent or difficult to retrieve. Pharmacologic treatment is not fully standardized. Knowledge of resistant strains in this respect is important. Statistical analysis for the effect of complications and treatment modalities on outcome shows that any result should be treated cautiously. The current series is by no means a valid substitute for a well-designed series of fungal endocarditis. However, the better outcome with Candida and patients treated with surgery confirm earlier results. An international multicentric standardized registry of cases with fungal endocarditis in order to improve the outcome of this disease is highly needed. The effect of diagnostic delay on outcome remains elusive and should be resolved.
{"title":"“Not much room for mushrooms” in the heart: knowns and unknowns of fungal infective endocarditis","authors":"Wilhelm Mistiaen","doi":"10.20517/2574-1209.2023.77","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.77","url":null,"abstract":"Fungal infective endocarditis is a rare but highly lethal condition. Its diagnosis is often delayed due to nonspecific symptoms, inconclusive medical imaging, and negative blood cultures. Recent reviews of cases and series over the last 5 years indicate that the condition remains rare and lethal. If fungi are identified as the causative agents in more than 5% of patient cases with infective endocarditis, it is likely that risk factors such as immune suppression or cardiac implants are probably involved. A series derived from recent case reports indicates that Candida and Aspergillus are still the main causative infectious agents, with. C parapsilosis on the rise. From these cases, diagnostic clues (frequent embolisms, ophthalmic involvement, large, mobile and friable vegetation, non-valvular cardiac manifestations) are pointing towards fungal IE. These reports, however, are not standardized and a publication bias towards rare microorganisms or towards a favorable outcome might exist. Complications might be underreported, and important data such as diagnostic delay are absent or difficult to retrieve. Pharmacologic treatment is not fully standardized. Knowledge of resistant strains in this respect is important. Statistical analysis for the effect of complications and treatment modalities on outcome shows that any result should be treated cautiously. The current series is by no means a valid substitute for a well-designed series of fungal endocarditis. However, the better outcome with Candida and patients treated with surgery confirm earlier results. An international multicentric standardized registry of cases with fungal endocarditis in order to improve the outcome of this disease is highly needed. The effect of diagnostic delay on outcome remains elusive and should be resolved.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"6 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-28DOI: 10.20517/2574-1209.2023.121
AlleaBelle Bradshaw, Jennifer S. Lawton
The many ways in which ATP-sensitive potassium (KATP) channels can be exploited for human benefit have expanded over recent decades. Especially since the early 2000s, research has improved our understanding of the components and mechanisms of KATP channels. They have the potential to have a prominent role in cardiac surgery. Pharmacologic and non-pharmacologic activation of KATP channels has been shown to be both cardioprotective and neuroprotective in early basic science and clinical studies. However, many questions remain unanswered and require further study, necessitating further basic science work and large human clinical trials. This review discusses the history and recent progress in the research relating to the use of KATP channels for cardiac surgery.
近几十年来，利用 ATP 敏感性钾（KATP）通道造福人类的途径越来越多。特别是自 2000 年代初以来，研究工作增进了我们对 KATP 通道的成分和机制的了解。它们有可能在心脏手术中发挥重要作用。在早期的基础科学和临床研究中，KATP 通道的药物和非药物激活已被证明具有心脏保护和神经保护作用。然而，许多问题仍未得到解答，需要进一步研究，这就需要进一步的基础科学工作和大型人体临床试验。本综述将讨论与心脏手术中使用 KATP 通道相关的研究历史和最新进展。
{"title":"Exploitation of KATP channels for cardiac surgery","authors":"AlleaBelle Bradshaw, Jennifer S. Lawton","doi":"10.20517/2574-1209.2023.121","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.121","url":null,"abstract":"The many ways in which ATP-sensitive potassium (KATP) channels can be exploited for human benefit have expanded over recent decades. Especially since the early 2000s, research has improved our understanding of the components and mechanisms of KATP channels. They have the potential to have a prominent role in cardiac surgery. Pharmacologic and non-pharmacologic activation of KATP channels has been shown to be both cardioprotective and neuroprotective in early basic science and clinical studies. However, many questions remain unanswered and require further study, necessitating further basic science work and large human clinical trials. This review discusses the history and recent progress in the research relating to the use of KATP channels for cardiac surgery.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"79 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-25DOI: 10.20517/2574-1209.2023.37
Tim Alberts, Susanne Eberl, Henning Hermanns
Thoracic aortic surgery poses significant challenges due to the complex anatomy and potential for life-threatening complications. Transesophageal echocardiography (TEE) has emerged as a crucial imaging tool in the management of patients undergoing these operations. TEE offers real-time, high-resolution imaging of the heart and aorta, enabling accurate assessment of aortic pathology, evaluation of cardiac function, and monitoring of intraoperative hemodynamics. Its semi-invasive nature, immediate availability, and ability to provide dynamic information make TEE an indispensable adjunct during these intricate procedures. One of the primary indications for TEE during thoracic aortic surgery is the assessment of aortic pathology, including aneurysms, dissections, and aortic valve diseases. TEE allows precise visualization of the extent, location, and severity of aortic lesions, facilitating decision-making regarding repair strategies, graft sizing, and intraoperative guidance. Furthermore, TEE aids in identifying associated cardiac abnormalities such as valvular or ventricular dysfunction, which may impact surgical planning and outcomes. This review aims to summarize the current evidence supporting the use of TEE during thoracic aortic surgical interventions and highlight its invaluable contributions to perioperative patient care.
胸主动脉手术因其复杂的解剖结构和潜在的危及生命的并发症而面临巨大挑战。经食道超声心动图（TEE）已成为治疗此类手术患者的重要成像工具。经食道超声心动图可对心脏和主动脉进行实时、高分辨率成像，从而准确评估主动脉病变、评估心脏功能并监测术中血流动力学。TEE 的半侵入性、即时可用性和提供动态信息的能力使其成为这些复杂手术中不可或缺的辅助手段。胸主动脉手术期间 TEE 的主要适应症之一是评估主动脉病变，包括动脉瘤、动脉夹层和主动脉瓣疾病。通过 TEE 可以精确观察主动脉病变的范围、位置和严重程度，有助于就修复策略、移植物大小和术中指导做出决策。此外，TEE 还有助于识别相关的心脏异常，如瓣膜或心室功能障碍，这可能会影响手术计划和结果。本综述旨在总结支持在胸主动脉手术干预期间使用 TEE 的现有证据，并强调其对围术期患者护理的宝贵贡献。
{"title":"Transesophageal echocardiography during surgery of the thoracic aorta in adults","authors":"Tim Alberts, Susanne Eberl, Henning Hermanns","doi":"10.20517/2574-1209.2023.37","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.37","url":null,"abstract":"Thoracic aortic surgery poses significant challenges due to the complex anatomy and potential for life-threatening complications. Transesophageal echocardiography (TEE) has emerged as a crucial imaging tool in the management of patients undergoing these operations. TEE offers real-time, high-resolution imaging of the heart and aorta, enabling accurate assessment of aortic pathology, evaluation of cardiac function, and monitoring of intraoperative hemodynamics. Its semi-invasive nature, immediate availability, and ability to provide dynamic information make TEE an indispensable adjunct during these intricate procedures. One of the primary indications for TEE during thoracic aortic surgery is the assessment of aortic pathology, including aneurysms, dissections, and aortic valve diseases. TEE allows precise visualization of the extent, location, and severity of aortic lesions, facilitating decision-making regarding repair strategies, graft sizing, and intraoperative guidance. Furthermore, TEE aids in identifying associated cardiac abnormalities such as valvular or ventricular dysfunction, which may impact surgical planning and outcomes. This review aims to summarize the current evidence supporting the use of TEE during thoracic aortic surgical interventions and highlight its invaluable contributions to perioperative patient care.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139159077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-21DOI: 10.20517/2574-1209.2023.98
Cynthia M Xu, M. Broadwin, Patrick Faherty, R. Teixeira, Mohamed Sabra, Frank W. Sellke, M. Abid
Aim: To determine the differences in improvement in cardiac function by intramyocardial (IM) vs. intravenous (IV) injection of human bone mesenchymal stem cell-derived extracellular vesicles (HBMSC-EV) after acute MI. Methods: FVB mice underwent acute MI via left anterior descending coronary artery ligation and subsequent injection of: (1) IM saline control; (2) IM HBMSC-EV; (3) IV saline control; and (4) IV HBMSC-EV. Cardiac function was evaluated with weekly postoperative echocardiography. On postoperative day 28, the mice were euthanized, and the heart, lungs, liver, spleen, and kidneys were harvested. Given previous studies showing HBMSC-EV hepatic uptake after IV injection, the liver was evaluated for changes in inflammation, fibrosis, and proliferation. Results: On postoperative day 28, there were no significant differences in left ventricular ejection fraction (P = 0.6151), fractional shortening (P = 0.1135), or anterior border zone fibrosis (P = 0.6333) in any of the experimental groups. Interestingly, there was a strong trend demonstrating improvement in infarct size on fibrosis staining, which did not reach significance (P = 0.05620). There were no differences in hepatic inflammation, fibrosis, and proliferation. Conclusions: Although there was a trend in the improvement in infarct size, a single-dose administration of neither IM nor IV injection of HBMSC-EV resulted in significant improvement in post-MI cardiac function. A major limitation of this study is the lack of trials determining the optimal dose of HBMSC-EV needed in this model. However, the current study demonstrates that future studies are required to either optimize administration or bioengineer HBMSC-EV with cardiac-homing properties.
目的：确定急性心肌梗死后心肌内注射（IM）与静脉注射（IV）人骨间充质干细胞衍生细胞外囊泡（HBMSC-EV）在改善心功能方面的差异。方法：FVB 小鼠经左冠状动脉前降支结扎后发生急性心肌梗死，随后注射：(1) IM 生理盐水对照组；(2) IM HBMSC-EV；(3) IV 生理盐水对照组；(4) IV HBMSC-EV。术后每周进行一次超声心动图检查，评估心脏功能。术后第 28 天，小鼠被安乐死，并收获心、肺、肝、脾和肾。鉴于之前的研究显示 HBMSC-EV 经静脉注射后会被肝脏吸收，因此对肝脏的炎症、纤维化和增生变化进行了评估。结果术后第 28 天，各实验组的左心室射血分数（P = 0.6151）、分数缩短率（P = 0.1135）或前缘区纤维化（P = 0.6333）均无显著差异。有趣的是，纤维化染色显示梗死面积有明显改善趋势，但未达到显著性（P = 0.05620）。肝脏炎症、纤维化和增生方面没有差异。结论虽然梗死面积有改善趋势，但单次注射 HBMSC-EV 均未显著改善心肌梗死后的心脏功能。本研究的一个主要局限是缺乏确定该模型所需 HBMSC-EV 最佳剂量的试验。不过，目前的研究表明，未来的研究需要优化给药或对 HBMSC-EV 进行生物工程改造，使其具有心脏归巢特性。
{"title":"Lack of cardiac benefit after intramyocardial or intravenous injection of mesenchymal stem cell-derived extracellular vesicles supports the need for optimized cardiac delivery","authors":"Cynthia M Xu, M. Broadwin, Patrick Faherty, R. Teixeira, Mohamed Sabra, Frank W. Sellke, M. Abid","doi":"10.20517/2574-1209.2023.98","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.98","url":null,"abstract":"Aim: To determine the differences in improvement in cardiac function by intramyocardial (IM) vs. intravenous (IV) injection of human bone mesenchymal stem cell-derived extracellular vesicles (HBMSC-EV) after acute MI.\u0000 Methods: FVB mice underwent acute MI via left anterior descending coronary artery ligation and subsequent injection of: (1) IM saline control; (2) IM HBMSC-EV; (3) IV saline control; and (4) IV HBMSC-EV. Cardiac function was evaluated with weekly postoperative echocardiography. On postoperative day 28, the mice were euthanized, and the heart, lungs, liver, spleen, and kidneys were harvested. Given previous studies showing HBMSC-EV hepatic uptake after IV injection, the liver was evaluated for changes in inflammation, fibrosis, and proliferation.\u0000 Results: On postoperative day 28, there were no significant differences in left ventricular ejection fraction (P = 0.6151), fractional shortening (P = 0.1135), or anterior border zone fibrosis (P = 0.6333) in any of the experimental groups. Interestingly, there was a strong trend demonstrating improvement in infarct size on fibrosis staining, which did not reach significance (P = 0.05620). There were no differences in hepatic inflammation, fibrosis, and proliferation.\u0000 Conclusions: Although there was a trend in the improvement in infarct size, a single-dose administration of neither IM nor IV injection of HBMSC-EV resulted in significant improvement in post-MI cardiac function. A major limitation of this study is the lack of trials determining the optimal dose of HBMSC-EV needed in this model. However, the current study demonstrates that future studies are required to either optimize administration or bioengineer HBMSC-EV with cardiac-homing properties.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"62 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138951657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.20517/2574-1209.2023.100
Amin Zahrai, K. Rahmouni, Fraser D. Rubens
Acute myocardial infarction (AMI) is the leading cause of cardiovascular mortality in developed countries. While primary percutaneous coronary intervention is the gold-standard first-line therapy for initial revascularization of a culprit vessel, coronary artery bypass grafting (CABG) surgery can allow for subsequent complete revascularization when additional high-risk coronary stenoses remain. The optimal timing of CABG after AMI remains controversial. Early surgery during the acute period can lead to a detrimental systemic inflammatory response and may be associated with a higher bleeding risk due to the use of antiplatelet and fibrinolytic agents. On the other hand, later surgery increases the risk of ischemic recurrence while waiting, with the potential for an irreversible decrease in myocardial function or death. This narrative review summarizes the evidence supporting decision-making for optimal timing of surgical revascularization in patients with AMI.
{"title":"Optimal timing of surgical revascularization in patients with acute myocardial infarction","authors":"Amin Zahrai, K. Rahmouni, Fraser D. Rubens","doi":"10.20517/2574-1209.2023.100","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.100","url":null,"abstract":"Acute myocardial infarction (AMI) is the leading cause of cardiovascular mortality in developed countries. While primary percutaneous coronary intervention is the gold-standard first-line therapy for initial revascularization of a culprit vessel, coronary artery bypass grafting (CABG) surgery can allow for subsequent complete revascularization when additional high-risk coronary stenoses remain. The optimal timing of CABG after AMI remains controversial. Early surgery during the acute period can lead to a detrimental systemic inflammatory response and may be associated with a higher bleeding risk due to the use of antiplatelet and fibrinolytic agents. On the other hand, later surgery increases the risk of ischemic recurrence while waiting, with the potential for an irreversible decrease in myocardial function or death. This narrative review summarizes the evidence supporting decision-making for optimal timing of surgical revascularization in patients with AMI.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"63 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139174740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-15DOI: 10.20517/2574-1209.2023.97
Elbert E. Heng, Hanjay Wang, O. Obafemi, Alison Marsden, Y. J. Woo, Jack H. Boyd
Saphenous vein grafts (SVGs) are the most widely used conduit in coronary artery bypass grafting (CABG) surgery; however, SVG failures due to neointimal hyperplasia present a significant long-term limitation to the effectiveness of myocardial revascularization. This review will provide a comprehensive overview of the biological mechanisms of vein graft failure, including compensatory endothelial proliferation, extracellular matrix deposition, and adventitial disruption. We will discuss historical and emerging strategies for vein graft failure prevention with a focus on the role of mechanical vein graft support using external stenting. Finally, we will highlight the results of preclinical and human trials and discuss future directions for investigation.
{"title":"The biomechanics and prevention of vein graft failure in coronary revascularization","authors":"Elbert E. Heng, Hanjay Wang, O. Obafemi, Alison Marsden, Y. J. Woo, Jack H. Boyd","doi":"10.20517/2574-1209.2023.97","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.97","url":null,"abstract":"Saphenous vein grafts (SVGs) are the most widely used conduit in coronary artery bypass grafting (CABG) surgery; however, SVG failures due to neointimal hyperplasia present a significant long-term limitation to the effectiveness of myocardial revascularization. This review will provide a comprehensive overview of the biological mechanisms of vein graft failure, including compensatory endothelial proliferation, extracellular matrix deposition, and adventitial disruption. We will discuss historical and emerging strategies for vein graft failure prevention with a focus on the role of mechanical vein graft support using external stenting. Finally, we will highlight the results of preclinical and human trials and discuss future directions for investigation.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"46 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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