Cell-based therapy has long been considered a promising strategy for the treatment of heart failure (HF). However, its effectiveness in the clinical setting is now doubted. Because previous meta-analyses provided conflicting results, we sought to review all available data focusing on cell type and trial design. The electronic databases PubMed, Cochrane library, ClinicalTrials.gov, and EudraCT were searched for randomized controlled trials (RCTs) utilizing cell therapy for HF patients from January 1, 2000 to December 31, 2020. Forty-three RCTs with 2855 participants were identified. The quality of the reported study design was assessed by evaluating the risk-of-bias (ROB). Primary outcomes were defined as mortality rate and left ventricular ejection fraction (LVEF) change from baseline. Secondary outcomes included both heart function data and clinical symptoms/events. Between-study heterogeneity was assessed using the I2 index. Subgroup analysis was performed based on HF type, cell source, cell origin, cell type, cell processing, type of surgical intervention, cell delivery routes, cell dose, and follow-up duration. Only 10 of the 43 studies had a low ROB for all method- and outcome parameters. A higher ROB was associated with a greater increase in LVEF. Overall, there was no impact on mortality for up to 12 months follow-up, and a clinically irrelevant average LVEF increase by LVEF (2.4%, 95% CI = 0.75−4.05, p = 0.004). Freshly isolated, primary cells tended to produce better outcomes than cultured cell products, but there was no clear impact of the cell source tissue, bone marrow cell phenotype or cell chricdose (raw or normalized for CD34+ cells). A meaningful increase in LVEF was only observed when cell therapy was combined with myocardial revascularization. The published results suggest a small increase in LVEF following cell therapy for heart failure, but publication bias and methodologic shortcomings need to be taken into account. Given that cardiac cell therapy has now been pursued for 20 years without real progress, further efforts should not be made. This meta-analysis is registered at the international prospective register of systematic reviews, number CRD42019118872.

A 71-year-old man presented to us with recurrent chest pain, which led to cardiac catheterization. He was a strong candidate for redo coronary artery bypass grafting (CABG). CT was performed to confirm whether the heart was adherent to the sternum and chest wall. For safety reasons, cardiopulmonary bypass (CPB) was first performed via right femoral cannulation before sternotomy. After the spontaneous right ventricular (RV) rupture, HTK was used to arrest the heart. Heart repair materials were applied to repair the fissure of RV to avoid further tearing and bleeding. A compromise scheme was adopted when it was found to be difficult to identify and expose well the target artery, due to severe adhesion. This was done to avoid possible severe consequences of further dissection of the heart. Intraoperative transesophageal echocardiography (TEE) was used to evaluate the cardiac function, and intra-aortic balloon pump (IABP) support was applied in time. In consideration of the RV enlargement, which TEE revealed may have been caused by myocardial edema and cardiac insufficiency, modified ultrafiltration was performed, and a timely decision of open chest management (OCM) with delayed sternal closure (DSC) was made to maintain hemodynamic stability. The patient had no further complications and eventually recovered well, according to a 4-month follow up.

Background: Right ventricular (RV)-arterial uncoupling is highly prevalent in patients having acute heart failure with preserved ejection fraction (HFpEF) accompanied by coronary artery disease (CAD), and it serves as a strong predictor of adverse outcomes. This study aimed to analyze the risk factors of RV-arterial uncoupling in order to explore novel therapeutic targets in acute HFpEF patients with CAD. Methods: This prospective study included 456 consecutive acute HFpEF patients with CAD. The patients were divided into RV-arterial uncoupling and coupling groups based on the optimal cutoff value, determining from a receiver operating characteristic (ROC) curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). Independent risk factors for RV-arterial uncoupling were identified using logistic regression analysis, and combined diagnosis of RV-arterial uncoupling was constructed. A ROC curve was then drawn to evaluate the influencing factors and the effectiveness of combined diagnosis. Results: In acute HFpEF patients with CAD, a TAPSE/PASP ratio of ≤ 0.43 provided good accuracy in identifying patients with RV-arterial uncoupling, with an area under the curve (AUC), 0.701, sensitivity of 58.6%, and specificity of 77.7%. Multivariable logistic regression analysis revealed that E/e´ (early diastolic mitral inflow velocity/early diastolic septal mitral annular tissue velocity), the internal diameter of the inferior vena cava (IVC), history of hypertension, atrial fibrillation, postoperative coronary artery bypass grafting (CABG) and interleukin-6 levels were the independent risk factors for RV-arterial uncoupling in acute HFpEF patients with CAD. Furthermore, left ventricular ejection fraction (LVEF), body mass index (BMI), red blood cell distribution width-standard deviation (RDW-SD), and serum albumin levels were protective factors for RV-arterial uncoupling ( P < 0.05). A combination of 9 common indexes, including E/e´, LVEF, IVC, hypertensive history, atrial fibrillation, postoperative CABG, BMI, RDW-SD, and serum albumin, was constructed and this common index was combined with interleukin-6 again to draw a ROC curve together with interleukin-6. The AUCs for the common index, interleukin-6, and the common index combined with interleukin-6 in diagnosing RV-arterial uncoupling were 0.862 (95% CI , 0.817–0.899), 0.944 (95% CI , 0.917–0.965) and 0.980 (95% CI , 0.957–0.993), respectively, with P < 0.001. Pairwise comparisons of these three evaluation methods showed P values all < 0.001, with the common index combined with interleukin-6 demonstrating the highest diagnostic efficacy for RV-arterial uncoupling, achieving a sensitivity of 94.8%, a specificity of 91.6%, and an accuracy of 92.9%. Conclusions: In acute HFpEF patients with CAD, E/e´, IVC, a history of hypertension, atrial fibrillation, CABG, and interleukin-6 are associated with an increased risk of RV-arterial uncoupling, whereas LVEF, BMI, RDW-SD, and serum albumin levels serve as positive factors. Interleukin-6 plays a significant role in RV-arterial uncoupling, and its clinical value is worthy of attention.

Objectives: This study aimed to evaluate the early and rapid diagnostic value and the cut-off value of Heart-type fatty acid-binding protein (H-FABP) for the perioperative myocardial infarction (PMI) diagnosis after off-pump coronary artery bypass grafting (OPCABG) surgery. Method: 109 patients scheduled for first-time, elective, and isolated OPCABG surgery were erolled in this single-center, prospective and consecutive study. Serial samples for measurement of H-FABP at pre-anesthesia induction (T0, baseline), completion of last distal anastomosis (T1), on ICU admission (T2), and at 2h (T3), 4h (T4), 8h (T5), 24h (T6), and 48h (T7) were taken to analyze for H-FABP. CK-MB and cTnI were taken at T4, T5, T6, and T7. Patients were first divided into three groups according to the level of cTnI and ECG changes within the early 24 hours. Results: 44 patients served as a control group, 52 patients identified as myocardial injury group, and 13 patients defined as myocardial infarction group. The level of H-FABP released was significantly higher in the myocardial infarction group than another two groups. Using a cut-off value of 20.53 ng/ml for H-FABP, the sensitivity was 84.62%, 92.31%, and 76.92% immediately, 2 hours, and 4 hours after entering the ICU. The sensitivity of combined H-FABP and cTnI was 92.31% and 84.62% at 4 and 8 hours after entering the ICU. Conclusions: With an optimal H-FABP cut-off level of 20.53 ng/ml, H-FABP was the early and reliable biomarker for PMI diagnosis after OPCABG.

Pseudoaneurysm (PSA) of the right ventricular outflow tract (RVOT) is an exceedingly rare adverse event after the surgical reconstruction of the RVOT for the treatment of congenital heart disease. We report an unusual giant PSA of RVOT in a 20-month-old child, who underwent correction of the tetralogy of Fallot. Her main symptoms were in the respiratory system, and chest X-ray also revealed the giant space-occupying lesion in the chest, which could’ve been misdiagnosed as a respiratory disease. After evaluation by the combination of echocardiography and cardiac computer tomography angiogram, the details of PSA were diagnosed, and surgical but not percutaneous intervention was selected. The exclusion of PSA successfully was performed by the femoral cannulation, exploratory through right ventriculotomy, closure of the defect using the Gore-Tex patch, and application of a retained drainage-tube inside the PSA.