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Precision and Targeted Therapy in Cardiac Surgery
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Precision and Targeted Therapy in Cardiac Surgery

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: 15 June 2024 | Viewed by 3538

Special Issue Editors

Dr. Kyriakos Spiliopoulos

E-Mail Website
Guest Editor
Faculty of Medicine, School of Health Sciences, University of Thessaly Department of Cardiothoracic Surgery, University Hospital of Larissa, Larisa, Greece
Interests: CABG surgery; heart valve surgery; minimal invasive cardiac surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Andrew Xanthopoulos

E-Mail Website
Guest Editor
Department of Cardiology, University Hospital of Larissa, Larissa, Greece
Interests: heart failure; acute heart failure; chronic heart failure; LVAD; heart transplantation; amyloidosis; devices; pulmonary hypertension
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The concept of personalized medicine to maximize benefits and improve patients’ outcomes has evolved over the last few decades. In this regard, cardiac surgery has undergone tremendous growth in recent years. Currently, operative mortality is as low as 1%–3% in elective cardiac surgical patients. This drastic reduction is the result of the evolutionary invention of numerous diagnostic and operative tools, which enabled heart surgeons to plan and perform patient-tailored surgeries. From the beginning of the millennium, the discipline underwent a strong evolution with the advent of minimally invasive techniques and transcatheter procedures. In this context, transcatheter aortic valve implantation (TAVI), MitraClip and transapical mitral chordae implantation (TOP-MINI), which are currently well-established therapeutical approaches in high-risk patients, have been further evaluated in order to be applied in intermediate-, as well as low-risk patients. In the field of heart failure surgery with the staggering technological advancements, focus is being placed on developing miniature assist devices. More compact, less-invasive centrifugal-flow blood pumps are being developed for long-term use, aiming to reduce the number of patients on the heart transplant waiting list. All these new technologies have led to the better treatment of complex cardiac diseases, thus providing enhanced outcomes, quality of services and quality of life for our patients.

Furthermore, while it is important to recognize the promise and potential of patient tailored management, it is also essential to debate whether the proposed outstanding goals are realistic. Will we actually be able to treat each patient individually? In this ever-changing landscape, we invite all physicians and surgeons with interest in surgically treated cardiac diseases to submit their work in this Special Issue. Our goal is to provide the readers with the cutting edge and up-to-date advances in the field of Precision and Targeted Therapy in Cardiac Surgery.

Dr. Kyriakos Spiliopoulos
Dr. Andrew Xanthopoulos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • evolution in cardiac surgery
  • minimal invasive cardiac surgery
  • heart valve procedures
  • heart failure surgery

Published Papers (3 papers)

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Research

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12 pages, 2836 KiB  
Article
Rejection Requiring Treatment within the First Year following Heart Transplantation: The UNOS Insight
by Marco Gemelli, Ilias P. Doulamis, Aspasia Tzani, Athanasios Rempakos, Polydoros Kampaktsis, Paulino Alvarez, Alvise Guariento, Andrew Xanthopoulos, Grigorios Giamouzis, Kyriakos Spiliopoulos, Rabea Asleh, Ernesto Ruiz Duque and Alexandros Briasoulis
J. Pers. Med. 2024, 14(1), 52; https://doi.org/10.3390/jpm14010052 - 29 Dec 2023
Viewed by 941
Abstract
(1) Background: Heart failure is an extremely impactful health issue from both a social and quality-of-life point of view and the rate of patients with this condition is destined to rise in the next few years. Transplantation remains the mainstay of treatment for [...] Read more.
(1) Background: Heart failure is an extremely impactful health issue from both a social and quality-of-life point of view and the rate of patients with this condition is destined to rise in the next few years. Transplantation remains the mainstay of treatment for end-stage heart failure, but a shortage of organs represents a significant problem that prolongs time spent on the waiting list. In view of this, the selection of donor and recipient must be extremely meticulous, considering all factors that could predispose to organ failure. One of the main considerations regarding heart transplants is the risk of graft rejection and the need for immunosuppression therapy to mitigate that risk. In this study, we aimed to assess the characteristics of patients who need immunosuppression treatment for rejection within one year of heart transplantation and its impact on mid-term and long-term mortality. (2) Methods: The United Network for Organ Sharing (UNOS) Registry was queried to identify patients who solely underwent a heart transplant in the US between 2000 and 2021. Patients were divided into two groups according to the need for anti-rejection treatment within one year of heart transplantation. Patients’ characteristics in the two groups were assessed, and 1 year and 10 year mortality rates were compared. (3) Results: A total of 43,763 patients underwent isolated heart transplantation in the study period, and 9946 (22.7%) needed anti-rejection treatment in the first year. Patients who required treatment for rejection within one year after transplant were more frequently younger (49 ± 14 vs. 52 ± 14 years, p < 0.001), women (31% vs. 23%, p < 0.001), and had a higher CPRA value (14 ± 26 vs. 11 ± 23, p < 0.001). Also, the rate of prior cardiac surgery was more than double in this group (27% vs. 12%, p < 0.001), while prior LVAD (12% vs. 11%, p < 0.001) and IABP (10% vs. 9%, p < 0.01) were more frequent in patients who did not receive anti-rejection treatment in the first year. Finally, pre-transplantation creatinine was significantly higher in patients who did not need treatment for rejection in the first year (1.4 vs. 1.3, p < 0.01). Most patients who did not require anti-rejection treatment underwent heart transplantation during the new allocation era, while less than half of the patients who required treatment underwent transplantation after the new allocation policy implementation (65% vs. 49%, p < 0.001). Patients who needed rejection treatment in the first year had a higher risk of unadjusted 1 year (HR: 2.25; 95% CI: 1.88–2.70; p < 0.001), 5 year (HR: 1.69; 95% CI: 1.60–1.79; p < 0.001), and 10 year (HR: 1.47; 95% CI: 1.41–1.54, p < 0.001) mortality, and this was confirmed at the adjusted analysis at all three time-points. (4) Conclusions: Medical treatment of acute rejection was associated with significantly increased 1 year mortality compared to patients who did not require anti-rejection therapy. The higher risk of mortality was confirmed at a 10 year follow-up. Further studies and newer follow-up data are required to investigate the role of anti-rejection therapy in the heart transplant population. Full article
(This article belongs to the Special Issue Precision and Targeted Therapy in Cardiac Surgery)
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12 pages, 1507 KiB  
Article
Transcriptomic Analysis of Tight Junction Proteins Demonstrates the Aberrant Expression and Function of Zona Occludens 2 (ZO-2) Protein in Stanford Type A Aortic Dissection
by Dimitrios E. Magouliotis, Arian Arjomandi Rad, Antonios Kourliouros, Alessandro Viviano, Marinos Koulouroudias, Mohammad Yousuf Salmasi, Alexandros Briasoulis, Filippos Triposkiadis, John Skoularigis and Thanos Athanasiou
J. Pers. Med. 2023, 13(12), 1697; https://doi.org/10.3390/jpm13121697 - 09 Dec 2023
Viewed by 891
Abstract
Objective: Thoracic aortic aneurysm dissection (TAAD) represents a cardiac surgery emergency characterized by the disrupted integrity of the aortic wall and is associated with poor prognosis. In this context, the identification of biomarkers implicated in the pathobiology of TAAD is crucial. Our aim [...] Read more.
Objective: Thoracic aortic aneurysm dissection (TAAD) represents a cardiac surgery emergency characterized by the disrupted integrity of the aortic wall and is associated with poor prognosis. In this context, the identification of biomarkers implicated in the pathobiology of TAAD is crucial. Our aim in the present original in silico study is to assess the differential gene expression profile of the tight junction proteins (TJPs) in patients with TAAD and to propose novel biomarkers for the diagnosis and prognosis of this disease. Methods: We implemented bioinformatics methodology in order to construct the gene network of the TJPs family, identify the differentially expressed genes (DEGs) in pathologic aortic tissue excised from patients with TAAD as compared to healthy aortic tissue, and assess the related biological functions and the associated miRNA families. Results: Data regarding the transcriptomic profile of selected genes were retrieved and incorporated from three microarray datasets, including 23 TAAD and 20 healthy control samples. A total of 32 TJPs were assessed. The zona occludens 2 (ZO-2) protein encoded by the gene TJP2 was significantly under-expressed in patients with TAAD compared to the control group (p = 0.009). ZO-2 was associated with fair discrimination and calibration traits in predicting the TAAD presentation. CpG islands of ZO-2 were demonstrated. No important difference was found regarding ZO-2 expression between aneurysmal non-dissected and healthy control aortic tissue. Finally, we performed gene set enrichment analysis (GSEA) and uncovered the major biological functions and miRNA families (hsa-miR-155-5p, hsa-miR-1-3p, hsa-miR-2118-5p, hsa-miR-4691-3p, and hsa-miR-1229-3p) relevant to ZO-2. Conclusions: These outcomes demonstrated the important role of ZO-2 in the pathobiology of TAAD. Full article
(This article belongs to the Special Issue Precision and Targeted Therapy in Cardiac Surgery)
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Review

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14 pages, 1878 KiB  
Review
Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure: Current Evidence and Future Opportunities
by Sho Suzuki, Takeshi Kitai, John Skoularigis, Kyriakos Spiliopoulos and Andrew Xanthopoulos
J. Pers. Med. 2023, 13(9), 1394; https://doi.org/10.3390/jpm13091394 - 18 Sep 2023
Cited by 1 | Viewed by 1040
Abstract
Atrial fibrillation (AF) and heart failure (HF) are highly prevalent cardiac disorders worldwide, and both are associated with poor prognosis. The incidence of AF and HF has been increasing substantially in recent years, mainly due to the progressive aging of the population. These [...] Read more.
Atrial fibrillation (AF) and heart failure (HF) are highly prevalent cardiac disorders worldwide, and both are associated with poor prognosis. The incidence of AF and HF has been increasing substantially in recent years, mainly due to the progressive aging of the population. These disorders often coexist, and may have a causal relationship, with one contributing to the development or progression of the other. AF is a significant risk factor for adverse outcomes in HF patients, including mortality, hospitalization, and stroke. Although the optimal treatment for AF with HF remains unclear, catheter ablation (CA) has emerged as a promising treatment option. This review provides a comprehensive overview of the current scientific evidence regarding the efficacy of CA for managing AF in HF patients. In addition, the potential benefits and risks associated with CA are also discussed. We will also explore the factors that may influence treatment outcomes and highlight the remaining gaps in knowledge in this field. Full article
(This article belongs to the Special Issue Precision and Targeted Therapy in Cardiac Surgery)
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