Cardiac xenotransplantation is advancing rapidly from basic research to early clinical use, but its research landscape has not been comprehensively mapped. We conducted a bibliometric and science-mapping analysis of English-language articles and reviews in the Web of Science Core Collection (1964-2025). Using VOSviewer, CiteSpace, and Bibliometrix, we assessed publication growth, collaboration networks, citation impact, and topic trends. The field has grown steadily and has accelerated in recent years in parallel with key clinical developments. Collaboration is strongest among institutions in the United States, Europe, and East Asia, and a small number of authors and centers contribute a large share of publications. Most studies are published in specialty transplantation journals, whereas major breakthroughs often appear in general medical journals. Research topics continue to focus on rejection and complement biology, while newer work highlights gene-edited donors, biosafety, clinical trial readiness, and pig-to-human models. Overall, the field appears to be maturing toward clinical implementation, and these findings can help guide research priorities, funding decisions, and policy planning.

Abstract Objectives This study aimed to evaluate the diagnostic accuracy of the elastic-to-muscular pulmonary artery area ratio (EM-AR) derived from 3D digital models for predicting pulmonary hypertension (PH), both alone and in combination with echocardiographic pulmonary arterial systolic pressure (PASP). Methods This retrospective diagnostic study enrolled 80 patients with suspected PH, using invasive mean pulmonary arterial pressure (mPAP) from right heart catheterization as the reference standard. Cross-sectional areas of elastic (third-order) and muscular (sixth-order) pulmonary arteries in the right lower lobe were measured from 3D digital models to calculate EM-AR. A multivariate linear regression model combining EM-AR and PASP was developed to predict mPAP (mPAPpredicted). Results Quantitative analysis revealed significant remodeling of the pulmonary arterial tree in the PH group, characterized by enlargement of elastic arteries (p < 0.001), reduction in muscular artery area (P < 0.001), and a consequent elevation in the EM-AR (P < 0.001). The EM-AR showed the strongest correlation with invasive mPAP (r = 0.73, P < 0.001) compared to its individual components (elastic artery: r = 0.54, P < 0.001; muscular artery: r = − 0.52, P < 0.001). The composite mPAP, derived from a multiple linear regression model of EM-AR and PASP, correlated strongly with invasive mPAP (r = 0.82, P < 0.001) and achieved superior diagnostic accuracy for PH (AUC = 0.95). At the optimal cut-off of 23.9 mmHg, it identified PH with 83.1% sensitivity and 95.2% specificity. Conclusions The EM-AR derived from 3D-printed digital models appears to be a promising indicator of pulmonary vascular remodeling. In our cohort, a multivariable model combining EM-AR with echocardiographic PASP demonstrated excellent diagnostic performance for the noninvasive prediction of pulmonary hypertension.

Reperfusion therapy is critical for acute myocardial infarction but is often accompanied by myocardial ischemia/reperfusion injury (MIRI). Phillyrin, a natural lignan from Forsythia suspensa, exerts anti-inflammatory and antioxidant effects; however, its role and mechanism in MIRI remain unclear. In this study, HL-1 cardiomyocytes are subjected to oxygen-glucose deprivation/reperfusion (OGD/R). Cell viability, apoptosis, oxidative stress, and inflammation are measured after phillyrin treatment. Multiomics (mRNA-seq, proteomics, and acetylproteomics) is used to identify key targets and pathways. Molecular docking, co-immunoprecipitation, site-directed mutagenesis, and western blot analysis are used to validate posttranslational regulation. A mouse MIRI model is established to confirm the in vivo cardioprotective effects of phillyrin. Phillyrin preserves cell viability and reduces apoptosis, oxidative stress, and inflammation in OGD/R-injured HL-1 cells. Multiomics integration reveals that phillyrin acts primarily through posttranslational regulation and highlights kinetochore scaffold 1 (KNL1) as the only protein that is both upregulated and hyperacetylated at lysine 605 (K605). Mechanistically, phillyrin may bind to the KNL1 C-terminus and enhance the interaction between KNL1 and acetyltransferase p300/CBP. KNL1 K605R mutation and Knl1 knockdown reduce KNL1 protein expression and reverse the inhibitory effects of phillyrin on p53 pathway-mediated apoptosis, oxidative stress, and inflammation. In mouse MIRI models, phillyrin reduces infarct size, myocardial damage, and cardiomyocyte apoptosis; these effects are abolished by knockdown of Knl1. Therefore, phillyrin promotes KNL1 acetylation at K605 to increase KNL1 protein expression, thereby inhibiting p53 signaling and alleviating apoptosis, oxidative stress, and inflammation in MIRI. This study identifies KNL1 acetylation at K605 as a novel posttranslational modification target for cardioprotection.

Cardiac xenotransplantation (CXTx) has emerged as a potentially transformative solution to the global shortage of donor organs, driven by recent breakthroughs in genome-editing technologies. This review provides a comprehensive overview of the field, tracing its evolution from early experimental barriers to the current stage of early clinical translation. We summarize the significant strides made in the development of genetically engineered donor pigs, in which multi-gene modifications have effectively overcome the obstacle of hyperacute rejection. Despite these advances, long-term graft survival remains limited by complex immunological and physiological challenges, including acute humoral xenograft rejection, cellular immune responses, and coagulation dysregulation. Furthermore, this review critically analyzes data from recent milestones, including studies in brain-dead decedent models and the first genetically modified pig-to-human heart transplants. These clinical endeavors have exposed critical unresolved issues, particularly antibody-mediated rejection and the biosafety risks associated with porcine viruses. In conclusion, we discuss the key pathways for future progress, emphasizing the urgent need for optimized immunosuppressive regimens, rigorous viral surveillance, and standardized preclinical protocols to establish CXTx as a safe and durable clinical reality.

Objectives This study aimed to investigate the functional recovery of an 8-gene-edited pig heart after orthotopic xenotransplantation, the characteristics of the recipient's immune responses, and the efficacy of postoperative complication management to provide comprehensive experimental evidence for the clinical translation of xenogeneic cardiac transplantation technology.Methods On December 27, 2025, an orthotopic heart was xenotransplanted from an 8-gene-edited pig to a rhesus macaque using the biatrial anastomosis technique. Postoperatively, comprehensive vital sign monitoring, immunosuppressive therapy, and complication interventions were implemented. Donor organ cardiac function, recipient immune indicators, and survival status were evaluated within 30 days after transplantation.Results The recipient macaque survived for more than 30 days postoperatively. The cardiac function of the donor heart gradually stabilized, with the ejection fraction increasing from 58% in the early postoperative phase to 66%. No hyperacute immune rejection occurred. Postoperative complications, including infection, pleural effusion, and blood pressure fluctuations, were effectively controlled with symptomatic treatment.Conclusions An 8-gene-edited pig heart demonstrates good biocompatibility in xenogeneic cardiac transplantation. Standardized surgical procedures, precise immunosuppressive regimens, and comprehensive postoperative care can effectively ensure desirable transplantation outcomes. This study offers an important technical reference for clinical xenogeneic cardiac transplantation.

To address critical challenges in clinical blood shortages and limited preservation periods, particularly affecting emergency transfusions, transgenic pig red blood cells (RBCs) emerge as a promising solution. We performed multi-gene editing on pig RBCs by knocking out three Xeno antigen genes (GGTA1, B4GALNT2, CMAH) and introducing high expression of human CD55 and CD47, generating 5-gene edited (5GE) RBCs. After co-incubating with human blood, we assessed their survival rate, along with physicochemical indicators related to hemolytic reactions and inflammatory responses. We further compared the physicochemical properties between transgenic pig blood and human blood. 5GE RBCs showed no significant agglutination, only mild hemolysis, and markedly reduced cytotoxicity. Binding by human antibodies and complement was significantly diminished. This study demonstrates the strong potential of genetically engineered porcine RBCs for emergency human transfusion, offering a viable alternative to alleviate blood shortages, especially when human RBCs are unavailable.

Background: Cardiovascular diseases remain one of the leading causes of death worldwide. Given the limited self-repair capacity of cardiac tissue, cardiac tissue engineering (CTE) aims to develop strategies and materials for repairing or replacing damaged cardiac tissue by combining biology, medicine, and engineering. Indeed, CTE has made significant strides since the discovery of induced pluripotent stem cells (iPSCs) in 2006, including creating cardiac patches, organoids, and chip models derived from iPSCs, thus offering new strategies for treating cardiac diseases. Methods: A systematic search for relevant literature published between 2003 and 2024 was conducted in the PubMed and Web of Science databases using “Cardiac Tissue Engineering”, “3D Bioprinting”, “Scaffold in Tissue Engineering”, “Induced Pluripotent Stem Cells”, and “iPSCs” as keywords. Results: This systematic search using the abovementioned keywords identified relevant articles for inclusion in this review. The resulting literature indicated that CTE can offer innovative solutions for treating cardiac diseases when integrated with three-dimensional (3D) bioprinting and iPSC technology. Conclusions: Despite notable advances in the field of CTE, multiple challenges remain relating to 3D-bioprinted cardiac tissues. These include maintaining long-term cell viability, achieving precise cell distribution, tissue vascularization, material selection, and cost-effectiveness. Therefore, further research is needed to optimize printing techniques, develop more advanced bio-inks, explore larger-scale tissue constructs, and ensure the biosafety and functional fidelity of engineered cardiac tissues. Subsequently, future research efforts should focus on these areas to facilitate the clinical translation of CTE. Moreover, additional long-term animal models and preclinical studies should be conducted to ensure the biosafety and functionality of engineered cardiac tissues, thereby creating novel possibilities for treating patients with heart diseases.

Accurate diagnosis and evaluation of Williams Syndrome (WS) are essential yet challenging for effective surgical management. This study aimed to quantify the hemodynamic changes of surgical repair for WS through virtual surgery and computational fluid dynamics (CFD) for surgical guidance and postoperative evaluation. A patient preliminarily diagnosed with WS was included in this study. 3D model alongside hemodynamic analysis was used to guide and evaluate the surgical procedure. Preoperative, predictive and postoperative models were created and analyzed using CFD. Key parameters, including blood flow velocity, pressure differences, wall shear stress, and other critical factors, were assessed to evaluate the surgery’s effectiveness. In the hemodynamics analysis, the CFD results of predictive model and postoperative model demonstrated a high level of consistency, and showed significant differences compared to the preoperative model. The velocity at the stenosis on the aorta decreased from 5.6 m/s before the operation to 1.6 m/s in the virtual model and 1.5 m/s in the postoperative model. Surgical repair increased the proportion of outlet flow of the descending aorta (dAo) from 28.7

Background: Multimodal imaging plays a crucial role in evaluating suspected cardiac tumours. In recent years, three-dimensional (3D) printing technology has continued to advance such that image-based 3D-printed models have been incorporated into the auxiliary diagnosis and treatment of cardiac tumour diseases. The purpose of this review is to analyze the existing literature on the application of 3D printing in cardiac tumour surgery to examine the current status of the application of this technology. Methods: By searching PubMed, Cochrane, Scopus and Google Scholar, as well as other resource databases, a completed review of the available literature was performed. Effect sizes from published studies were investigated, and results are presented concerning the use of 3D surgical planning in the management of cardiac tumours. Results: According to the reviewed literature, our study comes to the point that 3D printing is a valuable technique for planning surgery for cardiac tumours. As shown in the review report, Mucinous and sarcomatous tumours are the most commonly used tumours for 3D printing, magnetic resonance imaging (MRI) and computed tomography (CT) are the most commonly used technologies for preparing 3D printing models, the main printing technology is stereolithography, and the most used 3D modeling software is Mimics. The printing time and cost required for 3D printing are affected by factors such as the size of the type, complexity, the printed material and the 3D printing technology used. The reported research shows that 3D printing can understand the anatomy of complex tumour cases, virtual surgical simulation, as well as facilitate doctor-patient communication and clinical teaching. Conclusions: These results show that the development of 3D printing technology has brought more accurate and safe perioperative treatment options for patients with cardiac tumours. Therefore, 3D printing technology is expected to become a routine clinical diagnosis and treatment tool for cardiac tumours.

Objective: To investigate the correlations between cosmetic and radiographic parameters of shoulder balance, as well as the variations in cosmetic shoulder balance observed from different perspectives, among patients with adolescent idiopathic scoliosis (AIS) characterized by thoracic curves. Methods: A total of 43 patients with thoracic curves treated from July to October in 2022 in Nanjing Drum Tower Hospital were recruited in this study. There were 9 males and 34 females with a mean age of (14.3±1.5) years. All participants underwent comprehensive radiographic assessments and were photographed both from posterior and anterior views, focusing on the shoulder region as well as a higher level (maintaining a consistent vertical distance of 180 cm from the ground). Six cosmetic parameters were measured on the photographs: shoulder angle(α1), axilla angle(α2), shoulder area index 1(SAI1), shoulder area index 2 (SAI2), inner shoulder height (SHi) and outer shoulder height (SHo). Eight radiographic parameters were measured on the radiographs: radiographic shoulder height difference (RSHD), first rib angle (FRA), clavicle-rib cage intersection (CRCI), coracoid process height (CPH), T1 tilt, clavicle angle(CA), clavicle chest cage angle difference (CCAD) and Cobb angle. Differences among bilateral cosmetic indicators from different perspectives were analyzed and compared, and their correlation with bilateral radiographic indicators was studied. Results: There was no significant differences between anterior cosmetic parameters and posterior cosmetic parameters at the same level of observation(all P>0.05). However, when observing SHi, SHo, α1, and α2 at the shoulder level, it became evident that they exhibited significantly higher values compared to the corresponding higher level on the same side of the patients' bodies. This contrast was observed in both the dorsal [SHo: (0.11±1.20) cm vs (-0.44±1.39) cm, P=0.005; SHi: (0.64±0.86) cm vs (0.32±0.56) cm, P=0.003; α1:-0.47°±2.27° vs -0.77°±2.49°, P=0.014; α2:-3.06°±3.23° vs -2.21°±3.03°, P=0.034] and ventral [SHo: (0.12±1.29) cm vs (-0.48±1.35) cm, P=0.007; SHi: (0.61±0.88) cm vs (0.30±0.59) cm, P=0.006; α1:-0.46°±2.18° vs -0.69°±2.35°, P=0.018; α2:-3.26°±3.12° vs -2.05°±2.97°, P=0.029] aspects of the patients. SHi and SHo were more sensitive to this difference of height. The correlation coefficients between radiographic parameters and cosmetic aspects at the shoulder level varied from 0.374 to 0.767. Similarly, the correlation coefficients between radiographic parameters and cosmetic factors at the higher level ranged from 0.273 to 0.579 (all P<0.05). Conclusions: The cosmetic parameters had significant difference between different perspective of observation, the cosmetic parameters are needed to be observed at the shoulder level in the evaluation of patients' shoulder balance.

An anomalous left coronary artery originating from the pulmonary artery (ALCAPA) refers to the abnormal origin of the left coronary artery either from the main pulmonary artery, pulmonary artery sinus, or the left and right pulmonary arteries, with the main pulmonary artery or pulmonary artery sinus being the most common sites. If not diagnosed and treated promptly, this condition can result in death within the first year of life in 90% of patients. Asymptomatic children can survive into adulthood, but they are at a high risk of sudden death. In this article, we report a case of a 24-year-old pregnant woman who was diagnosed with ALCAPA during prenatal examination. The pregnancy was successfully maintained until 36 weeks, after which a cesarean section was performed. The patient was then admitted to the cardiac surgery department to improve cardiac function, and six weeks later, a successful left coronary artery transplantation was performed. The patient was discharged and followed up for three months, during which her condition remained stable.

瓣叶脱落是人工心脏瓣膜置换术的罕见并发症。该文报道了2例双叶型人工机械心脏瓣膜置换术后单瓣叶脱落病例，并结合文献探讨了瓣叶脱落原因及处理策略。瓣叶脱落原因可能与瓣膜设计、瓣叶材质有关，需再次行瓣膜置换术。脱落瓣叶破损并严重影响远端血管者，应积极通过手术取出；未对远端血管损伤者，可暂不拆除，但需进行严密随访。

During the eleven years from 2010 to 2021, preliminary statistics have shown that Fuwai Hospital completed 23,571 mechanical valve replacements for various types of valves, and 1139 mechanical valve replacements were performed in Guangyuan First People's Hospital. Only two patients developed valve leaflet escape, so valve leaflet escape is a rare postoperative complication. In 2010 and 2021, two patients were selected after they had unilateral leaflet escape after having mechanical valve replacements in Fuwai Hospital of Chinese Academy of Medical Sciences and Guangyuan First People's Hospital. Both patients underwent reoperations with the classic operation and the new bileaflet mechanical prosthetic heart valve was sutured. The treatment of detached single lobe and distal vessel was comprehensively determined, and the condition was treated according to the patient's symptoms, CT results, ultrasound results and other test results, as well as whether this detached lobe caused any abnormal hemodynamics of the distal vessel. The patient with mechanical aortic valve escape completed the 10-year follow-up, and patient with mechanical mitral valve escape completed the 3-month follow-up. there was no thrombosis or hematoma at the embolic site; the patient had no lower limb symptoms. The reason for the leaflet escape may be related to the valve design and the leaflet material. If the detached leaflets are damaged and if the distal blood vessels are affected, simultaneous surgical treatment is required. Those patients whose vessels were not damaged by the valve lobe should be carefully monitored.

OBJECTIVE:The purpose of this research was to explore the application value of a three-dimensional (3D)-printed heart in surgery for left ventricular outflow tract (LVOT) obstruction. METHODS:From August 2019 to October 2021, 46 patients with LVOT obstruction underwent surgical treatment at our institution. According to the treatment method, 22 and 24 patients were allocated to the experimental and control groups, respectively. In the experimental group, each patient's 3D-printed heart model was used for simulated preoperative surgery, and then the Morrow operation was performed. In the control group, only the Morrow operation was performed, without simulated preoperative surgery using a 3D-printed heart model. The intraoperative and postoperative data of patients in the two groups were recorded, and the clinical data of patients were compared between the two groups. RESULTS:The operation time, cardiopulmonary bypass time, intraoperative blood loss, hospitalization time, LVOT pressure difference (LVP), postoperative interventricular septal thickness (IST), aortic regurgitation (AR), systolic anterior motion (SAM), and postoperative left ventricular flow velocity (LVFV) were significantly lower in the experimental group than in the control group (P < 0.05). The inner diameter of the left ventricular outflow tract (IDLV) was larger in the experimental group than in the control group (P < 0.05). There was no significant difference in the postoperative ejection fraction, atrioventricular block rate or complication rate between the two groups (P > 0.05). CONCLUSION:A 3D-printed heart model for simulated surgery in vitro is conducive to formulating a more reasonable surgical plan and reducing the trauma and duration of surgery, thereby promoting the recovery and maintenance of the heart.

Accurate diagnosis and surgical selection of the double-outlet right ventricle (DORV) is both critical and difficult. Virtual models and three-dimensional (3D) printing have been used to provide morphological copies to doctors as reference. However, the existing methods have shortcomings in visualization of the surgical results, optimal surgical design, and accurate surgical scheme measurements. To overcome this problem, we performed surgical predictions by designing the intraventricular baffle and ventricular septal defect patch to evaluate surgical options and using 3D printing to guide the trimming of the baffle or patch. A complete set of processes including scanning, modeling, designing, 3D printing, and guiding the trimming of the baffle for the diagnosis and surgical planning of DORV was established. Six cases were used to evaluate the feasibility of this method. The average rate of misdiagnosis of the six cases by computed tomography and echocardiography was 42.5%, which was reduced to 4.6% when the diagnosis was established using the virtual models and 3D printing as auxiliary tools. The approach effectively improved diagnostic accuracy, guided the operation, and simplified the process of patch trimming. The proposed method can thus be used for improving the surgical simulation and guiding of the DORV surgery.

The study aimed to evaluate the effectiveness of blood pool and myocardial models made by stereolithography in the diagnosis of different types of congenital heart disease (CHD). Two modeling methods were applied in the diagnosis of 8 cases, and two control groups consisting of experts and students diagnosed the cases using echocardiography with computed tomography, blood pool models, and myocardial models. The importance, suitability, and simulation degree of different models were analyzed. The average diagnostic rate before and after 3D printing was used was 88.75% and 95.9% (P = 0.001) in the expert group and 60% and 91.6% (P = 0.000) in the student group, respectively. 3D printing was considered to be more important for the diagnosis of complex CHDs (very important; average, 87.8%) than simple CHDs (very important; average, 30.8%) (P = 0.000). Myocardial models were considered most realistic regarding the structure of the heart (average, 92.5%). In cases of congenital corrected transposition of great arteries, Williams syndrome, coronary artery fistula, tetralogy of Fallot, patent ductus arteriosus, and coarctation of the aorta, blood pool models were considered more effective (average, 92.1%), while in cases of double outlet right ventricle and ventricular septal defect, myocardial models were considered optimal (average, 80%).