{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:01:17Z","timestamp":1788368477904,"version":"build-2803163510"},"reference-count":42,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015652","name":"Barts Charity","doi-asserted-by":"publisher","award":["MRC0172"],"award-info":[{"award-number":["MRC0172"]}],"id":[{"id":"10.13039\/100015652","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015652","name":"Barts Charity","doi-asserted-by":"publisher","award":["G\u2010002547"],"award-info":[{"award-number":["G\u2010002547"]}],"id":[{"id":"10.13039\/100015652","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>As a major systemic insult, cardiac surgery can lead to significant muscle loss, which increases the time to recovery as well as being correlated with mortality. Highly variable loss of muscle mass (0%\u201340% rectus femoris cross\u2010sectional area [RFcsa]) and strength in the week after surgery has aided understanding of mechanisms of sarcopenia after acute illness. To include muscle recovery, patients' muscle phenotype beyond the first week after surgery and up to their return as outpatients was studied and correlated with protein and metabolomic markers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing elective aortic valve surgery were recruited. Muscle mass (RFcsa), strength (handgrip, knee extension and spirometry), body composition (by bioimpedance) and health\u2010related quality of life (generic questionnaire EQ\u20105D\u20105L) were determined pre\u2010operatively, 7\u2009days after surgery and at outpatient follow\u2010up. Blood samples were taken on Days 0, 1, 3, 7 and follow\u2010up. The plasma metabolome was determined in 20 patients at Days 0, 3, 7 and follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 31 participants, 20 were male: mean age 68.8\u2009years with a range between 48 and 85\u2009years. Proportionate mean loss of RFcsa between pre\u2010op and Day 7 values was 6.44% [95% CI 4.21 to 8.68, <jats:italic>n<\/jats:italic>\u2009=\u200931]; between pre\u2010op and follow\u2010up 9.69% [95% CI 4.92 to 14.96, <jats:italic>n<\/jats:italic>\u2009=\u200922]; and between Day 7 and follow\u2010up 3.60% [95% CI \u22121.30 to 8.48, <jats:italic>n<\/jats:italic>\u2009=\u200922]. By contrast to measures of muscle bulk, the strength and functionality assessments (knee extension, handgrip, spirometry and short physical performance battery) decreased in the first week after surgery (pre\u2010op to Day 7) followed by a return to baseline (Day 7 to follow\u2010up). Health\u2010related quality of life (cross\u2010walk index) changed little over the course of the study but correlated positively at follow\u2010up with muscle bulk (RFcsa: <jats:italic>r<\/jats:italic>\u2009=\u20090.58 [95% CI 0.19 to 0.81] <jats:italic>p<\/jats:italic>\u2009=\u20090.005) and strength of knee extension (<jats:italic>r<\/jats:italic>\u2009=\u20090.54 [95% CI 0.14 to 0.79] <jats:italic>p<\/jats:italic>\u2009=\u20090.010) and handgrip (<jats:italic>r<\/jats:italic>\u2009=\u20090.63 [95% CI 0.27 to 0.83] <jats:italic>p<\/jats:italic>\u2009=\u20090.002: <jats:italic>n<\/jats:italic>\u2009=\u200922). Both pre\u2010operative and peak (Day 3) plasma levels of short\u2010chain acyl\u2010carnitine markers of mitochondrial dysfunction correlated with proportional muscle loss at follow\u2010up and with strength at all timepoints.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prolonged follow\u2010up after aortic surgery demonstrated a divergence between the consistent recovery of strength and a significant proportion of patients continuing to lose muscle bulk. Markers of baseline and acute mitochondrial dysfunction predicted poor muscle outcomes up to outpatient follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.70051","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T03:43:58Z","timestamp":1755834238000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Mitochondrial Dysfunction Contributes to Sustained Muscle Loss After Cardiac Surgery: A Prospective Observational Study"],"prefix":"10.1002","volume":"16","author":[{"given":"Ashley\u00a0N.","family":"Thomas","sequence":"first","affiliation":[{"name":"Barts Heart Centre St Bartholomew's Hospital, Barts NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonis","family":"Kalakoutas","sequence":"additional","affiliation":[{"name":"Guy's and St Thomas' NHS Trust  London 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UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1615-1896","authenticated-orcid":false,"given":"Mark\u00a0J.\u00a0D.","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Barts Heart Centre St Bartholomew's Hospital, Barts NHS Trust  London UK"},{"name":"National Heart and Lung Institute Imperial College  London 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