Cirugía valvular

Eur Heart J Imaging Methods Pract. 2025 Aug 6;3(4):qyaf098. doi: 10.1093/ehjimp/qyaf098. eCollection 2025 Oct.

ABSTRACT

AIMS: Over the past decade, transcatheter valve replacement has emerged as a therapy for selected patients with valvular heart. Clinical experience with transcatheter mitral valve replacement (TMVR) has been limited to date and provides little insight into its potential as a viable therapy for MR. The present study aims to analyze the current longest follow-up real-life outcomes of TMVR procedures with a specific focus on the patient population left untreated due to the unfeasibility of the procedure.

RESULTS: Out of 3400 patients referred for mitral pathology, 88 were screened for TMVR procedure, being unfeasible for surgical and TEER procedure (Transcatheter Edge-to-Edge Repair). 37 pts (45%) were screened positive and treated with TMVR; 30 (81%) with Tendyne system (Abbott) and 7 (19%) with Tiara. For cardiac death, in TMVR the survival was 97.2%, 90.7%, and 90.7% at 1, 2, and 4 years, respectively. Concerning MT, instead, it was 86.4%, 77%, and 42% at 1, 2, and 4 years, respectively. A difference is seen between the two groups, P-value 0.024.

CONCLUSION: TMVR is a valid option in selected patients and give valid longer follow-up results. The TMVR-ineligible patients showed a progressive detrimental worse survival across the follow-up.

PMID:41058678 | PMC:PMC12499754 | DOI:10.1093/ehjimp/qyaf098

JMIR Form Res. 2025 Oct 7;9:e68710. doi: 10.2196/68710.

ABSTRACT

BACKGROUND: Heart valve surgery is associated with a high risk of perioperative complications. However, current approaches for predicting perioperative complications are all based on preoperative or intraoperative factors, without taking into account the fact that perioperative complications are multifactorial, dynamic, heterogeneous, and interdependent.

OBJECTIVE: We aimed to construct and quantify the association network among multiple perioperative complications to elucidate the possible evolution trajectories.

METHODS: This study used the data from China Cardiac Surgery Registry (CCSR), in which 37,285 patients were included in the analysis. A Bayesian network was used to analyze the associations among 12 complications. Score-based hill-climbing algorithms were used to build the structure and the association between them was quantified using conditional probabilities.

RESULTS: We obtained the network of valve surgery complications. A total of 13 nodes represented complications or death, and 34 arcs with arrows represented the directly dependent relationship between them. We identified clusters of complications that were logically related and not related and quantified the associations. The correlation coefficient between complications increases with the severity of the complications, ranging from 0.01 to 0.41. Meanwhile, the probability of death when multiple complications occurred was calculated. Even mild complications, when progressing to multiple organ dysfunction syndrome, result in a mortality rate of over 90%.

CONCLUSIONS: Our network facilitates the identification of associations among specific complications, which help to develop targeted measures to halt the cascade of complications in patients undergoing the valve surgery.

PMID:41056564 | PMC:PMC12503447 | DOI:10.2196/68710

Cureus. 2025 Sep 1;17(9):e91440. doi: 10.7759/cureus.91440. eCollection 2025 Sep.

ABSTRACT

BACKGROUND & AIMS: This study analyses the practice gap in addressing tricuspid regurgitation (TR) in patients undergoing left-sided valve surgery.

METHODS: This is a retrospective cohort study of patients operated on between January 2015 and December 2018. A total of 1,129 patients underwent left-sided valve operations for rheumatic aetiology. Tricuspid valve repair (TVr) was performed in 68 patients. Patients with follow-up data and isolated or predominantly mitral valve replacement were divided based on the severity of TR: Group 1 (n = 771), patients with mild TR; Group 2 (n = 109), patients with severe TR and severe pulmonary arterial hypertension (PAH); Group 3 (n = 33), patients with severe TR and non-severe PAH; and Group 4 (n = 68), patients with moderate to severe TR and a dilated tricuspid valve annulus. Group 4 patients received TVr. The primary endpoint was the appearance of severe TR at follow-up.

RESULTS: The mean age of the whole cohort of 1,129 patients (n = 598 (53%) males and n = 531 (47%) females) was 35.42 ± 13.91 years. Mean follow-up of 27.3 ± 18.9 months was available for 1,061 patients. The primary endpoint was observed in 6.3%, 21.1%, 49.5%, and 23.5% of patients, respectively, from Group 1 to Group 4. Preoperatively, mild TR was observed in 771, moderate in 147, and severe in 143 patients who completed follow-up. The primary endpoint was more common in patients with moderate TR (p = 0.04). The American Heart Association (AHA) and American College of Cardiology (ACC) collaborate to produce clinical practice guidelines providing evidence-based recommendations to improve cardiovascular health. These guidelines are the official policy of both organisations and are intended to provide a foundation for quality cardiovascular care globally, though the focus is on US medical practice. There was a departure from the recommendation in 66.6% of cases (Groups 2 and 3) involving patients with severe TR (Groups 2-4). The emergence of severe TR in Groups 2 and 4 was similar, even though patients in Group 2 did not receive TVr, contrary to the recommendation.

CONCLUSION: The appearance of severe TR during follow-up for patients with preoperatively severe TR with severe pulmonary hypertension (PH) was similar, irrespective of whether TVr was performed. This group should be further investigated regarding the need for TVr.

PMID:41050007 | PMC:PMC12489015 | DOI:10.7759/cureus.91440

Cardiovasc Revasc Med. 2025 Oct;79:41-44. doi: 10.1016/j.carrev.2025.03.002. Epub 2025 Mar 5.

ABSTRACT

BACKGROUND: The effect of ejection fraction on outcomes after transcatheter aortic valve replacement (TAVR) in heart failure (HF) patients remains unclear.

METHODS: Using the National Readmission Database (2016-2020), adult HF patients who underwent TAVR were identified, and outcomes were compared between those with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The primary outcome was all-cause inpatient mortality, while secondary outcomes included major bleeding, packed red blood cell (pRBC) transfusion, acute kidney injury (AKI), ischemic cerebrovascular accidents (CVA), valvular complications, conversion to open surgery, length of stay, and total charges.

RESULTS: Among 231,092 HF patients who underwent TAVR, 89,782 had HFrEF. Compared to HFpEF patients, HFrEF was associated with higher inpatient mortality (adjusted odds ratio [aOR] 1.97, 95 % CI 1.78-2.19, P < 0.001), major bleeding (aOR 1.49, 95 % CI 1.36-1.63, P < 0.001), pRBC transfusion (aOR 1.28, 95 % CI 1.19-1.38, P < 0.001), AKI (aOR 1.89, 95 % CI 1.79-1.99, P < 0.001), valvular complications (aOR 1.41, 95 % CI 1.21-1.64, P < 0.001), and conversion to open surgery (aOR 1.72, 95 % CI 1.28-2.34, P < 0.001), with no significant difference in ischemic CVA (aOR 1.12, 95 % CI 0.97-1.29, P = 0.13). HFrEF was also associated with longer hospital stays (adjusted mean difference [aMD] 2.06 days, 95 % CI 1.93-2.18, P < 0.001) and higher total charges (aMD $29,783, 95 % CI 25,106-34,460, P < 0.001).

CONCLUSION: Patients with HFrEF undergoing TAVR experienced worse outcomes compared to those with HFpEF. These findings underscore the need for meticulous patient selection and risk evaluation before performing TAVR in HF patients.

PMID:41043945 | DOI:10.1016/j.carrev.2025.03.002

Europace. 2025 Oct 3:euaf251. doi: 10.1093/europace/euaf251. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The direct oral anticoagulant (DOAC) score was recently developed to predict bleeding risk in patients with atrial fibrillation (AF) receiving oral anticoagulants. However, limited data show inconsistent results comparing its performance to the conventional HAS-BLED score in Asian populations with non-valvular AF receiving DOACs.

METHODS: We enrolled 21,142 patients with non-valvular AF receiving DOACs from a multicenter database in Taiwan (June 2012-December 2021). The primary endpoint was major bleeding events. Major bleeding events were defined according to the ISTH criteria. Areas under receiver operating characteristic curves (AUCs) were calculated for each score, with differences assessed using DeLong test.

RESULTS: A total of 21,142 AF patients (mean age 75.9±11.0 years; 41% female) treated with DOAC were included in the analysis. Major bleeding events occurred in 681 patients in one-year follow-up (3.66%/year). There were 82(0.43%/year) intracranial hemorrhage event occurred. Both the DOAC and HAS-BLED scores are associated with a significant risk of major bleeding event, with only modest predictive performance (AUC <0.7). The DOAC score showed a slightly but statistically significantly higher AUC compared with the HAS-BLED score (AUC:0.670, [95 %CI:0.650-0.689]) vs. 0.642, [0.623-0.663]; P<.001). Results from several reclassification analyses favored the DOAC score. Both the two scores showed a good calibration for the low to intermediate risk categories, while the two bleeding risk scores both overestimate the risk of major bleeding risk for the high risk categories. Subgroup analyses indicated that the superiority of DOAC score over HAS-BLED score is primarily driven by elderly patients (≥75 years) and prediction in risk of gastrointestinal bleeding.

CONCLUSIONS: The DOAC score, which employs a more granular scoring system compared to the HAS-BLED score, may enable finer bleeding risk discrimination among Asian patients with non-valvular AF receiving DOAC therapy.

PMID:41043006 | DOI:10.1093/europace/euaf251

Mol Med Rep. 2025 Dec;32(6):339. doi: 10.3892/mmr.2025.13704. Epub 2025 Oct 3.

ABSTRACT

The regulatory functions and underlying mechanisms of circular RNAs (circRNAs/circs) in atrial fibrillation (AF) are largely unknown. The present study aimed to assess the prognostic roles and potential biological functions of hsa_circ_0000118 in structural remodeling in AF. Gain‑ and loss‑of‑function cell models were established in mouse cardiac fibroblasts. Cell Counting Kit‑8 and Transwell assays were used to analyze the proliferation and migration of cardiac fibroblasts. To evaluate the underlying mechanisms, RNA immunoprecipitation and luciferase reporter assays were performed. hsa_circ_0000118 was demonstrated to be significantly upregulated in atrial tissues of patients with valvular heart disease with AF compared to those without AF. Elevated plasma levels of hsa_circ_0000118 were independently associated with poor prognosis in patients with AF. In vitro, hsa_circ_0000118 promoted collagen I and collagen III expression, and the migration of cardiac fibroblasts. Functional assays demonstrated that hsa_circ_0000118 acted as a competing endogenous RNA of microRNA (miR)‑34a‑5p to reduce the suppressive effect of miR‑34a‑5p on its target Smad4 in cardiac fibroblasts. In conclusion, hsa_circ_0000118 may serve as a non‑invasive prognostic biomarker for AF. The newly identified roles of hsa_circ_0000118 in AF provide a mechanistic understanding of structural remodeling in AF and pave the way towards novel therapies.

PMID:41041848 | DOI:10.3892/mmr.2025.13704

Cureus. 2025 Aug 30;17(8):e91270. doi: 10.7759/cureus.91270. eCollection 2025 Aug.

ABSTRACT

Infective endocarditis (IE) in people who inject drugs (PWID) has emerged as a growing public health concern. It entails two main issues future medicine will have to face: an increase in patients with substance abuse and the evolution of new microbial threats. The analysis of characteristics of the disease in this group of patients enables us to draw differentiating points. IE in PWID predominantly involves the right side of the heart, mainly the tricuspid valve. The prevalence of the disease is high in developed countries, in regions with a strong impact of drug abuse, particularly in the younger part of populations facing socioeconomic difficulties linked to changing life conditions in postindustrial economic systems. Staphylococcus aureus is by far the most frequent pathogen responsible for the infection in these patients, proportionally outnumbering the prevalence of this species in non-drug users. Also, higher rates of Gram-negative and fungal infections are posing a serious challenge in the treatment process. The Duke Criteria remain the common diagnostic methodology in all cases of IE, with echocardiography - both transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) - being staples for imaging. The identification of the pathogen includes both standard microbiologic blood culture tests and the use of advanced biomolecular methods. Management in an optimal therapeutic process requires targeted antimicrobial therapy, which in many cases has to be supported by invasive surgical or percutaneous interventions. The widening spectrum of surgical procedures, such as percutaneous vegetation debulking, transcatheter valve-in-valve implantation, or minimally invasive cardiac surgery, represents a positive change for patients in poor clinical condition who are not suitable for standard cardiothoracic procedures.. While short-term survival seems promising at first, the long-term results are still dissatisfying. The main area for improvement is the need for a multidisciplinary approach that integrates infection management and prevention with addiction treatment. An innovative approach combining these factors could lead to a better prognosis in PWID with IE in the future.

PMID:41030729 | PMC:PMC12477519 | DOI:10.7759/cureus.91270

J Cardiothorac Surg. 2025 Sep 30;20(1):353. doi: 10.1186/s13019-025-03625-1.

NO ABSTRACT

PMID:41029744 | PMC:PMC12487582 | DOI:10.1186/s13019-025-03625-1

J Am Heart Assoc. 2025 Oct 7;14(19):e043819. doi: 10.1161/JAHA.125.043819. Epub 2025 Sep 30.

ABSTRACT

BACKGROUND: Given the relatively high morbidity and death associated with transcatheter edge-to-edge repair for secondary mitral regurgitation, the development of optimal risk stratification models is imperative. The J-MACS (Japanese Registry for Mechanically Assisted Circulatory Support) score is a recently developed tool designed to stratify risk in patients with advanced heart failure undergoing durable left ventricular assist device implantation.

METHODS: Data were obtained from the OCEAN-Mitral (Optimized Catheter Valvular Intervention-Mitral) registry on patients with secondary mitral regurgitation and left ventricular ejection fraction <50% who underwent transcatheter edge-to-edge repair. A newly innovated modified J-MACS score, incorporating age, history of cardiac surgery, serum creatinine levels, and postprocedural moderate or greater tricuspid regurgitation, was calculated. Its prognostic significance regarding the primary outcome, comprising all-cause death and heart failure-related hospitalizations, was assessed.

RESULTS: A total of 2006 patients (median age, 77 years; 63% men) were included in the study. The median modified J-MACS score was 13.7 (interquartile range, 12.0-16.2). Based on statistically calculated optimal cutoff values of 11.4 and 14.0, patients were stratified into 3 risk categories: low, moderate, and high. The 2-year cumulative incidence of the primary outcome differed significantly among these groups (26%, 37%, and 51%, respectively; P<0.001). Risk group classification remained independently associated with the primary outcome, with an adjusted hazard ratio of 1.42 (95% CI, 1.13-1.71; P<0.001) for the intermediate risk versus low risk and 2.27 (95% CI, 1.67-2.96; P<0.001) for the high risk versus low risk.

CONCLUSIONS: The modified J-MACS score demonstrated an independent association with all-cause death and heart failure-related hospitalization following transcatheter edge-to-edge repair in patients with significant mitral regurgitation and systolic heart failure.

REGISTRATION: URL: https://upload.umin.ac.jp; Unique Identifier: UMIN000023653.

PMID:41025485 | DOI:10.1161/JAHA.125.043819

Cureus. 2025 Aug 26;17(8):e91027. doi: 10.7759/cureus.91027. eCollection 2025 Aug.

ABSTRACT

Fragility hip fractures are increasingly common in elderly patients and are associated with high morbidity and mortality. Cardiovascular comorbidities-including ischaemic heart disease, heart failure, and valvular disease-contribute significantly to poor outcomes. This study aimed to review perioperative cardiac complications in elderly patients undergoing fragility hip fracture repair and evaluate strategies for optimisation, with emphasis on postoperative atrial fibrillation (POAF), acute myocardial infarction (AMI), heart failure, and management of cardiac implantable electronic devices (CIEDs). We conducted a narrative review drawing data from the databases PubMed, Embase, and the Cochrane Library (January 2000-March 2024). The search terms included "hip fracture," "cardiac complications," "postoperative atrial fibrillation," "myocardial infarction," "heart failure," "valvular disease," and "cardiac implantable electronic devices." Guidelines from the National Institute for Health and Care Excellence (NICE), the European Society of Cardiology (ESC), and the American College of Cardiology/American Heart Association (ACC/AHA) were also reviewed. POAF was observed in ~3-4% of elderly hip fracture patients and is associated with significantly higher one-year mortality (60% vs. 19.5%). Risk factors include surgical delay beyond 48 hours and transfusion of >2 units of packed red blood cells. AMI and perioperative heart failure are frequently underdiagnosed due to atypical presentations. CIED management requires multidisciplinary coordination to avoid device malfunction. Cardiac optimisation in fragility hip fracture patients remains challenging due to heterogeneous evidence and variable practice. Development of validated POAF risk prediction tools, standardised treatment protocols, and structured multidisciplinary pathways may help improve outcomes and reduce healthcare burden.

PMID:41018305 | PMC:PMC12462645 | DOI:10.7759/cureus.91027

Mol Ther. 2025 Sep 27:S1525-0016(25)00814-7. doi: 10.1016/j.ymthe.2025.09.042. Online ahead of print.

ABSTRACT

Patients with Mucopolysaccharidosis type I Hurler (MPSIH) experience multisystem clinical manifestations which are only partially addressed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study evaluated outcomes from a lentiviral vector (LV)-mediated hematopoietic stem and progenitor cell gene therapy (HSPC-GT) trial (NCT03488394) in 8 MPSIH patients followed up to 4 years post-treatment. Key findings included corneal clouding, hearing loss (HL), carpal tunnel syndrome (CTS) and cardiac evaluations. A retrospective comparison with an external cohort of 9 MPSIH patients undergoing allo-HSCT was performed. All patients are alive at last follow-up, show stable engraftment without graft failure, insertional oncogenesis, or immune responses to the transgene. Notably, at last follow-up 3/8 HSPC-GT patients experienced corneal clouding resolution, while all allo-HSCT patients maintained moderate corneal clouding. 4/8 HSPC-GT patients showed normal hearing function at last follow-up due to improvement (n=3) or stabilization (n=1); 7/9 allo-HSCT patients had mild or moderate HL at baseline, while 2/9 showed moderate HL at last follow-up. No HSPC-GT patients required surgery for CTS developed after HSPC-GT, while 7/9 patients needed such surgery after allo-HSCT. No HSPC-GT patients developed severe cardiomyopathy or valvular disease, while in the HSCT cohort 4/9 patients experienced progression of valvular insufficiency although not requiring valve replacement. Our results indicate a favorable effect of HSPC-GT on MPSIH multisystemic manifestations up to 4-year after treatment; long-term, prospective comparative studies are warranted for definitive conclusions.

PMID:41017152 | DOI:10.1016/j.ymthe.2025.09.042

Int J Cardiovasc Imaging. 2025 Sep 29. doi: 10.1007/s10554-025-03508-5. Online ahead of print.

ABSTRACT

Due to the high mortality and morbidity of patients with aortic and mitral endocarditis, careful monitoring is necessary to recognize an early failure of antibiotic and cardiokinetic therapy and avoid a possible cardiogenic or septic shock. The timing of surgery is crucial for patients in whom medical therapy fails. The aim of our study is to identify potential echocardiographic biomarkers of adverse events in patients with left-sided native valve infective endocarditis. Sixty-four patients with aortic and/or mitral valve dysfunction(AOVD, MVD) from infective endocarditis were studied by three-dimensional transesophageal echocardiography(3DTEE) and transthoracic speckle tracking echocardiography(3DSTE). Sixty-four healthy subjects were selected as controls. Vegetation size and valvular features were assessed by 3DTEE. Standard transthoracic echocardiographic parameters were determined. Global left ventricular(LV) longitudinal strain(3D-LVGLS) and area strain(3D-LVGAS) were measured by 3DSTE. Averaged LV rotation and rotational velocities from the base and apex were obtained and used for calculation of LV twist and torsion. Endpoints were embolism and in-hospital mortality. Maximal vegetation dimension was 10 (4-29) mm if measured by 3DTEE and 7 (4-20) mm if measured by 2DTEE (p = 0.02). Valvular and perivalvular complications were present in 21(33%) and 13(20%) patients. AOVD/MVD patients had decreased GLS (p = 0.011), GAS (p = 0.003) and LVtwist (p = 0.024) compared with control subjects. By multivariate analysis, vegetation mobility(p = 0.001), vegetation size(p = 0.003), perivalvular complications(p = 0.006), and bivalvular vegetations(p = 0.009) were independent predictors of embolic events. Valve-related complications(p = 0.001), vegetation size(p = 0.029), 3D-LVGLS(p = 0.013), and 3D-LVGAS(p = 0.002) were predictive of in-hospital mortality. Using a composite endpoint of both outcomes, ROC curves suggested that 3D valvular and LV function parameters had higher diagnostic accuracy for identifying adverse events than 2D parameters. 3D combined evaluation of vegetation size, regurgitant volume and LV area strain had the highest diagnostic accuracy (AUC 0.89, p = 0.001). Significant improvement in global χ2 value was noted with 3D strain parameters compared with LV ejection fraction for predicting outcome (from 82.3 to 90.5, p = 0.004). 3D combined assessment of anatomical-functional valve characteristics and LV function strain parameters improves the sensitivity of the echocardiographic indices in predicting cardiac morbidity and mortality of left-sided native valve infective endocarditis.

PMID:41016998 | DOI:10.1007/s10554-025-03508-5

Eur J Intern Med. 2025 Sep 26:106514. doi: 10.1016/j.ejim.2025.106514. Online ahead of print.

ABSTRACT

BACKGROUND: To provide information on adults with congenital heart disease (ACHD) undergoing non-cardiac surgeries (NCS), specific risk compared non-ACHD, independent risk factors for adverse outcome and mortality.

METHODS: Based on non-selective data including all in-hospital admissions in Germany from 2009 to 2021, all ACHD cases that underwent NCS were selected. NCS was categorized in low, medium and high-risk procedures. As primary endpoints, major adverse cardiovascular events (MACE), major infection (MIE), major bleeding (MBE), major thromboembolism (MTE), and in-hospital death were defined. Outcomes of ACHD were compared to a propensity score matched cohort of non-ACHD.

RESULTS: Overall, 15,349 inpatient ACHD cases were selected for analysis. Of those 72.3 % (n=11,094) were simple, 20.1 % (n=3,086) were moderate and 7.6 % (n=1,169) were complex ACHD. Patients with more than moderate ACHD faced a substantially higher risk for adverse outcome regarding all predefined endpoints compared to non-ACHD. Specifically, risk for MACE was increased with an Odds ratio (OR) of 1.29 (95 % CI 1.11-1.51) for moderate ACHD and OR 1.58 (95 % CI 1.23-2.02) for complex ACHD. In-hospital mortality was OR 1.39 (95 % CI 1.13-1.71) for moderate and OR 2.22 (95 % CI 1.62-3.03) for complex ACHD compared to non-ACHD.

CONCLUSIONS: Patients with more than moderate complexity ACHD are at specific risk for adverse outcomes when undergoing non-cardiac surgery. Further analyses are needed to give precise recommendations on the choice of appropriate surgical site as well as how to improve care and outcome of ACHD undergoing NCS.

PMID:41015714 | DOI:10.1016/j.ejim.2025.106514

Medicina (Kaunas). 2025 Sep 11;61(9):1650. doi: 10.3390/medicina61091650.

ABSTRACT

Background and Objectives: This study aimed to assess the clinical and anatomical predictors of acute cardiac complications after transcatheter aortic valve implantation (TAVI). Materials and Methods: All patients who underwent a TAVI procedure for severe aortic stenosis between November 2016 and May 2025 at a tertiary center in Romania were screened for inclusion. Of those, patients who had available computer tomography valvular sizing reports were included in the present study. Results: A total of 485 patients were included in this study. Balloon-expandable valves were implanted in 381 patients (78.5%), while self-expanding valves were used in 104 patients (21.4%). A total of sixty-nine (14.2%) patients suffered at least one acute cardiac complication following TAVI, and in-hospital death occurred in nine (1.8%) patients. In the multivariable analysis, clinical parameters-such as diabetes mellitus, left bundle branch block, or left ventricular diameter-and anatomic parameters, such as left coronary artery height and sinotubular junction height, were predictors of acute complications. Similarly, periprocedural characteristics, such as maximum transprosthetic gradient and the use of the Portico/Navitor valve platform was also associated with the occurrence of acute complications. Conclusions: A high acute complications rate is typical for TAVI, although most complications can be successfully treated and the in-hospital death rate is low. Left coronary artery height and sinotubular junction height were predictors of acute complications, among other clinical and procedural characteristics.

PMID:41011039 | PMC:PMC12472114 | DOI:10.3390/medicina61091650

Heart Lung Circ. 2025 Sep 25:S1443-9506(25)00493-7. doi: 10.1016/j.hlc.2025.06.005. Online ahead of print.

ABSTRACT

BACKGROUND: The Perceval bioprosthesis is a contemporary sutureless technology utilised for surgical aortic valve replacement (AVR). Perceval valves allow for AVR with reduced cross-clamp and cardiopulmonary bypass times, which correlates with improved postoperative patient morbidity and mortality. However, there is a paucity of literature reporting the medium-term outcomes from Perceval AVR in New Zealand. We aimed to investigate the mid-term outcomes from Perceval AVR at our single centre.

METHOD: All consecutive patients undergoing Perceval AVR (during isolated or combined procedures) at our unit from March 2011 to August 2021 were retrospectively analysed from a prospectively-collected database.

RESULTS: Across the 10-year study period, 145 patients (mean age: 73.2 years; males: 71.7%; mean EuroSCORE II: 3.78%) underwent Perceval AVR. The most common indication for surgery was aortic stenosis (82.5%). The operative caseload was complex, with only 27.6% of patients undergoing first-time isolated AVR. The mean crossclamp and cardiopulmonary bypass times were 74.7±40.6 and 111.3±63.6 minutes respectively. Latest follow-up transthoracic echocardiography (performed at a mean of 2.2±1.7 years postoperatively) revealed that 96% of patients had either none or only trivial paravalvular/transvalvular leaks. The 30-day mortality and stroke rates were 6.2% and 2.1% respectively. Medium-term survival rates across 5-year and 9.5-year follow-up were 70% and 55% respectively. There was only one reoperation on the aortic valve.

CONCLUSIONS: Across an older patient population undergoing complex cardiac surgery, Perceval AVR facilitates acceptable short-term and medium-term outcomes in terms of both prosthetic valvular function and survival.

PMID:41006104 | DOI:10.1016/j.hlc.2025.06.005

JACC Case Rep. 2025 Sep 24;30(29):105142. doi: 10.1016/j.jaccas.2025.105142.

ABSTRACT

BACKGROUND: Bioprosthetic valve failure is a significant and debilitating sequela in cardiac patients caused primarily by structural changes in valve leaflets due to endocarditis, calcification, and thrombosis.

CASE SUMMARY: We describe a rare case of bioprosthetic pulmonary valve failure due to an allergic reaction to molybdenum within the valve cage. We describe the clinical presentation, clinical methods leading to the diagnosis, and treatment progression until we could resolve symptoms and a significant return of valvular competency.

DISCUSSION: After excluding infectious etiologies as a cause, we used skin allergy testing to identify molybdenum as the allergic agent. The patient's symptoms and valve function improved and stabilized with immunosuppression and antihistamines.

TAKE-HOME MESSAGES: Allergy to a valve metal component was diagnosed with skin allergy and treated with immunosuppression and antihistamines.

PMID:41005850 | DOI:10.1016/j.jaccas.2025.105142

J Thorac Cardiovasc Surg. 2025 Sep 24:S0022-5223(25)00793-7. doi: 10.1016/j.jtcvs.2025.09.027. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined the feasibility of creating Cox-Maze IV lesions, including the ablation of the left posterior wall (box) and the isthmus lines, using nanosecond pulsed field ablation (nsPFA) in a beating heart porcine model.

METHODS: Nine pigs underwent surgical nsPFA. Lesions included right atrial appendage, left atrial appendage, left atrial posterior wall (the box), and isthmus lines, as replicated by ablating across the mitral and tricuspid annuli. Each ablation lasted 2.5 - 5 s. At 30 days, the cardiac tissue was examined histologically. Ablation lines were sectioned at 5-mm intervals and stained with 10% triphenyl tetrazolium chloride and Gomori trichrome. Exit block testing and echocardiography were performed before, after, and 30-days post-ablation. Valvular and coronary tissues were assessed by a blinded pathologist.

RESULTS: Seven pigs were survived for an average of 26 ± 8 days. Two pigs died acutely from refractory ventricular fibrillation immediately after transvalvular ablations. Transmurality was confirmed for 99.6% (251/252) of histological cross-sections and 97% (32/33) of lesions. The mean ablated tissue thickness was 6.7 ± 3.3 mm. At 30 days, exit block was confirmed at 94% of available testing sites (16/17). There was no evidence of progression of baseline valvular regurgitation. Histological assessment did not find significant differences between ablated and non-ablated valves or coronary arteries.

CONCLUSION: An nsPFA clamp device effectively created transmural lesions, including the box and isthmus lesions. This non-thermal energy source may shorten procedural time and enable surgical ablation in the beating heart. However, the relationship between nsPFA and ventricular arrhythmias warrants additional study.

PMID:41005435 | DOI:10.1016/j.jtcvs.2025.09.027

Ann Cardiol Angeiol (Paris). 2025 Sep 25;74(5):101954. doi: 10.1016/j.ancard.2025.101954. Online ahead of print.

ABSTRACT

BACKGROUND: Severe calcific aortic stenosis (AS) is the most common valvular heart disease in the elderly and carries a poor prognosis without intervention. The introduction of transcatheter aortic valve implantation (TAVI) in 2002 profoundly reshaped therapeutic strategies. This study aimed to evaluate changes in patient management and outcomes at the Departmental Hospital Center of La Roche‑sur‑Yon over three time periods: 2005 (pre‑TAVI era), 2015 (early TAVI integration), and 2022 (TAVI‑dominant era).

METHODS: We conducted a retrospective, single-center observational study including all patients hospitalized for symptomatic severe AS or reduced left ventricular ejection fraction. Clinical characteristics, operative risk scores, management strategies, and one-year outcomes were analyzed.

RESULTS: Between 2005 and 2022, the number of patients managed for SAS increased by 158% (65 in 2005, 136 in 2015, 168 in 2022). Mean age (79 years in 2022) and male proportion (60%) remained stable. Therapeutic strategies shifted markedly (p < 0.001): surgery predominated in 2005 (67%), whereas TAVI became the most frequent treatment in 2022 (55%), followed by surgery (21%) and medical therapy (24%). Surgically treated patients were increasingly selected, with a median EuroSCORE II falling from 3,95 % (2005) to 1.1% (2022). One-year all-cause mortality in 2022 was 0% after surgery, 5.9% after TAVI (down from 28.8% in 2015, p = 0.008), and 68% with medical therapy (p < 0.001). Heart failure rehospitalizations were also more frequent in the medical group (33% vs 6% after TAVI and 2% after surgery; p = 0.016). The proportion of patients not presented at the heart team meeting declined significantly (17% in 2022 vs 35% before 2015; p < 0.001). The waiting times nevertheless remained significant (median of 70 days between admission and the MDT meeting, plus 41 days before the procedure).

CONCLUSIONS: Integration of TAVI has profoundly transformed AS management in our center, now the dominant strategy with significantly improved one-year prognosis. Medically treated patients still experience poor outcomes, underscoring the need to reduce delays and streamline the care pathway.

PMID:41004876 | DOI:10.1016/j.ancard.2025.101954

Med Sci (Basel). 2025 Jun 20;13(3):81. doi: 10.3390/medsci13030081.

ABSTRACT

Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ significantly, with primary MR requiring direct valvular intervention and SMR necessitating a comprehensive approach incorporating guideline-directed medical therapy (GDMT), revascularization, and resynchronization strategies. The MitraClip, a transcatheter edge-to-edge repair (TEER) device, has emerged as a recommended intervention for symptomatic severe SMR despite optimal GDMT. Objectives: This study aims to evaluate national trends in MitraClip placements in the U.S. from 2016 to 2021 and to assess 90-day readmission events following the procedure. Additionally, we analyze patient and socioeconomic factors associated with heart failure readmissions post-MitraClip placement to optimize patient selection criteria. Methods: The study utilized data from the National Inpatient Sample (NIS) for the years 2016-2021 and the National Readmissions Database (NRD) for 2021. Patients who underwent MitraClip placement were identified using ICD-10 code 02UG3JZ. We stratified the population based on demographics, hospital resource utilization, and comorbidities. Index admissions were classified based on the presence or absence of heart failure remissions within 90 days post-procedure. Statistical analyses, including ANOVA and logistic regression, were conducted to identify factors associated with readmissions. Results: MitraClip utilization demonstrated a rising trend from 2016 to 2021, with total annual procedures increasing from 869 to 2488. Mean patient age remained stable at 76-79 years, with a nearly equal sex distribution. In-hospital mortality remained low (1-3%) throughout the study period. A steady increase in hospital charges was observed, alongside a decline in the mean length of stay. Analysis of 4918 index admissions for MitraClip placement in 2021 identified 780 total readmissions within 90 days, with 206 (26.4%) attributed to heart failure. Factors significantly associated with increased risk of heart failure readmissions included atrial fibrillation (OR 3.77, CI 1.82-4.23), pulmonary hypertension (OR 3.96, CI 1.49-5.55), and chronic lung disease (OR 1.91, CI 1.32-2.77). Conclusions: The increasing adoption of MitraClip underscores its growing role in managing SMR. However, heart failure readmissions remain a significant concern. Identifying high-risk patient profiles can refine selection criteria and enhance post-procedural management strategies to improve clinical outcomes. Further research is needed to optimize patient selection and refine risk stratification for MitraClip interventions.

PMID:41003149 | PMC:PMC12471826 | DOI:10.3390/medsci13030081

Cureus. 2025 Aug 25;17(8):e90972. doi: 10.7759/cureus.90972. eCollection 2025 Aug.

ABSTRACT

Native valve infective endocarditis (IE) refers to infection resulting from the seeding of bacteria onto the heart valves, usually in patients with one or more risk factors such as intravenous drug use, poor dentition or recent dental surgery, prior structural or valvular heart disease, or indwelling cardiac devices. Although viridans group streptococci (VGS) are a common cause of aortic valve endocarditis, it is uncommon for the infection to result from bacterial translocation across the intestinal mucosa during gastroenteritis. This case involves a 64-year-old female who presented with an acute onset of shortness of breath, weakness, nausea, vomiting, rigors, and night sweats lasting two to three weeks. She also reported a week of nonbloody diarrhea that has since resolved. A CT pulmonary angiogram revealed an acute pulmonary embolism (PE) in the right upper lobe without evidence of right heart strain. A transthoracic echocardiogram, obtained during the work-up for her PE, showed a mobile density on the right coronary cusp concerning for vegetation. Transesophageal echocardiogram confirmed a mobile density on the right coronary cusp of the aortic valve, consistent with a vegetation larger than 10 mm. Blood cultures grew Streptococcus oralis/mitis, and the patient was diagnosed with IE. She subsequently underwent early aortic valve replacement with cardiothoracic surgery. The source of the IE in this patient remains unclear. However, based on her history of a week of profuse, nonbloody diarrhea prior to any other symptom onset, it is likely that bacterial translocation from the gut during an acute episode of gastroenteritis was the source of the bacteremia leading to vegetation. While VGS are typical causes of IE, the infection usually originates from the oral cavity and less commonly from the lower GI tract. This patient had no recent dental procedures and no dental issues to suggest an oral route of infection. Her presentation with acute PE and subsequent diagnosis of native aortic valve endocarditis secondary to gastroenteritis was atypical, particularly as it occurred in a native valve without underlying risk factors.

PMID:41001307 | PMC:PMC12459982 | DOI:10.7759/cureus.90972