Valvular cardiac surgery

Biomolecules. 2025 May 6;15(5):670. doi: 10.3390/biom15050670.

ABSTRACT

Cardiomyopathies comprise a heterogeneous group of cardiac disorders characterized by structural and functional abnormalities in the absence of significant coronary artery disease, hypertension, valvular disease, or congenital defects. Major subtypes include hypertrophic, dilated, arrhythmogenic, and stress-induced cardiomyopathies. Oxidative stress (OS), resulting from an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, has emerged as a key contributor to the pathogenesis of these conditions. ROS-mediated injury drives inflammation, protease activation, mitochondrial dysfunction, and cardiomyocyte damage, thereby promoting cardiac remodeling and functional decline. Although numerous studies implicate OS in cardiomyopathy progression, the precise molecular mechanisms remain incompletely defined. This review provides an updated synthesis of current findings on OS-related signaling pathways across cardiomyopathy subtypes, emphasizing emerging therapeutic targets within redox-regulatory networks. A deeper understanding of these mechanisms may guide the development of targeted antioxidant strategies to improve clinical outcomes in affected patients.

PMID:40427563 | PMC:PMC12108637 | DOI:10.3390/biom15050670

Biomedicines. 2025 May 21;13(5):1256. doi: 10.3390/biomedicines13051256.

ABSTRACT

Hypertrophic cardiomyopathy (HCM) is often associated with left ventricular outflow tract (LVOT) obstruction, which affects a substantial proportion of patients. This obstruction results from a range of anatomical abnormalities involving both the valvular and subvalvular structures. Pharmacological therapies play a pivotal role in the management of LVOT obstruction, with a range of drug classes exhibiting distinct mechanisms of action. Beta-blockers, including atenolol and nadolol, are considered the first-line treatment due to their ability to reduce heart rate and myocardial contractility and enhance diastolic filling. Non-dihydropyridine calcium channel blockers, such as verapamil and diltiazem, are utilized as second-line agents when beta-blockers are ineffective or contraindicated. Disopyramid, a Class 1A antiarrhythmic agent, is employed for patients who do not respond to initial therapeutic interventions and can reduce LVOT gradients. Recent advancements in cardiac myosin modulators, such as Mavacamten and Aficamten, offer targeted therapies by modulating myosin-actin interactions to reduce LVOT gradients and improve symptoms, with promising results from clinical trials. Although gene therapy is still in its nascent stages, it has the potential to address the genetic basis of HCM by employing techniques such as genome editing, gene replacement, and the modulation of signaling pathways. For patients exhibiting severe symptoms or demonstrating unresponsiveness to medical treatment, invasive therapies, such as septal reduction therapy and alcohol septal ablation, are considered. Ultimately, the treatment and prevention of atrial fibrillation and sudden cardiac death are two key points of HCM management in both obstructive and non-obstructive forms. This review aims to provide an overview of current pharmacological and invasive strategies, as well as emerging therapies, in the management of HCM.

PMID:40427081 | PMC:PMC12108688 | DOI:10.3390/biomedicines13051256

World J Pediatr Congenit Heart Surg. 2025 May 27:21501351251339390. doi: 10.1177/21501351251339390. Online ahead of print.

ABSTRACT

BACKGROUND: To improve understanding of indications and outcomes for cardiac surgery for rheumatic aortic valvular disease in the young.

METHODS: Single institution retrospective cohort aged < 18 years with rheumatic heart disease who underwent surgery for isolated rheumatic aortic valve disease between 2000 and 2019. Baseline, intermediate follow-up, and late follow-up data were collected. Left ventricular (LV) dysfunction defined as LV ejection fraction < 55% or LV shortening fraction < 27%.

RESULTS: Thirty-nine patients who were 8 to 18 years of age were included (median age 14 years), weighing 27 to 157 kg (median 78 kg) with follow up of 2 to 15 years (median 7 years). Index operations were valve repair 6 of 39 (15%), valve replacement 33 of 39 (84%) with homograft (n = 20), and mechanical valve (13). The 30-day mortality was zero. Overall mortality was 8 of 39 (20%); 17 of 39 (43%) underwent reoperation. At intermediate and late follow up, 27% (7/26) and 53% (18/34) had persistent dysfunction, respectively. Baseline LV dysfunction increased the risk of death (hazard ratio 13.3 [1.52-115.5], P = .003), which increased adjusting for higher body surface area (BSA). All those with baseline weight > 105 kg either died or had LV dysfunction at late follow up (P = .001). Freedom from late valve-related complications at 5, 10, and 15 years was 72%, 31%, and 23%, respectively.

CONCLUSIONS: Preoperative LV dysfunction is associated with an increased risk of death for pediatric patients undergoing isolated rheumatic aortic valve surgery. This risk increases further, adjusting for BSA. There was a high rate of reoperations and late complications.

PMID:40421517 | DOI:10.1177/21501351251339390

J Cardiothorac Surg. 2025 May 26;20(1):238. doi: 10.1186/s13019-025-03471-1.

ABSTRACT

BACKGROUND: Pulmonary valve replacement (PVR) is the most common valve replacement procedure for pulmonary valve dysfunction in congenital heart diseases (CHD). Despite the long-term need for anticoagulation and potential bleeding complications in mechanical PVR (MPVR), prosthetic dysfunction and reoperation might occur less frequently. The major guidelines on the CHD management have no recommendation on the valve type for the PVR. So, we systematically reviewed the latest literature on the efficacy and safety of MPVR with different etiologies.

METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered with PROSPERO (CRD42023425339). A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase. The primary outcomes evaluated include all-cause mortality, reintervention for mechanical prostheses, valvular thrombosis, thromboembolic events, prosthetic valve dysfunction, major bleeding events, right ventricular failure, and infective endocarditis. A random-effects model was employed for the meta-analysis. The quality of the studies was assessed using the Newcastle-Ottawa Scale.

RESULTS: The literature search was conducted up to June 12, 2023, and included 16 records in the qualitative synthesis, with 13 studies also included in the quantitative synthesis. Our systematic review indicates that the previously published patient-level analysis remains the most reliable evidence to date on MPVR, with 91%, 97%, and 95% 5-year freedom from valvular thrombosis, reintervention, and all-cause mortality, respectively. Our meta-analysis indicated low pooled incidence proportions of other outcomes as follows: Major bleeding (mean follow-up = 68.79 months, 16/336, 5% [95% CI 3-8]); Valvular dysfunction (mean follow-up = 68.89 months, 70/708, 10% [95% CI 8-12]); Thromboembolic events (mean follow-up = 78.28 months, 9/293, 3% [95% CI 2-6]); and Infectious endocarditis (mean follow-up = 42.03 months, 7/518, 1% [95% CI 1-3]).

CONCLUSIONS: Despite showing acceptable efficacy and safety in MPVR, there is still a significant knowledge gap in choosing the most appropriate prosthetic valve in patients undergoing PVR. High-quality research is warranted to resolve the existing gap in evidence.

PMID:40420269 | PMC:PMC12105212 | DOI:10.1186/s13019-025-03471-1

J Clin Exp Hepatol. 2025 Sep-Oct;15(5):102554. doi: 10.1016/j.jceh.2025.102554. Epub 2025 Mar 27.

ABSTRACT

Liver transplantation (LT) is the only cure for patients with end-stage liver disease. With an increase in the prevalence of obesity and associated metabolic risk factors cardiovascular disease, in particular coronary artery disease is increasingly recognised in patients with liver cirrhosis. Identification and management of these cardiovascular risk factors may influence post-transplant clinical outcomes. A detailed assessment of patients' cardiovascular status is therefore crucial in the decision-making of patients for LT. Identification of patients with CAD requires risk stratification around perioperative and long term post-operative period. Advanced age, male sex, smoking diabetes mellitus, hypertension, obesity and metabolic-associated steatohepatitis (MASH) cirrhosis significantly increase the risk of coronary artery disease (CAD). Patients with these high-risk factors should undergo cardiac investigations with higher sensitivity to identify CAD. Patients with low-risk factors for CAD may undergo cardiac investigations with high specificity. Patients with cirrhosis may also suffer from conditions directly related to liver disease such as cirrhotic cardiomyopathy and porto-pulmonary hypertension, and conditions unrelated to liver disease such as arrhythmias. Rarely, valvular heart disease may be identified during transplant evaluation. Clinicians managing patients for liver transplantation should carefully evaluate cardiovascular risk and treat it appropriately prior to the surgery, to minimise post-transplant complication. A multidisciplinary approach involving transplant physicians, anaesthetists, cardiologists and transplant surgeons is strongly recommended.

PMID:40415922 | PMC:PMC12099453 | DOI:10.1016/j.jceh.2025.102554

REC Interv Cardiol. 2024 Jul 9;6(3):191-200. doi: 10.24875/RECIC.M24000470. eCollection 2024 Jul-Sep.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative and less invasive treatment to surgical aortic valve replacement (SAVR). Left ventricular global longitudinal strain (LV-GLS) can reveal changes in left ventricular performance before involvement of ejection fraction. Our aim was to present and evaluate our center's experience regarding short- and long-term reverse left ventricular remodeling using two-dimensional-speckle tracking echocardiography-derived LV-GLS after TAVI compared with SAVR.

METHODS: Our multidisciplinary cardiac team carefully evaluated 65 patients for SAVR who presented with severe symptomatic aortic stenosis and who had high, intermediate, or low surgical risk. The patients underwent either TAVI with an Evolut-R self-expanding valve or SAVR. Echocardiographic evaluation was performed before, 1 month, and 1 year after the procedure.

RESULTS: TAVI was performed in 31 patients and SAVR in 34 patients. The incidence of valvular and paravalvular leak was higher in the TAVI group despite early favorable LV remodeling with a significant decrease in left ventricular mass index and E/e' shortly after the procedure and an early detectable improvement in LV-GLS from -8.18 ± 1.81 to -14.52 ± 2.52, reaching -16.12 ± 2.69 at 1 year (P < .001). This early improvement was not observed in the SAVR group. TAVI preserved right ventricular function without affecting tricuspid annular plane systolic excursion or increasing estimated pulmonary artery pressure.

CONCLUSIONS: Patients who underwent TAVI had earlier and significantly better LV remodeling with early reduction in left ventricular mass index, E/e' ratio, and significant early improvement in LV-GLS without concomitant impairment of left ventricular ejection fraction percentage or deterioration of right ventricular function.

PMID:40415771 | PMC:PMC12097341 | DOI:10.24875/RECIC.M24000470

Interv Cardiol Clin. 2025 Jul;14(3):425-432. doi: 10.1016/j.iccl.2024.09.006.

ABSTRACT

Mitral valve stenosis remains highly prevalent among the US population although with dramatically shifting demographics. The significance of rheumatic mitral disease in developing nations persists, despite improvements in preventative measures and early detection, and its presence in developed countries is still evident as observed through international migration. In addition, the substantial growth in the aging population with a heightened occurrence of concurrent cardiovascular risk factors is leading to an increased prevalence of chronic calcific degeneration and degeneration of previously repaired or replaced valves. This article aims to review various transcatheter therapies in the treatment of mitral valve stenosis.

PMID:40414666 | DOI:10.1016/j.iccl.2024.09.006

BMJ Open. 2025 May 24;15(5):e101417. doi: 10.1136/bmjopen-2025-101417.

ABSTRACT

BACKGROUND: Aortic valve stenosis (AVS) represents the most prevalent primary valvular lesion necessitating surgical intervention or transcatheter intervention in Europe and North America. Its prevalence is increasing at a rapid rate as a consequence of the ageing population. A variety of mechanical interventions are available to determine the management of AVS; however, there is currently a paucity of robust data with which to perform a comparative analysis of the efficacy of surgical aortic valve replacement (SAVR) and that of conventional stented xenograft bioprostheses (BP) or sutureless aortic valves (SAV) and transcatheter aortic valve implantation (TAVI). The present study aims to compare the effectiveness and clinical outcomes of SAVR using BP or SAV technique and TAVI in patients with severe AVS.

METHODS AND ANALYSIS: A collaboration between three cardiac surgery centres across two European countries has resulted in the conception of the Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement trial. This prospective non-randomised trial is designed to evaluate the long-term outcomes of TAVI in comparison to SAVR for AVS in patients at risk of severe valve obstruction. The registry will enrol successive patients who have undergone mechanical intervention for AVS between January 2015 and December 2025. Investigators will assess the difference between replacement procedures for both the standard surgical approach and the transcatheter procedure. The principal clinical outcome under consideration will be the composite degree of all-cause mortality, ischaemic stroke or rehospitalisation at 10 years. The present study will also have a number of secondary endpoints, including all-cause mortality, followed by functional status, hospitalisation, neurocognition, physiological measures (echocardiographic assessment), adverse events and reoperation.

ETHICS AND DISSEMINATION: It is hypothesised that the nature of the trials will serve to minimise bias related to institutional volume and surgical experience. Each participating centre is required to have an aortic valve programme that enables proper follow-up and management of any late aortic events following replacement surgery for the AVS. The data collected will provide valuable insight into the comparative effectiveness of various surgical approaches, both standardised and advanced, in aortic valve surgery and TAVI. This comprehensive analysis will contribute significantly to the development of robust international guidelines.

TRIAL REGISTRATION NUMBER: Clinical Trial Gov.Com. ID: NCT05261204 IRB. ID: 2022011057.

PMID:40413055 | PMC:PMC12104930 | DOI:10.1136/bmjopen-2025-101417

J Am Coll Radiol. 2025 May;22(5S):S67-S78. doi: 10.1016/j.jacr.2025.02.038.

ABSTRACT

Cardiac risk stratification is clinically useful prior to initiation of oncologic therapy in asymptomatic patients in order to guide treatment decisions and allow for initiation of cardioprotective therapy or modification of treatment regimens. Once oncology treatment is underway, patients may develop cardiac symptoms. In this setting, imaging can be used for assessment of ventricular and valvular function, myocardial characterization, pericardial effusion or constriction, as well as to evaluate for ischemia as a cause of symptoms. Results can help guide treatment choices and shared decision-making regarding modification or cessation of treatments with associated cardiotoxicity. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

PMID:40409896 | DOI:10.1016/j.jacr.2025.02.038

JACC Case Rep. 2025 May 21;30(11):103312. doi: 10.1016/j.jaccas.2025.103312. Epub 2025 Apr 9.

ABSTRACT

Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension and valvular heart disease. The accurate assessment of RV function is however limited by the presence of concomitant tricuspid regurgitation (TR). Implantation of a novel transcatheter tricuspid valve device in this case highlights the importance of recognizing these limitations, and the need to define alternative ways to measure RV systolic function, contextualized to pulmonary pressure in patients with severe TR. It also demonstrates the clinical potential of perforation of the pop-off zone in this prosthesis, to create mild residual TR, thereby reducing the increase in RV afterload of this intervention, and its impact on RV systolic function.

PMID:40409857 | DOI:10.1016/j.jaccas.2025.103312

Circ Heart Fail. 2025 May 22:e012489. doi: 10.1161/CIRCHEARTFAILURE.124.012489. Online ahead of print.

ABSTRACT

Recent findings emphasize the potential role of invasive hemodynamic assessment in guiding transcatheter mitral and tricuspid valve percutaneous interventions. Right heart catheterization-derived parameters offer insights into hemodynamic changes associated with valvular heart diseases, pulmonary hypertension phenotyping, and right ventricular to pulmonary artery coupling. This might improve prognostic stratification for candidates to transcatheter therapies. This review provides a clinical overview of available data regarding the utility of preoperative right heart catheterization-derived parameters in patients undergoing mitral and tricuspid percutaneous repair or replacement.

PMID:40401405 | DOI:10.1161/CIRCHEARTFAILURE.124.012489

Cardiol J. 2025 May 22. doi: 10.5603/cj.104429. Online ahead of print.

NO ABSTRACT

PMID:40401360 | DOI:10.5603/cj.104429

JACC Asia. 2025 May 3:S2772-3747(25)00224-8. doi: 10.1016/j.jacasi.2025.03.011. Online ahead of print.

ABSTRACT

Valvular heart disease poses a significant health burden in the Asia-Pacific region, with its epidemiology varying widely across countries caused by diverse socioeconomic and health care situations. Rheumatic heart disease remains prevalent, especially in low- to middle-income areas, while degenerative valvular diseases are emerging in developed regions caused by an aging population. Significant disparities in access to health care and intervention result in variable clinical outcomes. In the past decade, transcatheter interventions have revolutionized the management of patients with valvular heart disease globally. In the Asia-Pacific region, the uptake and development of transcatheter valvular interventions has been slow until recent years. Continued collaboration across the Asia-Pacific region is essential to mitigate the impact of the upcoming surge of valvular heart disease in this diverse and rapidly changing area.

PMID:40396937 | DOI:10.1016/j.jacasi.2025.03.011

Comput Biol Med. 2025 Jun;192(Pt B):110398. doi: 10.1016/j.compbiomed.2025.110398. Epub 2025 May 18.

ABSTRACT

BACKGROUND: Aortic annuloplasty, involving the implantation of an external ring around the aortic root to reduce annular dimensions, is a promising treatment for aortic valve insufficiency. However, its hemodynamic effects remain underexplored due to the absence of computational models validated by experimental and clinical data.

METHODS: This study introduces a computational fluid-structure interaction (FSI) model of supra valvular aortic annuloplasty using 4D-flow magnetic resonance imaging (MRI). Native and post-annuloplasty conditions of idealized aortic root phantoms, including the aortic valve, were CAD-modelled and 3D-printed with elastic resin. These phantoms were tested in a mock circulatory flow-loop providing normal pulsatile physiologic conditions using a glycerol-water mixture to simulate blood viscosity. Flow and pressure data collected from sensors were used as boundary conditions for FSI simulations. Experimental velocity fields from 4D-flow MRI were compared to computational results to assess model accuracy.

RESULTS: MRI scans of the annuloplasty model showed an increased peak systolic velocity (up to 145.4 cm/s) and localized flow alterations, corresponding to a higher pressure gradient across the valve. During regurgitation, the annuloplasty model showed broader velocity distributions compared to the native condition. The FSI simulations closely matched 4D-flow MRI data, with strong correlation coefficients (r > 0.93) and minimal Bland-Altman differences, particularly during systolic phases.

CONCLUSIONS: This study establishes an integrative methodology combining in-vitro, in-silico, and clinical imaging techniques to evaluate aortic annuloplasty hemodynamics. The in-vitro validated digital twin framework offers a pathway for patient-specific modelling, enabling prediction of surgical outcomes and optimization of aortic valve repair strategies.

PMID:40388869 | DOI:10.1016/j.compbiomed.2025.110398

Cureus. 2025 Apr 18;17(4):e82515. doi: 10.7759/cureus.82515. eCollection 2025 Apr.

ABSTRACT

Cardiac arrhythmias are common in post-coronary artery bypass graft (CABG) settings. It is a common practice to use temporary epicardial pacing wires at the end of cardiac surgery to prevent fatal arrhythmias (e.g., bradycardia,atrioventricular (AV) block, and asystole). It may also be used for sequential atrio-ventricular pacing for improved cardiac output in patients with poor ejection fraction. Epicardial wires are usually implanted around the right atrium and ventricle. Not every patient requires temporary epicardial pacing. However, certain risk factors may predispose patients to life-threatening AV blocks and ventricular tachyarrhythmias. These risk factors include advancing age, valvular surgery, poor left ventricular function, structural heart disease, diabetes mellitus, preoperative beta-blocker or digoxin use, and pre-existing history of arrhythmias. Only a handful of cases have been described in the literature where this seemingly lifesaving measure can trigger life-threatening events. Here, we describe a case where epicardial pacing wires trigger ventricular arrhythmias due to improper sensing.

PMID:40385734 | PMC:PMC12085962 | DOI:10.7759/cureus.82515

Kardiol Pol. 2025 May 14. doi: 10.33963/v.phj.105656. Online ahead of print.

NO ABSTRACT

PMID:40365895 | DOI:10.33963/v.phj.105656

Clin Cardiol. 2025 May;48(5):e70152. doi: 10.1002/clc.70152.

ABSTRACT

BACKGROUND: Left atrial appendage occlusion (LAAO) is an established therapy for stroke prevention in non-valvular atrial fibrillation (NVAF), but outcomes in Hispanic populations remain underexplored.

OBJECTIVE: The objective of our study was to evaluate the inpatient outcomes of Hispanic patients undergoing LAAO as compared to non-Hispanic white patients.

METHODS: We conducted a retrospective cohort study using the National Inpatient Sample (NIS). From 157 434 LAAO hospitalizations identified, 133 517 were non-Hispanic white and 6814 were Hispanic/Latino. The primary outcome was in-hospital mortality.

RESULTS: Unadjusted odds in the Hispanic/Latino group were higher for mortality (OR 1.78, 95% CI 1.18-2.68, p 0.006), stroke (OR 1.64, 95% CI 1.26-2.14, p < 0.001), infectious complications (OR 3.89, 95% CI 3.03-4.99, p < 0.001), major bleeding (OR 1.22, 95% CI 1.11-1.33, p < 0.001), DVT/PE (OR 2.15, 95% CI 1.58-2.93, p < 0.001), and vascular complications (OR 1.81, 95% CI 0.53-0.93, p < 0.001). After adjusting for covariates and comorbidities, Hispanic/Latino patients had still greater odds of mortality (aOR 1.20, 95% CI 0.75-1.92, p 0.445), infectious complications (aOR 3.54, 95% CI 2.62-4.55, p < 0.001), and vascular complications (aOR 1.57, 95% CI 1.22-2.03, p < 0.001). Non-Hispanic white patients had higher adjusted odds of pericardial effusion/tamponade (aOR 0.64, 95% CI 0.52-0.95, p 0.03), while Hispanic/Latino patients also had higher adjusted odds of cardiac arrest (aOR 1.99, 95% CI 1.15-3.42, p 0.46).

CONCLUSION: Hispanic/Latino patients undergoing LAAO experience higher odds of infectious and vascular complications compared to non-Hispanic white patients. These findings highlight the need to further investigate disparities in procedural outcomes.

PMID:40365821 | PMC:PMC12076124 | DOI:10.1002/clc.70152