Valvular cardiac surgery

Res Pract Thromb Haemost. 2025 Jul 29;9(5):102988. doi: 10.1016/j.rpth.2025.102988. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Antithrombotic therapy (AT) after cardiac valve surgery is complex, with guidelines often relying on limited evidence.

OBJECTIVES: This study examines real-world adherence to the European Society of Cardiology Class II, level C recommendations for AT in valve surgery, as well as the 6-month impact of AT on patient outcomes.

METHODS: This prospective, observational subanalysis of the European Society of Cardiology EURObservational Research Programme Valvular Heart Disease II survey included 6 substudies examining different valve interventions and AT regimens. Patient demographics, clinical characteristics, and 6-month outcomes were compared between groups receiving the recommended AT and those who did not.

RESULTS: Guideline adherence varied widely (39.5%-81.1%) across substudies. Factors influencing AT decisions included cardiovascular risk factors, atrial fibrillation, and prior percutaneous coronary intervention. In unadjusted analyses of 3 substudies, 6-month all-cause mortality was significantly higher in patients not receiving the recommended AT. However, no significant differences were observed in thromboembolic events, bleeding, or other complications between AT and non-AT groups across all substudies at 6 months.

CONCLUSION: This analysis reveals potential mortality benefits associated with guideline-recommended AT in some patient groups. However, the observational nature of the study limits causal inferences, emphasizing the importance of further prospective research to optimize AT strategies and improve patient outcomes in this complex clinical setting, particularly as new AT and valve types emerge.

PMID:40933058 | PMC:PMC12419113 | DOI:10.1016/j.rpth.2025.102988

REC Interv Cardiol. 2025 Apr 29;7(3):146-153. doi: 10.24875/RECICE.M25000508. eCollection 2025.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Although early discharge protocols after transcatheter aortic valve implantation (TAVI) have demonstrated to be safe in various studies, they are usually applied in high-experience centers. This study analyzes the length of stay of the first 100 patients undergoing TAVI in a center without on-site cardiac surgery, differentiating between very early (< 24 hours), early (24-48 hours), and late discharge (> 48 hours). Furthermore, the study evaluates the feasibility of an early discharge protocol during the team's learning curve.

METHODS: We conducted a prospective observational study from April 2022 through January 2024. A pre- and postoperative management protocol was implemented, including assessments in the Valvular Heart Disease Clinic, admission to the cardiac surgery intensive care unit with electrocardiographic monitoring, and specific discharge criteria in full compliance with an established protocol for the management of conduction disorders. Early follow-up evaluations were performed in the outpatiently after discharge.

RESULTS: A total of 100 patients (50% women) were included, with a mean age of 82.4 ± 5.3 years and a EuroSCORE II score of 4.38 ± 5.1%. The median length of stay was 2 days (range, 1-19). A total of 27.27% of patients were discharged in < 24 hours, 48.49% within the 24-48 hours following implantation, and 24.24% 48 hours later. The 30-day cardiovascular mortality rate was 1%. A total of 6 patients were readmitted with procedural complications within the first 30 days.

CONCLUSIONS: The implementation of a standardized care protocol allows for early and safe discharge in most patients, even during the team's learning cuve.

PMID:40933016 | PMC:PMC12418241 | DOI:10.24875/RECICE.M25000508

EClinicalMedicine. 2025 Aug 30;88:103477. doi: 10.1016/j.eclinm.2025.103477. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: Paediatric patients who underwent surgery for mitral regurgitation (MR) have a high risk of recurrence or death; however, no prediction tool has been developed to risk-stratify this challenging subpopulation.

METHODS: In this multicentre cohort study, paediatric patients undergoing surgery for congenital MR in Shanghai Children's Medical Center in January 1st, 2009-December 31st, 2022 were included for analysis while those had a combination with infective endocarditis, anomalous left coronary artery from the pulmonary artery, rheumatic valvular disease, connective tissue disease, or single ventricle were excluded. A Cox regression model predictive of the primary outcome (a composite of mortality or mitral valve [MV] re-operation) was derived and converted to a point-based risk score. This score was externally validated in a cohort of patients undergoing MR surgeries between January 1st, 2009 and December, 31st, 2022 in eight independent hospitals in China. The Harrell's c index and Hosmer-Lemeshow test was used to quantify the discrimination and calibration of the risk score.

FINDINGS: In total, 2640 patients (female: 57% [n = 1505]) with a median age of 0.99 (IQR, 0.47-2.60) years were included. The primary outcome occurred in 262 patients (16.6%) over a median of 5.7-year follow-up in the derivation cohort (n = 1581; median age of 1.03 years [IQR, 0.47-2.67]) and in 130 (12.3%) over a median of 7.1-year follow-up in the validation cohort (n = 1059; median age of 0.93 years [IQR, 0.46-2.51]). The score variables included preoperative variables (age, the presence of primary MR, N-terminal pro-brain natriuretic peptide, left ventricular ejection fraction, and left atrium z score), perioperative changes in z scores of LA and left ventricular end-diastolic dimension, and the procedural variable (use of MV annuloplasty or not). This risk score, ranging from -22 to 10, yielded strong discrimination (Harrell's c index: 0.85, 95% CI, 0.83-0.87) and exhibited good calibration of postoperative 10-year primary outcome (Hosmer-Lemeshow; χ2 = 9.85; P = 0.33) in the derivation cohort, which maintained in the validation cohort (Harrell's c index: 0.86, 95% CI, 0.83-0.89; Hosmer-Lemeshow; χ2 = 23.80; P = 0.64). In addition, a simplified stratification of the score model (low-risk: -22 to -5, intermediate risk: -4 to 0, high risk: >0) showed good performances in predicting the primary outcome in both derivation and validation (Ps < 0.001).

INTERPRETATION: The scoring system represents a crucial step towards personalised management care for paediatric MR. However, this model has not been applied in clinical practice and require validation in large and diverse cohorts of patients. Further work should aim to incorporate other novel multi-modality metrics to optimise the PRIMARY score.

FUNDING: Chinese National Natural Science Foundation of China, Science and Technology Commission of Shanghai Municipality, Science and Technology Project of Guizhou Province.

PMID:40926901 | PMC:PMC12414831 | DOI:10.1016/j.eclinm.2025.103477

Eur Heart J. 2025 Sep 9:ehaf609. doi: 10.1093/eurheartj/ehaf609. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Atrial fibrillation (AF) is a prevalent complication after cardiac surgery, worsening patient outcomes. Considering the established role of Ca2+-handling abnormalities in AF pathogenesis, this study aimed to evaluate if integrating cytosolic Ca2+-handling measurements with clinical risk factors enhances the risk prediction of post-operative AF.

METHODS: Clinical data from 558 patients undergoing cardiac surgery without pre-existing AF from two centres were analysed. From 94 of these patients, atrial cardiomyocytes were isolated from collected right atrial appendages and Ca2+ handling (L-type Ca2+ current, intracellular Ca2+ concentration) was assessed using patch-clamp. The predictive performance of combining both clinical and single-cell Ca2+ handling parameters was tested using sequential feature selection and logistic regression models.

RESULTS: Single-cell Ca2+-handling parameters through cluster analysis correlated with post-operative AF development and several cardiac diseases. Integration of Ca2+-handling parameters into a new post-operative AF risk prediction model improved its predictive accuracy by increasing the areas under the receiver operating characteristic (ROC) curves from 0.69 to 0.71 in the training and 0.76 to 0.79 in the validation cohort. Systolic Ca2+ level, along with clinical parameters such as age, left atrial dilatation, valvular heart disease, impaired renal function, and serum magnesium, was identified as an independent risk factor for post-operative AF. Additionally, a predictive score for AF occurrence at discharge and during rehabilitation has been developed, with area under the curve (AUC) values of 0.84 and 0.71, respectively. Incorporating the occurrence of AF during the immediate post-operative period as an additional predictor significantly enhanced the prediction of AF at discharge, achieving an AUC value of 0.94.

CONCLUSIONS: Integrating cellular Ca2+ handling signature with clinical predictors improves the prediction of post-operative AF, highlighting the potential of incorporating functional cellular data into clinical risk models.

PMID:40923107 | DOI:10.1093/eurheartj/ehaf609

JTCVS Open. 2025 Jun 10;26:115-121. doi: 10.1016/j.xjon.2025.05.010. eCollection 2025 Aug.

ABSTRACT

OBJECTIVES: To describe the clinical presentation of patients with gonadal neuroendocrine tumors and carcinoid heart disease (CaHD) and to evaluate long-term outcomes following valvular surgery.

METHODS: Retrospective review of patients with primary gonadal neuroendocrine tumor who were surgically treated for CaHD at our institution between 1990 and 2021.

RESULTS: Eight patients (median age, 70 years) were included in the study, 7 with ovarian tumors and 1 with testicular tumor. None of the patients had liver metastasis at the time of cardiac surgery. Three patients presented with both CaHD symptoms and carcinoid syndrome symptoms (diarrhea and flushing). Three others presented with symptoms of CaHD but without diarrhea or flushing. One patient with ovarian tumor presented with severe diarrhea and flushing without CaHD symptoms and had tumor resection but then developed severe CaHD symptoms few months later. The last patient presented initially with an asymptomatic testicular mass, which was resected, but then developed severe CaHD symptoms years later. All patients had severe tricuspid regurgitation at time of surgery, and 7 had severe pulmonary regurgitation. All were treated with replacement of affected valves. Both 5- and 10-year survival rates were 86% and were higher than a control group of patients with CaHD and nongonadal primary neuroendocrine tumor (35% and 23%, respectively).

CONCLUSIONS: Patients with primary gonadal neuroendocrine tumors can develop CaHD in the absence of liver metastasis. Some patients have delayed presentation of cardiac symptoms, emphasizing the importance of thorough assessment and regular echocardiographic follow-up. Cardiac intervention is safe and yields excellent long-term survival.

PMID:40923064 | PMC:PMC12414394 | DOI:10.1016/j.xjon.2025.05.010

Turk Kardiyol Dern Ars. 2025 Sep 8. doi: 10.5543/tkda.2025.54968. Online ahead of print.

ABSTRACT

OBJECTIVE: Management of aortic stenosis (AS) requires integrating complex clinical, imaging, and risk stratification data. Large language models (LLMs) such as ChatGPT and Gemini AI have shown promise in healthcare, but their performance in valvular heart disease, particularly AS, has not been thoroughly assessed. This study systematically compared ChatGPT and Gemini AI in addressing guideline-based and clinical scenario questions related to AS.

METHOD: Forty open-ended AS-related questions were developed, comprising 20 knowledge-based and 20 clinical scenario items based on the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines. Both models were queried independently. Responses were evaluated by two blinded cardiologists using a structured 4-point scoring system. Composite scores were categorized, and comparisons were performed using Wilcoxon signed-rank and chi-square tests.

RESULTS: Gemini AI achieved a significantly higher mean overall score than ChatGPT (3.96 +- 0.17 vs. 3.56 +- 0.87; P = 0.003). Fully guideline-compliant responses were more frequent with Gemini AI (95.0%) than with ChatGPT (72.5%), although the overall compliance distribution difference did not reach conventional significance (P = 0.067). Gemini AI performed more consistently across both question types. Inter-rater agreement was excellent for ChatGPT (κ = 0.94) and moderate for Gemini AI (κ = 0.66).

CONCLUSION: Gemini AI demonstrated superior accuracy, consistency, and guideline adherence compared to ChatGPT. While LLMs show potential as adjunctive tools in cardiovascular care, expert oversight remains essential, and further model refinement is needed before clinical integration, particularly in AS management.

PMID:40919834 | DOI:10.5543/tkda.2025.54968

Front Cardiovasc Med. 2025 Aug 22;12:1600757. doi: 10.3389/fcvm.2025.1600757. eCollection 2025.

ABSTRACT

INTRODUCTION: Left ventricular assist device (LVAD) implantation is a highly effective procedure for the management of selected advanced heart failure patients, prolonging patient life and improving quality. Additional cardiac pathologies, especially valvular regurgitation or coronary heart disease, are common in LVAD recipients, whereas reports on the surgical management of heart failure combined with aortic disease are rare.

CASE PRESENTATION: We present a case of a 60-year-old patient with an aortic sinus aneurysm, aortic regurgitation, and end-stage heart failure. LVAD implantation was performed concomitantly with the Bentall procedure and Cabrol shunt technique. The patient was discharged uneventfully on postoperative day 26. This suggests that combining LVAD implantation with additional cardiovascular procedures could be an alternative strategy for patients with complex heart failure conditions.

CONCLUSION: LVAD implantation combined with additional aortic surgery can be a feasible alternative with acceptable risk, especially for patients who have elected to pursue LVAD as destination therapy. Successful outcomes require adequate preoperative evaluation, experienced cardiac surgeons, and close postoperative care.

PMID:40918189 | PMC:PMC12411443 | DOI:10.3389/fcvm.2025.1600757

Ann Thorac Surg. 2025 Sep 3:S0003-4975(25)00844-6. doi: 10.1016/j.athoracsur.2025.08.028. Online ahead of print.

ABSTRACT

BACKGROUND: Recent advances in transcatheter valve techniques often compete with open cardiac operations in managing high-risk patients with valvular disease, especially in the elderly. This study assessed late survival and quality of life after valvular surgery in octogenarians with prior sternotomy.

METHODS: We identified octogenarians who underwent cardiac valve reoperations between 2004 and 2023. Study end points were long-term mortality, long-term self-reported physical activity, and general health status.

RESULTS: A total of 934 octogenarians (median age, 83 years; 29% women) had valve reoperations. Reoperations were isolated procedures in 72% (aortic [58%], mitral [10%], and tricuspid [4%]), multiple valve procedures in 16%, and valve + coronary artery bypass graft (CABG) in 12%. Previous operations were isolated CABG in 53%, isolated valve in 27%, valve + CABG in 17%, and others in 3%. Operative mortality was 6%. Total hospital stay was 6 days (4-9 days). Median survival was 5.6 years in this cohort compared with 5.9 years for a sex- and age-matched US population. At 1-, 3-, and 5-year follow-up, most survey respondents reported significant improvement in their general health status and physical activity levels. Renal failure (hazard ratio [HR], 2.1; P < .001), history of atrial fibrillation (HR, 1.2; P = .029), peripheral vascular disease (HR, 1.2; P = .026), cerebrovascular disease (HR, 1.2; P = .022), moderate or severe chronic lung disease (HR, 1.7; P < .001), and concomitant tricuspid valve surgery (HR, 1.5; P = .0022) were independently associated with increased late mortality.

CONCLUSIONS: Repeated valve surgery in octogenarians can be performed with excellent short- and long-term outcomes. Age alone should not be a contraindication to reoperation for patients requiring intervention for valvular disease.

PMID:40912622 | DOI:10.1016/j.athoracsur.2025.08.028

J Heart Lung Transplant. 2025 Sep 5:S1053-2498(25)01951-5. doi: 10.1016/j.healun.2025.04.015. Online ahead of print.

NO ABSTRACT

PMID:40910964 | DOI:10.1016/j.healun.2025.04.015

Neurologia (Engl Ed). 2025 Sep;40(7):668-675. doi: 10.1016/j.nrleng.2025.07.009.

ABSTRACT

BACKGROUND: Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHA2DS2-VASc ≥2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously.

OBJECTIVE: To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA2DS2-VASc ≥2) and to determine adequate timing of its performance.

METHODS: This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (n=31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n=97; 75.8%), after 90 days.

RESULTS: Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHA2DS2-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9±34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group.

CONCLUSIONS: Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.

PMID:40903150 | DOI:10.1016/j.nrleng.2025.07.009

Ann Med Surg (Lond). 2025 Aug 2;87(9):5870-5877. doi: 10.1097/MS9.0000000000003662. eCollection 2025 Sep.

ABSTRACT

Rheumatic heart disease (RHD) and papillary fibroelastoma (PFE) are distinct cardiovascular disorders that can rarely occur together. RHD is a chronic condition caused by untreated streptococcal infections, primarily affecting the mitral valve and resulting in severe valvular damage. On the other hand, PFE is a benign heart tumor, usually affecting the aortic valve, and is typically asymptomatic, often discovered incidentally through imaging. The simultaneous presence of RHD and PFE, especially involving the mitral and aortic valves, has only been reported in two case studies. This review examines the pathophysiology, clinical features, diagnostic challenges, and treatment options for both conditions. Echocardiography is the primary diagnostic tool, and surgery, involving tumor removal and valve replacement, is the standard treatment for symptomatic cases. Although this dual condition is rare, the review highlights the significance of early detection, particularly in areas where RHD is common, and calls for additional research to explore the potential connections between these conditions and improve patient care.

PMID:40901114 | PMC:PMC12401350 | DOI:10.1097/MS9.0000000000003662

Eur Heart J. 2025 Sep 3:ehaf519. doi: 10.1093/eurheartj/ehaf519. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Aortic stenosis may be managed differently in women and men, but evidence remains limited. Sex-specific characteristics and outcomes of low- to intermediate-risk patients assigned to transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) from the DEDICATE-DZHK6 trial are described.

METHODS: The DEDICATE-DZHK6 trial demonstrated non-inferiority for the primary outcome of all-cause death or stroke at 1 year. Sex-specific effects were evaluated in this predefined descriptive subgroup analysis.

RESULTS: A total of 1394 patients (43.3% women) were included. Women were older (women: 74.8 ± 4.6 years vs men: 74.2 ± 4.2 years, P = .020) and at higher operative risk [median Society of Thoracic Surgeons risk score 2.1% (1.5-2.7) vs 1.5% (1.0-2.2), P < .001]. All-cause death or stroke at 1 year was 5.2% in the TAVI vs 11.5% in the SAVR group [hazard ratio (HR) 0.46; 95% confidence interval (CI) 0.25-0.82] in women and 5.4% vs 9.0% (HR 0.61; 95% CI 0.35-1.03) in men. At 1 year after TAVI vs SAVR, all-cause death occurred in 2.6% vs 6.7% (HR 0.41; 95% CI 0.17-0.90) in women and 2.6% vs 5.9% (HR 0.44; 95% CI 0.20-0.88) in men. Stroke occurred in 2.6% vs 6.2% (HR 0.43; 95% CI 0.18-0.93) in women and 3.1% vs 3.6% (HR 0.89; 95% CI 0.41-1.90) in men.

CONCLUSIONS: Among patients with severe aortic stenosis at low to intermediate risk, TAVI was non-inferior to SAVR for the primary outcome in women and men with lower event rates in patients assigned to TAVI. Women were at particular risk for early complications irrespective of the assigned treatment and at increased stroke risk after SAVR.

PMID:40900118 | DOI:10.1093/eurheartj/ehaf519

BMJ Open. 2025 Sep 2;15(9):e096823. doi: 10.1136/bmjopen-2024-096823.

ABSTRACT

INTRODUCTION: Evidence-based early rehabilitation intervention after heart valve surgery has been proven to have many benefits, but the experience of implementing nurse-led early rehabilitation combining exercise and psychology is still lacking. It is urgent to find a more acceptable and cost-effective method to provide exercise intervention and psychological support. The aim of this study is to design a nurse-led cardiac rehabilitation programme to increase the physical capacity and mental health for heart valve patient based on broaden-and-build theory.

METHODS AND ANALYSIS: A non-blinded randomised controlled trial will be conducted. A total of 86 adults diagnosed with heart valve disease will be recruited and randomly assigned to the control group and intervention group. The recovery for valvular heart disease intervention, based on the broaden-and-build theory, will be guided one-on-one by a multidisciplinary team and will consist of two main components: physical intervention and psychological intervention. The baseline assessment will be conducted 1 to 2 days after admission, and sequent evaluations will be implemented at post-intervention, 3 months after intervention and 6 months after intervention. The primary outcome is the finding of six-min walk test and mental state. Other outcomes include quality of life, 36-item short-form health survey, Short Physical Performance Battery, stress, coping modes and social support.

ETHICS AND DISSEMINATION: This study was conducted following the Helsinki Declaration and was approved by the ethics committee of the Zhong Da Hospital, Southeast University (2024ZDSYLL098-P01). The results of this study are scheduled to be published in relevant peer-reviewed journals.

TRIAL REGISTRATION NUMBER: Registered at the Chinese Clinical Trials.gov (ChiCTR2400090853).

PMID:40897479 | PMC:PMC12406905 | DOI:10.1136/bmjopen-2024-096823

Glob Heart. 2025 Aug 28;20(1):71. doi: 10.5334/gh.1462. eCollection 2025.

ABSTRACT

BACKGROUND: The clinical significance of atherosclerotic disease in more than one vascular bed, that is, polyvascular disease, in valvular heart surgery remains poorly understood. This study aims to establish the prevalence and prognostic value of polyvascular disease for long-term outcomes after valvular heart surgery.

METHODS: Patients receiving valvular heart surgery at two tertiary centres from January 1, 2010 to December 31, 2021 were identified. We examined the effect of atherosclerotic disease in three major vascular beds, including coronary artery disease (CAD), ischaemic cerebrovascular accidents (CVA) and peripheral vascular disease (PVD), on postoperative major adverse cardiac events (MACE) and all-cause mortality. Polyvascular disease was defined as atherosclerotic disease in ≥2 vascular beds.

RESULTS: Of 3843 patients (mean age 58 ± 13 years; 52% male), 1266 (33%) had atherosclerotic disease in ≥1 vascular beds, including 207 (5.4%) with polyvascular disease. Patients with vascular disease were older with more comorbidities, higher surgical risk and more aortic stenosis. Over a median follow-up of 6.37 years (IQR: 3.40-9.54), patients with polyvascular disease had the greatest long-term MACE risk [HR: 1.68 (1.35-2.10)], followed by those with monovascular disease [HR: 1.43 (1.24-1.65)]. Both monovascular and polyvascular disease independently predicted mortality and MACE. Patients with extracardiac vascular disease had independently greater long-term MACE risk than CAD [HR: 1.56 (1.27-1.92)].

CONCLUSION: Patients undergoing valvular heart surgery exhibit a high prevalence of vascular disease. The risk of adverse outcomes rises with both the presence and extent of vascular disease, and extracardiac vascular disease confers greater risk of MACE than CAD.

PMID:40894084 | PMC:PMC12396194 | DOI:10.5334/gh.1462

BMC Anesthesiol. 2025 Sep 1;25(1):441. doi: 10.1186/s12871-025-03317-2.

ABSTRACT

BACKGROUND: The implantation of a Swan-Ganz catheter for invasive hemodynamic monitoring is an established measure after cardiac surgery. A rare but serious complication is the formation of a knot in the heart, which can be diagnostically challenging. We report on a patient who developed left heart failure postoperatively after quadruple bypass surgery combined with aortic valve replacement and in whom a knot formed inadvertently during monitoring using a Swan-Ganz catheter.

CASE PRESENTATION: An 82-year-old female underwent combined quadruple coronary artery bypass grafting and aortic valve replacement for severe coronary and valvular heart disease. Postoperatively, she experienced acute left ventricular dysfunction, necessitating mechanical circulatory support with an Impella device. A Swan-Ganz catheter was placed through the internal jugular vein for accurate hemodynamic monitoring. After placement, unexpected catheter immobility raised suspicion of an intracardiac knot. Initial transthoracic echocardiography did not clearly visualize the lesion; however, subsequent chest radiography and jugular vein ultrasound confirmed catheter-associated intracardiac knot formation. Considering the heightened risk for cardiac injury and thromboembolic events, interdisciplinary consensus recommended bedside surgical extraction. The catheter and associated knot were successfully removed via transcutaneous vascular incision without complications. Inspection revealed knot formation proximal to the catheter thermistor, while the balloon remained intact and functional.

CONCLUSION: Intracardiac knot formation associated with Swan-Ganz catheter placement is rare but presents significant risks. Timely interdisciplinary assessment, multimodal imaging, and surgical extraction under controlled conditions effectively mitigate potential complications, enabling safe catheter removal and favorable patient outcomes.

PMID:40890593 | PMC:PMC12403380 | DOI:10.1186/s12871-025-03317-2

Open Heart. 2025 Sep 1;12(2):e003476. doi: 10.1136/openhrt-2025-003476.

ABSTRACT

BACKGROUND: Valvular surgery for infective endocarditis (IE) can improve survival but carries substantial risk. Limited data exist on long-term outcomes for patients who survive surgery compared with a background population. We aim to compare long-term mortality and morbidity in patients with IE, who survive 90-days following valvular surgery to a matched Danish background population.

METHODS: Using Danish registries, we identified patients who survived >90 days post-valvular surgery for first-time IE (2010-2023). Each patient was matched 1:3 with controls from the background population by age, sex and selected comorbidities. All-cause mortality was assessed at 5 and 10 years using the Kaplan-Meier estimator and the multivariate Cox model. Further, we examined the time spent in hospital during the first year following the index date.

RESULTS: We identified 1050 patients (77.5% male, median age 65.8 years) surgically treated for IE and 3150 controls. The most common pathogens were: Viridans group streptococci (44.6%), Staphylococcus aureus (23.1%), Enterococci (17.9%). Patients with IE had higher absolute 5-year (20.1% vs 12.9%, p=0.001) and 10-year (38.5% vs 27.9%, p<0.001) mortality compared with controls. Adjusted 5-year and 10-year mortality rates were also higher in patients with IE (5-year HR=1.49 (95% CI 1.24 to 1.79) and 10-year HR 1.38 (95% CI 1.19 to 1.60)). Patients with IE experienced more frequent and longer hospitalisations within the first year postsurgery, as 36.8% patients with IE were hospitalised within the first year following index compared with 17.5% in the matched controls. 9.3% of patients with IE were hospitalised for >14 days compared with 3.0% in matched controls. 60 patients with IE (5.7%) died within the first year following index compared with 51 (1.6%) in the matched controls.

CONCLUSION: Patients with IE who underwent valve surgery had a higher crude mortality than their controls from the background population. After adjusting for confounders, 5-year and 10-year mortality rates remained higher in the IE patient population.

PMID:40890021 | DOI:10.1136/openhrt-2025-003476

Eur Heart J. 2025 Sep 1:ehaf674. doi: 10.1093/eurheartj/ehaf674. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: While surgical left atrial appendage occlusion (SLAAO) reduces stroke in atrial fibrillation (AF) patients, its efficacy in patients without pre-operative AF but with CHA₂DS₂-VASc ≥2 remains uncertain despite their high post-operative AF risk (15-54%). The aim of this study was to evaluate whether prophylactic SLAAO reduces post-operative thrombo-embolic events in valvular surgery patients.

METHODS: The OPINION was a multicentre, open-label, randomized, superiority trial conducted at three cardiac surgery centres in China. Eligible non-AF patients with CHA₂DS₂-VASc ≥2 and an indication for valve repair or replacement due to mitral or aortic valve lesions were randomly assigned (1:1) to undergo SLAAO (intervention arm) or not undergo SLAAO (control arm) during surgery. The primary outcome was a composite of ischaemic stroke, transient ischaemic attack (TIA), or cardiovascular mortality assessed at 1 year. The primary analysis was done in the intention-to-treat population.

RESULTS: Between April 2021 and June 2024, a total of 2157 patients were enrolled and randomized. After exclusion of 39 patients who withdrew informed consent, 2118 participants were included in the intention-to-treat population (1062 in the SLAAO group and 1056 in the control group). Baseline characteristics were well-balanced between the SLAAO group and control group (mean age 55.5 [11.4] vs 55.6 [11.5] years, P = .65; female 32.9% vs 32.3%, P = .78; CHA2DS2-VASc score 2.88 [0.98] vs 2.87 [0.96], P = .83; median EuroSCORE II 1.58% [1.42%] vs 1.56% [1.28%], P = .74). The 1-year primary endpoint occurred in 73 (6.9%) patients in the SLAAO group and in 87 (8.2%) patients in the control group (hazard ratio 0.83; 95% confidence interval 0.61-1.14; P = .25).

CONCLUSIONS: For valvular surgery patients with CHA₂DS₂-VASc scores ≥2 but no pre-operative AF, routine prophylactic left atrial appendage closure did not significantly reduce the incidence of the primary composite endpoint (ischaemic stroke, TIA, and cardiovascular mortality) at 1-year follow-up.

TRIAL REGISTRATION: ChiCTR.org registry ChiCTR2100042238.

PMID:40888584 | DOI:10.1093/eurheartj/ehaf674

Circ Cardiovasc Interv. 2025 Sep;18(9):e015702. doi: 10.1161/CIRCINTERVENTIONS.125.015702. Epub 2025 Sep 1.

ABSTRACT

BACKGROUND: Transcatheter tricuspid valve annuloplasty (TTVA) with the Cardioband system is a safe and effective option for high-risk patients with symptomatic severe tricuspid regurgitation (TR). Hemodynamics play a crucial role in these patients. However, it remains unclear if hemodynamic changes after TTVA are linked to clinical outcomes.

METHODS: Consecutive patients with severe functional TR who underwent TTVA between 2019 and 2022 were retrospectively analyzed. Right heart catheterization was performed before and after cinching to assess hemodynamic parameters, including XV height (difference between the V-wave and the nadir of right atrial pressure). The primary end point was 2-year survival.

RESULTS: Fifty-eight patients with complete hemodynamic assessment were included. All patients presented with torrential (40%), severe (38%), or massive (22%) TR. TR was reduced by ≥2 grades in 83% and by ≥1 grade in 97%. Hemodynamics following TTVA showed significant increases in median cardiac index (2.4-2.8 L/[min·m²]), pulmonary artery pulsatility index (1.73-2.13), and right ventricle cardiac power index (0.15-0.21 W/m²). Right atrial pressure (mean/V-wave) decreased significantly, with the most notable change in XV height (12.5 to 7 mm Hg; P<0.001). Lower postprocedural XV height independently predicted 2-year survival (P=0.002) and was significantly associated with lower TR grade at follow-up (P=0.002) and right ventricle reverse remodeling (P<0.001). Immediate right ventricle remodeling was also associated with 2-year survival (P=0.024).

CONCLUSIONS: Postprocedural XV height was independently associated with 2-year survival and linked to TR reduction and right ventricle remodeling. TTVA improves hemodynamics even in advanced TR, and hemodynamic markers may support risk stratification.

PMID:40888413 | DOI:10.1161/CIRCINTERVENTIONS.125.015702

World J Transplant. 2025 Sep 18;15(3):102768. doi: 10.5500/wjt.v15.i3.102768.

ABSTRACT

Heart transplantation is a life-saving procedure for many people throughout the world. Data shows that in 2024, there was an increase in the volume of adult heart transplantation in the United States even as there was a decrease in the volume of pediatric heart transplantation to the lowest volume in a decade. Organ availability remains a major limiting factor affecting transplant volume. This mandates that innovation must take place to increase the supply of donor organs. While some strategies such as donation after cardiac death, hepatitis C virus + transplantation, and ABO-incompatible transplantation have increased the pool for donation, it still falls short of meeting the demand. Other proposed strategies include splitting the donor heart to provide multiple partial heart transplants, domino partial heart transplantation, changes in legislation including opt-out legislation, and xenotransplantation. Further evolution and refinement of these strategies will make a meaningful impact on patients awaiting life-saving heart transplants.

PMID:40881767 | PMC:PMC12038578 | DOI:10.5500/wjt.v15.i3.102768

J Am Heart Assoc. 2025 Sep 2;14(17):e041907. doi: 10.1161/JAHA.125.041907. Epub 2025 Aug 29.

ABSTRACT

BACKGROUND: The association of outcomes with initial clip selection has not been investigated in patients undergoing transcatheter edge-to-edge repair with the MitraClip G4.

METHODS: We analyzed 2257 patients receiving the MitraClip G4 according to the initial clip type: short (NT/NTW) versus long (XT/XTW) and narrow (NT/XT) versus wide (NTW/XTW). We performed a propensity-matched analysis of baseline anatomical features in patients with primary and secondary mitral regurgitation (MR).

RESULTS: The proportions of the initial clip types were as follows: NT, 18.9%; NTW, 41.7%; XT, 5.1%; and XTW, 34.3%. The proportions of the MR severity ≤1+ at discharge and 1 year were not significantly different among the 4 clip types. The incidence of death or heart failure hospitalization was not significantly different between the initial long and short clip groups and between the initial wide and narrow clip groups. After propensity matching, in patients with primary MR, long clips were significantly associated with a greater MR reduction (2.87±0.89 versus 2.62±0.99, P=0.04) and a higher proportion of the MR severity ≤1+ at 1 year (68.2% versus 48.6%, P=0.04) than short clips. In patients with secondary MR, long or wide clips had a similar MR severity at discharge and 1 year as short or narrow clips.

CONCLUSIONS: Residual MR severity and outcomes were not different regardless of the initial clip type, indicating the optimal clip selection in the real-world settings with the MitraClip G4. In patients with primary MR, greater and more durable MR reduction may be expected by using the initial long clips.

REGISTRATION: URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN-ID: UMIN000023653.

PMID:40879026 | DOI:10.1161/JAHA.125.041907