Valvular cardiac surgery

Eur Heart J. 2025 Aug 29:ehaf194. doi: 10.1093/eurheartj/ehaf194. Online ahead of print.

NO ABSTRACT

PMID:40878295 | DOI:10.1093/eurheartj/ehaf194

Eur J Cardiothorac Surg. 2025 Aug 2;67(8):ezaf276. doi: 10.1093/ejcts/ezaf276.

NO ABSTRACT

PMID:40878291 | DOI:10.1093/ejcts/ezaf276

Yonsei Med J. 2025 Sep;66(9):529-536. doi: 10.3349/ymj.2024.0455.

ABSTRACT

PURPOSE: The morphological and functional characteristics and clinical significance of the left atrial appendage (LAA) are well established in patients with non-valvular atrial fibrillation (AF). However, data on the LAA characteristics in patients with mitral valve (MV) disease are limited. This study aimed to identify the LAA characteristics in AF patients with severe MV disease.

MATERIALS AND METHODS: A total of 506 AF patients who underwent cardiac computed tomography (CT) as preoperative evaluations for MV surgery were retrospectively analyzed. The prevalences of different LAA morphologies (cactus, cauliflower, windsock, chicken wing), LAA ostium diameter, LAA volume, and LAA flow stasis or thrombus were assessed. The LAA variables were compared according to the predominant MV dysfunction.

RESULTS: The most common LAA morphology was cactus (n=211, 41.7%), followed by cauliflower (n=143, 28.3%), windsock (n=90, 17.8%), and chicken wing (n=60, 11.9%). The average LAA ostium maximal diameter and LAA volume were 35.3±8.0 mm and 22.1±15.1 mL, respectively. LAA stasis was found in 215 patients (42.5%) and LAA thrombus in 93 patients (18.4%). Patients with mitral stenosis predominance showed significantly smaller LAA volume compared to those with mitral regurgitation predominance (17.8±11.7 mL vs. 26.9±16.8 mL, p<0.001). However, LAA flow stasis [190 (71.7%) vs. 25 (10.4%), p<0.001] and thrombus [89 (33.6%) vs. 4 (1.7%), p<0.001] were remarkably prevalent in these patients.

CONCLUSION: Due to advanced LAA remodeling in AF patients with severe MV disease, the morphologic distribution of LAA types differs from that established in patients without MV disease.

PMID:40873139 | PMC:PMC12394754 | DOI:10.3349/ymj.2024.0455

Eur J Med Res. 2025 Aug 29;30(1):818. doi: 10.1186/s40001-025-03096-z.

ABSTRACT

BACKGROUND: Critical gaps persist in clinical guidelines and resuscitation strategies for induction and maintenance phase peri-anesthetic cardiac arrest (IM-PACA), urgently necessitating exploration of feasible solutions during anesthesia induction and maintenance periods. This study evaluates a modified cardiopulmonary bypass (CPB) strategy for managing IM-PACA in valvular heart disease (VHD) surgical patients.

METHODS: A retrospective analysis was performed on IM-PACA patients (n = 21) from 1,043 cardiac valve surgeries between March 2019 and January 2022 as the cardiac arrest-resuscitation group (CAR group). Patients who completed normal cardiac valve surgery (n = 84) were randomly selected from the medical record database as the Routine Surgery group (RS group), serving as a benchmark control for the standard efficacy of routine surgery. The CAR group completed surgery after modified cardiopulmonary bypass strategy; the RS group completed surgery as planned. This study reviewed the possible causes of cardiac arrest in the CAR group and performed statistical analysis on surgical time-related metrics (total surgical duration, cardiopulmonary bypass duration, etc.) and postoperative follow-up data (paravalvular leak, cardiac-related complications, etc.) using SPSS 26.0.

RESULTS: The short-term postoperative survival rate was 95.24% in the CAR group and 100% in the RS group. Baseline characteristics including gender, age, and smoking history showed no significant differences between the two groups (P > 0.05). The CAR group showed a significantly shorter pericardiotomy-to-CPB time (250.00 (205.00-269.50) vs. 512.50 (459.25-563.00) s; P < 0.001), but longer rewarming time (68.00 (63.50-74.50) vs. 48.00 (35.25-61.75) min; P < 0.001), ventilator duration (980.00 (619.00-1106.50) vs. 900.00 (630.00-1103.75) min; P = 0.002), and higher day 2 drainage (190 (157.50-215.00) vs. 105 (71.25-150.00) ml; P < 0.001) compared to the RS group. Other intraoperative and postoperative parameters revealed no statistically significant differences when compared with the RS group (P > 0.05).

CONCLUSIONS: For IM-PACA patients undergoing cardiac valve surgery, the modified cardiopulmonary bypass strategy is an effective rescue method, and the strategy of continuing surgery after resuscitation is completely feasible.

PMID:40877919 | PMC:PMC12395764 | DOI:10.1186/s40001-025-03096-z

Biomedicines. 2025 Jul 30;13(8):1856. doi: 10.3390/biomedicines13081856.

ABSTRACT

Background: The prevalence of cardiogenic shock (CS) resulting from the progression of heart failure (PHF) is increasing and remains associated with high mortality. This study aimed to compare the clinical characteristics and outcomes of patients who developed CS due to PHF versus those whose CS was caused by other aetiologies (non-PHF). Methods: We retrospectively analysed 280 patients admitted to a Polish tertiary care centre between January 2021 and April 2024. The cohort was divided into two groups: PHF (n = 84, 30%) and non-PHF (n = 196, 70%). Results: Compared to the non-PHF group, PHF patients more frequently had chronic kidney disease (30% vs. 15%, p < 0.01), and significant valvular disease (30% vs. 13%, p < 0.01). PHF patients exhibited significantly lower white blood cell counts (9.4 [6.9-16.4] vs. 13.3 [10.4-17.6], p < 0.01) and troponin T levels (188 [61-1392] vs. 10,921 [809-45,792], p < 0.01). In-hospital mortality was significantly lower among PHF patients (52% vs. 65%, p = 0.04). Although the overall use of mechanical circulatory support (MCS) did not differ between groups, significant differences in the types of MCS applied were observed (p < 0.01). Additionally, PHF patients underwent fewer coronary revascularisation procedures (15% vs. 70%, p < 0.01). Conclusions: Patients with PHF-related CS exhibit distinct clinical profiles and may experience lower in-hospital mortality when appropriately diagnosed and treated with a personalised approach. Further prospective, multicentre studies are warranted to optimize the management of this growing subgroup of CS patients.

PMID:40868111 | PMC:PMC12383962 | DOI:10.3390/biomedicines13081856

Radiol Cardiothorac Imaging. 2025 Aug;7(4):e240218. doi: 10.1148/ryct.240218.

ABSTRACT

Left ventricular assist devices (LVADs) are used for short-term support, as a bridge to transplant, or as destination therapy in patients with end-stage systolic heart failure. Imaging plays a crucial role in assessing the anatomic suitability for implantation and in detecting complications following both implantation and explantation. LVAD-associated complications can affect the pump, inflow cannula, outflow graft, or driveline. Echocardiography is effective for evaluating inflow cannula position and certain parameters, such as inflow and outflow velocities, valvular regurgitation, and ventricular dilatation; however, its ability to visualize the interiors of the inflow and outflow cannulas is limited. MRI is contraindicated for patients with LVADs. Contrast-enhanced chest CT imaging has become the preferred diagnostic modality for evaluating outflow graft complications. This imaging essay describes the CT findings and complications associated with LVADs, particularly the commercially available HeartMate II and HeartMate 3 devices (Abbott Laboratories). The HeartWare device (Medtronic), although recalled by the U.S. Food and Drug Administration, will also be mentioned. Keywords: Cardiac Assist Devices, CT Imaging Supplemental material is available for this article. © RSNA, 2025.

PMID:40874839 | DOI:10.1148/ryct.240218

Echocardiography. 2025 Sep;42(9):e70279. doi: 10.1111/echo.70279.

ABSTRACT

BACKGROUND: Transcatheter edge-to-edge mitral valve repair (TEER) is an effective and safe method for treating high-risk patients with severe mitral regurgitation (MR). Two approved devices, MitraClip (Abbott Vascular) and PASCAL (Edwards Lifesciences), use leaflet approximation to reduce MR and may also influence annular dimensions via leaflet tension. The purpose of this study is to analyze the acute mitral annular dimensional changes following PASCAL implantation and correlate with long-term results.

METHODS: A retrospective analysis was conducted on 115 high-risk patients (mean age 76 ± 11 years) with moderate-to-severe and severe MR (grade 3.9 ± 0.3, EROA 49± 23 mm2, LV ejection fraction 47% ± 14%). All patients had elevated surgical risk scores (logistic EuroSCORE 23.6% ± 11.5%, EuroSCORE II 6.9% ± 5%, STS Score 5.5± 4.2). Intraprocedural transesophageal echocardiography (TOE) was post-analyzed using specialized software to assess mitral annular geometry.

RESULTS: PASCAL effectively reduced MR (grade 3.9 ± 0.3 to 1.2 ± 0.5, p < 0.001) in all patients. Significant reductions in 3D annulus area (15 ± 4cm2 to 13.9 ± 4cm2, 7.1% ± 9.9%, p < 0.001) and perimeter (14 ± 1.7 cm to 13.5 ± 1.8 cm, 3.2% ± 5.9%, p < 0.001) were observed in 77.4% of our cohort immediately after TEER. Anterior-posterior (AP) diameter showed greater reduction (4.1 ± 0.6 cm to 3.8 ± 0.6 cm, p < 0.001, 6.3% ± 7.8%) compared to medial-lateral diameter (4.3 ± 0.5 cm to 4.2 ± 0.6 cm, p < 0.001, 3.2% ± 8%), and these changes resulted in a more elliptic valve at the end of the procedure (ellipticity from 105% ± 8% to 109% ± 10%, p = 0.001). The reduction of the annulus dimensions correlated with the residual MR at discharge (p = 0.001), while these patients also achieved optimal long-term echocardiographic results with mild MR (p = 0.019).

CONCLUSIONS: TEER with PASCAL acutely reduces mitral annular dimensions, favoring a more elliptic valve shape, particularly through AP diameter reduction. These changes correlate with sustained MR improvement.

PMID:40873407 | DOI:10.1111/echo.70279

Int J Cardiol. 2025 Aug 25;442:133826. doi: 10.1016/j.ijcard.2025.133826. Online ahead of print.

ABSTRACT

BACKGROUND: The long-term natural history of moderate tricuspid regurgitation (TR) patients with preserved left-ventricular ejection fraction (LVEF) and without severe left-sided valvular heart disease (VHD) remains ambiguous. We aimed to assess the outcomes of patients with moderate TR, preserved LVEF and without concomitant severe left-sided VHD.

METHODS: We evaluated patients diagnosed with moderate TR in our centers between 2012 and 2020. The primary outcome was all-cause death, the secondary outcome was the composite of all-cause death+heart failure (HF) hospitalization, also accounting for pulmonary artery systolic pressure (PASP) values and concomitant moderate left-sided VHD.

RESULTS: Among 1198 moderate TR patients, 53 % had New York Heart Association class ≥II and mean LVEF was 58 ± 5 %. After a median follow-up of 2.9 years, 3-year survival was 69 % (95 % confidence interval [CI]: 66 %-72 %), significantly worse than an age- and gender-matched population (p < 0.001), and 3-year survival free from the secondary composite outcome was 63 % (95 % CI: 60-67 %). At secondary analysis, increasing PASP values were associated with worse adjusted prognosis, and in patients with PASP <35 mmHg 3-year survival free from the primary and secondary outcome was 85 % (95 % CI: 80 %-89 %) and 80 % (95 % CI: 75 %-86 %), respectively. Finally, among patients with concomitant moderate left-sided VHD groups, the group with moderate aortic stenosis+moderate TR presented the worst adjusted prognosis, and patients with isolated moderate TR had a yearly mortality of 8.9 % (95 % CI: 6.0 %-11.0 %).

CONCLUSIONS: Our cohort of moderate TR patients, despite having preserved LVEF and no concomitant severe left-sided VHD, presented significant risk of death and of HF hospitalization.

PMID:40865733 | DOI:10.1016/j.ijcard.2025.133826

G Ital Cardiol (Rome). 2025 Sep;26(9):656-665. doi: 10.1714/4542.45430.

ABSTRACT

Atrial secondary tricuspid regurgitation (A-STR) is a complex and increasingly recognized form of valvular heart disease that arises primarily due to right atrial and tricuspid annular dilation in the absence of intrinsic leaflet pathology. Unlike ventricular secondary tricuspid regurgitation, which is driven by right ventricular remodeling, A-STR is predominantly associated with atrial fibrillation, heart failure with preserved ejection fraction, and other conditions that lead to chronic right atrial remodeling. This condition has been underappreciated despite its significant prevalence and impact on patient morbidity and mortality. Echocardiography is the primary diagnostic tool for diagnosing and assessing patients with A-STR. The natural history of A-STR is unfavorable, with potential worsening over time, particularly if the underlying conditions are not properly treated. Treatment options include cardioversion of atrial fibrillation and medical treatment of heart failure with preserved ejection fraction, which may promote reverse remodeling of the right heart structures and reduce STR severity in some cases. Surgical tricuspid valve annuloplasty remains the gold standard for severe cases, but transcatheter interventions are emerging as potential alternatives. This review provides a comprehensive overview of A-STR, encompassing its epidemiology, pathophysiology, diagnostic approaches, and treatment strategies. By synthesizing current evidence and highlighting gaps in knowledge, this paper aims to guide clinicians in the management of this challenging condition and to inspire future research.

PMID:40864484 | DOI:10.1714/4542.45430

JAMA. 2025 Sep 23;334(12):1077-1083. doi: 10.1001/jama.2025.13580.

ABSTRACT

IMPORTANCE: Partial heart transplant, or living valve replacement, has the potential to advance surgical management of irreparable valvular disease by providing a viable option with capacity for growth.

OBJECTIVES: To describe the early experience and assess the feasibility, safety, and efficacy of partial heart transplant in patients with congenital heart valve disease.

DESIGN, SETTING, AND PARTICIPANTS: Case series of the first 19 patients to undergo partial heart transplant at a single high-volume pediatric cardiac surgery and transplant center in the US between April 2022 and December 2024. No patients were excluded or lost to follow-up.

EXPOSURES: Partial heart transplant using semilunar valves from donor hearts. Maintenance immunosuppression consisted of tacrolimus monotherapy with a trough level goal of 4 to 8 ng/mL.

MAIN OUTCOMES AND MEASURES: Efficacy was defined as growth of the transplanted valve annulus and leaflets over time. Secondary outcomes included valve dysfunction and complications related to immunosuppression.

RESULTS: Among the 19 participants with irreparable congenital heart valve dysfunction, 53% were male and 47% female. The median age at the time of transplant was 97 days. The median follow-up was 26 weeks. Three patients received partial heart transplant of both semilunar valves, 7 underwent living pulmonary valve replacement in the pulmonary position, 2 had a living aortic valve allograft in the aortic position, and 7 had a living aortic valve allograft in the pulmonary position. Nine patients constituting the initial cohort of partial heart transplant recipients had their annular diameter and valve leaflet length longitudinally analyzed for growth. All valves functioned well and demonstrated growth along appropriate z scores. Annular diameter increased from medians of 7 mm (aortic valve) and 9 mm (pulmonary valve) to 14 mm (aortic valve) and 17 mm (pulmonary valve), respectively. Leaflet length similarly increased from medians of 0.5 mm (aortic valve) and 0.49 mm (pulmonary valve) to 1 mm (aortic valve) and 0.675 mm (pulmonary valve), respectively. One patient required reoperation unrelated to the implanted valve. No significant complications related to immunosuppression were observed.

CONCLUSIONS AND RELEVANCE: Partial heart transplant appears feasible, safe, and efficacious. All transplanted valves demonstrated growth based on annular and leaflet length measurements. Careful follow-up and monitoring are crucial to support the continued expansion of this novel technique.

PMID:40864436 | PMC:PMC12457970 | DOI:10.1001/jama.2025.13580

Int J Surg Protoc. 2025 Mar 20;29(2):26-29. doi: 10.1097/SP9.0000000000000039. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Rheumatic heart disease (RHD) remains a major health challenge in Africa, where the prevalence is notably high. Valvular surgery is a crucial procedure for managing severe RHD. However, the current state and historical trend of research on this subject in African populations is not well understood. Understanding the scope, subject matter, and quality of the literature on this topic over time is essential to inform future research and clinical practice.

OBJECTIVE: This paper aims to assess the current published literature to evaluate vital outcomes such as surgical outcomes, survival rates, postoperative complications, long-term quality of life, morbidities, mortalities, and barriers to valve surgery for patients with RHD in Africa.

METHODS: This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). An extensive search will be conducted across different databases, including PubMed, Scopus, Web of Science, Cochrane Library, African Index Medicus, and African Journals Online. Studies will be identified through keyword searches and will be reviewed against predefined inclusion and exclusion criteria by two reviewers, with a third reviewer resolving any discrepancies. A narrative synthesis will be conducted to describe the findings.

CONCLUSION: The findings from this scoping review will provide an understanding of the current literature on valvular surgery for RHD in African contexts. This will help guide future research directions in this field.

PMID:40861286 | PMC:PMC12373035 | DOI:10.1097/SP9.0000000000000039

J Surg Case Rep. 2025 Aug 23;2025(8):rjaf663. doi: 10.1093/jscr/rjaf663. eCollection 2025 Aug.

ABSTRACT

Papillary fibroelastoma (PFE) is a rare, benign cardiac tumor usually arising from the heart valves, whereas non-valvular involvement is uncommon. We report herein a case of a 71-year-old Asian male who developed an ischemic stroke during hospitalization for gastrointestinal bleeding. A stroke workup led to the incidental detection of a cardiac mass in the left ventricular outflow tract, later confirmed as PFE following surgical excision without complications. This case highlights the importance of cardiac imaging in patients with cryptogenic stroke and supports early surgical excision to prevent recurrent embolic events.

PMID:40860283 | PMC:PMC12374799 | DOI:10.1093/jscr/rjaf663

Anaesthesia. 2025 Aug 26. doi: 10.1111/anae.16753. Online ahead of print.

ABSTRACT

INTRODUCTION: Peri-operative anaemia is a common problem in patients undergoing cardiac surgery. Postoperative anaemia is not well understood relative to pre-operative anaemia; limited data exist on haemoglobin recovery and mortality after discharge, especially in the era of restrictive transfusion practice. We aimed to investigate the associations of pre-operative and persistent postoperative anaemia with 1-year mortality in patients undergoing valvular heart surgery.

METHODS: We identified patients who had undergone valvular heart surgery and allocated them to one of four groups based on their pre-operative (haemoglobin ≥ 130 g.l-1 and < 130 g.l-1 in men and ≥ 120 g.l-1 and < 120 g.l-1 in women) and postoperative (measured 2 months after surgery; haemoglobin ≥ 100 g.l-1 and < 100 g.l-1 in both men and women) anaemia status. The four groups were: pre- and postoperative non-anaemia (non-anaemia-non-anaemia); pre-operative anaemia-postoperative non-anaemia (anaemia-non-anaemia); pre- and postoperative anaemia (anaemia-anaemia); and pre-operative non-anaemia-postoperative anaemia (non-anaemia-anaemia). The primary outcome was 1-year mortality.

RESULTS: Data from 2486 patients were included. Pre-operative anaemia was diagnosed in 1107 patients (44.5%) and 279 (11.9%) met the diagnostic criteria for persistent anaemia 2 months postoperatively. The overall 1-year mortality rate was 3.3%. The highest rate was observed in the anaemia-anaemia group (17.8%), followed by the non-anaemia-anaemia (13.1%), anaemia-non-anaemia (2.9%) and non-anaemia-non-anaemia (0.5%) groups. Multivariable Cox regression analysis showed that the non-anaemia-anaemia group had the highest risk of 1-year mortality (adjusted hazard ratio 14.44, 95%CI 4.88-42.69), followed by the anaemia-anaemia group (adjusted hazard ratio 10.94, 95%CI 4.41-27.16).

DISCUSSION: Our study highlights the high prevalence of persistent anaemia following valvular heart surgery. Persistent anaemia 2 months postoperatively is associated with an increased risk of 1-year mortality.

PMID:40859452 | DOI:10.1111/anae.16753

Braz J Cardiovasc Surg. 2025 Aug 26;40(5):e20240405. doi: 10.21470/1678-9741-2024-0405.

ABSTRACT

OBJECTIVE: To evaluate the long-term performance of a bovine pericardium valve prosthesis in individuals who required valve replacement in the Brazilian public health system.

METHODS: Medical records of patients having mitral or aortic valve replacement with bovine pericardium valve prostheses between 1978 and 1994 at a Brazilian hospital were reviewed in this retrospective study. Safety was assessed through the complications and serious adverse events rates in the early and long terms. Successful valve replacement was defined by absence of complications and serious adverse events up to 30 days after surgery.

RESULTS: A total of 439 surgeries were performed in 382 patients with a mean age of 46.45 ± 13.93 years. Mean follow-up time was 6.26 years (up to 26.13 years). Rheumatic etiology was present in 83.5% of the cases. Mitral valve replacement was the most performed surgery. Five complications in five patients were recorded up to 30 days after surgery, and the rate of serious adverse events for the same period was 10.3%. Successful valve replacement rate was 90.7%. Postoperative complications were reported during the follow-up period in 29.6% of the procedures, being calcification the most common with 17.3%.

CONCLUSIONS: Despite the young age of the patients, safety outcomes were in accordance with what is reported in the literature for bioprostheses, with acceptable complication, serious adverse events, and freedom from reintervention rates.

PMID:40857581 | PMC:PMC12400614 | DOI:10.21470/1678-9741-2024-0405

J Med Life. 2025 May;18(5):494-508. doi: 10.25122/jml-2025-0085.

ABSTRACT

Postoperative atrial fibrillation (POAF) is a frequent complication of cardiac surgery associated with adverse outcomes. Systemic inflammation is implicated in POAF pathogenesis, suggesting inflammatory biomarkers may have predictive value. This study investigated the predictive capacity of readily accessible inflammatory markers for POAF during the early postoperative period in the cardiac intensive care unit, particularly within the 48-72-hour window when POAF most commonly occurs. In this prospective, single-center study, we enrolled 70 patients undergoing elective cardiac surgery with cardiopulmonary bypass. We measured preoperative and postoperative (24h, 48h) levels of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-17A (IL-17A). POAF was systematically monitored. We assessed the predictive value of these markers using ROC curve analysis and logistic regression, adjusting for clinical risk factors. The coronary cohort showed that the NLR at both 24 hours and 48 hours were the most discriminative markers for predicting POAF, with PCR at 48 hours achieving a moderate AUC of 0.66. In multivariate regression models, PCR at 48 hours (P = 0.009) and age (P = 0.046) emerged as significant predictors, while NLR and CPB duration were moderately correlated with the occurrence of POAF. In contrast, within the valvular patient subgroup, the NLR again exhibited promising predictive value, along with increased markers of tissue injury such as CK, LDH, and creatinine. Readily accessible postoperative inflammatory markers, particularly NLR at 24 hours and CRP at 48 hours, demonstrated moderate predictive value for POAF in patients undergoing elective cardiac surgery. These markers, especially NLR and CRP, may potentially contribute to improved POAF risk stratification in clinical practice when combined with clinical risk factors. Furthermore, our analysis also indicates that preoperative IL-17A levels may influence the occurrence of POAF. Therefore, alongside CRP and NLR, preoperative IL-17A can be considered a potentially significant marker for atrial fibrillation following cardiac surgery. However, these findings are preliminary and require validation in larger, multi-center studies to confirm their clinical utility and inform preventative strategies.

PMID:40599146 | PMC:PMC12207702 | DOI:10.25122/jml-2025-0085

Sci Rep. 2025 Jul 2;15(1):22770. doi: 10.1038/s41598-025-98828-w.

ABSTRACT

Cerebral embolic protection (CEP) devices may be a tool to mitigate the perioperative stroke risk in cardiac surgery. However, studies are limited. The aim of this study was to analyze the feasibility, safety, and efficacy of CEP use in high-risk cardiac surgery. Ten high-risk surgical candidates with native valvular heart disease (mainly mitral with severe MAC) or failed bioprosthesis were consecutively enrolled between March 2023 and April 2024. All participants underwent open-heart surgery with use of Sentinel CEP. The CEP device was successfully deployed and recaptured in all cases without any Sentinel-related complications reported. Clearly visible, large deposits of calcium debris were captured. No significant neurological deficits (above mild neurological dysfunction; NIHSS > 5) were reported in any of the patients. Nine patients suffered postprocedural complications ranging from new-onset left bundle branch block to cardiogenic shock. One individual gradually deteriorated and ultimately died. Importantly, her neurological status remained intact throughout the course of the hospitalization. All other patients were discharged in good standing. The current study extends the early experience demonstrating the feasibility and safety of Sentinel CEP in high-risk cardiac surgery. Particularly in the highest-risk patient sub-sets CEP devices may offer advantages reducing the risk of periprocedural episodes and improving outcomes.

PMID:40596683 | PMC:PMC12215302 | DOI:10.1038/s41598-025-98828-w

Semin Thorac Cardiovasc Surg. 2025 Jun 27:S1043-0679(25)00092-9. doi: 10.1053/j.semtcvs.2025.04.009. Online ahead of print.

ABSTRACT

Ischemic mitral regurgitation (IMR) is a complex heterogeneous complication following myocardial infarction, characterized by left ventricular (LV) remodeling and subsequent valvular distortion. The primary mechanisms include papillary muscle displacement, mitral leaflet tethering, and impaired coaptation following annular dilatation. IMR is associated with poor prognosis and an increased incidence of heart failure. We reviewed studies on the surgical management of IMR published over the past two decades. While mitral valve repair has been favored for its advantages of low perioperative mortality and LV function preservation, high rates of mitral regurgitation recurrence limit its long-term durability. Regarding repair strategy, apart from restrictive mitral annuloplasty, the adjunctive techniques of papillary muscle relocation, papillary muscle approximation, and leaflet augmentation have been proposed. These approaches aim to address LV remodeling and improve leaflet coaptation by mitigating subvalvular tethering. Moreover, the application of true-size annuloplasty and "functional repair" strategies in IMR patients with enlarged LV emphasizes the need to tailor interventions to patients' LV dimensions and dynamic changes. Accumulating clinical evidence highlights the importance of meticulous patient selection and functional mitral valve repair, which remains a promising approach contingent on enhanced understanding of IMR's pathophysiology and its interplay with LV remodeling. The current review summarizes our patient selection criteria and indications for surgical repair (including the use of adjunctive techniques of subvalvular intervention) or mitral valve replacement.

PMID:40582431 | DOI:10.1053/j.semtcvs.2025.04.009

Can J Cardiol. 2025 Jun 27:S0828-282X(25)00525-2. doi: 10.1016/j.cjca.2025.06.068. Online ahead of print.

ABSTRACT

BACKGROUND: In vitro studies demonstrated that direct oral anticoagulants (DOACs) down-regulate expression of proteins involved in calcification and inflammation. This hypothesis-testing study evaluates whether DOAC therapy is associated with decreased valvular calcification in patients with aortic stenosis (AS), anticoagulated due to concomitant atrial fibrillation (AF).

METHODS: In this case-control study 72 Caucasian patients with isolated severe AS were compared with 53 individuals with AF concomitant to severe AS, treated with DOACs for 28.7±13.8 months. Sixteen valves from AS patients on rivaroxaban (20 mg/day, AS-RIVA) and 20 valves from age-, sex-matched non-anticoagulated individuals with AS were subjected to micro-computed tomography (micro-CT), to estimate valvular calcification ex vivo. Calcium volume (CV), surface volume (SV), CV/SV ratio and trabecular thickness (TbTh) were assessed. Valvular expression of osteopontin, NF-κB, and IL-6 was evaluated by immunostaining.

RESULTS: Micro-CT showed that AS-RIVA patients had lower CV (-62.7%), SV (-46.2%), CV/SV ratio (-35.6%), and maximal TbTh (-21.1%), compared to patients not taking rivaroxaban (all p<0.05). Duration of rivaroxaban use correlated inversely with micro-CT parameters, peak transvalvular velocity, and maximal transvalvular pressure gradient. Decreased valvular expression of osteopontin (-20.4%), NF-κB (-26%), and two-fold lower IL-6 fluorescence intensity were observed in the AS-RIVA group compared to the remainder (all p<0.05). Moreover, osteopontin expression was inversely associated with the duration of rivaroxaban use and positively with micro-CT parameters.

CONCLUSIONS: Long-lasting rivaroxaban use in AS patients was associated with lower aortic valve leaflet calcification, reflected by micro-CT parameters, and osteopontin expression, suggesting a potential impact of rivaroxaban on valvular calcification.

PMID:40582401 | DOI:10.1016/j.cjca.2025.06.068

J Thorac Cardiovasc Surg. 2025 Jun 26:S0022-5223(25)00543-4. doi: 10.1016/j.jtcvs.2025.06.023. Online ahead of print.

ABSTRACT

OBJECTIVE: Our study aims to compare long-term survival and clinical outcomes of ring and band prostheses for annuloplasty repair of functional mitral regurgitation (FMR).

METHODS: From 3/2005 to 11/2017, 160 patients with moderate to severe FMR underwent undersized annuloplasty using semirigid complete ring (CR, N=69) or partial band (PB, N=91) prostheses of the same material and manufacturer. Primary outcomes were long-term survival and clinical outcomes, while secondary outcomes included comparison of postoperative echocardiography data.

RESULTS: Both groups had comparable baseline characteristics, cardiac function, FMR severity, and perioperative complications. CR and PB experienced equivalent 10-year freedom from CV mortality(65.2% vs 68.3%, P=.39), and FMR recurrence (78.5% vs 71.4%, P=.27).At mean follow-up of 58±46 months, both groups had parallel increase in ejection fraction (+7±16 vs +5±15%, P=.35) and reduction of left ventricle internal diameter end-diastole (-0.5±0.8 vs -0.4±0.9 cm, P=.61). CR had greater reduction in left ventricle internal diameter end-systole (-0.6±0.9 vs -0.2±0.9 cm, P=.007) but higher mean (5.6±3.4 vs 5.0±7 mmHg, P=.025) and peak (16.7±19.4 vs 12.9±10.7 mmHg, P=.048) transvalvular pressure gradients (TPG). Mean TPG predicted postoperative mortality at 10-years (HR 1.19[CI 95% (1.0037-1.357)], P=.013).

CONCLUSION: CR and PB annuloplasty for FMR confer equivalent 10-year survival and MR recurrence. CR repair was associated with increased LV reverse remodeling yet higher long-term valvular gradients.

PMID:40581290 | DOI:10.1016/j.jtcvs.2025.06.023

JACC Case Rep. 2025 Jun 25;30(16):103761. doi: 10.1016/j.jaccas.2025.103761.

ABSTRACT

BACKGROUND: A sinus of Valsalva aneurysm (SoVA) is a rare cardiac condition caused by the dilation of a coronary sinus. If untreated, it can commonly lead to valvular dysfunction, arrhythmias, or rupture.

CASE SUMMARY: A 71-year-old patient with hypertension and hyperlipidemia presented with an embolic stroke. Multimodality imaging revealed a large, 7.0 cm × 5.6 cm SoVA originating from the noncoronary sinus and causing nearly complete obstruction of the left atrium. The aneurysm was surgically repaired, and the patient made a full recovery.

DISCUSSION: In rare cases, a stroke may be the initial presentation of a SoVA. The probable cause of the patient's stroke was attributed to thrombus formation within the SoVA that embolized.

TAKE-HOME MESSAGES: This case emphasizes the importance of multimodality imaging for the diagnosis of a SoVA and for planning surgical repair. Additionally, clinicians should consider a SoVA in the differential diagnosis for a patient presenting with a stroke.

PMID:40579110 | DOI:10.1016/j.jaccas.2025.103761