Valvular cardiac surgery

JACC Cardiovasc Interv. 2025 Jun 23;18(12):1540-1553. doi: 10.1016/j.jcin.2025.03.036.

ABSTRACT

BACKGROUND: In women with severe aortic stenosis, there are limited data regarding outcome differences following transcatheter (TAVR) vs surgical aortic valve replacement (SAVR).

OBJECTIVES: The authors sought to examine outcomes of TAVR vs SAVR in a patient-level pooled analysis of women in the RHEIA and PARTNER 3 trials.

METHODS: Patients in both trials were randomly allocated to a balloon-expandable SAPIEN 3/Ultra valve or to surgical bioprostheses. Individual patient data of female participants in the 2 trials were pooled. The primary endpoint was all-cause mortality, all stroke, or rehospitalization at 1 year.

RESULTS: A total of 376 women were randomized to TAVR and 336 to SAVR. The mean age was ∼73 years, and the mean Society of Thoracic Surgeons (STS) score was 2.1%. Kaplan-Meier estimates of event rates at 1 year with TAVR vs SAVR were 8.5% vs 16.8% for the composite of all-cause mortality, all stroke, or rehospitalization (absolute difference -8.2%; 95% CI: -13.1% to -3.3%; P < 0.001), 1.1% vs 2.1% (P = 0.27) for all-cause mortality, 2.7% vs 3.9% (P = 0.35) for all stroke, and 5.4% vs 11.9% (P = 0.002) for rehospitalization. The composite endpoint of all-cause death or stroke was similar between the 2 treatment groups: 3.5% vs 5.4% (absolute difference -1.9%; 95% CI: -5.0% to 1.1%; P = 0.21).

CONCLUSIONS: Among women with symptomatic severe aortic stenosis, TAVR led to a reduction in the rate of the combined endpoint of all-cause mortality, stroke, or rehospitalization at 1-year follow-up, largely due to a significant reduction in the rate of rehospitalization.

PMID:40562469 | DOI:10.1016/j.jcin.2025.03.036

Tomography. 2025 May 28;11(6):62. doi: 10.3390/tomography11060062.

ABSTRACT

Aortic valve stenosis (AS) is a valvular heart disease that imposes a high afterload on the left ventricle (LV) due to restricted opening of the aortic valve, resulting in LV hypertrophy. Severe AS can lead to syncope, angina pectoris, and heart failure. The number of patients with AS has been increasing due to aging populations, the growing prevalence of lifestyle-related diseases, and advances in diagnostic technologies. Therefore, accurate diagnosis and appropriate treatment of AS are essential. In recent years, transcatheter aortic valve implantation (TAVI) has become feasible, and the number of procedures has rapidly increased, particularly among elderly patients. As treatment options for AS expand and diversify, detailed pre-procedural evaluation has become increasingly important. In particular, diagnostic imaging modalities such as computed tomography (CT) have advanced significantly, with notable improvements in image quality. With recent advancements in CT technology-such as increased detector rows, faster gantry rotation speeds, new image reconstruction methods, and the introduction of dual-energy imaging-the scope of cardiac assessment has expanded beyond the coronary arteries to include valves, myocardium, and the entire heart. This includes evaluating restricted AV opening and cardiac function using four-dimensional imaging, assessing AV annulus diameter and AS severity via calcium scoring with a novel motion correction algorithm, and detecting myocardial damage through late-phase contrast imaging using new reconstruction techniques. In cases of pre-TAVI evaluation or congenital bicuspid valves, CT is also valuable for assessing extracardiac structures, such as access routes and associated congenital heart anomalies. In addition, recent advancements in CT technology have made it possible to significantly reduce radiation exposure during cardiac imaging. CT has become an extremely useful tool for comprehensive cardiac evaluation in patients with aortic stenosis, especially those being considered for surgical treatment.

PMID:40560008 | PMC:PMC12196544 | DOI:10.3390/tomography11060062

J Cardiovasc Dev Dis. 2025 Jun 17;12(6):230. doi: 10.3390/jcdd12060230.

ABSTRACT

Rising morbidity and mortality from cardiovascular disease (CVD) have increased interest in precision and preventive management to reduce long-term sequelae. While retinal imaging has traditionally been recognized for identifying vascular changes in systemic conditions such as hypertension and type 2 diabetes mellitus, a new ophthalmologic field, cardiac-oculomics, has associated retinal biomarker changes with other cardiovascular diseases with retinal manifestations. Several imaging modalities visualize the retina, including color fundus photography (CFP), optical coherence tomography (OCT), and OCT angiography (OCTA), which visualize the retinal surface, the individual retinal layers, and the microvasculature within those layers, respectively. In these modalities, imaging-derived biomarkers can present due to CVD and have been linked to the presence, progression, or risk of developing a range of CVD, including hypertension, carotid artery disease, valvular heart disease, cerebral infarction, atrial fibrillation, and heart failure. Promising artificial intelligence (AI) models have been developed to complement existing risk-prediction tools, but standardization and clinical trials are needed for clinical adoption. Beyond risk estimation, there is growing interest in assessing real-time cardiovascular status to track vascular changes following pharmacotherapy, surgery, or acute decompensation. This review offers an up-to-date assessment of the cardiac-oculomics literature and aims to raise awareness among cardiologists and encourage interdepartmental collaboration.

PMID:40558665 | PMC:PMC12194434 | DOI:10.3390/jcdd12060230

J Am Heart Assoc. 2025 Jul;14(13):e040556. doi: 10.1161/JAHA.124.040556. Epub 2025 Jun 25.

NO ABSTRACT

PMID:40557791 | DOI:10.1161/JAHA.124.040556

Ann Thorac Surg. 2025 Jun 21:S0003-4975(25)00545-4. doi: 10.1016/j.athoracsur.2025.06.008. Online ahead of print.

ABSTRACT

BACKGROUND: The advanced presentation of rheumatic heart disease in Rwanda often necessitates surgical intervention. We summarize the outcomes of valvular heart surgeries in Rwanda between 2006 and 2023.

METHODS: 366 patients in the Rwandan cardiac surgery registry who underwent valvular surgery were included in this study. We examined surgical details, perioperative outcomes, and long-term outcomes. Cox multivariable analyses were conducted to assess factors predictive of survival outcomes. Additionally, subgroup analyses compared outcomes between mechanical valve replacement and bioprosthetic valve replacement.

RESULTS: The average age at surgery was 25.0±10.2 years, with the majority being female (63.9%). Mitral valve surgery, either alone (45.9%) or in conjunction with tricuspid valve surgery (20.8%), was the most common procedure (66.7%). The 30-day postoperative mortality rate was 2.2%. Over an average follow-up of 7.8±4.5 years, the all-cause mortality rate was 18.2%. Patients who received a bioprosthetic valve replacement had a higher all-cause mortality rate than those who received a mechanical valve replacement (32.7% vs. 15.6%, P=0.008). The most common long-term complications for mechanical valve patients were embolism and bleeding (13.0%), compared to structural valve deterioration (26.5%) in bioprosthetic valve patients.

CONCLUSIONS: The low 30-day mortality rate reflects success in careful patient selection, meticulous surgery, and dedicated perioperative care. Mechanical valve replacement demonstrated superior long-term survival over bioprosthetic valve replacement mainly due to valve degeneration and need for reoperation in bioprosthetic patients. Key areas of improvement include strengthening postoperative follow-up and capacity for increased surgical complexity.

PMID:40550320 | DOI:10.1016/j.athoracsur.2025.06.008

Methodist Debakey Cardiovasc J. 2025 Jun 18;21(1):68-73. doi: 10.14797/mdcvj.1499. eCollection 2025.

ABSTRACT

About 25% of patients diagnosed with coronavirus disease 19 (COVID-19) experience cardiovascular complications, contributing to 40% of related deaths. Here we discuss a 69-year-old male with a history of congestive heart failure and preserved ejection fraction at New York Heart Association (NYHA) class II who presented with new dyspnea, cough, and paroxysmal nocturnal dyspnea. He was subsequently diagnosed with COVID-19 pneumonia, and while he initially recovered, he later showed worsening symptoms with progression to NYHA class IV. Follow-up echocardiogram revealed a decline in ejection fraction to 40% and severe aortic insufficiency. He underwent surgical aortic valve replacement, resolving his symptoms. This case highlights COVID-19's potential to cause rapid progression of valvular disease.

PMID:40547044 | PMC:PMC12180435 | DOI:10.14797/mdcvj.1499

Cureus. 2025 May 22;17(5):e84655. doi: 10.7759/cureus.84655. eCollection 2025 May.

ABSTRACT

Background Significant valve disease requires surgical intervention, either valve repair or valve replacement. For minor disease, balloon dilation is a possibility. The choice between mechanical and bioprosthetic valves requires a judgment regarding the benefits and risks of each procedure. A mechanical prosthetic valve requires lifelong anticoagulation, whereas a bioprosthetic valve tends to degenerate over a few years, with faster degeneration observed in younger patients. Objective To assess the survival outcomes, postoperative complications, and reoperation rates in patients who underwent prosthetic mechanical valve replacement with acenocoumarol and low-dose aspirin (75 mg), with adequate International Normalized Ratio (INR) monitoring. Methods and materials This was a retrospective study involving data from patients who underwent mechanical cardiac valve replacement between 1971 and 2022. This study adhered to the principles outlined in the Declaration of Helsinki and received approval from the institutional ethics review board of Bombay Hospital (Regn. No: ECR/296/Inst/MH/2013; Date: 08/12/2021). Results A total of 768 patients were included. The mean overall survival rate was 35.2%, and it was higher in men than in women. The majority of patients belonged to a younger age group (≤18 years: 6.3%, 19-40 years: 47.7%, 41-60 years: 42.2%, >60 years: 3.9%). The mean overall survival rate was higher in men (37.4%) than in women (28.4%). In the first year post-surgery, females experienced Major Adverse Cardiac and Cerebrovascular Events (MACCE) at a rate of 11.1 person-years, while males had none. Among patients classified as New York Heart Association (NYHA) class III, the incidence rate of MACCE was 2.7 person-years, whereas for NYHA class IV patients, it was 8.3 person-years. These trends persisted to some extent at the fifth year post-surgery. Conclusion Survival outcomes were influenced by factors such as age, sex, type of valve replacement, and NYHA class, with certain subgroups showing better survival rates. The first year post-surgery presented a higher incidence of MACCE, which declined over time. Mechanical valve replacement with appropriate anticoagulation can offer favorable long-term outcomes, particularly in younger patients. However, early postoperative risks, especially in women and those with advanced heart failure, highlight the need for individualized care and close monitoring. Future research should aim to refine patient selection, explore sex-based outcome disparities, and optimize anticoagulation strategies to further improve survival and quality of life in this population.

PMID:40546510 | PMC:PMC12182600 | DOI:10.7759/cureus.84655