This study explores whether preprocedural left atrial (LA) strain predicts outcomes in individuals with rheumatic, severe mitral stenosis undergoing mitral valve (MV) interventions. Data were from the MASTER (Multicenter Mitral Stenosis with Rheumatic Etiology) registry, including patients with severe mitral stenosis who underwent percutaneous mitral valvuloplasty or MV replacement. Participants with moderate or greater dysfunction of other valves or missing strain data were excluded. The primary outcome was a composite of all-cause mortality and heart failure hospitalization. Decreased LA reservoir strain was defined as <12.2%, determined through receiver operating characteristic analysis. Among 609 individuals (mean age 57.4±12.1 years; 73% women), 424 (69.6%) had MV replacement and 185 (30.4%) underwent percutaneous MV. Those with decreased LA strain (n=307) were older, had more atrial fibrillation, smaller MV area, elevated mean diastolic pressure gradient, and increased right ventricular systolic pressure than those with preserved LA strain (n=302). Over a median follow-up of 6.1 (2.3-10.7) years after MV intervention, 7.7% (n=47) experienced the primary outcome, with significantly higher rates observed in individuals with decreased LA strain (P=0.001). Multivariate analysis showed decreased LA strain (hazard ratio [HR], 2.04 [95% CI, 1.06-3.93]; P=0.001), older age, and higher right ventricular systolic pressure were independent predictors of adverse outcomes. Preprocedural decreased LA reservoir strain was associated with adverse clinical outcomes after MV intervention in individuals with severe mitral stenosis. These findings suggest that LA strain could serve as a marker for optimizing the timing of MV intervention.

Microscopic polyangiitis (MPA) is a rare disease characterized by systemic vasculitis. However, perioperative endobronchial haemorrhage in these patients is not well-documented in medical literature. We present the case of a 62-year-old woman with MPA who developed massive airway bleeding during thoracoscopic mitral valve replacement. The haemorrhage was successfully managed with bronchoscopic localization and bronchial artery embolization, which led to a rapid recovery. This case increases the awareness of endobronchial haemorrhage in patients with MPA and underscores the critical role of a prepared, multidisciplinary team in achieving a successful outcome.

ObjectıvesRobot-assisted mitral valve replacement has been shown to be comparable to conventional surgery in terms of safety and efficacy. Our institution has performed robot-assisted mitral valve replacement using the Da Vinci Surgical System for over a decade. This study aimed to evaluate the time-related evolution of clinical outcomes and the impact of the surgical learning curve.MethodsPatients who underwent robot-assisted mitral valve replacement between July 2013 and January 2024 were evaluated. All procedures were performed by 4 surgeons certified in robotic cardiac surgery, each with prior experience of more than 100 conventional mitral valve replacements. To assess the learning curve, cumulative sum analysis was conducted on cardiopulmonary bypass time and the Mitral Surgery Complexity Score.ResultsA total of 233 patients were included in the analysis. The mean patient age was 48.4 (13.9) years; 117 (50.2%) were male. The mean cardiopulmonary bypass time was 170.3 (55.1) min. Cumulative sum analysis of cardiopulmonary bypass time revealed 3 phases: a learning phase (cases 1-27), a proficiency phase (cases 28-92), and a mastery phase (cases 93 onward). Mitral Surgery Complexity Scores decreased during the early phase, followed by an increase after case 92, indicating a transition towards more complex cases.ConclusionsRobot-assisted mitral valve replacement has a measurable learning curve, with surgical efficiency and case complexity evolving over time. Approximately 93 procedures appear necessary to achieve operative stability and to confidently expand indications to include more complex patients.

To qualitatively explore patients' lived experiences and coping mechanisms following mitral valve replacement (MVR) at the National Cardiac Institute in Tanzania. A descriptive qualitative study using in-depth interviews and thematic analysis. The study was conducted at the National Cardiac Institute, located in Dar es Salaam, the sole tertiary cardiac centre in Tanzania offering open-heart surgery. 17 participants were purposively sampled. Inclusion criteria were as follows: patients aged ≥18 years, had at least 28 days post-MVR, without chronic conditions (eg, diabetes and HIV) and attending postoperative cardiac clinics. Semi-structured interviews conducted in May 2024 using an interviewer guide explored post-MVR challenges, daily life adjustments, patient-provider interactions and coping strategies. Thematic analysis was employed to identify key themes. Three primary themes emerged: (1) Quality of life after MVR, encompassing physical, social, economic and psychological challenges; (2) Quality of care after MVR, highlighting patient-provider interactions and access to services; and (3) Adapting to post-MVR life, including psychological adaptation and lifestyle modification. Participants reported improved quality of life through shared experiences and support. Patients experienced physical, socio-economic and psychological challenges post-MVR. However, quality of life improved through access to care, peer support and adaptive coping. Adaptation to life with an artificial valve is feasible with robust support systems, even in resource-limited settings.

Caseous liquefaction is a rare variant of mitral annular calcification that can lead to cavity formation in the atrioventricular groove. We report a case of mitral valve replacement in a 76-year-old woman with a large caseous cavity, coronary artery disease, severe mitral valve stenosis and atrial fibrillation. Preoperative computed tomography showed a large caseous cavity (3 x 3.5 cm) in the posterior annulus extending into the atrioventricular groove. After unroofing and evacuation, the cavity was excluded with a pericardial patch. The lower edge of the patch was sutured to the ventricular side of the cavity; valve sutures passed through the residual posterior leaflet, the upper edge of the patch and the atrial edge of the cavity. The mitral prosthesis was then secured. The patient was weaned from cardiopulmonary bypass without complications. Intraoperative echocardiography demonstrated a well-seated mitral prosthesis with no valvular or paravalvular leaks. Postoperative imaging confirmed successful exclusion of the cavity in the atrioventricular groove. The postoperative echocardiogram revealed a mean gradient of 4 mmHg across the mitral prosthesis and no mitral regurgitation. Patch exclusion of the caseous cavity is a safe and feasible approach to support implanting a mitral prosthesis and obliterating a cavity.

Severe mitral annular calcification (MAC) carries an increased risk of perioperative complications in patients undergoing mitral valve surgery and may be considered a prohibitive surgical risk. Cavitron ultrasonic surgical aspiration (CUSA) has been reported as a method for controlled debridement of severe MAC during mitral valve surgery; however, experience in the literature is limited. We assessed 30-day and intermediate-term outcomes in 67 consecutive patients (mean age: 72 [SD 9] years; female sex: 65.7% [44/67]) with severe MAC who underwent mitral valve repair or replacement for mitral stenosis and/or regurgitation using CUSA from March 2021 through December 2024. Operations included isolated mitral valve replacement (41.8% [28/67]), isolated mitral valve repair (4.5% [3/67]), mitral and aortic valve replacement (37.3% [25/67]), mitral valve replacement with coronary bypass (6.0% [4/67]), and mitral and aortic valve replacement with coronary bypass (10.4% [7/67]). Intermediate survival was estimated using the Kaplan-Meier method. Mortality rate was 6.0% (4/67), stroke was 3.0% (2/67), and new postoperative atrial fibrillation was 29.0% (20/67). There were no atrioventricular groove ruptures. At a median echocardiographic follow-up time of 361 days (interquartile range [IQR] 112, 671), moderate paravalvular leak occurred in 3.0% (1/67). Mid-term all-cause mortality was 9.0% at a mean follow-up time of 42.5 (95% CI, 39.0, 46.0) months. The use of CUSA to debride severe mitral annular calcification in patients undergoing mitral valve surgery is associated with acceptable short-term morbidity and mortality and durable intermediate-term results. This technique allows surgical intervention in patients who may otherwise be deemed prohibitive surgical risk.

This study aimed to assess long-term outcomes of automated titanium fasteners versus hand-tied knots in mitral valve surgery. In this retrospective, single-centre analysis, 2678 adult patients who underwent mitral valve repair or replacement between November 2008 and November 2024 at the Medical University of Vienna were included. Patients were grouped according to the suture-securing technique used: automated titanium fasteners versus hand-tied knots. The primary endpoint was prosthetic dehiscence (either mitral annuloplasty ring or valve replacement prosthesis) requiring reintervention. Secondary endpoints comprised ischaemic stroke, intracranial bleeding, and all-cause mortality during the follow-up period. Among the study population, 1072 (40%) underwent mitral valve surgery using an automated titanium fastener device, and 1606 (60%) with conventional hand-tied sutures. A total of 31 patients (1.2%) had prosthetic dehiscence during the follow-up period. The risk of prosthetic dehiscence was significantly lower in the automated titanium fastener group in both univariable (crude sub-hazard ratio [sHR] 0.32; 95% confidence interval [CI], 0.12-0.86, P = .023) and multivariable competing risk regression analysis (adjusted sHR 0.34; 95% CI, 0.12-0.91, P = .033). Automated titanium fastener group was not associated with an increased risk of ischaemic stroke (adjusted sHR 0.92; 95% CI, 0.67-1.27, P = .600), intracranial bleeding (adjusted sHR 0.89; 95% CI, 0.52-1.52, P = .675), or all-cause mortality (adjusted hazard ratio 0.93; 95% CI, 0.74-1.18, P = .559). The use of an automated titanium fastener device seems to be associated with a lower risk of prosthetic dehiscence in mitral valve surgery. Due to the limited number of prosthetic dehiscence events and the potential for residual confounding, the results should be interpreted with caution.

Guiding Early Management in Severe Mitral Stenosis with Extensive Mitral Annular Calcification: A Transseptal ViMAC Case.

Mitral valve replacement with biological valve following annular decalcification with ultrasonic aspirator.

Traumatic papillary muscle rupture is an uncommon cause of acute mitral regurgitation (MR). We report the perioperative management of a case of severe MR due to the posteromedial papillary muscle rupture in a 33-year-old man who had blunt chest trauma caused by fall of an electric lamp post over him. He also had an additional finding of a Ventricular Septal Defect (VSD). He successfully underwent a mitral valve replacement (MVR) with a VSD repair surgery and was discharged on the sixth day of the surgical correction. Sometimes respiratory symptoms because of hemothorax, rib fractures can mask the cardiac trauma and pose diagnostic dilemma. Careful examination and imaging of the heart can detect a serious problem to address it.

Conventional versus Minimally Invasive Mitral Valve Replacement in Early and Midterm Outcomes: Comparative Study

Modified mitral valve replacement technique using transcatheter aortic valve for severe mitral annular calcification.

Objectives: This study aimed to evaluate early postoperative changes in right ventricular (RV) functional parameters and to determine their association with operative characteristics in patients undergoing mitral valve replacement (MVR) for rheumatic mitral valve disease. Methods: A prospective observational study was conducted among 50 patients undergoing MVR at a tertiary cardiac center. Preoperative and early postoperative (within 48 hours) echocardiographic parameters—including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), ejection fraction (EF), and tricuspid regurgitation (TR)—were compared. RV dysfunction (RVD) was defined as FAC &lt; 35%. Changes in RV function were correlated with operative variables, and predictors of postoperative RVD were identified using multivariable logistic regression. Results: The mean age of the cohort was 38.7 ± 12 years, with 60% female participants. Preoperatively, 36% (18/50) had RVD, of which 33.3% improved after surgery, while 66.7% exhibited persistent dysfunction. New-onset RVD occurred in 20% of patients. Significant postoperative reductions were observed in TAPSE (p = 0.013) and EF (p = 0.020), whereas PASP showed significant improvement (p = 0.005). No significant correlations were found between operative times and delta FAC. Preoperative RVD emerged as the only independent predictor of postoperative RVD (adjusted OR 4.06, 95% CI 1.16–14.21; p = 0.028). Conclusions: Early postoperative RV dysfunction is common following MVR, particularly among patients with pre-existing impairment. Operative times did not significantly influence postoperative RV performance, suggesting a multifactorial trajectory of RV recovery. Early identification and closer follow-up of high-risk patients may help improve postoperative outcomes.

The article conducts a study on the effect of early cardiological rehabilitation on physical function and clinical outcomes in patients after mitral or aortic valve replacement. The study included 20 patients (12 in the intervention group, 8 in the control group) who underwent elective heart valve surgery. The intervention group received early rehabilitation from day 2 after surgery, including physical activity, walking, and endurance exercises. The assessment was performed before surgery, at discharge, and 6 months later using the SPPB, SF-12, 6MWT, and HADS scales. The analysis was performed in IBM SPSS Statistics 21.0. Results. The patients in the intervention group demonstrated significant improvements in physical function (SPPB), endurance (6MWT), and PCS compared with the control group. SPPB proved to be a statistically significant predictor of readmission (p = 0.017) and mortality (p = 0.006) during 6 months of follow-up. Early cardiac rehabilitation is safe, effective and can be considered as a mandatory stage of treatment for patients after valve replacement. Further studies with an expanded sample are needed to confirm the long-term effectiveness of the program.

X-linked cardiac valvular dysplasia (XCVD) has been associated with missense or in-frame deletion variants in FLNA. We report a Japanese family with cardiac valvular dysplasia. The proband was diagnosed with multiple valve dysplasia at a primary school health checkup. He also exhibited skin hyperextensibility and joint hypermobility. His younger monozygotic twin brothers were diagnosed with multiple valve dysplasia during their 1-month pediatric checkups. One of them exhibited severe valvular disease and required aortic and mitral valve replacement at age 16 due to progressive regurgitation. All three patients showed no developmental delay or evidence of periventricular nodular heterotopia on brain MRI. We identified a novel hemizygous FLNA variant, NM_001456.4(FLNA):c.2023-6_2026delinsACGCT, in all three patients. Splicing analysis revealed an in-frame deletion of two amino acids, p.Val675_Lys676del. No significant difference was observed in overall expression levels of FLNA transcript between the patient and a healthy individual. In silico structural modeling revealed that this deletion disrupts an α-helix positioned between β-strands of domains 4 and 5, which would impair the structural stability of FLNA. This variant was not found in public genomic databases. In conclusion, we identified a novel likely pathogenic variant in FLNA, p.Val675_Lys676del, the smallest in-frame deletion reported to date in XCVD. Patients with this variant showed variable severity, and some presented with extracardiac features. Our findings expand both the genetic and phenotypic spectrum of XCVD.

An unusual case of infective endocarditis caused by a strain of extended-spectrum β-lactamase Escherichia coli O25b:H4-B2-ST131 originating from a urinary tract infection is described. This paper has thoroughly analyzed the distinctive genotypic, phenotypic, and phylogenetic elements of the strain, correlating them with the patient’s severe clinical presentation, diagnostic course, and successful outcome achieved through intensive antibiotic and surgical management, culminating in mitral valve replacement. Additionally, we proposed a hypothesis regarding the pathophysiology of infective endocarditis caused by extended-spectrum β-lactamase Escherichia coli, based on genotypic and phylogenetic analyses. A host-related explanatory approach was also assessed. Understanding the importance of early and real-time genotyping and molecular characterization of an Escherichia coli strain with a potential mechanism for developing infective endocarditis may help guide future clinical practice.

Introduction. Combined aortic and mitral valve lesions on the background of coronary artery disease require complex surgical correction and are associated with high perioperative risk and frequent complications. Local data on such interventions remain limited. Aim. To determine the structure of complications following combined aortic and mitral valve replacement with concomitant coronary artery bypass grafting (AVR+MVR+CABG). Materials and Methods. A retrospective single-center study included 57 patients operated in 2018-2023. Clinical, laboratory, and echocardiographic parameters were analyzed; operative risk was assessed using EuroSCORE II and STS models. Intra- and postoperative parameters were recorded; complications were classified as acute kidney injury (AKI, KDIGO), bleeding (BARC≥3), infectious, neurological, cardiac, pericarditis, rethoracotomy, and in-hospital mortality. Uni- and multivariate logistic regression was used to identify predictors of the composite endpoint (mortality / major complications) with ORs and 95 % CI (p&lt;0.05). Results and discussion. Patients were high-risk: EuroSCORE II Me 7.0 % [4.3-10.9], STS mortality 12.2 % [8.7-17.3], STS mortality/morbidity 61.3 % [49.9-69.0]. In-hospital mortality was 10.5 % (6/57). The main causes of death were acute kidney injury progressing to multiorgan failure (n=2), acute cerebrovascular accident (n=1), pneumonia with septic shock (n=1), mediastinitis with sepsis (n=1), and acute graft thrombosis resulting in myocardial infarction (n=1). Major postoperative complications included: AKI 38.0 % (dialysis-dependent 15.8 %), infectious complications 47.4 % (mediastinitis 7.0 %), neurological disorders 43.9 % (delirium/encephalopathy), stroke 7.0 %, rethoracotomy for bleeding 12.3 %, and pericarditis 10.5 %. Typical hyperlactatemia peaked at 6 hours and normalized within 48 hours. Postoperative valve gradients remained within expected ranges; left ventricular ejection fraction at discharge was Me 50 % [41-56]. Preventive priorities include KDIGO-based AKI prevention, neuroprotection and delirium/stroke prevention strategies, strengthened infection control, blood conservation programs, and refined perioperative risk stratification. Conclusions. The combined valve–coronary cohort demonstrated high surgical risk, with elevated EuroSCORE II and STS indices and hospital mortality of 10.5 %. Functional results were satisfactory: prosthetic valve gradients remained within expected limits, and LVEF at discharge (Me 50 % [41-56]) indicated stable systolic performance. The postoperative course was dominated by an organ-dysfunction–driven complication structure, including renal complications (AKI 38.0 %, dialysis-dependent 15.8 %), infectious events (47.4 %, mediastinitis 7 %), neurological disorders (delirium/encephalopathy 43.9 %, stroke 7 %), and additional cardiac/bleeding complications (re-thoracotomy 12.3 %, pericarditis 10.5 %). The findings support the need for standardized perioperative pathways, emphasizing KDIGO-based renal protection, neuroprotection, infection control, and blood-conservation strategies, with combined EuroSCORE II+STS use for precise risk stratification.

The authors present redo mitral valve replacement, aortic valve and tricuspid valve replacement in a patient with recurrent infective endocarditis following COVID-19 infection. This patient with EuroSCORE II 19.24% underwent successful triple valve replacement.

IntroductionBioprosthetic heart valves (BHVs) are increasingly used in valvular heart disease, offering favourable haemodynamics and lower thrombogenic risk compared to mechanical valves. However, long-term durability remains limited by structural valve degeneration (SVD).Case reportA 70-year-old male presented with severe heart failure 4years after bioprosthetic mitral and aortic valve replacement. Imaging confirmed SVD affecting both valves, necessitating high-risk redo surgery. Postoperatively, the patient developed profound systemic inflammatory response syndrome (SIRS) to cardiopulmonary bypass (CPB), refractory to vasopressors and steroids, and died within 24hours.DiscussionFurther investigations revealed elevated isolated anti-cardiolipin IgM antibodies, raising suspicion of autoimmune-mediated valve thrombosis as a contributor to this case of early SVD.ConclusionThis case highlights the importance of thorough diagnostic evaluation in cases of early SVD, the need to individualise anticoagulation strategies in at-risk patients, and serves as a critical reminder of the serious inflammatory complications that can occur post-surgery.

Frailty, characterized by reduced physiological resilience, is a pivotal risk factor in older adults undergoing major cardiac procedures. Although previous analyses have linked frailty to adverse surgical outcomes, knowledge gaps persist due to methodological inconsistency across frailty tools and limited synthesis of complications such as delirium, infection, and renal dysfunction. The objective of this systematic review and meta-analysis is to determine the prevalence of preoperative frailty in older adults undergoing major cardiac procedures, and assess its association with postoperative outcomes, including cardiac, respiratory, renal, infectious, stroke, and bleeding complications, postoperative delirium, hospital and intensive care unit (ICU) length of stay, nonhome discharge, hospital readmission, and both 30-day and 1-year mortality. A prespecified protocol was registered with PROSPERO (CRD#42024574916), following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, and Cochrane databases were searched for English-language studies of patients undergoing major cardiac procedures, including coronary artery bypass grafting (CABG), aortic or mitral valve replacement or repair, transcatheter aortic valve replacement (TAVR), or combined procedures. Validated frailty instruments (eg, Fried Frailty Phenotype, Clinical Frailty Scale) were required to determine preoperative frailty, along with reporting at least 1 postoperative outcome. Noncardiac surgeries, minor procedures, case reports, and reviews were excluded. Random-effects meta-analyses generated odds ratio (OR) or standardized mean difference (SMD) values with 95% confidence intervals (CI). Nineteen studies (n = 11,667; mean ± SD age 71.9 ± 8.1 years, 28% female) met inclusion criteria, spanning North America, Europe, Asia, and Oceania. The overall prevalence of preoperative frailty was 16.8%. Frailty was significantly associated with delirium (OR, 4.11; 95% confidence interval [CI], 2.00-8.45; P <.001), infection (OR, 3.72; 95% CI, 2.27-6.12; P <.001), renal complications (OR, 2.72; 95% CI, 2.05-3.60; P <.001), and extended hospital (SMD, 0.69 ; 95% CI, 0.35-1.02; P <.001) and ICU (SMD, 0.72; 95% CI, 0.51-0.94; P <.001) stays. Frailty increased the odds of 30-day (OR, 3.58; 95% CI, 2.16-5.93; P <.001) and 1-year (OR, 2.25; 95% CI, 1.56-3.25; P <.001) mortality. Frailty affects nearly 1 in 5 older adults requiring major cardiac procedures. Frailty was significantly associated with adverse postoperative outcomes, including delirium, infections, renal complications, extended length of stay, and mortality. As frailty is potentially modifiable, targeted strategies-such as prehabilitation, nutritional optimization, and enhanced perioperative monitoring-may improve outcomes. Incorporating routine frailty screening into standard preoperative practice allows for earlier identification of high-risk patients, efficient resource allocation, and perioperative care planning.