Heart Valve Research Articles

Assessing the Impact of Cardiac Output and Valve Orientation on Bioprosthetic Pulmonary Valve Hemodynamics Using In Vitro 4D-Flow MRI and High-Speed Imaging.

Pulmonary valve replacement (PVR) using bioprosthetic valves is a common procedure performed in patients with repaired Tetralogy of Fallot and other conditions, but these valves frequently become dysfunctional within 15years of implantation. The causes for early valve failure are not clearly understood. The purpose of this study was to explore the impact of changing cardiac output (CO) and valve orientation on local hemodynamics and valve performance. A 25mm bioprosthetic valve was implanted in an idealized 3D-printed model of the right ventricular outflow tract (RVOT). The local hemodynamics at three COs and two valve orientations were assessed using 4D-Flow MRI and high-speed camera imaging. Noticeable differences in jet asymmetry, the amount of recirculation, leaflet opening patterns, as well as the size and location of reversed flow regions were observed with varying CO. Rotation of the valve resulted in drastic differences in reversed flow regions, but not forward flow. Flow features observed in the valve with low CO in this study have previously been correlated with calcification, hemolysis, and leaflet fatigue, indicating their potential negative impact on local hemodynamics and leaflet performance.

Perioperative Complications and In-Hospital Mortality in Radical Nephroureterectomy Patients with Heart Valve Replacement.

Perioperative complication rates and in-hospital mortality after radical nephroureterectomy (RNU) in patients with a history of heart valve replacement are unknown. Within the National Inpatient Sample (2000-2019), we identified non-metastatic upper urinary tract carcinoma patients treated with RNU according to the presence or absence of a history of heart valve replacement. Propensity score matching (1:10 ratio) and multivariable logistic regression as well as Poisson regression models were used. Of 15,423 RNU patients, 151 (1.0%) harbored heart valve replacement. This proportion increased over the study span from 0.5% to 1.4% (p=0.02). Heart valve replacement patients were older (median 78 vs. 72 years; p<0.001), more frequently male (73 vs. 60%; p=0.002), and more frequently harbored a Charlson Comorbidity Index (CCI) ≥3 (36 vs. 27%; p=0.002). After 1:10 propensity score matching for age, sex, and CCI, the patients exhibited higher rates of perioperative bleeding (7.4 vs. 2.4%; odds ratio [OR] 3.2; p<0.001), blood transfusions (24.0 vs. 17.0%; OR 1.6; p=0.02), and cardiac complications (24.0 vs. 14.0%; OR 2.1; p<0.001). Conversely, heart valve replacement patients did not exhibit higher rates of critical care therapy (OR 1.06; p=0.8), higher rates of in-hospital mortality (OR 0.8; p=0.8), and longer length of stay (OR 1.4; p=0.052) than their RNU counterparts without a history of heart valve replacement. RNU patients with a history of heart valve replacement are at significantly increased risk of perioperative bleeding, blood transfusions, and cardiac complications; however, despite these increased risks, they neither exhibited higher critical care therapy rates or higher in-hospital mortality rates, nor did they require significantly longer hospital stay.

Insights from pulse field energy in patients with prosthetic mechanical heart valves undergoing ablation for atrial fibrillation

Insights from pulse field energy in patients with prosthetic mechanical heart valves undergoing ablation for atrial fibrillation

Cardiovascular Diseases in Public Health: Chromosomal Abnormalities in Congenital Heart Disease Causing Sudden Cardiac Death in Children

Chromosomal abnormalities (CAs) are changes in the number or structure of chromosomes, manifested as alterations in the total number of chromosomes or as structural abnormalities involving the loss, duplication, or rearrangement of chromosomal segments. CAs can be inherited or can occur spontaneously, leading to congenital malformations and genetic diseases. CAs associated with cardiovascular diseases cause structural or functional alterations of the heart, affecting the cardiac chambers, valves, coronary arteries, aorta, and cardiac conduction, thus increasing the likelihood of arrhythmias, cardiac arrest, and sudden cardiac death (SCD). An early diagnosis and the adequate management of chromosomal abnormalities associated with cardiovascular diseases are essential to prevent SCD, which is a serious public health problem today. In our review, we analyzed the structural and functional CAs responsible for congenital heart disease (CHD) that increase the risk of SCD and analyzed the prevention strategies to be implemented to reduce SCD.

CFD Investigation of Mechanical Heart Valve Orientations in Modulating Left Ventricular Hemodynamics

This study provides a comprehensive computational analysis of how mechanical heart valve orientations impact left ventricular (LV) hemodynamics, with potential implications for surgical valve placement. Focusing on monoleaflet valves (MLV) and bileaflet valves (BLV), the research explores how different valve angles influence blood flow patterns within the LV chamber. The analysis includes velocity contours, streamline patterns, vorticity contours, and temporal velocity fluctuations to elucidate the effects of valve orientation on LV performance. Findings indicate that valve orientation significantly influences flow coherence and blood velocity. For instance, a 20-degree orientation in the MLV alters jet flow in ways that could affect wall shear stress distribution. At a 45-degree angle, the MLV produces a more centralized jet flow, enhancing flow uniformity and aligning more closely with physiological conditions. In contrast, a 55-degree angle skews the jet flow, potentially leading to adverse hemodynamic effects. Similarly, BLV orientations at 45, 55, 60, and 70 degrees showed that lower angles improved flow efficiency, reducing energy losses and minimizing the risk of regurgitation, while higher angles led to turbulent and potentially damaging flow patterns. Comparative results at a 45-degree orientation demonstrated the superior performance of BLV in regulating normal velocity, with BLV reducing average blood velocity by 38.77% compared to a 29.53% reduction with MLV. These results underscore the importance of optimizing mechanical heart valve orientations to enhance left ventricular hemodynamics. The findings carry significant clinical implications, supporting evidence-based valve placement decisions that can substantially improve patient outcomes, survival rates and long-term cardiovascular health.

A new finite element formulation unifying fluid-structure and fluid-fluid interaction problems

When the accurate simulation of two materials that interact through their common and deformable interface is of interest, the efficient treatment of the interface determines the success or failure of a numerical method. In this work, we propose a new, robust and easy-to-code finite element formulation for such interaction problems. The remedy of the interface constraints, namely the continuity of velocities and stresses, is accomplished using a single-node approach and the same continuous basis functions for the velocities in both materials. Given that only Newtonian fluids will be examined, we do not have to introduce basis functions for the stress components. The XFEM method, which enriches locally the continuous basis function of a variable that presents a discontinuity, is employed to tackle the discontinuous behavior of the pressure across the interface. The incorporation of Petrov-Galerkin stabilization schemes enhances further our formulation and allows the usage of equal order interpolants for velocities and pressure. We solve the coupled system of equations in a monolithic manner to alleviate the convergence problems of the segregated approach. The novel aspect of our method is that its ingredients do not differentiate based on the constituent materials of the problem, and it can be used interchangeably for either a fluid-structure or a fluid-fluid interaction problem. The accuracy of the new finite element formulation is assessed by comparing its numerical results to those of the literature in three problems: i) the flow through a partially collapsible channel, ii) the induced motion of a flexible elastic plate, iii) the filament stretching of a Newtonian thread surrounded by another immiscible viscous fluid. In all cases, we are in agreement with the results of the literature. Furthermore, we conduct a challenging, 3D simulation for a setup that resembles the motion of a three-leaflet stented aortic heart valve.

Q Fever Endocarditis: A Challenging Diagnosis in a Patient Referring Weight Loss and Anorexia, and With Granulomas in Gastric Biopsy Specimens.

Diagnosis of Q fever endocarditis is challenging since clinical findings are non-specific and diagnosis is mainly made by indirect methods such as serology. A progressive constitutional syndrome, severe asthenia, anorexia with no fever and histopathological findings of non-necrotizing gastric granulomas in a gastric biopsy were found preceding a cardiac failure in our case report. Prolonged treatment with doxycycline and hydroxychloroquine is mandatory, and cardiac valve surgery may be needed.

Biocompatibility of boron-enriched pyrolitic carbon

The Institute for Nuclear Problems of the Belarusian State University (INP BSU) has developed equipment and optimized the technology for synthesizing boron-doped pyrocarbon, a material for application in heart valve endoprostheses.The purpose of this work was to evaluate the general and biochemical blood tests, mass coefficients of animal organs and the dynamics of reactions of rat tissues to implantation of pyrocarbon material in the subcutaneous tissues of the interscapular region. Animals were monitored for 90 days. According to the morphometric data, the boron-doped pyrocarbon, synthesized in INP BSU, was found to be non-irritating to the tissue in comparison with the control sample during all periods of observation. There was no significant effect of implantation of pyrolytic carbon on the parameters of the blood general and biochemical analysis in rats compared with healthy animals. The results of necropsy showed that the mass of organs and mass coefficients of animals did not deviate from the physiological norm during different periods of pyrocarbon sample implantation.Thus, the boron-doped pyrocarbon material synthesized in INP BSU can be used for manufacturing heart valve endoprostheses.

A Study on The Evaluation of The Echocardiographic Measurements in Normal Healthy Adult Population of Saharanpur District

Echocardiography is a widely utilized, non-invasive imaging modality essential for diagnosing and monitoring cardiovascular diseases. Echocardiographic measurements provide detailed structural and functional insights into the heart, aiding clinicians in assessing cardiac anatomy, valve function, and hemodynamics. Key measurements include chamber dimensions, wall thickness, ejection fraction (EF), stroke volume, and diastolic function. Advanced modalities, such as Doppler imaging, enable precise evaluation of blood flow velocities and pressures, offering critical information on valvular regurgitation, stenosis, and pulmonary artery pressures.

How much do we know about nanobacteria?

Background/PurposeNanobacteria, known to date as self-replicating, nano-scale size organisms, smaller than bacteria. However, whether these are living organisms or agglomeration of biomolecules was one of the most controversial issues for many years. One of the reasons for debate is their lack of any genetic material. Although many studies investigate whether nanobacteria are the cause of diseases that affect human health, the discussions did not reach a conclusion. While most studies try to unravel the structures of nanobacteria, some studies investigated their effects on diseases. It has been proposed that pathological calcifications in kidney and dental pulp stones, as well as calcifications in heart valves and arteries, might be caused by nanobacteria. In this study, we investigated the effects and molecular structures of nanobacteria on the formation of atheroma plaques that cause atherosclerosis. MethodsNanobacteria grown from atheroma plaques in cell culture medium were analysed by scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy (EDS). Macromolecules of nanobacteria were separated by SDS-polyacrylamide gel electrophoresis and their sensitivity to protease and nucleases was tested. After determining their resistance to nucleases and susceptibility to proteinase K, protein profiles were determined by quadrupole time-of-flight mass spectrometry (QTOF-MS). ResultsIn SEM, spherical structures with sizes ranging from 80 to 900 nm were visualized. EDS analyses showed that very low concentration of phosphorus (P: 0.3 %) indicated absence of nucleic acids. The resistance was observed to proteases. Also, protein profiles indicated human proteins, with a high percentage of albumin. ConclusionIt was determined that nanobacteria derived from atheroma plaque were structures composed of human proteins. The findings confirmed the theory that nanobacteria are non-living structures formed by a mechanism called biocrystallization. Although the accumulation of nanobacteria may be a contributing element to the creation of atheroma plaque, it is possible that the etiological components that initiate the formation of the plaque are not nanobacteria.

Five-year Multiple Comparison of Transcatheter Aortic Valves: Insights from the OBSERVANT II study

BACKGROUNDHead-to-head comparisons of second and third generations of THVs are mostly limited to two-arm studies, and to mid-term follow-up so far. Aim of the study was to simultaneously compare clinical outcomes of transcatheter aortic valve replacement (TAVR) with four different transcatheter heart valves (THVs) at 5 years. METHODSPatients undergoing transfemoral TAVR with four second-generation THV platforms and enrolled in the multicenter, prospective OBSERVANT II study from December 2016 to September 2018, were compared according to the THV received. Outcomes were adjudicated through a linkage with administrative databases and adjusted using inverse propensity of treatment weighting (IPTW) based on propensity score.The primary endpoints were death from any cause and major adverse cardiac and cerebrovascular events (MACCE) at 5 years. Cumulative rates were reported consecutively for Evolut R/ PRO, SAPIEN 3, ACURATE neo and Portico groups. RESULTSA total of 2,493 patients were considered. The median age was 83 years and the median EuroSCORE 2 was 4.9%. After IPTW adjustment, the rates of all-cause death (53.6% vs. 46.7% vs. 50.5% vs. 46.3%, p=0.06) and MACCE (57.2% vs. 51.2% vs. 54.4% vs. 50.6%, p=0.08) did not differ among groups at 5 years. The rate of re-hospitalization for heart failure (HF) (33.9% vs. 27.0% vs. 31.6% vs. 33.7%, p=0.02) was significantly lower for SAPIEN 3 THV at 5 years. CONCLUSIONSData from real-world practice showed sustained and comparable effectiveness of TAVR considering all the available THVs up to 5 years, but SAPIEN 3 showed a lower rate of rehospitalization for HF.

A qualitative study on the experiences of caregivers of children undergoing surgery for congenital heart diseases

ObjectiveThis study explores the experiences of caregivers of pediatric cardiac surgery patients, aiming to deepen understanding of their role and improve the caregiving process. MethodsA qualitative, phenomenological approach was employed using individual, semi-structured interviews with a heterogeneous sample of caregivers (both mothers and fathers) of children who had undergone surgery for congenital heart disease. Interviews were conducted face-to-face from June 2023 to May 2024, following Creswell's interview techniques. Data collection and analysis were performed simultaneously using MAXQDA software. ResultsParticipants included caregivers of children aged 2 months to 17 years, with caregivers themselves aged 25 to 50 years. Most children had undergone surgery for congenital heart valve disease, with surgeries ranging from one to three. Three main themes and nine sub-themes were identified: (1) “Comprehensive health journey” described caregivers' experiences from diagnosis through treatment and their interactions with healthcare professionals; (2) “Challenges” encompassed social isolation, financial strain, work-life balance issues, and the impact on the education process; and (3) “Uncertainty” captured caregivers' anxiety about the future and concerns regarding home care. ConclusionThe findings offer valuable insights into the challenges and needs of caregivers in the pediatric cardiac surgery context, highlighting areas where support services and interventions could be beneficial. Implications to practiceThe study emphasizes the importance of healthcare professionals providing caregivers with clear information and empathetic support, which can enhance both caregiver well-being and patient outcomes.

Outcomes of Device Extraction in Patients with Chronic Kidney Disease on Renal Replacement Therapy and Cardiac Implantable Electronic Device Infections

BackgroundPatients with chronic kidney disease (CKD) on renal replacement therapy (RRT) are at high risk for cardiovascular implantable electronic device (CIED) infections. Although device extraction is standard management, it is often avoided in these patients due to high procedural risks. ObjectivesEvaluate the outcomes of CIED extraction in CKD on RRT patients with device infection. MethodsThis study utilized data from the TriNetX research network. The International Classification of Diseases-10th Revision-Clinical Modification coding system was used to identify patients. Adults with a history of CKD on RRT and CIED infection were included. Patients with renal transplantation and prosthetic heart valves were excluded. Patients were stratified by device extraction. The primary outcome was mortality at one year. ResultsA total of 530 patients were identified, of whom 30% (n=159) underwent device extraction. Following propensity score matching (PSM), 302 patients remained, with 151 in each group. Kaplan-Meier survival analysis demonstrated a significant one-year survival benefit for patients in the device extraction group (59.2%) compared to the no-extraction group (48.8%, p=0.043, HR 0.696, 95% CI 0.489-0.991). Freedom from complications such as pericardial effusion was similar between groups. Sensitivity analysis using Cox proportional hazards, adjusted for baseline confounders, confirmed the survival benefit of extraction, with a reduced mortality risk (HR 0.581, 95% CI 0.382-0.883, p=0.011)." ConclusionIn CKD on RRT patients with CIED infection, device extraction is associated with a reduction in all-cause mortality at one year. However, the rate of device extraction is low in this group.

Balloon Aortic Valvuloplasty with Simultaneous Aortic Root Injection: A case report of an Adjunctive Strategy to Computed Tomography for Predicting Coronary Obstruction in transcatheter aortic valve-in-transcatheter aortic valve (TAV-in-TAV) Procedures

Abstract Background Computed tomography (CT) assessment is the standard for predicting coronary obstruction (CO) caused by sinus sequestration (SS) during transcatheter aortic valve (TAV) implantation in degenerated TAV (TAV-in-TAV) procedure, but it may not always be accurate. This report describes a prediction method for CO by using balloon aortic valvuloplasty (BAV) during TAV-in-TAV. Case summary An 87-year-old woman with a history of balloon-expandable transcatheter heart valve (BE-THV) implantation 7 years prior was admitted with worsening dyspnea. Echocardiography revealed severe THV deterioration, and CT confirmed calcium proliferation in the THV. Our heart team decided to perform a TAV-in-TAV procedure using a 23-mm BE-THV. Preoperative CT imaging indicated an intermediate risk of CO. To evaluate CO risk more precisely, the top of a 20-mm balloon was positioned near the top of a BE-THV stent and inflated, followed by simultaneous aortic root injection (SARI). During SARI, contrast flowed into both coronary arteries, predicting a low risk of CO. Based on these findings, TAV-in-TAV was performed without coronary protection. The procedure was completed successfully without CO. After the procedure, the patient’s symptoms improved, and echocardiography showed normal valve function. She was discharged without complications and remains under outpatient follow-up care. Discussion The diagnostic method for predicting CO using BAV with SARI could serve as a valuable adjunctive diagnostic tool in patients with an intermediate or high risk of SS anatomy after TAV-in-TAV. In such cases, this method may provide additional insights concerning precise CO risk and the indication of leaflet modification technique during TAV-in-TAV.

Early outcomes of the novel Myval THV series compared to SAPIEN THV series and Evolut THV series in individuals with severe aortic stenosis.

There are limited head-to-head randomised trials comparing the performance of different transcatheter heart valves (THVs). We aimed to evaluate the non-inferiority of the balloon-expandable Myval THV series compared to the balloon-expandable SAPIEN THV series or the self-expanding Evolut THV series. The LANDMARK trial randomised 768 patients in a 1:1 ratio, (Myval THV series [n=384] vs contemporary series with 50% SAPIEN THV series [n=192] and 50% Evolut THV series [n=192]). The non-inferiority of Myval over the SAPIEN or Evolut THV series in terms of the 30-day primary composite safety and effectiveness endpoint as per the third Valve Academic Research Consortium (VARC-3) was tested in an intention-to-treat population with a predefined statistical power of 80% (1-sided alpha of 5%) for a non-inferiority margin of 10.44%. The Myval THV series achieved non-inferiority for the primary composite endpoint over the SAPIEN THV series (24.7% vs 24.1%, risk difference [95% confidence interval {CI}]: 0.6% [not applicable {NA} to 8.0]; p=0.0033) and the Evolut THV series (24.7% vs 30.0%, risk difference [95% CI]: -5.3% [NA to 2.5]; p<0.0001). The incidences of pacemaker implantation were comparable (Myval THV series: 15.0%, SAPIEN THV series: 17.3%, Evolut THV series: 16.8%). At 30 days, the mean pressure gradient and effective orifice area were significantly better with the Myval THV series compared to the SAPIEN THV series (p<0.0001) and better with the Evolut THV series than with the Myval THV series (p<0.0001). At 30 days, the proportion of moderate to severe prosthetic valve regurgitation was numerically higher with the Evolut THV series compared to the Myval THV series (7.4% vs 3.4%; p=0.06), while not significantly different between the Myval THV series and the SAPIEN THV series (3.4% vs 1.6%; p=0.32). The Myval THV series is non-inferior to the SAPIEN THV series and the Evolut THV series in terms of the primary composite endpoint at 30 days. ClinicalTrials.gov: NCT04275726; EudraCT number 2020-000,137-40.

Cardiogenic shock mortality according to Aetiology in a Mediterranean cohort: Results from the Shock-CAT study.

Mortality in cardiogenic shock (CS) remains elevated, with the potential for CS causes to impact prognosis and risk stratification. The aim was to investigate in-hospital prognosis and mortality in CS patients according to aetiology. We also assessed the prognostic accuracy of CardShock and IABP-SHOCK II scores. Shock-CAT study was a multicentre, prospective, observational study conducted from December 2018 to November 2019 in eight university hospitals in Catalonia, including non-selected consecutive CS patients. Data on clinical presentation, management, including mechanical circulatory support (MCS) were analysed comparing acute myocardial infarction (AMI) related CS and non-AMI-CS. The accuracy of CardShock and IABP-SHOCK II scores to assess 90day mortality risk were also compared. A total of 382 CS patients were included, age 65.3 (SD 13.9) years, 75.1% men. Patients were classified as AMI-CS (n=232, 60.7%) and non-AMI-CS (n=150, 39.3%). In the AMI-CS group, 77.6% were STEMI. Main aetiologies for non-AMI-CS were heart failure (36.2%), arrhythmias (22.1%) and valve disease (8.0%). AMI-CS patients required more MCS than non-AMI-CS (43.1% vs. 16.7%, P<0.001). In-hospital mortality was higher in AMI-CS (37.1 vs. 26.7%, P=0.035), with a two-fold increased risk after multivariate adjustment (odds ratio 2.24, P=0.019). The IABP-SHOCK II had superior discrimination for predicting 90day mortality when compared with CardShock in AMI-CS patients [area under the curve (AUC) 0.74 vs. 0.66, P=0.047] although both scores performed similarly in non-AMI-CS (AUC 0.64 vs. 0.62, P=0.693). In our cohort, AMI-CS mortality was increased by two-fold when compared with non-AMI-CS. IABP-SHOCK II score provides better 90day mortality risk prediction than CardShock score in AMI-CS, but both scores performed similar in non-AMI-CS patients.

Early results of female patients who underwent mitral valve surgery through periareolar incision approach.

Approaches that require less invasive procedures, offer heal in a shorter time and provide better cosmetic results have gained importance with the technological and modern developments in cardiac surgery. Esthetically preferred results can be achieved after heart valve surgery using a periareolar incision, especially in female patients. In the present study, we aimed to present our results after surgery using periareolar incision in female patients. We retrospectively evaluated the 1-year follow-up results in the postoperative period of isolated mitral valve replacement and tricuspid valve repair with mitral valve replacement using a periareolar incision with direct observation in 32 patients between 2020 and 2023. At the end of 1-year follow-up, we evaluated the patients' visual satisfaction with the incision site using a visual analog scale. According to the postoperative follow-up results, no prosthetic mitral valve dysfunction was detected in any of the patients at the 1st year echocardiography controls. Mild tricuspid valve insufficiency was detected in 3 patients who underwent tricuspid valve repair. Besides, a high level of satisfaction was observed in the patients' incision site evaluations with a visual analog scale at the end of the first year, and no numbness was reported in the periareolar region in any of the patients. Our study shows that surgical results similar to conventional methods can be achieved with the periareolar approach, and patient satisfaction and recovery times are shorter and more satisfying. We also think that the periareolar incision can be made without videoassisted equipment and this may reduce the surgical cost.

Infective Endocarditis by Biofilm-Producing Methicillin-Resistant Staphylococcus aureus—Pathogenesis, Diagnosis, and Management

Infective Endocarditis by Biofilm-Producing Methicillin-Resistant Staphylococcus aureus—Pathogenesis, Diagnosis, and Management

Association Between the Expression of T Helper Type 17 Cell-Related Cytokines and Valve Damage in Rheumatic Heart Disease.

The study aimed to clarify the association between Th17 cell-related cytokine expressions and valve damage in rheumatic heart disease (RHD). Twenty RHD patients undergoing mitral valve replacement surgery were selected as the observation group (Group O), and 20 non-rheumatic valve disease patients undergoing mitral valve replacement surgery (degenerative mitral valve prolapse) were recruited as the control group (Group C). Histopathological examination with hematoxylin and eosin (H&E) staining was conducted to observe inflammatory cell infiltration, fibrosis, and neovascularization. Immunohistochemical staining was performed to analyze Th17 cell-related cytokines (interleukin (IL)-17, IL-6, IL-23, IL-21) in patients' cardiac valve tissues. Spearman correlation analysis was employed to investigate the correlation between Th17-related cytokines and inflammatory cell infiltration, fibrosis, and neovascularization. compared to the Group C, the Group O exhibited significantly higher proportions of IL-17, IL-21, IL-6, and IL-23 positive cells and immunohistochemical scores in valve tissues (P < 0.05). Additionally, inflammatory cell infiltration scores, tissue fibrosis scores, and neovascularization scores in valve tissues were significantly higher in the Group O compared to the Group C (P < 0.05). The expression of Th17-related cytokines IL-17, IL-21, IL-6, and IL-23 in valve tissues showed a positive correlation with inflammatory cell infiltration, fibrosis, and neovascularization (P < 0.05). Conclusion: The results demonstrate a notable association between Th17 cell-related cytokine expressions in the heart valves of RHD patients and valve damage, providing a potential target for the treatment and prevention of RHD.

Effect of a Machine Learning-Derived Early Warning Tool With Treatment Protocol on Hypotension During Cardiac Surgery and ICU Stay: The Hypotension Prediction 2 (HYPE-2) Randomized Clinical Trial.

Cardiac surgery is associated with perioperative complications, some of which might be attributable to hypotension. The Hypotension Prediction Index (HPI), a machine-learning-derived early warning tool for hypotension, has only been evaluated in noncardiac surgery. We investigated whether using HPI with diagnostic guidance reduced hypotension during cardiac surgery and in the ICU. Randomized clinical trial conducted between May 2021 and February 2023. Single-center study conducted in an academic hospital in the Netherlands. Adults undergoing elective on-pump coronary artery bypass grafting, with or without single heart valve surgery, were enrolled if a mean arterial pressure (MAP) greater than or equal to 65 mm Hg was targeted during the surgical off-pump phases and ICU stay. After eligibility assessment, 142 of 162 patients approached gave informed consent for participation. Patients randomized 1:1 received either diagnostic guidance in addition to standard care if HPI reached greater than or equal to 75 (n = 72) or standard care alone (n = 70). The primary outcome was the severity of hypotension, measured as time-weighted average (TWA) of MAP less than 65 mm Hg. Secondary outcomes encompassed hypertension severity and intervention disparities. Of 142 patients randomized, 130 were included in the primary analysis. The HPI group showed 63% reduction in median TWA of hypotension compared with the standard care group, with a median of differences of -0.40 mm Hg (95% CI, -0.65 to -0.27; p < 0.001). In the HPI group, patients spent a median 28 minutes (95% CI, 17-44 min) less in hypotension, with a measurement duration of 322 minutes in the HPI group and 333 minutes in the standard care group. No significant differences were observed in hypertension severity, treatment choice, or fluid, vasopressors, and inotrope amounts. Using HPI combined with diagnostic guidance on top of standard care significantly decreased hypotension severity in elective cardiac surgery patients compared with standard care.