Design and rationale of the Impella®-protected cardiac surgery trial (IMPACT): A multicenter, single-arm pilot study in high-risk cardiac surgery patients.

Despite the technically challenging nature of valve-sparing root replacement, restoration of aortic valve competence can be achieved through a complete understanding of the aortic root anatomy and pathophysiology. In this review, we discuss the physiology of normal aortic root function as well as pathophysiologic mechanisms contributing to aortic valve incompetence. Preoperative planning for valve-sparing root replacement is discussed, including the use of imaging to guide surgical decision-making. Pitfalls and pearls of the critical technical steps for both valve-sparing root replacement and repair of both tricuspid and bicuspid aortic valves are provided. Finally, current evidence guiding best practices in valve-sparing root replacement and aortic valve repair is presented to support decision-making for patient selection.

Transcatheter pulmonary valve replacement (TPVR) has transformed the management of patients with congenital heart disease (CHD) with dysfunctional pulmonary outflow tracts. Technological advancements have expanded the number of patients eligible for this minimally invasive alternative to surgical valve replacement. With the introduction of larger self-expanding valves and adaptive prestenting systems, TPVR has become accessible to patients with complex anatomies, including those with native right ventricular outflow tract (RVOT) disease. Recent studies have demonstrated the excellent clinical outcomes of TPVR thus far, while also acknowledging the occurrence of rare complications. Crucial questions guiding the future of TPVR management include: timing to refer for TPVR, how to optimize valve durability, enhance preprocedural screening with advanced imaging and electrophysiology studies, and improve hemodynamic monitoring. These advancements underscore TPVR's adaptability and efficacy, offering new solutions for complex cases and improving outcomes. Future research should focus on optimizing patient selection and intervention timing, as well as addressing long-term durability and complications.

Isolated Transcatheter and Surgical Aortic Valve Replacement in the Evolut Low-Risk Trial: 5-Year Comparative Outcomes.

Immediate Postoperative Pacing Dependency Is Not Associated With Worse Mid-Term Survival in Redo Mitral Valve Surgery.

Postoperative pulmonary decline is an established complication of open-heart surgery extending beyond the immediate postoperative phase. Inflammation-mediated lung damage and ischaemia-reperfusion injury secondary to extracorporeal circulation is a proposed pathophysiological driver. GLP-1 receptor agonists (GLP-1RA) have emerged as promising protective agents in this setting. Investigate whether infusion of the GLP-1RA, exenatide during cardiopulmonary bypass and weaning thereof, can mitigate the decline in diffusing capacity and ventilatory performance 3 months postoperative, compared to placebo. In this predefined explorative substudy of the randomised, clinical GLORIOUS trial, 878 adult patients undergoing non-emergent coronary artery bypass grafting (CABG) and/or surgical aortic valve replacement (SAVR) were randomised to a continuous infusion of the GLP-1RA, exenatide or placebo during cardiopulmonary bypass, extending into the early postoperative period. Diffusing capacity of the lung for carbon monoxide (DLCO) and ventilatory performance (FEV1/FVC) were measured preoperatively and 3 months postoperatively. Median DLCO (% predicted corrected) declined from 80% preoperative to 72% 3 months postoperative, corresponding to a -7.7 percentage point (pp) difference (95% CI 6.2 to 9.1; p < 0.001). FEV1/FVC declined from 0.75 preoperative to 0.73 postoperative, corresponding to a -1.6 difference (95% CI 1.0 to 2.1; p < 0.001). However, there were no significant differences in decline between the exenatide and placebo groups (all p > 0.3). Findings were consistent across subgroup analyses. While both diffusing capacity and ventilatory performance exhibited a mild-to-moderate decline 3 months after open-heart surgery, the GLP-1RA exenatide did not mitigate this decline compared with placebo. Pulmonary dysfunction is one of the most common complications to open-heart surgery. The present study confirms a decline in diffusing capacity of the lung for carbon monoxide (DLCO) and in ventilatory performance measured as FEV1/FVC at 3 months postoperatively compared to preoperative measurements. Infusion of GLP-1 receptor antagonist during cardiopulmonary bypass and weaning did not mitigate the pulmonary decline compared to placebo.

Sutureless aortic valves, such as the Perceval (Corcym) valve, provide important procedural advantages and favorable mid- to long-term outcomes; however, potentially serious aortic complications related to their self-expanding stent structure remain incompletely understood. Thus, we report the case of an 85-year-old woman who developed early-onset localized ascending aortic dissection after aortic valve replacement with a sutureless valve. The entry tear was located at the level of the stent edge, slightly proximal to the aortotomy suture line, and the dissection extended only between these two points, suggesting a localized stent-aortic wall interaction with external mechanical stress as a potential trigger.

This study aimed to compare the effects of Del Nido cardioplegia (DNC) and conventional cold blood cardioplegia (CBC) on early myocardial functional recovery, as assessed by cardiac magnetic resonance imaging, in patients with reduced ejection fraction undergoing concomitant coronary artery bypass grafting (CABG) and mitral valve replacement (MVR). This single-center prospective study was conducted between April 2024 and January 2025 and included 42 patients with a left ventricular ejection fraction (LVEF) <45% who underwent concomitant CABG and MVR. The mean age was 62.2±10.6 years, and 69.0% (n=29) of the patients were male. Patients were divided into two groups according to the myocardial protection strategy used: CBC (n=23) and DNC (n=19). Preoperative demographic, laboratory, and echocardiographic data were collected, and CMR was performed approximately 1 week before surgery to establish baseline values. Intraoperative parameters, postoperative clinical, laboratory, and echocardiographic findings as well as follow-up CMR findings obtained 1 month postoperatively were analyzed and compared between the groups. The aortic cross-clamp time was significantly longer in the DNC group than in the CBC group (p=0.016), whereas the total volume of infused cardioplegia was comparable between the groups (p=0.323). Intraoperative blood transfusion requirements were significantly higher in the DNC group (p=0.013). Regarding myocardial recovery, the DNC group demonstrated superior biventricular improvement. Significant reductions in left ventricular end-diastolic volume (p<0.001) and end-systolic volume (p<0.001) indicated pronounced reverse remodeling and were accompanied by a modest increase in LVEF (p=0.046). Similarly, postoperative right ventricular (RV) function was significantly better in the DNC group (p=0.026), with a significant decrease in the RV end-systolic volume index (p=0.025), reflecting improved systolic emptying. Although in-hospital mortality was numerically higher in the DNC group (31.6% vs. 8.7%), the difference was not statistically significant (p=0.112). Importantly, all deaths were associated with refractory low cardiac output syndrome during the postoperative intensive care unit stay. CMR findings suggest that DNC may be a safe and effective myocardial protection strategy in patients with reduced LVEF undergoing CABG and MVR. Furthermore, DNC appeared superior to CBC in promoting early biventricular reverse remodeling in this study population. The higher mortality observed in the DNC group may be attributable to the small sample size, longer cross-clamp times, greater operative complexity, and potential selection bias.

Carcinoid heart disease (CHD) is associated with advanced neuroendocrine tumor liver metastases (NETLM) and may preclude surgical cytoreduction. We assessed perioperative and long-term outcomes of hepatectomy in patients with CHD. We retrospectively analyzed 311 patients undergoing cytoreductive hepatectomy for intestinal NETLM: non-functional (n = 163), carcinoid syndrome (CS) without CHD (n = 110), and CHD (n = 38), including patients undergoing pre-hepatectomy valve replacement. CHD patients more frequently had >10 liver metastases (78%) and larger lesions (median 9.5 cm) and required major hepatectomy more often (58%). Major morbidity was higher in CHD (up to 47%), yet 90-day mortality remained low (≤4%). Median overall survival after hepatectomy was comparable across groups (12.5 vs. 9.1 vs. 11.4 years; p = .19), including matched analyses. With optimal cardiac management, cytoreductive hepatectomy in CHD is feasible and provides long-term survival comparable to patients without CHD.

Aortic Root Thrombus Following Transcatheter Aortic Valve Replacement in a Patient with HeartMate 3 Left Ventricular Assist Device Support

Design and rationale of the prospective, randomized, controlled trial to assess the management of moderate aortic stenosis by clinical surveillance or transcatheter aortic valve replacement: The PROGRESS Trial.

Aortic stenosis (AS) may lead to left ventricular (LV) hypertrophy (LVH). After aortic valve replacement (AVR), LVH often does not regress fully. This has been associated with a worse prognosis. This study aimed at comparing LVH regression between male and female patients and to discover cardiac molecular factors associated with it. Myocardial samples were collected from 18 patients (50% female) who underwent surgical AVR. Preoperative and postoperative LV mass indices (LVMi) were compared between male and female patients. Expression of ADGRL4 and AQP7 was quantified by PCR and assessed with relative regression of LVMi. High-depth RNA-sequencing data from LV free-wall tissues of subjects with heart failure were employed for RNA editing analysis. Male patients had significant LVH regression (P < 0.05) after AVR, while female patients did not (P = 0.116). In male patients, a significant relationship was found between the expression of ADGRL4 (P < 0.05, R2 = 0.497) and AQP7 (P < 0.05, R2 = 0.576) and LVMi regression after AVR. This relationship was insignificant for ADGRL4 (P = 0.704, R2 = 0.0220) and AQP7 (P = 0.860, R2 = 0.00477) in female patients. RNA editing analysis revealed significant sex-biased differences in intronic adenosine-to-inosine (A-to-I) editing of AQP7, with five positions, particularly within Alu elements, along with sex-biased predicted RBP binding motifs. Recognizing patients at risk of defective LVH regression using molecular factors could lead to more intensive postoperative follow-up and earlier treatment, consequently improving reverse remodeling and prognosis. The present findings warrant further research in a larger study.NEW & NOTEWORTHY Regression of left ventricular hypertrophy is associated with better long-term outcome. This study demonstrates a significant relationship between ADGRL4 and AQP7 gene expression in perioperatively collected myocardial tissues and the regression of left ventricular mass postoperatively in male patients with aortic stenosis only. This could contribute to the development of a sex-based tool to predict the extent of postoperative hypertrophy regression.

Outcome of a Prospective Registry to Evaluate the Performance of the MANTA Vascular Closure Device in EVAR Patients.

Sternotomy causes substantial postoperative pain. Recently, several less invasive nerve blocks have been described that are safer to use even on anticoagulated patients. This study aims to evaluate early pain management using ultrasound-guided superficial parasternal intercostal plane block (SPIP) in patients undergoing aortic valve replacement via full sternotomy. This was a randomized, placebo-controlled trial performed in a tertiary referral hospital. Seventy-four elective patients scheduled for aortic valve replacement via full sternotomy were included. Patients were randomized to receive a preoperative SPIP block using either 40 mL of ropivacaine 7.5 mg/mL or 40 mL of 0.9% saline. Cumulative oxycodone consumption during the first 24 postoperative hours was recorded and analyzed as the primary outcome. Pain at rest was assessed using the numerical rating scale (NRS) scores 48 h postoperatively. Additional secondary outcomes included the need for vasopressors and antiemetics, recovery of bowel function, time spent in the intensive care unit (ICU), and nerve block-related complications. The 24-h cumulative consumption was not significantly different between groups (93.8 mg ± 33.3 vs. 109.4 mg ± 37.9, p = 0.066). NRS pain scores at rest were reduced in the patients with SPIP at 4 (5.0 ± 1.8 vs. 3.3 ± 2.4, p = 0.002). No differences were found in additional secondary outcomes. In this randomized controlled trial a single-shot SPIP block did not reduce the 24-h cumulative opioid consumption after cardiac surgery. This trial in a cardiac surgical cohort tested for possible benefit of a single injection superficial parasternal intercostal plane block for post-operative analgesia for post-sternotomy pain. The study found no post-op opioid treatment reduction with the treatment, but some analgesia effect cannot be ruled out.

The internal geometric annuloplasty ring is the only commercially available aortic annuloplasty ring designed to reduce and prevent annular dilatation during aortic valve repair; however, data regarding its long-term durability remain limited. Here we present our mid-term outcomes. A retrospective review was conducted of all adult patients who underwent aortic valve repair using the internal geometric annuloplasty ring between January 2017 and May 2025. Patients requiring valve reintervention were included in the analysis. Eighteen aortic valve repairs were performed in 17 patients (mean age, 54 ± 15 years; 16 males; 14 tricuspid valves, 2 bicuspid valves, 1 unicuspid valve), including 1 redo repair. Ten cases (56%) involved concomitant aortic root remodeling. Tricuspid 21-mm rings were used most frequently (61%). During a mean follow-up of 3.7 ± 1.7 years, 8 reinterventions were required in 7 patients (44%) owing to severe aortic insufficiency (AI; n = 7) or endocarditis with moderate AI (n = 1). The 5-year estimated reintervention rate was 40.8% (95% confidence interval, 20.0%-70.5%). Reinterventions included surgical aortic valve replacement (n = 5), redo internal geometric annuloplasty (n = 1), aortic root replacement (n = 1), and valve-in-ring transcatheter aortic valve replacement (n = 1). In surgical cases, postexplantation annular dimensions of the ring consistently returned to their preimplantation sizes. In our experience, 44% of patients receiving the internal geometric annuloplasty ring required aortic valve reintervention. Although effective in reducing annular size, the ring's rigid intra-annular design and the potential for excessive annular downsizing may predispose to recurrent insufficiency and limit future transcatheter options, prompting careful consideration of its broad application.

Rheumatic heart disease is not over: Cardiac cirrhosis and multivalvular sequelae in an endemic setting - A case series and review.

From the first aortic valve replacement (AVR) in 1960, surgical approaches evolved toward reduction of surgical invasiveness and enhanced recovery. Conventional minimally invasive approaches still require postoperative opioid use and chest restrictions. To further minimize aortic valve surgery, a robotic technique for transcervical AVR (TC-AVR) was developed to avoid major chest wall incisions and to facilitate expedited recovery. Following extensive cadaver simulations, the TC-AVR was performed in 7 patients between March and July 2025. The procedure includes cervical incision, similar to a thyroidectomy approach, representing a working port for robotic AVR. Cardiopulmonary bypass is established with femoral cannulation. After native valve excision, a conventional prosthetic valve is implanted with a running suture technique. Patients (mean age, 66 ± 8 years; 71% male) presented mostly with severe aortic stenosis, whereas a bicuspid aortic valve was present in 57%. Mean aortic cross-clamp and cardiopulmonary bypass times were 118 and 218 minutes, respectively, with reductions observed in later cases. There was no postimplantation aortic regurgitation, and intraoperative peak and mean gradients were 10 ± 5 mm Hg and 5 ± 2 mm Hg, respectively. There were no deaths. Postoperatively, no opioids were required for patients not needing reoperation (uncomplicated cases; n = 5), with mean in-hospital stay of 3.2 days (2-4 days). Patients resumed daily activities soon after discharge, unrestricted by chest precautions. Robotic TC-AVR is feasible, with the potential to offer superior patient recovery compared with traditional approaches. Accordingly, continued development of this technique and specialized instrumentation along with further safety evaluation are warranted and should be actively pursued.

Impact of Adverse Events on Costs and Length of Stay Following Transcatheter Tricuspid Valve Replacement.

Postoperative high-grade atrioventricular block is prevalent following congenital aortic valve, root and left ventricular outflow tract (LVOT) surgery. We aimed to evaluate the application of presurgical cardiac computed tomography (CT) estimation of the conduction axis in mitigating this issue. Patients with congenital aortic valve, root and LVOT disease evaluated and operated in our center from February 2022 to August 2025 who underwent presurgical CT with intact central fibrous body were included. Anatomical landmarks were used to estimate the atrioventricular node (point A), His bundle course (point B), and left bundle branch origin (point C) relative to the aortic virtual basal ring plane, and guide avoidance during cardiac surgery. Fifty-three patients were included (mean age, 32 years [range, 2-68 years]; 72% male). The most common diagnoses were bileaflet (70%) and unileaflet (10%) aortic valves, and LVOT obstruction (7%). Points A, B, and C were located at a mean depth of +11.8 ± 4.8 mm, +3.3 ± 3.2 mm, and +1.5 ± 2.7 mm inferior to the aortic virtual basal ring plane, respectively. Some form of aortic valve repair was performed in 38 patients (72%). The remaining 15 patients (28%) underwent some form of aortic valve replacement. One patient (1.9%) developed high-grade atrioventricular block with permanent pacemaker insertion, with subsequent spontaneous resolution. This incidence compared favorably to our prior report of 10% in a similar cohort without pre-surgical CT conduction system estimation. This CT-based conduction axis estimation may mitigate conduction damage risk during congenital LVOT, aortic valve, and root surgery. Further prospective multisurgeon, multicenter studies are necessary to validate this approach.

Assessment of the gradient gap after TAVR with balloon and self-expandable valves: Analysis of a large patient cohort.