Investigation of fetal right ventricular contraction using pressure driven fluid structure interaction modeling

Bicuspid aortic valve (BAV) is the most common congenital heart lesion that can be associated with significant valve dysfunction in childhood. Surgical interventions for this condition often include pulmonary autograft (Ross procedure) or aortic valve replacement (mechanical - mAVR - or bioprosthetic - bAVR). Aortic valve repair (Rpr) was a common primary intervention for BAV with aortic stenosis at our institution during the study period. This single-center cohort study included 150 adults with BAV and aortic stenosis who underwent 197 surgical interventions during childhood. We investigated important clinical demographic differences, long-term freedom from repeat aortic valve intervention, and long-term freedom from adverse events based upon the type of definitive aortic valve surgery. We hypothesized that Ross and mAVR would demonstrate superior temporal durability, but that mAVR would have more associated adverse events, and that Ross would require more lifetime sternotomies. Ross and mAVR demonstrated superior temporal durability when compared to other aortic valve interventions by pairwise comparison (Rpr vs mAVR p < 0.001; Rpr vs Ross p < 0.001; Rpr vs bAVR p = 0.075; mAVR vs Ross p = 0.924; mAVR vs bAVR p = 0.026; Ross vs bAVR p = 0.001). Ross demonstrated superior freedom from adverse events when compared directly to bAVR (Rpr vs mAVR p = 0.755; Rpr vs Ross p = 0.033; Rpr vs bAVR p = 0.816; mAVR vs Ross p = 0.040; mAVR vs bAVR p = 0.847; Ross vs bAVR p = 0.006). Ross procedure was not associated with an increased number of lifetime sternotomies compared to mAVR. Concurrent Konno procedure was not an independent predictor of worse outcomes.

The dataset comprises Building Management System (BMS) data from an educational building located on the main campus of Aalborg University in Denmark, as well as from Empa's NEST (Next Evolution in Sustainable Building Technologies) demonstrator building in Switzerland. The buildings contain main and sub-meters for all equipment using electricity or thermal energy. The equipment using thermal energy includes air handling units (water-based heating coils), space heating (floor heating, radiators, and ceiling heating), and domestic hot water (heat exchangers). Besides the energy data, room data, such as temperature, CO2 concentration, occupant presence, radiator valve opening, and ventilation damper opening, are included for all rooms in the buildings. The data spans 6 to 28 months, depending on the building and the measurement points. The data was collected as raw data with a time resolution between 1 and 10 min. The dataset is expected to be useful for various applications, including model calibration, machine learning, and occupant analysis.

Prediction method for control valve operating conditions based on corrected mass flow

This study investigates the association between cardiac interventions and the risk of developing unilateral sensorineural hearing loss (USNHL) or sudden sensorineural hearing loss (SSNHL). This retrospective cohort study included 120,429,580 patients from the TriNetX US Collaborative Network. Inpatient, ambulatory, and academic medical centers. All patients undergoing various cardiac interventions were stratified into groups based on embolic risk, surgical approach (open vs. minimally invasive), and dialysis dependence. We aim to determine whether embolic events, anesthesia exposure, surgical trauma, or altered circulatory dynamics contribute to postprocedural hearing loss. Risk ratios (RR) with 95% CI were calculated to assess the relative risk of USNHL/SSNHL across these groups, with a P -value < 0.05 considered significant. Patients with intermediate embolic risk (atrial fibrillation, TIA, or stroke without anticoagulation) had a significantly increased risk of hearing loss. High embolic risk patients with anticoagulation also had elevated risk but to a lesser degree. Open valve replacement and open bypass did not significantly increase risk of hearing loss. Patients undergoing general anesthesia for cardiac surgery had a higher risk of hearing loss compared with general anesthesia alone. Dialysis-dependent patients had a significantly increased risk of hearing loss. Embolic burden, valvular surgery, and dialysis dependence are associated with increased USNHL/SSNHL risk following cardiac interventions. While cardiac surgery contributes to hearing loss, open procedures do not necessarily increase risk compared with minimally invasive techniques. Further research is needed to identify preventive strategies. Level III.

Long-Term Outcomes of Postoperative Atrial Fibrillation After Cardiac Surgery: Results from 19,000 Patients.

Minimally invasive mitral valve (MIMV) surgery has increased in prevalence due to reduced postoperative pain, length of stay, and improved cosmesis. However, there is a lack of data describing the risk and impact of postoperative diaphragm dysfunction (DD) after MIMV. Consecutive patients at a single institution undergoing isolated mitral valve surgery either via full sternotomy (FS) or MIMV (right thoracotomy) between 2015 and 2024 were included. The diagnosis of DD was based on postoperative diaphragm elevation on chest X-ray and confirmation via ultrasound Sniff test. Factors associated with postoperative DD were identified, and postoperative outcomes were compared between groups. The incidence of postoperative DD was 3.0% (n = 35) among the 1,155 patients undergoing MV surgery. The incidence of DD was 1.8% after FS and 9.3% after MIMV (P < 0.001). Among MIMV patients, all suffered from right DD. After controlling for age, body mass index, and pulmonary comorbidities, MIMV was independently associated with postoperative DD compared with FS (odds ratio = 5.1, 95% CI: 2.4 to 11.0, P < 0.001). Although patients with and without DD had similar postoperative outcomes, those patients older than 70 years with DD had longer postoperative ventilation times (P = 0.03) and hospital length of stay (P = 0.02). MIMV via right thoracotomy is associated with increased risk of postoperative DD and increased ventilation times and hospital length of stay for elderly patients. Further studies are needed to elucidate the causes for diaphragm injury to minimize this complication.

While minimally invasive cardiac surgery has gained widespread popularity, full sternotomy (FS) remains the standard approach, particularly for multi-component cardiac surgery due to concerns over restricted exposure and technical challenges with minimally invasive surgical (MIS) approaches. We sought to compare clinical outcomes in patients undergoing MIS approaches to full FS for combined aortic valve and aortic surgeries. PubMed, Web of Science, Scopus, and Cochrane CENTRAL were systematically searched to identify studies comparing MIS to FS in patients undergoing combined aortic valve and aortic surgery. The primary endpoints were cardiopulmonary bypass time, cross-clamp time, operative time, and postoperative mortality. A total of 1,114 patients from nine studies were analyzed. Compared to FS, MIS approach for combined aortic valve and aortic surgery demonstrated comparable cardiopulmonary bypass time (MD = -3.2min; 95% CI: [-10.10, 3.68]; P = 0.36), cross-clamp time (MD = -1.4min; 95% CI: [-7.17, 4.34]; P = 0.63), operative time (MD = 6.6min; 95% CI: [-10.2, 23.4]; P = 0.45), operative mortality (RR = 0.56; 95% CI: [0.20, 1.52]; P = 0.25), and overall mortality at follow up (RR = 0.46; 95% CI: [0.07, 3.21]; P = 0.43). MIS was associated with a significantly shorter mechanical ventilation duration (MD = -3.9h; 95% CI: [-5.89, -2.06]; P < 0.0001), hospital stay (MD = -1.2 days; 95% CI: [-2.01, -0.47]; P = 0.002), risk of re-exploration for any cause (RR = 0.47; 95% CI: [0.23, 0.97]; P = 0.04). There was no significant difference for ICU stay, stroke, atrial fibrillation, permanent pacemaker implantation, acute kidney injury, and sternal dehiscence between the two groups. Our meta-analysis suggests that MIS is a feasible alternative to FS for combined aortic valve and aortic surgeries in carefully selected patients at experienced centers, offering shorter recovery times with comparable operative and long-term mortality. This meta-analysis was registered on PROSPERO. CRD42024597960.

Infective endocarditis is an infectious heart disease strongly associated with morbidity and mortality. Up to half of the patients with infective endocarditis require heart valve surgery. While early exercise-based rehabilitation is well documented for patients recovering from heart surgery for non-infective endocarditis, there is limited research on those who have undergone valve surgery due to this infection. This study aimed to explore the early aerobic training in this patient population. A single-centre prospective feasibility study was conducted using the UK Medical Research Council's framework for complex interventions. The study investigated the feasibility (recruitment, retention, adherence), safety, acceptability, and preliminary functional outcomes of 4 × 4 interval training in this patient population. Training session data included the number, duration, and intensity, which were monitored via the Apple Watch S5 (Present Age-Predicted Maximum Heart Rate) and the Borg RPE scale. Functional outcomes were evaluated at baseline and 3 months post-surgery, including sub-maximal oxygen uptake (treadmill protocol), 6-min walk test, and quality of life (HeartQoL, EQ-5D-5L). Sixteen patients consented to participate, with 12 initiating the intervention and 11 completing it, yielding a retention rate of 91.7%. Training adherence averaged 73.1% of the minimum expected sessions, with high participant satisfaction and no serious adverse events reported. At the 12-week follow-up, participants demonstrated measurable change in functional capacity, including an increase in workload capacity (+ 95 W), METs (+ 3.4), and 6-min walk test distance (+ 219m). Health-related quality of life also showed a noticeable increase, with HeartQoL physical and emotional scores increasing by 1.0 and 1.3, respectively, and EQ-5D-5L VAS scores rising by 17.2. The EQ-5D-5L index increased from 0.61 at baseline to 0.87 after 12weeks. Interval training, when conducted with appropriate safeguards and tailored to individual needs, is a feasible and safe intervention for patients recovering from endocarditis and cardiac surgery. The observed improvements in functional capacity, quality of life, and patient satisfaction support the need for larger controlled studies. Clinical Trials, ID NCT05703022. Registered on 25 November 2021, http://www. gov.

Early discontinuation of long-term anticoagulation after surgical left atrial appendage occlusion.

Staphylococcus aureus strains sustain their high-virulent phenotype during native endocarditis.

Prosthetic valve endocarditis (PVE) is a life-threatening complication following valve replacement and is often challenging to diagnose in the early postoperative period. Coronary embolization is a rare manifestation of infective endocarditis, and PVE presenting as acute coronary syndrome is exceptionally uncommon. A 73-year-old man underwent surgical aortic valve replacement with a 21-mm bioprosthetic valve. His postoperative course was uneventful, and he was discharged without anticoagulation therapy. One month later, he developed exertional dyspnea, gastrointestinal symptoms, and intermittent chest pain, which progressed to cardiogenic shock with severe bradycardia. Emergent coronary angiography revealed acute occlusion of the right coronary artery, and percutaneous coronary intervention was performed. Intravascular ultrasound and contrast-enhanced computed tomography revealed a low-echoic, low-attenuation lesion at the right coronary ostium, initially interpreted as thrombotic material. Despite successful revascularization, profound circulatory instability persisted. Subsequent echocardiography revealed prosthetic valve dehiscence with an annular abscess, confirming early PVE. Emergent surgery included annular reconstruction with a bovine pericardial patch, aortic root replacement, removal of the coronary stent, and coronary artery bypass grafting. Intraoperative hemodynamics remained unstable, necessitating postoperative veno-arterial extracorporeal membrane oxygenation support. The patient ultimately succumbed to non-occlusive mesenteric ischemia on postoperative day 10. This case illustrates a rare and complex presentation of early PVE manifesting as acute right coronary artery occlusion. Coronary imaging alone may be insufficient to differentiate infected vegetation from thrombus. Early valve-focused echocardiographic evaluation is essential in patients with recent valve surgery presenting with acute coronary events.

Patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may require left ventricular (LV) unloading to prevent pulmonary congestion and adverse hemodynamic interactions. However, defining the need and timing of unloading remains challenging, as current approaches rely predominantly on cardiac and pulmonary parameters, often neglecting systemic and organ-level congestion. We report the case of a 53-year-old woman admitted with cardiogenic shock following pericardial drainage and mediastinal mass biopsy. Due to rapid hemodynamic deterioration, VA-ECMO was initiated, resulting in stabilization. Early echocardiographic assessment showed severe biventricular dysfunction but evidence of partial aortic valve opening without LV distension. To further characterize the hemodynamic profile, splanchnic Doppler ultrasound was performed, demonstrating preserved renal arterial flow (resistive index <0.72), continuous intrarenal venous flow, and low portal vein pulsatility (<30%), consistent with a non-congestive phenotype. Based on this integrated assessment, LV unloading was deferred. Subsequent pulmonary artery catheterization confirmed low filling pressures despite reduced cardiac output. A diagnosis of stress-induced cardiomyopathy was suspected, and levosimendan was administered, leading to rapid improvement in cardiac function and successful ECMO weaning. Final pathology revealed a thymic neuroendocrine carcinoma. This case highlights the limitations of relying solely on cardiac indices to guide LV unloading decisions during VA-ECMO. Splanchnic Doppler provided a non-invasive, real-time evaluation of the perfusion-congestion balance at the organ level, complementing echocardiographic and invasive hemodynamic data. The integration of multimodal monitoring may allow a more comprehensive understanding of patient-device interaction and support individualized management strategies. Further research is needed to validate the role of splanchnic ultrasound in guiding unloading decisions and optimizing outcomes in patients with cardiogenic shock supported by VA-ECMO.

Emergent simultaneous cesarean section and maternal cardiac surgery.

Sex-related disparities affect diagnosis, referral, and prognosis of aortic valvular diseases. Contemporary US data on transcatheter aortic valve implantation (TAVI) by sex are limited. To characterize 10-year trends in TAVI use, periprocedural complications, and long-term outcomes among Medicare beneficiaries, stratified by sex. This nationwide, retrospective, population-based cohort study used US Medicare claims data from fee-for-service beneficiaries discharged after TAVI from January 1, 2013, to December 31, 2022. The median follow-up time was 2.19 (IQR, 0.94-3.79) years. Exclusions included patients who had concomitant valve surgery, infective endocarditis, valve-in-valve TAVI, transapical TAVI, TAVI for pure aortic insufficiency, or later conversion to Medicare Advantage. Analyses were conducted between October 1, 2024, and April 1, 2025. TAVI. The primary outcome was all-cause mortality. Secondary outcomes included periprocedural mortality, vascular complications, acute kidney injury, major or life-threatening bleeding, stroke, acute myocardial infarction (AMI), permanent pacemaker implantation (PPI), and hospitalization for heart failure (HF). Adjusted odds ratios (AORs) and hazard ratios (AHRs) with 95% CIs were estimated. The study included 314 123 patients (141 233 women [45.0%] and 172 890 men [55.0%]). Women were older than men (mean [SD] age, female: 80.3 [7.8] years; male: 79.4 [7.7] years; standardized mean difference, 12%). The proportion of female patients who underwent TAVI declined from 47.6% in 2013 to 43.6% in 2022 (P < .001). Compared with men, women had higher periprocedural mortality (2.5% vs 2.2%; AOR, 1.20 [95% CI, 1.14-1.26]), vascular complications (5.8% vs 3.6%; AOR, 1.65 [95% CI, 1.60-1.71]), and bleeding (10.4% vs 6.8%; AOR, 1.67 [95% CI, 1.62-1.71]) but less PPI (16.9% vs 20.0%; AOR, 0.81 [95% CI, 0.79-0.82]). Long-term mortality was lower in female patients (AHR, 0.92; 95% CI, 0.91-0.93), although their risks of HF hospitalization, AMI, stroke, and bleeding were higher. Among Medicare beneficiaries, women constituted a progressively declining proportion of patients treated with TAVI, experienced more periprocedural complications, and demonstrated modestly better long-term survival compared with men. Further work is needed to understand factors influencing these trends and to refine sex-specific strategies for optimal outcomes.

Paravalvular leak (PVL) is a significant complication following valve surgery, typically affecting elderly patients and manifesting as heart failure or hemolytic anemia. While uncommon in younger populations, its occurrence presents unique clinical challenges. This report describes a unique case of a 19-year-old male presenting with a rare combination of aortic paravalvular leakage and mitral annuloplasty ring dehiscence. Five months post-surgery, the patient presented with icteric sclerae and tea-colored urine. Laboratory evaluation confirmed intravascular mechanical hemolysis, evidenced by indirect hyperbilirubinemia and the hallmark presence of schistocytes (helmet cells) on a peripheral blood smear. Transthoracic echocardiography identified the specific mechanical triggers: a prosthetic aortic valve PVL and severe mitral regurgitation due to ring dehiscence. Management involved immediate medical stabilization using diuretics, rate-control agents, and the continuation of lifelong warfarin therapy. Due to the mechanical nature of the defect, the patient was referred to a tertiary center for transesophageal echocardiography and evaluation by a multidisciplinary heart team for definitive surgical or transcatheter intervention. This case emphasizes the critical importance of early clinical recognition of mechanical hemolysis in rare, young populations with complex prosthetic valve failures. A multidisciplinary heart team approach and gold-standard imaging are essential to minimize morbidity and ensure the near-complete elimination of the leak required to resolve hemolysis.

Current evidence does not support superiority of one cardioplegia type over another, but stems from low-risk populations. Therefore, we compared outcomes of multimorbid, high-risk infective endocarditis (IE) patients receiving Custodiol®crystalloid or Calafiore blood cardioplegia during cardiac surgery. We retrospectively analyzed 553 patients (mean EuroScore II 22.7 ± 21.1) who underwent surgery for IE between 2009 and 2023 and received either cold crystalloid (Custodiol®, n = 335) or warm blood (Calafiore, n = 218) cardioplegia. The primary endpoint was 1-year mortality. Secondary endpoints included 30-day mortality, postoperative stroke, and new-onset dialysis. Propensity score matching (1:1, 14 covariates) resulted in 175 matched pairs. Statistical analysis included nonparametric and exact tests. In the overall cohort, patients receiving Custodiol® were higher risk and had higher mortality and morbidity. After matching, there was no significant difference in 1-year mortality between patients receiving Custodiol® and Calafiore (37.1% vs. 28.6%, p = 0.09). 30-day mortality trended to be lower in the Calafiore group without reaching statistical significance (22.9% vs. 14.9%, p = 0.057). However, stroke was less frequent (4.6% vs. 10.9%, p = 0.029), ICU stay was shorter (3[1-8] vs. 6[3-12.5] days, p < 0.001) and postoperative dialysis was numerically less common (13.7 vs. 20.6%, p = 0.091). These differences were most evident in procedures with shorter cross-clamp times, such as isolated mitral or aortic valve surgery, where mortality and recovery parameters consistently favored Calafiore. In high-risk endocarditis patients warm blood cardioplegia may be superior to cold crystalloid, although differences did not reach statistical significance. However, propensity matching may not have accounted for all differences, which warrants further discussion and investigation.

Simulations Predict Improved Valve Performance Without Direct Leaflet Intervention After Neonatal Truncus Arteriosus Repair.

Intravenous drug abuse (IVDA) has increased the incidence of infective endocarditis. Standard management includes traditional open surgery and more recently described percutaneous tricuspid valve debulking. Study goals were to compare clinical outcomes and identify financial differences between percutaneous tricuspid debulking and tricuspid surgery for isolated tricuspid valve endocarditis. A single-center, retrospective cohort patient study of isolated tricuspid valve endocarditis was performed. Patients underwent either percutaneous debulking with the AngioVac system (n=14, 83% IVDA) or tricuspid valve surgery (n=23, 76% IVDA). Length of stay, readmission rates, mortality, echocardiographic parameters, hematologic markers, transfusion rates, and total charges for index hospitalization were evaluated between groups. In patients who underwent either percutaneous debulking or open surgery, length of stay (17±17 vs 20±13 days, p=0.48), 30-day readmission (29% vs 26%, p=0.87), in-hospital mortality (7% vs 0%, p=0.20), and 30-day mortality (7% vs 0%, p=0.20) were not statistically different. One-year mortality (21% vs 4%, p=0.11) trended toward but did not reach significance. Postoperative tricuspid valve regurgitation (2.5±1.1 vs 1.0±0.3, p<0.0001) and transfusion rates (2±3 vs 6±6 units, p=0.02) were significantly different between therapies. Total charges for hospitalization were not statistically different ($557,066±457,520 vs $571,615±324,254, p=0.91). Tricuspid debulking is a potential alternative to surgery for patients with infective tricuspid endocarditis. Similar outcomes, costs, and avoidance of prosthetic material in patients with active IVDA are potential benefits.

48. Impact of Right Ventricular Dysfunction on Clinical Outcomes between Tricuspid Valve Repair and Replacement in Isolated Tricuspid Valve Surgery