Journal and News Scan

Some patients with infective endocarditis receive exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. Hence, this study aimed to compare the outcomes in patients with infective endocarditis and a surgical indication in those who underwent or did not undergo valve surgery. To this end, the authors performed a pooled analysis of Kaplan-Meier derived reconstructed time‐to‐event data from studies comparing conservative and surgical treatment. Four studies with a total of 3,003 patients and a median follow up time of 7.6 months were included. Overall, patients with an indication for surgery who were surgically treated had a significantly lower risk of mortality compared with patients who received conservative treatment (hazard ratio [HR], 0.27 [95 percent CI, 0.24–0.31], P <0.001). Survival was superior among patients who underwent surgery when compared with those who did not, at one month (87.6 percent versus 57.6 percent; HR, 0.31 [95 percent CI, 0.26–0.37], P <0.01), at 6 months (74.7 percent versus 34.6 percent), and at 12 months (73.3 percent versus 32.7 percent).

Aortic valve regurgitation (AR) often occurs after left ventricular assist device (LVAD) implantation. Transcatheter aortic valve implantation (TAVI) is a viable alternative to surgical aortic valve replacement (SAVR) in this cohort, most of whom have a high surgical risk profile. Procedure outcome and survival were analyzed. From 2017 to 2023, 27 LVAD patients with significant AR received elective or urgent TAVI at this center. Of these patients, 25 percent had device landing zone pre-stenting followed by a standard TAVI device and 59 percent received standard TAVI devices, with 37 percent of these patients requiring a second transcatheter heart valve (THV). Aortic regurgitation in more than trace amounts affected 6 percent of patients at discharge. Fifteen percent received AR-dedicated TAVI devices, with none requiring a second THV and no AR at discharge. TAVI has promising outcomes and survival in LVAD patients, with tailored devices and pre-stenting enhancing procedure success.

Heart transplantation for adult congenital heart disease (ACHD) is associated with challenging pretransplant support, long waitlists, and high early post-transplant mortality. The authors used 2,737 patients from the United Network for Organ Sharing database to examine whether changing practices have altered outcomes in the period from 1992 to after 2018, when the allocation system changed. The listed and transplanted patients gradually increased, but the proportion receiving a transplant remained constant. There were decreases in both the proportion delisted or dying after listing and the waitlist times, especially after 2018. Mortality at 30 days post-transplant remains high but has significantly improved. The authors concluded that more complex patients do not have worse outcomes and that the new donor allocation system has reduced wait times without affecting early mortality.

This commentary succinctly reviews the 2021 coronary revascularization and the 2023 chronic coronary disease guidelines with relation to use of PCI and CABG in patients with ischemic cardiomyopathy and ejection fraction (EF) less than or equal to 35 percent, and reviews findings from Alzahrani et al. There is data suggesting the superiority of CABG compared to PCI in these populations, particularly with regards to completeness of revascularization and long-term outcomes that support keeping use of CABG in this particular patient population as a Class I recommendation.