Journal and News Scan

This study compared outcomes between patients undergoing valve-in-valve transcatheter aortic valve replacement (ViV TAVR) and redo surgical aortic valve replacement (redo SAVR) using a retrospective analysis of institutional databases, which included data from 2013 to 2022 for TAVR and 2011 to 2022 for SAVR. A total of 198 patients underwent ViV TAVR and 147 patients underwent redo SAVR. Both groups had an operative mortality rate of 2 percent, but the observed-to-expected operative mortality ratio was higher in the redo SAVR group (1.2) compared to ViV TAVR (0.32). Patients in the redo SAVR group were more likely to experience complications, including transfusions, reoperations for bleeding, new onset renal failure requiring dialysis, and the need for permanent pacemakers. 
 
Echocardiographic outcomes showed that the mean gradient across the aortic valve was significantly lower in the redo SAVR group at both postoperative day 30 and one year. Survival estimates for one year were similar for both procedures, and multivariable Cox regression indicated no significant difference in mortality risk between the two groups (hazard ratio 1.39, 95 percent CI 0.65-2.99; P = .40). However, heart failure readmission rates were higher in the ViV cohort. 
 
While both ViV TAVR and redo SAVR demonstrated comparable mortality rates, the redo SAVR group had better mean gradients and lower rates of heart failure readmissions but faced more postoperative complications. These findings suggest that despite a higher risk profile, redo SAVR may offer certain advantages over ViV TAVR in selected patients. 

In this article, the authors detail the seven pillars for successful management of tricuspid valve endocarditis. Surgical indications for tricuspid valve endocarditis include heart failure, uncontrolled infection, and septic emboli risk. Surgical techniques may vary, however, the focus for this procedure is on the debridement of infected material and managing valve function. Approaches include valve repair, replacement, or techniques such as the Kay repair and the De Vega annuloplasty, each with their own specific benefits and risks. Novel suction devices, such as the AngioVac System, show promise in removing vegetations effectively and safely. The management of infective tricuspid endocarditis requires a collaborative approach, involving cardiac surgery, cardiology, and an infectious disease specialist, but primarily relies on long-term intravenous antibiotics. 

This study utilized data from 1,266,545 consecutive isolated coronary artery bypass graft (CABG) operations (2008-2016) in The Society of Thoracic Surgeons Adult Cardiac Surgery Database to develop risk assessment tools to predict the likelihood of perioperative transfusions and the expected volume of blood products required. 
 
The study found that 657,821 patients (51.9 percent) received transfusions of red blood cells (RBC), fresh frozen plasma (FFP), cryoprecipitate, and/or platelets. The researchers established a rapid risk score based on five key variables: age, body surface area, sex, preoperative hematocrit, and the use of an intra-aortic balloon pump. 
 
The full model showed C-statistics indicating good predictive performance: 0.785 for any blood product, 0.815 for RBC, 0.707 for FFP, and 0.699 for platelets. The rapid risk assessments also demonstrated effective predictive capability, with C-statistics of 0.752, 0.785, 0.670, and 0.661, respectively. Calibration plots indicated strong alignment between observed and expected transfusion risks, with discrepancies of less than 10.8 percent across different risk percentiles. 
 
Overall, the study concluded that these well-calibrated risk assessment tools can guide surgeons in understanding the risks associated with transfusions and the anticipated need for blood products, ultimately helping to optimize patient outcomes and improve resource management in clinical settings. 

In this meta-analysis, the authors included three randomized controlled trials (RCTs) conducted in patients with heart failure (HF) and moderate to severe functional mitral regurgitation (FMR), comparing treatment with the MitraClip device in addition to medical therapy (device arm) to medical therapy alone (control arm). The following trials were included: COAPT, MITRA-FR, and RESHAPE-HF2. For this meta-analysis, the authors used common endpoints that were reported in each trial, namely, the first publication of COAPT, MITRA-FR, and RESHAPE-HF2, the extended two-year follow-up report of MITRA-FR, and one additional paper on RESHAPE-HF2. 
 
The meta-analysis showed no statistically significant difference in all-cause mortality within 24 months (HR: 0.76 [95 percent CI: 0.57-1.01]; P = 0.056) and cardiovascular mortality within 24 months (HR: 0.77 [95 percent CI: 0.56-1.06]; P = 0.112). However, the models showed better outcomes for the device group compared with the control group regarding total unplanned HF hospitalizations within 24 months (HR: 0.69 [95 percent CI: 0.49-0.97]; P = 0.0324), a composite of recurrent events of hospitalization for HF or all-cause mortality within 24 months (HR: 0.71 [95 percent CI: 0.50-0.995]; P = 0.0486), and change in six-minute walk distance from baseline to 12 months (mean change in meters: 32.55 [95 percent CI: 2.68-62.43]; P = 0.0327). 
 
In summary, this meta-analysis, including the three largest RCTs on this topic, suggests benefits for HF hospitalizations and improvement in six-minute walk distance after M-TEER with the MitraClip device in addition to medical therapy, compared with medical therapy alone, in patients with symptomatic HF and moderate to severe FMR. However, there was no significant benefit in cardiovascular or all-cause mortality.