Journal and News Scan

This retrospective analysis examined trends and outcomes of aortic valve replacement in patients under the age of 65 with aortic stenosis from 2013 to 2021, focusing on transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR). Among 9,557 patients, TAVR usage increased from 7.1 percent to 54.7 percent during the study period. While 30-day mortality was similar between the two groups, TAVR was associated with higher six-year mortality (23.3 percent versus 10.5 percent) and a greater need for permanent pacemaker implantation. These findings suggest the need for a randomized controlled trial to compare long-term outcomes between TAVR and SAVR in younger patients.  

In this study-level meta-analysis of randomized controlled trials (RCTs) evaluating the effect of early aortic valve replacement (AVR) versus clinical surveillance (CS) in patients with asymptomatic severe aortic stenosis (AS), four RCTs were identified and included for analysis: AVATAR, RECOVERY, EARLY TAVR, EVOLVED. Prespecified outcomes included all-cause and cardiovascular mortality, unplanned cardiovascular or heart failure (HF) hospitalization, and stroke. A total of 1,427 patients (719 in the early AVR group and 708 in the CS group) were included for analysis.  

At an average follow-up time of 4.1 years, early AVR was associated with a significant reduction in unplanned cardiovascular or HF hospitalization (14.6 percent versus 31.9 percent; HR: 0.40; 95 percent CI: 0.30-0.53;P<0.01) and stroke (4.5 percent versus 7.2 percent; HR: 0.62; 95 percent CI: 0.40-0.97;P=0.03). However, no statistically significant differences in all-cause mortality (9.7 percent versus 13.7 percent; HR: 0.68; 95 percent CI: 0.40-1.17;P=0.17) and cardiovascular mortality (5.1 percent versus 8.3 percent; HR: 0.67; 95 percent CI: 0.35-1.29; P=0.23) were observed with early AVR compared with CS. The authors conclude that early AVR is associated with a significant reduction in unplanned cardiovascular or HF hospitalization and stroke, but no difference in all-cause or cardiovascular mortality compared with CS. 

In this article, the authors provide the first global quantification of women cardiac surgeons (WCS) and examine factors related to workforce diversity. The authors report that women constitute 8.0 percent (1,178/14,651) of the international cardiac surgical workforce, with a median of 0.00 WCS per million women (IQR: 0.00–0.09). North America (11.4 percent) and Europe (10.3 percent) have the highest regional representation, while East Asia (2.9 percent) and the Middle East (1.7 percent) have the lowest. High-income countries (9.9 percent) have double the proportion of WCS compared to low- and middle-income countries (4.8 percent), with a notable absence in low-income countries. Female representation correlates with Gross National Income (GNI) per capita (τ = 0.39), the Global Gender Gap Index (GGGI) (τ = 0.26), and health expenditure (τ = 0.26). 

This study investigates lung transplant outcomes across age groups, highlighting key survival trends and risk factors. Among the 33,644 recipients, older patients (aged 65–79 years) more frequently underwent single lung transplantation. Bilateral lung transplantation provided a significant survival advantage over single lung transplantation for recipients up to 74 years of age, but not for those aged 75–79, who showed poor long-term survival regardless of procedure type. A history of prior cardiac surgery was identified as a significant risk factor for decreased survival, with older patients more likely to receive single lung transplants if they had such a history. 

This research underscores the importance of tailored patient selection and surgical approaches for older lung transplant candidates. The findings offer valuable insights into optimizing outcomes and resource allocation for an increasingly older transplant population.