Journal and News Scan

In his presidential address to the AATS annual congregation, Dr. Lars Svensson shared ideas and insights into CT surgeons’ purpose as physicians, what it takes to become a master surgeon (40,000 hours), how surgery is similar to car racing, and what it takes to push the limits of what is possible to drive progress and innovation. He discusses the values of vision and leadership, shares a mantra for success and attaining the highest quality patient care possible, and discusses ways to reach such a lofty goal. He also touches on the importance of building a great team, and how to lead such a team, devise a strategy, and measure progress along the way. This is a thorough, elaborate, and eloquent address that is thought provoking and inspirational.

For hypoplastic left heart syndrome patients undergoing staged reconstruction, the neoaortic root can dilate so that the incidence of neoaortic valve insufficiency increases over time. This article aims to evaluate the outcomes of neoaortic root geometries and valvular function after chimney reconstruction in the Norwood operation in 20 patients. Researchers found that chimney reconstruction did allow patients to avoid significant neoaortic valve regurgitation and preserve conical configuration in the mid-term. However, further studies are needed to evaluate long term outcomes of this form of reconstruction.

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.