Journal and News Scan

Heart transplantation (HT) is the only life extending option in adults with congenital heart disease (CHD) and end stage heart failure. This study evaluated outcomes after heart transplantation in adults with univentricular versus biventricular CHD. One-hundred-forty-nine patients were included, 55 of whom (36.9 percent) had univentricular CHD. Follow up was for a mean of 10.1 years. Sixty-four patients died during follow up, including 47 before discharge from hospital. Multivariable analysis showed univentricular physiology (odds ratio (OR) 2.99, 95 percent CI 1.33–6.74) and female recipient gender (OR 2.76, 95 percent CI 1.23–6.74) carried higher risk of early mortality. For patients who survived the early period, long-term survival was excellent and did not differ between the groups.

Between 2001 and 2021, 51 percent (n = 28,012) of US pediatric heart donors underwent cardiopulmonary resuscitation (CPR). Donor acceptance was lower after CPR (54 percent versus 66 percent; P < .001) and across successive quartiles of CPR duration (P < .001). Posttransplant survival was worse in donors who received more than 55 minutes of CPR (11.1 years vs 9.2 years; P = .025). There was no survival difference between the recipients of donors who received less than 55 minutes of CPR and no CPR (11.1 years vs 11.2 years; P = .571).

This commentary refers to “PCI or CABG for left main coronary artery disease: the SWEDEHEART registry,” by J. Persson et al. In their commentary, the authors discuss the evidence that shows lower rates of major adverse events at five years in patients who underwent CABG compared with PCI for the treatment of left main disease.

In this article the authors aimed to report the midterm outcomes after endovascular aortic repair in patients with Marfan or Loeys-Dietz syndrome. Patients were analyzed based on the timing of the procedure, whether it was an elective or emergency procedure, and the nature of the landing zone (safe vs. unsafe). A population of 419 patients with Marfan (n = 352) or Loeys-Dietz syndrome (n = 67) from two European centers was analyzed. Among them, 39 patients (9 percent) underwent endovascular aortic repair. Thoracic endovascular repair (TEVAR) was performed in 34 patients and abdominal endovascular aortic repair (EVAR) was performed in five patients. The indication for endovascular repair was aortic dissection in 13 (33 percent) patients, aortic aneurysm in 22 (57 percent) patients, and other indications in in 4 (10 percent) patients. There was no statistically significant difference in the rate of reinterventions between patients with unsafe landing zones and the patients with safe landing zones (P = 0.609), and no increased probability for reintervention after elective endovascular intervention compared to emergency procedures (P = 0.916). Hence, the authors concluded that endovascular aortic repair in patients with Marfan or Loeys-Dietz syndrome is feasible and safe in patients with a safe landing zone, and a viable option when employed by a multidisciplinary aortic team even if the landing zone is unsafe.