Journal and News Scan

A novel transapical beating-heart septal myectomy (TA-BSM) procedure was performed for patients with latent obstruction and outcomes were compared with those for patients with resting obstruction. The population was comprised of 120 patients with symptomatic hypertrophic obstructive cardiomyopathy, 33 with latent obstruction, and 87 with resting obstruction. There were no important differences in baseline characteristics, but those with latent obstruction had lower basal septal thickness, higher midventricular thickness, smaller left atria, and higher frequency of mitral subvalvular anomalies. After surgery, there was no significant difference in early deaths or midterm survival and the New York Heart Association class was significantly improved. This novel TA-BMS procedure achieved equivalent outcomes regardless of resting left ventricular outflow tract gradients.

This viewpoint article offers a quick overview of 10 articles selected by the authors as the best papers on valvular heart disease published in 2023. The selection was restricted to publications in The New England Journal of Medicine, the Journal of the American Medical Association, Lancet, European Heart Journal, Circulation, the Journal of the American College of Cardiology, and JAMA Cardiology. The 10 papers were chosen based on a consensus between the three authors, who rated quality, the potential impact on clinical practice and future research, and expected interest for the cardiovascular readership. Among others, some selected papers are the Trigistry registry, and the Triluminate, Notion (10 -year results), Partner 3 (five-year results), and PROACT Xa trials.

This retrospective multicenter study examined late surgical outcomes for children from low and middle income countries with double outlet right ventricle (DORV). DORV was defined as both great arteries arising entirely or mostly from the right ventricle. A total of 81 consecutive DORV repairs were performed between 1996 and 2022. Six subtypes of DORV were divided into two overall groups: (i) DORV-committed ventricular septal defect (VSD) and (ii) DORV-noncommitted (nc) VSD. Four Fontan patients were excluded, and three patients were lost to follow up. Overall perioperative mortality was 7.4 percent. Overall, 1--year survival was 86 percent. Early mortality was similar in both groups. There was a trend toward satisfactory outcome of biventricular repair for simple DORV with committed VSD compared with complex DORV with ncVSD.

In this study, the authors aimed to analyze the one-year outcome after aortic valve (AV) repair versus surgical AV replacement (SAVR) in patients with aortic regurgitation (AR) using data from the German Aortic Valve Registry (GARY). A total of 8,076 AR patients were included in the analysis. The AV was repaired in 2,327 patients (29 percent) and 5,749 patients (71 percent) underwent SAVR. Patients were matched to correct for baseline differences in both study groups. After adjusting for baseline differences, the one-year survival rate was 97.7 percent (95 percent CI, 97.0 percent to 98.5 percent) in the AV repair cohort versus 96.4 percent (95 percent CI, 95.9 percent to 96.9 percent) SAVR cohort (log-rank P < 0.001). Cox regression analysis showed a significant age independent advantage of AV repair compared with SAVR (hazard ratio, 0.68; 95 percent CI, 0.51-0.90; P < 0.0001) on one-year survival. Furthermore, cardiac event-free survival at one year was 85.7 percent (95 percent CI, 483.8 percent to 87.7 percent) in the AV repair group versus 81.7 percent (95 percent CI, 80.7 percent to 82.9 percent) in the SAVR group (log-rank P < 0.001). There was no difference in the need for AV reintervention when comparing both the AV repair and SAVR cohorts (P = 0.59). The authors concluded that AV repair surgery, if technically feasible, is associated with higher superior one-year survival and one-year cardiac event-free survival than SAVR.