Journal and News Scan

This article highlights the first partial heart transplant in a newborn who was born with persistent truncus arteriosus and irreparable truncal valve dysfunction. This condition remains an issue due to the lack of implantable heart valves that can grow with the patient, and therefore patients require recurrent implant exchanges until adulthood.

The team at Duke have also published the case in JAMA, detailing the first case of a partial heart transplant through implantation of growing heart valves. The authors report a good outcome at one year.

In this article, the authors evaluated the practice trends and three-year outcomes following transcatheter edge-to-edge repair (TEER) and surgical repair for degenerative MR in the United States. Medicare and Medicaid data of 53,117 mitral valve interventions for degenerative MR (surgery or TEER) between 2012 and 2019 were analyzed. After excluding patients with rheumatic and congenital disease, endocarditis, myocardial infarction, cardiomyopathy, and concomitant or prior coronary revascularizations, a total of 27,170 patients remained in the analysis.

The total annual volume of mitral interventions did not significantly change (p=0.18) during the study period. However, surgical cases decreased by a third while TEER increased. The included patients were 52.5 percent male and had a mean age of 73.5 years. A total of 7,755 patients underwent TEER, and 19,415 underwent surgical repair. Surgical patients were younger (p <0.001), with less comorbidity and frailty. After matching for baseline characteristics, the resulting 4,532 patient pairs presented with a three-year survival rate after TEER of 65.9 percent (95 percent CI 64.3-67.6) and 85.7 percent (95 percent CI 84.5-86.9) after surgery (p <0.001). The three-year stroke rates after TEER or surgery were 1.8 percent (95 percent CI 1.5-2.2) and 2.0 percent (95 percent CI 1.6-2.4) (p=0.49), respectively. The three-year heart failure readmission rates after TEER or surgery were 17.8 percent (95 percent CI 16.7-18.9) and 11.2 percent (95 percent CI 10.3-12.2 and p <0.001), respectively. Finally, the three-year mitral reintervention rates after TEER or surgery were 6.1 percent (95 percent CI 5.5-6.9) and 1.3 percent (95 percent CI 1.0-1.7 and p<0.001), respectively.

In this Invited Perspective article, the authors address major challenges identified in the 2022 Congenital Heart Surgeon’s Workforce Survey, including saturation of the job market, low individual surgeon case-volume, and surgeon dissatisfaction in congenital cardiac surgery.

Stroke after transcatheter aortic valve implantation (TAVI) is associated with considerably worse postinterventional outcomes. However, predictors of stroke and the long-term risk after TAVI remain unknown. In this study from the SwissTAVI registry, the authors aimed to investigate the short- and long-term incidence and predictors of stroke following TAVR. A total of 11,957 patients (mean age 81.8 ± 6.5 years, 48.0 percent female) who underwent TAVI between 2011 and 2021 were included in the analysis. History of a previous stroke (11.8 percent) and atrial fibrillation (32.3 percent) were common among the analyzed patients. The thirty-day incidence of stroke was 3.0 percent, with 69 percent of the strokes occurring within the first 48 hours after TAVI. The incidence of stroke was 4.3 percent at one year and 7.8 percent at five years. After adjusting for matched comparison with same age and sex general population, the risk of stroke was significantly higher in the TAVI population during the first two years after TAVI. In the first year, SSR is 7.26 (95 percent CI: 6.3-8.36) and 6.82 (95 percent CI: 5.97-7.79) for males and females, respectively. In the second year, SSR is 1.98 (95 percent CI: 1.47-2.67) and 1.48 (95 percent CI: 1.09-2.02) for males and females, respectively. The authors concluded that TAVI patients experienced a higher risk of stroke up to two years after TAVI and a comparable risk after that.