Journal and News Scan

Cardiac valve replacement during pregnancy is a high-risk operation that is performed occasionally when indicated. This study queried the Registry of Pregnancy and Cardiac disease (ROPAC) III database, as well as available cases in the literature, and found an overall maternal mortality of 9 percent, while fetal mortality was 34 percent. Maternal mortality occurred in eight cases, all of whom underwent a mitral valve replacement. Predictors of maternal mortality included surgeries performed during the first trimester and acute malfunction of the prosthetic valve. The mean gestational age during delivery was 36.4 weeks in women who underwent cardiac surgery, with a preterm birth at 31.7 percent, and most women delivered via Cesarean section (71 percent). Interestingly, when comparing cases before and after 2010, there was no significant improvement in survival over time. This underscores the importance of preventing valve dysfunction before pregnancy, highlighting the role of preconception assessment and counselling. 

In recent years, there has been a trend toward using more bioprosthetic valves compared to mechanical valves in patients under 65 years old. This study evaluated Austrian patients undergoing isolated surgical aortic valve replacement over a 10-year period and compared the outcomes of 1,018 patients receiving mechanical valves to 2,743 receiving a bioprosthetic valves, specifically in patients aged 50 to 65 years. The authors found that the biologic group had significantly higher risks of major adverse cardiac events, reoperation rates, and worsened overall survival compared to the mechanical valve group, which remained true even after propensity matching. Interestingly, stroke and bleeding risks were similar between the groups, which contrasts with reports from other studies. While 92.7 percent of mechanical valve patients received direct thrombin inhibitors, FXa inhibitors, or Vitamin K antagonists, 52.3 percent of bioprosthetic valve patients also received these medications. The authors suggest that careful consideration of the risks vs benefits of aortic valve choice, especially in younger patients, is warranted in light of their findings. 

In this article, the authors describe a novel strategy for neonates with hypoplastic left heart syndrome (HLHS) and intact atrial septum (IAS). Due to the emergency need for creating unrestrictive atrial communication in these patients, traditional interventions include fetal balloon atrial septostomy or postnatal transcatheter, surgical, or hybrid interventions. However, none of these interventions have been associated with excellent results for HLHS/IAS, resulting in dismal outcomes for these patients.  

 The authors present a case of a neonate with a fetal diagnosis of HLHS/IAS, in which they planned an elective cesarean section at 38 weeks. During the procedure, they performed an open atrial septectomy using a bicaval inflow occlusion technique while the baby was mid-delivery, as a part of the ex utero intrapartum treatment (EXIT) procedure. The procedure was uneventful, and it was followed the next day with Stage I Norwood/Sano palliation. The patient did extremely well, was discharged two weeks later, and continues to do well during his follow-up visits. This approach is both novel and logistic for this challenging group of patients, and the authors hope it will open the door for similar patients in the future. 

With the improvement in survival rates for heart transplant recipients, cardiac valvular disease is more frequently being encountered in this group of patients. This includes conditions such as aortic stenosis and mitral regurgitation in the transplanted heart. This article discusses the role of transcatheter-based therapies, including transcatheter aortic valve implantation (TAVI) and mitral transcatheter edge-to-edge repair (M-TEER), in heart transplant recipients. Fifteen patients were studied, with nine undergoing TAVI and six receiving M-TEER. The authors found these procedures to be feasible and efficient in improving echocardiographic allograft function, reporting a median survival of two years post-elective procedures. However, survival outcomes were found to be dependent on the urgency of the intervention performed.