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The article discusses the evolution of endoscopic mitral valve surgery (MVS) over an 11-year period at a high-volume center. It highlights the increasing age of patients, prevalence of comorbidities like hypertension and atrial fibrillation, and the performance of additional procedures over time. Despite these changes, the study shows excellent perioperative and mid-term outcomes for patients undergoing endoscopic MVS, making it the preferred approach for MVS at the center. [Extracted from the article]

The TAPIR Registry was established to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in patients who had previously undergone surgical mitral valve repair or replacement (SMVR). The study included 365 patients from 16 European centers and compared their outcomes with a control group of 4,832 patients who had not undergone prior mitral valve surgery. Results showed that TAVI in patients with prior SMVR was safe and feasible, with no significant increase in 5-year mortality compared to those without prior mitral valve surgery, although there was a higher incidence of mild paravalvular regurgitation in the former group. [Extracted from the article]

The article explores the long-term impact of postoperative atrial fibrillation (postAF) after endoscopic mitral valve surgery (endoMVS). A retrospective analysis of 1,031 patients who underwent endoMVS revealed that postAF occurred in 38.7% of patients, with those without postAF being younger and having fewer comorbidities. While 30-day survival was not affected by postAF, 5-year survival was significantly worse in patients with postAF, highlighting the importance of perioperative rhythm management and anticoagulation in endoMVS. [Extracted from the article]

This article compares the outcomes of using supraannular self-expanding transcatheter heart valves (THV) versus intraannular THV in patients with small aortic annuli for transcatheter aortic valve implantation (TAVI). The study found that both types of THV showed similar early clinical and hemodynamic outcomes, with no significant differences in mortality, pacemaker implantation, stroke, myocardial infarction, renal failure, or device success rates. While the study suggests that the Nitinol stent design in small aortic annuli may offer hemodynamic benefits, further research is needed to assess the long-term durability of these results. [Extracted from the article]

The article discusses the use of vascular closure devices (VCDs) for percutaneous cannulation during endoscopic mitral valve surgery (MVS). A study of 301 patients showed that percutaneous femoral cannulation using an 18-Fr VCD resulted in low postoperative vascular access site complications, with only 2.7% of patients experiencing issues such as bleeding or pseudoaneurysm formation. The overall mortality rate at 30 days was 0%, indicating that the use of VCDs for percutaneous cannulation in MVS is both feasible and safe. [Extracted from the article]

This article from the journal "Thoracic & Cardiovascular Surgeon" explores the reasons for non-feasibility of repair in totally endoscopic mitral valve surgery (MVS) at a high-volume single center. The study found that reasons for mitral valve replacement included sclerotic leaflet degeneration, rheumatic disease, MV stenosis, acute endocarditis, and failed repair attempts. Despite the challenges, the outcomes of totally endoscopic MVS with replacement were reasonable, making it a valid option for selected patients. [Extracted from the article]

This article discusses the use of balloon over- and underfilling strategies in transcatheter aortic valve implantation (TAVI) for patients with borderline aortic annuli dimensions. The study analyzed outcomes of 126 patients who received TAVI using balloon-expandable transcatheter heart valves with modified balloon filling volumina. The results showed that individualized balloon filling strategies were safe and effective in addressing borderline aortic annulus dimensions, with overfilling more common in patients with mild calcification and underfilling less frequent. Propensity score matching revealed no significant differences in clinical endpoints between patients with individualized versus nominal balloon filling. [Extracted from the article]

This article examines changes in patient characteristics and procedural measures over a 10-year period in aortic valve-in-valve procedures for degenerated surgical bioprostheses. The study found a shift towards lower-risk profiles in patients over time, changes in access routes and types of transcatheter heart valves used, shorter procedure times, and increased rates of certain procedures like BASILICA and valve fracturing. Despite these changes, outcomes such as device success, stroke, and 30-day mortality remained consistently positive, indicating the procedure's clinical efficacy and safety. [Extracted from the article]

The article explores the use of preprocedural biomarkers to predict outcomes after transcatheter aortic valve implantation (TAVI). A study of 3,687 patients undergoing TAVI found that preoperative hemoglobin, creatinine, troponin, CRP, and NT-proBNP were significant predictors of 30-day mortality and acute kidney injury. These biomarkers may indicate baseline cardiac and/or end-organ injury, and further studies are needed to evaluate combined stratification models with established risk tools like EuroSCORE II. [Extracted from the article]

The article explores the impact of concomitant surgical atrial fibrillation (AF) ablation in patients undergoing endoscopic mitral valve surgery (endMVS). The study analyzed data from 1,037 patients between 2012 and 2022, categorizing them based on the presence of preoperative AF and whether they received AF ablation during surgery. Results showed that patients without AF were younger and had fewer comorbidities, leading to better outcomes post-surgery. Concomitant AF ablation was found to be safe and feasible, potentially improving long-term outcomes for patients undergoing endMVS. [Extracted from the article]

This article discusses the outcomes of transcatheter aortic valve implantation (TAVI) in patients who had previous aortic root surgery with failing native or prosthetic aortic valves. The study included 21 patients who underwent TAVI after various types of aortic root surgeries. The results showed that TAVI for failing aortic root surgery is safe and feasible, with low rates of mortality and rehospitalization at the 1-year mark. The study emphasizes the importance of meticulous planning and analysis to minimize risks in this specific subgroup of patients. [Extracted from the article]

The article compares Aortic Valve-in-Valve (ViV) procedures for degenerated bioprosthetic surgical aortic valve replacement (SAVR) with transcatheter heart valves (THV). The study found that ViV procedures for both SAVR and THV showed similar clinical safety and efficacy, but there were differences in procedural measures, such as the types and sizes of valves used. The time to ViV was notably shorter after transcatheter aortic valve implantation (TAVI), indicating a potential increase in ViV procedures for THV in the future. [Extracted from the article]

Systemic inflammation due to cardiogenic shock is associated with vasoplegia leading to organ-hypoperfusion, right heart failure and poor clinical outcome. Extracorporeal cytokine hemoadsorption emerged to attenuate excessive levels of inflammatory cytokines, potentially improving patient outcome. Nevertheless, its prognostic impact during high-risk LVAD implantation remains unknown. 40 consecutive patients with advanced heart failure underwent continuous-flow LVAD implantation at our institution between 2018 and 2020. Out of 25 high-risk patients in cardiogenic shock (INTERMACS profile 1 and 2), 9 patients (CytoSorb-group) underwent LVAD implantation with, 16 patients (Control-group) without simultaneous cytokine hemoadsorption during cardiopulmonary bypass. Besides preoperative patient characteristics, postoperative lactate clearance, vasopressor administration and mean arterial pressure, perioperative complication and 30-day mortality rates, were retrospectively analyzed. Apart from an increased rate of re-operations within the CytoSorb-group baseline characteristics including the severity of left and right ventricular dysfunction and consecutive signs of end-organ failure were similar in both groups. Of note, all included patients, were categorized as INTERMACS profile ≤2 prior to LVAD implantation. Preoperative short-term mechanical circulatory support bridging was comparable (66.7% vs. 75%; p=0.66) prior to LVAD implantation. Procedural characteristics including intraoperative volume management and postoperative vasopressor administration were similar in both groups. There was no difference regarding postoperative lactate clearance, although postoperative mean arterial pressure was significantly higher in the Control-group (71.3mmHg vs. 57.4mmHg; p<0.01). Furthermore, the 30-day mortality rate was significantly higher in the CytoSorb-group (33.3 vs. 0.0%; p=0.01). Extracorporeal cytokine hemoadsorption during high-risk LVAD implantation was not associated with a decrease of postoperative vasopressor support, improved hemodynamics, nor an accelerated lactate clearance. [ABSTRACT FROM AUTHOR]

(1) Background: Transfemoral transcatheter aortic valve implantation (TAVI) has become the standard treatment for most patients with severe symptomatic aortic stenosis. Intravascular lithotripsy may facilitate transfemoral TAVI (IVL-TAVI) even in patients with severely calcified iliofemoral disease. We assessed technical aspects and clinical outcomes of this novel approach compared to alternative transaxillary access (TAX-TAVI). (2) Methods: IVL-TAVI was performed for severe iliofemoral calcifications precluding standard transfemoral access in 30 patients from 2019 to 2022 at a single academic heart center. IVL was performed as part of the TAVI procedure in all cases. Results were compared to a control group of 44 TAX-TAVI procedures performed for the same indication from 2016 to 2021. The safety outcome was a composite of all-cause death, stroke, access-related bleeding ≥ type 2 within 24 h and major vascular access site complications at 30 days. The efficacy outcome was defined as a technical success according to VARC-3. (3) Results: Median age was 78.2 [74.3, 82.6] years, 45.9% were female and mean STS-PROM was 3.6% [2.3, 6.0]. Iliofemoral calcifications were more severe in the IVL-TAVI vs. TAX-TAVI groups (lesion length: 63.0 mm [48.6, 80.3] vs. 48.5 mm [33.1, 68.8]; p = 0.043, severe calcification at target lesion: 90.0% vs. 68.2%; p = 0.047, and median arc calcification 360.0° [297.5, 360.0] vs. 360.0° [180.0, 360.0]; p = 0.033). Technical success was achieved in 93.3% vs. 81.8% ( p = 0.187) in IVL- and TAX-TAVI and the safety outcome occurred in 10.0% vs. 31.8% in IVL- and TAX-TAVI ( p = 0.047), respectively. (4) Conclusions: IVL-assisted transfemoral TAVI was feasible and safe with favorable outcomes compared to TAX-TAVI. IVL may further expand the number of patients eligible for transfemoral TAVI and may help overcome limitations of an alternative access.

Background: Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after transcatheter aortic valve implantation (TAVI) in patients receiving first-generation transcatheter heart valves (THV)., Aims: The aim of the present study was to assess the prevalence of LVOT calcification as well as its impact on outcomes in a contemporary TAVI patient cohort., Methods: This retrospective single-centre analysis includes 1,207 patients who underwent transfemoral TAVI between 2012 and 2018 and in whom adequate contrast-enhanced multislice computed tomgraphy (MSCT) imaging for quantification of LVOT calcification was available., Results: Significant LVOT calcification, defined as >10 mm 3 , was present in 37.4% (n=451) of the patient cohort. After applying propensity score matching there was no difference between patients without (w/o; n=358) and with (w; n=358) significant LVOT calcification with respect to baseline clinical characteristics. At 30 days, the composite of all-cause mortality and non-disabling/disabling stroke occurred more often in patients w LVOT calcification compared to those w/o (4.6 vs 10.1%, p=0.008). Moreover, the composite VARC-3 endpoint of device success at 30 days was in favour of patients w/o LVOT calcification (82.2% vs 73.4%, p=0.007). According to Kaplan-Meier analysis, all-cause mortality one year after TAVI was higher in patients w vs w/o LVOT calcification (12.9 vs 21.4 %, p=0.004)., Conclusions: In patients undergoing TAVI, the presence of significant LVOT calcification is common and associated with worse short-term clinical and functional outcomes as well as higher one-year mortality rates compared to patients w/o LVOT calcification.

Background: Functional mitral regurgitation (FMR) is a common finding of advanced heart failure with detrimental effects. The prognostic impact of uncorrected FMR prior to left ventricular assist device (LVAD) implantation remains controversial., Methods: Between 2016 and 2019 77 patients underwent continuous-flow LVAD implantation at our institution. 34 patients showed FMR ≥ 2 (MR-group), whereas 43 patients showed FMR < 2 (Control-group). Data was retrospectively analyzed. Primary composite endpoint comprised freedom from death, stroke, pump-thrombosis, major bleeding and right heart failure (RHF) after 1 year., Results: Baseline characteristics, including the severity of left and right ventricular dysfunction, and periprocedural results were comparable. The overall survival during a mean follow up of 24.9 months was 55.9% in the MR-group versus 58.1% in the Control-group (p = 0.963), whereas 1-year event-free survival was 35.3% in the MR-group compared to 44.2% in the Control-group (p = 0.404). RHF within the first postoperative year occurred more frequently in the MR-group (35.3% vs. 11.6%; p = 0.017). Furthermore, RV function was significantly reduced in comparison to baseline values in the MR-group. 12 months after surgery, 74% of patients in the MR-group were classified as NYHA III in comparison to 24% of patients in the Control-group (p < 0.001)., Conclusions: Preoperative uncorrected FMR prior to LVAD implantation did not affect overall survival, nevertheless it was associated with an impaired RV function and increased incidence of right heart failure during follow-up. Furthermore, preoperative FMR ≥ 2 was associated with persistent symptoms of heart failure., (© 2022. The Author(s).)