Journal and News Scan

The NOTION-2 trial aimed to compare transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low-risk patients less than 75 years old, including with both tricuspid and bicuspid aortic stenosis (AS). Low-risk patients aged less than 75 years with severe symptomatic AS were enrolled and randomized to TAVI or SAVR. The primary endpoint was a composite of all-cause mortality, stroke, or rehospitalization related to the procedure, valve, or heart failure at 12 months. A total of 370 patients were enrolled with a mean age of 71.1 years and a median Society of Thoracic Surgeons risk score of 1.1 percent. A total of 100 patients had bicuspid AS. While major bleeding and new-onset atrial fibrillation were more common among SAVR patients, non-disabling stroke, permanent pacemaker implantation, and moderate or greater paravalvular regurgitation were more frequent in the TAVI group. Overall, the rate of the composite of death, stroke, or rehospitalization at one year was similar between TAVI (10.2 percent) and SAVR (7.1 percent). The absolute risk difference was 3.1 percent with a 95 percent confidence interval (CI), −2.7 percent to 8.8 percent; hazard ratio (HR) 1.4, 95 percent CI: 0.7 to 2.9; p = 0.3. The risk of the primary composite endpoint was 8.7 percent and 8.3 percent in patients with tricuspid AS (HR 1.0, 95 percent CI: 0.5 to 2.3) and 14.3 percent and 3.9 percent in patients with bicuspid AS (HR 3.8, 95 percent CI: 0.8 to 18.5) treated with TAVI or SAVR, respectively (P for interaction = 0.1). Based on the results, the authors call for caution in young bicuspid AS TAVI patients.

Minimally invasive surgery is routinely used for thymectomies, and techniques continue to evolve. Yang developed and studied a modified subxiphoid approach for thymectomy utilizing VATS with a sternal retractor to improve visualization in the operative field. The authors raise an interesting question to see how this modified approach would fare compared to robotic thymectomies, especially with regard to feasibility and cost of use.

In this article, the authors present their single center outcomes of the Commando procedure as a means to achieve double valve replacement in patients with radiation heart disease or previous valve replacement with destroyed intervalvular fibrosa. The authors looked to compare early and intermediate-term outcomes of the Commando procedure performed for noninfective pathologies against outcomes of patients undergoing double valve replacement. A total of 129 Commando procedures were performed at the Cleveland Clinic between 2011 and 2022, compared to 1,191 stand double valve replacement. Their findings showed comparable short-term outcomes, but intermediate-term survival was less favorable after the Commando procedure.

The use of minimally invasive mitral valve surgery (MIMVS) has increased in recent years, and surgeons are seeing more patients requiring reoperation after MIMVS. This study analyzed early outcomes and long-term survival in this group. A total of 187 patients were included, with 18 percent undergoing repeat mitral valve (MV) repair and 82 percent undergoing MV replacement. Redo mitral valve surgery (MVS) was completed via median sternotomy in 90 percent of cases. Thirty-day mortality was 6.4 percent. Estimated five and twelve year survival were 62 percent and 38 percent, respectively. Preoperative stroke and infective endocarditis were independent predictors of long-term mortality. The research found that redo MVS can be performed safely in this group, yielding low early mortality and acceptable long-term survival rates.