Journal and News Scan

This comparative study evaluated outcomes between surgical aortic valve replacement with Y-incision aortic annular enlargement (SAVR with Y-AAE) vs transcatheter aortic valve replacement (TAVR) in 362 low-to-intermediate risk patients with severe native aortic stenosis and small aortic annuli (≤25mm). The Y-AAE technique allowed upsizing by three to four valve sizes (median size 29) compared to standard TAVR sizing. SAVR with Y-AAE demonstrated significantly superior hemodynamics outcomes at 24 to 36 months, including a larger effective orifice area (2.7 vs 1.9 cm²), lower mean gradients (5 vs 9.5 mmHg), no prosthesis-patient mismatch (0 percent vs 20.1 percent), minimal aortic insufficiency (3.0 percent vs 26 percent), and greater left ventricular mass regression (42 percent vs 22 percent). Operative mortality rates were similar (0 percent vs 2 percent), while pacemaker requirements were lower (1.4 percent vs 10.3 percent). Three-year survival favored SAVR with Y-AAE (98 percent vs 79 percent, p<0.01). The authors conclude that SAVR with Y-incision annular enlargement should be considered for low-to-intermediate risk aortic stenosis patients given its excellent hemodynamics and potential for improved valve longevity. 

This study evaluated the outcomes of mitral valve re-repair vs replacement after failed primary mitral regurgitation repair. The Society of Thoracic Surgeons (STS) database was queried, and 1,749 reoperations after failed mitral repair for degenerative regurgitation were identified: 410 re-repairs (23.4 percent) and 1,339 replacements (76.6 percent). Re-repair demonstrated superior intermediate-term survival compared to replacement (adjusted HR 1.96, p=0.022), with lower postoperative morbidity (6.8 percent vs 11 percent, p=0.042). Factors favoring re-repair included younger age, fewer comorbidities, reintervention within two years, and posterior leaflet pathology. The authors concluded that mitral re-repair offers significant survival advantages over replacement in appropriately selected patients, suggesting it should be preferentially pursued at expert centers when anatomically feasible for recurrent degenerative mitral regurgitation. 

The PERSEVERE study evaluated one-year outcomes of the AMDS Hybrid Prosthesis for acute DeBakey Type I aortic dissection with malperfusion. This prospective, single-arm trial enrolled 93 patients across 26 US sites between July 2022 and May 2023. Primary endpoints included major adverse events including mortality, stroke, renal failure requiring dialysis, myocardial infarction, and distal anastomotic new entry tears (DANE). Through one-year, mortality was 20.4 percent (compared to 42.7 percent in the reference cohort), with minimal events occurring beyond 30 days and no postoperative DANE tears. Secondary outcomes showed 96 percent freedom from unanticipated aortic reoperation and 100 percent arch patency. Positive aortic remodeling demonstrated total aortic diameter stabilization (100 percent in Zone 1, 98 percent in Zone 2, and 73 percent in Zone 3), true lumen expansion (96 percent, 94 percent, and 70 percent respectively), and false lumen thrombosis (91 percent, 92 percent, and 88 percent respectively). The authors conclude that the AMDS device provides encouraging outcomes with reduced mortality and favorable aortic remodeling in this high-risk population. 

The PROCTOR trial randomized 220 post-coronary artery bypass grafting patients with saphenous vein graft (SVG) failure to native vessel percutaneous coronary intervention (PCI) (n=108) or SVG PCI (n=112). At one-year, major adverse cardiac events occurred in 34 percent with native PCI vs 19 percent with SVG PCI (HR 2.14; P=0.006). Nonfatal target-territory myocardial infarction (MI) was higher with native PCI (HR 2.12; P=0.029), as was repeat revascularization (HR 2.19; P=0.044). PCI-related MI occurred in 13 percent with native PCI and one percent with SVG PCI (HR 14.85; P=0.009). All-cause mortality did not differ (HR 1.59; P=0.472). SVG PCI produced significantly better one-year outcomes.