Journal and News Scan

Long-term evidence about bioprosthetic tricuspid valve replacement is scarce. This study aims to investigate the long-term clinical outcomes of patients who underwent tricuspid valve replacement with bioprostheses. This multicenter retrospective study included patients from 10 high-volume centers in seven different countries who underwent tricuspid valve replacement with bioprostheses. Echocardiographic and clinical data were reviewed, and long-term outcomes were investigated. Of the 675 patients, isolated tricuspid valve replacement was performed in 358 patients (53 percent), while 317 (47 percent) underwent concomitant procedures. Between these two groups, patients who underwent combined procedures reported a significantly higher incidence of infection, atrioventricular block, multiorgan failure, longer ICU and hospital stays, and higher 30-day mortality compared to patients who underwent isolated procedures. The overall 30-day mortality occurred in 70 patients (10.4 percent) (46 [14.6 percent] in the combined group vs 24 [6.74 percent] in the isolated group, p = 0.001). During follow-up, there was a continuous rate of attrition due to death, with cumulative incidences of death at five, 10-, and 15-years being 27.2 percent, 46.2 percent, and 60.6 percent, respectively. In contrast, the risk of reintervention started to significantly increase after 10 years of follow-up, with cumulative incidences of reintervention being 6.1 percent, 10.8 percent, and 23.3 percent, respectively. Freedom from tricuspid valve reintervention, pacemaker implantation, tricuspid valve endocarditis, and major thromboembolic events at 15 years were 56.5 percent,77.3 percent, 84.0 percent, and 86.4 percent, respectively. The authors conclude that tricuspid valve replacement with bioprostheses is an effective treatment, despite being associated with relatively high early and long-term mortality. However, the risk of structural valve degeneration rises significantly after 10 years. 

In this study, the authors investigate the clinical presentation, microbiological profile, and outcomes of infective endocarditis in octogenarians. This multicenter retrospective analysis, utilizing data from the CAMPAIGN Registry, includes 4,917 consecutive patients suffering from infective endocarditis. The authors specifically analyzed data on octogenarians undergoing surgery due to infective endocarditis, with primary outcomes measuring 30-day mortality and five-year survival. Out of the total cohort, 292 patients (5.9 percent) were octogenarians, with a median age of 82 years (range 81-84 years), compared to a median age of 65 years (range 54-73 years) in the nonoctogenarian cohort. The median EuroSCORE II was 16.5 (9.5-40.4) in the octogenarian group and 9.7 (4.4-21.5) in the nonoctogenarian group (p < 0.001). There was a higher number of males in the nonoctogenarian group (p < 0.001). Prosthetic valve endocarditis (p < 0.001) and pacemaker endocarditis (p < 0.001) were higher in the octogenarian group. Streptococcal infections were more frequent in the octogenarians (p = 0.033), whereas a significantly higher number of nonoctogenarians suffered from blood culture-negative infective endocarditis (p = 0.002). The rate of postoperative adverse cerebrovascular events and postoperative morbidities was comparable between the groups. The 30-day mortality was higher in the octogenarian group (p < 0.001). Survival rates at one year and five years were 48 percent and 39 percent, respectively, in the octogenarian group (p < 0.001). The authors conclude that infective endocarditis in the elderly is associated with a higher risk and may present with a different clinical profile. Although advanced age does play a role in the outcomes of surgery for infective endocarditis, it alone should not be the sole factor to rule out surgery in this cohort. 

This ex vivo study used computational fluid dynamics to evaluate the hemodynamic effects of various degrees of stenosis in end-to-side anastomoses commonly found in coronary artery bypass grafting. Using a porcine heart model, researchers created 25 percent, 50 percent, 75 percent, 90 percent, and 100 percent stenosis configurations in both longitudinal shortening and bilateral narrowing. At 75 percent stenosis, both types of narrowing produced abnormal flow separation, low wall shear stress, and high oscillatory regions distal to the anastomosis toe—conditions associated with intimal hyperplasia and potential graft failure. Anastomotic stenosis below 50 percent demonstrated acceptable hemodynamics. The study highlights the need for further research on long-term clinical outcomes related to suboptimal anastomotic construction techniques. 

In this study, the authors compared the long-term outcomes of patients who underwent left atrial appendage closure during mitral repair with those who did not, specifically in patients without atrial fibrillation (AF). The analysis included 10,810 patients from a large US national registry who underwent isolated mitral repairs. Of these, 1,875 (17 percent) received closure, while 8,935 (83 percent) did not. Propensity score matching was performed based on baseline characteristics. The primary outcome of any stroke or thromboembolism was compared between matched groups, with death considered as a competing risk. All-cause mortality was also compared. 
 
Propensity matching yielded 1,875 well-matched patient pairs (mean age: 71 years, 45 percent female, median CHA2DS2-Vasc score 3.0). New post-operative AF was more common in the closure group (45 percent vs 38.4 percent, p<0.01). There was no difference in 30-day mortality (1.2 percent vs 1.1 percent, p=0.88). The closure group demonstrated a reduction in stroke and thromboembolism over five years (6.4 percent vs 8.3 percent, HR: 0.74, 95 percent CI: 0.57-0.96, p=0.023). However, there was no difference in five-year survival rates (91 percent vs 91 percent, HR: 0.99, 95 percent, CI: 0.80-1.23, p=0.95). 
 
The authors concluded that left atrial appendage closure at the time of isolated mitral repair in patients without AF may be associated with an increased incidence of postoperative AF, but it also appears to reduce the risk of late stroke and thromboembolism compared to mitral repair alone.