Journal and News Scan

In this meta-analysis, the authors included three randomized controlled trials (RCTs) conducted in patients with heart failure (HF) and moderate to severe functional mitral regurgitation (FMR), comparing treatment with the MitraClip device in addition to medical therapy (device arm) to medical therapy alone (control arm). The following trials were included: COAPT, MITRA-FR, and RESHAPE-HF2. For this meta-analysis, the authors used common endpoints that were reported in each trial, namely, the first publication of COAPT, MITRA-FR, and RESHAPE-HF2, the extended two-year follow-up report of MITRA-FR, and one additional paper on RESHAPE-HF2. 
 
The meta-analysis showed no statistically significant difference in all-cause mortality within 24 months (HR: 0.76 [95 percent CI: 0.57-1.01]; P = 0.056) and cardiovascular mortality within 24 months (HR: 0.77 [95 percent CI: 0.56-1.06]; P = 0.112). However, the models showed better outcomes for the device group compared with the control group regarding total unplanned HF hospitalizations within 24 months (HR: 0.69 [95 percent CI: 0.49-0.97]; P = 0.0324), a composite of recurrent events of hospitalization for HF or all-cause mortality within 24 months (HR: 0.71 [95 percent CI: 0.50-0.995]; P = 0.0486), and change in six-minute walk distance from baseline to 12 months (mean change in meters: 32.55 [95 percent CI: 2.68-62.43]; P = 0.0327). 
 
In summary, this meta-analysis, including the three largest RCTs on this topic, suggests benefits for HF hospitalizations and improvement in six-minute walk distance after M-TEER with the MitraClip device in addition to medical therapy, compared with medical therapy alone, in patients with symptomatic HF and moderate to severe FMR. However, there was no significant benefit in cardiovascular or all-cause mortality. 

This single-center study investigated the long-term outcomes of patients aged 60 years old or less with low complexity coronary anatomy with equivalent indication for coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI). Other inclusion criteria beyond age included a SYNTAX score of 23 or lower, proximal left anterior descending (LAD) involvement, left main (LM) or multivessel disease (MVD). A total of 68 percent (n=374) of patients underwent PCI as the index revascularization strategy with a median follow-up period of 9.3 years. The authors found that all-cause mortality was higher in patients who underwent PCI at both intermediate five-year and complete follow-up points. At the total follow-up, the incidence rate was 5.8 versus 14.0 deaths per 1,000 people in CABG versus PCI groups, respectively. 

This study investigated the true incidence and risk factors for prolonged pleural effusion/chylothorax (PPE/C) following pediatric cardiac surgery, as well as its impact on other postoperative outcomes. This UK-based study collected data prospectively from five centers between 2015 and 2017, analyzing a total of 3,090 procedures (surgical and hybrid). This study found an incidence of 6.5 percent for PPE/C, highest after Fontan and other complex cases, occurring at median postoperative day six. Interestingly, cases of PPE/C with no other morbidity were associated with an eight-day increase in hospital length of stay (LOS), compared to those with multimorbidity, where the LOS was not significantly affected, but early mortality was higher. 

Aortic stenosis is the most prevalent valvular heart condition necessitating surgical intervention, with full sternotomy (FS) traditionally being the standard approach for surgical aortic valve replacement (SAVR). However, many patients undergoing AVR are high-risk candidates, leading to the development and evolution of transcatheter aortic valve replacement (TAVR) as an alternative treatment. Not all patients qualify for TAVR due to anatomical limitations, making minimally invasive AVR a potential solution for certain cases to avoid the risks associated with sternotomy. The most common MIAVR techniques include ministernotomy and upper hemisternotomy, but right anterior minithoracotomy (RAMT) may offer additional benefits by completely avoiding sternotomy. RAMT has also proven to be more cost-effective than sternum-based techniques. 
 
However, RAMT AVR presents technical challenges and a steeper learning curve, which may hinder its widespread adoption. This article provides a comprehensive overview of RAMT AVR, including patient selection, preoperative considerations, and clinical outcomes compared to sternotomy AVR and ministernotomy AVR. Overall, the article highlights the potential of RAMT AVR in managing aortic stenosis while calling for further research to strengthen the evidence base.