Journal and News Scan

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. 

This article summarizes the most important issues and recommendations regarding the anatomy and physiology of tetralogy-like lesions, including diagnosis prior to medical, interventional, or surgical intervention; the timing and types of interventions; management of high-risk patients; and the need for future interventions in a subset of patients. The full versions of the original guidelines are reprinted in the supplement, providing a more comprehensive overview and enabling a more detailed approach to tetralogy and its variants.