Journal and News Scan

This study examines the impact of the 2018 United Network for Organ Sharing (UNOS) heart transplant allocation criteria change on posttransplant stroke rates. The study included 19,512 patients from the UNOS database who received a heart transplant between October 18, 2014, and October 17, 2022, divided into precriteria change (n = 9768) and postcriteria change (n = 9744) cohorts. The primary outcome was stroke, and secondary outcomes included mortality and adverse events. The study found that the 2018 donor heart allocation criteria change is associated with a higher risk of posttransplant stroke. Posttransplant stroke increased the risk of mortality by six-fold during the early posttransplant period. 

This large, retrospective study (1997–2023) found that surgical resection offers a significant survival benefit for both stage III and stage IV pulmonary carcinoid tumors, including those with metastatic disease. Surgery reduced mortality risk in both stages, regardless of histologic subtype, and survival rates were similar after lobectomy or sublobar resection. Atypical histology and the presence of multiple metastases were associated with worse outcomes. Chemotherapy and radiotherapy did not provide additional survival benefits. These findings, supported by SEER database analyses, suggest that surgery should be considered even for advanced-stage or metastatic pulmonary carcinoid tumors, challenging current conservative guidelines. 

Cardiac valve replacement during pregnancy is a high-risk operation that is performed occasionally when indicated. This study queried the Registry of Pregnancy and Cardiac disease (ROPAC) III database, as well as available cases in the literature, and found an overall maternal mortality of 9 percent, while fetal mortality was 34 percent. Maternal mortality occurred in eight cases, all of whom underwent a mitral valve replacement. Predictors of maternal mortality included surgeries performed during the first trimester and acute malfunction of the prosthetic valve. The mean gestational age during delivery was 36.4 weeks in women who underwent cardiac surgery, with a preterm birth at 31.7 percent, and most women delivered via Cesarean section (71 percent). Interestingly, when comparing cases before and after 2010, there was no significant improvement in survival over time. This underscores the importance of preventing valve dysfunction before pregnancy, highlighting the role of preconception assessment and counselling. 

In recent years, there has been a trend toward using more bioprosthetic valves compared to mechanical valves in patients under 65 years old. This study evaluated Austrian patients undergoing isolated surgical aortic valve replacement over a 10-year period and compared the outcomes of 1,018 patients receiving mechanical valves to 2,743 receiving a bioprosthetic valves, specifically in patients aged 50 to 65 years. The authors found that the biologic group had significantly higher risks of major adverse cardiac events, reoperation rates, and worsened overall survival compared to the mechanical valve group, which remained true even after propensity matching. Interestingly, stroke and bleeding risks were similar between the groups, which contrasts with reports from other studies. While 92.7 percent of mechanical valve patients received direct thrombin inhibitors, FXa inhibitors, or Vitamin K antagonists, 52.3 percent of bioprosthetic valve patients also received these medications. The authors suggest that careful consideration of the risks vs benefits of aortic valve choice, especially in younger patients, is warranted in light of their findings.