Journal and News Scan

In this article, the authors describe a novel strategy for neonates with hypoplastic left heart syndrome (HLHS) and intact atrial septum (IAS). Due to the emergency need for creating unrestrictive atrial communication in these patients, traditional interventions include fetal balloon atrial septostomy or postnatal transcatheter, surgical, or hybrid interventions. However, none of these interventions have been associated with excellent results for HLHS/IAS, resulting in dismal outcomes for these patients.  

 The authors present a case of a neonate with a fetal diagnosis of HLHS/IAS, in which they planned an elective cesarean section at 38 weeks. During the procedure, they performed an open atrial septectomy using a bicaval inflow occlusion technique while the baby was mid-delivery, as a part of the ex utero intrapartum treatment (EXIT) procedure. The procedure was uneventful, and it was followed the next day with Stage I Norwood/Sano palliation. The patient did extremely well, was discharged two weeks later, and continues to do well during his follow-up visits. This approach is both novel and logistic for this challenging group of patients, and the authors hope it will open the door for similar patients in the future. 

With the improvement in survival rates for heart transplant recipients, cardiac valvular disease is more frequently being encountered in this group of patients. This includes conditions such as aortic stenosis and mitral regurgitation in the transplanted heart. This article discusses the role of transcatheter-based therapies, including transcatheter aortic valve implantation (TAVI) and mitral transcatheter edge-to-edge repair (M-TEER), in heart transplant recipients. Fifteen patients were studied, with nine undergoing TAVI and six receiving M-TEER. The authors found these procedures to be feasible and efficient in improving echocardiographic allograft function, reporting a median survival of two years post-elective procedures. However, survival outcomes were found to be dependent on the urgency of the intervention performed. 

This meta-analysis evaluated the performance of The German Registry of Acute Aortic Dissection Type A (GERAADA) score in predicting 30-day mortality after type A acute aortic dissection (TAAAD) surgery across 11 studies. With an observed mortality of 12.2 percent, GERAADA showed moderate discrimination (AUC 0.70) and good calibration, with a pooled expected mortality of 18.4 percent compared to EuroSCORE II's 5.8 percent. When both scores were directly compared in five studies, GERAADA showed better calibration than EuroSCORE II, while the discrimination between the two remained similar. The study concludes GERAADA offers better calibration for predicting 30-day postoperative mortality following TAAAD and highlights the challenges of predicting outcomes in complex cases. 

This retrospective study analyzed outcomes of 970 bilateral lung transplant recipients at a single center from 2007–2023, stratified by age groups: 15–64, 65–69, 70–74, and 75–years. Findings showed that older recipients (greater than or equal to 65 years) had similar short-term outcomes, including 1-year survival rates, compared to younger patients, despite longer hospital stays and less frequent need for extracorporeal membrane oxygenation (ECMO) at 72 hours post-transplant. Median survival decreased with age: 6.1 years (15–64), 4.8 years (65–69), 4.7 years (70–74), and 4.5 years (75–79). Five-year survival rates were 58.0 percent, 46.8 percent, 44.5 percent, and 47.2 percent, respectively. Causes of death varied with age; graft failure was more common in younger patients, while infection, malignancy, and cardiovascular disease predominated in older groups. This study highlights the increasing acceptance of lung transplantation in elderly patients, especially those aged 70–74, demonstrating that careful selection can yield acceptable perioperative outcomes and that advanced age should not be considered an absolute contraindication for lung transplantation.