Robotic-assisted ablation of atrial fibrillation (RA-AF) is a minimally invasive procedure that requires accurate planning and anatomical assessment to reduce the risk of complications: Cardiac Magnetic Resonance (CMR) can safely be used for pre-procedural planning, providing good quality images without the use of ionizing radiation. The aim of the study is to evaluate how CMR can be used to assist the surgeon in the planning and execution of a safe and effective robotic-assisted procedure.

A single-center observational study of 27 patients (25 persistent AF, 2 paroxysmal AF) undergoing robotic-assisted left atrial epicardial ablation with left atrial appendage exclusion. CMR was used in 22 patients; 5 underwent CT due to contraindications. Three-dimensional CMR reconstructions were reviewed preoperatively to optimize probe placement and energy delivery. The contrast agent used was gadoteridol (ProHance®, Bracco Imaging, Milan, Italy; catalog no. 117258).

Mean age was 64 ± 7 years; 81% were male. Hypertension (81%) and diabetes (22%) were common comorbidities. CMR showed enlarged LA (volume index 76 ± 17.6 mL/m²) and fibrosis predominantly on the LA roof (81%) and lateral wall (45%). No LAA thrombi were observed. All patients underwent successful robotic AF ablation with no intraoperative ischemic or bleeding complications. 3D CMR reconstructions facilitated intraoperative surgical guidance.

CMR-guided robotic AF ablation is feasible, safe, and effective. Pre-procedural fibrosis mapping and 3D anatomical visualization enhance surgical planning and may improve outcomes. Larger prospective studies are required to confirm prognostic value.

Historically, the heart allocation process relied heavily on local organ procurement organizations and geographic proximity, leading to disparities and inequitable outcomes driven by regional donor availability rather than clinical urgency. The 2018 revision of the heart transplantation allocation policy by the United Network for Organ Sharing (UNOS) significantly transformed the landscape of heart transplantation in the United States. This review critically examines the rationale, implementation, and impact of these policy changes, focusing on their effectiveness in addressing longstanding shortcomings, including geographical disparities, inadequate clinical risk stratification, and remaining challenges.

A detailed review of published literature on the heart allocation system and national data from the Scientific Registry of Transplant Recipients was conducted.

The new heart allocation system significantly reduced waitlist mortality, from 139 deaths to 114 deaths per 100 patient-years, among the highest urgency patients. Meanwhile, median wait times for Status 1 candidates decreased from 112 to 39 days. The new policy particularly benefited patients assisted with temporary mechanical circulatory support devices such as extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pumps, and Impella devices, whose transplantation rates increased substantially. Indeed, one-year survival rates for patients supported by ECMO improved after policy adoption (90% post-2018 vs. 74% pre-2018). However, the broadened geographic radius (500 nautical miles) intended to enhance equity promoted increased ischemic times (from 3.0 hours to 3.4 hours), raising concerns about long-term graft viability. Financial and logistical implications, such as increased organ transportation costs and resource utilization, were notable challenges. Additionally, stable patients with durable left ventricular assist devices (LVADs) experienced deprioritization unless complications arose, raising concerns about prolonged wait times and associated morbidity. Thus, despite clear improvements, persistent challenges remain.

The changes to the heart allocation system brought significant benefits to the patients with high acuity status listings; however, some challenges remain. Meanwhile, the transition to a continuous distribution model, which employs a composite allocation score, holds promise for further refining patient prioritization by balancing medical urgency, geography, post-transplant survival predictions, and biological factors. Nonetheless, enhancements in donor organ preservation, standardized exception request processes, and optimized allocation algorithms remain essential to sustain the fairness, efficiency, and clinical effectiveness of the system.

Lower antegrade body perfusion (LABP) can shorten the duration of hypothermic circulatory arrest. However, the efficacy of LABP combined with mild hypothermic circulatory arrest (MiHCA) remains unclear. This randomized controlled trial investigated whether applying LABP during total arch replacement (TAR) improves clinical outcomes compared to moderate hypothermic circulatory arrest (MoHCA).

Adult patients undergoing first-time TAR were randomly assigned to the MiHCA group (n = 147, MiHCA + LABP) or the MoHCA group (n = 147). Primary outcomes included the incidence of temporary neurological dysfunction (TND), permanent neurological deficit (PND), acute kidney injury (AKI), and serum alanine aminotransferase (ALT) levels.

The baseline characteristics were comparable between the groups. No significant differences were observed in the incidence of TND or PND. However, the MiHCA group had a significantly shorter circulatory arrest time (5 vs. 16 minutes; p < 0.001), lower incidence of AKI (29.9% vs. 41.5%; p = 0.039), and lower ALT levels at 24 hours postoperatively (39.3 vs. 48.0 U/L; p = 0.012).

MiHCA combined with LABP appears to be a safe and feasible strategy in total arch replacement for acute type A aortic dissection. The addition of LABP significantly reduces the time of circulatory arrest, which may contribute to lower rates of AKI and improved hepatic function postoperatively.

ChiCTR2000033852, https://www.chictr.org.cn/hvshowproject.html?id=38552&v=1.1.

Scientific attention is increasingly being drawn to the emotional impact and neurodevelopmental difficulties experienced by children and adolescents with heart disease. Therefore, this article aimed to review the literature from the last decade on health-related quality of life (HR-QoL) and cognitive functions (CFs) in children and adolescents with heart disease, highlighting its implications for these populations.

This rapid systematic review and meta-analysis were conducted using the Web of Science (WoS) database. We used the Scale for the Assessment of Narrative Review Articles (SANRA) as a quality control check and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Two meta-analyses were conducted to synthesize intelligence quotient (IQ) and QoL outcomes using data extracted from eligible studies. Random-effects models, Hedges’ G or mean differences, and I² statistics derived from Cochran’s Q were applied to assess effect sizes and between-study heterogeneity.

A total of 133 articles were identified, and 23 were eligible. The main results suggested a relationship between the characteristics and consequences of heart disease and neurodevelopment, which influence QoL and functional areas. The meta-analysis revealed a significant decrease in total IQ in patients compared to controls. We also found that the psychosocial QoL of the patient was significantly lower than the physical QoL.

Neurodevelopment and QoL are fundamental aspects that must be addressed in a preventive manner.This review responds to the challenges faced by children and adolescents with congenital heart disease (CHD) who have undergone one or more surgical interventions, particularly regarding neurodevelopmental outcomes and executive function deficits, as examined through cohort and cross-sectional studies. However, a critical gap remains in the literature regarding longitudinal studies that evaluate the impact of short-, medium-, and long-term interventions specifically designed for this population.

The neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and lymphocyte–monocyte ratio (LMR) are recognized markers linked to inflammation and have been studied across various fields. This study aimed to evaluate which systemic inflammation indices are more specific to post-cardiac surgery mortality and morbidity.

A total of 1528 cardiac surgery patients were retrospectively analyzed, including a subset of 1205 patients who underwent coronary artery bypass grafting (CABG). This study assessed the associations between the NLR, PLR, and LMR and postoperative complications. The predictive accuracy of indices was also specifically compared within the CABG subgroup. While the NLR and PLR indicated the occurrence of events, the LMR, with a receiver operating characteristic curve below 0.5, was interpreted as “free of events”. The cut-off values were determined as NLR: 3.10, PLR: 143.9, and LMR: 3.52.

The NLR correlated with higher mortality and complications, whereas the PLR showed no significant relation to neurological complications. The LMR was found to be related to the non-occurrence of events. Patients with higher NLR and PLR values experienced increased mortality and major adverse cardiac and cerebrovascular events, as well as a higher incidence of complications, including postoperative revision, atrial fibrillation (AF), and renal issues. Conversely, higher LMR values corresponded with lower rates of such complications.

The NLR has emerged as a crucial indicator for predicting mortality and complications in cardiac surgery patients, more so than the PLR and LMR. Specifically, the NLR can be used to indicate the risk of mortality and complications in cardiac surgery. This prediction can be supported further using the PLR and LMR.

Pulmonary congestion is a key manifestation of decompensated heart failure (HF) and contributes to adverse outcomes, especially in patients with permanent atrial fibrillation (AF). However, practical tools enabling bedside, repeatable, and real-time assessment of pulmonary congestion remain limited. To create and internally validate a non-invasive predictive model for pulmonary congestion in patients with HF and permanent AF utilizing hemodynamic, echocardiographic, and clinical parameters.

This retrospective study included 66 patients with HF and permanent AF, classified into pulmonary congestion and non-congestion groups based on standardized chest radiography criteria. Cardiography (ICG) parameters, echocardiographic indices, and laboratory markers were evaluated. A multivariable logistic regression model was developed using a backward elimination approach guided by the Akaike Information Criterion (AIC). Model performance was evaluated using the area under the curve (AUC), calibration, and decision curve analysis, with internal validation conducted through bootstrap resampling. Model interpretability was further assessed by comparing AUCs of individual predictors and examining risk stratification based on model-derived scores.

The final model identified independent associations of pulmonary congestion with left ventricular ejection fraction (LVEF) (OR = 0.934, 95% CI = 0.879–0.992), E/e′ ratio (OR = 1.229, 95% CI = 1.029–1.467), and thoracic fluid conductivity (TFC) (OR = 1.237, 95% CI = 1.070–1.431). The model showed strong discriminative ability (AUC = 0.865, 95% CI = 0.773–0.956), satisfactory calibration (Hosmer-Lemeshow test, p > 0.05), and clinical utility. Internal validation using 500 bootstrap resamples confirmed these results, with robust discrimination (corrected AUC = 0.853, 95% CI = 0.763–0.942), consistent calibration, and maintained net clinical benefit. Model interpretability analysis confirmed its added discriminative value over individual predictors and supported its utility in stratifying pulmonary congestion risk.

The proposed model provides a practical, non-invasive approach for identifying pulmonary congestion in patients with HF and AF. It may facilitate early bedside detection and support dynamic clinical decision-making.

Heart transplantation (HTx) has undergone a transformative evolution since the first successful human procedure in 1967. Initially limited by surgical challenges, graft preservation and rejection, the field has advanced through innovations in immunosuppression, mechanical circulatory support (MCS), and donor organ utilization. Despite these achievements, critical challenges persist, including organ shortages, ischemia-reperfusion injury (IRI), and inequities in allocation. Emerging technologies such as normothermic machine perfusion (NMP), donation after circulatory death (DCD) and xenotransplantation aim to expand the donor pool and improve graft viability.

This review synthesizes historical and contemporary literature on the evolution of HTx, examining milestones in surgical technique, immunosuppressive strategies and graft preservation. Special emphasis is placed on recent innovations, including ABO-incompatible transplantation, machine perfusion systems, DCD protocols, and xenotransplantation. Comparative analyses of donor policies and the role of MCS as bridge or destination therapy are also considered.

HTx has progressed from experimental surgery to the gold standard for end-stage heart failure, with survival markedly improved by modern immunosuppression and surgical refinements. However, donor shortage and IRI remain major limitations. Recent advances are reshaping the field: DCD, supported by ex vivo and regional perfusion, is expanding the donor pool with comparable outcomes to traditional donation. Machine perfusion technologies enable prolonged preservation, functional assessment of marginal grafts, and potential reduction of IRI. ABO-incompatible transplantation, particularly in infants, has increased donor availability with outcomes comparable to compatible grafts and is now being explored in adults. Xenotransplantation, enabled by CRISPR/Cas9 gene editing of porcine hearts, has reached early human applications, representing a potential paradigm shift despite unresolved immunological and ethical challenges. Meanwhile, durable ventricular assist devices (LVADs) and short-term MCS (e.g., Impella 5.5, ECMO) continue to evolve, serving as effective bridges to transplant or alternatives for non-eligible patients, with survival outcomes approaching transplantation in select groups.

HTx is entering a new era defined by advanced preservation technologies, expanded donor utilization, and the promise of gene-edited xenografts. While outcomes continue to improve, successful integration of these innovations requires addressing ethical, economic, and equity challenges. Ongoing research, clinical trials, and policy reforms will be critical to fully realize their potential and ensure equitable access for patients with advanced heart failure.

Cryoballoon ablation (CBA) and laser balloon ablation (LBA) are important techniques for treating atrial fibrillation (AF). However, the differences in their effectiveness remain unclear. This study aimed to systematically evaluate and compare the efficacy of CBA and LBA in AF treatment.

A comprehensive search of major databases, including PubMed, Cochrane Library, Embase, and Web of Science, was conducted up to July 2024 to identify clinical studies comparing CBA and LBA for treating AF. Odds ratios (ORs) were calculated using a fixed-effect model. Study differences, quality, and potential publication bias were also assessed.

A total of 16 randomized controlled trials (RCTs) involving 4437 patients were included in the meta-analysis. The meta-analysis showed that compared to LBA, CBA was associated with a higher risk of phrenic nerve paralysis (PNP) (OR: 1.81, 95% confidence interval (CI): 1.23–2.67, p = 0.003, I² = 0.0%). However, CBA demonstrated a higher success rate of pulmonary vein isolation (PVI) (OR: 2.14, 95% CI: 1.18–3.88, p = 0.013, I² = 11.2%) and a shorter surgery duration standardized mean difference (SMD): –0.58, 95% CI: –0.88 to –0.29, p = 0.000, I² = 75.3%). No significant differences were found between CBA and LBA regarding stroke, cardiac tamponade, hematoma, or 12-month AF recurrence rates.

Compared to LBA, CBA offers a higher success rate of PVI and shorter surgery durations but with an increased risk of PNP.

INPLASY202480069, https://inplasy.com/inplasy-2024-8-0069/, last accessed on August 14, 2024.

Mitral valve repair is a widely used operation to treat mitral regurgitation. However, the annuloplasty ring used may fail, causing mitral regurgitation to recur several years after the operation. Transcatheter mitral valve-in-ring (MViR) replacement may become a potential therapeutic strategy for those patients with high surgical risks.

This study presents a case report of a patient who underwent transcatheter MViR replacement using a novel Renato valve. A 67-year-old female presented with chest discomfort, and an echocardiogram showed severe mitral regurgitation and symptomatic left ventricular (LV) dysfunction. The patient had a surgical history of mitral repair, and the mitral regurgitation was due to the failed annuloplasty ring. As the patient was a poor candidate for the redo operation, we performed transcatheter MViR replacement using a novel Renato valve at our institution. The post-procedure transesophageal echocardiogram revealed a significant reduction in mitral regurgitation. The patient was discharged uneventfully, and the symptoms were alleviated.

Transcatheter MViR replacement is a safe procedure for patients with a failed annuloplasty ring and LV dysfunction.

Transcatheter aortic valve replacement (TAVR) has become an established treatment for severe aortic stenosis, offering a minimally invasive alternative to surgical aortic valve replacement. Frequently, preoperative angiogram identifies coronary artery disease requiring percutaneous coronary intervention and thus dual antiplatelet therapy. While TAVR is associated with lower rates of bleeding and transfusion compared to surgical valve replacement, bleeding complications remain a concern. The impact of antiplatelet therapy on periprocedural bleeding, transfusion requirements, and long-term survival following TAVR remains uncertain.

A retrospective review was conducted on 1116 patients who underwent TAVR between 2012 and 2021. Bleeding severity and outcomes were classified using the Bleeding Academic Research Consortium (BARC) criteria. Medication regimens, including preoperative antiplatelet therapy, were documented. Statistical analysis was performed using univariate, bivariate, and survival estimates to assess the impact of bleeding and transfusion on long-term outcomes.

A total of 248 patients were on dual antiplatelet therapy (DAPT). Of these, 105 patients (9.4%) required a transfusion during hospitalization. Patients on preoperative ticagrelor DAPT were significantly more likely to require transfusions compared to clopidogrel DAPT, aspirin, and no antiplatelet therapy (26.3% vs. 12.8% and 7.9% and 9.2%; p = 0.01) compared to those on aspirin alone. Long-term survival was significantly worse in DAPT groups (p < 0.01). Female gender (p < 0.01), hyperlipidemia (p = 0.02), coronary artery disease (p < 0.01), and peripheral vascular disease (p < 0.01) were significantly more prevalent in patients receiving dual antiplatelet therapy compared to those on aspirin or no therapy.

Preoperative DAPT significantly increases the risk of periprocedural bleeding and transfusion, leading to decreased survival after TAVR. Severe bleeding independently predicts poorer survival outcomes. Consideration should be given to the timing of percutaneous coronary intervention (PCI) and antiplatelet strategy prior to TAVR to optimize periprocedural safety. The impact of modifying preoperative antiplatelet strategies on medium and long-term clinical outcomes warrants further investigation.