Malnutrition frequently occurs in older adults receiving cardiac surgery and is often linked to poor long-term prognosis. In geriatric care, the Geriatric Nutritional Risk Index (GNRI) offers a practical and efficient assessment tool to evaluate malnutrition risk, yet its relationship with cardiovascular mortality following cardiac valve surgery remains inadequately explored.
This research employed a retrospective cohort design with a sample of 170 patients of ≥60 years or older who underwent valve surgery at a tertiary hospital in 2013. To evaluate nutritional status, we employed using GNRI. The principal outcome was cardiovascular death with a median 7.2 years follow-up. Our methodological framework for investigating the GNRI-cardiovascular mortality link integrated three key components: multivariable Cox regression (to estimate hazard ratios), restricted cubic spline modeling (to explore non-linear trends), and Kaplan–Meier analysis (to visualize survival curves).
The results indicated a significant inverse linear the correlation of GNRI with the risk of cardiovascular mortality (p for nonlinearity = 0.274). After multivariable adjustment, per unit increment in GNRI showed a significant association 41% decline in the risk of death from cardiovascular causes (hazard ratios (HR): 0.59, 95% CI: 0.38–0.90, p = 0.015). Individuals with GNRI ≤92 had significantly worse long-term survival than those with GNRI >92 (p = 0.0057).
Preoperative GNRI is independently related to cardiovascular deaths in elderly postoperative cardiac valve surgery patients. A reduced GNRI signifies a significant marker for late cardiovascular death over the long term in cardiac valve surgery.
To compare the clinical outcomes between isolated aortic valve replacement (AVR) using a conventional stented bioprosthetic valve (St. Jude, Epic™ Valve Porcine) and a sutureless bioprosthetic valve (Perceval).
This single-center retrospective study evaluated 160 patients who underwent isolated surgical minimally invasive AVR between January 2020 and December 2024. Demographic, intraoperative, and postoperative data, as well as echocardiographic findings, were analyzed and compared.
Patients were divided into two groups: Perceval (n = 73) and St. Jude (n = 87). Patients in the Perceval group were older and had higher EuroSCORE 2 scores. The Perceval group showed significantly shorter cardiopulmonary bypass and aortic cross-clamp times (53.45 ± 24.18 vs. 68.02 ± 21.05 min; p < 0.001; and 40 ± 20.11 vs. 53.24 ± 17.34 min; p < 0.001). The intensive care unit (ICU) stay, intubation time, and hospital discharge time were significantly shorter in the Perceval group (p < 0.05). The requirement for inotropic support was also lower (2.8% vs. 24.1%, p < 0.001). At the 30-day follow-up, the perceval group had significantly lower mean and maximum transvalvular gradients. Complication rates were low in both groups, with one case of permanent pacemaker implantation and two reinterventions in the Perceval group.
Sutureless AVR with a Perceval valve is a safe and effective alternative to conventional stented bioprostheses, particularly in elderly patients. It offers shorter operative times and improves early postoperative recovery without compromising the clinical or hemodynamic outcomes.
Mitral valve repair has emerged as the gold standard treatment for mitral regurgitation, offering superior long-term outcomes compared with valve replacement. However, the repair process remains one of the most technically demanding and clinically complex procedures in cardiac surgery. Moreover, despite significant advances in surgical techniques, imaging modalities, and transcatheter interventions, the complexity of mitral valve anatomy and pathophysiology continues to present formidable obstacles to clinicians worldwide. The complexity of mitral repair encompasses both technical surgical skills and a sophisticated understanding of valve mechanics, advanced interpretation of imaging, and multidisciplinary team coordination. Thus, as we advance into an era of precision medicine and personalized cardiac interventions, addressing these difficulties becomes increasingly critical for optimizing patient outcomes and advancing the field of structural heart disease. This comprehensive review describes the multifaceted challenges encountered in contemporary mitral valve repair, including anatomical complexity, pathological heterogeneity, technical limitations, patient selection difficulties, and concerns about long-term durability. Moreover, we analyze the outcomes of various repair strategies, discuss the limitations of current approaches, and explore future directions in this rapidly evolving field. This review provides a strategic vision to advance personalized mitral valve interventions and optimize patient outcomes by bridging current limitations and actionable priorities for the future.
Fenestration is a well-established modification of the Fontan procedure intended to reduce systemic venous pressure and limit early postoperative complications. However, the optimal fenestration diameter that balances clinical benefits with systemic oxygenation remains uncertain. This study aimed to evaluate the association between fenestration size and early outcomes following extracardiac Fontan surgery.
We retrospectively analyzed pediatric patients who underwent fenestrated extracardiac Fontan surgery at Cho Ray Hospital between January 2020 and March 2025. Fenestration diameters ranged from 4 to 8 mm. Postoperative complications were categorized as pulmonary, cardiovascular, infectious, renal, or mortality events. Continuous outcomes included postoperative pleural drainage duration, intensive care unit stay, hospital stay, and perioperative change in peripheral arterial oxygen saturation (SpO2). Correlation analyses were employed to assess the associations between fenestration size and outcomes.
Twenty patients (median age: 5 years; 70% male) were included. Pulmonary complications were most common (85%), with pneumonia and pleural effusion observed in 65% of cases. Fenestration size was not associated with overall complication incidence; however, cardiovascular complications differed between groups (p = 0.045), without a linear trend (p for trend = 0.271). Oxygenation improved significantly perioperatively (median SpO2 increased from 76% to 86%, mean change: 10.6%; p = 0.001). Fenestration size correlated inversely with perioperative SpO2 change (ρ = –0.75; p < 0.001), while larger fenestrations correlated with shorter pleural drainage (ρ = –0.71; p = 0.001) and reduced hospital stay (ρ = –0.59, p = 0.012).
Fenestration significantly impacts early outcomes after a Fontan operation. Larger fenestrations promoted faster recovery, with shorter pleural drainage and hospital stays, but conferred a smaller oxygenation benefit. Individualized fenestration sizing may help optimize early outcomes in pediatric Fontan patients.
Fracture of guidewires may occur during attempts to recanalize severely calcified chronic total occlusions (CTOs) via percutaneous coronary intervention (PCI). When a fractured guidewire becomes entrapped within the lesion, rotational atherectomy (RA) may serve as a safe rescue strategy.
We report a case in which RA was utilized both to recanalize the heavily calcified CTO and to simultaneously ablate the entrapped guidewire fragment.
RA may serve as a safe rescue strategy to manage the fractured guidewires within CTO segments.
Evidence regarding the reliability of transthoracic echocardiography (TTE) in assessing valvular gradients immediately following transcatheter aortic valve implantation (TAVI) remains conflicting. Thus, this study aimed to compare post-procedural TTE and invasive mean aortic valve (AV) pressure gradients immediately after TAVI.
This was a retrospective, single-institution cohort study of consecutive TAVIs between 2012 and 2023. Immediate post-procedural mean AV pressure gradients were measured invasively via pigtail catheter and non-invasively via TTE. The Spearman coefficient was used to assess the correlation between TTE and invasive gradients. Multivariable Cox proportional-hazards regression was performed for long-term survival.
A total of 1589 patients underwent TAVI with available TTE and invasive pressure gradients. A total of 49.2% received self-expanding valves (SEVs), and 50.8% received balloon-expanding valves (BEVs); 7.2% underwent valve-in-valve (ViV); 17.6% received a small valve (Evolut ≤26 mm, Sapien ≤23 mm, and Portico/Navitor ≤25 mm). For the entire cohort, the TTE and invasive mean gradients showed a moderate correlation (Spearman ρ = 0.401), with a median absolute difference of 2.2 [1.0–4.0] mmHg. The SEV gradients were more strongly correlated than the BEV gradients (ρ = 0.447 vs. 0.345). Similarly, the small valve gradients were more strongly correlated than the large valve gradients (ρ = 0.455 vs. 0.375), while the ViV gradients were more strongly correlated than the native TAVI gradients (ρ = 0.575 vs. 0.357). A total of 1.6% of the patients had a difference >10 mmHg between the invasive and TTE gradients. In the multivariable Cox regression, a >10 mmHg discordance was not significantly associated with an increased hazard of death after TAVI (p = 0.326).
Following TAVI, we observed a moderate correlation between TTE and invasive measurements of mean AV pressure gradients, with only modest discordance noted between measurement modalities.
Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. While often considered a transient and expected complication, recent evidence suggests that POAF is associated with an increased risk of recurrence, thromboembolic events, and long-term morbidity. Moreover, the management of POAF remains debated, particularly regarding the choice between rate- and rhythm-control strategies and the use of anticoagulation. A narrative literature review was conducted using the PubMed, the Cochrane Library, and Google Scholar databases. Studies that focused on adult patients who developed POAF after coronary artery bypass grafting or valve surgery and addressed at least one of the following were included: recurrence patterns, treatment strategies (rate vs. rhythm control), stroke risk stratification, or anticoagulation. Studies focusing on nonsurgical atrial fibrillation (AF), pediatric populations, or animal models were excluded. A total of 45 articles were included for the final analysis. A total of 8 studies evaluated the recurrence of POAF after discharge. Across these studies, recurrence ranged between 30% and 60%, with many episodes occurring within the first month and remaining asymptomatic. Continuous monitoring tools, such as implantable loop recorders and handheld electriocardiogram (ECGs), showed a significantly higher detection rate than usual care. Seven studies compared rate- and rhythm-control strategies; in most patients, sinus rhythm was maintained regardless of the approach. Rate control, typically with beta-blockers, was favored as a safer first-line option. However, rhythm control, particularly through catheter ablation, showed improved outcomes in patients with heart failure or persistent symptoms. Nine studies examined stroke risk. The risk score for stroke in atrial fibrillation (CHA2DS2-VASc) score, although widely used in the general atrial fibrillation population, was validated primarily in the nonsurgical and transient AF population and may underestimate short-term thromboembolic risk in the postoperative setting. Some studies reported that stroke risk increased significantly once the CHA2DS2-VASc score reached ≥4, highlighting the potential for early postoperative thromboembolism. Several articles explored whether tools designed for subclinical AF, such as the risk stratification tools for subclinical atrial fibrillation (SCAF) score, could better stratify POAF risk. Notably, stroke risk increased significantly when episodes of atrial fibrillation exceeded 48 hours, suggesting that both duration and timing post-surgery are important considerations. Nine studies addressed anticoagulation. Oral anticoagulants, particularly apixaban, were associated with modest reductions in thromboembolic events but also with increased bleeding complications. Meanwhile, despite eligibility, fewer than 30% of patients received anticoagulation upon discharge. POAF is a common but underrecognized complication of cardiac surgery that carries a significant risk. Individualized management strategies guided by early rhythm monitoring and refined risk assessment tools are essential for optimizing outcomes.
Right ventricular failure (RVF) remains a major determinant of morbidity and mortality following left ventricular assist device (LVAD) implantation. In its most severe form, RVF necessitates right ventricular assist device (RVAD) support, which is associated with markedly worse early and long-term outcomes. While numerous studies have examined predictors of post-LVAD RVF, few have focused specifically on RVAD implantation as a discrete and clinically decisive endpoint. We therefore performed a systematic review and meta-analysis to identify robust preoperative predictors of RVAD requirement following LVAD implantation.
A systematic literature search of MEDLINE, EMBASE, SCOPUS, and PubMed was conducted from inception to August 2025 in accordance with PRISMA guidelines. Studies enrolling adult patients undergoing durable or temporary LVAD implantation and reporting preoperative predictors of postoperative RVAD requirement were included. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic, with predefined sensitivity and subgroup analyses based on LVAD era and study size.
Twenty studies met inclusion criteria, of which nineteen comprising 31,591 patients were included in the meta-analysis. Several consistent preoperative predictors of RVAD requirement were identified across clinical, haemodynamic, echocardiographic, and laboratory domains. Patients requiring RVAD were younger (MD –3.57 years) and more frequently female, had a higher likelihood of prior cardiac surgery, INTERMACS Profile 1 status, and need for preoperative mechanical support including ventilation and intra-aortic balloon pump. Haemodynamic predictors included elevated central venous pressure, higher CVP/PCWP ratio, lower cardiac index, and reduced right ventricular stroke work index. Echocardiographic predictors included severe tricuspid regurgitation and lower tricuspid annular plane systolic excursion. Laboratory markers of hepatic dysfunction, coagulopathy, malnutrition, anaemia, thrombocytopenia, and elevated natriuretic peptides were also significantly associated with RVAD implantation. Subgroup analyses demonstrated consistent direction of effects across LVAD eras and study sizes.
RVAD requirement after LVAD implantation is driven by a constellation of high clinical acuity, haemodynamic compromise, and end-organ dysfunction rather than any single isolated variable. A comprehensive, multi-parameter preoperative assessment is essential to identify patients at highest risk and to guide patient selection, preoperative optimisation, and consideration of planned biventricular support strategies.