Heart最新文献

{"title":"Beyond the shock: standardising mechanical circulatory support in acute myocardial infarction cardiogenic shock.","authors":"Ahmad Jabri, Sant Kumar, Pedro Villablanca","doi":"10.1136/heartjnl-2025-326921","DOIUrl":"10.1136/heartjnl-2025-326921","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"528-529"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac resynchronisation therapy among adults with a systemic right ventricle: a multicentre experience.","authors":"Flavia Fusco, Giancarlo Scognamiglio, Mikael Dellborg, Payam Dehghani, Susan M Jameson, W Aaron Kay, Jonathan W Cramer, Isabelle Vonder Muhll, Eric V Krieger, Fred H Rodriguez, Luke J Burchill, Jeremy Nicolarsen, Joseph Kay, Robert M Kauling, Sangeeta Shah, Anthony Magalski, Joshua Wong, David S Celermajer, David William Baker, Jolien W Roos-Hesselink, Salil Ginde, Jamil Aboulhosn, Marissa Kuo, Christopher DeZorzi, Paul Khairy, Carla P Rodriguez-Monserrate, Shelby Kutty, William Wilson, Adam M Lubert, Jasmine Grewal, Frank Han, Timothy Cotts, Stephen Pylypchuk, Tripti Gupta, Petra Antonová, Clare O'Donnell, Anitha John, Pastora Gallego, Alexandra van Dissel, Alexander R Opotowsky, Elizabeth Yeung, Craig S Broberg, Berardo Sarubbi","doi":"10.1136/heartjnl-2025-326384","DOIUrl":"10.1136/heartjnl-2025-326384","url":null,"abstract":"<p><strong>Background: </strong>Cardiac resynchronisation therapy (CRT) is a key treatment for heart failure (HF) in acquired heart disease, but its benefits in adults with congenital heart disease and a systemic right ventricle (sRV) remain unclear. This study aimed to assess whether CRT improves outcomes in patients with sRV.</p><p><strong>Methods: </strong>This is an international, retrospective study including patients >18 years from 33 centres with transposition of the great arteries (TGA) following atrial switch operation and congenitally corrected TGA. The primary endpoint included overall survival and survival free from HF. The secondary endpoint was a composite of death, hospitalisation for HF, heart transplant, mechanical support and ventricular tachycardia/implantable cardioverter-defibrillator therapies.</p><p><strong>Results: </strong>We identified 105 out of 1721 patients (3.5%) who underwent CRT. Median follow-up after CRT implant was 4.6 (1.6-8) years. QRS improvement was limited to those with previous pacing (167±35 vs 154±28 ms; p=0.002). Following CRT, there was no significant change in B-type natriuretic peptide values, peak VO₂ and tricuspid regurgitation severity by echocardiography. CRT complications occurred in 10 (9.5%), though they were usually minor. Patients with CRT were propensity-matched to controls according to age, sex, anatomy, presence of complex disease, previous HF and sRV dysfunction at baseline. At univariable analysis, CRT (HR 4.39-95%, CI 1.6 to 11.9; p=0.003), older age and moderate-to-severe sRV dysfunction at baseline were predictive of death, while CRT (HR 3-95%, CI 1.3 to 7; p=0.01) and sRV dysfunction were associated with HF admission. By multivariable analysis, CRT (HR 8.8-95%, CI 2.9 to 26.6; p=0.0001) and age (HR 1.1%-95%, CI 1.01 to 1.15; p<0.0001) were independently associated with poorer outcome.</p><p><strong>Conclusion: </strong>In this retrospective study in the largest population thus far described with an sRV, CRT implant was not associated with improved survival, even after controlling for key confounders.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"549-556"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asthma and risk of degenerative valvular heart disease: a prospective cohort study.","authors":"Zuoxiang Wang, Xifeng Qian, Junxing Lv, Ziang Li, Zheng Yin, Can Wang, Sheng Zhao, Xiaojin Gao, Yongjian Wu","doi":"10.1136/heartjnl-2024-325575","DOIUrl":"10.1136/heartjnl-2024-325575","url":null,"abstract":"<p><strong>Background: </strong>Asthma has been associated with the development and progression of various cardiovascular diseases but its relationship with degenerative valvular heart disease (VHD) remains unclear. This study investigated the association between asthma and incident degenerative VHD, including aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR) and pulmonary regurgitation (PR).</p><p><strong>Methods: </strong>We analysed 483 735 participants from the UK Biobank (median age 56.5 years; 45.2% male) who were free of VHD at baseline. Asthma status was self-reported at recruitment. Incident VHD was ascertained through hospital admission and mortality records using International Classification of Diseases, Tenth Revision codes. Cox proportional hazards models were used to estimate HRs and 95% CIs for each VHD subtype, adjusting for demographic, lifestyle and clinical covariates. Sensitivity analyses accounted for asthma medications, duration of asthma and competing risks.</p><p><strong>Results: </strong>Over a median follow-up of 13.8 years, 5388 participants developed AS, 2650 AR, 6088 MR and 821 PR. Asthma was associated with increased risk of AS (HR 1.31; 95% CI 1.21 to 1.41), AR (HR 1.24; 95% CI 1.11 to 1.39), MR (HR 1.19; 95% CI 1.10 to 1.28) and PR (HR 1.34; 95% CI 1.10 to 1.62). The association with AR was attenuated after adjusting for asthma medications (HR 1.12; 95% CI 0.97 to 1.30). Results were robust across multiple sensitivity analyses, including adjustment for asthma duration and exclusion of participants with pre-existing cardiovascular disease.</p><p><strong>Conclusions: </strong>Asthma is independently associated with a modestly increased risk of several degenerative VHDs, particularly aortic and mitral valve diseases. These findings suggest a potential shared inflammatory pathway and highlight the need for heightened cardiovascular surveillance in individuals with asthma.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"576-582"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revascularisation strategies for non-acute myocardial ischaemic syndromes.","authors":"Michal J Kawczynski, Fabio Barili, James M Brophy, Raffaele De Caterina, Giuseppe Biondi Zoccai, Amedeo Anselmi, William E Boden, Alessandro Parolari, Samuel Heuts","doi":"10.1136/heartjnl-2025-326101","DOIUrl":"10.1136/heartjnl-2025-326101","url":null,"abstract":"<p><strong>Background: </strong>Contemporary guidelines by the European Society for Cardiology and American College of Cardiology/American Heart Association for the treatment of non-acute myocardial ischaemic syndromes dispute the value of revascularisation and differ in their recommendation to perform revascularisation. A Bayesian network meta-analysis was performed, evaluating the strength of evidence for the comparative incremental effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) over medical therapy on long-term outcomes.</p><p><strong>Methods: </strong>A hierarchical Bayesian network meta-analysis was designed (PROSPERO CRD42024541215, date 20 May 2024), including randomised controlled trials (RCTs) published between 2005 and 10 June 2025, which consisted of three initial treatment modalities: optimal medical therapy (OMT), PCI+OMT and CABG+OMT. The primary outcome was all-cause mortality at maximum follow-up; secondary outcomes were trates of the rates of myocardial infarction, stroke and re-revascularisation at maximum follow-up, expressed in HRs and 95% credible intervals (CrIs), accompanied by surface under the cumulative ranking curve (SUCRA) scores.</p><p><strong>Results: </strong>10 RCTs, comprising 10 742 patients, were included. For all-cause mortality, the estimated median HR of CABG+OMT versus OMT was 0.84 (95% CrI 0.68-1.07); the HR of PCI+OMT versus OMT was 0.93 (0.79-1.16); and the HR of CABG+OMT versus PCI+OMT was 0.91 (0.71-1.13). The SUCRAs of a CABG+OMT strategy ranking as the optimal revascularisation treatment regarding mortality, myocardial infarction, stroke and re-revascularisation were 88.1%, 99.7%, 17.5% and 99.5%, respectively. Results were consistent across sensitivity analyses, including in the node-splitting models.</p><p><strong>Conclusions: </strong>This Bayesian network meta-analysis found that an initial CABG (+OMT) revascularisation strategy was associated with higher probabilities of optimal outcomes, with the exception of stroke, compared with an initial PCI (+OMT) revascularisation strategy, although CrIs overlapped, suggesting that some uncertainty remains.</p><p><strong>Prospero registration number: </strong>CRD42024541215.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"530-538"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of internal thoracic artery use in patients with prior mediastinal radiation undergoing coronary artery bypass grafting: a Maryland statewide propensity-matched analysis.","authors":"Alice L Zhou, Ifeanyi D Chinedozi, Sari D Holmes, James S Gammie, Deven Patel, Armaan F Akbar, Diane Alejo, Jennifer Lawton, Glenn Whitman, Rawn Salenger, Jessica B Briscoe, Zachary E Darby, Duke Cameron, Hanghang Wang","doi":"10.1136/heartjnl-2025-325949","DOIUrl":"10.1136/heartjnl-2025-325949","url":null,"abstract":"<p><strong>Background: </strong>The safety of internal thoracic artery (ITA) grafting in patients undergoing coronary artery bypass grafting (CABG) with prior mediastinal radiation remains controversial due to concerns regarding compromised sternal perfusion and radiation-induced injury. This study evaluated whether prior mediastinal radiation is associated with adverse perioperative outcomes in patients undergoing CABG with ITA grafting.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database. A total of 29 206 patients who underwent CABG with ITA use between 1 July 2011 and 31 March 2023 were analysed. Patients with and without prior mediastinal radiation were propensity-matched (1:10) using the nearest neighbour method. The primary outcome was the composite of operative mortality and deep sternal wound infection (DSWI). Secondary outcomes included other infectious complications, major morbidities, postoperative hospital length of stay, and 30-day readmission.</p><p><strong>Results: </strong>Among 29 206 patients, 294 (1%) had a history of mediastinal radiation. Patients with prior radiation were older (median (IQR) 70 (60-75) vs 66 (59-73) years, p<0.001), more frequently female (66% vs 25%, p<0.001) and had a higher prevalence of chronic lung disease (31% vs 19%, p<0.001). After propensity matching, no significant differences were observed in the primary composite outcome (2% vs 3%, p=0.53) or in secondary outcomes.</p><p><strong>Conclusions: </strong>In this large retrospective cohort, prior mediastinal radiation was not associated with an increased risk of perioperative adverse events in patients undergoing CABG receiving ITA grafts. These findings demonstrate no evidence of safety concerns with the use of ITA grafting in patients with prior radiation and challenge the practice of excluding these patients from arterial revascularisation strategies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"557-562"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney function and risk of heart failure in older adults: findings from a prospective cohort study.","authors":"Oyunchimeg Buyadaa, Rory Wolfe, Andrew M Tonkin, Christopher M Reid, Zhen Zhou, James B Wetmore, Michelle A Fravel, Robyn L Woods, Kevan R Polkinghorne","doi":"10.1136/heartjnl-2025-325700","DOIUrl":"10.1136/heartjnl-2025-325700","url":null,"abstract":"<p><strong>Background: </strong>We examined whether impaired kidney function, identified through elevated levels of urine albumin to creatinine ratio (UACR) or reduced estimated glomerular filtration rate (eGFR), is associated with hospitalisation or death due to heart failure (HF) in a large community-based cohort of older adults.</p><p><strong>Methods: </strong>We included 17 834 participants from the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial and follow-up ASPREE eXTension observational study with complete baseline data on albuminuria and eGFR. HRs for hospitalisation due to HF (HHF), HF death, a composite outcome of HHF and HF death, and HF re-admission were calculated using Cox models adjusting for potential confounders.</p><p><strong>Results: </strong>Over a median follow-up of 8.6 years, 354 (1.98%) participants had a first hospitalisation for HF and 147 (0.82%) died due to HF. Participants with albuminuria (UACR ≥3.0 mg/mmol; 11.3%) had higher risk for HHF, HF death and the combined HF outcome compared with those with no albuminuria (HRs 1.47 (95% CI 1.12 to 1.92), 1.55 (95% CI 1.04 to 2.33) and 1.33 (95% CI, 1.05 to 1.70), respectively). In participants with albuminuria, there was also an increased risk for re-admission due to HF (HR 1.30 (95% CI 1.03 to 1.65)), although there was no difference in risk of HF death. For eGFR, a U-shaped relationship was observed with increased risk of HHF, HF death and the HF composite outcome at both low (eg, <60 mL/min/1.73 m²) and high (eg, >90 mL/min/1.73 m²) eGFR levels. However, the association at high eGFR was not statistically significant and may reflect residual confounding. No association was observed between eGFR and HF re-admission.</p><p><strong>Conclusions: </strong>In this large cohort of older adults, albuminuria was associated with increased risk of HF outcomes, supporting its role in HF risk assessment. Low eGFR was also linked to higher risk of HHF, HF death and the HF composite outcome. Associations with high eGFR were not conclusive and should be considered hypothesis-generating.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"569-575"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk prediction models for incident heart failure: a systematic review and meta-analysis.","authors":"Jose Miguel Navarro, Barbara Stella Doumouras, William Douglas, Paul Tieu, Veronica Chan, Tsz Hin Alexander Lau, David Bobrowski, Clarissa Yu, Chang Nancy Wang, Mohamed Adam, Joshua G Lee, Jennifer E Ho, Daniel Levy, Husam Abdel-Qadir, Heather Ross, Farid Foroutan","doi":"10.1136/heartjnl-2025-327118","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327118","url":null,"abstract":"<p><strong>Background: </strong>Early identification of patients at risk of heart failure (HF) provides opportunities for preventative management. Though models have been developed to predict HF incidence, their validation remains unclear. Our objective was to summarise the performance, as observed in validation studies, of risk prediction models for incident HF.</p><p><strong>Methods: </strong>In addition to articles from three previous systematic reviews, a search in Medline and Embase from 2014 to 2025 identified derivation or validation studies for incident HF prediction models. Performance was assessed in models validated in ≥1 cohort, with random-effects meta-analyses used to pool discrimination measures, and calibration descriptively summarised. We used the Prediction Model Risk Of Bias Assessment Tool to assess risk of bias in individual studies and the Grading of Recommendations, Assessment, Development and Evaluation approach to assess certainty in inferences drawn from the evidence.</p><p><strong>Results: </strong>From 24 531 publications identified, 76 studies representing 238 models were included. Risk of bias was high in 82.9% of assessments. With moderate to high certainty, among 64 models validated in at least one cohort, four models had moderate and eight models had high discrimination. In patients with low predicted risk, calibration may have been adequate. The Predicting Risk of CVD EVENTs (PREVENT), Atherosclerosis Risk in Communities (ARIC), and Multi-Ethnic Study of Atherosclerosis (MESA) models were most promising for further validation and impact studies. Among externally validated models, 14 were derived using machine learning, six incorporated novel biomarkers such as proteomics and polygenic risk scores, and nine included measures of social determinants of health as predictors.</p><p><strong>Conclusions: </strong>The PREVENT, ARIC and MESA risk scores demonstrate promising performance and should be prioritised for further validation and progression to impact studies.</p><p><strong>Prospero registration number: </strong>CRD42021266756.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home-based, online-monitored high-intensity interval training improves fitness in patients with tetralogy of Fallot: a randomised controlled trial.","authors":"Wouter Jeroen van Genuchten, Zina Fejzic, Robert M Kauling, Laurens Koopman, Arend W van Deutekom, Arie P van Dijk, Linda Elisabeth van den Berg, Beatrijs Bartelds, Eric Boersma, Miranda Snoeren, Alexander Hirsch, Willem A Helbing","doi":"10.1136/heartjnl-2025-327201","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327201","url":null,"abstract":"<p><strong>Introduction: </strong>Reduced exercise performance is common in patients with repaired tetralogy of Fallot (rToF) and relates to adverse outcomes. The effects of high-intensity interval training (HIIT) in rToF are unknown. Furthermore, it is unknown if home-based, online-monitored exercise training is effective in rToF. We aimed to examine the feasibility, safety and effects of home-based HIIT in patients with rToF.</p><p><strong>Methods: </strong>Patients aged 12-30 years (n=34, median age 16 (IQR 14-23)) with rToF were randomised to a 12-week home-based HIIT programme or standard of care (SOC). HIIT was prescribed in three 30 min sessions/week, with heart rate telemonitoring. SOC included exercise as usual. Co-primary end points were mean differences in peak oxygen consumption (VO2) and maximal workload, analysed using linear mixed-effects (LME) models. Secondary end points were: echocardiography, ECG and MRI-derived measures of cardiac structure and function.</p><p><strong>Results: </strong>No serious adverse events occurred. After HIIT, peak VO2 increased from 38.3 (34.0-42.5) mL/kg/min to 40.9 (36.6-45.2) mL/kg/min (∆ 4.0 mL/kg/min, compared with control period (95% CI 1.52 to 6.53)), workload increased from 204 (174-234) W to 218 (188-248) W (∆ 17 W, compared with control period (95% CI 5 to 30)). No changes in cardiac volumes and ejection fraction were observed after HIIT. VO2 improved after HIIT independent of baseline fitness, body mass index and biventricular size. Notably, lower right ventricular ejection fraction (RV EF) was associated with greater improvement.</p><p><strong>Conclusion: </strong>HIIT significantly enhances exercise capacity in adolescents and young adults with rToF without adverse effects on cardiac structure or function, although the sample size limits the detection of subtle changes and can be successfully performed at home with online monitoring. This intervention offers a feasible alternative to traditional, on-site supervised exercise programmes, for patients with rToF, including those with lower RV EF.</p><p><strong>Trial registration number: </strong>NTR2731.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current evidence for diagnosis and management of cardiac vasculitis.","authors":"Shaun Khanna, Aditya Bhat, Liza Thomas, Clare Arnott, Nitesh Nerlekar","doi":"10.1136/heartjnl-2025-327506","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327506","url":null,"abstract":"<p><p>Cardiac vasculitis represents a heterogeneous group of immune-mediated disorders that can involve the coronary vessels, myocardium, valvular apparatus and pericardial tissues. Despite its rarity, cardiac vasculitis may result in significant clinical sequelae such as acute coronary syndrome, heart failure, cardiac arrhythmias and pericarditis. Diagnosis is challenging because symptoms are often non-specific and overlap with other cardiovascular conditions. Early recognition is therefore crucial to prevent delayed treatment and disease progression. Advances in non-invasive multimodality imaging and collaborative cardio-rheumatology care have transformed recognition and management of this disease spectrum. Emerging techniques such as hybrid positron emission tomography-cardiac MRI and quantitative CT imaging permit in-vivo characterisation of inflammation. As per European Alliance of Associations for Rheumatology recommendations, treatment requires early intensive immunosuppression to induce remission, coupled with comprehensive cardiovascular risk management. Additional research is required to validate imaging-guided management algorithms, refine vasculitis-specific cardiovascular risk and define long-term outcomes across disease subtypes.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial chords in endoscopic mitral valve repair: a comparative analysis of surgical techniques and long-term outcomes.","authors":"Felix Nägele, Can Gollmann-Tepeköylü, Johannes Splika, Daniel Höfer, Leo Pölzl, Alexander Lu, Michael Graber, Clemens Engler, Jakob Hirsch, Lukas Stastny, Simone Gasser, Juliane Kilo, Johannes Holfeld, Ludwig Müller, Michael Grimm, Nikolaos Bonaros","doi":"10.1136/heartjnl-2026-327812","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-327812","url":null,"abstract":"<p><strong>Background: </strong>The use of artificial chords for mitral valve prolapse during minimally invasive mitral valve repair (MIMVR) has increased over the past two decades, driven by advancements in surgical techniques and the need for reproducible and durable repair strategies. This study aimed to compare the outcomes of single artificial chords versus premeasured loops and identify predictors for long-term success.</p><p><strong>Methods: </strong>Between 2001-2023, perioperative data and long-term outcomes of 1186 consecutive patients who underwent MIMVR at the University Hospital Innsbruck, Austria were analysed and reported according to the Mitral Valve Research Consortium criteria, including all-cause mortality, freedom from reoperation and technical success defined as freedom from reoperation or recurrent mitral regurgitation>moderate. A competing risk analysis was performed to account for the risk of mortality long-term.</p><p><strong>Results: </strong>The mean age of the cohort was 60.6±12.6 years, with 61.6% males. Among them, 581 patients received artificial chords (151 single chords and 430 premeasured loops). At a median follow-up of 5.0 (4.45-5.53) years, survival was 98.4%, 95.4% and 92.7% at 1, 5 and 10 years, respectively. At 15 years, cumulative incidence of death or reoperation was 8.5% in the loop group and 11.0% in the single expanded polytetrafluoroethylene (ePTFE) chord group (p=0.90), with a hazard ratio of 0.95 (95% CI 0.44 to 2.06). The loop technique was associated with shorter cross-clamp times (100 vs 121 min, p<0.001) and more implanted chords (5.0 vs 2.0, p<0.001) compared with the ePTFE chord technique. There was no significant difference in long-term success: event-free survival at 10 years: 92% (87-97%) in the loops group versus 93% (89-97%) in the single ePTFE chords group, p=0.5. Left atrial appendage occlusion emerged as the only independent predictor for long-term success (HR: 0.11 (0.014-0.839), p=0.033), whereas the choice of technique did not influence long-term outcomes.</p><p><strong>Conclusions: </strong>Both single artificial chords and premeasured loops provided excellent perioperative and long-term outcomes in MIMVR. The loop technique facilitated shorter operative times and greater chordal implantation efficiency without compromising long-term repair durability or event-free survival.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}