Laura Besola, Federico Giorgi, Michele Celiento, Danilo Ruggiero, Giacomo Ravenni, Andrea Colli
{"title":"A glimpse into the future of valve-in-valve to treat early bioprosthesis structural degeneration-are we really doing right?","authors":"Laura Besola, Federico Giorgi, Michele Celiento, Danilo Ruggiero, Giacomo Ravenni, Andrea Colli","doi":"10.21037/acs-2025-etavr-14","DOIUrl":"https://doi.org/10.21037/acs-2025-etavr-14","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"179-181"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transcatheter aortic valve replacement explantation experience in Japanese high-volume center.","authors":"Kazuo Shimamura, Ai Kawamura, Daisuke Yoshioka, Yusuke Misumi, Koichi Maeda, Kizuku Yamashita, Takuji Kawamura, Shigeru Miyagawa","doi":"10.21037/acs-2024-etavr-0167","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0167","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve replacement (TAVR) explant is an essential therapeutic option for late-stage biological valve failure (BVF) or prosthetic valve endocarditis (PVE) following TAVR, though poor outcomes have been reported. This study assesses TAVR explant outcomes at a high-volume Japanese center.</p><p><strong>Methods: </strong>From October 2009 to December 2023, 10 TAVR explants were performed after 1,364 TAVR procedures at a leading Japanese high-volume center, and clinical outcomes were retrospectively analyzed. Data were drawn from a prospectively maintained database, assessing preoperative and intraoperative variables, as well as short- and long-term postoperative outcomes.</p><p><strong>Results: </strong>Thirty-nine BVFs were observed during follow-up, and 16 (41.0%) redo-TAVRs were performed in the same timeframe. In the 10 (25.6%) TAVR explant cases, the median age of the patients was 79.5 years, with a predicted mortality for isolated surgical aortic valve replacement (SAVR) by Society of Thoracic Surgeons (STS) score of 4.5%. The primary indications for TAVR explant were PVE (40.0%) and structural valve deterioration (SVD) (30.0%). Concomitant procedures were necessary in 90% of cases, including aortic repair (40.0%) and mitral replacement or repair (30.0%). Aortic annulus reinforcement using autologous pericardium was performed in 30% of cases. The 30-day mortality rate was 20%, with 20% of cases requiring temporary mechanical circulatory support and postoperative continuous hemodiafiltration. In mid-term outcomes, the survival rate was 60% in 1 year and 40% in 3 years, respectively.</p><p><strong>Conclusions: </strong>In this Japanese high-volume center experience, TAVR explants predominantly involved elderly patients and frequently required a concomitant procedure. The outcome was generally poor, comparable to those in Western countries. As the number of TAVR explants is expected to increase in Japan, knowledge-sharing within heart teams, including cardiac surgeons, is essential.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"131-140"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transcatheter versus surgical aortic valve replacement in low- to intermediate-risk patients: a meta-analysis of reconstructed time-to-event data.","authors":"Tomonari Shimoda, Yoshihisa Miyamoto, Junichi Shimamura, Hiroki Ueyama, Yujiro Yokoyama, Michel Pompeu Sá, Tsuyoshi Kaneko, Tomo Ando, Hisato Takagi, Shinichi Fukuhara, Toshiki Kuno","doi":"10.21037/acs-2024-etavr-0096","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0096","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement (SAVR) for severe symptomatic aortic stenosis (AS), including low-risk patients. We aimed to update a systematic review and conduct a meta-analysis of reconstructed time-to-event data from randomized control trials (RCTs) in low-/intermediate-risk patients.</p><p><strong>Methods: </strong>Systematic searches were performed in PubMed, EMBASE, Cochrane CENTRAL, and specific websites up to November 2023, for RCTs. A meta-analysis was performed using the reconstructed time-to-event data from the provided Kaplan-Meier (KM) curves from the included RCTs. The primary outcome was all-cause mortality, and the secondary outcomes included a composite outcome (all-cause mortality and disabling stroke), and heart failure rehospitalization. Landmark analysis for endpoints beyond 1 year was performed. The study protocol was registered on PROSPERO (CRD42023487893).</p><p><strong>Results: </strong>Six RCTs with a total of 7,389 patients were included. The survival was comparable between both groups [hazard ratio (HR), 1.03; 95% confidence interval (CI): 0.93-1.14; P=0.57]. The composite outcome and heart failure rehospitalization were comparable between the two groups. Lower mortality with TAVR was observed compared to SAVR before 1 year (HR, 0.82; 95% CI: 0.68-0.98; P=0.03), while TAVR was associated with higher risk of mortality beyond 1 year (HR, 1.13; 95% CI: 1.01-1.27; P=0.04). Similarly, the TAVR group was associated with lower risk for the composite endpoint and heart failure rehospitalization before 1 year, but with higher rates beyond 1 year.</p><p><strong>Conclusions: </strong>Among low- to intermediate-risk patients, TAVR was found to be associated with favorable outcomes in the short-term (0-1 year). However, our landmark analysis demonstrated TAVR to be associated with poorer outcomes beyond 1 year.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"73-84"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Explanting transcatheter aortic valves: comparative insights and surgical nuances in native versus valve-in-valve scenarios.","authors":"Shinichi Fukuhara","doi":"10.21037/acs-2024-etavr-0123","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0123","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"176-178"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kanhua Yin, Marc Titsworth, Yujiro Yokoyama, Chi Chi Do-Nguyen, Bo Yang
{"title":"Y-incision aortic annular enlargement after surgical explantation of transcatheter aortic valve bioprosthesis.","authors":"Kanhua Yin, Marc Titsworth, Yujiro Yokoyama, Chi Chi Do-Nguyen, Bo Yang","doi":"10.21037/acs-2024-etavr-0152","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0152","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"173-175"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Grace S Lee, Gilbert Tang, Syed Zaid, Derrick Y Tam
{"title":"The current state of redo transcatheter aortic valve replacement (TAVR) and limitations: why TAVR explant is important as the valve reintervention strategy.","authors":"Grace S Lee, Gilbert Tang, Syed Zaid, Derrick Y Tam","doi":"10.21037/acs-2024-etavr-0149","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0149","url":null,"abstract":"<p><p>The rise of transcatheter aortic valve replacement (TAVR) over the past two decades has substantially changed the lifetime management of patients with aortic valve disease. As the indications for TAVR expand to include younger and lower-risk patients, the proportion of patients who subsequently require reintervention for failed transcatheter heart valves (THVs) will increase. The two primary options for reintervention are redo TAVR and TAVR explant followed by surgical aortic valve replacement (SAVR). The indications for redo TAVR in the short term include emergency \"bailout\" procedures due to malpositioning, embolization, or long-term device failure due to paravalvular leak (PVL) or valvular degeneration. However, redo TAVR is not suitable for all patients. Those with prohibitive coronary anatomy, multivalvular involvement, severe patient-prosthetic mismatch, or endocarditis should be referred for TAVR explant, which is a comparatively higher-risk procedure. Redo TAVR has generally been associated with low mortality and complication rates, with key procedural considerations being valve selection [e.g., sizing, balloon-expandable valve (BEV) <i>vs.</i> self-expandable valve (SEV)], access, and coronary protection. TAVR explant poses numerous technical challenges, including concomitant ascending aorta or aortic root replacement, mitral valve involvement, or adhesions to the coronary ostia. Compared to redo TAVR, TAVR explant is associated with higher rates of short-term mortality and periprocedural complications. The 30-day mortality rates of TAVR explant approach 20%, and 1-year mortality rates range from 20% to 30%, with significantly greater risk associated with concomitant procedures. The data on both redo TAVR and TAVR explant are limited to observational cohorts without long-term follow-up. Given that patient populations and indications for redo TAVR and TAVR explant are vastly different, direct comparisons of outcomes between these two groups should be avoided. Nonetheless, multidisciplinary Heart Team collaboration remains imperative to advancing our knowledge of redo TAVR or TAVR explant procedures and the careful lifetime management of patients with aortic valve disease.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"98-111"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin T Muston, Winky Lo, Aditya Eranki, Massimo Boffini, Antonio Loforte
{"title":"Cardiac transplantation in controlled donation after circulatory death: a meta-analysis of long-term survival using reconstructed time-to-event data.","authors":"Benjamin T Muston, Winky Lo, Aditya Eranki, Massimo Boffini, Antonio Loforte","doi":"10.21037/acs-2024-dcd-20","DOIUrl":"10.21037/acs-2024-dcd-20","url":null,"abstract":"<p><strong>Background: </strong>Controlled donation after circulatory death (cDCD) allografts made up a small fraction of donor hearts available for transplant, however it is estimated this could increase to 30% in future years. The purpose of this systematic review and meta-analysis was to describe the largest and most up-to-date short- and long-term survival outcomes for cDCD cardiac transplantation.</p><p><strong>Methods: </strong>Three electronic databases were selected to complete the initial literature search from inception of records until February 2024. Primary outcomes were short-term survival at 12 months, as well as long-term time-to-event survival data. These data were calculated using aggregated Kaplan-Meier curves according to established methods. The secondary outcomes were acute rejection and primary graft dysfunction.</p><p><strong>Results: </strong>Following the PRISMA screening protocol, ten studies were included for analysis, eight of which were published in the last 12 months. A pooled cohort of 1,219 donor/recipient pairs were analyzed, of which all had graphical extraction of individual patient data to reveal an aggregated Kaplan-Meier curve. The survival estimates at 1, 3 and 5 years for the pooled cDCD cohort were 92.4%, 85.3% and 85.3%, respectively. In-hospital mortality rates were low at just 2.5%.</p><p><strong>Conclusions: </strong>While only making up a small percentage of current heart transplant figures, cDCD allografts may not only significantly reduce waitlist times, but could also increase the donor pool, and improve survivability over current procurement techniques. Ultimately, cDCD allografts show promise in offering an effective and favorable procurement source for cardiac transplantation worldwide.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 1","pages":"1-10"},"PeriodicalIF":3.3,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lu Wang, Michael T Cain, Eduardo Minambres, Jordan R H Hoffman, Marius Berman
{"title":"Thoracoabdominal normothermic regional perfusion-approaches to arch vessels and options of cannulation allowing donation after circulatory death multi-organ perfusion and procurement.","authors":"Lu Wang, Michael T Cain, Eduardo Minambres, Jordan R H Hoffman, Marius Berman","doi":"10.21037/acs-2025-dcd-28","DOIUrl":"10.21037/acs-2025-dcd-28","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 1","pages":"70-72"},"PeriodicalIF":3.3,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The anesthetist perspective: optimization of cardiac allograft from withdrawal of life support to reperfusion in the controlled donation after circulatory death.","authors":"Marinella Zanierato, Antonio Rubino","doi":"10.21037/acs-2024-dcd-0098","DOIUrl":"10.21037/acs-2024-dcd-0098","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 1","pages":"58-60"},"PeriodicalIF":3.3,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}