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A thorough literature search was conducted on patients with Left Ventricular Assist Device (LVAD) and aortic insufficiency undergoing transcatheter aortic valve replacement (TAVR). We identified all original research studies that compared the long-term outcomes of surgical transcatheter aortic valve replacement (SAVR) versus TAVR for patients with LVAD, published between 1990 and 2023. The primary endpoint was the composite of in-hospital mortality, stroke, transient ischemic attack, myocardial infarction (MI), pacemaker implantation, vascular complications and cardiac tamponade. Secondary endpoints were the median overall survival (OS), the incidence of acute kidney injury (AKI), any bleeding needing transfusions or reintervention and cost. A total of fourteen studies and 358 patients were included (TAVR: 242; SAVR: 116). The composite outcome, the incidence of AKI, the bleeding needing transfusion, along with cost were significantly higher in the SAVR group. In addition, there was no significant difference between TAVR and SAVR in terms of median OS. The median OS in the TAVR group was 18 months. Finally, the most common causes of death were progression of heart failure and pneumonia. The present meta-analysis indicates that TAVR is associated with enhanced outcomes compared to SAVR for patients with LVAD presenting aortic insufficiency. Further well-designed original studies with greater sample sizes are necessary to validate our findings., (© 2024. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Objective: We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG)., Methods: Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median overall survival (OS) and event-free OS were the primary endpoints. Comparison of median OS between the right internal mammary artery (RIMA) and radial artery (RA) as a second arterial conduit was the secondary endpoint. Subgroup analyses were performed regarding patients older than 70 years, with diabetes mellitus, and females. A sensitivity analysis was performed with the leave-one-out method., Results: Forty-four studies were included in the qualitative and thirty-nine in the quantitative synthesis. After pooling data from 180 to 459 patients, the MAG group demonstrated a higher OS (HR, 0.589; 95% CI, 0.58-0.60; p < 0.0001) and event-free OS compared with the SAG group (HR, 0.828; 95% CI, 0.80-0.86; p < 0.0001). In addition, RITA was associated with superior OS compared with RA as a second arterial conduit (HR, 0.936; 95% CI, 0.89-0.98; p = 0.009). MAG was also superior to SAG in patients over 70 years, females, and patients with diabetes mellitus. Sensitivity analysis demonstrated a small-size study effect on the female subgroup analysis., Conclusion: The present meta-analysis indicates that MAG is associated with enhanced survival outcomes compared to SAG for patients undergoing isolated CABG., (© 2022. The Author(s).)

Transcatheter aortic valve implantation (TAVI) evolved to an established treatment for meanwhile moderate-risk surgical patients suffering from severe aortic stenosis. Due to its less invasiveness, avoiding the use of cardiopulmonary bypass, the procedure demonstrated to be an efficient and safe treatment option. However, long-term results regarding these new valve prostheses are still lacking. Potential prosthesis failure and/ or dysfunction would require either, if feasible, a transcatheter "valve in valve" procedure, or a conventional surgical valve replacement. In the literature, anecdotal reports are describing surgical removal techniques of the currently transcatheter-implanted prostheses. We herein propose a modified surgical removal technique of an infected Edwards SAPIEN 3 Transcatheter Heart Valve 18 months after its implantation.

Objective: The performance comparison of the recently introduced European System for Cardiac Operative Risk Evaluation II in predicting operative as well as mid-term mortality, with its previous version in patients after combined aortic valve replacement and coronary artery bypass grafting surgery., Methods: This retrospective analysis included 216 patients operated on at one institution from 01/1999 to 12/2005. Accuracy and calibration of EuroSCORE I and II were assessed by plotting the areas under the receiver operator curves and comparing observed and predicted mortalities., Results: EuroSCORE II showed, regarding early mortality, a slightly higher discriminatory accuracy with an area under the receiver operator curve of 0.77, while additive and logistic EuroSCORE I areas were 0.749, 0.75, respectively. The highest specificity and sensitivity level was approached for EuroSCORE II at a predicted mortality of 4.4 %. Receiver operator curves concerning mid-term mortality revealed areas for additive, logistic EuroSCORE and EuroSCORE II of 0.745, 0.739 and 0.718 with the highest accuracy levels at predicted mortalities of 6.5, 6.48 and 3.88 %, respectively. Mean predicted mortalities by logistic EuroSCORE and EuroSCORE II were 8.35 and 3.99 %, respectively, while overall observed operative mortality was 6.3 %. In "high-risk" patients (EuroSCORE > 13), EuroSCORE II underestimated early and mid-term outcomes., Conclusions: Regarding operative mortality, EuroSCORE II showed in this study a slightly higher discriminatory accuracy than EuroSCORE I. There were no significant differences in the calibration of the two model versions in "low-" and "moderate-risk" patients regarding early as well as mid-term mortality. Analyses in larger patient populations will contribute to further model improvement.