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The article discusses a study on the declaration, determination, and concept of death in the context of organ donation after circulatory determination of death (DCDD), conducted by Kathleen N. Fenton and Anne Dalle Ave, published in the journal "The American Journal of Bioethics." It examines the ethical and practical implications of declaring death before the irreversible cessation of respiratory and circulatory functions, particularly in DCDD programs.

Partial heart transplantation, also known as living valve implantation, has the potential to revolutionize neonatal heart surgery and pediatric heart transplantation. This procedure offers a safer and more durable alternative to other valve operations for infants with valvular heart disease. It is technically similar to implanting a homograft, making it familiar to congenital heart surgeons. While there are ethical considerations, such as the potential impact on the heart transplant waiting list, partial heart transplantation could also address racial and ethnic disparities in outcomes. Further research is needed to determine the best candidates for the procedure and the optimal immunosuppressive needs. Overall, partial heart transplantation shows promise in improving the care of these complex patients. [Extracted from the article]

Tricuspid valve annuloplasty (TA) during mitral valve repair (MVr) is associated with increased risk of permanent pacemaker (PPM) implantation, but the magnitude of risk and long-term clinical consequences have not been firmly established. This study assesses the incidence rates of PPM implantation after isolated MVr and following MVr with TA as well as the associated long-term clinical consequences of PPM implantation. State-mandated hospital discharge databases of New York and California were queried for patients undergoing MVr (isolated or with concomitant TA) between 2004 and 2019. Patients were stratified by whether or not they received a PPM within 90 days of index surgery. After weighting by propensity score, survival, heart failure hospitalizations (HFHs), endocarditis, stroke, and reoperation were compared between patients with or without PPM. A total of 32,736 patients underwent isolated MVr (n = 28,003) or MVr + TA (n = 4,733). Annual MVr + TA volumes increased throughout the study period (P < 0.001, trend), and PPM rates decreased (P < 0.001, trend). The incidence of PPM implantation <90 days after surgery was 7.7% for MVr and 14.0% for MVr + TA. In 90-day conditional landmark-weighted analyses, PPMs were associated with reduced long-term survival among MVr (HR: 1.96; 95% CI: 1.75-2.19; P < 0.001) and MVr + TA recipients (HR: 1.65; 95% CI: 1.28-2.14; P < 0.001). In both surgical groups, PPMs were also associated with an increased risk of HFH (HR: 1.56; 95% CI: 1.27-1.90; P < 0.001) and endocarditis (HR: 1.95; 95% CI: 1.52-2.51; P < 0.001), but not with stroke or reoperation. Compared to isolated MVr, adding TA to MVr was associated with a higher risk of 90-day PPM implantation. In both surgical groups, PPM implantation was associated with an increase in mortality, HFH, and endocarditis. [Display omitted] [ABSTRACT FROM AUTHOR]