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OBJECTIVES There remains debate over the optimal mitral valve replacement (MVR) option for patients aged 50–70 years. The objective of this study was to retrospectively compare the long-term outcomes of mechanical and bioprosthetic MVR in this patient population. METHODS Data from patients undergoing MVR between 2004 and 2018 were retrospectively reviewed. The primary outcome was all-cause mortality. Secondary outcomes included perioperative and late morbidity. RESULTS Two hundred and eight-six propensity-matched patients (n  = 143 mechanical; n  = 143 bioprosthetic) aged 50–70 years were included in the final analysis. Maximum follow-up was 15.8 years. There was no significant difference in all-cause mortality between the groups at 30 days, 1 year, 5 years, 10 years, and at the longest follow-up. Patients who underwent mechanical MVR experienced significantly lower rates of postoperative atrial fibrillation (P  = 0.001). There were no significant differences in rates of sepsis, acute kidney injury, superficial and deep sternal wound infection, mediastinal bleeding, and permanent pacemaker implantation. At the longest follow-up, there were no differences in myocardial infarction, stroke, heart failure or overall rehospitalization. At the same time point, there was an increased rate of MVR in patients receiving a bioprosthetic valve (P  = 0.015). CONCLUSIONS Survival following mechanical and bioprosthetic MVR in patients 50–70 years of age is similar to up to 15 years of follow-up. Bioprosthetic MVR is associated with an increased risk of repeat MVR. Mechanical MVR is not associated with an increased risk of stroke. Valve selection in this patient population requires diligent consideration of structural valve deterioration and subsequent reoperation risk as well as bleeding and thromboembolic risk. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes and coronary artery disease are two common conditions that often co-exist. In recent years, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been demonstrated to provide significant cardioprotective benefits, especially among patients with heart failure. Objective: In this systematic review, we look to identify the outcomes SGLT2i use in patients undergoing coronary revascularization. Methods: Pubmed and Embase were systematically searched for articles describing the outcomes of patients taking SGLT2i and undergoing coronary revascularization. 834 titles and abstracts were screened, 42 full texts were reviewed, and 18 studies were found to meet the inclusion criteria and were included in this review. Results: For patients undergoing coronary artery bypass grafting and percutaneous coronary intervention, the use of SGLT2i resulted in reductions in mortality, hospitalization for heart failure, and improved blood glucose; however, these benefits were not consistently reported in the literature. Reduced inflammatory markers and positive cardiac remodeling were identified among patients taking SGLT2i. Conclusions: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been demonstrated to provide benefits for patients with heart failure along with a host of positive modulatory effects on the cardiovascular system, including reductions in inflammatory properties, hypertension, and left ventricular volume load. Given the clear benefit provided by SGLT2i to patients with cardiovascular disease and a host of positive properties that are expected to be protective for patients with ischemic heart disease, future investigation into the relationship between SGLT2i and outcomes for patients undergoing revascularization is imperative. [ABSTRACT FROM AUTHOR]

Background: Short‐term continuous flow (STCF) ventricular assist devices (VADs) are utilized in adults with cardiogenic shock; however, mortality remains high. Previous studies have found that high pre‐operative MELD‐XI scores in durable VAD patients are associated with mortality. The use of the MELD‐XI score to predict outcomes in STCF‐VAD patients has not been explored. We sought to determine the relationship between MELD‐XI and outcomes in adults with STCF‐VADs. Methods: This was a retrospective review of adults implanted with STCF‐VADs between 2009 and 2019. Receiver operating characteristic (ROC) analysis was performed to predict outcomes and Kaplan–Meier analysis was done to assess survival. Results: Seventy‐nine patients were included with a median MELD‐XI score of 21.2 (IQR 13.5, 27.0). Patients with an unsuccessful wean from support (p < 0.001) or major post‐operative bleeding (p = 0.03) had significantly higher pre‐implant MELD‐XI scores. The optimal MELD‐XI cut‐point for mortality was 24.9 with 27.8 for major bleeding. Survival was worse among patients in the high‐risk MELD‐XI group, however, not statistically significant (p = 0.09). Prior ECMO support, but not MELD‐XI, was an independent predictor of unsuccessful wean (p = 0.03). Conclusions: Pre‐operative MELD‐XI score was a moderate predictor of unsuccessful wean with limited utility in predicting bleeding in patients on STCF‐VAD support. This scoring system may be useful in the clinical setting for pre‐implant risk stratification and counseling among patients and outcomes. [ABSTRACT FROM AUTHOR]