Health-economic evaluation is increasingly important in cardiac surgery as technological innovation and procedural complexity place growing demands on global healthcare system. While novel approaches such as minimally invasive and transcatheter interventions often incur higher upfront costs, downstream reductions in morbidity, length of stay, and resource utilization can generate meaningful economic value when assessed across the full episode of care. However, translating economic evidence into practice requires consideration of analytic perspective, time horizon, affordability, and healthcare system structure. Aligning reimbursement strategies with long-term value through longitudinal and episode-based approaches may improve sustainability, equity, and adoption of high-value cardiac surgical care.
BACKGROUND:Neonates with critical congenital heart disease (CCHD) are at risk for long-term cognitive impairments, including memory deficits. We aimed to assess the incidence and timing of mammillary body (MB) injury, critical memory structures, in neonates with CCHD and explore its association with cognitive outcome at 2 years of age. METHODS:We included neonates who underwent surgery with cardiopulmonary bypass in the first 6 weeks of life. Pre- and postoperative cerebral magnetic resonance imaging were reviewed for MB injury, defined as signal change on T1-, T2-, or diffusion-weighted imaging, or atrophy. Cognitive outcomes at 2 years were measured using the Dutch Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS:A total of 96 neonates were included. MB injury was present in 5% preoperatively and 61% postoperatively (P < 0.001). It was not related to other acquired brain lesions. Preoperative MB injury occurred more frequently in neonates with younger postmenstrual age at birth (P = 0.002) and those who developed low cardiac output syndrome before surgery (P = 0.030). Similarly, new postoperative MB injury was associated with younger postmenstrual age at surgery (P = 0.002) as well as perioperative low cardiac output syndrome (P = 0.033). No significant differences in cognitive index scores emerged between children with neonatal MB injury and those without. CONCLUSIONS:MB injury is frequent in neonatal CCHD, predominantly postoperatively, and is associated with low cardiac output syndrome and younger postmenstrual age. The relationship between neonatal MB injury and cognitive and memory outcomes later in life warrants further study.
BACKGROUND:Left subclavian artery (LSA) revascularization during frozen elephant trunk (FET) procedures remains technically challenging, as no commercially available off-the-shelf graft provides direct in situ access. The COOK FET-FEN device (COOK Medical, Bloomington, IN) incorporates a dedicated LSA fenestration to facilitate standardized bridging stent placement. We report early clinical outcomes with this device. METHODS:A retrospective analysis was conducted on the first 48 consecutive patients who underwent total aortic arch replacement using the COOK FET-FEN device at 2 centres between June 2023 and June 2025. The graft consists of a proximal unstented polyester segment and a distal stented segment that incorporates an LSA fenestration for in situ stenting. Early cases used physician-modified grafts (5-mm cautery fenestration), followed by premanufactured fenestrated grafts (FEN; 8-10 mm). Outcomes included technical success, neurologic events, mortality, and reinterventions. RESULTS:In situ LSA stenting was technically successful in all patients. Stroke occurred in 1 patient (2.1%), and hospital mortality was 4.2% (n = 2). At 18 months follow-up (median, 8.8 ± 2.1) overall survival was 93.5%, with one late death unrelated to the FET-FEN procedure. Reinterventions occurred in 19.2% of patients, including LSA-related reinterventions in 10.6%. Freedom from LSA reintervention and distal aortic reintervention at 1 year was 89.6% and 85.5%, respectively. CONCLUSIONS:The COOK FET-FEN device enables reliable in situ LSA revascularization during FET procedures, with high technical success and acceptable early clinical outcomes. The fenestrated design provides a reproducible platform for LSA stenting, including complex arch reconstructions. Longer-term follow-up is required to assess durability and further refine patient selection.
BACKGROUND:Microvascular injury (MVI) remains an important unmet therapeutic target in acute myocardial infarction. Progress in the field depends heavily on preclinical studies aimed at understanding the mechanisms underlying MVI and evaluating novel therapeutic strategies. Such studies are often complex and rely extensively on image-based data, which may be vulnerable to inappropriate image reuse or manipulation. Because concerns regarding research integrity can undermine confidence in the scientific evidence base, we sought to determine the prevalence of problematic articles in the preclinical MVI literature using mouse, rat, and pig models of myocardial ischemia-reperfusion. METHODS:After screening for eligibility, we used the AI-powered software tool Imagetwin to systematically assess all included articles for inappropriate image duplication and manipulation. All findings were confirmed by the authors. We also noted all other serious issues encountered by chance. RESULTS:We assessed 201 articles, of which 57 (28.4%) were deemed problematic: 46 articles for image-related concerns and 11 for data-related concerns. Corresponding authors of problematic articles were most frequently affiliated with institutions in China (38 articles, 66.7%). The 3 publishers with the highest absolute number of problematic articles were Elsevier (11 articles), Springer (9 articles), and Wiley (9 articles). CONCLUSIONS:The prevalence of problematic articles in the preclinical MVI literature using mouse, rat, and pig models of myocardial ischemia-reperfusion was 28.4%. Continued vigilance by publishers, reviewers, and readers is important to maintain the integrity and reliability of the scientific record.
Previous articles have comprehensively reported on clinical outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with chronic kidney disease, including dialysis patients. Some studies suggest better short-term outcomes with TAVR, including less periprocedural mortality, acute-on-chronic kidney injury, bleeding, and shorter length of stay, but similar or worse long-term survival compared with SAVR. Although clinical outcomes have been studied, comparative durability and risk of structural valve deterioration (SVD) between transcatheter and surgical bioprosthetic valves in dialysis patients remain poorly defined. The therapeutic approach for the treatment of aortic valve disease in patients with end-stage renal disease is clinically relevant because these patients have short life expectancy and often receive bioprosthetic valves that are at higher risk for accelerated SVD and failure. In this review we synthesize current literature that describes TAVR and SAVR valve durability in patients with end-stage renal disease with a focus on mechanisms of bioprosthetic SVD, and outcomes associated with TAVR and SAVR, and explore strategies for lifelong management of aortic valve disease, including considerations for reintervention.
