Background For more than half a century, left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) has been understood primarily as a consequence of septal hypertrophy. However, the correlation between septal thickness and obstruction severity is inconsistent, and cardiac myosin inhibitors can markedly reduce, and in many patients eliminate, LVOTO without septal resection. Aim To reappraise the pathophysiology of dynamic LVOTO and its implications for surgical strategy. Methods We performed a narrative review of PubMed, MEDLINE, and Scopus (1990–2026), informed by our institutional experience with minimally invasive septal myectomy in over 1000 HCM patients (unpublished institutional data). Results Obstruction is best understood as a dynamic phenomenon arising from the interaction of four factors: ventricular geometry, the mitral and subvalvular apparatus, septal morphology, and contractile state. Septal thickness is one contributor among several rather than the dominant driver. Myosin inhibitors target the contractile component; surgery modifies geometry and mitral–septal relationships. A subset of patients requires adjunctive mitral–subvalvular procedures beyond isolated septal resection. Conclusions Septal myectomy is being redefined as a geometric intervention rather than a debulking procedure. Understanding the relative contribution of each mechanistic component can guide patient‐specific matching of surgical and medical therapies.
BackgroundConventional risk scoring systems often lack optimization for long-term prognosis, necessitating the exploration of machine learning (ML) methods in predicting mortality after coronary artery bypass grafting (CABG). This study aimed to identify risk factors for long-term mortality in isolated CABG patients and compare the performance of ML models with EuroSCORE II.MethodsThis single-center, retrospective study analyzed the 10-year follow-up data of 350 patients who underwent isolated CABG between January 2011 and January 2012. The dataset comprised 52 variables, including clinical and procedural data. After preprocessing and SMOTE resampling, ensemble ML models were trained using Lasso-based feature selection; performance was compared with the full EuroSCORE II model.ResultThe best-performing model utilized the top 8 features selected by Lasso regression, achieving a higher recall (0.768) and F1 score (0.462) compared to the model using the full feature set. The eight most predictive features were X-clamp time, cardiopulmonary bypass (CPB) time, first-year blood glucose levels, MACCE, elevated pulmonary artery pressure (PAH), 10th-year blood glucose levels, intervention for peripheral arterial disease (PAD), and first-year LDL levels. The ML pipeline (AUC: 0.559) achieved discrimination comparable to EuroSCORE II (AUC: 0.604) (p = 0.403).ConclusionML-based analysis identified procedural duration, long-term metabolic control, and PAD-related variables as key determinants of long-term mortality after CABG. Notably, MACCE history and elevated PAH further contributed to risk stratification. ML models achieved discrimination comparable to traditional risk scores while offering improved interpretability for long-term outcomes, suggesting that integration with established clinical scoring systems may enhance patient-specific mortality prediction.
Introduction Heart transplant (HT) for donors after circulatory death (DCD) versus donor after brain death (DBD) have not been fully explored in patients bridged with HeartMate 3 (HM3) left ventricular assist devices (Abbott, Chicago, IL). This study aims to assess survival outcomes in DCD vs DBD HT in patients bridged with HM3. Materials and Methods All adults >= 18 years bridged to HT with HM3 between October 18, 2018, and March 31, 2025, were identified from the UNOS database and stratified by donor type (DCD vs DBD). Primary outcome was 90-day, 1-year, and 3-year survival. Multivariable risk adjustment was performed. Results Following exclusion, 2380 patients (296 DCD and 2084 DBD) were identified. DCD patients had longer duration of HM3 support (671 days [343.5, 1122] vs 535 days [294.5, 912.5], p 0.0005), had fewer days on waitlist (83.5 days [20, 356] vs 137.5 days [32, 426], p 0.0072), were more frequently male (82.8% vs 77.4%, p 0.0351), blood type O (55.7% vs 38.4%, p < 0.001), and status 4 listing (44.3% vs 35.2%, p < 0.001). There was no difference in survival between DCD and DBD patients at 90 days (92.9% vs 92.8%, p 0.98), 1 year (89.4% vs 88.4%, p 0.68), or 3 years (78.7% vs 82.2%, p 0.66). Following multivariable adjustment, DCD donor status was not associated with increased mortality (HR 0.97 [0.65-1.45]; p = 0.875). Conclusion Survival between DCD and DBD HT in patients bridged with HM3 shows no significant difference. DCD utilization has potential to safely expand the donor pool in this population.
The Ross procedure provides a living autologous aortic valve substitute and avoids lifelong anticoagulation, but its effect on health‐related quality of life (HRQoL) relative to alternative aortic valve strategies remains incompletely defined. We conducted a systematic review of studies published from January 2000 to 17 September 2026 evaluating postoperative HRQoL after the Ross procedure using validated patient‐reported outcome instruments. Twelve studies met the eligibility criteria. Six directly compared Ross recipients with mechanical aortic valve replacement (mAVR): three reported significantly better Ross outcomes in at least one SF‐36 domain, one favoured the mechanical group in selected domains, and two found no significant difference. A randomised comparison with homograft aortic root replacement demonstrated higher physical functioning, general health and physical component scores after Ross at long‐term follow‐up. Comparisons with aortic valve repair were generally similar. Paediatric and young‐adult studies demonstrated generally preserved HRQoL compared with healthy or relevant reference populations, although psychological concerns were identified in selected cohorts. Contemporary long‐term data using PROMIS‐10 and MacNew similarly demonstrated preserved physical and favourable mental and disease‐specific HRQoL after Ross. Important limitations included substantial clinical and methodological heterogeneity, absence of preoperative HRQoL in most studies, residual confounding in observational comparisons and selection/non‐response bias. Available evidence suggests that long‐term HRQoL after the Ross procedure is generally preserved, with selected domain‐level advantages reported against mAVR and homograft comparators. However, the heterogeneous and predominantly observational evidence base does not establish global HRQoL superiority of Ross over alternative aortic valve procedures.
Background Coronary artery bypass grafting (CABG) is one of the most common cardiac surgeries worldwide. Whether performed electively or urgently, CABG is associated with significant differences in postoperative outcomes. Urgent CABG is associated with higher postoperative morbidity and mortality, often influenced by preoperative cardiac risk factors. This study compares the demographics, clinical characteristics, and outcomes of patients undergoing urgent versus elective CABG. Methods This retrospective study analyzed data from 4872 patients who underwent CABG between 2019 and 2022 at Rajaie Cardiovascular Medical and Research Institute. Urgent CABG was defined as surgery performed within 24–72 h (mostly within 48 h) of a precipitating clinical event. The primary outcome was in‐hospital mortality, while secondary outcomes included postoperative complications such as cardiac arrest and acute kidney injury. Echocardiographic indices and laboratory parameters were also evaluated. Multivariable logistic regression analysis was performed to identify independent risk factors associated with in‐hospital mortality. Results In this study of 4872 patients undergoing CABG, 81.6% had elective and 18.4% had urgent surgery. Urgent CABG was associated with significantly higher in‐hospital mortality compared with elective procedures (6.8% vs. 2.7%, p = 0.01), while the rate of acute kidney injury was similar. In multivariable logistic regression analysis, increasing age, longer cardiopulmonary bypass time, renal dysfunction, and urgent surgery independently increased the risk of in‐hospital mortality, while higher preoperative LVEF was protective. Conclusion Primary outcome and mortality after CABG are determined by a combination of patient‐ and procedure‐related factors. Older age, renal dysfunction, prolonged cardiopulmonary bypass time, lower preoperative ejection fraction, and urgent surgical status significantly increase the risk of early postoperative death, with urgent CABG more than doubling mortality compared with elective surgery. These findings emphasize the importance of individualized risk assessment, timely referral, optimal preoperative stabilization, and meticulous perioperative management, particularly in high‐risk and urgent cases, to improve short‐term surgical outcomes and reduce in‐hospital mortality.
