Transcatheter aortic valve implantation (TAVI) has significantly expanded the access to aortic valve replacement in numerous populations as well as increased the overall volume of aortic valve replacement since its approval. Beyond its use for symptomatic, severe aortic stenosis, the emergence of new data regarding the importance of cardiac damage has led to exploration of the use of TAVI in patients with asymptomatic, severe aortic stenosis and those with moderate aortic stenosis. Data have demonstrated a potential benefit of TAVI in patients, with asymptomatic, severe aortic stenosis, particularly with respect to rehospitalization, however the data are less complete for patients with moderate aortic stenosis, which is the subject of multiple ongoing randomized trials. This review will provide a current overview of the data surrounding the use of TAVI in these 2 populations as well as explore the future directions of TAVI use in these patients.
Post-operative challenges, including reduced respiratory function and slower overall recovery, are often associated with thoracic surgeries. Rehabilitation strategies have been important over the years for their potential to support patient recovery and improve post-surgical outcomes. Studies published up to March 2025 across the databases, including Google Scholar, PubMed, and ProQuest, were retrieved and analyzed for this systematic review. Out of the initially selected 29 studies systematically reviewed, 8 fulfilled the final inclusion criteria and were included in the analysis. Postoperative rehabilitation strategies such as physiotherapy-based programs, nurse-led initiatives, and technology-assisted interventions have been included in the systematic review and found to influence the recovery following thoracic surgery. Interventions like these improve pulmonary function, better pain management, enhanced functional capacity, reduced complication rates, and shorter recovery periods. The findings suggest that rehabilitative approaches may contribute to better postoperative outcomes. However, further clinical research is still needed to develop more standardized rehabilitation protocols.
Management of acute esophageal perforation varies significantly. Data are particularly limited regarding optimal management of patients with Boerhaave's syndrome (BS). We aimed to compare operative to endoscopic management for patients with acute esophageal injury at a high-volume tertiary referral center. This retrospective cohort study included adult patients presenting to a tertiary referral center with acute esophageal perforation from January 2002 to January 2023. Patients with esophageal cancer or prior esophagectomy were excluded. Our primary variable of interest was endoscopic (EM) versus operative management (OM) and our outcomes of interest included incidence of major postoperative morbidity and 30-day mortality. Additional covariates included demographic characteristics and preoperative clinical factors. Among 117 patients, 65 (56%) met criteria for BS, and 52 (44%) had other etiologies. Mean age was 57 ± 18 years, and 36 patients (31%) were female. Overall, 95 patients (81%) received OM. Twenty-two patients (19%) had EM with stenting; of these, 5 patients (23%) also had endoluminal vac therapy. Median ICU length of stay was 6 days (IQR 8), 30 patients (26%) required readmission, and 30-day mortality was 2.6% (3 patients, 1 with EM). Among patients with BS, 13 (20%) had EM and 52 (80%) had OM. Between BS patients managed endoscopically versus operatively, there were no significant differences in use of enteral feeding access, leaks, strictures, length of stay, readmission, or 30-day mortality (P > 0.05). At a high-volume center, endoscopic management with stenting and/or endoluminal therapy can be safely employed for well-selected patients, including those with BS.
The comparative clinical outcomes of the modified Konno procedure (MKP) and transaortic septal myectomy (TSM) for severe left ventricular outflow tract (LVOT) obstruction in children remain unclear. A total of 177 consecutive patients (age <14 years old) underwent surgical treatments, categorized by MKP or TSM technique (MKP n = 45, TSM n = 132). After propensity-score matching, 45 MKP patients were matched 1:1 with TSM patients. At discharge, the MKP group demonstrated a significantly lower LVOT peak gradient compared to the TSM group (median, 3.2 vs 11.6 mmHg, P = 0.011), which persisted at follow-up (median, 4.8 vs 11.6 mmHg, P = 0.01) in matched data. Although postoperative atrioventricular block was more frequent in the MKP group, no significant difference was observed in permanent pacemaker implantation rate between groups (P = 0.108). During follow-up (median, 1.08 years, 0.25-2.5), the incidence of recurrent LVOT obstruction was higher in the TSM group (17.8% vs 0%). Recurrent LVOT obstruction was associated with aortic annulus size (hazard ratio [HR] = 0.811; 95% confidence interval [CI], 0.675-0.974; P = 0.025) and preoperative LVOT peak gradient (HR = 1.030, 95% CI: 1.010-1.050, P = 0.003). The smaller aortic annulus size (<12.5 mm) or severe LVOT obstruction (>82.5 mmHg) significantly decreased the risk of survival free from recurrent LVOT obstruction (P = 0.01, P < 0.001). The MKP can provide better relief of LVOT obstruction than TSM in young children, particularly with a small aortic annulus or severe obstruction. MKP may not increase the risk of permanent pacemaker implantation and mortality.
The valved Sano (VS) right ventricle-to-pulmonary artery (RV-PA) shunt was developed to eliminate conduit regurgitation and thereby decrease volume load on the single right ventricle (RV) after the Norwood procedure. By reducing diastolic backflow, VS may limit tricuspid regurgitation and preserve RV function. Additional theoretical advantages include facilitated postoperative recovery and improved pulmonary artery (PA) growth. Despite compelling physiology, available evidence remains limited and largely retrospective. We describe the postoperative course of a low-weight neonate with hypoplastic left heart syndrome who underwent a Norwood procedure using a VS, and we review published literature addressing early outcomes, reintervention burden, late survival, and PA growth. Use of a VS can be associated with improved early physiologic recovery, lower postoperative lactate, faster diuresis and enteral advancement, and better early RV function. Short-term survival appears equivalent to the non-valved Sano. Interstage reinterventions remain frequent (40%-60% before stage II). Late survival beyond stage II is comparable to non-valved Sano. Femoral vein homograft-based conduits may promote greater PA growth and reduce the need for PA augmentation, but findings vary across centers. Valve competence commonly decays within 3-6 months, resulting in conduit regurgitation. VS conduits may facilitate early recovery and potentially favor PA growth when constructed with competent Femoral vein homograft segments, yet they have not demonstrated superior late survival or reduced reintervention burden. Larger multicenter studies are required to clarify optimal patient selection and long-term impact.
