Objective: To evaluate the progression of systemic atrioventricular valve regurgitation (sAVVR) after the insertion of a systemic-to-pulmonary artery (SP) shunt. Methods: This multicenter, retrospective study (2009-2024) enrolled patients undergoing primary SP shunt and divided them into biventricular (BiV) and univentricular (UniV) groups. The primary outcome was the change in sAVVR grade between preoperative and second-stage repair. Secondary outcomes included changes in systemic atrioventricular valve annulus diameter (sAVVD), systemic ventricular diastolic diameter (sVDd), and bilateral pulmonary artery (PA) sizes. Subgroup analyses were performed for UniV by the presence of common atrioventricular valve and ventricle morphology. Results: Eighty-six patients in the BiV group and 105 patients in the UniV were included. Progression of sAVVR in both cohorts was observed (P < .05). Moderate or severe sAVVR developed more in UniV (BiV: from 0% to 4.7% vs UniV: from 8.1% to 21.9%, P < .05) with more sAVV intervention (BiV 1.2% vs UniV 16.2%, P < .05). The BiV group showed increased sAVVD, sVDd, and PA sizes (P < .05). In UniV, sAVVD and PA sizes increased, but sVDd change was not significant (P = .058). Among UniV, preoperative mild or greater sAVVR was more common in patients with common atrioventricular valve ((72.7%) or a dominant right ventricle (70.7%). Multivariable logistic regression identified heterotaxy as a risk factor for sAVVR progression (odds ratio, 1.42; 95% CI, 1.20-1.69; P < .05), with greater sAVVD and sVDd enlargement in patients with heterotaxy. Conclusions: SP was associated with sAVVR progression in both BiV and UniV; however, clinically significant sAVVR was uncommon in BiV. Heterotaxy independently predicted sAVVR progression, likely due to greater AV valve and ventricular dilatation.

OBJECTIVES:Concerns persist regarding pulmonary regurgitation after transannular patch repair (TAP) for tetralogy of Fallot. Despite the introduction of various architectural preservation techniques, the optimal strategy remains controversial. Our goal was to compare different right ventricular outlet tract reconstruction techniques. METHODS:PubMed, EMBASE and Cochrane Central were searched through March 2024 to identify comparative studies on right ventricular outlet tract reconstruction techniques (PROSPERO ID: CRD42024519404). The primary outcome was mid-term pulmonary regurgitation, with secondary outcomes including postoperative mortality, postoperative pulmonary regurgitation, length of intensive care unit stays, postoperative right ventricular outlet tract pressure gradient and mid-term mortality. We performed a network meta-analysis to compare outcomes among TAP, valve-repairing (VR), TAP with neo-valve creation (TAPN) and valve-sparing (VS). RESULTS:Two randomized controlled studies and 32 observational studies were identified with 8890 patients. TAP carried a higher risk of mid-term pulmonary regurgitation compared to TAPN [hazard ratio, 0.53; 95% confidence interval (CI) (0.33; 0.85)] and VS [hazard ratio, 0.27; 95% CI (0.19; 0.39)], with no significant difference compared to VR. VS was also associated with reduced postoperative mortality compared to TAP [risk ratio, 0.31; 95% CI (0.18; 0.56)], in addition to reduced ventilation time. TAP also carried an increased risk of postoperative pulmonary regurgitation compared to the other groups. The groups were comparable in terms of length of intensive care unit stay, right ventricular outlet tract pressure gradient and mid-term mortality. CONCLUSIONS:VR was associated with a reduced risk of postoperative pulmonary regurgitation, whereas TAPN was associated with reduced risks of both postoperative and mid-term pulmonary regurgitation.

The 2018 heart allocation system has significantly influenced heart transplantation and left ventricular assist device (LVAD) utilization. Our study aims to investigate age-related outcomes following LVAD implantation in the post-allocation era. Using the National Inpatient Sample, we analyzed data from 7375 patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by age categories. The age groups were 18–49, 50–59, 60–69, and over 70. These represented 26%, 26%, 31%, and 17% of patients, respectively. Patients aged 60–69 and those over 70 exhibited higher in-hospital mortality rates of 12% and 17%, respectively, compared to younger age groups (7% for 18–49 and 6% for 50–59). The age groups 60–69 and over 70 were independent predictors of mortality, with adjusted odds ratios of 1.99 (p = 0.02; 95% confidence interval [CI], 1.12–3.57) and 2.88 (p = 0.002; 95% CI, 1.45–5.71), respectively. Additionally, a higher Charlson Comorbidity Index was associated with increased in-hospital mortality risk (adjusted odds ratio 1.39; p = 0.02; 95% CI, 1.05–1.84). Additionally, patients above 70 experienced a statistically shorter length of stay. Nonhome discharge was found to be significantly high across all age categories. However, the difference in hospitalization cost was not statistically significant across the age groups. Our study highlights that patients aged 60 and above face an increased risk of in-hospital mortality following LVAD implantation in the post-allocation era. This study sheds light on age-related outcomes and emphasizes the importance of considering age in LVAD patient selection and management strategies.

Background: Postinfarct ventricular septal defect (PIVSD) is a serious complication of acute myocardial infarction (AMI). Transcatheter closure is a potential alternative to surgical closure for PIVSD patients.Objective: This meta-analysis compares the clinical outcomes of transcatheter closure versus surgical closure for PIVSD.Methods: A systemic search of PubMed and Embase until January 2023 identified studies comparing transcatheter versus surgical PIVSD closure. Primary outcomes included short-term mortality. Short-term mortality referred to the number of in-hospital or 30-day deaths. Secondary outcomes comprised residual shunt/reintervention incidence, difference in time from AMI or PIVSD diagnosis to intervention, the presence of cardiogenic shock, incidence of perioperative mechanical support, PIVSD size difference, and overall mortality at follow-up.Results: Seven studies comprising 603 patients were included. Short-term mortality (OR, 1.30; 95% CI [0.90, 1.89]; p=0.17; I2 = 3.0%) did not significantly differ between the two groups. The incidence of residual shunt/reintervention (OR, 3.56; CI, 1.33-9.59; p=0.01; I2 = 63.0%) and PIVSD size (mean difference, -3.94 mm; CI [-6.90, -0.99]; p=0.09; I2 = 83.0%) were significantly different; however, the other secondary outcomes were not significantly different.Conclusion: Transcatheter and surgical closure demonstrate similar short-term mortality. Despite a higher incidence of residual shunt or reintervention in transcatheter closure, it may be a viable option in patients with small size of PIVSD.

Background: The introduction of the new heart allocation system in 2018 has significantly changed the landscape of heart transplantation and trends of durable left ventricular assist device (LVAD) utilization. Although the quality of durable LVAD has improved, the impact of age on in-hospital mortality for LVAD implantation remains unknown under the new allocation system. Objective: We aimed to investigate the influence of age on the outcome following the LVAD implantation under the new heart allocation system. Method: We utilized the National Inpatient Sample to investigate patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by different age groups. We also investigated independent predictors of in-hospital mortality. Result: A total of 7,375 patients underwent LVAD implantation between January 2019 and December 2020. Among these patients, individuals aged 18-49, 50-59, 60-69, and over 70 years old accounted for 26%, 26%, 31%, and 17%, respectively. In-hospital mortality rates in the aforementioned age groups were 7%, 6%, 12%, and 17%, respectively. Notably, the age groups of 60-69 and over 70 compared to age <59 exhibited independent predictors of mortality, with an adjusted odds ratio (aOR) of 1.99 (p=0.02; 95% confidence interval [CI), 1.12-3.57) and 2.88 (p=0.002; 95% CI 1.45-5.71), respectively. Charlson Comorbidity Index (aOR, 1.39; p=0.02; 95% CI, 1.05-1.84) was also associated with increased risks of mortality. Conclusion: Our findings indicate that individuals over 60 years-old or with higher Charlson Comorbidity Index face a higher risk of in-hospital mortality following LVAD implantation.

We report a case of isolated idiopathic congenital tricuspid valve calcification that necessitated urgent neonatal surgical intervention. Hemodynamic analysis revealed circular shunt caused by severe tricuspid regurgitation, pulmonary regurgitation, and a hypoplastic right ventricle. The patient successfully underwent tricuspid valve repair at postnatal day 10. Although intervention for neonatal tricuspid valve is challenging, hemodynamic evaluation and early surgical intervention are necessary in patients with this rare cardiac calcification.

Myxoma is the most common benign cardiac tumor. Absent pulmonary valves, often treated surgically in childhood, are associated with 3-6% of tetralogy of Fallot. It is unusual for absent pulmonary valves without other congenital heart diseases to be asymptomatic until adulthood. Here, we report the unique case of an 80-year-old female with right ventricular outflow tract myxoma and absent pulmonary valve that has, to our knowledge, never been reported. We successfully performed a simple mass resection and pulmonary valve implantation.

Coronary anatomy is key for arterial switch operations as reimplantation for coronary artery patterns originating from the same sinus is often challenging. We experienced an extremely rare coronary artery anatomy case (Leiden convention: 1 R, 1LCx) and successfully performed an arterial switch operation with coronary button extension and neo-pulmonary trunk realignment maneuver.