Contemporary surgical management of infective endocarditis of the aortic root.

Infective endocarditis involving the aortic root is associated with a high degree of morbidity and mortality. Native aortic root infections can develop from aggressive organisms or from delays in diagnosis or definitive care, whereas prosthetic valve infections commonly result in extensive destruction of the aortic root and neighboring structures. Early detection, tailored antibiotic therapy, thoughtful pre-operative planning, and multidisciplinary heart team management are the keys to optimizing patient outcomes. Aggressive and complete surgical debridement are mandatory prior to aortic root reconstruction. Surgical experience and patient-centered decision making are critical in selecting the optimal reconstructive strategy for the aortic root and adjacent structures. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01604-6.

Estimated pulse-wave velocity predicts survival in patients requiring extracorporeal membrane oxygenation.

INTRODUCTION: Arterial stiffness, measured by estimated pulse-wave velocity is a known predictor of major adverse cardiovascular events, however its predictive value in patients requiring extracorporeal membrane oxygenation (ECMO) is unknown. METHODS: A retrospective cohort study was performed at the London Health Science Centre in London, Canada between 1996-2021, totaling 255 patients requiring ECMO. Estimated pulse-wave velocity (ePWV) was calculated using an algorithm from the Reference Values for Arterial Stiffness Collaboration. Recorded outcomes included in-hospital death, ischemic stroke, hemorrhagic stroke, renal failure and need for renal replacement therapy (RRT). For adjusted analysis, survival-to-discharge was used. Multivariate logistic regression and propensity-score matching were utilized to control for confounding. RESULTS: On univariate analysis, higher ePWV was significantly predictive of ischemic stroke (OR 1.676, p = 0.0002) and in-hospital death (OR 1.20, p = 0.006), but insignificant for predicting hemorrhagic stroke (OR 1.07, p = 0.710), and appeared protective for renal failure (OR 0.88 [0.78-0.99], p = 0.034) and RRT (OR 0.87, p = 0.027). On multivariate analysis and propensity-score matching, five of six models demonstrated ePWV as an independent predictor of survival-to-discharge. (OR 0.70, p = 0.00,021; OR 0.72, p = 0.0002; OR 0.87, p = 0.045; OR 0.85, p = 0.013; OR 0.57, p = 0.012). CONCLUSIONS: ePWV is a promising marker for risk-stratification in ECMO patients. Further investigation is required to better delineate the role of arterial health assessment in disease trajectory and strengthen the validity of AS as a marker of interest in medical and surgical management.

Coaptation length predicts early- and intermediate-term durability following degenerative mitral repair.

OBJECTIVES: The impact of coaptation length on recurrent mitral regurgitation following degenerative mitral repair is not fully understood. METHODS: Between May 2008 and February 2021, 386 consecutive patients underwent mitral repair for degenerative mitral regurgitation at a single centre. We compared patients with a post-repair coaptation length >11 mm (long-coaptation group, n = 230) and ≤11 mm (short-coaptation group, n = 156). The coaptation length cutoff was selected based on published postoperative transesophageal echocardiographic measurement of mitral repair patients and healthy controls. Propensity score with inverse probability of treatment weighting (IPTW) analyses were performed. The median duration of clinical follow-up was 41 months and follow-up was complete in the entire cohort. RESULTS: The long-coaptation patients underwent more neochord implantation (89% vs 65%, P < 0.001) and less leaflet resection (11% vs 29%, P < 0.001). Overall in-hospital/30-day mortality and mitral reintervention occurred in 3 (1%) and 4 (1%) patients, respectively, and freedom from recurrent mitral regurgitation was 98% at 1 year and 94% at 5 years. Freedom from recurrent mitral regurgitation moderate or greater was significantly higher in the long-coaptation patients (IPTW-adjusted difference in average time to recurrent mitral regurgitation: 31 months, 95% confidence interval 9-53, P = 0.006). However, there was no difference in intermediate-term survival between both groups (IPTW-adjusted difference in average time to death: 9.5 months, 95% confidence interval -27 to 46, P = 0.61). Stratified analysis and pairwise comparison of different coaptation intervals also appeared to support the protective effect of longer coaptation on repair durability. CONCLUSIONS: Longer coaptation length appears to be associated with improved intermediate-term durability after mitral repair.