Search Results (513)

Tricuspid regurgitation (TR) is being increasingly recognized in the patient population. It is a common cardiac cause of chronic disability. This pathology is characterized by a heterogeneous and broad spectrum of clinical manifestations with signs and symptoms. The results from various and different analyses and studies suggest that TR-related deaths may have increased over the last 20 years. This trend may justify a greater focus on timely diagnosis and management of TR. For a long time, this problem has been underestimated or treated with only pharmacological therapy (diuretics). The use of the isolated surgical option remains infrequent, especially in patients at high surgical risk, for whom a significant number of patients with TR are still not treated, and a disability remains that is difficult to manage and rehabilitate. To date, there are emerging as an alternative to surgery in high-risk patients with severe TR multiple transcatheter devices that aim to reduce TR through different functional mechanisms. There are numerous minimally invasive treatments for TR, and many devices used for the treatment of this disabling pathology. In fact, there are various treatments with a transcatheter approach using ever-new devices. The use of heterotopic implantation of bioprosthetic valves in the superior and inferior vena cava represents an additional therapeutic armamentarium that, through caval reflux, can constitute an additional resource, too. Starting from a single clinical experience and describing a clinical case report, a narrative review has been undertaken by reviewing the various studies that have investigated this type of approach and their impact on the general, cardiac, and functional sides, to then discuss the cost–benefit ratio in light of knowledge on this specific topic. Full article

Since its first description in the late nineteenth century, the epidemiology of infective endocarditis (IE) has changed considerably. Once primarily affecting younger individuals with structural heart disease, IE is now increasingly encountered in older patients with multiple comorbidities and frequent healthcare exposure. Population ageing, end-stage renal disease (ESRD), immunosuppression, and injection drug use (IDU) have broadened the pool of susceptible hosts. At the same time, the increasing use of prosthetic valves (PVs), cardiac implantable electronic devices (CIEDs), and transcatheter cardiac interventions has reshaped the clinical spectrum of IE. This epidemiological transition has also been accompanied by shifts in microbiological patterns, with a growing predominance of staphylococci and enterococci, as well as marked geographic and socioeconomic variation in disease burden. This review summarizes the contemporary epidemiology of IE, with an emphasis on the host-, healthcare-, and microbiological factors underlying its evolving clinical profile. Full article

Background and Objectives: Cardiac implantable electronic devices (CIEDs), including permanent pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, are increasingly used in an aging population characterized by multimorbidity and a high prevalence of psychiatric and cognitive disorders. Depression, anxiety, post-traumatic stress disorder (PTSD), mild cognitive impairment, and dementia may affect informed consent, adherence to therapy, quality of life, and long-term cardiovascular outcomes in patients undergoing CIED implantation. The aim of this review was to summarize the prevalence and clinical significance of psychiatric and cognitive disorders in patients undergoing CIED implantation and to discuss practical strategies for their assessment in routine cardiology practice. Materials and Methods: This narrative review was based on a literature search of PubMed, Web of Science, and the National Health Library database covering the literature from 2010 to 2025, including a broad search strategy. Original studies and review articles were included, having confirmed their definite association with the subject. Results: Psychiatric disorders and cognitive impairment were highly prevalent among patients with CIEDs and were associated with impaired adherence, reduced participation in rehabilitation, lower quality of life, and worse cardiovascular outcomes. ICD therapies, particularly inappropriate therapies, were strongly associated with anxiety, depressive symptoms, and PTSD-related distress. Cognitive impairment may compromise informed consent, recognition of complications, and compliance with post-implantation recommendations. Several validated screening tools, including MMSE, MoCA, HADS, BDI-II, STAI, and FSAS, may facilitate early identification of high-risk patients, and their most appropriate use in various clinical scenarios, including pre- and post-CIED implantation was described. Conclusions: Psychiatric disorders and cognitive impairment are common and clinically relevant in patients undergoing CIED implantation. Routine psychological and cognitive assessment before and after implantation should be considered an important component of modern multidisciplinary cardiac care, potentially affecting the decision to implant the device, and likely influencing the type of the implanted device. Full article

Background/Objectives: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been associated with potential clinical and economic benefits; however, its adoption among patients remains limited in some healthcare settings. This study examined patients’ intention to use RM services by applying an extended Technology Acceptance Model (TAM) that incorporates perceived effectiveness (PE), perceived barriers (PB), perceived threat (PT), and economic considerations, as well as the influence of socioeconomic factors. Methods: A cross-sectional survey was conducted among 104 patients with CIEDs in Taiwan using validated questionnaires. Structural equation modeling (SEM) was employed to examine the relationships among the proposed constructs. The association between intention to use and actual service utilization was explored. The correlations between sociodemographic factors and the constructs were analyzed using analysis of variance (ANOVA). Results: SEM showed that perceived effectiveness (PE), perceived usefulness (PU) and perceived ease of use (PEOU) were significantly associated with intention to use RM services, with economic considerations also having a significant contribution. Intention to use RM services further predicted actual adoption. However, PB and PT did not moderate these relationships. Sociodemographic factors influenced RM acceptance, with younger, more educated, employed, higher-income, and professionally employed patients reporting stronger perceptions and greater intention to use RM. Conclusions: This study reinforces the TAM framework in the context of health-related technology adoption. Overall, the adoption of RM services is complex and shaped by psychological, economic, and demographic factors, highlighting the need for user-friendly design, targeted education on clinical benefits, and flexible pricing and reimbursement strategies to improve equitable and sustained use. Full article

Inadequate vein access is a frequent obstacle during cardiac implantable electronic device (CIED) upgrade procedures; thus, bail-out strategies are employed. A 71-year-old male with dilated cardiomyopathy bearing a 7-year-old right-sided dual-chamber pacemaker was scheduled for upgrade to an implantable cardioverter defibrillator. The case presented two main challenges—first, pacemaker dependency, and second, an occluded right subclavian vein. In a shared decision-making approach, the decision was made to “abandon” the right-sided ventricular lead in situ, reposition the right-sided atrial lead by tunneling over the sternum into the left pectoral area, and implant a new left-sided defibrillator lead. During the 2-year follow-up our patient remained clinically stable and the CIED fully functional. Herein, beyond case presentation we also elaborate on individualized alternative treatment strategies for patients with venous access site occlusion in a literature review. Full article

Background/Objectives: Predictors of left atrial appendage thrombus (LAAT) in adequately anticoagulated patients with atrial fibrillation (AF) referred for direct current cardioversion (DCCV) remain insufficiently defined, particularly in populations with a high prevalence of cardiac implantable electronic devices (CIEDs). The aim of this study was to identify clinical and echocardiographic determinants of LAAT and/or dense spontaneous echocardiographic contrast (SEC) in patients with persistent AF referred for DCCV. Methods: This prospective observational study included 510 consecutive patients with persistent AF who had received at least 3 weeks of effective anticoagulation and underwent transthoracic and transesophageal echocardiography prior to elective DCCV. The primary endpoint was the presence of LAAT and/or dense SEC (Fatkin grade 3–4). Independent predictors were identified using multivariable logistic regression. Results: LAAT and/or dense SEC were detected in 192 patients (37.6%)—of whom 73 had overt LAAT, 19 had borderline LAAT, and the remainder had dense SEC (Fatkin grade 3–4). Independent predictors included lower left ventricular ejection fraction (OR 0.95 per 1% increase, 95% CI 0.94–0.97, p < 0.0001), reduced right ventricular fractional area change (OR 0.93 per 1% increase, 95% CI 0.91–0.94, p < 0.0001), larger left atrial area (OR 1.05 per 1 cm² increase, 95% CI 1.01–1.09, p = 0.011), and female sex (OR 1.78, 95% CI 1.14–2.79, p = 0.012). Moderate or greater mitral regurgitation was associated with a lower risk (OR 0.50, 95% CI 0.30–0.82, p = 0.007). The CHA₂DS₂-VASc score and the presence of right ventricular leads were not independently associated with LAAT/SEC. The model showed good discrimination (AUC 0.81, 95% CI 0.77–0.84). Conclusions: In anticoagulated patients with persistent AF, LAAT and/or dense SEC remain common and are primarily driven by echocardiographic markers of biventricular dysfunction and left atrial remodeling rather than by traditional clinical risk scores or the presence of cardiac devices. Full article

The increasing use of cardiac implantable electronic devices (CIEDs) in pediatric and adolescent populations has led to a growing need for transvenous lead extraction (TLE). However, data on long-term outcomes remain limited. This study aimed to evaluate the efficacy and safety of TLE using mechanical rotational dilator sheaths in a pediatric cohort. This retrospective single-center study included 35 patients who underwent TLE between 2007 and 2025. Outcomes were compared between Evolution^® (Cook Medical, Bloomington, IN, USA) and TightRail™ (Spectranetics/Philips, Colorado Springs, CO, USA) sheath systems. A total of 40 leads were extracted (mean age at extraction: 15.1 ± 4.2 years; 57% male). The most common indication for extraction was lead fracture/dysfunction (22/35–63%). Complete success with the procedure was achieved in 23 (66%) patients, and clinical success in 30 (86%). Major complications requiring surgery occurred in 5 (14%) patients, and minor complications in 2 (6%). Notably, all major complications occurred in patients with implantable cardioverter-defibrillator (ICD) leads (p = 0.013), including innominate vein injury, pericardial effusion, tricuspid entrapment, and cardiac perforation. A comparison of the Evolution^® (n:20) and TightRail™ (n:15) sheath groups showed no statistically significant differences in complete procedural success (p = 0.603), clinical success (p = 0.604), or the incidence of major complications (p = 0.640). No procedure-related mortality was observed. TLE using mechanical rotational dilator sheaths in pediatric patients is feasible and provides acceptable clinical success rates. However, the risk of major complications remains considerable, particularly in patients with ICD leads. These findings highlight the importance of careful procedural planning and performing TLE in experienced centers with immediate surgical backup. Full article

Background and Clinical Significance: Infective endocarditis is a disease of the endocardial surface of the heart, most often affecting heart valves (native or prosthetic) or intracardiac device. Although relatively rare, it carries high embolic risk of complications and mortality. Complete device extraction is recommended; however, conventional surgery may be prohibitive in frail patients with multiple comorbidities. Case presentation: We present a case of a 74-year-old male with implantable cardioverter-defibrillator (ICD)-related infective endocarditis and large lead-associated vegetation measuring approximately 3 cm in size. Due to a high operative risk assessed by Euro SCORE II, a minimally invasive percutaneous approach using the Penumbra vacuum-assisted aspiration system was selected. The procedure enabled successful debulking of the vegetation, followed by complete device removal and targeted antibiotic therapy. The patient’s clinical condition improved, with normalization of inflammatory markers and no recurrence of infection, and a new ICD was safely reimplanted after recovery. Conclusions: This case highlights the potential role of percutaneous vacuum-assisted aspiration as an effective and less invasive therapeutic option in high-risk patients with CIED-related infective endocarditis, particularly when conventional surgical management is contraindicated or requires bridging therapy until the patient’s status is stabilized. Full article

Isolated pulmonary valve endocarditis (PV-IE) is a rare condition. Its epidemiology, clinical profile, and management remain poorly characterized. A systematic review was conducted to provide a contemporary characterization (2020–2025) of adult cases with isolated PV-IE. Individuals with previous cardiac surgeries, cardiac implantable electronic devices (CIEDs), or long-term venous catheters were excluded. Of 1902 citations identified, 72 studies were selected with 79 eligible cases, mostly case reports. Patients were predominantly male (78.5%) with a median age of 43 years. Congenital heart disease (CHD) and injection drug use (IDU) were risk factors in 30.4% and 27.8% of cases, respectively, while 41.8% had neither (No-CHD/IDU group). Staphylococcus aureus was the leading pathogen (39%), followed by streptococci (16.5%) and Enterococcus faecalis (8.9%). Vegetations were large (median, 19.5 mm), and pulmonary septic emboli highly prevalent (~93% of cases). More than half (54.4%) of patients underwent surgery. Hospital mortality was low (7.6%). Differences across risk factor subgroups were observed, with higher median age in No-CHD/IDU patients and more staphylococcal etiology in patients with IDU, although treatment approaches and mortality did not differ. This review highlights distinct characteristics and the overall favorable short-term prognosis of isolated PV-IE, underscoring the need for larger, systematically collected datasets. Full article

In many countries, patients’ access to transcatheter aortic valve implantation (TAVI) is limited by reimbursement issues or delayed admission to heart valve centers, thus increasing the risk of adverse events in wait-listed patients. The TAVI AT HOME (TAH) is a single-arm, multicenter study aiming to evaluate the safety and efficacy of transfemoral TAVI performed at centers without on-site cardiac surgery by expert operators. The primary endpoint is 30-day all-cause mortality. This study focuses on the run-in phase of the registry, which was required by the ethics committee to perform an interim safety analysis. The outcome of 20 TAH patients enrolled at three Italian centers from May 2023 to May 2024 was compared to 41 TAVI cases included in the permanent local registry, matching the TAH inclusion/exclusion criteria. The two groups had similar baseline characteristics. Significantly more patients in the TAH group were deemed at prohibitive risk (85.0% vs. 56.1%; p = 0.026) but had similar surgical risk scores. A self-expanding device was used in most cases (60.7%). Technical success did not differ between groups (95.0% in the TAH vs. 85.4%, p = 0.409). No deaths at 30 days (primary endpoint) were observed. The 1-year survival rate did not differ between groups. After interim data analysis, the ethics committee authorized the completion of the TAH enrollment and extension to other centers. The TAH approach might represent an alternative model to allow timely access to TAVI without compromising safety and effectiveness. Full article

Background and Objectives: Cardiac implantable electronic device (CIED) infections remain among the most serious complications of pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy procedures. They are associated with substantial morbidity, mortality, prolonged hospitalization, system extraction, long-term antimicrobial therapy, and increased healthcare costs. As most infections arise from perioperative contamination or procedure-related complications, prevention has become a major priority in contemporary electrophysiology practice. This review aimed to summarize current evidence on the prevention of CIED infections, with particular emphasis on modifiable risk factors and perioperative preventive measures. Materials and Methods: A focused narrative review was undertaken using targeted searches of PubMed/MEDLINE and Scopus, supplemented by major international guideline and consensus documents, with priority given to contemporary guidelines, randomised trials, meta-analyses, and major observational studies relevant to CIED infection prevention. Results: Prevention of CIED infection requires a structured, multifactorial approach spanning the entire procedural pathway. Key preventive strategies include careful reassessment of device indication, individualized device selection, correction of modifiable risk factors, postponement of elective implantation in the presence of active infection, appropriate perioperative antibiotic prophylaxis, and optimized management of anticoagulant and antiplatelet therapy to minimize pocket hematoma. Additional relevant measures include meticulous skin antisepsis, limitation of temporary invasive devices and unnecessary hardware, appropriate venous access selection, careful generator pocket creation and wound closure, and avoidance of early reintervention whenever feasible. Antibacterial envelopes may reduce major CIED infections in selected high-risk patients, whereas routine escalation of preventive measures without proven benefit is not supported. Conclusions: CIED infection prevention is inherently multifactorial and depends on the consistent application of evidence-based measures before, during, and after device implantation. Rigorous control of modifiable risk factors, prevention of pocket hematoma, appropriate antimicrobial prophylaxis, and meticulous procedural technique remain the cornerstones of effective infection prevention in patients undergoing CIED procedures. Full article

Background: Post-sternotomy mediastinitis remains a devastating complication of cardiac surgery. Although most cases are bacterial, fungal mediastinitis due to Candida albicans is rare, aggressive, and particularly difficult to treat because of biofilm formation, prosthetic involvement, and limited penetration of systemic antifungal agents into infected tissues. Taurolidine is a taurine-derived antimicrobial compound with broad antibacterial, antifungal, and anti-biofilm properties that has shown promising results in catheter-related infection prevention and cardiac implantable electronic device surgery. Case summary: We report, to our knowledge, the first intramediastinal use of taurolidine for Candida albicans mediastinitis after biological Bentall surgery. Following urgent resternotomy and extensive debridement, 200 mL of taurolidine solution was instilled into the mediastinum for 60 min, then aspirated. Postoperatively, taurolidine irrigation via mediastinal drainage was combined with negative-pressure wound therapy and systemic antifungal treatment. Results: Rapid microbiological sterilization was achieved, inflammatory markers normalized, and follow-up computed tomography demonstrated complete resolution of mediastinal infection. Delayed sternal closure was then performed successfully without recurrence at 6-month follow up. Conclusion: To our knowledge, this represents the first reported use of intramediastinal taurolidine irrigation for fungal mediastinitis following cardiac surgery. Intramediastinal taurolidine irrigation may represent a promising adjunctive strategy for mediastinitis after cardiac surgery in high-risk patients. Further clinical evaluation is warranted. Full article

Background: The increasing use of advanced cardiac surgical therapies, particularly left ventricular assist devices (LVADs), has improved survival in patients with end-stage heart failure. However, the psychological burden associated with these therapies—especially depression and suicidality—remains underrecognized. Objectives: This narrative review synthesizes current evidence on the prevalence, underlying mechanisms, risk factors, screening strategies, and management of depression and suicidality in patients undergoing LVAD implantation and other advanced cardiac surgical interventions. Methods: A structured literature search of PubMed, Embase, and Scopus was conducted for studies published between 2020 and 2025 addressing depression, suicidal ideation, suicide attempts, and psychological distress in LVAD and advanced cardiac therapy populations. Results: Depression affects approximately 20–42% of patients with advanced heart failure, including those supported with LVADs, while suicidal ideation is reported in up to 12% of LVAD recipients, with higher rates of suicide attempts compared to other chronic disease populations. Risk factors are multifactorial and can be categorized into patient-related, disease-related, device-related, and psychosocial domains. Proposed mechanisms include neurohormonal dysregulation, systemic inflammation, and psychological processes such as loss of autonomy and existential distress. Although validated screening tools and multidisciplinary management strategies are available, their implementation in routine clinical practice remains inconsistent. Conclusions: Depression and suicidality represent significant and complex challenges in patients undergoing advanced cardiac therapies, particularly LVAD support. Systematic mental health screening and integrated, multidisciplinary care models are essential to improve patient outcomes. Future research should focus on longitudinal assessment, standardized suicide risk monitoring, and the development of targeted, evidence-based interventions for this vulnerable population. Full article

Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia, present in up to 14–20% of patients undergoing cardiac surgery, with the number of patients expected to double within the next decade. Despite a Class I recommendation for concomitant surgical ablation and a Class I-B recommendation for left atrial appendage (LAA) occlusion in patients with AF undergoing cardiac surgery (Class IIa for endoscopic or hybrid AF ablation), both procedures remain substantially underutilized in clinical practice. The design of the Mapping atrial fibrillation after Epicardial Surgical Ablation plus AtriClip to Guide Endocardial ablation (MESAGE) prospective study is presented. Materials and Methods: A narrative literature review was conducted using PubMed through March 2025. Randomized controlled trials, multicenter registries, meta-analyses and current clinical guidelines were prioritized. The MESAGE study protocol is presented in accordance with the SPIRIT recommendations. Results: Randomized evidence demonstrates that hybrid ablation achieves 32–48% greater arrhythmia freedom than catheter ablation (CA) alone in persistent and long-standing persistent AF, with comparable safety and significantly fewer interventions at two-year follow-up. Epicardial LAA occlusion with the AtriClip device achieves complete occlusion in all patients with an 87.5% relative reduction in ischemic stroke risk in anticoagulation-free follow-up. Continuous implantable loop recorder (ILR)-based monitoring reveals AF recurrence in substantially more patients than conventional monitoring, with AF burden emerging as a more meaningful endpoint than arrhythmia freedom. The MESAGE study enrolls 40 patients undergoing cardiac surgery who have pre-existing AF, pre-randomized 1:1 to pulmonary vein isolation (PVI) alone versus PVI-BOX, with mandatory pre-operative ILR implantation, intra-operative AtriClip LAA exclusion, and systematic Day-60 endocardial mapping and supplementary ablation using the Affera dual-energy system. Conclusions: Hybrid epicardial–endocardial ablation combined with LAA exclusion and continuous ILR monitoring represents a comprehensive, mechanistically rational and evidence-informed approach to AF management in patients undergoing cardiac surgery, although current evidence remains heterogeneous, and the benefits depend on the AF phenotype and monitoring strategy. The MESAGE pilot study will generate hypothesis-generating prospective comparative data on epicardial PVI versus PVI-BOX in the concomitant surgical setting, assessed through systematic post-surgical endocardial mapping and continuous rhythm monitoring. Full article

Background: Emerging evidence highlights the importance of the MIF–sCD74 axis in health and disease, including its role in regulating cell death. While studies in routine cardiac surgery suggest perioperative relevance, its role in end-stage heart failure (ESFH) patients undergoing left ventricular assist device (LVAD) implantation remains unexplored. Moreover, although MIF and sCD74 induce necroptosis in neonatal cardiac myofibroblasts, the effects of MIF, its paralog D-DT, and sCD74 on adult cardiac myofibroblasts (CMFs) are unknown. Methods: Plasma concentrations of sCD74, MIF and D-DT were measured perioperatively in a small cohort of patients with ESHF undergoing LVAD implantation (n = 20). As a preclinical model of ESHF, primary adult CMFs were treated with recombinant MIF, D-DT and sCD74 to evaluate their effects on cellular viability and health. Results: In LVAD patients, sCD74 and D-DT levels were significantly increased 24 h postoperatively, whereas MIF levels were reduced compared to baseline. ROC curve analysis demonstrated a good discriminatory power of 24 h post-OP sCD74 (AUC = 0.83), sCD74/MIF ratio (AUC = 0.82), and D-DT levels (AUC = 0.88) for acute kidney injury, composite outcome, and right heart failure (RHF), respectively. In adult CMFs, MIF and sCD74 synergistically reduced viable cell counts (p = 0.0083), whereas D-DT reduced cell counts in an sCD74-independent manner (p = 0.0004). Yet, measures of metabolism, proliferation, apoptosis and necrosis along with inflammatory gene expression remained unchanged. Conclusions: Our findings indicate that the balance of MIF, D-DT, and sCD74 during LVAD implantation may be clinically relevant. In particular, an imbalance characterized by elevated sCD74 or D-DT and reduced MIF levels 24 h post-surgery was associated with unfavorable clinical outcomes. Yet, the current findings are exploratory and hypothesis-generating because of a small sample size. Thus, the prognostic value of plasma levels for postoperative complications after LVAD implantation, and the effects of MIF/D-DT/sCD74 imbalance on cardiac myofibroblasts, need to be validated in larger cohorts and in advanced human experimental models. Full article