Search Results (265)

Background: Sex-based disparities in the presentation, management, and outcomes of infective endocarditis (IE) remain insufficiently characterized despite their growing recognition. This study systematically evaluates current evidence on sex differences in the presentation, treatment, and outcomes of IE. Methods: A systematic review and meta-analysis were conducted according to PRISMA and Cochrane guidelines. EMBASE, MEDLINE, PubMed, the Cochrane Library, and Google Scholar were searched up to October 2024. Twenty-four studies including 139,952 patients (79,698 men and 60,254 women) were analyzed. Primary outcomes were mortality (in-hospital, 30-day, and 1-year), stroke, and treatment modality (medical vs. surgical). Secondary outcomes included complications, procedural characteristics, and hospital course. Results: Men were younger at diagnosis and had higher rates of substance abuse and coronary artery disease, while women more often had hypertension, diabetes, chronic lung disease, and prior valvular pathology. Men more frequently had aortic and prosthetic valve IE, whereas women had mitral and tricuspid involvement. Men were about 65% more likely to undergo surgery for infective endocarditis than women, while women were predominantly managed medically. Men had lower in-hospital (OR 0.81, 95% CI 0.72–0.92) and 1-year mortality (OR 0.76, 95% CI 0.61–0.94), though 30-day mortality did not differ significantly. Women experienced shorter hospital stays but longer ICU admissions and more heart failure, whereas men had more recurrent IE. Conclusions: Men underwent surgery more often and had better short- and long-term survival. Women presented later, with greater comorbidity and higher complication rates. Enhanced recognition of sex-specific risk and equitable surgical referral may improve IE outcomes. Full article

Background: The advantage of employing multidisciplinary heart teams (MDHT) for the selection process of minimally invasive (MIS) mitral valve repair (MVr) and mitral valve replacement (MVR) has been previously substantiated. Here, we outline the contributions each member of the MDHT at our institution made during the intra-operative and peri-operative periods and describe their impacts on short-term outcomes. Patients and Methods: This is a single-center retrospective review of all 278 adult patients who underwent MIS MVR or MVr by a single surgeon at our institution between 2006 and 2023. The repair’s efficacy was assessed intraoperatively and at 1 year post-operation. The surgical technique involved a mini-thoracotomy and valve repair or replacement. Outcomes included post-operative mortality, complications, operative time, repair success rate, hospital length of stay (LOS), and post-operative ejection fraction. There was no control group, as all patients undergoing MIS MVR/MVr were treated within an MDHT model. Results: Delivery of regional anesthesia via paravertebral catheter (PVC) was associated with a statistically significant shorter hospital LOS (6.52 vs. 7.81 days, p = 0.028). Enhanced Recovery After Surgery (ERAS) implementation by nurses was associated with a potentially clinically important, although not statistically significant, reduction in LOS (6.7 vs. 10.1 days, p = 0.168). Introduction of the COR-KNOT^® DEVICE for securing annuloplasty sutures was associated with a statistically significant reduction in operative time (288 vs. 326 min, p < 0.001). Percutaneous cannulation, proctored by interventional cardiology in 2019, was associated with a decrease in lymphocele rate from 6.2% before 2019 to 0% after 2019. Conclusions: Initiatives implemented by our MDHT were associated with reduced post-operative LOS, shorter operative times, and lower incidence of post-operative complications. Full article

Minimally Invasive Cardiac Surgery (MICS) was developed in the late 1990s and has taken giant strides over the last 30 years. Nowadays, it is an important part of the cardiac surgery practice, accounting for one-third of total heart surgeries globally, with remarkable results. It is mostly performed for Mitral Valve repair but also for Aortic Valve Replacement and coronary artery bypass. However, the chronological evolution that led MICS to its current status has never been properly described. The best format to share a historical journey is the state-of-the-art (SotA) review. To the best of our knowledge, there are no orthodox SotA reviews on MICS. The aim of our study is to describe the current key MICS techniques, their historical development, and to discuss their role in the future of our specialty. Full article

Over the past three decades, cardiac surgery has undergone a deep transformation, shifting from full median sternotomy to minimally invasive (MICS) and micro-invasive techniques. These approaches aim to achieve equivalent therapeutic outcomes while reducing surgical trauma, postoperative pain, hospitalization time, and healthcare costs. Minimally invasive strategies are now widely applied to aortic and mitral valve surgery, coronary artery bypass grafting, atrial fibrillation ablation, and combined procedures. Key advancements such as sutureless prostheses, video- and robotic-assisted systems, and enhanced imaging technologies have improved surgical precision and clinical outcomes while promoting faster recovery and superior cosmetic results. Evidence from randomized trials and observational studies demonstrates that MICS provides mortality and morbidity rates comparable to conventional surgery, with additional benefits in high-risk, elderly, and frail patients. Micro-invasive transcatheter interventions, particularly transcatheter aortic valve implantation (TAVI) and transcatheter mitral repair or replacement, have further expanded therapeutic options for patients unsuitable for open-heart surgery. Their success has fostered debate not between conventional and minimally invasive surgery, but between minimally invasive and micro-invasive approaches. Hybrid procedures—combining surgical and percutaneous techniques—exemplify a multidisciplinary evolution aimed at tailoring treatment to patient-specific anatomy, comorbidities, and risk profiles. Despite clear advantages, these techniques present challenges, including a steep learning curve, increased procedural costs, and the requirement for specialized equipment and institutional expertise. Optimal patient selection based on clinical risk assessment and advanced imaging remains essential. Future directions include refinement of robotic platforms, artificial intelligence-based decision support, miniaturization of instruments, and broader validation of emerging technologies in younger and low-risk populations. Minimally and micro-invasive cardiac surgery represent a paradigm shift toward patient-centered care, offering reduced physiological burden, improved functional recovery, and long-term outcomes comparable to conventional techniques. As innovation continues, these approaches are poised to become integral to modern cardiac surgical practice. Full article

Background: The aim of this study was to explore the baseline characteristics, risk factors, and prognosis of surgical patients with left-sided valvular infective endocarditis (IE) complicated by preoperative neurological complications, as well as the impact of complication subtypes and surgical timing on outcomes. Methods: A retrospective analysis of 605 consecutive surgical patients with left-sided valvular IE (May 2012–June 2024) was performed. Patients were stratified into neurological complication and non-complication groups, with 1:1 propensity score matching (PSM) balancing baseline confounders. Six neurological complication subtypes were defined; surgical timing was categorized as early (≤7 days for infarction, ≤30 days for hemorrhage) or delayed. Logistic/Cox regression analyzed risk factors and prognosis; subgroup analyses compared modified Rankin Scale (mRS) scores, and Kaplan–Meier curves evaluated long-term survival. Results: Mitral valve involvement, highly mobile vegetations, and longer IE symptom-to-surgery time were risk factors for neurological complications. After PSM balancing, the neurological complications group had similar in-hospital, long-term mortality to the control group, but a significantly higher new-onset cerebral complication rate. In total, 81.5% of complication patients achieving mRS ≤ 2 (good functional status) with infarction showed improved postoperative mRS scores. Cerebral hemorrhage was an independent predictor of in-hospital mortality, while cerebral hemorrhage and regional infarction were independent predictors of new-onset cerebral complication. Early surgery in infarction patients increased the neurological complication rate. Conclusion: Neurological complication incidence was 27.8%. Mitral valve involvement, high vegetation mobility, and preoperative emboli were risk factors. Except for preoperative cerebral hemorrhage and regional infarction, which increase the risk of in-hospital mortality, neurological complications overall do not affect short-term and long-term mortality rates, but increase the risk of postoperative neurological deterioration. Individualized surgical timing is recommended. Full article

Background and Objectives: Infective endocarditis (IE) continues to represent a life-threatening clinical entity, particularly in patients with advanced involvement of the cardiac fibrous skeleton. This study was designed to determine the incidence and to evaluate both short- and long-term outcomes in patients undergoing complex surgical intervention necessitating patch reconstruction for extensive and destructive IE. Materials and Methods: Between January 2008 and December 2024, 678 patients underwent cardiac surgery for IE at University Hospital Frankfurt/Main. The primary endpoint was long-term survival; the secondary endpoint was freedom from reoperation. Results: Ninety-six patients (14%) required complex patch reconstruction, owing to the severe involvement of the cardiac fibrous skeleton. The median age was 68 years (interquartile range [IQR], 16.5 years). Forty-three patients underwent redo surgery following previous cardiac procedures. Abscess formation was identified in 88% of cases (n = 85). Infective endocarditis was predominantly left-sided in 97% of patients (n = 94). In 40 patients (41%), the aortomitral continuity or the left ventricular outflow tract (LVOT) was involved. Combined surgical procedures were performed in 85 patients (87.6%), including 19 commando or hemi-commando operations. Thirty-day mortality was 20% (n = 19). The estimated 5- and 10-year survival rates were 46.5 ± 5.5% and 26.1 ± 6.8%, respectively. Survival did not differ significantly between native and prosthetic valve endocarditis, nor between commando/hemi-commando procedures and cases with abscess formation but preserved aorto-mitral continuity. Conclusions: In industrialized countries, extensive IE with abscess formation or destruction of the cardiac skeleton is predominantly associated with Staphylococcus aureus. Patients undergoing commando or hemi-commando procedures do not experience inferior survival compared with other patients with extensive IE. No survival advantage was observed for native versus prosthetic valve IE in the presence of extensive abscess formation. Full article

Background: The minimally invasive approach is increasingly recognized as the standard for surgical management of mitral valve disease. Advances in endoscopic visualization and surgical instrumentation have enhanced precision while minimizing trauma, improving both functional and esthetic outcomes. This study presents a single-center experience with total endoscopic mitral valve repair (MVR) performed using two- or three-dimensional video-assisted technology. Methods: Between October 2022 and September 2025, 239 patients underwent total endoscopic MVR at our institution. Demographic, operative, and postoperative data were collected and analyzed. Results: Median age was 63 years, with 64.4% male. Median logistic EuroSCORE and EuroSCORE II were 2.53 and 0.83, respectively. Most patients were NYHA class II (54.4%), and 47.7% had pulmonary hypertension. Mitral annuloplasty was performed in 99.2% of cases; 78.6% received Gore-Tex chordae, 6.3% underwent posterior leaflet resection, and 11.7% edge-to-edge repair. Conversion to sternotomy occurred in 0.4%. In-hospital mortality was 1.3%; stroke occurred in 0.4%. Postoperative atrial fibrillation developed in 26.8%, while major complications such as sepsis (2.1%) and renal failure requiring dialysis (1.3%) were infrequent. Median ventilation time was 5 h, ICU stay was 2 days, and hospital stay was 7 days. Pre-discharge echocardiography showed ≤mild regurgitation in 99.2%. Conclusions: Total endoscopic MVR using two- or three-dimensional video assistance is safe, feasible, and yields excellent clinical, functional, and cosmetic results, with low morbidity and rapid recovery. Full article

Mitral regurgitation (MR) is one of the most prevalent valvular disorders worldwide, with a growing burden driven by population aging and improved diagnostic capabilities. Understanding the mechanism of MR, whether primary, due to intrinsic valve abnormalities, or secondary, resulting from atrial or ventricular remodeling, is essential for optimal management. Echocardiography, particularly advanced modalities such as three-dimensional imaging and strain analysis, plays a central role in this process. It allows accurate quantification of MR severity, detailed characterization of valve and ventricular anatomy, and assessment of remodeling, all of which are critical for determining the optimal timing for intervention. Beyond diagnosis, echocardiography is indispensable in guiding therapy selection: it informs surgical planning by defining leaflet pathology for repair versus replacement strategies, and directs transcatheter interventions by guiding interatrial septal puncture, catheter orientation, and device deployment in real time. While surgery remains the gold standard for primary MR, transcatheter approaches including edge-to-edge repair and emerging mitral valve replacement are increasingly relevant, particularly in patients at high surgical risk or with complex anatomy. This review emphasizes the pivotal role of echocardiography in the pre-procedural assessment of MR, highlighting its ability to integrate anatomical, functional, and hemodynamic information to guide patient-tailored therapeutic strategies and optimize outcomes within a Heart Team framework. Full article

Mitral annular calcification makes conventional mitral valve surgery extremely challenging and has led to growing interest in less invasive alternatives such as transcatheter mitral valve replacement. Alongside percutaneous approaches, some centers have explored open transatrial implantation of transcatheter heart valves in patients with heavily calcified annuli. This systematic review examines the current evidence on this hybrid “valve-in-MAC” technique, tracing its clinical evolution, technological refinements, patient outcomes, and ongoing debates. Key themes emerging from the literature include the adaptation of existing balloon-expandable and mitral-specific devices to the complex anatomy of calcified mitral annuli, the open transatrial approach as a safer alternative to extensive surgical debridement, and advances in imaging and device design aimed at reducing left ventricular outflow tract obstruction and paravalvular leak. Persistent uncertainties remain, particularly regarding patient selection, long-term valve performance, and comparisons with conventional surgical repair or replacement. Although open transatrial implantation appears technically feasible and provides favorable hemodynamic results compared with fully percutaneous procedures, reported 30-day mortality remains high (approximately 19–27%). This reflects the advanced age, frailty, and multiple comorbidities typical of this patient group rather than procedural shortcomings. Current evidence is limited, with few comparative studies and little data on valve durability. Future work should prioritize multicenter prospective registries and well-designed comparative studies to better define the role of this emerging salvage strategy. Full article

Mitral regurgitation is one of the most prevalent valvular heart diseases globally and the second most common indication for cardiac valve surgery, surpassed only by aortic stenosis. Over the past decades, open-heart mitral valve surgery has been the gold-standard intervention for this complex disorder, but in recent years, transcatheter edge-to-edge repair has emerged as a valuable option in selected clinical scenarios. However, a considerable proportion of patients develop recurrent mitral regurgitation during follow-up, leading to a significant increase in morbidity and mortality. In this context, data is limited regarding the optimal approach. This review provides an overview of the current evidence on transcatheter mitral valve intervention therapies for the management of recurrent mitral regurgitation following transcatheter edge-to-edge repair. Full article

Background and Clinical Significance: Creutzfeldt–Jakob disease (CJD) is a rare and fatal neurodegenerative disorder caused by prion protein misfolding. The disease poses significant diagnostic challenges, particularly when its initial symptoms mimic other conditions, such as transient ischemic attacks. Early recognition and differentiation from other neurological conditions are critical, as misdiagnosis may lead to unnecessary interventions. This case highlights a unique presentation of CJD in a male Caucasian patient with a history of cardiac surgery and mitral valve prosthesis, emphasizing the role of multidisciplinary evaluation in complex neurological cases. Case Presentation: A male patient in his mid-sixties with a history of mitral valve mechanical prosthesis and prior infective endocarditis presented with progressive cognitive decline, memory impairment, and episodes of confusion. Initial cardiovascular investigations suggested mitral valve prosthesis thrombosis, while neurological assessment pointed toward transient brain ischemia. However, brain imaging remained inconclusive. Given the rapid deterioration of cognitive and motor functions, further diagnostic workup was performed. MRI findings revealed cortical diffusion restrictions consistent with probable CJD. Despite symptomatic management, the patient’s condition worsened, leading to akinetic mutism and death within eight days of diagnosis. Conclusions: This case underscores the diagnostic complexity of CJD, particularly when initial symptoms overlap with transient ischemic events. It highlights the importance of comprehensive neuroimaging and an interdisciplinary approach in recognizing atypical neurodegenerative diseases to improve diagnostic accuracy and patient management. Full article

Background/Objectives: Acute bacterial endocarditis (ABE) is a frequent situation and continues to be a challenge. Mitral valve involvement during acute bacterial endocarditis is often the result of the spread of the endocarditic process from the adjacent aortic valve. Mitral involvement, on the other hand, could also be an expression of the initial localization of the bacteria. The best option for treating mitral ABE is still a matter of debate. Recent reports have shown satisfactory results with mitral reconstructive techniques in the treatment of mitral ABE. In this study, we present a comprehensive review of our 10-year institutional experience in the surgical management of acute mitral endocarditis with a focus on technical considerations, outcomes, and the durability of mitral valve repair in this high-risk population. Methods: We queried the institutional database, cross-referencing patients admitted with a diagnosis of “acute bacterial endocarditis” with patients undergoing surgical procedures for “valvular disease” at our division. Out of 1136 valvular procedures listed in our PACS database, 180 patients were admitted with a diagnosis of active acute endocarditis, and 46 included treatment of the mitral valve. We analyzed and compared short- and long-term follow-up (ranging from 3 to 141 months with a mean of 42 ± 38 months) of these 46 patients, dividing them into two groups: mitral valve repair (MVr) and mitral valve replacement (MVR). Results: 18 (40%) patients underwent reconstructive treatment of the mitral valve, and 28 (60%) underwent mitral valve replacement. Cumulative in-hospital mortality was 10% (5 pts, all from the MVR group), however, with no difference between the two groups. A shorter time gap from diagnosis to surgery (<10 days) was the only predictive factor for early mortality. A further 11 patients died during follow-up (2 from group A and 9 from group B). Long-term survival, on the other hand, was negatively influenced by MV surgical replacement (p = 0.0178), older patients’ age (>60 years), and urgent surgical procedures. Finally, patients with MVr also experienced a favorable postoperative event-free curve for endocarditis recurrence (p = 0.0260) and time elapsed before recurrence (p = 0.0438). Conclusions: Mitral valve repair in the case of active endocarditis could be a treatment associated with more favorable outcomes, providing that a complete eradication of infective tissue can be accomplished. Conservative treatment, when feasible, seems to offer favorable cumulative long-term outcomes. Full article

Background: Pulmonary hypertension is common in left-sided heart valve disease, with historical studies reporting mortality rates up to 31% in severe cases undergoing mitral valve surgery. This study evaluates the impact of severe pulmonary hypertension on outcomes of mechanical mitral valve replacement with posterior leaflet preservation by comparing results with patients having mild-to-moderate pulmonary hypertension. Methods: Prospective analysis of 86 patients with mitral valve disease undergoing mechanical valve replacement with posterior leaflet preservation from March 2015 to September 2016 was conducted. Patients were stratified by pulmonary artery pressure: severe (≥60 mmHg, n = 19) versus mild–moderate (35–59 mmHg, n = 67). Primary outcomes included mortality, complications, and functional recovery at 1, 6, and 12 months. Results: The cohort included 67 patients (77.9%) with mild–moderate pulmonary hypertension and 19 patients (22.1%) with severe pulmonary hypertension. Severe pulmonary hypertension patients demonstrated higher NYHA functional class (73.7% class III vs. 46.2%, p = 0.03), larger left atrial diameter (56.3 ± 9.8 vs. 49.5 ± 6.7 mm, p = 0.01), and higher mean pressure gradients (14.4 ± 5.3 vs. 11.3 ± 5.0 mmHg, p = 0.025). Mortality was 5.3% in the severe group versus 0% in the mild–moderate group (p = 0.331). Patients with severe pulmonary hypertension required longer ICU stays (6.3 ± 3.7 vs. 4.7 ± 2.2 days, p = 0.024) but showed no significant differences in ventilation time, reoperation rates, or major complications. At the 12-month follow-up, both groups achieved equivalent outcomes in pulmonary artery pressures, left ventricular function, and cardiac dimensions. Conclusion: In this study with a relatively small sample size, severe pulmonary hypertension was associated with significantly longer intensive care unit stay but not with higher mortality compared to mild–moderate pulmonary hypertension, with both groups attaining comparable functional and hemodynamic parameters at 12 months after mechanical mitral valve replacement with posterior leaflet preservation. Full article

Background/Objectives: Despite growing awareness of mitral annular disjunction’s (MAD) clinical significance, robust data regarding the outcomes of surgical interventions on MAD remain sparse. This meta-analysis aims to systematically evaluate the current evidence on the efficacy and safety of mitral valve (MV) surgery in patients with MAD. Methods: A systematic review was conducted from inception until May 2025 for studies comparing patients undergoing MV surgery with and without MAD and was registered in PROSPERO: CRD42025649821. Results: Patients with MAD were generally younger (59.3 ± 5.0 vs. 63.4 ± 2.2 years, standardized mean difference: −0.3073), had fewer comorbidities but more complex valve lesions (41.0% vs. 13.7%, risk difference: 0.2627) compared to those without MAD. MV replacement was performed less frequently in the MAD group than in the No-MAD group (risk ratio, RR: 0.690 [95% confidence interval, CI: 0.508; 0.937], p = 0.017), probably related to the significant difference in age between the two groups. The MAD cohort demonstrated a higher incidence of ventricular arrhythmia both after surgery (RR: 7.255 [95%CI: 1.231; 42.763], p = 0.029) and during follow-up (incidence rate ratio, IRR: 2.750 [95%CI: 1.372; 5.512], p = 0.004). Although the MAD group experienced more arrhythmic events over time, this did not translate into a significant difference in overall mortality compared to patients without MAD (IRR: 0.573 [95%CI: 0.072; 4.555], p = 0.599). Conclusions: This meta-analysis revealed significant baseline differences between the populations. Our findings suggest that patients with MAD remained at significantly higher risk for both postoperative and long-term arrhythmias. These results highlight the need for close arrhythmic surveillance in this population. Full article

Background/Objectives: Giant atrial chambers are rare but clinically important conditions, most often linked to rheumatic mitral valve disease, though they may also occur in congenital or other acquired disorders. Despite their low prevalence, they entail major hemodynamic, arrhythmogenic, and extracardiac risks. This study aimed to review recent evidence on giant atrial pathology—including giant left atrium (GLA), giant right atrium (GRA), and atrial appendage aneurysms—and to illustrate its relevance through cases of symptomatic extracardiac compression. Methods: A PubMed search on 15 September 2025 using “giant atrium” and limited to human, free full-text studies from the last 10 years yielded 93 results. After screening, 21 reports describing 24 cases were analyzed and compared with institutional experience. Results: GLA is most often defined by an anteroposterior diameter ≥6.5 cm or ≥8 cm, while criteria for GRA and appendage aneurysms remain inconsistent. Reported complications include atrial fibrillation, thromboembolism, and compression of mediastinal structures, with presentations such as dysphagia or airway obstruction. While valve surgery alone may suffice, many authors recommend concomitant atrial reduction or aneurysm resection in symptomatic patients. Conclusions: Giant atrial pathology, though uncommon, carries significant cardiac and extracardiac implications. Management should be individualized, and awareness of atypical manifestations is critical for timely diagnosis and treatment. Full article