PubMed Posts

Background: We investigated the international mini-mitral registry (MMIR) for differences in minimally-invasive access for surgery on the mitral and tricuspid valve. We compared direct vision with partially or fully endoscopic approaches.

Methods: From 2015 to 2021, 7,513 consecutive patients underwent mini-MVR ± TVR in 17 international Heart-Valve-Centers. Data were collected according to MVARC definitions and 6463 patients undergoing first time mitral with or without tricuspid valve surgery were analyzed. Uni- and multivariable regression analyzes were performed to compare the different approaches.

Results: Patients were 65 years (57% male) and oldest in the direct-vision group (n = 1594). Endoscopes (video-assisted: n = 2850, fully-endoscopic: n = 1963) were used in slightly more selected patients (less obesity, diabetes, dialysis, CAD, pulmonary hypertension, reduced LVEF and urgent status compared to direct vision). Robot was used in 56 cases (most selected, no mortality, not further analyzed). Fully-endoscopically, most cases were repairs, concomitant tricuspid surgery was lowest (13% vs. 20%) and both cardiopulmonary bypass and cross-clamp times were longest (90 min, IQR 71-113 min). Cross-clamp times were shortest in the direct vision group (-20 min). Technical success was high (above 96%), in-hospital mortality and stroke rates low and not significantly different between groups. Low output was highest with direct vision and acute kidney injury highest fully-endoscopically. However, this difference was not significant.

Conclusions: In this large registry, the type of minimally-invasive approach did not significantly affect outcome. It appears that fully endoscopic and robotic cases are used more selectively. Mastering both techniques may optimize patient care.

Objective: Evidence on optimal therapeutic strategies for atrial functional mitral regurgitation (AFMR) remains limited. This study aimed to evaluate patient characteristics, surgical techniques, and outcomes in AFMR patients from the Mini Mitral International Registry.

Methods: Patients undergoing mini mitral surgery for AFMR between 2015 and 2023 were identified. Exclusion criteria included organic lesions, abnormal leaflet motion, reduced left ventricular function, absence of annular dilation, and previous mitral procedures.

Results: Of 7,957 patients, 430 (5.4%) met AFMR criteria. The cohort was elderly (median age 73), predominantly female (67.7%), with frequent atrial fibrillation (AF) (69.7%). Mitral repair was performed in 91.4% of patients, all via isolated annuloplasty except 3. Complete rings were used in 97.1%. On multivariable analysis anterior mitral leaflet (AML) pseudo-prolapse was associated with an increased likelihood of valve replacement (OR 5.3, 95%CI 1.07-9.12). Concomitant tricuspid repair, AF ablation, and left atrial appendage closure were performed in 44.2%, 40.5%, and 25.6%, respectively. At discharge, 99% had none or mild regurgitation; in-hospital mortality and stroke were 2.3% and 1.9%.

Conclusions: Findings from the MMIR indicate that mitral repair with isolated annuloplasty was the preferred surgical strategy for AFMR, providing satisfactory procedural and early clinical outcomes. The presence of AML pseudo-prolapse reduced the likelihood of valve repair. Overall operative results were favorable, with 99% of patients experiencing no or mild residual mitral regurgitation. These findings may serve as a reference for clinical decision-making in AFMR treatment pathways.

Study objectives: Previous studies have suggested that obstructive sleep apnea (OSA) may be associated with aortic dilatation. We aimed to further characterize the association between OSA severity with thoracic aortic diameter.

Methods: We evaluated 1,470 patients attending an Australian clinic during 2014-2023 and who underwent transthoracic echocardiogram followed by polysomnographic study in the following 6 months (43.7% female, median age 65 years, median body mass index 29.6 kg/m²). Aortic root and ascending aortic diameters were compared among patients based on OSA severity, defined by apnea-hypopnea index.

Results: OSA was observed in 90% of patients. Both aortic root and ascending aorta diameters were associated with increasing OSA severity (P < .01). These associations remained significant when indexed for height, but not body surface area. Multivariate analysis considering age, weight, hypertension status, atrial fibrillation, and smoking history suggested an independent role of OSA on aortic dimensions in females but not in males. However, a case-control sensitivity analysis did not demonstrate a significant difference in aortic diameter between no/mild OSA compared to moderate/severe OSA.

Conclusions: This is the largest study examining the association of OSA and thoracic aortic dimensions in a clinical sample. It found a significant increase in both aortic root and ascending aorta diameters with increasing OSA severity, although this may be explained by shared risk factors such as age, body mass index, hypertension, and atrial fibrillation. A minor independent association between aortic dimensions and OSA severity was observed in females but not males. Further research is warranted to explore the relationship between OSA and aortopathy.

Background: Myocardial infarction (MI) is a leading cause of death worldwide and can eliminate up to a third of the cardiomyocytes within the human heart. Although cardiomyocytes undergo mitosis during early development, most cardiomyocytes cease cell cycling soon after birth. In contrast, rodent MI models have shown that cardiomyocytes increase mitosis in response to ischemia; however, this has not been shown in humans.

Methods: Using a unique premortem post-MI human heart, immunostaining, bulk RNA sequencing, proteomics, metabolomics, single-nucleus RNA sequencing and a novel post-MI human biopsy method, we investigated human cardiomyocyte mitosis post-MI.

Results: We show that adult human cardiomyocytes exhibit increased mitosis and cytokinesis in response to ischemia.

Conclusions: Future development of therapeutics to enhance this intrinsic mitotic potential could lead to new treatments that reverse heart failure via cardiac regeneration.

Myocardial infarction (MI) contributes to significant morbidity and mortality globally. Platelet derived growth factor-AB (PDGF-AB) is potentially a novel translational therapeutic for improving cardiac function post-MI, which we assess here using a 60 day porcine left anterior descending artery occlusion ischemia-reperfusion model. MI was induced in 10 female Landrace swine, with 5 controls, 5 receiving PDGF-AB treatment and 2 additional shams. PDGF-AB improved left ventricular ejection fraction 58 days after MI, without affecting overall infarct scar size, as shown using serial cardiac magnetic resonance imaging. Preserved infarct zone microvascular function and increased vessel maturity was also observed. Multi-omic analyses showed that PDGF-AB treatment altered the expression of proteins, metabolites, and lipids that are known to be involved in myocardial energetics and redox balance. Novel therapeutics such as PDGF-AB may lead to more sustained salvage of cardiac function by modulating the post-MI microvasculature, myocardium and extracellular matrix.

Keywords: ageing; age‐OME; excitation‐contraction coupling; human heart; metabolism; omics.

Keywords: Mini-Mitral International Registry; clinical outcome; endo-aortic balloon occlusion; minimally invasive surgery; mitral valve; transthoracic clamping.

Keywords: Cardiovascular Diseases; Heart Failure; Heart Failure, Systolic; Myocardial Infarction.

Keywords: Confocal Microscopy; Diabetes; Human Myocardium; Ischaemic Cardiomyopathy; Multi-omics.