Heart Preservation Techniques for Transplantation

Heart transplant remains the gold standard of end-stage heart failure treatment. The number of heart transplants performed each year has increased and the number of recipient candidates has been increasing even more. As a result, recipients are now matched with donors over longer distances with increasing organ ischemic time. Organ preservation strategies have been evolving to minimize ischemia reperfusion injury following longer ischemic times. This chapter will include updated organ donation and preservation techniques for heart transplant including organ donation after brain death (DBD) and donation after circulatory death (DCD). The expansion of cardiac donation after circulatory death (DCD) and new techniques for heart preservation may increase the use of hearts from extended criteria donors and thus expand the heart donor pool

Concomitant Atrial Fibrillation Surgery

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is the major cause of stroke and heart failure. The treatment options of AF include medical treatment and catheter-based or surgical ablation. Cox et al. introduced the Cox-Maze procedure (the cut-and-sew Maze) that was first performed clinically in 1987 at Barnes Jewish Hospital, St. Louis, MO. This procedure is characterized by multiple incisions created at both left and right atria to terminate AF while allowing the electrical impulse generated from sinoatrial node to atrioventricular node. The Cox-Maze IV is the latest iteration developed by Damiano Jr. et al., which replaced the previous cut-and-sew Maze with a combination of less invasive linear lesions achieved by new ablation technology, the bipolar radiofrequency (RF), and cryoablation. This chapter describes the operative techniques, preoperative planning, indication for surgery, and future option of surgical treatment

Impact of Mitral Regurgitation Etiology on Mitral Surgery After Transcatheter Edge-to-Edge Repair

International audienceBackground: Although >150,000 mitral TEER procedures have been performed worldwide, the impact of MR etiology on MV surgery after TEER remains unknown.Objectives: The authors sought to compare outcomes of mitral valve (MV) surgery after failed transcatheter edge-to-edge repair (TEER) stratified by mitral regurgitation (MR) etiology.Methods: Data from the CUTTING-EDGE registry were retrospectively analyzed. Surgeries were stratified by MR etiology: primary (PMR) and secondary (SMR). MVARC (Mitral Valve Academic Research Consortium) outcomes at 30 days and 1 year were evaluated. Median follow-up was 9.1 months (IQR: 1.1-25.8 months) after surgery.Results: From July 2009 to July 2020, 330 patients underwent MV surgery after TEER, of which 47% had PMR and 53.0% had SMR. Mean age was 73.8 ± 10.1 years, median STS risk at initial TEER was 4.0% (IQR: 2.2%-7.3%). Compared with PMR, SMR had a higher EuroSCORE, more comorbidities, lower LVEF pre-TEER and presurgery (all P < 0.05). SMR patients had more aborted TEER (25.7% vs 16.3%; P = 0.043), more surgery for mitral stenosis after TEER (19.4% vs 9.0%; P = 0.008), and fewer MV repairs (4.0% vs 11.0%; P = 0.019). Thirty-day mortality was numerically higher in SMR (20.4% vs 12.7%; P = 0.072), with an observed-to-expected ratio of 3.6 (95% CI: 1.9-5.3) overall, 2.6 (95% CI: 1.2-4.0) in PMR, and 4.6 (95% CI: 2.6-6.6) in SMR. SMR had significantly higher 1-year mortality (38.3% vs 23.2%; P = 0.019). On Kaplan-Meier analysis, the actuarial estimates of cumulative survival were significantly lower in SMR at 1 and 3 years.Conclusions: The risk of MV surgery after TEER is nontrivial, with higher mortality after surgery, especially in SMR patients. These findings provide valuable data for further research to improve these outcomes