Journal and News Scan

The Warden procedure is a common surgical method for repairing partial anomalous pulmonary venous return (PAPVR), but it may be complicated by cavoatrial anastomosis obstruction.  A retrospective analysis of 136 patients at Bambino Gesù Children’s Hospital revealed no deaths, with a median follow-up of 6.5 years. This study found that patients younger than 4.4 years or weighing less than 17.1 kg had a higher risk of requiring reintervention, suggesting that delaying the procedure until these thresholds are met may reduce the risk of complications unless clinically necessary.  

The authors performed a systematic review and meta-analysis to estimate the pooled mortality, morbidity, and reoperation rates after common arterial trunk primary repair. Among 319 articles retrieved, 43 studies including 4,844 patients met the inclusion criteria. The pooled early mortality was 11.23 percent (95 percent CI, 9.4-13.37). There was no difference in early mortality rates between multicenter and single-center studies. A sub-analysis comparing neonatal and nonneonatal repair groups showed a significantly lower mortality rate in the neonatal group (P < .001). At follow-up, the pooled mortality was 0.72 percent per year (95 percent CI, 0.51-0.93), and the reoperation rate for the right ventricle pulmonary artery conduit was 3.4 percent per year (95 percent CI, 2.24-4.57). This meta-analysis supports the current tendency of performing primary repair during the neonatal period and can serve as a benchmark for future studies. 

This study analyzed data from the UK Mini Mitral trial, which compared recovery in patients undergoing either a sternotomy or a minimally invasive thoracoscopically-guided right minithoracotomy procedure for mitral valve repair, using wrist-worn triaxial accelerometers to track physical activity and sleep. Results indicated that the minimally invasive approach led to significantly higher total activity counts and more time spent in moderate-to-vigorous physical activity at six- and 18-weeks post-surgery, along with lower sedentary time. Overall, the findings suggest that wearable accelerometers are effective for assessing recovery after cardiac surgery. 

Sanad and colleagues report promising early- to mid-term outcomes of aortic valve neocuspidization (AVNeo), commonly known as the Ozaki procedure, in patients with rheumatic heart disease. 
 
The study was conducted in Egypt, where rheumatic heart disease remains prevalent. Over a nearly four-year period, 33 patients with rheumatic disease underwent AVNeo, with a mean age of approximately 39 years. Overall survival was excellent, with no early mortalities and only two late deaths: one due to infective endocarditis and aortic root abscess three years postoperatively, and the other from COVID-19 approxiamtely two weeks after surgery. Two patients required early reoperations: one for bleeding and the other for aortic insufficiency due to failure of the right neo-cusp, which the authors attribute to suture line dehiscence. One patient required permanent pacemaker implantation one year after surgery, potentially due to conduction tissue injury during debridement. 
 
Despite the relatively young age of the cohort, AVNeo was favored over other valve replacement options for its potential to reduce the need for future reoperations and to avoid lifelong anticoagulation. The authors also emphasize the cost-effectiveness of AVNeo, particularly highlighting its relevance in low- to middle-income and resource-limited settings. 
 
Overall, this study supports AVNeo as a promising surgical option with favorable early and mid-term outcomes in a challenging patient population.