Volume 41 - Issue 1

INTRODUCTION: Several clinical trials have demonstrated the non-inferiority of transcatheter aortic valve replacement compared with surgical aortic valve replacement in patients with severe aortic stenosis and low to intermediate surgical risk. However, mid-term results are still contentious. We performed this meta-analysis to compare the safety and efficacy of transcatheter vs. surgical aortic valve replacement in the mid-term in patients with aortic stenosis at low to moderate surgical risk.
METHODS: We searched Embase, PubMed^®, and Cochrane databases for randomized clinical trials that compared transcatheter with surgical aortic valve replacement in patients with symptomatic severe aortic stenosis with a follow-up of at least four years. Outcomes of interest were all-cause mortality and disabling stroke.
RESULTS: We included six randomized clinical trials encompassing 6,444 patients with severe aortic stenosis, of whom 3,282 (50.9%) underwent transcatheter aortic valve replacement. There was no difference in all-cause mortality (risk ratio [RR] 1.08; 95% confidence interval [CI] 0.94 - 1.25; P = 0.30) and disabling stroke (RR 0.95; 95% CI 0.75 - 1.21; P = 0.67) between groups. In the subgroup analysis, five-year mortality (RR 1.28; 95% CI 1.10 - 1.49) was higher in the transcatheter group. The new pacemaker implantation (RR 2.22; 95% CI 1.42 - 3.45) rate was higher in the transcatheter group. However, the new atrial fibrillation (RR 0.40; 95% CI 0.31 - 0.52) rate was higher in the surgical group.
CONCLUSION: Mid-term mortality and disabling stroke rates in patients with severe aortic stenosis treated with either transcatheter or surgical aortic valve replacement were similar.

INTRODUCTION: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker for heart stress and heart failure, with its production triggered by the stretching of cardiac fibers. This study investigates if elevated NT-proBNP levels can independently predict poor outcomes for patients undergoing heart surgery.
METHODS: A systematic review was performed in the PubMed^®, Latin American and Caribbean Health Sciences Literature (or LILACS), Physiotherapy Evidence Database (PEDro), Web of Science, and Embase databases, with the following descriptors: "NT-proBNP" OR "NTproBNP" OR "N- terminal pro-B-type natriuretic peptide" OR "N- terminal pro brain natriuretic peptide" OR "amino terminal pro brain natriuretic peptide" AND "Cardiovascular Surgical Procedures" NOT "Pediatric" OR "children" NOT "cancer" OR "oncology" NOT "animal*". Articles that evaluated NT-proBNP and adverse outcomes in cardiac surgical patients were chosen. The levels of evidence and the strength of recommendation were assessed considering the Grading of Recommendations, Assessment, Development and Evaluation (or GRADE) system and validity by the PEDro scale. For systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (or PRISMA) criteria and the Population, Intervention, Comparison, Outcome (or PICO) strategy were followed.
RESULTS: Forty-seven articles were included, of which 17 were related to serious complications, including mortality.
CONCLUSION: Preoperative NT-proBNP is a prognostic marker for mortality, length of stay in the postoperative intensive care unit, postoperative acute kidney injury, postoperative atrial fibrillation, postoperative low cardiac output, postoperative prolonged mechanical ventilation time, prolonged hospitalization time, unscheduled hospital readmission related to heart problems, and postoperative heart failure.

The rising cardiovascular disease burden in Africa necessitates a strengthened healthcare system including enhanced access to cardiac surgery, the definitive treatment for several surgical cardiovascular diseases. Though open-heart surgery, the most invasive type of cardiac surgery, was already possible in Africa over five decades ago, with pioneering surgeons performing atrial septal defect repairs via surface cooling in Ghana as early as 1964, its development across the continent has been hindered by significant challenges. This study highlights the challenges faced by both established and nascent open-heart surgery programs across Africa. We further identify key areas for sustaining and expanding open-heart surgery programs, including robust training for surgeons and support staff, resource allocation, and enhanced capacity building. By systematically analyzing the landscape of open-heart surgery in Africa, this paper proposes a multifactorial approach to overcome these limitations and ensure equitable access to this life-saving intervention for a vastly underserved population.

The neocuspidization technique using autologous pericardium (AVNeo^®) is a recent alternative for aortic valve replacement in selected patients. Between 2019 and 2023, we applied it in 56 patients, evaluating surgical outcomes, survival, reintervention rates, and clinical and echocardiographic results. We analyzed its advantages, patient selection criteria, limitations, and management of bicuspid valves. We also assessed whether it is suitable for all patients and discussed the midterm outcomes observed. AVNeo^® may offer a promising option, especially for younger patients, by preserving native anatomy and avoiding prosthetic materials, though long-term data and further research are still needed.