Vol. 30 No. 1 (2025)

Background: Eptifibatide is a known antiplatelet that is used in patients undergoing percutaneous coronary intervention for ACS, and it is proven to have a positive outcome. Despite thrombocytopenia not being reported in the pivotal trials, the emerging literature associated this link. We aim to further investigate this association and provide real-world data from a single centre. Methods: A retrospective study was conducted in Heart Hospital at Hamad Medical Corporation from 2016 to 2022. All patients admitted with ACS and received Eptifibatide were included in the study. Patients with confirmed secondary causes of thrombocytopenia were excluded. The data is reported in the form of mean, median, standard deviation, interquartile range, and percentage. Results: Twenty-six patients met the inclusion criteria, with an average age of 54 ± 11 years, and all patients were males. The baseline platelets count was 157 ± 80, and haemoglobin was 14 ± 2. Fourteen patients had platelets drop by more than 50% of their baseline. Thrombocytopenia developed after eptifibatide infusion by 36 ± 29. The average haemoglobin post-eptifibatide infusion was 13.5 ± 1.7 g/dL. Three patients required platelet transfusion, 23 patients were managed conservatively, and one patient died. Conclusion: Eptifibatide can cause life-threatening thrombocytopenia, which can be simply reversed by ceasing the infusion. However, platelet transfusion might be necessary in some patients. Neither the mechanism nor the risk factors are clear, and further studies are recommended to understand this association better.

Objective: Infective endocarditis requires prompt recognition and treatment due to its high mortality and morbidity rates. Few studies compare long-term patient outcomes after mitral and aortic valve endocarditis surgery. Hence, we aim to assess this in our cohort. Methods: We included adult patients aged 18 and above who underwent surgery between April 2011 and April 2021 for first-time native aortic or mitral valve endocarditis in our study. Patients were followed up until July 2024. Results: 94 patients were included in our study. Streptococcus was the most common bacterial species causing infective endocarditis and was more prevalent in the aortic group than the mitral group. Conversely, Staphylococci were more common in the mitral group. Patients undergoing mitral valve surgery had longer bypass and cross-clamp times compared to the aortic group. There was no statistical difference between aortic valve (AV) and mitral valve (MV) endocarditis in early post-operative re-exploration rates, post-operative cerebrovascular accidents (CVA), or post-operative dialysis. Patients with AV and MV endocarditis had comparable in-hospital and 1-year post-surgery mortality rates. Although the mortality rate for aortic valve endocarditis was higher at both 5-year and 8-year follow-ups, it was not statistically significant. Conclusions: Despite some differences in peri-operative variables, there was no significant difference in short- and long-term mortality rates after aortic and mitral valve endocarditis surgery.

Background and aim of the study: During the COVID-19 pandemic in Bavaria, surgical ICU resources were reallocated, and elective procedures were postponed, impacting the management of infective endocarditis (IE). This study evaluated early surgical outcomes in patients with native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE) before and during the pandemic. Methods: We retrospectively analyzed 94 patients (66% male) treated pre-pandemic (August 2018–March 21, 2020) and 84 patients (76% male) treated during the pandemic (March 22, 2020–November 2021). NVE cases comprised 78% pre-pandemic and 68% during the pandemic, while PVE cases increased from 22% to 32%. Preoperative characteristics, surgical urgency, postoperative complications, and in-hospital mortality were assessed. Explanted valves underwent histological, microbiological, and molecular analyses, including fluorescence in situ hybridization (FISH) with 16S rRNA PCR/sequencing. Results: During the pandemic, preoperative NYHA class III-IV increased significantly (NVE: 49% to 74%; PVE: 29% to 70%; all p<0.05). Urgent surgeries became more frequent (NVE: 27% to 49%, p=0.017; PVE: 20% to 52%, p=0.034), and the interval from diagnosis to surgery in PVE patients was prolonged (11 vs. 16 days, p=0.038). More complex procedures, including double-valve surgeries, were required (9.5% vs. 37%, p=0.022). Postoperatively, re-thoracotomy rates increased in NVE cases (OR: 9.106, p<0.001), while odds ratios for stroke, sepsis, and prolonged ICU stay in PVE patients trended higher but lacked statistical significance. Conclusion: The pandemic led to diagnostic delays, worsened preoperative conditions, and increased surgical urgency in IE patients, underscoring the need for resilient healthcare strategies to maintain timely surgical care during future crises.

Background and Study Aims: Rheumatic heart disease (RHD) remains a leading cause of mitral valve disease globally, particularly in developing countries, where it poses a significant burden on cardiovascular health. Mitral valve repair (MVP) and replacement are the primary surgical interventions; however, the optimal selection between these procedures remains a subject of ongoing debate. This study aims to systematically review the clinical outcomes of MVP in patients with RHD and compare them with those of mitral valve replacement (MVR), thereby addressing a critical gap in the existing literature. Methods: This study adopts a systematic review methodology in accordance with PRISMA guidelines to screen relevant literature published between 2000 and 2024. The data sources for this study include PubMed, Embase, and the Cochrane Library. The key outcome measures include early mortality (defined as death from any cause within 30 days post-surgery), long-term survival, reoperation rates, and valve-related complications. Results: Five studies encompassing a total of 3,543 patients were analyzed. Compared with MVR, MVP demonstrated a non-significant trend toward lower 30-day mortality (OR 0.74, 95% CI 0.50–1.10; P = 0.14). Long-term survival appeared to favor MVP, with a hazard ratio (HR) of 0.63 (95% CI 0.35–1.11; P = 0.11), although without reaching statistical significance. MVP was associated with a significantly higher risk of reoperation (HR 3.85, 95 % CI 2.18–6.78; P < 0.00001), but a substantially lower incidence of valve-related complications, including thromboembolic events and infective endocarditis (HR 0.36, 95% CI 0.21–0.61; P < 0.001). Conclusions: MVP in patients with RHD reduces early mortality, improves long-term survival, and lowers the incidence of valve-related complications. However, it is associated with a higher risk of reoperation.

Background and aim of the study: Minimally invasive approaches for aortic valve replacement (AVR) are clinically beneficial for patients but are more technically demanding for surgeons. Sutureless AVR is a new and minimally invasive approach. The study aim was to evaluate initial AVR outcomes in patients aged >75 years after setting up a sutureless minimally invasive surgery program. Methods: Between January 2014 and December 2015, a total of 108 patients aged >75 years with indication of isolated elective AVR received a sutureless bioprosthesis using the minimally invasive approach (sutureless group). The latter group was compared with a second group of patients (n = 115) who received a stented valve through a full median sternotomy (stented group) at the authors’ institution between January 2012 and December 2013. After propensity score matching, 95 pairs of patients were available for analysis. Results: Preoperative demographic variables were similar between the matched groups. The aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times were each shorter in the sutureless group (p <0.01). Perioperative mortality was 1% in the stented group, but no mortality occurred in the sutureless group (p = 0.32). Early postoperative extubation, intensive care unit and hospital stays, need for transfusion, and overall hospital stay were lower in the sutureless group. Frequency of pacemaker implantation was higher in the sutureless group than in the stented group (8.3% versus 1.9%; p = 0.05). Aortic transvalvular gradients were lower in the sutureless group (p = 0.01). Conclusion: In the authors’ experience, the sutureless aortic valve was a useful tool for establishing a minimally invasive AVR program. The technique was safe, and the shorter ACC and CPB times increased the likelihood of early extubation, reduced the need for blood transfusions, and demonstrated good hemodynamic performance. Patients who underwent sutureless AVR showed an increased need for pacemaker implantation.

Background and Aim of the Study: An incompetent bicuspid aortic valve (BAV) can be treated through valve replacement or repair using various surgical techniques. This study presents the outcomes of a 13-year single-surgeon experience in BAV repair and compares two annuloplasty techniques: external and subcommissural aortic annuloplasty. Materials and Methods: A total of 150 consecutive patients (111 males; mean age: 43.2 ± 17.5 years) with BAV insufficiency, with or without aortic dilatation, underwent valve repair at three institutions. Multivariable logistic regression was used to identify associations between risk factors and major adverse events. Among these, 50 patients were prospectively assigned to one of two groups based on the annular stabilization technique: Group EA received external annuloplasty, while Group SCA underwent subcommissural annuloplasty. All patients in both groups were evaluated by transthoracic echocardiography before surgery and two years postoperatively. Results: There was no in-hospital mortality, and all patients survived throughout the follow-up period. Nine patients (6%) developed moderate to severe postoperative insufficiency and required reoperation. The Kaplan–Meier estimated freedom from reoperation at eight years was 100% in patients who did not undergo subcommissural annuloplasty, compared to 81% in those who did (p = 0.037). External annuloplasty was associated with a significantly smaller postoperative aortic annulus diameter (24.1 ± 2.6 mm vs. 25.8 ± 2.1 mm, p < 0.05), and lower mean and peak transvalvular gradients (7 ± 4 mmHg vs. 13 ± 4 mmHg, p = 0.02; and 15.3 ± 9.7 mmHg vs. 20.7 ± 5.6 mmHg, p = 0.03, respectively). Aortic root or ascending aorta replacement was also found to be a predictor of repair durability (p = 0.0039). Conclusions: Bicuspid aortic valve repair provides favorable short- and midterm outcomes. External annuloplasty offers superior annular stabilization and hemodynamic performance compared to subcommissural annuloplasty. Additionally, concomitant aortic replacement further improves the long-term durability of the repair.

Infective endocarditis (IE) is a rare but life-threatening cardiac condition. Healthcare-associated infective endocarditis (HAIE) is an emerging subtype that occurs more than 48 hours after hospital admission, often following invasive procedures. Its occurrence in patients with end-stage kidney disease (ESKD) is not uncommon. Prosthetic valve endocarditis may also be healthcare-associated (HA-PVE) when it develops within one year of valve replacement. Antimicrobial-resistant Staphylococcus species are increasingly implicated in both forms. Amidst a paucity of data on HAIE in Nigeria, we report a case series involving both native valve HAIE in ESKD patients and prosthetic valve HAIE (HA-PVE). These cases were identified over one year in a 150-bed private tertiary healthcare institution in Southwest Nigeria. Patients were diagnosed based on the modified Duke’s criteria. HAIE was attributed to central-line cannulation in ESKD patients, while HA-PVE occurred within a year of valve surgery. Methicillin-resistant Staphylococcus species were the causative pathogens. Elevated erythrocyte sedimentation rates and neutrophilia were consistent findings. This study emphasizes the importance of early and thorough cardiovascular evaluation in ESKD patients with central-line access to facilitate early IE detection. Hemogram and sepsis biomarkers may serve as adjuncts to blood culture in confirming diagnosis. Glycopeptide antibiotics should be considered as first-line empirical therapy. Healthcare-associated IE involving native and prosthetic valves can present with diverse symptoms. The aforementioned diagnostic and management strategies are particularly relevant in resource-limited settings.

Calcific aortic stenosis (AS) is the most common valvular heart disease requiring invasive intervention. While the implantation of an artificial heart valve restores normal intracardiac hemodynamics, baseline left ventricular (LV) parameters can significantly influence both early and long-term postoperative outcomes. It is well-established that patients with LV dilation experience worse outcomes after surgical or transcatheter treatment of severe AS compared to those with normal LV dimensions. However, the impact of reduced LV volume remains insufficiently explored. This study aims to investigate the effect of small LV dimensions on clinical outcomes in the management of severe high-gradient AS, based on existing literature. We conducted a scoping review using PubMed, Google Scholar, and Elibrary databases. Articles published between 2015 and 2024 were included, though earlier publications were also referenced to support specific sections. Both original research articles and systematic reviews were examined. The central focus of this study is to investigate the impact of small LV size on clinical outcomes in patients undergoing treatment for severe high-gradient AS. According to the existing literature, small LV size is associated with significantly higher 30-day and 2-year all-cause mortality (20.8% vs. 14.3%; adjusted HR, 1.58 [95% CI, 1.20–2.09]; p = 0.0013) and cardiovascular mortality (8.8% vs. 5.5%; adjusted HR, 1.93 [95% CI, 1.25–2.98]; p = 0.0028). Furthermore, considerable emphasis has been placed on the low transvalvular flow (low flow–high gradient) pattern, which represents a critical predictor of clinical outcomes in severe AS. Notably, the 2-year cardiovascular event-free survival rate in patients exhibiting the low flow–high gradient pattern is 30 ± 12%. These findings underscore the importance of LV size and flow patterns in prognostic assessments and therapeutic decision-making for severe AS. The authors emphasize that these patterns require further investigation for early identification and minimization of perioperative risks, determination of optimal timing for surgical or transcatheter intervention, and improvement of prognosis for patients following treatment of severe aortic stenosis.

Heart valve replacements are life-saving procedures essential for patients with dysfunctional heart valves. The global market for prosthetic heart valves is valued at approximately USD 8.71 billion in 2024, with devices available in various forms, including mechanical, transcatheter, and biological valves used for both replacement and repair procedures. While traditional prosthetic valves have improved survival, they present several limitations that contribute to postoperative complications over time. These include limited durability, the need for long-term anticoagulation due to clot formation linked to immune responses, mechanical valve noise (often described as clicking or squishing sounds), the inability to accommodate growth in pediatric patients, and suboptimal anatomical fit for certain individuals with complex health conditions. Moreover, common complications associated with these valves include stroke, bleeding, and leakage around valve flaps following surgery. In contrast, emerging 3D printed heart valves, fabricated from advanced co-polymers, show promise in early laboratory studies, demonstrating excellent tissue compatibility and the potential to reduce or eliminate the need for lifelong blood-thinning medications