Tamer Owais

Background: Valve-in-Valve (VIV) transcatheter aortic valve replacement (TAVR) is a potential solution for malfunctioning surgical aortic valve prostheses, though limited data exist for its use in Perceval valves. Methods: searches were performed on PubMed and Scopus up to 31 July 2023, focusing on case reports and series addressing VIV replacement for degenerated Perceval bioprostheses. Results: Our analysis included 57 patients from 27 case reports and 6 case series. Most patients (68.4%) were women, with a mean age of 76 ± 4.4 years and a mean STS score of 6.1 ± 4.3%. Follow-up averaged 9.8 ± 8.9 months, the mean gradient reduction was 15 ± 5.9 mmHg at discharge and 13 ± 4.2 mmHg at follow-up. Complications occurred in 15.7% of patients, including atrioventricular block III in four patients (7%), major bleeding or vascular complications in two patients (3.5%), an annular rupture in two patients (3.5%), and mortality in two patients (3.5%). No coronary obstruction was reported. Balloon-expanding valves were used in 61.4% of patients, predominantly the Sapien model. In the self-expanding group (38.6%), no valve migration occurred, with a permanent pacemaker implantation rate of 9%, compared to 5.7% for balloon-expanding valves. Conclusions: VIV-TAVR using both balloon-expanding and self-expanding technologies is feasible after the implantation of Perceval valves; however, it should be performed by experienced operators with experience both in TAVR and VIV procedures.

Background: Transcatheter mitral valve-in-valve (TMVIV) or valve-in-ring (TMVIR) replacement offer an alternative therapy for high risk patients. We aimed to highlight the operative and postoperative results of TMVIV and TMVIR procedures. Results: We included all patients underwent TMVIV and TMVIR procedures between 2017 and 2020 at two heart centers in Germany. We included a total of 36 high risk patients in our study where 12 received TMVIV and 24 received TMVIR. All patients underwent TMVIV or TMVIR with Edwards Sapien XT or S3 transcatheter valves (Edwards Lifesciences). The mean age was 79 (75–83 years old). The median (IQR) preoperative STS score was 9 (7–13)% and EuroSCORE II was 14.5% (12–16). The majority of our patients were operated via transapical approach (n = 26) and the minority via transseptal approach (n = 10). Out of our records, none of our patients required reopening for bleeding or any other surgical complications. None of our patients required reintervention during the 6 months follow-up period. One mortality was recorded on fifth postoperative day due to low cardiac output syndrome (obviously because of LVOT obstruction by the anterior mitral leaflet). The average blood loss was 200 ml in the first 24 h in patients underwent transapical approach. Average operative time was 93 min and all patients were immediately extubated after the procedure in the operating room (even the patient with echocardiographically documented LVOT obstruction who died on the fifth postoperative day). Length of Intensive Care Unit stay was 2 ± 1.2 days and length of hospital stay was 4.1 ± 1.2 days. In the follow up period, echocardiograms showed normal prosthetic valve function with low transvalvular gradients, no LVOT obstruction in TMVIR cases and no evidence of valve migration or thrombosis (except in one patient). Concerning 6 months readmission, it was recorded in 2 patients due to right sided heart failure symptoms due to preexisting high degree of tricuspid valve regurge which did not disappear or even decrease after the operation and the other patient due to gastrointestinal bleeding. Conclusions: TMVIV and TMVIR offer an efficient, safe and less invasive alternative in high surgical risk patients.

New transcatheter equipment and accumulated experience have stimulated further refinements in implantation techniques. We aimed to compare the outcomes of transfemoral transcatheter aortic valve replacement with and without the use of contrast medium in patients with glomerular filtration rate from Journal of Invasive Cardiology.

Background: Our objective in this multicenter retrospective study is to discuss the optimum timing for CABG after STEMI. The second question is whether the Off-Pump technique differs regarding the timing or affects the outcome compared to the On-Pump technique. Methods: Between September 2009 and June 2016 in Saudi German hospitals group in Saudi Arabia and central Hospital BadBerka in Germany, 379 STEMI patients, who were not candidates for or failed PCI; were operated for CABG. 200 (52.77%) were operated Off-Pump and 179(47.23%) On-Pump; with an age range of 36-63years. 195 males in the off-pump patients (97.5%) and 175 males (97.76%) in the on-pump patients. we arranged them into 2main groups; group A as off-Pump and group B as on-pump. Both groups were further subdivided into groups A1 (off-pump early surgery; 100 patients), group A2 (off-pump late surgery; 100 patients) group B1 (on-pump early surgery; 88 patients) and group B2 (late surgery; 91 patients). We excluded patients with Complicated PCI, Mechanical complications, Cardiogenic shock, Life threatening arrhythmias and Late presentation of ischemia or infarction after PCI. Results: 25 mortalities occurred in early operated cases. There were no intraoperative mortality in the groups operated late after the infarction, and only one late postoperative mortality in group B2. 9 mortalities in group A1 (4.5% of the off-pump CABG-9% of group A1) and 16 mortalities of group B (8.9% of group B, 15 cases in group B1; 17% and 1 case in group B2; 1.09%). There was significant statistical difference between group A and group B, A1 and A2, B1 and B2; regarding the intra-and postoperative mortality with p-value of 0.004, 0.0022, 0.001 intraoperatively and 0.0047, 0.001, 0.003 postoperatively. The postoperative duration for mechanical ventilation was longer in group B than in group A, and longer in group A1 compared to group A2. The use of intra-aortic balloon pump was more in group B than A and more in A1 compared to A2 also more in cases of group B1 than B2. The use of inotropic support was more in group B than A while it was less in A2 than A1 and more in B1 than B2. The total ICU and hospital stay were longer in cases of B than A and more in A1 than A2, also longer in B1 than B2. The intra and post operative arrhythmias and complications were more in A1 than A2 and in B1 than B2. Conclusion: The more we wait after STEMI for surgical intervention for cases not candidate or failed for primary PCI, the better the outcome of surgery With no sharp time limit for postponing the surgery.

We would like to present our experience of surgical excision of intracardiac tumors using a video-assisted minimally-invasive cardiac surgery (MIC) t