Hendrik Treede

Tricuspid regurgitation (TR) is a clinical syndrome in which integrated multimodality imaging is central to diagnosis, timely referral, procedural selection, and assessment of treatment success. This narrative state-of-the-art review focuses on the imaging information that changes decisions along the surgical pathway while positioning surgery within contemporary transcatheter practice. Transthoracic echocardiography remains the gateway examination; three-dimensional transoesophageal echocardiography refines leaflet and annular anatomy; cardiac magnetic resonance provides the most reproducible assessment of right ventricular volumes and function; and cardiac computed tomography defines annular geometry, adjacent structures, device leads, and access. We distinguish guideline-endorsed thresholds from observational or consensus-derived decision aids and link mechanism, annular dilatation, leaflet tethering, right ventricular reserve, pulmonary haemodynamics, and end-organ risk to the choice of repair, replacement, transcatheter therapy, or surveillance. Particular emphasis is placed on perioperative imaging: the effects of anaesthesia and loading conditions, accurate septolateral annular measurement, the definition of an acceptable post-bypass result, and the significance of central vs. eccentric residual jets. A dedicated section compares imaging requirements for transcatheter edge-to-edge repair and transcatheter tricuspid valve replacement and summarizes post-procedural surveillance. The central message is that imaging does not replace clinical judgement; it provides the shared language through which the Heart Team selects the right intervention before irreversible right-heart and end-organ damage develops.

Background: Ventricular septal rupture is a rare but devastating complication of acute myocardial infarction, frequently associated with cardiogenic shock and poor prognosis. Data regarding successful treatment strategies remain limited, and operative mortality significantly decreases when surgery can be delayed by 7–14 days. Case Summary: We present the case of a 61-year-old patient diagnosed with a posterior transmural myocardial infarction complicated by a large ventricular septal rupture. Right heart catheterization showed significant right ventricular (RV) overload, with elevated right atrial pressure (20 mmHg), right ventricular end-diastolic pressure (22 mmHg), and an elevated mean pulmonary artery pressure (44 mmHg). Due to the cardiogenic shock, we reduced the left-to-right shunt and achieved right ventricular unloading using a percutaneous microaxial flow pump (mAFP) with 5.5 L/min support as a bridge to surgical repair. This hemodynamic stabilization enabled a novel approach using triple patch reconstruction for post-infarction ventricular septal rupture. Discussion: This case highlights the effectiveness of early hemodynamic support with percutaneous mAFP in stabilizing patients with acute ventricular septal rupture, facilitating delayed surgical intervention, allowing time for infarct tissue to scar. The combined use of advanced surgical techniques and mechanical support may represent a key strategy in the management of this complex condition.

Objective: To avoid potential groin incision associated complications and further streamline surgery percutaneous femoral cannulation using different vascular closure devices (VCDs) has emerged to establish cardiopulmonary bypass during minimally invasive heart valve surgery (HVS). Design: The Percutaneous peRipheral cannulatiOn for Minimally InvaSive heart valve surgEry (PROMISE) multicentre registry included patients, receiving percutaneous vascular access site (VAS) closure during minimally invasive HVS. Retrospective analyses were performed to evaluate major and minor VAS-related complications of plug- (group 1) vs suture-based (group 2) systems according to modified Valve Academic Research Consortium (VARC) 3 criteria (ie, retrograde dissection, vascular injury, conversion to surgical cut-down, or vascular intervention). Results: In total, 755 patients (66.1% (499/755) male; median age 61.9 years) were included and treated using a plug- (n = 450) or suture-based (n = 305) VCD. Most prevalent comorbidities were hypertension (53.8%; 335/755) and atrial fibrillation (29.4%; 222/755), resulting in a median STS Prom Score of 0.5%. Prevalence of peripheral artery disease was 4.4% (33/450). Immediate hemostasis was significantly higher in the plug-based group (99.8% (445/450) vs 77.7% (237/305); P < .001). Accordingly, application of a second VCD (0.0% (0/450) vs 34.8% (106/305); P < .001) as well as conversion rates to surgical cut-down (1.3% (6/450) vs 3.9% (12/305); P = .04) were significantly lower. Prevalence of VAS-related complications (ie, arterio-venous (AV) fistula (0.2% (1/450) vs 0% (0/305); P > .99), pseudoaneurysm (0.4% (2/450) vs 0% (0/305); P = .66), or postoperative VAS bleeding (1.6% (7/450) vs 0.7% (2/305); P = .26)) was low in both the groups (2.9% (13/450) vs 5.2% (16/305); P = .14). Conclusions: VAS-related complications were favourably low in both the groups. Plug-based VCDs are potentially associated with significantly higher rates of immediate hemostasis and lower incidence for additional VCD or surgical cut-down. Usage of dedicated VCD (plug- and suture-based) for VAS closure after percutaneous cannulation is feasible, safe, and further decreases invasiveness in minimally invasive HVS.

Primary mitral regurgitation is a valvular heart disorder that found to be treated with surgery that has been the gold standard for decades with different techniques to approach this pathology. In the last decade, Transcatheter Edge-to-Edge Repair emerged as a valid option for this type of pathology, in case of surgical unsuitability. Others device emerged as well leaving less remark compared with Transcatheter Edge-to-Edge Repair. The article analyse the old and new frontiers as well as the controversies of this phenotype.

Aims: To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults undergoing transcatheter aortic valve implantation (TAVI). Methods and results: We followed the European Society of Cardiology (ESC) methodology for the development of QIs. Key domains were identified by constructing a conceptual framework for the delivery of TAVI care. A list of candidate QIs was developed by conducting a systematic review of the literature. A modified Delphi method was then used to select the final set of QIs. Finally, we mapped the QIs to the EuroHeart (European Unified Registries on Heart Care Evaluation and Randomized Trials) data standards for TAVI to ascertain the extent to which the EuroHeart TAVI registry captures information to calculate the QIs. We formed an international group of experts in quality improvement and TAVI, including representatives from the European Association of Percutaneous Cardiovascular Interventions, the European Association of Cardiovascular Imaging, and the Association of Cardiovascular Nursing and Allied Professions. In total, 27 QIs were selected across 8 domains of TAVI care, comprising 22 main (81%) and 5 secondary (19%) QIs. Of these, 19/27 (70%) are now being utilized in the EuroHeart TAVI registry. Conclusion: We present the 2023 ESC QIs for TAVI, developed using a standard methodology and in collaboration with ESC Associations. The EuroHeart TAVI registry allows calculation of the majority of the QIs, which may be used for benchmarking care and quality improvement initiatives.

Daniel-Sebastian Dohle, Philipp Pfeiffer, Chris Probst, Hendrik Treede; Acute Type I aortic dissection: “is simultaneous descending stent grafting justified?”,

Daniel-Sebastian Dohle, Philipp Pfeiffer, Chris Probst, Hendrik Treede; Andexanet Alfa and Heparin Resistance in Cardiac Surgery: Experiences and risks associat