Asian Cardiovascular and Thoracic Annals

Valve-in-valve transcatheter aortic valve implantation (TAVI) has been confirmed as effective. Additionally, aortic annular enlargement has been advocated to avoid small valves at initial surgery, because they can cause patient-prosthesis mismatch, particularly after TAVI in surgical aortic valve replacement (SAVR). However, results remain unclear for TAVI with a small initial aortic valve in small body size patients. The purpose is to clarify the TAVI valve function after a small surgical valve in a small body population.

We retrospectively screened 52 cases of TAVI in SAVR performed from 2018 to 2024. Post-procedural TAVI valve function and post-procedural New York Heart Association (NYHA) functional class were examined.

Of 52 TAVI in SAVR cases, 16 cases had a 19 mm initial surgical aortic valve, and 19 cases had 21 mm. The mean age of these 35 cases was 83.1 years old and 20% were male. Mean body surface area was 1.39 cm². After TAVI in SAVR in 35 cases, the mean pressure gradient was 18.5 mmHg, and the effective orifice area (EOA) was 1.10 cm². Even after 19-mm SAVR, the mean pressure gradient was 13.4 mmHg, and EOA was 1.13 cm², excluding 3 cases of off-label use and 3 cases of balloon-expandable valves. At the time of last follow-up, 86.2% of survivors remained in NYHA I or II.

Self-expanding TAVI in a certain type of SAVR provided sufficient valve function in a population with small body size, even after small-sized initial surgical prostheses. Surgeons need to ensure that the proper type and size of surgical prosthesis are implanted.

Full median sternotomy is the traditional operative approach for ascending aortic aneurysm repair. Minimally invasive approaches are being used more frequently by surgeons to enhance recovery.

This is a single-institution, multi-surgeon retrospective review of adult patients who underwent elective aneurysm surgery involving the ascending aorta and proximal arch between 1 January 2015 and 30 June 2024 with and without aortic valve replacement/repair. Exclusion criteria included re-operation, aortic root procedure, and other concomitant valve procedure or coronary artery bypass grafting. Operative and short-term clinical outcomes were compared between patients undergoing upper hemi-sternotomy (UHS) and full median sternotomy (FMS).

Among 166 patients in the analysis dataset, 84 (50.6%) underwent FMS and 82 (49.4%) underwent UHS. UHS and FMS groups had similar median cardiopulmonary bypass time (129 vs. 137 min, p = 0.436) and median aortic cross-clamp time (92 vs. 96.5 min, p = 0.900). Patients undergoing UHS were more likely to be discharged home (93.9% vs. 83.3%, p = 0.032) and had a shorter length of stay (5 vs. 6 days, p < 0.001) compared to FMS. 30-day mortality occurred in one patient (1.2%) in the FMS group.

Elective aneurysm repair can be performed safely with less invasive hemi-sternotomy approaches. Minimally invasive approaches enhance recovery after surgery. Future prospective studies are needed to clarify potential benefits in postoperative pain and quality of life.

The saphenous vein graft (SVG) remains widely used in coronary artery bypass grafting (CABG). The no-touch (NT) technique offers atraumatic procedures in vein harvesting. Its effectiveness is still compared to conventional (CON) methods.

We conducted a systematic review using electronic databases, focusing on studies that compared the NT and CON techniques in CABG. The primary outcomes assessed were major adverse cardiac and cerebrovascular events (MACCE), graft patency, and leg complications. Kaplan–Meier estimates and the Cox proportional hazards model were used to analyze MACCE-free survival. This study has been registered on PROSPERO(CRD42024553619).

A total of seven studies, including three randomized controlled trials and four prospective cohort studies, encompassing 3859 patients, were included in the analysis. The NT technique showed significantly higher overall graft patency (OR 1.59; 95% CI 1.18–2.15; p < 0.001; I²= 49%), especially in the right coronary artery (OR 1.63; 95% CI 1.25–2.13; p < 0.001; I²= 0%). However, the NT technique had a higher incidence of leg complications (OR 2.49; 95% CI 1.73–3.60; p < 0.001; I²= 10%). No significant difference in 3-year MACCE-free survival (log-rank p = 0.47).

The NT SVG harvesting technique has the potential to improve patency rates, especially when utilized as a conduit to the right coronary artery territory.