Background: Renal function is a crucial factor affecting the prognosis of patients with end-stage heart failure (HF). The differential impacts of heart transplantation and left ventricular assist device (LVAD) implantation on renal function are unclear. Therefore, we compared the perioperative renal function changes in patients who underwent heart transplantation with that of patients who underwent LVAD implantation.

Methods: This study included 77 patients who underwent heart transplantation and 59 patients who underwent LVAD implantation at five hospitals between January 2019 and December 2023. These patients were divided into two groups based on surgery type: heart transplantation or LVAD implantation. The estimated glomerular filtration rates (eGFRs) before surgery and on postoperative days (PODs) 1, 7, and 30 were compared. A subgroup analysis was conducted for patients with preoperative renal dysfunction, and paired-samples t-tests were used to compare renal function changes before and one month after surgery.

Results: Patients in the LVAD group were older (56.4 vs. 44.4 years, P<0.001) and had lower preoperative eGFRs (72.5 vs. 91.3 mL/min/1.73 m², P=0.001) than patients in the heart transplantation group did. On POD 1 and POD 7, the LVAD group continued to have a lower eGFR than the heart transplantation group. The baseline eGFRs were not significantly different (63.3 vs. 60.4 mL/min/1.73 m², P=0.44) in patients with preoperative renal dysfunction (eGFR <90 mL/min/1.73 m²). However, on PODs 1, 7, and 30, the eGFR in the LVAD group was significantly greater than that in the heart transplantation group. By POD 30, renal function in the LVAD group had recovered to near-normal levels (60.4–87.6 mL/min/1.73 m²), whereas in the heart transplantation group, the eGFR remained close to the preoperative level (63.3–63.4 mL/min/1.73 m²). In the LVAD group, the eGFR significantly increased on POD 30, with 84.7% (50/59) of the LVAD patients showing varying degrees of improvement in renal function. In the heart transplantation group, patients’ eGFRs on POD 30 were comparable to their preoperative values, with more than half of them showing a decreased eGFR. Among the patients with preoperative renal dysfunction, 10 without a history of preoperative continuous renal replacement therapy (CRRT) underwent postoperative CRRT in the heart transplantation group; nine of them died within three months of transplantation. In the LVAD group, three patients without preoperative CRRT support required CRRT postoperatively, with one case of early mortality.

Conclusions: For patients with end-stage HF and concurrent renal dysfunction, compared to heart transplantation, LVAD implantation with this new device resulted in significantly improved renal function. With no malfunctions, the device operated in a safe and effective manner and was successfully managed to improve renal function.

Keywords: Left ventricular assist device (LVAD); heart transplantation; renal function; end-stage heart failure (end-stage HF)

Background: Currently, mitral valve replacement is the primary method of reintervention for patients with rheumatic heart disease (RHD) after percutaneous mitral balloon commissurotomy (PMBC). This study aims to investigate the feasibility of mitral valve repair in such patients and report its therapeutic outcomes compared to mitral valve replacement.

Methods: Data from patients with previous PMBC who underwent mitral valve surgery as disease progression between January 2011 and August 2023 were retrospectively analyzed. The patients were divided into two groups: the repair group and the replacement group. The stabilized inverse probability of treatment weighting (SIPTW) method was used to balance baseline characteristic differences between the two groups. Clinical outcomes investigated included freedom from mitral valve reoperation and overall survival. Survival curves were generated with the Kaplan-Meier (K-M) method, and differences between groups were compared using the Log-rank test.

Results: A total of 210 patients were included in this study (32 in the repair group and 178 in the replacement group), with an average age of 56.6±10.0 years. After SIPTW, the baseline characteristics between the two groups were comparable. The median follow-up time for the entire cohort was 75.6 months. K-M analysis, adjusted for SIPTW, showed no significant differences between the two groups in terms of freedom from mitral valve reoperation and overall survival (Log-rank P=0.07 and 0.36, respectively).

Conclusions: According to our results, even if patients with RHD have previously undergone PMBC, there is still a possibility of mitral valve repair in suitable patients, with good clinical outcomes.

Keywords: Rheumatic heart disease (RHD); percutaneous mitral balloon commissurotomy (PMBC); mitral valve repair; mitral valve replacement

Intermountain Health cardiovascular clinician and researcher Viet Le, DMSc, MPAS, PA-C, FACC, will serve as the next editor of the American College of Cardiology’s CardioSmart program. Le is the first non-physician leader of the program.

Researchers have developed cutting-edge MRI technology to diagnose a common heart problem more quickly and accurately than ever before.

Aortic stenosis is a progressive and potentially fatal condition, affecting about five per cent of 65-year-olds in the US - with increasing prevalence in advancing age. 

Symptoms include chest pains, a rapid fluttering heartbeat and feeling dizzy, short of breath and fatigued – particularly with activity.

The new study reveals how a four-dimensional flow (4D flow) MRI scan can diagnose aortic stenosis more reliably than current ultrasound techniques.

The superior accuracy of the new test means doctors can better predict when patients will require surgery.