Cardiothoracic Surgery

Pre-operative anaemia increases post–cardiac surgery mortality, largely via transfusion-related risk

In this nationwide Netherlands cohort of 71,053 cardiac surgery patients, 20.3% had WHO-defined pre-operative anaemia. Anaemic patients received red blood cell transfusion more often than non-anaemic patients (52.7% vs 17.5%) and had higher 120‑day mortality (4.2% vs 1.6%). After multivariable adjustment, pre-operative anaemia remained independently associated with 120‑day mortality (adjusted OR 1.66, 95% CI 1.47–1.87). Mediation analysis attributed 58.9% of the anaemia–mortality association to in-hospital red blood cell transfusion, increasing to 77.3% in patients ≥70 years. These data support anaemia optimization and transfusion-sparing strategies, particularly in older cardiac surgery candidates. 1

FFR-guided PCI reduces MACCE after TAVI versus angiography guidance

The FAITAVI trial randomized 320 elderly patients with aortic stenosis and intermediate coronary lesions undergoing TAVI to FFR-guided or angiography-guided PCI. At 12 months, FFR-guided PCI lowered MACCE versus angiography guidance (8.5% vs 16.0%; HR 0.52, 95% CI 0.27–0.99; P = 0.047). The difference was largely driven by reduced all-cause mortality with FFR guidance (HR 0.31, 95% CI 0.10–0.96). Other components of the composite endpoint were numerically lower but not individually significant. These findings support routine physiology-based lesion assessment when planning coronary revascularization in TAVI candidates with intermediate stenoses. 2

M-TEER improves outcomes and health status across baseline KCCQ strata in secondary MR

RESHAPE-HF2 randomized 505 patients with symptomatic heart failure and moderate-to-severe ventricular secondary mitral regurgitation to M-TEER plus GDMT versus GDMT alone. M-TEER reduced cardiovascular death or heart failure hospitalization across baseline KCCQ tertiles, with hazard ratios 0.71, 0.50, and 0.73 and no significant trend by tertile. M-TEER improved KCCQ clinical summary, total symptom, and overall summary scores at 1, 6, 12, and 24 months versus medical therapy alone (all P < 0.05). At 6 months, M-TEER patients had higher odds of clinically meaningful KCCQ improvement and lower odds of deterioration. These results suggest baseline health status should not be used to withhold M-TEER in appropriate secondary MR candidates. 3