Cardiothoracic Surgery

Lower-volume TAVR and MTEER operators have worse 30-day outcomes in a national registry

This TVT Registry cohort included 358,943 TAVR and 51,407 MTEER procedures from 2020 to 2023 at 827 and 493 US hospitals, respectively. Low-volume TAVR operators (<15 cases/year) had higher adjusted 30-day mortality than high-volume operators (>37/year) (OR 1.13, 95% CI 1.02–1.26). They also showed higher in-hospital complication rates (OR 1.09, 95% CI 1.03–1.16) and inferior process-of-care measures. For MTEER, low-volume operators (<8/year) had higher in-hospital complications (OR 1.31, 95% CI 1.11–1.56) than higher-volume operators. These findings support explicit operator-volume expectations and structured proctoring when expanding structural valve programs. 1

Consensus favors minimalist anesthesia with selective monitoring for transfemoral TAVI

An Italian interdisciplinary panel used the RAND/UCLA method to rate 1,032 scenarios for transfemoral TAVI anesthesia management. Local anesthesia and conscious sedation were considered appropriate for most clinical situations, including many higher-risk patients. Additional arterial or central venous catheters were recommended only in selected high-risk cases rather than as routine practice. Nurse-administered anesthesia, pulmonary artery catheterization, and pulse-wave cardiac output monitoring were deemed inappropriate in all scenarios. General anesthesia and deep sedation were usually inappropriate but retained uncertainty in specific complex or unstable contexts. 2

Lower INR targets for mechanical valves offer no bleeding benefit and may raise thromboembolic risk

This nationwide cohort included 3,473 mechanical heart valve patients treated with vitamin K antagonists across 17 anticoagulation clinics. Lower therapeutic INR ranges were associated with poorer anticoagulation control compared with higher traditional ranges. Lower ranges were not linked to fewer major or clinically relevant bleeding events (adjusted HR 0.80, 95% CI 0.57–1.10). In patients with non-aortic valves and/or added risk factors, lower targets were possibly associated with more thromboembolism (adjusted HR 1.3, 95% CI 0.94–1.9). No clear thrombotic difference appeared in isolated aortic valves, but absence of bleeding benefit argues against broadly lowering INR targets. 3