European Heart Journal

Surgery is an effective therapy in the treatment of left-sided infective endocarditis (IE) in patients for whom antibiotic treatment alone is unlikely to be curative or may be associated with ongoing risk of complications. However, the interplay between indication for surgery, its risk, and timing is complex and there continue to be challenges in defining the effects of surgery on disease-related outcome. Guidelines published by the American College of Cardiology/American Heart Association and the European Society of Cardiology provide recommendations for the use of surgery in IE, but these are limited by a low level of evidence related to predominantly observational studies with inherent selection and survival biases. Evidence to guide the timing of surgery in IE is less robust, and predominantly based on expert consensus. Delays between IE diagnosis and recognition of an IE complication as a surgical indication and transfers to surgical centres also impact surgical timing. This comparison of the two guidelines exposes areas of uncertainty and gaps in current evidence for the use of surgery in IE across different indications, particularly related to its timing and consideration of operative risk.

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Association of transcatheter edge-to-edge repair with improved survival in older patients with severe, symptomatic degenerative mitral regurgitation

Giovanni Benfari, Paul Sorajja, Giovanni Pedrazzini, Maurizio Taramasso, Mara Gavazzoni, Luigi Biasco, Benjamin Essayagh, Francesco Grigioni, Richard Bae, Christophe Tribouilloy, Jean-Louis Vanoverschelde, Hector Michelena, Vinayak N Bapat, David Vancraynest, Catherine Klersy, Moreno Curti, Prabin Thapa, Maurice Enriquez-Sarano

doi : 10.1093/eurheartj/ehab910

European Heart Journal, Volume 43, Issue 17, 1 May 2022, Pages 1626â€“1635

Randomized clinical trials demonstrated transcatheter edge-to-edge repair (TEER) efficacy in improving outcome vs. medical management for functional mitral regurgitation, but limited randomized data are available for the treatment of degenerative mitral regurgitation (DMR). We aimed to compare the outcome of older patients treated with TEER vs. unoperated DMR.

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New insights into transcatheter edge-to-edge repair: filling a gap for undertreatment of primary mitral regurgitation in the elderly?

Bernard Iung, Marina Urena

doi : 10.1093/eurheartj/ehac039

European Heart Journal, Volume 43, Issue 17, 1 May 2022, Pages 1636â€“1638

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Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial

Nirat Beohar, Gorav Ailawadi, Lak N Kotinkaduwa, BjÃ¶rn Redfors, Matheus Simonato, Zixuan Zhang, Loren Garrison Morgan, Esteban Escolar, Saibal Kar, David Scott Lim, Jacob M Mishell, Brian K Whisenant, William T Abraham, JoAnn Lindenfeld, Michael J Mack, Gregg W Stone

doi : 10.1093/eurheartj/ehac026

European Heart Journal, Volume 43, Issue 17, 1 May 2022, Pages 1639â€“1648

Baseline renal dysfunction (RD) adversely impacts outcomes among patients with heart failure (HF) and severe secondary mitral regurgitation (MR). Heart failure and MR, in turn, accelerate progression to end-stage renal disease (ESRD), worsening prognosis. We sought to determine the impact of RD in HF patients with severe MR and the impact of transcatheter mitral valve repair (TMVr) on new-onset ESRD and the need for renal replacement therapy (RRT).

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Heart and kidney: towards an integrated approach to secondary mitral regurgitation

Volker Rudolph

doi : 10.1093/eurheartj/ehac084

European Heart Journal, Volume 43, Issue 17, 1 May 2022, Pages 1649â€“1651

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Endothelial cell-derived tetrahydrobiopterin prevents aortic valve calcification

Zongtao Liu, Nianguo Dong, Haipeng Hui, Yixuan Wang, Fayun Liu, Li Xu, Ming Liu, Zhenqi Rao, Zhen Yuan, Yuqiang Shang, Jun Feng, Zhejun Cai, Fei Li

doi : 10.1093/eurheartj/ehac037

European Heart Journal, Volume 43, Issue 17, 1 May 2022, Pages 1652â€“1664

Tetrahydrobiopterin (BH4) is a critical determinant of the biological function of endothelial nitric oxide synthase. The present study was to investigate the role of valvular endothelial cell (VEC)-derived BH4 in aortic valve calcification.

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Calcific aortic valve disease: novel insights into nitric oxide signalling

Simon Kraler, Vidu Garg, Alexander Akhmedov

doi : 10.1093/eurheartj/ehac050

European Heart Journal, Volume 43, Issue 17, 1 May 2022, Pages 1665â€“1667

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Genome-wide association study reveals novel genetic loci: a new polygenic risk score for mitral valve prolapse

Carolina Roselli, Mengyao Yu, Victor Nauffal, Adrien Georges, Qiong Yang, Katie Love, Lu Chen Weng, Francesca N Delling, Svetlana R Maurya, Maren SchrÃ¶lkamp, Jacob Tfelt-Hansen, Albert HagÃ¨ge, Xavier Jeunemaitre, StÃ©phanie Debette, Philippe Amouyel, Wyliena Guan, Jochen D Muehlschlegel, Simon C Body, Svati Shah, Zainab Samad, Sergiy Kyryachenko, Carol Haynes, Michiel Rienstra, Thierry Le Tourneau, Vincent Probst, Ronan Roussel, Inez J Wijdh-Den Hamer, Joylene E Siland, Kirk U Knowlton, Jean Jacques Schott, Robert A Levine, Emelia J Benjamin, Ramachandran S Vasan, Benjamin D Horne, Joseph B Muhlestein, Giovanni Benfari, Maurice Enriquez-Sarano, Andrea Natale, Sanghamitra Mohanty, Chintan Trivedi, Moore B Shoemaker, Zachary T Yoneda, Quinn S Wells, Michael T Baker, Eric Farber-Eger, Hector I Michelena, Alicia Lundby, Russell A Norris, Susan A Slaugenhaupt, Christian Dina, Steven A Lubitz, Nabila Bouatia-Naji, Patrick T Ellinor, David J Milan

doi : 10.1093/eurheartj/ehac049

European Heart Journal, Volume 43, Issue 17, 1 May 2022, Pages 1668â€“1680

Mitral valve prolapse (MVP) is a common valvular heart disease with a prevalence of >2% in the general adult population. Despite this high incidence, there is a limited understanding of the molecular mechanism of this disease, and no medical therapy is available for this disease. We aimed to elucidate the genetic basis of MVP in order to better understand this complex disorder.

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