Thorac Cardiovasc Surg
DOI: 10.1055/s-0044-1786758
Review Article

Cardiac Surgery 2023 Reviewed

Hristo Kirov
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
,
Tulio Caldonazo
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
,
Murat Mukharyamov
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
,
Sultonbek Toshmatov
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
,
Johannes Fischer
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
,
Ulrich Schneider
2   Department of Cardiac Surgery, Saarland University Medical Center, Homburg Saar, Germany
,
Thierry Siemeni
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
,
Torsten Doenst
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
› Author Affiliations

Abstract

We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term “cardiac surgery AND 2023.” We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.

Supplementary Material



Publication History

Received: 06 February 2024

Accepted: 03 April 2024

Article published online:
13 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Doenst T, Schneider U, Caldonazo T. et al. Cardiac surgery 2022 reviewed. Thorac Cardiovasc Surg 2023; 71 (05) 356-365
  • 2 Doenst T, Schneider U, Can T. et al. Cardiac surgery 2021 reviewed. Thorac Cardiovasc Surg 2022; 70 (04) 278-288
  • 3 Kirov H, Caldonazo T, Diab M. et al. Koronarchirurgie–eine Literaturübersicht 2022. Z Herz Thorax Gefässchir 2023; 37: 231-236
  • 4 Caldonazo T, Kirov H, Diab M, Färber G, Mukharayamov M, Doenst T. Literaturübersicht 2022 zur Herzklappenchirurgie. Z Herz Thorax Gefässchir 2023; 37: 308-314
  • 5 Doenst T, Caldonazo T, Schneider U. et al. Cardiac surgery 2020 reviewed. Thorac Cardiovasc Surg 2021; (e-pub ahead of print). DOI: 10.1055/s-0041-1729762.
  • 6 Doenst T, Bargenda S, Kirov H. et al. Cardiac surgery 2019 reviewed. Thorac Cardiovasc Surg 2020; 68 (05) 363-376
  • 7 Mejia OAV, Meneghini B, Freitas FL. et al. The FRAGILE clinical trial: the impact of the coronary artery bypass graft in frailty. Eur Heart J 2023; 44 (02) ehad65.2282
  • 8 Mukharyamov M, Schneider U, Kirov H, Caldonazo T, Doenst T. Myocardial protection in cardiac surgery-hindsight from the 2020s. Eur J Cardiothorac Surg 2023; 64 (06) 64
  • 9 Hemmerich C, Heep M, Gärtner U, Taghiyev ZT, Schneider M, Böning A. Myocardial recovery, metabolism, and structure after cardiac arrest with cardioplexol. Thorac Cardiovasc Surg 2023; (e-pub ahead of print). DOI: 10.1055/s-0043-1772210.
  • 10 Gaudino M, Brophy JM. The controversy on the treatment of left main coronary artery disease. J Thorac Cardiovasc Surg 2022; 163 (05) 1864-1869
  • 11 Byrne RA, Fremes S, Capodanno D. et al. 2022 Joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG. Eur J Cardiothorac Surg 2023; 64 (02) ezad286
  • 12 De Filippo O, Di Franco A, Boretto P. et al. Percutaneous coronary intervention versus coronary artery surgery for left main disease according to lesion site: a meta-analysis. J Thorac Cardiovasc Surg 2023; 166 (01) 120-132.e11
  • 13 Persson J, Yan J, Angerås O. et al. PCI or CABG for left main coronary artery disease: the SWEDEHEART registry. Eur Heart J 2023; 44 (30) 2833-2842
  • 14 Tam DY, Fang J, Rocha RV. et al. Real-world examination of revascularization strategies for left main coronary disease in Ontario, Canada. JACC Cardiovasc Interv 2023; 16 (03) 277-288
  • 15 Zimmermann FM, Ding VY, Pijls NHJ. et al; FAME 3 Investigators. Fractional flow reserve-guided PCI or coronary bypass surgery for 3-vessel coronary artery disease: 3-year follow-up of the FAME 3 trial. Circulation 2023; 148 (12) 950-958
  • 16 Fearon WF, Zimmermann FM, De Bruyne B. et al; FAME 3 Investigators. Fractional flow reserve-guided pci as compared with coronary bypass surgery. N Engl J Med 2022; 386 (02) 128-137
  • 17 Mehaffey JH, Hayanga JWA, Kawsara M. et al. Contemporary coronary artery bypass grafting vs multivessel percutaneous coronary intervention. Ann Thorac Surg 2023; 116 (06) 1213-1220
  • 18 Kirov H, Caldonazo T, Riedel LL. et al. Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with left main or multivessel disease. Sci Rep 2023; 13 (01) 22323
  • 19 Gaudino M, Chadow D, Rahouma M. et al. Operative outcomes of women undergoing coronary artery bypass surgery in the US, 2011 to 2020. JAMA Surg 2023; 158 (05) 494-502
  • 20 Hannan EL, Wu Y, Harik L. et al. Coronary artery bypass surgery versus percutaneous interventions for women with multivessel coronary artery disease. J Thorac Cardiovasc Surg 2023; (e-pub ahead of print). DOI: 10.1016/j.jtcvs.2023.12.009.
  • 21 Galli M, Benenati S, Zito A. et al. Revascularization strategies versus optimal medical therapy in chronic coronary syndrome: a network meta-analysis. Int J Cardiol 2023; 370: 58-64
  • 22 Redfors B, Stone GW, Alexander JH. et al. outcomes according to coronary revascularization modality in the ISCHEMIA trial. J Am Coll Cardiol 2024; 83 (05) 549-558
  • 23 Gaudino M, Di Franco A, Spadaccio C. et al. Difference in spontaneous myocardial infarction and mortality in percutaneous versus surgical revascularization trials: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 2023; 165 (02) 662-669
  • 24 Doenst T, Haverich A, Serruys P. et al. PCI and CABG for treating stable coronary artery disease: JACC review topic of the week. J Am Coll Cardiol 2019; 73 (08) 964-976
  • 25 Doenst T, Bonow RO, Bhatt DL, Falk V, Gaudino M. Improving terminology to describe coronary artery procedures: JACC review topic of the week. J Am Coll Cardiol 2021; 78 (02) 180-188
  • 26 Diletti R, den Dekker WK, Bennett J. et al; BIOVASC Investigators. Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial. Lancet 2023; 401 (10383): 1172-1182
  • 27 Biscaglia S, Guiducci V, Escaned J. et al; FIRE Trial Investigators. Complete or culprit-only PCI in older patients with myocardial infarction. N Engl J Med 2023; 389 (10) 889-898
  • 28 Stähli BE, Varbella F, Linke A. et al; MULTISTARS AMI Investigators. Timing of complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med 2023; 389 (15) 1368-1379
  • 29 Fazel R, Yeh RW, Cohen DJ. et al. Intravascular imaging during percutaneous coronary intervention: temporal trends and clinical outcomes in the USA. Eur Heart J 2023; 44 (38) 3845-3855
  • 30 Hannan EL, Zhong Y, Cozzens K. et al. Ad hoc percutaneous coronary intervention in stable patients with multivessel or unprotected left main disease. JACC Cardiovasc Interv 2023; 16 (14) 1733-1742
  • 31 Blankenship JC, Patel K. High rates of ad hoc PCI may mandate a modified heart team approach. JACC Cardiovasc Interv 2023; 16 (14) 1743-1745
  • 32 Rappoport N, Aviel G, Shahian DM. et al. Resternotomy coronary artery bypass 1999-2018: insights from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2023; 115 (01) 62-71
  • 33 Naito S, Demal TJ, Sill B. et al. Impact of surgeon experience and centre volume on outcome after off-pump coronary artery bypass surgery: results from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry. Heart Lung Circ 2023; 32 (03) 387-394
  • 34 Gaudino M, Bakaeen FG, Sandner S. et al. Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS). Ann Thorac Surg 2023; 116 (04) 659-674
  • 35 Gaudino M, Sandner S, An KR. et al. Graft failure after coronary artery bypass grafting and its association with patient characteristics and clinical events: a pooled individual patient data analysis of clinical trials with imaging follow-up. Circulation 2023; 148 (17) 1305-1315
  • 36 Liakopoulos OJ, Kuhn EW, Hellmich M. et al; StaRT-CABG Investigators. Statin loading before coronary artery bypass grafting: a randomized trial. Eur Heart J 2023; 44 (25) 2322-2331
  • 37 Sandner S, Redfors B, Gaudino M. Antiplatelet therapy around CABG: the latest evidence. Curr Opin Cardiol 2023; 38 (06) 484-489
  • 38 Forrest JK, Deeb GM, Yakubov SJ. et al; Evolut Low Risk Trial Investigators. 4-Year outcomes of patients with aortic stenosis in the evolut low risk trial. J Am Coll Cardiol 2023; 82 (22) 2163-2165
  • 39 Mack MJ, Leon MB, Thourani VH. et al; PARTNER 3 Investigators. Transcatheter aortic-valve replacement in low-risk patients at five years. N Engl J Med 2023; 389 (21) 1949-1960
  • 40 Mack MJ, Leon MB, Smith CR. et al; PARTNER 1 trial investigators. 5-Year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015; 385 (9986) 2477-2484
  • 41 Barili F, Freemantle N, Pilozzi Casado A. et al. Mortality in trials on transcatheter aortic valve implantation versus surgical aortic valve replacement: a pooled meta-analysis of Kaplan-Meier-derived individual patient data. Eur J Cardiothorac Surg 2020; 58 (02) 221-229
  • 42 Ahmad Y, Howard JP, Arnold AD. et al. Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials. Eur Heart J 2023; 44 (10) 836-852
  • 43 Barili F, Brophy JM, Ronco D. et al; International Evidence Grading Research Initiative Targeting Transparency and Quality (INTEGRITTY). Risk of bias in randomized clinical trials comparing transcatheter and surgical aortic valve replacement: a systematic review and meta-analysis. JAMA Netw Open 2023; 6 (01) e2249321
  • 44 Sá MP, Jacquemyn X, Van den Eynde J. et al. Midterm survival of low-risk patients treated with transcatheter versus surgical aortic valve replacement: meta-analysis of reconstructed time-to-event data. J Am Heart Assoc 2023; 12 (21) e030012
  • 45 Chen Q, Malas J, Megna D. et al. Bicuspid aortic stenosis: national three-year outcomes of transcatheter versus surgical aortic valve replacement among Medicare beneficiaries. J Thorac Cardiovasc Surg 2023; (e-pub ahead of print). DOI: 10.1016/j.jtcvs.2023.12.002.
  • 46 Sá MP, Van den Eynde J, Simonato M. et al. Late outcomes of valve-in-valve transcatheter aortic valve implantation versus re-replacement: Meta-analysis of reconstructed time-to-event data. Int J Cardiol 2023; 370: 112-121
  • 47 Makkar RR, Chikwe J, Chakravarty T. et al Transcatheter mitral valve repair for degenerative mitral regurgitation. JAMA 2023; 329 (20) 1778-1788
  • 48 Thourani VH, Habib R, Szeto WY. et al. Survival after surgical aortic valve replacement in low-risk patients: a contemporary trial benchmark. Ann Thorac Surg 2024; 117 (01) 106-112
  • 49 Forrest JK, Deeb GM, Yakubov SJ. et al; Low Risk Trial Investigators. 3-Year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients with aortic stenosis. J Am Coll Cardiol 2023; 81 (17) 1663-1674
  • 50 Johnston DR, Mahboubi R, Soltesz EG. et al; Cleveland Clinic Aortic Valve Center Collaborators. Redefining “low risk”: outcomes of surgical aortic valve replacement in low-risk patients in the transcatheter aortic valve replacement era. J Thorac Cardiovasc Surg 2023; 165 (02) 591-604.e3
  • 51 Ehrlich T, Abeln KB, Froede L, Burgard C, Giebels C, Schäfers HJ. Valve-sparing aortic root replacement-for all patients?. J Thorac Cardiovasc Surg 2023; (e-pub ahead of print). DOI: 10.1016/j.jtcvs.2023.08.055.
  • 52 Jahanyar J, de Kerchove L, Arabkhani B. et al. Three decades of reimplantation of the aortic valve-the Brussels experience. Ann Cardiothorac Surg 2023; 12 (03) 244-252
  • 53 Feindel CM, Fan CS, Park J, Ouzounian M, David TE. Reimplantation of the aortic valve in patients with tricuspid aortic valve: the Toronto General Hospital experience. Ann Cardiothorac Surg 2023; 12 (03) 237-243
  • 54 El-Hamamsy I, Toyoda N, Itagaki S. et al. Propensity-matched comparison of the ross procedure and prosthetic aortic valve replacement in adults. J Am Coll Cardiol 2022; 79 (08) 805-815
  • 55 Shimamura J, Fukuhara S, Yokoyama Y, Takagi H, Ouzounian M, Kuno T. Systematic review and meta-analysis of time-to-event long-term outcomes following the Ross procedure. J Thorac Dis 2023; 15 (09) 4693-4702
  • 56 Sá MP, Tasoudis P, Jacquemyn X. et al. Long-term outcomes of patients undergoing aortic root replacement with mechanical versus bioprosthetic valves: meta-analysis of reconstructed time-to-event data. J Am Heart Assoc 2023; 12 (18) e030629
  • 57 Vogt F, Santarpino G, Fujita B. et al; GARY Executive Board. Surgical aortic valve replacement in patients aged 50-69 years-insights from the German Aortic Valve Registry (GARY). Eur J Cardiothorac Surg 2022; 62 (01) 62
  • 58 Choi Y, Ahn JM, Kang DY. et al; ADAPT-TAVR Investigators. Frequency, predictors, and clinical impact of valvular and perivalvular thrombus after transcatheter aortic valve replacement. JACC Cardiovasc Interv 2023; 16 (24) 2967-2981
  • 59 Costa G, Criscione E, Todaro D, Tamburino C, Barbanti M. Long-term transcatheter aortic valve durability. Interv Cardiol 2019; 14 (02) 62-69
  • 60 Huang Y, Schaff HV, Swarna KS. et al. Benefit of anticoagulation early after surgical aortic valve replacement using bioprosthetic valves. Mayo Clin Proc 2023; 98 (12) 1797-1808
  • 61 Wang TY, Svensson LG, Wen J. et al. Apixaban or warfarin in patients with an on-x mechanical aortic valve. NEJM Evid 2023; 2 (07) a2300067
  • 62 Törngren C, Jonsson K, Hansson EC, Taha A, Jeppsson A, Martinsson A. Medical therapy after surgical aortic valve replacement for aortic regurgitation. Eur J Cardiothorac Surg 2023; 63 (05) 63
  • 63 Stone GW, Abraham WT, Lindenfeld J. et al; COAPT Investigators. Five-year follow-up after transcatheter repair of secondary mitral regurgitation. N Engl J Med 2023; 388 (22) 2037-2048
  • 64 Boekstegers P, Hausleiter J, Schmitz T. et al; MITRA-PRO Investigators. Intraprocedural residual Mitral Regurgitation and Survival After Transcatheter Edge-to-Edge Repair: Prospective German Multicenter Registry (MITRA-PRO). JACC Cardiovasc Interv 2023; 16 (05) 574-585
  • 65 Biasco L, Klersy C, Benfari G. et al. Restoration of life expectancy after transcatheter edge-to-edge mitral valve repair. JACC Cardiovasc Interv 2023; 16 (18) 2231-2241
  • 66 Watt TMF, Brescia AA, Murray SL. et al. Does sustained reduction of functional mitral regurgitation impact survival?. Semin Thorac Cardiovasc Surg 2024; 36 (01) 37-46
  • 67 Elbadawi A, Dang AT, Hamed M. et al. Transcatheter edge-to-edge repair for mitral regurgitation using PASCAL or MitraClip. Catheter Cardiovasc Interv 2023; 102 (03) 521-527
  • 68 Badhwar V, Chikwe J, Gillinov AM. et al. Risk of surgical mitral valve repair for primary mitral regurgitation. J Am Coll Cardiol 2023; 81 (07) 636-648
  • 69 Anyanwu AC, Adams DH. Benchmarking mitral valve repair: defining standards for surgical and percutaneous treatment of severe mitral regurgitation. J Am Coll Cardiol 2023; 81 (07) 649-652
  • 70 Akowuah EF, Maier RH, Hancock HC. et al; UK Mini Mitral Trial Investigators. Minithoracotomy vs conventional sternotomy for mitral valve repair: a randomized clinical trial. JAMA 2023; 329 (22) 1957-1966
  • 71 Caldonazo T, Sá MP, Jacquemyn X. et al. Respect versus resect approaches for mitral valve repair: a meta-analysis of reconstructed time-to-event data. Am J Cardiol 2024; 213: 5-11
  • 72 Vahanian A, Beyersdorf F, Praz F. et al; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2022; 43 (07) 561-632
  • 73 Mohamed MS, Al Ali O, Hashem A. et al. Trends and outcomes of transcatheter tricuspid valve repair and surgical tricuspid valve repair in patients with tricuspid valve regurgitation; a population based study. Curr Probl Cardiol 2023; 48 (07) 101714
  • 74 Sorajja P, Whisenant B, Hamid N. et al; TRILUMINATE Pivotal Investigators. Transcatheter repair for patients with tricuspid regurgitation. N Engl J Med 2023; 388 (20) 1833-1842
  • 75 Dreyfus J, Galloo X, Taramasso M. et al. TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation. Eur Heart J 2023; 45 (08) 586-597
  • 76 Diab M, Bonaros N, Doenst T. Immortal Time Bias: the hidden confounder in assessing cardiosurgical treatment effects. Eur Heart J 2023; 44 (33) 3149-3151
  • 77 Schroder JN, Patel CB, DeVore AD. et al. Transplantation outcomes with donor hearts after circulatory death. N Engl J Med 2023; 388 (23) 2121-2131
  • 78 Griffith BP, Goerlich CE, Singh AK. et al. Genetically modified porcine-to-human cardiac xenotransplantation. N Engl J Med 2022; 387 (01) 35-44
  • 79 Moazami N, Stern JM, Khalil K. et al. Pig-to-human heart xenotransplantation in two recently deceased human recipients. Nat Med 2023; 29 (08) 1989-1997
  • 80 Sohns C, Fox H, Marrouche NF. et al; CASTLE HTx Investigators. Catheter ablation in end-stage heart failure with atrial fibrillation. N Engl J Med 2023; 389 (15) 1380-1389
  • 81 Mehra MR, Netuka I, Uriel N. et al; ARIES-HM3 Investigators. Aspirin and hemocompatibility events with a left ventricular assist device in advanced heart failure: the ARIES-HM3 randomized clinical trial. JAMA 2023; 330 (22) 2171-2181
  • 82 Wu J, Zafar MA, Liu Y. et al. Fate of the unoperated ascending thoracic aortic aneurysm: three-decade experience from the Aortic Institute at Yale University. Eur Heart J 2023; 44 (43) 4579-4588
  • 83 Perez ZG, Zafar MA, Velasco JJ. et al. Aortic size at the time of type A and type B dissections. Ann Thorac Surg 2023; 116 (02) 262-268
  • 84 Elbatarny M, Stevens LM, Dagenais F. et al. Hemiarch versus extended arch repair for acute type A dissection: results from a multicenter national registry. J Thorac Cardiovasc Surg 2024; 167 (03) 935-943.e5