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Background Aortic valve dysfunction is a rare but relevant long-term complication after orthotopic heart transplantation (HTX). Treatment options include surgical (SAVR) and transcatheter (TAVR) aortic valve replacement, but evidence is limited to the level of case reports. Methods A total of 2054 patients underwent HTX between 1986 and 2023 at the Deutsches Herzzentrum der Charité, Berlin, Germany, 16 of them underwent aortic valve replacement (SAVR, N = 7; TAVR, N = 9) after HTX. In this case series we report on the outcomes of these 16 patients (age 29-73 years). Results Isolated aortic valve regurgitation occurs in 5 (31%) patients (TAVR N = 1, SAVR N = 4), while 11 patients (69%) suffer from aortic valve stenosis. Severe pre-procedural heart failure is present in 38% of the patients. Thirty-day mortality is 0%, in-hospital mortality is N = 2 (22%) patients due to sepsis, both patients were severely decompensated prior to TAVR. An uneventful postoperative course occurs in 8 (50%) patients, the patient’s functional status improves in 12 (75%) cases. Conclusion TAVR is the increasingly preferred treatment for aortic valve dysfunction after heart transplantation, but SAVR is a feasible alternative for individuals who are ineligible for TAVR. Further information is needed on the appropriate procedural timing in these high-risk patients. Plain Language Summary Developing aortic valve disease, which comes from stiffness and/or leakage of the valve, is rare after heart transplantation, but leads to recurrence of heart failure with a high burden of symptoms. The treatment in severe cases is the replacement of the dysfunctional valve either by surgery or by using a thin tube, which is inserted through the blood vessels (catheter). Here we share our center’s experience with aortic valve procedures after heart transplantation in 16 patients. Valve replacement via catheter is preferred as it limits trauma for the patient, but surgical replacement is feasible in individuals who are ineligible for the catheter procedure. There are special concerns for redo-procedure with the risk of periprocedural infections; however, 75% of our patients showed an improvement in their well-being and quality of life after treatment. Roehrich, Hinkov et al. report a case series on treating aortic valve dysfunction after heart transplantation, which may cause recurrent heart failure. Authors find that transcatheter aortic valve replacement is preferred in these complex, high-risk cases, while surgery remains an option for patients who are ineligible for catheter-based treatment.

Cardiovascular (CV) implants are still associated with thrombogenicity due to insufficient hemocompatibility. Endothelialization of their luminal surface is a promising strategy to increase their hemocompatibility. In this review, we provide a collection of research studies and review articles aiming to summarize the recent efforts on surface modifications of CV implants, including stents, grafts, valves, and ventricular assist devises. We focus in particular on the implementation of micrometer or nanoscale surface modifications, physical characteristics of known biomaterials (such as wetness and stiffness), and surface morphological features (such as gratings, fibers, pores, and pits). We also review how biomechanical signals originating from the endothelial cell for surface interaction can be directed by topography engineering approaches toward the survival of the endothelium and its long-term adaptation. Finally, we summarize the regulatory and economic challenges that may prevent clinical implementation of endothelialized CV implants.

Thrombogenicity remains a major issue in cardiovascular implants (CVIs). Complete surficial coverage of CVIs by a monolayer of endothelial cells (ECs) prior to implantation represents a promising strategy but is hampered by the overall logistical complexity and the high number of cells required. Consequently, extensive cell expansion is necessary, which may eventually lead to replicative senescence. Considering that micro-structured surfaces with anisotropic topography may promote endothelialization, we investigated the impact of gratings on the biomechanical properties and the replicative capacity of senescent ECs. After cultivation on gridded surfaces, the cells showed significant improvements in terms of adherens junction integrity, cell elongation, and orientation of the actin filaments, as well as enhanced yes-associated protein nuclear translocation and cell proliferation. Our data therefore suggest that micro-structured surfaces with anisotropic topographies may improve long-term endothelialization of CVIs.

Abstract Objectives Minimally invasive mitral valve repair (MIMVR) is the preferred approach to treat mitral regurgitation in specialized centres. Custodiol and Del Nido cardioplegia are widely used, yet direct comparative data on their efficacy and safety in this setting remain limited. This study investigated their efficacy and impact on early outcomes in a propensity-matched cohort. Methods We performed a single-centre, retrospective matched cohort study of 2490 patients undergoing minimally invasive mitral valve surgery between October 2014 and January 2025. After exclusions, 960 patients entered 1:1 propensity score matching based on risk factors, baseline characteristics and procedural parameters, yielding 778 matched cases treated with Custodiol or Del Nido cardioplegia. Perioperative dynamics of cardiac enzymes were evaluated as the primary outcome measure, along with an exploratory analysis on clinical outcomes. Results Del Nido cardioplegia was associated with lower postoperative creatine kinase and creatine kinase‑MB levels, most pronounced in the first 24 hours (P < .001). Del Nido yielded a lower inotrope score at 6 hours, higher perioperative sodium and fewer cardioversions for ventricular arrhythmia after declamping with fewer shocks required (all P < .001). Rates of major complications were similar between groups, and 30‑day mortality was 0% in both groups. Conclusions Del Nido cardioplegia provided superior myocardial protection based on biomarker dynamics and a lower incidence of post-cross-clamp ventricular arrhythmia, while overall clinical outcomes remained comparable. It may therefore be considered the preferred single-dose cardioplegic solution for MIMVR. Mitral regurgitation is the second most prevalent valvular heart disease in developed countries and a major indication for surgery. Graphical Abstract

Zusammenfassung Die Herz-Lungen-Maschine (HLM) ist der Grundbaustein der Herzchirurgie. Ihre Anwendung bleibt heutzutage weiterhin bei der Mehrzahl an kardiochirurgischen Operationen unentbehrlich. Trotz ihrer fast 70-jährigen Existenz und zahlreichen technischen Designverbesserungen repräsentiert sie eine invasive Intervention in die physiologische Integrität des menschlichen Körpers. Diese Nebeneffekte zeigen sich in der Form des systemisch inflammatorischen Response-Syndroms (SIRS), das in seiner schwersten Form mit einer Inzidenz von 10–20 % in eine überschießende Immunantwort mit nahezu unkontrollierbarer hämodynamischer Instabilität münden kann und letale und komplikationsträchtige Therapieergebnisse für das kardiochirurgische Patientenkollektiv bringt. Interessanterweise sind die Veränderungen des intestinalen Mikrobioms unter HLM-Anwendung trotz ihrer fundamentalen immunregulatorischen Rolle noch nicht ausreichend untersucht worden. Unser Projekt zielt darauf ab zu identifizieren, wie sich Mikrobiom, Metagenom und Metabolom post-HLM verändern, und diese Erkenntnisse mit der Aktivierung verschiedener Inflammationsmechanismen und dem postoperativen Verlauf der Patienten zu korrelieren. Die Aufklärung eines Zusammenhangs zwischen Mikrobiomveränderung und SIRS-Mechanismen kann in innovative translationale Therapieansätze für die SIRS-Bewältigung durch Mikrobiommodulation resultieren. Darüber hinaus kann die Identifizierung von SIRS-suszeptiblen Ausgangsmikrobiomkompositionen ein Instrument zur präoperativen Risikostratifizierung bieten.