Kirov Hristo, Caldonazo Tulio, Mukharyamov Murat, Toshmatov Sultonbek, Fleckenstein Philine, Kyashif Timur, Siemeni Thierry, Doenst Torsten
Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany.
Thorac Cardiovasc Surg. 2025 Aug;73(5):332-345. doi: 10.1055/a-2548-4098. Epub 2025 Mar 27.
For the 11th consecutive time, we systematically reviewed the cardio-surgical literature for the past year (2024), using the PRISMA approach for a results-oriented summary. In 2024, the discussion on the value of randomized and registry evidence increased, triggered by consistent findings in the field of coronary artery disease (CAD) and discrepant results in structural heart disease. The literature in 2024 again confirmed the excellent long-term outcomes of CABG compared with PCI in different scenarios, generating further validation for the CABG advantage reported in randomized studies. This has been reflected in the new guidelines for chronic CAD in 2024. Two studies indicate novel perspectives for CABG, showing that cardiac shockwave therapy in CABG improves myocardial function in ischemic hearts and that CABG guided by computed tomography is safe and feasible. For aortic stenosis, an early advantage for transcatheter (TAVI) compared with surgical (SAVR) treatment has found more support; however, long-term TAVI results keep being challenged, this year by new FDA and registry data in favor of SAVR. For failed aortic valves, redo-SAVR showed superior results compared with valve-in-valve TAVI. In the mitral field, studies showed short-term noninferiority for transcatheter treatment compared with surgery for secondary mitral regurgitation (MR), and significant long-term survival benefit in registries with surgery for primary MR. Finally, surgery was associated with better survival compared with medical therapy for acute type A aortic intramural hematoma. 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.
我们连续第11次系统回顾了过去一年（2024年）的心脏外科文献，采用PRISMA方法进行以结果为导向的总结。2024年，由于冠状动脉疾病（CAD）领域的一致发现以及结构性心脏病的不一致结果，关于随机对照试验证据和注册研究证据价值的讨论有所增加。2024年的文献再次证实，在不同情况下，冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI）相比具有出色的长期疗效，为随机研究中报告的CABG优势提供了进一步验证。这一点在2024年慢性CAD的新指南中得到了体现。两项研究为CABG带来了新的视角，表明CABG中的心脏冲击波疗法可改善缺血性心脏的心肌功能，并且计算机断层扫描引导下的CABG是安全可行的。对于主动脉瓣狭窄，经导管主动脉瓣置换术（TAVI）与外科主动脉瓣置换术（SAVR）相比的早期优势得到了更多支持；然而，TAVI的长期结果不断受到挑战，今年新的美国食品药品监督管理局（FDA）和注册数据支持SAVR。对于失败的主动脉瓣，再次进行SAVR显示出比瓣膜内瓣膜TAVI更好的结果。在二尖瓣领域，研究表明，对于继发性二尖瓣反流（MR），经导管治疗与手术相比短期非劣效，而在原发性MR手术的注册研究中有显著的长期生存获益。最后，与急性A型主动脉壁内血肿的药物治疗相比，手术治疗与更好的生存率相关。本文总结了我们认为重要的出版物。它不可能完整，也难免有个人解读，但为针对患者的决策提供了最新信息。
