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Journal and News Scan
This paper explores the application of a novel aortic valve visualization and pressurization device to inspect the valve under physiological conditions following aortic repair. The authors report their results in a cohort of twenty-four patients.This paper explores the application of a novel aortic valve visualization and pressurization device to inspect the valve under physiological conditions following aortic repair. The authors report their results in a cohort of twenty-four patients.
This is the newly published latest version of Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection developed by the Japanese Circulation Society, Japanese Society for Cardiovascular Surgery, Japanese Association for Thoracic Surgery, and Japanese Society for Vascular Surgery. Compared to the 2022 ACC/AHA Guidelines on Aortic Disease, the Japanese document discusses the following topics in more detail, along with 86 figures and 1,943 references, which may warrant careful study. Topics included definition, pathogenesis, and epidemiology; pathology; symptoms, examinations, and diagnosis; selection of treatment; treatment for aortic aneurysm; treatment for aortic dissection, issues associated with aortic surgery, other aortic diseases; rehabilitation; and various issues of medical treatment for aortic diseases.
This is an open access genomic study of carotid atheroma in Viennese patients with a useful extensive discussion on potential translational value of the signature of calcification, juxtaposed to sonographic diagnostics and in the quest to manage the risk of rupture of carotid atheromatous plaque. The article also has gravitas in the light of the updated ESVS guidelines in carotid disease.
The authors reported the prognostic impact of donor transmitted coronary artery disease in heart transplantation in their retrospective multicenter cohort study. They found that TCAD was not associated with reduced survival. However, TCAD patients showed increased risk of cardiovascular death.The authors reported the prognostic impact of donor transmitted coronary artery disease in heart transplantation in their retrospective multicenter cohort study. They found that TCAD was not associated with reduced survival. However, TCAD patients showed increased risk of cardiovascular death.
Survival of diabetics after single or multiple coronary artery bypass grafting was compared in a national database over twenty years with 69,224 patients. End points were long-term all-cause mortality and thirty-day clinical outcomes. 17,474 nondiabetic and 10,989 diabetic matched pairs were generated. At a median of 5.9 years after grafting, mortality was statistically significantly lower after multiple arterial grafting in both diabetic and nondiabetic cohorts. The incidence of myocardial infarction was significantly higher in single rather than multiple grafting for both cohorts. Multiple arterial grafting was associated with improved survival for both diabetic and nondiabetic patients.
While much research is ongoing regarding the safety of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) after prior coronary artery bypass (CABG), there is limited data on morbidity outcomes and discharge locations among these two procedures. This article looked into a single center experience over fifteen years and found shorter length of stay, less new-onset atrial fibrillation, and more discharges home in the TAVR group compared to the SAVR group, with an overall improved morbidity profile.
During some transcatheter aortic valve implant (TAVI) procedures, complications require conversion to emergency open heart surgery (E-OHS). This study evaluated early and midterm outcomes in a large center over fifteen years. Patients were grouped by surgical risk and the study time was divided into three five-year periods. In the entire study period, 1.1 percent of TAVI patients (74/6903) required E-OHS. The rate of E-OHS decreased over the three periods, from 3.5 percent to 0.4 percent. However, the proportion of patients from the study with low or intermediate risk increased considerably, from 1 percent to 26 percent. In-hospital mortality was 62 percent in high-risk and 12.5 percent in low and intermediate-risk patients. One-year survival was 31.8 percent in high-risk and 87.5 percent in low/intermediate risk patients.
This study reports outcomes of protocolized management of chest drain removal on-table for patients undergoing wedge resections and minor thoracic procedures. Chest drains were removed at the end of the operation if air leak was < 20 ml/min. Between 2016 and 2021, 107 patients underwent on-table chest drain removal with a 0.9 percent reintervention rate. Safe on-table chest drain removal using digital drainage in select cases challenges the need for routine drain insertion in thoracic surgery.
The risk of dissection associated with fluoroquinolone use has gained wide acceptance, but recent data indicate there’s more to the story. Pasternak and colleagues report a Swedish, multicenter, propensity-matched study of one million treatment episodes examining the relationship between fluoroquinolone use and aneurysm or dissection. Interestingly, after adjustment for confounders, the absolute risk of aneurysm or dissection associated with fluoroquinolone use was smaller than previously reported, risk was found to be driven by aneurysm rather than dissection, and greatest risk was identified in the first ten days during treatment.
The authors present the first autoregulated total artificial heart implant in the United States. The Aeson total artificial heart provides biventricular support with improvements in hemocompatibility and autoregulation in response to higher filling pressures, when compared to previous generations. The authors present the case of a patient who was successfully bridged to transplant using this improved total artificial heart implant.