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Journal and News Scan
March 3, 2018
Submitted by: Arie Blitz
The STS/ACC TAVR Registry was analyzed to determine the effect of tricuspid regurgitation (TR) on outcomes after transcatheter aortic valve replacement (TAVR). The authors found that TR, of any severity, is quite common in TAVR patients (80%). The breakup of TR severity was as follows:
- Mild TR: 56%
- Moderate TR: 19%
- Severe TR: 5%
Findings: Along with higher predicted risk, increasing TR severity was associated with increased mortality and readmission.
Should the TR of a certain severity be addressed at the time of TAVR? How?
March 2, 2018
Submitted by: Claire Vernon
Patient Care
The first deceased donor lung transplant in the UAE was performed at the Cleveland Clinic Abu Dhabi’s Heart and Vascular Institute, making the hospital the first in the country to offer heart, liver, and lung transplants.
The king of Morocco underwent surgery for an arrhythmia in Paris, France.
Malaysia hosted the first Joint Surgical Colleges Fellowship Examination in Cardiothoracic Surgery to be held outside the UK.
Drugs and Devices
AtriCure, Inc, has launched the AtriClip Flex-V™ Left Atrial Appendage Exclusion System in the United States, the newest design to be added to the AtriClip line of devices.
The US Food and Drug Administration has issued a warning about the use of clarithromycin in patients with heart disease.
Research, Trials, and Funding
Children with congenital heart disease are considered well-connected to health care regardless of socioeconomic background, however researchers from New York City found that neighborhood health disparities for these patients were similar to those observed in general pediatric patients.
The American Lung Association has released its first Lung Force “State of Lung Cancer” report, which evaluates cancer incidence, survival, and treatment around the US.
Researchers from California have identified iron as a key element to Aspergillus invasion in transplanted lungs of mice.
March 1, 2018
Submitted by: Aristotle Protopapas
A 16-year retrospective analysis of cardiac transplantation outcomes, recommending cold ischemic times of less than two hours for older donors.
March 1, 2018
Submitted by: Arie Blitz
This Stanford group retrospectively reviewed their experience over a 10-year period with 293 patients who underwent either limited aortic root repair or root replacement.
Results:
- No significant difference in weighted perioperative mortality.
- No significant difference in weighted survival.
- However, there was a significantly higher rate of later reoperation in the limited root repair group (11% versus 0%, p<0.001).
March 1, 2018
Submitted by: Arie Blitz
The authors present a thorough expert consensus review on the prevention—preoperative, intraoperative, and postoperative—and the postoperative management of sternal wound infections. The authors conclude with a guideline with class recommendations and levels of evidence.
This article should be in every cardiac surgeon's armamentarium.
March 1, 2018
Submitted by: Arie Blitz
This single-center group retrospectively reviewed their experience (2004-2014) with at least two arterial conduits for triple-vessel coronary artery disease to assess the benefit of adding a third arterial conduit versus a venous conduit to the right-sided circulation. A total of 167 propensity-matched pairs were compared. In this small study comparing intermediate survival, no benefit of adding a third arterial conduit was appreciated (HR 0.72, p = 0.411).
February 28, 2018
Submitted by: Claire Vernon
The EJCTS and ICVTS are publishing a series of Statistical Primers to help clinicians perform and interpret research. In the first series of primers, Buccheri and coauthors provide a conceptual framework for conducting, interpreting, and critically evaluating meta-analyses. With an increasing number of meta-analyses being performed, it is crucial for surgeons to increase their understanding of the methodology.
Read the commentary article on the importance of this series of statistical primers here.
February 28, 2018
Submitted by: Aristotle Protopapas
A retrospective Mount Sinai small series on selective emergent implantation of long-term ventricular assist devices in cardiogenic shock. It challenges the traditional concept of short-term stabilisation with ECMO or short-term support, and is likely to generate criticism and discussions.
February 28, 2018
Submitted by: Arie Blitz
The Mayo Clinic team retrospectively reviewed their experience with isolated CABG for multivessel coronary artery disease over a 15-year period to assess usage of bilateral internal mammary arteries (BIMA) and selected outcomes. The population included a total of 6468 isolated CABG procedures.
Some of the salient findings from their study are:
- The use of BIMA doubled over the most recent 4-year period (13% to 27%).
- Propensity-matched patients exhibited a survival advantage for BIMA patients, with a hazard ratio of 0.81.
- Sternal infection was not significantly higher in the BIMA group.
The authors conclude that BIMA use should be encouraged and expanded.
February 28, 2018
Submitted by: Arie Blitz
The authors retrospectively examined the mid-term outcomes in 34 patients who required stabilization of the sternum with the Synthes Titanium Sternal Fixation System for either established sternal dehiscence or high risk for sternal dehiscence. Reported outcomes (at a median follow-up period of 1.4 years) were as follows:
- All patients had stable sternums on physical exam.
- Bone consolidation assessment by CT scans on follow-up showed: complete consolidation of bone in 26% of patients, near-complete in 39%, partial in 10%, and missing in 26%.
- 13 patients (38%) required plate removal for either pain or infection.
While thoracic stabilization was thus achievable, the authors caution that the non-negligible complication rate should reserve plating for patients at high risk for dehiscence and who are unsuitable for standard closure.