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Journal and News Scan
June 8, 2023
Submitted by: Jo Chikwe
This analysis of 279 neonates with pulmonary atresia and intact ventricular septum who underwent surgical or catheter intervention between 2009 and 2019 in nineteen centers showed that seventy-nine (28 percent) underwent right ventricular decompression, 151 (54 percent) underwent systemic-to-pulmonary shunt or ductal shunt only, thirty-six (13 percent) underwent both, and eleven (4 percent) received transplants. Major adverse events—including in-hospital mortality (8 percent), cardiopulmonary resuscitation (13 percent), stroke (6 percent), and mechanical circulatory support (13 percent)—were reported in fifty-seven patients (20 percent). Lower weight and the presence of two major coronary stenoses predicted major adverse events, and the authors recommend vigilance in procedural planning in patients with these risk factors.
June 8, 2023
Submitted by: Cameron Lind
A study in the United States found that disparities regarding race, socioeconomic status, and rural location result in lack of access to a thoracic surgeon for an esophagectomy. Patients in the study underwent elective esophagectomy for esophageal or gastric cardia cancer, Barrett esophagus, or achalasia. While the proportion of esophagectomies performed by thoracic surgeons increased over the four-year study period, demographic differences persisted. Patients who were uninsured, identified as non-white, received care in a rural setting, or had metastatic cancer were significantly less likely to have their esophagectomy performed by a thoracic surgeon.
June 8, 2023
Submitted by: EACTS Staff
The authors investigated the outcomes of thoracic endovascular aortic repair for retrograde Stanford type A acute aortic dissection (R-AAAD) at their institution. The early- and mid-term outcomes of thoracic endovascular aortic repair for R-AAAD in nineteen patients were satisfactory, but long-term follow-up is needed. The indications for such repair have been expanded to include low-risk and emergency cases at the authors’ institute.
June 1, 2023
Submitted by: Wei-Guo Ma
The first official guidelines for implantable mechanical circulatory support (MCS) were published in 2013 by the International Society for Heart and Lung Transplantation (ISHLT). Ten years later, because of substantial advancements in the MCS field, much of the original report is no longer clinically relevant, so ISHLT commissioned a ten-year update. Like the 2013 MCS guidelines, the 2023 update are organized into individual task forces covering preoperative, intraoperative, and postoperative management of MCS patients treated with implantable left ventricular assist devices (LVADs), including four additional task forces, for a total of nine. With those additions, ISHLT says this 2023 guideline document is the most comprehensive resource guiding the management of patients with durable mechanical circulatory support (DMCS).
The nine task forces are as follows:
- Selection of candidates for durable mechanical circulatory support (DMCS) and risk management before implantation for fixed comorbidities.
- Patient optimization, consent, and appropriate timing for MCS: Modifiable risk management before implantation.
- Intraoperative and immediate postoperative management
- Inpatient management of patients with DMCS.
- Outpatient management of the mechanical circulatory support device recipient.
- VAD in adults with congenital heart disease.
- Evaluation for recovery.
- Biventricular assist devices and total artificial heart specifications.
- Center quality metrics, outcomes, volume, and staffing.
June 1, 2023
Submitted by: Mary Hammon
The authors examined the safety of combining aortic root replacement with frozen elephant trunk (FET) total arch replacement. Outcomes were similar between the FET alone and FET with aortic root replacement groups. Adding aortic root replacement was not associated with increased mortality and there was no difference in overall survival between the groups. Although concomitant root replacement lengthens the operation time, it does not appear to increase risk in an experienced centre with high volumes.
June 1, 2023
Submitted by: Aristotle Protopapas
This five-year follow-up of a large randomized controlled clinical trial on outcomes after transcatheter edge-to-edge repair of severe mitral regurgitation, as compared with outcomes after maximal doses of guideline-directed medical therapy alone, suggests superiority of the transcatheter 'Alfieri' (Mitra-clip) repair over BMT.
It will be interesting to juxtapose transcatheter to surgical repair, especially over a longer period. It's worth noting that more than one in ten recipients suffered device-related complications.
May 25, 2023
Submitted by: Cameron Lind
A study found that patients who underwent a second TAVR procedure were no more likely to experience adverse outcomes than those who have only undergone one TAVR. Because TAVR patients are expanding into younger populations, the analysis of registry data is important in informing decision making among these patients, who are more likely to need a second TAVR in their lifetimes.
May 25, 2023
Submitted by: Cameron Lind
Pectus excavatum is frequently associated with congenital heart disease that requires surgery. This comprehensive review of pectus excavatum in children and adults describes the morphology, pathophysiology, indications for repair, surgical strategies, and clinical outcomes.
May 25, 2023
Submitted by: Cameron Lind
Seventeen procedures were identified by a Delphi process as feasible for simulation-based training. The top five were video-assisted thoracoscopic surgery (VATS) lobectomy; VATS segmentectomy; VATS mediastinal lymph node dissection; diagnostic flexible bronchoscopy and robot-assisted thoracic port placement; and robot-assisted surgery docking and undocking. The authors concluded these procedures should be integrated in the thoracic surgery curriculum and should specifically be taught using simulation-based training.
May 19, 2023
Submitted by: Jo Chikwe
In 737 patients who underwent esophagectomy at an experienced single center, strictures developed in 105 patients, or 14 percent, that required endoscopic dilation within a year. Risk factors for stricture included anastomotic leaks (hazard ratio [HR], 2.5), and anastomotic techniques other than triangular linear stapling with 60 mm staplers, which had a stricture rate of 3.2 percent (manual sewing: HR, 9.6; circular stapling: HR, 66.5; hybrid linear stapling: HR, 5.4). The authors conclude that a large anastomosis area with triangular linear stapling prevents strictures after esophagectomy.