Journal and News Scan

This randomized trial of dabigatran vs warfarin for anticoagulation in patients immediately after or more than 3 mos after MVR or AVR with a mechanical valve was stopped early after enrollment of 252 pts. There were both excess bleeding events and excess thromboembolic events in the dabigatran group, indicating no benefit and increased risk of dabigatran compared to warfarin.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and its prevalence is ∼1–2% of the general population, but higher with increasing age and in patients with concomitant heart disease. The Cox-maze III procedure was a groundbreaking development and remains the surgical intervention with the highest cure rate, but due to its technical difficulty alternative techniques have been developed to create the lesions sets. The field is fast moving and there are now multiple energy sources, multiple potential lesion sets and even multiple guidelines addressing the issues surrounding the surgical treatment of AF both for patients undergoing this concomitantly with other cardiac surgical procedures and also as stand-alone procedures either via sternotomy or via videothoracoscopic techniques. The aim of this document is to bring together all major guidelines in this area into one resource for clinicians interested in surgery for AF. Where we felt that guidance was lacking, we also reviewed the evidence and provided summaries in those areas. We conclude that AF surgery is an effective intervention for patients with all types of AF undergoing concomitant cardiac surgery to reduce the incidence of AF, as demonstrated in multiple randomized studies. There is some evidence that this translates into reduced stroke risk, reduced heart failure risk and longer survival. In addition, symptomatic patients with AF may be considered for surgery after failed catheter intervention or even as an alternative to catheter intervention where either catheter ablation is contraindicated or by patient choice.

Forty-six patients with acute type A aortic dissection underwent valve-sparing root repair with replacement of all pathological sinuses of Valsalva. The actuarial survival rate at 8 years was 85.5 ± 5.6% with no valve-related events and no reoperation on the proximal aorta/aortic valve during the follow-up

A 41 minute presentation on some of the techniques used to address MAC (mitral annular calcification) is followed by an operative video demonstrating several of the techniques. Techniques include mechanical debridement, CUSA debridement, supra-annular MVR, and infra-annular MVR.