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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Les James, Deane E. Smith, Aubrey C. Galloway, Darien Paone, Michael Allison, Shashwat Shrivastav, et al.

The benefits of early extubation in the operating room (OR) following cardiac surgery remain unproven. In this study, the authors evaluated perioperative outcomes after extubation in the OR versus extubation in the intensive care unit (ICU) in patients who underwent nonemergency isolated coronary artery bypass grafting (CABG). A total of 1,397 patients who underwent nonemergency isolated CABG during a six-year period were analyzed. Among them, 891 (63.8 percent) patients were extubated in the ICU, and 506 (36.2 percent) were extubated in the OR. After propensity score matching, 414 patient pairs were compared. Adjusted comparison did not show differences between the two groups in the incidence of major early postoperative complications such as reintubation, re-exploration for bleeding, stroke, renal failure, or thirty-day mortality. Furthermore, patients extubated in the OR had shorter ICU (P < 0.0001) and hospital stays (P < 0.0001), were more frequently discharged directly home (P < 0.0001), and presented with a lower thirty-day readmission rate (P = 0.04). Based on these results, the authors suggest a wider adoption of routine OR extubation for nonemergency CABG.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Alsoufi B, Kozik D, Lambert AN, Wilkens S, Trivedi J, Deshpande S

Infants awaiting pediatric heart transplantation (PHT) have long waitlist duration and high mortality due to donor shortage. This study examined whether increased donor-recipient weight ratio (DRWR) higher than 2.0, the recommended cutoff, resulted in adverse outcomes. 1,392 infants undergoing PHT between 2007 and 2020 were included. They were divided into three groups: A (DRWR ≤ 1.0, n = 239); B (DRWR 1.0–2.0, n = 947; C (DRWR > 2, n = 206). DRWR ranged from 0.5 to 4.1 and other variables were comparable between groups. Patients in group C were more likely to be ventilated, receive an ABO blood group-incompatible heart, and have longer donor ischemia times. The DRWR group was not associated with operative death in either congenital or cardiomyopathy patients. Infants in group C had shorter waitlist durations and no demonstrable increase in adverse outcomes.

Source: tctMD
Author(s): Michael O’Riordan

A recently published article showed the benefit of TEER compared to mitral valve surgery in older, sicker patients with a high risk in surgery. Based on the French administrative hospital discharge database, the study collected information from all consecutive patients treated for primary or secondary mitral regurgitation with isolated TEER or isolated mitral valve surgery (repair or replacement) between 2012 and 2022. A total of 57,030 patients were found in the database, and after propensity score matching, a total of 2,160 patients were included for analysis in each arm. This study has led to controversy and a heated discussion within the cardiovascular community. In his article, Michael O'Riordan from TCTMD interviews the study's primary author and other experts in the field, providing insights into this issue and a comprehensive overview of the topic.

Source: The Annals of Thoracic Surgery
Author(s): Michael C Grant, Cheryl Crisafi, Adrian Alvarez, Rakesh C Arora, Mary E Brindle, Subhasis Chatterjee, Joerg Ender, Nick Fletcher, Alexander J Gregory, Serdar Gunaydin, Marjan Jahangiri, Olle Ljungqvist, Kevin W Lobdell, Vicki Morton, V Seenu Reddy, Rawn Salenger, Michael Sander, Alexander Zarbock, Daniel T Engelman

In this joint statement, ERAS and STS present a list of potential program elements, literature review, and a consensus on ERAS clinical practice. The statement is an update to the 2019 guidance and includes new clinical data.

Source: tctMD
Author(s): Yael L. Maxwell

 In findings presented at the STS annual meeting, the ten-year data showed the survival benefit of multi- over single-arterial grafting in all but patients who are severely obese. The study used data from the STS Adult Cardiac Surgery Database to look at patients who underwent isolated CABG over a ten-year period. The long-term survival rate was significantly better for patients who received multiple arterial grafting. The authors of the study acknowledged the reasons surgeons have not taken this data into account as lack of education and suspicion around the evidence.

Source: El Pais
Author(s): Jessica Mouzo

This article highlights the first partial heart transplant in a newborn who was born with persistent truncus arteriosus and irreparable truncal valve dysfunction. This condition remains an issue due to the lack of implantable heart valves that can grow with the patient, and therefore patients require recurrent implant exchanges until adulthood.

The team at Duke have also published the case in JAMA, detailing the first case of a partial heart transplant through implantation of growing heart valves. The authors report a good outcome at one year.

Source: Interdisciplinary Cardiovascular and Thoracic Surgery
Author(s): Grubitzsch H, Caliskan E, Ouarrak T, Senges J, Doll N, Knaut M et al

This study used CardioSurgery Atrial Fibrillation (CASE-AF) registry data to evaluate outcomes of surgery for long standing persistent AF at one year. No AF recurrence at one year is defined by the presence of AF, no re-ablation, no further cardioversion, and no rehospitalization due to AF after a three-month blanking period. Early mortality (30 days) was 2 percent and morbidity was low. Various ablation techniques were used. Of the 202 qualifying patients, 106 (56 percent) had no AF recurrence and 93 percent of these were asymptomatic. Multivariable analysis showed that surgical ablation was most effective when delivered concomitant with endocardial cryoablation.

Source: JTCVS
Author(s): Joanna Chikwe, Qiudong Chen, Michael E Bowdish, Amy Roach, Dominic Emerson, Annetine Gelijns, Natalia Egorova

In this article, the authors evaluated the practice trends and three-year outcomes following transcatheter edge-to-edge repair (TEER) and surgical repair for degenerative MR in the United States. Medicare and Medicaid data of 53,117 mitral valve interventions for degenerative MR (surgery or TEER) between 2012 and 2019 were analyzed. After excluding patients with rheumatic and congenital disease, endocarditis, myocardial infarction, cardiomyopathy, and concomitant or prior coronary revascularizations, a total of 27,170 patients remained in the analysis.

The total annual volume of mitral interventions did not significantly change (p=0.18) during the study period. However, surgical cases decreased by a third while TEER increased. The included patients were 52.5 percent male and had a mean age of 73.5 years. A total of 7,755 patients underwent TEER, and 19,415 underwent surgical repair. Surgical patients were younger (p <0.001), with less comorbidity and frailty. After matching for baseline characteristics, the resulting 4,532 patient pairs presented with a three-year survival rate after TEER of 65.9 percent (95 percent CI 64.3-67.6) and 85.7 percent (95 percent CI 84.5-86.9) after surgery (p <0.001). The three-year stroke rates after TEER or surgery were 1.8 percent (95 percent CI 1.5-2.2) and 2.0 percent (95 percent CI 1.6-2.4) (p=0.49), respectively. The three-year heart failure readmission rates after TEER or surgery were 17.8 percent (95 percent CI 16.7-18.9) and 11.2 percent (95 percent CI 10.3-12.2 and p <0.001), respectively. Finally, the three-year mitral reintervention rates after TEER or surgery were 6.1 percent (95 percent CI 5.5-6.9) and 1.3 percent (95 percent CI 1.0-1.7 and p<0.001), respectively.

Source: The New England Journal of Medicine
Author(s): John L. Sapp, M.D., Soori Sivakumaran, M.D., Calum J. Redpath, M.B., Ch.B., Ph.D., Habib Khan, M.D., Ratika Parkash, M.D., Derek V. Exner, M.D., Jeff S. Healey, M.D., Bernard Thibault, M.D., Laurence D. Sterns, M.D., Nhat Hung N. Lam, B.Sc., Jaimie Manlucu, M.D., Ahmed Mokhtar, M.D., et al., for the RAFT Long-Term Study Team

This is a useful manuscript on long-term follow up confirming the findings of the five-year study, with regards to superior survival on CRT than on ICD. The authors discuss the limitations of the chronology of the trial in relation to novel pharmacological options for cardiac failure.

Source: The Annals of Thoracic Surgery
Author(s): Elizabeth H. Stephens, Jennifer C. Romano, Andrea J. Carpenter, Stephen C. Yang, Damien J. LaPar, Stephanie Fuller

In this Invited Perspective article, the authors address major challenges identified in the 2022 Congenital Heart Surgeon’s Workforce Survey, including saturation of the job market, low individual surgeon case-volume, and surgeon dissatisfaction in congenital cardiac surgery.

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