Journal and News Scan

The number of patients at intermediate and low surgical risk treated by transcatheter aortic valve implantation (TAVI) is rapidly increasing. Current guidelines recommend performing TAVI in heart valve centers with surgical backup. Nonetheless, there is an ongoing discussion about possibly abrogating on‐site surgical backup for TAVI procedures to increase accessibility. However, concerns and uncertainty exist about the safety of performing TAVI in nonsurgical centers.

This collaborative effort, using pooled data from 14 German centers, presents contemporary outcomes of patients undergoing emergency open-heart surgery (E-OHS) due to severe intraprocedural complications during elective transfemoral TAVI. 

The authors conclude that in the setting of a heart team approach with immediate surgical backup, E‐OHS due to potentially lethal TAVI complications is not a futile clinical situation, with acceptable short‐ and long‐term outcomes, especially in low and intermediate-risk patients.

In a single-center series of 502 patients who underwent thoracoscopic ablation and left atrial appendage closure, of whom 333 had preoperative and postoperative computed tomographic imaging, complete left atrial appendage closure (defined as residual stump <1 cm on computed tomography one year postoperatively) was lower with the stapled resection (83 percent) compared with a clip (96 percent), and the residual left atrial appendage stump depth was greater (5.3 vs 2.9 mm, respectively). Two patients with a residual stump experienced an ischemic stroke during follow-up. 

The authors report the results of their randomized controlled trial (RCT) exploring the use of preoperative CT three-dimensional (3D) reconstruction and its impact on operative time and outcomes in thoracoscopic segmentectomy. The authors conducted a multicenter (three hospitals) RCT between 2019 and 2023, randomizing patients 1:1 to either 3D reconstruction CT or standard chest CT. The primary endpoint was operative time. Overall, 191 patients with small peripheral tumors were randomized. There was no statistically significant difference in operative time or clinical outcomes between the groups.

This study evaluated the outcomes after the use of cardiac shockwave therapy (SWT) combined with coronary artery bypass surgery (CABG) in patients with reduced left ventricular ejection fraction (LVEF) due to ischemic cardiomyopathy. Patients with LVEF ≤ 40 percent requiring CABG were enrolled in this single-blind, parallel-group, sham-controlled trial. Patients were randomly assigned to undergo direct cardiac SWT or sham treatment in addition to CABG. The primary efficacy endpoint was the improvement in LVEF measured by cardiac magnetic resonance imaging from baseline to 360 days. A total of 63 patients were randomized, 30 patients in the SWT group and 28 patients in the sham group. A greater improvement in LVEF was observed in the SWT group (Δ from baseline to 360 days: SWT 11.3 percent; Sham 6.3 percent, SD 7.4, P = 0.0146). Furthermore, patients in the SWT group significantly improved in the six minute walking test 360 days after randomization. The authors conclude that direct cardiac SWT, in addition to CABG, improves LVEF and physical capacity in patients with ischemic heart failure.