Journal and News Scan

The VRECOVERY trial investigated the impact of virtual reality (VR) distraction therapy on postoperative pain, anxiety, and quality of recovery in patients undergoing coronary artery bypass grafting (CABG) surgery as a single-center randomized controlled trial. A total of 192 participants were allocated to either the intervention or control group. The intervention group received VR distraction therapy on postoperative days 1, 2 and 3, while the control group received standard postoperative care. Primary outcomes were measured in both groups directly following the VR sessions in the intervention group. Of the initial participants, 100 patients completed the trial, and it was noted that VR-distraction therapy demonstrated a significant decrease in postoperative pain and anxiety levels compared to the control group.  

This study investigated the impact of nighttime intensive staffing and failure to rescue (FTR) after cardiac surgery. This study compared two eras that were characterized by the presence and absence of nighttime intensivists staffing. The results showed that nighttime ICU coverage reduced FTR rates in postcardiotomy patients while complication rates and ICU census remained stable. Furthermore, the increase in relative value units suggested an economically stable model.

The debate continues over long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease. This study, based on the SWEDEHEART registry, analyzed 57,097 revascularized patients with NSTEMI and multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality. 
 
Percutaneous coronary intervention was the primary therapy in 42,190 patients (73.9 percent), while 14,907 (26.1 percent) received CABG. During a median follow-up of 7.1 years, PCI was associated with higher risks of death (adjusted odds ratio [aOR] 1.67; 95 percent confidence interval [CI] 1.54-1.81) and MI (aOR 1.51; 95 percent CI 1.41-1.62), but there was no significant difference in stroke. Repeat revascularization was three times more likely to PCI (aOR 3.01; 95 percent CI 2.57-3.51), while heart failure risk was 15 percent higher (aOR 1.15; 95% CI 1.07-1.25). CABG provided longer survival within 15 years, especially in patients under 70 years of age, with left main disease or left ventricular dysfunction, though, this benefit diminished over shorter time horizons. 
 
The authors concluded that CABG is associated with lower risks of mortality, MI, repeat revascularization, and heart failure in patients with NSTEMI, particularly in high-risk subgroups. However, its survival benefit lessens with shorter life expectancy. 

This study analyzed mechanisms of repair failure after mitral valve repair using chordal replacement and annuloplasty for degenerative mitral regurgitation. Between 2003 and 2010, 344 patients underwent mitral valve repair at the German Heart Center Munich. After a mean follow-up of 9.7 years, 38 patients (11 percent) required reoperation, with causes of failure being disease progression (39.5 percent), technical failure (38.8 percent), and endocarditis (18.4 percent). Re-repair was performed in 28.9 percent of cases, often involving redo annuloplasty or chordal replacement. Mitral valve replacement was needed in 63.2 percent of cases, particularly in patients with mitral valve sclerosis. Redo mitral valve repair was more common for technical failure, while mitral valve replacement was more often needed for valve sclerosis.