Journal and News Scan

Investigators reported the distribution of thoracic aortic growth in smokers based on longitudinal data of current and ex-smokers aged 50-70 years from the Danish Lung Cancer Screening Trial. Mean and 95th percentile of annual aortic growth of the ascending aortic and descending aortic diameters were calculated with the first and last noncontrast computed tomography scans during follow-up.

A total of 1,987 participants (56% male, mean age 57.4 ± 4.8 years) were included and followed for a median of 48 months. The ascending and descending aortic growth was approximately 0.1 mm/year and consistent with growth in the general population. The 95th percentile ranged from 0.42 to 0.47 mm/year, depending on sex and location. Larger aortic growth was associated with lower age, increased height, absence of medication for hypertension or hypercholesterolemia, and lower Agatston scores.

Later this year, AATS will launch two new open access journals, JTCVS Open and JTCVS Techniques, to provide authors with additional options to publish high-quality information of importance to thoracic and cardiovascular surgeons.

Hamandi and colleagues reviewed outcomes for 95 patients who underwent isolated tricuspid valve (TV) surgery between 2007 and 2017 at their institution. For 41% of patients, the procedure was reoperative, following either prior coronary artery bypass grafting or prior valve surgery. Valve repair was performed in over 70% of patients. Operative mortality was low, being 3.2% overall and with no mortality in the last 6 years studied (73 patients). The authors conclude that careful patient selection and current periprocedural management have improved morbidity and mortality of isolated TV surgery, and they suggest that these outcomes can serve as a benchmark for catheter-based TV interventions.

Transcatheter aortic valve replacement (TAVR) is expanding to younger patients, but the feasibility of TAVR in failing transcatheter aortic valves (TAV) remains unknown. Dr Tang and colleagues demonstrate in a retrospective review of 551 TAVR procedures by evaluating the postdeployment aortogram using a novel aortic root anatomic classification that TAV-in-TAV after Edwards SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) TAVR may not be feasible in >20% of S3 TAVR procedures and in >50% among patients with type 3 roots.

Unique challenges for TAV-in-TAV compared to surgical aortic valve replacement: (1) the native aortic valve leaflets remain in situ after the initial TAVR, acting as a barrier facing the LM orifice; (2) there is currently no predictable way to align the TAV neocommissures with native commissures; (3) often the only way to engage the left main coronary artery is from the TAV stent frame.

This is particularly important given the potential expansion of TAVR to low-risk and/or younger patients who may need redo TAVR. The ascertainment of aortic root type, STJ and SH relative to TVH is essential to guide valve selection and positioning for TAV-in-TAV feasibility on the basis of left main coronary artery obstruction risk.