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Journal and News Scan
March 22, 2016
Submitted by: Ruben Osnabrugge
In this study the STS/ACC Transcatheter Valve Therapy registry was used to compare TAVI in nonogenarians versus TAVI in patients <90 years old. In total 3,773 (15.7%) of the patients were >90 years old. Mortality at 30 days and 1-year was significantly higher for nonogenarians (8.8% vs. 5.9%, p<0.001 and 24.8% vs. 22.0%, p=0.001, respectively). With regard to quality of life, nonogenarians did worse at 30 days than the younger patients, while at 1 year there was no significant difference. Although the study had to exclude 35% of the long-term follow-up and there were many missing quality of life data, the authors conclude that this large study confirms the safety and efficacy of TAVR in nonogenarians.
March 22, 2016
Submitted by: Arie Blitz
This retrospective study evaluated the relationship between the timing betweenLHC and CABG and its effect on renal function in a cohort of 2371 patients at a single center. Findings included:
A shorter interval between LHC and CABG was independently associated with postop kidney injury in patients undergoing on-pump CABG, but not in those undergoing OPCAB.
Question: Should the findings of this study influence whether you perform off-pump vs. on-pump CABG if CABG is performed within a week of LHC, independent of other considerations?
March 21, 2016
Submitted by: CTSNet Staff
The new AHA/ACC Scientific Statement represents significant progress regarding the management of anomalous aortic origin of a coronary artery (AAOCA) by liberalizing the exercise restrictions on those asymptomatic patients with anomalous aortic origin of the right coronary artery. More data regarding the risk of and risk factors for sudden cardiac death (SCD) from AAOCA are needed and can only be obtained with collaboration between multiple centers. Future statements or guidelines should focus on a more detailed definition of ‘‘asymptomatic’’ as well as on additional provocative screening evaluations for risk of SCD prior to allowing these children to return to competitive sport.
March 21, 2016
Submitted by: Arie Blitz
This French group retrospectively compared their experience with tricuspid valve replacements (n=188) using either tissue (82%) or mechanical (18%) valves during a >30-year period. Findings from the study included:
- Almost half the cases were reoperative surgeries, and concomitant procedures were performed in 71%.
- Overall operative mortality was 28%, but decreased down to 10% in the most recent decade.
- Freedom from structural valve deterioration trended higher for mechanical valves but did not reach statistical significance.
- Freedom from thromboembolic events and any valve-related adverse events were significantly higher for tissue valves.
- Eleven patients required repeat tricuspid valve replacements for structural valve disease at a mean interval of 16 years (range 4 to 33 years). None of these valves were mechanical at the original implantation.
March 20, 2016
Submitted by: Arie Blitz
This instructive paper includes three separate meta-analyses focusing on patient-prosthesis mismatch (PPM) after TAVR. These meta-analyses revealed the following:
- The incidence of PPM after TAVR is 35% (moderate 27%, severe 8%).
- The incidence of PPM after TAVR is significantly less than that for SAVR, with an OR of 0.23.
- PPM after TAVR does not seem to impact survival at a mean follow-up interval ranging from 18 months to 4 years.
March 18, 2016
Submitted by: Rakesh Arora
As the Authors have stated: "maximal medical therapy can no longer be seen as a justifiable end‐point for refractory circulatory shock, at least in well‐resourced health settings." To frame their discussion on mechnical circulatory support (MCS) in the current era, they have provided a case vignette for options potentially available to the patient with cardiorespiratory collapse.
March 18, 2016
Submitted by: Aristotle Protopapas
Not only an authoritative 16 year retrospective report on 957 planned aortic aneurysm surgeries from Cleveland Clinic, but a stimulating critique ( pages 771-774) with Tyrone David who was the invited discussant of the manuscript at its presentation at the AATS last April. The debate on selective criteria on replacing an aorta with a diameter of 46mm are particularly interesting (page 772).
March 14, 2016
Submitted by: Rakesh Arora
Early hepatic dysfunction has previously been reported to be an independent risk factor for poor prognosis in critical ill patients. Hepatic and bowel ischemic complication are unfortunately common in patients that require venoarterial (VA) ECMO therapy following a cardiac surgery procedure. It is unclear if biomarkers of liver dysfunction predict outcomes in these patients. Therefore, in this single centre, retrospective study, the Authors sought to determine the predictive value of liver function variables on all-cause mortality in 240 patients requiring venoarterial (VA) ECMO therapy following a cardiac surgery procedure. The Authors have found that elevated values of alkaline phosphatase and total bilirubin were sensitive parameters for predicting the short-term and long-term outcomes in postoperative cardiac patients requiring VA-ECMO. The Authors have concluded that these may represent important biomarkers in the decision-making algorithm in the implementation of ECMO.
March 14, 2016
Submitted by: Arie Blitz
The Hopkins group reviewed differential outcomes in close to 800 patients who had undergone bilateral IMA revascularization during CABG. The compared configurations included:
- IS LITA-LAD and IS RITA-left coronary circulation
- IS LITA-LAD and IS RITA-right coronary circulation
- IS RITA-LAD and IS LITA-left coronary circulation
- IS LITA-LAD and Composite RITA to anywhere
Outcomes analysis failed to detect a difference in outcome endpoints consisting of long-term survival or repeat revascularization among the four configurations.
Is this enough evidence to say that it does not matter which of the techniques you use?
March 13, 2016
Submitted by: Arie Blitz
This Belgian study prospectively analyzed the predictors of long-term mortality in a group of 107 consecutive CABG patients with an LV EF < 35%. All patients underwent preoperative Cardiac MR to assess both LV and RV EF. Right ventricular systolic dysfunction (RVSD), defined as an RV EF < 35%, was a strong independent predictor of mortality at a median follow-up of 4.7 years. The presence of RVSD more than doubled long-term mortality.