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Journal and News Scan
January 18, 2015
Submitted by: J. Rafael Sadaba
This a retrospective study of 175 patients who had survived more than 12 months following TAVI and for whom there were clinical and echocardiographic follow up data. Outcomes were compared between patients with significant (grade II or more) aortic regurgitation (AR) and those without significant aortic regurgitation (less than grade II). Paravalvular, but not intravalvular, AR appeared to improve over time, mainly in the first 6 months. Patients who remained with significant AR grade at 6 month follow-up showed significantly worse survival than patients with less than grade II AR.
January 18, 2015
Submitted by: J. Rafael Sadaba
This is an interesting review of the current status of hybrid coronary revascularization (HCR). The authors discuss the merits and disadvantages of simultaneous versus staged procedures and describe the individual components of HCR. They also analyze the current evidence with regards to results and suggest indications for this type of therapy.
January 18, 2015
Submitted by: Tom C. Nguyen
Anemic off-pump CABG (n=361) versus on-pump CABG (n=578) patients were compared. In anemic patients, off-pump CABG was associated with lower early morbitidy and mortality. 1 to 6 month follow-up mortality, however, was higher in the off-pump CABG cohort.
January 17, 2015
Submitted by: Arie Blitz
The authors perform a meta-analysis of the limited studies available on the utility of tricuspid valve surgery in patients with significant TR at the time of LVAD implantation. No RCTs are available on this issue; however, six observational studies were analyzed by the group. The analysis reveals that, although the addition of TV surgery clearly increases the cardiopulmonary bypass time, no conclusions are warranted regarding the efficacy or safety of TV surgery in these patients. The jury remains out on this controversial issue.
January 17, 2015
Submitted by: Joel Dunning
Guidelines advocate changes in fatty acid consumption to promote cardiovascular health.
This papers summarizes evidence about associations between fatty acids and coronary disease.
They conclude that Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.
January 16, 2015
Submitted by: Joel Dunning
Transcatheter aortic valve implantation has also evolved as a suitable treatment option for degenerative surgical heart valve disease, with considerable experience in the aortic and mitral positions. Success of a valve-in-valve (VIV) procedure depends on four main concepts. These include the following:
- Understanding transcatheter heart valve design.
- A detailed understanding of the design or anatomy, in particular fluoroscopic appearances of the failing SHV.
- Correct sizing of the chosen transcatheter heart valve prosthesis for the existing SHV.
- The ideal implantation position for the transcatheter heart valve.
The aim of this article is to emphasize the impact of the anatomy and design features of surgical heart valve disease (SHV) to provide an understanding of VIV procedures and ensure their success, with focus on VIV in the failing aortic SHV.
January 15, 2015
Submitted by: Arie Blitz
Dr. Asai and colleagues from Japan report on their midterm results using the "butterfly" technique of leaflet resection for posterior leaflet prolapse. In this procedure, the shape of the resected specimen of prolapsed leaflet resembles the shape of a butterfly as opposed to the conventional quadrangular shape. The authors argue that the procedure allows an adjustable height reduction of the posterior leaflet with minimal tissue resection and no annular plication. This may minimize the risk of SAM following mitral repair. Both early and midterm outcomes following the butterfly resection were excellent, with superb durability of the repair.
January 14, 2015
Submitted by: Joseph Basha
The authors describe a "huge" increase in ECMO usage for pulmonay failure with a trend, though not statistically significant, towards improved outcomes. Interestingly, there was not any appreciable increase in hospital costs associated with this significant increase in ECMO utilization. The improved survival was most evident in centers categorized as "medium" size centers doing at least 6 ECMO procedures per year. However, the authors point out that patients transferred to a larger center on ECMO were considered survivors but the outcome of the transferred patients was not available. The authors also contemplate that the improved survival trend is related to improved technology and protocols and that this technological improvement will result in an even greater increase in ECMO usage in the future.
January 14, 2015
Submitted by: Mark Ferguson
This RCT compared daily 200mg or 300mg of FXI-ASO (an antisense oligonucleotide that reduces levels of factor XI) to daily 40mg of enoxaparin in pts undergoing knee replacement surgery. The end point was thromboembolism. FXI-ASO significantly reduced factor XI levels in a dose-response manner. FXI-ASO 200 mg was equivalent to enoxaparin in frequency of the end point (27% vs 30%) and FXI-ASO was superior (4%). Bleeding was evident in 8% after enoxaparin and in 4% after either dose of FXI-ASO.
January 14, 2015
Submitted by: Mark Ferguson
A tool for assessing competency in chest tube insertion was developed and validated using mannequins and patients. Scores varied according to participant experience, and interrater consistency in evaluations was high. It is suggested that this assessment tool can be used to judge the development of competence in chest to insertion and to evaluate the effectiveness of teaching.