Journal and News Scan

In this manuscript, the authors report on a retrospective study looking at the progression of aortic stenosis (AS) in 1558 patients with mild, moderate and severe AS and preserved left ventricular function. They conclude that the progression of severity depends significantly on the severity of the AS at baseline. Although the average rate of progression in AS mean gradient is slower than previously reported, a significant proportion of patients were observed to progress to higher grades of severity or AVR within the recommended time frames for echocardiographic follow-up. In this model, few clinical variables were associated with significantly accelerated progression: in patients with mild AS only age and gender and in patients with moderate AS renal disease and hyperlipidemia beyond age and gender.

Provocative study that analyzes lower body perfusion in a porcine model during cardiopulmonary bypass with an actuated IABP in place to effect pulsatile perfusion.  Parameters of distal perfusion including measurement of pressures and microsphere perfusion indicate that flow distal to the balloon pump may be impaired. 

This manuscript reports on the findings of a meta-analysis of retrospective observational studies comparing clinical outcomes at 1-year in patients treated by either transfemoral (TF) or transapical (TA) transcatheter aortic valve implantation for sever aortic stenosis. Major vascular complications were more common in the TF group and 30-day hospital mortality was higher in the TA group. There were no significant differences at 1-year in all-cause mortality, incidence of myocardial infarction or incidence of stroke.

In this prospective randomized study from the Cardiothoracic Trials Network Investigators, the authors compare the results between CABG alone and CABG plus mitral valve repair in 301 patients with ischemic moderate mitral insufficiency and coronary artery disease. In these patients, the addition of mitral valve repair with a rigid or semirigid complete annuloplasty ring to CABG, was not associated with greater improvement in the left ventricular end-systolic volume index (primary endpoint) at 1 year. There were also no significant differences between the groups in mortality, the composite end point of cardiac or cerebrovascular events, readmissions, or quality of life. There were more neurological events in the CABG plus repair group. The authors conclude that, at one-year follow up, there is no meaningful advantage in adding mitral valve annuloplasty in patients with moderate ischemic mitral insufficiency undergoing CABG.