Journal and News Scan

In this article by Kieser and colleagues in which they analyzed 1000 patients receiving CABG, the authors report that when using arterial grafts, incomplete revascularization (occurrence, 14%) was not associated with increased midterm mortality over a median of 54 months in patients <80 years of age (HR 1.2, 95% CI 0.7-2.1), while it was in patients >80 years old (HR 5.7, 95% CI 1.8-18.0). 

In this paper the authors use data from cohort A of the PARTNER trial to evaluate the effect of preoperative moderate to severe mitral regurgitation on survival at two years in patients treated with surgical aortic valve replacement (SAVR) and TAVI. Mitral regurgitation improved significantly in both groups at 30 days. Preoperative mitral regurgitation had a negative effect on survival in the SAVR group but not in the TAVI group. The authors conclude that TAVI may be a reasonable treatment option in a selected group of patients with aortic stenosis and mitral regurgitation.

The purpose of this meta–analysis is to compare the safety, clinical efficacy, and survival outcomes of MitraClip implantation with surgical correction of severe MR. Despite a higher risk profile in the MitraClip patients compared to surgical intervention, the clinical outcomes were similar although surgery was more effective in reducing MR in the early post procedure period. The authors conclude the non–inferiority of the MitraClip as a treatment option for severe, symptomatic MR in comparison to conventional valvular surgery.

Methods

Six electronic databases were searched for original published studies from January 2000 to August 2013.
Two reviewers independently appraised studies, using a standard form, and extracted data on methodology, quality criteria, and outcome measures.
All data were extracted and tabulated from the relevant articles’ texts, tables, and figures and checked by another reviewer.
Overall 435 publications were identified.
Results

After applying selection criteria and removing serial publications with accumulating number of patients or increased length of follow-up, four publications with the most complete dataset were included for quality appraisal and data extraction.
There was one randomized controlled trial (RCT) and three prospective observational studies.
At baseline, patients in the MitraClip group were significantly older (P=0.01), had significantly lower LVEF (P=0.03) and significantly higher EuroSCORE (P<0.0001).
The number of patients with post-procedure residual MR severity >2 was significantly higher in the MitraClip group compared to the surgical group (17.2% vs. 0.4%; P<0.0001).
30-day mortality was not statistically significant (1.7% vs. 3.5%; P=0.54), nor were neurological events (0.85% vs. 1.74%; P=0.43), reoperations for failed MV procedures (2% vs. 1%; P=0.56), NYHA Class III/IV (5.7% vs. 11.3; P=0.42) and mortality at 12 months (7.4% vs. 7.3%; P=0.66).

Bicuspid aortic valve (BAV) has been considered as a relative contraindication for transcatheter aortic valve implantation (TAVI) in aortic valve stenosis. In this retrospective study of the German TAVI registry, the authors have compared outcomes in patients with bicuspid and tricuspid aortic valves (TAV). Out of the 1424 patients included in the registry, 38 had bicuspid aortic valves. After TAVI, the incidence of significant aortic regurgitation (≥II) was significantly higher in patients with BAV (25 vs 15%). Interestingly, the need for pacemaker implantation was higher in patients with TAV (35 vs 17%). There was no difference in 30 day mortality and BAV was not found to be associated with 1-year mortality in the univariate and Cox regression analysis. Although the findings are interesting, they should be interpreted with caution because of the nature of the study.