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Journal and News Scan
April 24, 2024
Submitted by: EACTS Staff
Heart transplantation for adult congenital heart disease (ACHD) is associated with challenging pretransplant support, long waitlists, and high early post-transplant mortality. The authors used 2,737 patients from the United Network for Organ Sharing database to examine whether changing practices have altered outcomes in the period from 1992 to after 2018, when the allocation system changed. The listed and transplanted patients gradually increased, but the proportion receiving a transplant remained constant. There were decreases in both the proportion delisted or dying after listing and the waitlist times, especially after 2018. Mortality at 30 days post-transplant remains high but has significantly improved. The authors concluded that more complex patients do not have worse outcomes and that the new donor allocation system has reduced wait times without affecting early mortality.
April 24, 2024
Submitted by: EACTS Staff
This study examined the gender distribution of session leaders and abstract presenters at two international European cardiothoracic meetings from 2017 to 2022. The primary outcome was to evaluate the proportion of female session leaders and abstract presenters. During this time, 397 out of 3,007 (13.2 percent) session leaders and 955 out of 6,251 abstract presenters were female. Over this period, the proportions of female session leaders and abstract presenters increased significantly. However, women are still underrepresented in these roles at these meetings. More efforts are required by cardiothoracic organizations to address the gender gap, and the authors suggest specific steps that could be taken to address this.
April 24, 2024
Submitted by: Mujtaba Mubashir
This commentary succinctly reviews the 2021 coronary revascularization and the 2023 chronic coronary disease guidelines with relation to use of PCI and CABG in patients with ischemic cardiomyopathy and ejection fraction (EF) less than or equal to 35 percent, and reviews findings from Alzahrani et al. There is data suggesting the superiority of CABG compared to PCI in these populations, particularly with regards to completeness of revascularization and long-term outcomes that support keeping use of CABG in this particular patient population as a Class I recommendation.
April 24, 2024
Submitted by: EACTS Staff
The authors report on midterm outcomes in 39 patients with Marfan (MFS) or Loeys-Dietz syndrome (LDS) after endovascular aortic repair (EVAR). Patients were analyzed based on planned versus emergency procedure and safe or unsafe landing zone. Thirty-four patients had thoracic EVAR and five had abdominal EVAR. There were no statistically significant differences between reinterventions in patients with safe and unsafe landing zones, or between emergency and planned procedures. The authors conclude that EVAR in these patients is feasible and safe. EVAR is viable in connective tissue disease when used by a multidisciplinary aortic team, even when the landing zone is in native tissue.
April 18, 2024
Submitted by: Mujtaba Mubashir
This large-scale review of the Dutch Lung Cancer Audit for Surgery Database summarizes the variability in the current practice in surgical care for primary spontaneous pneumothorax. A total of 1,851 patients were reviewed. The most performed surgical procedure across the country was a bullectomy with pleurodesis (83 percent). There was significant variation in length of stay and complication rates across hospitals. This study showcases the power of using large scale national databases to outline current practices nationwide thus identifying target areas and opportunities for improvement nationally.
April 18, 2024
Submitted by: Mujtaba Mubashir
This study reviews 44 patients with stage IB (larger than 4 cm) to IIIA non-small cell lung cancer who were treated on sequential platform arms of the NEOSTAR trial. Twenty-two patients were treated with nivolumab and chemotherapy and 22 patients were treated with ipilimumab, nivolumab, and chemotherapy. While surgical resections are feasible and safe, the vast majority of resections are performed via thoracotomy. Interestingly, the addition of ipilimumab seems to correlate with a higher major pathological response (MPR), and perceived difficulty of resection by surgeons, likely due to increased tissue inflammation. Postoperatively, there did not seem to be a difference in adverse effects amongst the groups, although small sample size may limit conclusions.
April 18, 2024
Submitted by: Jason Trevis
This study aimed to describe the use of perioperative mechanical circulatory support (MCS) and its impact on outcomes in patients with ischemic cardiomyopathy undergoing surgical revascularization. Between 2015 and 2021, data from 378 patients with an ejection fraction below 35 percent and undergoing isolated coronary artery bypass grafting (CABG) were analyzed based on utilization of MCS—no MCS, preoperative MCS and postoperative MCS. Authors included patients requiring intra-aortic balloon pump, extracorporeal membrane oxygenation, or Impella device within the MCS groups. The primary outcome was operative mortality.
April 18, 2024
Submitted by: Jo Chikwe
An international group of clinicians and investigators with expertise in clinical and translational research provide advice to early career cardiac surgeons and anesthesiologists interested in mechanistic studies, randomized clinical trials, observational studies, and meta-analyses.
April 10, 2024
Submitted by: Mateo Marin-Cuartas
This report presents trends and outcomes of cardiac surgery following initial transcatheter aortic valve replacement (TAVR). The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for all adult patients undergoing cardiac surgery after a previously placed TAVR between January 2012 and March 2023. A total of 5457 patients were identified, of which 2972 (54.5 percent) underwent SAVR (surgical aortic valve replacement), and 2485 (45.5 percent) underwent non-SAVR cardiac surgery. The frequency of cardiac surgery after TAVR increased by 4235.3 percent overall and 144.6 percent per year throughout the study period. The incidence of operative mortality and stroke were 15.5 percent and 4.5 percent, respectively. The observed to expected mortality ratios based on the STS risk score were significantly greater than 1.0, demonstrating a poor performance of the existing STS risk estimation models.
April 10, 2024
Submitted by: Mateo Marin-Cuartas
In preclinical studies, microplastics and nanoplastics have been found to be a potential risk factor for cardiovascular disease. However, there is a lack of clinical evidence that this risk extends to humans. The authors conducted a prospective, multicenter, observational study involving patients undergoing carotid endarterectomy. The excised carotid plaque specimens were analyzed for microplastics and nanoplastics. The primary endpoint of a composite of myocardial infarction, stroke, or death from any cause was compared among patients with evidence of microplastics and nanoplastics in plaque as compared against patients with a plaque that showed no evidence of microplastics and nanoplastics. A total of 304 patients were enrolled in the study, and 257 completed a mean follow up of 34 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4 percent), with a mean level of 21.7 μg per milligram of plaque. A total of 31 patients (12.1 percent) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2 μg per milligram of plaque. Patients in whom microplastics and nanoplastics were detected within the atheroma were at higher risk for a primary endpoint event than those in whom these substances were not detected (hazard ratio, 4.53; 95 percent confidence interval, 2.00 to 10.27; P<0.001).