Journal and News Scan

Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges. A multidisciplinary group evaluated the evidence on mechanisms, diagnosis, and prognosis of PMI. The review found that postoperative troponin thresholds associated with increased mortality risk are markedly higher than those found in current PM definitions. Large increases in other biomarkers are also prognostically relevant, even if supporting evidence of ischemia is lacking. A new algorithm for PMI detection was proposed, and researchers recommended that PMI should be included in the primary composite outcome of trials of coronary interventions.

This article investigates long term survival of total arterial coronary artery bypass grafting comparatively in a male versus female population. The retrospective analysis revealed that, compared to vein dependent procedures, total arterial revascularization was closely associated with a reduced incidence of long-term all-cause mortality for both male (HR, 0.86; 95 percent CI, 0.81–0.91; P < 0.001) and female (HR, 0.82; 95 percent CI, 0.73–0.91; P < 0.001) cohorts.

This study used the German registry of acute aortic dissection type A (GERAADA) score to predict thirty-day mortality in an aortic center in the United States. Six-hundred-eighty-five patients who underwent surgery for acute type A aortic dissection were included. Thirty-day mortality was 12 percent. The GERAADA score had very good discrimination power (area under the receiver operating characteristic 0.762). The observed versus estimated mortality ratio was 0.543, indicating the model overestimated risk. The authors concluded the GERAADA score is a good tool to estimate thirty-day mortality, although it may overestimate the risk in experienced aortic centers.

Overall, 4,365 patients were diagnosed and operated on for infective endocarditis (IE) from 2000 to 2021. Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95 percent CI: 0.322-0.926, p= 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95 percent CI: 0.077-0.933, p= 0.039). The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.