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Journal and News Scan
January 11, 2024
Submitted by: Mateo Marin-Cuartas
Preinterventional frailty assessment is gaining relevance in both cardiac surgery and transcatheter aortic valve implantation (TAVI). Nowadays, frailty assessment is an essential part of the heart team discussions when evaluating patients for cardiac surgery and transcatheter interventions. There is, however, a lack of consensus on how to assess frailty for the prediction of outcomes of cardiovascular operations or transcatheter interventions. Hence, the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) reviewed the available literature and developed a consensus statement on preinterventional frailty assessment in patients scheduled for cardiac surgery or TAVI. The recommendations of the consensus statement are focused on surgical procedures and TAVI. However, based on the available literature on frailty assessment related to other transcatheter interventions, such as transcatheter edge-to-edge mitral valve repair and the similarity of these patients to TAVI cohorts, the authors propose to apply the recommendations in this consensus statement to patients undergoing other transcatheter interventions as well.
January 11, 2024
Submitted by: Diego Pena
In this article, the author describes three patients who had undergone previous mitral and aortic valve replacement, experiencing cardiogenic shock due to valve dysfunction. The initial evaluation demonstrated that the patients were deemed inoperable based on risk score calculations. AV ECMO was employed to recover them from cardiogenic shock and severe acidosis. Successful redo surgical valve replacement was performed in all cases, and the results are presented, followed by a discussion and literature review. The paper concludes that AV ECMO might be beneficial for patients with these severe conditions, providing them with a chance for survival after undergoing valve replacement redo surgery.
January 11, 2024
Submitted by: Mujtaba Mubashir
Spread through air spaces (STAS) is a recently identified marker that predicts worse outcomes in patients with lung cancer and is postulated to be one of the reasons why some patients with early-stage lung adenocarcinoma have uncharacteristically high locoregional recurrence rates. This is a marker that is challenging and unreliable to identify on frozen sections but is proving to be an important determinant of deciding the extent of oncological resection. Additional investigation into better identifying STAS is needed at this time. The authors in this excellent commentary highlight some of the work done so far in this regard, and the future steps needed.
January 4, 2024
Submitted by: EACTS Staff
The authors used machine learning techniques on twenty-year outcome data from 436 consecutive patients who underwent mitral valve repair over an eighteen-year period. The endpoints were actuarial survival and freedom from moderate or high mitral regurgitation (MR). Five machine learning models were used, and concordance indices (C-indices) were compared. The study shows that machine learning models were able to predict overall mortality and MR recurrence after mitral valve repair. The C-indices of machine learning models were higher than those of the Cox model. Further validation will be required.
January 4, 2024
Submitted by: Mujtaba Mubashir
Acute type A aortic dissection is a highly morbid condition, with high mortality approaching about 40 percent. The authors of this article report that women tend to present with more atypical symptoms and have earlier deterioration compared to men, including neurological dysfunction and more aortic rupture events before surgical intervention. They also present later in life than men. Long term mortality between genders appears to be similar. Overall, it is important to realize these different disease progression patterns amongst genders given its high clinical relevance.
January 4, 2024
Submitted by: Mujtaba Mubashir
The study of acute aortic syndromes, particularly the study of aortic mechanics, is quite challenging due to the dynamic nature of the aorta, complex and variable geometry, and the presence of a valve in constant motion. Several theoretical and mechanical models have been developed previously; however, all have limitations thus affecting the quality of decision making. The authors of this excellent paper propose new mathematical models to more closely mimic aortic mechanics, including discussion of practical models to test these hypotheses. While a large knowledge gap still exists, this paper aims to bridge the gap further.
January 4, 2024
Submitted by: EACTS Staff
Current intraoperative methods for evaluating aortic valve repair often fail to predict the final echocardiographic outcome. The authors developed an aortic valve visualization and pressurization (AVP) device for use during cardioplegia and present results from its use in 24 patients undergoing valve sparing root replacement. The authors conclude that the AVP device can be a useful tool for intraoperative evaluation of the aortic valve, helping to make the result of surgery more predictable.
December 20, 2023
Submitted by: Jason Trevis
This paper utilized the Delphi method to establish interdisciplinary consensus for the initial investigations, diagnostic imaging, referral pathway and interhospital transfer for patients with acute aortic syndrome. The authors represent the coming together of experts from the multidisciplinary team, as well as members of the public, including patient representatives. This comes following the global patient-led work of THINK AORTA.
December 20, 2023
Submitted by: Mateo Marin-Cuartas
The incidence, predictors, and prognostic impact of rehospitalization following transcatheter aortic valve implantation (TAVI) has not been widely investigated and reported. This information is especially missing based on real-world practice data. Hence, the authors retrospectively analyzed a total of 1,397 patients who underwent TAVI between 2016 and 2020 in East Denmark. The medical records of all patients were reviewed to validate rehospitalizations up to one year after discharge from the index TAVI. A total of 615 patients (44 percent) had an unplanned rehospitalization within the first year after TAVI. The incidence of unplanned rehospitalization rate was three times higher in the early post-TAVI period (i.e., within 30 days) compared with the late post-TAVI period (i.e., 30 days to 1 year; 2.5 vs. 0.8 per patient-year, respectively; P < 0.001). Early rehospitalization was most frequently procedure related, whereas late rehospitalization was mostly related to baseline comorbidities. Early and late heart failure related rehospitalization was associated with a considerably higher one and five-year mortality risk (hazard ratio (HR) of 4.3 and 3.2 for 1-year mortality and HR of 3.2 and 2.9 for 5-year mortality, respectively; P < 0.001). Given the elevated frequency of rehospitalization following TAVI and the poor long-term survival associated with heart failure related rehospitalization, the authors conclude that TAVI trials should include rehospitalization as a major study endpoint.
December 20, 2023
Submitted by: Mateo Marin-Cuartas
In this LACES “Experts’ Insights” interview, Dr. Michael Borger, co-chair of the recently published 2023 ESC/EACTS Endocarditis Guidelines, briefly summarizes the most important take-home messages and changes of the guidelines.