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Journal and News Scan
March 21, 2016
Submitted by: Arie Blitz
This French group retrospectively compared their experience with tricuspid valve replacements (n=188) using either tissue (82%) or mechanical (18%) valves during a >30-year period. Findings from the study included:
- Almost half the cases were reoperative surgeries, and concomitant procedures were performed in 71%.
- Overall operative mortality was 28%, but decreased down to 10% in the most recent decade.
- Freedom from structural valve deterioration trended higher for mechanical valves but did not reach statistical significance.
- Freedom from thromboembolic events and any valve-related adverse events were significantly higher for tissue valves.
- Eleven patients required repeat tricuspid valve replacements for structural valve disease at a mean interval of 16 years (range 4 to 33 years). None of these valves were mechanical at the original implantation.
March 20, 2016
Submitted by: Arie Blitz
This instructive paper includes three separate meta-analyses focusing on patient-prosthesis mismatch (PPM) after TAVR. These meta-analyses revealed the following:
- The incidence of PPM after TAVR is 35% (moderate 27%, severe 8%).
- The incidence of PPM after TAVR is significantly less than that for SAVR, with an OR of 0.23.
- PPM after TAVR does not seem to impact survival at a mean follow-up interval ranging from 18 months to 4 years.
March 18, 2016
Submitted by: Rakesh Arora
As the Authors have stated: "maximal medical therapy can no longer be seen as a justifiable end‐point for refractory circulatory shock, at least in well‐resourced health settings." To frame their discussion on mechnical circulatory support (MCS) in the current era, they have provided a case vignette for options potentially available to the patient with cardiorespiratory collapse.
March 18, 2016
Submitted by: Aristotle Protopapas
Not only an authoritative 16 year retrospective report on 957 planned aortic aneurysm surgeries from Cleveland Clinic, but a stimulating critique ( pages 771-774) with Tyrone David who was the invited discussant of the manuscript at its presentation at the AATS last April. The debate on selective criteria on replacing an aorta with a diameter of 46mm are particularly interesting (page 772).
March 14, 2016
Submitted by: Rakesh Arora
Early hepatic dysfunction has previously been reported to be an independent risk factor for poor prognosis in critical ill patients. Hepatic and bowel ischemic complication are unfortunately common in patients that require venoarterial (VA) ECMO therapy following a cardiac surgery procedure. It is unclear if biomarkers of liver dysfunction predict outcomes in these patients. Therefore, in this single centre, retrospective study, the Authors sought to determine the predictive value of liver function variables on all-cause mortality in 240 patients requiring venoarterial (VA) ECMO therapy following a cardiac surgery procedure. The Authors have found that elevated values of alkaline phosphatase and total bilirubin were sensitive parameters for predicting the short-term and long-term outcomes in postoperative cardiac patients requiring VA-ECMO. The Authors have concluded that these may represent important biomarkers in the decision-making algorithm in the implementation of ECMO.
March 14, 2016
Submitted by: Arie Blitz
The Hopkins group reviewed differential outcomes in close to 800 patients who had undergone bilateral IMA revascularization during CABG. The compared configurations included:
- IS LITA-LAD and IS RITA-left coronary circulation
- IS LITA-LAD and IS RITA-right coronary circulation
- IS RITA-LAD and IS LITA-left coronary circulation
- IS LITA-LAD and Composite RITA to anywhere
Outcomes analysis failed to detect a difference in outcome endpoints consisting of long-term survival or repeat revascularization among the four configurations.
Is this enough evidence to say that it does not matter which of the techniques you use?
March 13, 2016
Submitted by: Arie Blitz
This Belgian study prospectively analyzed the predictors of long-term mortality in a group of 107 consecutive CABG patients with an LV EF < 35%. All patients underwent preoperative Cardiac MR to assess both LV and RV EF. Right ventricular systolic dysfunction (RVSD), defined as an RV EF < 35%, was a strong independent predictor of mortality at a median follow-up of 4.7 years. The presence of RVSD more than doubled long-term mortality.
March 13, 2016
Submitted by: Arie Blitz
The authors reviewed the Medicare database to analyze the trends in CABG surgery within this population over a 12-year period. Trends in the Medicare population included the following:
- CABG volume decreased by 46%.
- An increasing percentage of CABGs were with fewer grafts (<2).
- ITA use increased from 76% to 89%.
- Comorbidites increased over time.
- The risk-adjusted mortality decreased by 27%.
March 11, 2016
Submitted by: Arie Blitz
The authors provide an excellent overview of the rationale for screening all patients with a new diagnosis of cardiomyopathy for coronary artery disease. This rationale includes the following:
- Two-thirds of patients with HF and reduced EF have CAD.
- Patients with CAD may deny angina, especially diabetics and females.
- Even without risk factors, more than 10% of HF patients have CAD.
- The important benefit of revascularization and secondary prevention in patients with CAD.
March 7, 2016
Submitted by: Joseph Basha
This is a very interesting and provocative article that discusses Exracorporeal Cardiac Life Support (ECLS) as an adjunct to CPR. ECLS has gained in popularity with new tools and techniques, ECLS guidelines, protocols and better understanding of the importance of early initiation.