Journal and News Scan

In this meta‐analysis, the authors performed a pooled analysis of time‐to‐event data from Kaplan-Meier curves of randomized controlled trials (RCTs) and propensity‐score matched (PSM) studies comparing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in low-risk patients. The meta-analysis aimed to assess the midterm outcomes of both treatment strategies in low-risk patients. A total of eight studies (three RCTs, five PSM studies) published by December 31, 2022 met the eligibility criteria and included 5,444 patients. 2,639 patients underwent TAVR and 2,805 patients underwent SAVR. In low‐risk patients, TAVR showed a higher risk of all‐cause mortality at eight years of follow up. SAVR was associated with improved survival beyond two years. The survival benefit of SAVR was driven by PSM studies and could not be observed in RCTs. The addition of more extended follow up data from ongoing RCTs will help confirm the possible difference in mid and long term survival between TAVR and SAVR in the low‐risk population.

The clinical problem addressed in this study is bleeding in patients who undergo ECMO. The authors endeavor to address the issue through a quantitative cohort study by reflecting on how to target the behavior of platelets.

Segmentectomy is on the rise, but understanding of the segmental bronchial branching pattern is limited. Computed tomography scans of 303 patients were used to determine and categorize the branching of the right upper lobe bronchi. Four major types and eleven subtypes were identified. Volumetry was done to determine the predominant segment in each case. The order of frequency of branching types was trifurcated nondefective (64.4 percent), then bifurcated nondefective (22.1 percent), bifurcated defective (8.6 percent), and trifurcated half-defective (4.0 percent). In 71 percent of cases, one segment was volumetrically predominant, and in 52 percent of all cases this was segment three. There was a higher risk of complex branching in the volumetrically nonpredominant segment and care should be taken during segmentectomy of these segments.

Surgical tricuspid valve replacement (TVR) is associated with a high risk of postoperative atrioventricular (AV) block. However, placing pacemaker leads through a tricuspid bioprosthesis is discouraged since it might impair bioprosthesis function. Hence, alternative pacing approaches should be considered according to current cardiac pacing guidelines. 

This single center retrospective study assessed the benefits and risks of prophylactic epicardial pacemaker implantation during TVR. A total of eighty patients, with a mean age of fifty-seven years, who underwent TVR with concomitant prophylactic epicardial pacemaker implantation were analyzed. TVR was isolated in 28, or 35 percent of patients, but patients with other concomitant procedures were also included. During the postoperative period, with a mean follow-up period of thirty-five months, heart rhythm was analyzed in fifty-nine out of eighty patients. Cardiac pacing was needed in twenty-seven out of fifty-nine, or 46 percent of patients. Eight, or 14 percent, of patients had complete pacing dependency; ten, or 17 percent, of patients had a high degree AV block; nine, or 15 percent, of patients had a high ventricular pacing rate of over 80 percent. A postoperative spontaneous heart rate of over 70 bpm (P = 0.02) and the presence of a narrow QRS-complex (P = 0.03) were identified as predictors of lower cardiac pacing requirement. Epicardial pacemaker implantation was safe, with related complications observed in two, or 2.5 percent of patients. 

Given the frequent occurrence of AV block following TVR and the acceptable safety profile, the authors concluded that the prophylactic epicardial pacing strategy in patients undergoing TVR should be considered. The results from this study provide additional information to discuss the need for prophylactic epicardial pacing in patients undergoing tricuspid valve surgery.