Journal and News Scan

This is an observational outcome study for the comparative effectiveness of SAVR–TAVR procedures for the treatment of severe aortic stenosis at 93 Italian centers. From the entire cohort of 5468 patients, 650 pairs of patients who underwent SAVR and transfemoral TAVR with similar baseline demographic and clinical characteristics were obtained using a propensity score method.

The primary endpoints of this analysis were death from any cause, and major adverse cardiac and cerebrovascular events (MACCE) at 1 year. Transfemoral TAVR was comparable to surgical replacement with respect to 1-year rates of death from any cause, MACCE, and repeat hospitalization due to cardiac reasons. Nevertheless, in the TAVR group there was a higher incidence of paravalvular leak, major vascular damage and need for pacemaker.

A single institution retrospectively reviewed the correlation of preoperative serum albumin level with outcomes after LVAD implantation from 2006 to 2014.  A lower albumin level was associated with a significant increase in postop renal failure and prolonged hospitalization, but not overall short-term and long-term survival.

Case series of 500 consecutive patients undergoing POEM from September 2008 through November 2013 at a tertiary referral center in Japan.  At 2 month follow-up, the success rate was 91.3% (defined as Eckardt score < 2 or reduced > 4 points). Two hundred sixty-eight patients had esophagitis on endoscopy (64.7%), but only 71 (16.8%) had reflux symptoms. At 1-2 years, the success rate was 91%, 9 of 16 patients has esophagitis on endoscopy, and 19.4% had heartburn symptoms. Lastly, at 3 years the success rate was 88.5%, again 9 of 16 patients had esophagitis on endoscopy, and 56.3% had heartburn symptoms. Complications occurred in 16 patients (3.2%), the most severe being 1 pneumothorax requiring a chest tube and 1 case of bleeding controlled endoscopically but requiring blood transfusion; there were no deaths. The authors point out that one advantage of POEM over Heller myotomy is that the length of the myotomy can be better tailored to the individual patient. 

In this manuscript the authors describe their findings in a retrospective review of prospectively obtained 5-year follow up data on 353 patients undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis in 8 Italian centres.Transfemoral access was used in 317 patients (89.8%); in the rest of the patients in whom the transfemoral approach was  not feasible, a trans-subclavian access was employed. During follow-up, there were 241 re-hospitalizations for cardiovascular reasons in 164 (46%) patients. Acute heart failure was the most frequently reason reported (42.7%), followed by requirement of permanent pacemaker implantation (17.4%). On transthoracic echocardiography, mean pressure gradients decreased from 55.6 ±16.8 mm Hg (pre-TAVI) to 10.3±6.5 mm Hg (in-hospital post-TAVI) (p < 0.001). Five-year survival was 45% and freedom from re-hospitalization for cardiac reasons was 54%. Signs of prosthetic failure were observed in 15 patients (4.2%). The presence of moderate or severe paravalvular regurgitation after TAVI was associated with increased late mortality. The authors concluded that the procedure appears to be an adequate and lasting resolution of aortic stenosis in selected high-risk patients.