Journal and News Scan

During some transcatheter aortic valve implant (TAVI) procedures, complications require conversion to emergency open heart surgery (E-OHS). This study evaluated early and midterm outcomes in a large center over fifteen years. Patients were grouped by surgical risk and the study time was divided into three five-year periods. In the entire study period, 1.1 percent of TAVI patients (74/6903) required E-OHS. The rate of E-OHS decreased over the three periods, from 3.5 percent to 0.4 percent. However, the proportion of patients from the study with low or intermediate risk increased considerably, from 1 percent to 26 percent. In-hospital mortality was 62 percent in high-risk and 12.5 percent in low and intermediate-risk patients. One-year survival was 31.8 percent in high-risk and 87.5 percent in low/intermediate risk patients.

The risk of dissection associated with fluoroquinolone use has gained wide acceptance, but recent data indicate there’s more to the story. Pasternak and colleagues report a Swedish, multicenter, propensity-matched study of one million treatment episodes examining the relationship between fluoroquinolone use and aneurysm or dissection. Interestingly, after adjustment for confounders, the absolute risk of aneurysm or dissection associated with fluoroquinolone use was smaller than previously reported, risk was found to be driven by aneurysm rather than dissection, and greatest risk was identified in the first ten days during treatment. 

This study compared in-hospital mortality risk prediction after cardiac surgery using the EuroSCORE II system with results generated by several machine-learning techniques. The dataset contained 227,087 adult patients, among whom there were 6,258 deaths (2.76 percent). Machine learning techniques showed some statistical improvements over EuroSCORE II, but the clinical impact of this was modest. The addition of other risk factors in future studies may result in further improvements.

Can we increase the rate and consistency of organ donation from donors experiencing out-of-hospital arrest? What are the challenges and opportunities associated with procurement from this population? The International Liaison Committee on Resuscitation released a scientific statement defining a protocol for organ donation after cardiac arrest, designed for applicability to all health systems. Read the full statement from Circulation journal ahead of print.