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Journal and News Scan
January 24, 2024
Submitted by: Jason Trevis
This article highlights the first partial heart transplant in a newborn who was born with persistent truncus arteriosus and irreparable truncal valve dysfunction. This condition remains an issue due to the lack of implantable heart valves that can grow with the patient, and therefore patients require recurrent implant exchanges until adulthood.
The team at Duke have also published the case in JAMA, detailing the first case of a partial heart transplant through implantation of growing heart valves. The authors report a good outcome at one year.
January 24, 2024
Submitted by: EACTS Staff
This study used CardioSurgery Atrial Fibrillation (CASE-AF) registry data to evaluate outcomes of surgery for long standing persistent AF at one year. No AF recurrence at one year is defined by the presence of AF, no re-ablation, no further cardioversion, and no rehospitalization due to AF after a three-month blanking period. Early mortality (30 days) was 2 percent and morbidity was low. Various ablation techniques were used. Of the 202 qualifying patients, 106 (56 percent) had no AF recurrence and 93 percent of these were asymptomatic. Multivariable analysis showed that surgical ablation was most effective when delivered concomitant with endocardial cryoablation.
January 24, 2024
Submitted by: Mateo Marin-Cuartas
In this article, the authors evaluated the practice trends and three-year outcomes following transcatheter edge-to-edge repair (TEER) and surgical repair for degenerative MR in the United States. Medicare and Medicaid data of 53,117 mitral valve interventions for degenerative MR (surgery or TEER) between 2012 and 2019 were analyzed. After excluding patients with rheumatic and congenital disease, endocarditis, myocardial infarction, cardiomyopathy, and concomitant or prior coronary revascularizations, a total of 27,170 patients remained in the analysis.
The total annual volume of mitral interventions did not significantly change (p=0.18) during the study period. However, surgical cases decreased by a third while TEER increased. The included patients were 52.5 percent male and had a mean age of 73.5 years. A total of 7,755 patients underwent TEER, and 19,415 underwent surgical repair. Surgical patients were younger (p <0.001), with less comorbidity and frailty. After matching for baseline characteristics, the resulting 4,532 patient pairs presented with a three-year survival rate after TEER of 65.9 percent (95 percent CI 64.3-67.6) and 85.7 percent (95 percent CI 84.5-86.9) after surgery (p <0.001). The three-year stroke rates after TEER or surgery were 1.8 percent (95 percent CI 1.5-2.2) and 2.0 percent (95 percent CI 1.6-2.4) (p=0.49), respectively. The three-year heart failure readmission rates after TEER or surgery were 17.8 percent (95 percent CI 16.7-18.9) and 11.2 percent (95 percent CI 10.3-12.2 and p <0.001), respectively. Finally, the three-year mitral reintervention rates after TEER or surgery were 6.1 percent (95 percent CI 5.5-6.9) and 1.3 percent (95 percent CI 1.0-1.7 and p<0.001), respectively.
January 23, 2024
Submitted by: Aristotle Protopapas
This is a useful manuscript on long-term follow up confirming the findings of the five-year study, with regards to superior survival on CRT than on ICD. The authors discuss the limitations of the chronology of the trial in relation to novel pharmacological options for cardiac failure.
January 17, 2024
Submitted by: Jo Chikwe
In this Invited Perspective article, the authors address major challenges identified in the 2022 Congenital Heart Surgeon’s Workforce Survey, including saturation of the job market, low individual surgeon case-volume, and surgeon dissatisfaction in congenital cardiac surgery.
January 17, 2024
Submitted by: Jason Trevis
This review explores the application of invasive hemodynamic assessments in the personalization of care for patients with left ventricular assist devices (LVADs). The authors provide a comprehensive approach to their use in triaging patients with low-flow alarms, assessing right ventricular function, evaluating reversal of pulmonary vasculature remodeling, and determining the precipitation for residual heart failure symptoms.
January 17, 2024
Submitted by: Mateo Marin-Cuartas
Stroke after transcatheter aortic valve implantation (TAVI) is associated with considerably worse postinterventional outcomes. However, predictors of stroke and the long-term risk after TAVI remain unknown. In this study from the SwissTAVI registry, the authors aimed to investigate the short- and long-term incidence and predictors of stroke following TAVR. A total of 11,957 patients (mean age 81.8 ± 6.5 years, 48.0 percent female) who underwent TAVI between 2011 and 2021 were included in the analysis. History of a previous stroke (11.8 percent) and atrial fibrillation (32.3 percent) were common among the analyzed patients. The thirty-day incidence of stroke was 3.0 percent, with 69 percent of the strokes occurring within the first 48 hours after TAVI. The incidence of stroke was 4.3 percent at one year and 7.8 percent at five years. After adjusting for matched comparison with same age and sex general population, the risk of stroke was significantly higher in the TAVI population during the first two years after TAVI. In the first year, SSR is 7.26 (95 percent CI: 6.3-8.36) and 6.82 (95 percent CI: 5.97-7.79) for males and females, respectively. In the second year, SSR is 1.98 (95 percent CI: 1.47-2.67) and 1.48 (95 percent CI: 1.09-2.02) for males and females, respectively. The authors concluded that TAVI patients experienced a higher risk of stroke up to two years after TAVI and a comparable risk after that.
January 17, 2024
Submitted by: Mateo Marin-Cuartas
In this brief interview, Dr. Mokryk, a cardiac surgeon from Kiev, Ukraine, talks about his experience working as a cardiac surgeon under extreme conditions in a war situation. He talks about finding ways to circumvent obstacles in an affected region and keep producing outstanding results.
January 11, 2024
Submitted by: Jo Chikwe
This cross-sectional analysis of data from the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges comparing cardiothoracic surgeon faculty demographics and salary between 2019 and 2021 indicates that women comprised 11.5 percent of the cardiothoracic workforce and earned, on average, $0.71 to $0.86 for every $1.00 earned by men. Ascending academic rank correlated with greater salary disparity. Between 2019 and 2021, women at associate professor, professor, and chief rank experienced a decrease in mean salary whereas men at the same rank experienced an increase in mean salary.
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.