This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
December 5, 2016
Submitted by: Stuart Head
In the largest randomized trial on PCI versus CABG in patients with left main disease (n=1905) and with an inclusion criteria of a SYNTAX score >33, PCI with everolimus-eluting stents was non-inferior to CABG for the composite endpoint of death, stroke, and myocardial infarction at a trial of 3-year follow-up (15.4% versus 14.7%, respectively). However, landmark analysis showed a significant increase in endpoints beyond 30-day follow-up with PCI (HR 1.44, 95% CI 1.06-1.96). Longer follow-up results from the EXCEL trial are required to determine whether PCI is really non-inferior in terms of long-term outcomes.
December 5, 2016
Submitted by: J. Rafael Sadaba
In this manuscript, the authors describe their findings in a propensity score matched analysis of a retrospectively acquire data on 9792 patients undergoing CABG or heart valve surgery over a 6-year period. 461 matched pairs were identified and analysed in order to evaluate the effect of left atrial appendage (LAA) closure on postoperative atrial fibrillation (POAF), stroke and mortality. In this cohort of patients, LAA closure during routine non–AF-related cardiac surgery was independently associated with increased risk of early POAF and did not significantly influence the risk of stroke or long-term mortality.
December 3, 2016
Submitted by: J. Rafael Sadaba
In this manuscript, the authors offer a comprehensive and thorough review of the pathophysiology of aortic stenosis and relate this to the different potential medical treatment options to slow down the progression of the disease.
November 28, 2016
Submitted by: Arie Blitz
An extremely important journal article comprised of two case reports involving valve perforation and insufficiency following use of the Cor-Knot Automated Fastener (LSI Solutions, Victor, NY, USA) during valve replacement. Injuries to the leaflets of either a native or prosthetic valve after valve repair or replacement, respectively, consisted of perforations. These perforations corresponded precisely to areas where the valve leaflets would likely abrade against the metallic fasteners of the Cor-Knot. The most likely mechanisms leading to this complication include a non-parallel orientation of the fasteners with respect to the valve annulus and the use of an intra-annular valve replacement technique during AVR. To prevent this complication, the authors suggest that surgeons should be meticulous about orienting the fasteners parallel to the valve annulus and should consider revising their AVR technique to positioning the prosthetic valve in a supra-annular rather than annular position when using the Cor-Knot device. Comment: Of note, this is a rare complication with the Cor-Knot device, but can easily be prevented by following the suggestions of the authors.
November 24, 2016
Submitted by: Arie Blitz
The authors performed a meta-analysis to evaluate (1) if the timing of tracheostomy after cardiac surgery and (2) whether the type of tracheostomy (open v. percutaneous) impacted the incidence of sternal wound infection (SWI). The findings were as follows: The overall incidence of SWI was 7% (operative mortality was 23%). The incidence of SWI did not differ between the early (<14 days) vs. the late (>14 days) tracheostomy groups. The timing after cardiac surgery showed a SWI rate of 3% after percutaneous v. 9% after open tracheostomy, but this difference did not reach statistical significance.
A single institution experience is reported for outcomes of aortic allograft use in 353 pts undergoing 92 subcoronary and 261 root replacements. Hospital mortality was 5.9%. Mean follow-up was 12 years, during which time 113 pts died. 20-year survival was 41%. 117 pts required valve-related reoperations. Long-term mortality was related to LV dilatation and severe AR.
Early single institution experience with minimally invasive sutureless aortic valve replacement was reported. Among 300 patients, surgeon-specific and institution-specific learning curves were evaluated for technical success and 30-day complications. A cluster of complications occurred early in the experience and then standardized. No significant learning curve was identified for technical success, although 3 of 6 surgeons exhibited a brief initial learning curve for this metric.
An institutional registry of ECMO patients was surveyed to determine predictors of survival among patients receiving ECMO in the presence of sepsis. Among 151 studied patients, pneumonia was the most common cause of sepsis. Mortality was predicted by advanced age, longer door-to ECMO times, gram-negative sepsis, and sepsis due to infections other than pneumonia.
In this single institution retrospective study, the relationship of PA pressure to long-term mortality was assessed in patients undergoing unifocalization for pulmonary atresia with VSD. A mean PA intraoperative pressure > 25mm Hg was associated with worse survival, and was the sole predictor of medium-term death.
November 23, 2016
Submitted by: Ruben Osnabrugge
Valve in valve transcatheter aortic valve implantation (ViV-TAVI) is an alternative to redo surgical aortic valve replacement (SAVR) in inoperable patients and inpatients at high operative risk. This has become even more important now that approximately 80% of all SAVR are bioprostheses and bioprostheses are implanted at younger age. Several TAVI valves have received CE mark and premarket approval for use in degenerated bioprosthesis. This study analysed the effects of design of four different surgical bioprostheses on the hydrodynamic function of an Edwards Sapien XT valve implanted as a ViV-TAVI. Main findings of this study were: Although there was complete coaptation of the leaflets in all 23-mm label-size ViV combinations, there were considerable differences in regurgitation measurements. This means the differences are attributable to paravalvular leakage. The Sapien XT in the Trifecta and the Perimount had the largest paravalvular leakage compared to the Aspire and Mosaic valves. The paravalvular leakages are most likely the result of different valve material as the porcine leaflets of the Aspire and the Mosaic are less stiff and provide better seal. Surgical valves with externally mounted leaflets (Trifecta) have an increased risk of paravalvular leakage in the ViV combination. On the other hand, mean pressure gradient (MPG) was lower in valves with a higher surgical inner diameter (the Perimount and Trifecta valves). Higher MPG was the result of underexpansion of the Sapien XT in the Trifecta and Mosaic valves, leading to axial overlap of the leaflets. In conclusion: This study showed that surgical valves with a large valve area improved hemodynamics for future ViV-TAVI combinations. Moreover, internally mounted leaflets seem to decrease the risk of paravalvular leakage. Although this is an interesting study, this bench test study was limited to 23mm surgical valves and no calcifications or pannus of the surgical valves were simulated. Use of the valve-in-valve app developed by Dr. Bapat, remains helpful for clinicians making decisions on which TAVI valve is recommended in a specific surgical valve (https://itunes.apple.com/nl/app/valve-in-valve/id655683780?mt=8)