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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Tyler J. Beute, Matthew D. Orem, Timothy M. Schiller, Matthew Goehler, Jessica Parker, Charles L. Willekes, Tomasz Timek

The authors retrospectively reviewed their minimally invasive aortic valve replacement experience over a three-year period to assess the outcomes in patients undergoing conventional knot tying (n = 39) versus automated knot tying with the Cor-Knot device (n = 53).  Aortic cross-clamp time was approximately 10 minutes shorter in the latter group.  Postoperative mortality and morbidity were comparable, as was valve function at one year.

Source: The Annals of Thoracic Surgery
Author(s): Fenton H. McCarth, Sreekanth Vemulapalli, Zhuokai Li, Vinod Thourani, Roland A. Matsouaka, Nimesh D. Desai, Ajay Kirtane, Saif Anwaruddin, Matthew L. Williams, Jay Giri, Prashanth Vallabhajosyula, Robert H. Li, Howard C. Herrmann, Joseph E. Bavaria, Wilson Y. Szeto

The STS/ACC TAVR Registry  was analyzed to determine the effect of tricuspid regurgitation (TR) on outcomes after transcatheter aortic valve replacement (TAVR).  The authors found that TR, of any severity, is quite common in TAVR patients (80%).  The breakup of TR severity was as follows:

  • Mild TR:             56%
  • Moderate TR: 19%
  • Severe TR:         5%

Findings:  Along with higher predicted risk, increasing TR severity was associated with increased mortality and readmission.

Should the TR of a certain severity be addressed at the time of TAVR?  How?

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

The first deceased donor lung transplant in the UAE was performed at the Cleveland Clinic Abu Dhabi’s Heart and Vascular Institute, making the hospital the first in the country to offer heart, liver, and lung transplants.

The king of Morocco underwent surgery for an arrhythmia in Paris, France.

Malaysia hosted the first Joint Surgical Colleges Fellowship Examination in Cardiothoracic Surgery to be held outside the UK.

 

Drugs and Devices

AtriCure, Inc, has launched the AtriClip Flex-V™ Left Atrial Appendage Exclusion System in the United States, the newest design to be added to the AtriClip line of devices.

The US Food and Drug Administration has issued a warning about the use of clarithromycin in patients with heart disease.

 

Research, Trials, and Funding

Children with congenital heart disease are considered well-connected to health care regardless of socioeconomic background, however researchers from New York City found that neighborhood health disparities for these patients were similar to those observed in general pediatric patients.

The American Lung Association has released its first Lung Force “State of Lung Cancer” report, which evaluates cancer incidence, survival, and treatment around the US.

Researchers from California have identified iron as a key element to Aspergillus invasion in transplanted lungs of mice.

Source: Texas Heart Institute Journal
Author(s): Heidi J. Reich, Jon A. Kobashigawa, Tamar Aintablian, Danny Ramzy, Michelle M. Kittleson, Fardad Esmailian

A 16-year retrospective analysis of cardiac transplantation outcomes, recommending cold ischemic times of less than two hours for older donors.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Peter Chiu, Jeffrey Trojan, Sarah Tsou, Andrew B. Goldstone, Y. Joseph Woo, Michael P. Fischbein

This Stanford group retrospectively reviewed their experience over a 10-year period with 293 patients who underwent either limited aortic root repair or root replacement.  

Results:

  • No significant difference in weighted perioperative mortality.
  • No significant difference in weighted survival.
  • However, there was a significantly higher rate of later reoperation in the limited root repair group (11% versus 0%, p<0.001).
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Harold L. Lazar, Thomas Vander Salm, Richard Engelman, Dennis Orgill, Steven Gordon

The authors present a thorough expert consensus review on the prevention—preoperative, intraoperative, and postoperative—and the postoperative management of sternal wound infections.  The authors conclude with a guideline with class recommendations and levels of evidence.

This article should be in every cardiac surgeon's armamentarium.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Suvitesh Luthra, Miguel M. Leiva-Juárez, Maciej Matuszewski, Ian S. Morgan, John S. Billing

This single-center group retrospectively reviewed their experience (2004-2014) with at least two arterial conduits for triple-vessel coronary artery disease to assess the benefit of adding a third arterial conduit versus a venous conduit to the right-sided circulation.  A total of 167 propensity-matched pairs were compared.  In this small study comparing intermediate survival, no benefit of adding a third arterial conduit was appreciated (HR 0.72, p = 0.411).

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Sergio Buccheri, Gottfried H Sodeck, Davide Capodanno

The EJCTS and ICVTS are publishing a series of Statistical Primers to help clinicians perform and interpret research. In the first series of primers, Buccheri and coauthors provide a conceptual framework for conducting, interpreting, and critically evaluating meta-analyses. With an increasing number of meta-analyses being performed, it is crucial for surgeons to increase their understanding of the methodology.

Read the commentary article on the importance of this series of statistical primers here.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Amit Pawale, Yosef Schwartz, Shinobu Itagaki, Sean Pinney, David H. Adams, Anelechi C. Anyanwu

A retrospective Mount Sinai small series on selective emergent implantation of long-term ventricular assist devices  in cardiogenic shock. It challenges the traditional concept of short-term stabilisation with ECMO or short-term support, and is likely to generate criticism and discussions.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Nishan Saran, Chaim Locker, Sameh M. Said, Richard C. Daly, Simon Maltais, John M. Stulak, Kevin L. Greason, Alberto Pochetino, Hartzell V. Schaff, Joseph A. Dearani, Lyle D. Joyce, Brian D. Lahr, David L. Joyce

The Mayo Clinic team retrospectively reviewed their experience with isolated CABG for multivessel coronary artery disease over a 15-year period to assess usage of bilateral internal mammary arteries (BIMA) and selected outcomes.  The population included a total of 6468 isolated CABG procedures.  

Some of the salient findings from their study are:

  • The use of BIMA doubled over the most recent 4-year period (13% to 27%).
  • Propensity-matched patients exhibited a survival advantage for BIMA patients, with a hazard ratio of 0.81.
  • Sternal infection was not significantly higher in the BIMA group.

The authors conclude that BIMA use should be encouraged and expanded.

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