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Journal and News Scan

Source: Journal of the American Heart Association
Author(s): Lindsey Rosman, Rachel Lampert, Songcheng Zhuo, Quefeng Li, Niraj Varma, Matthew Burg, Allison E. Gaffey, Tiffany Armbruster, Anil Gehi

Wearables are increasingly used by patients with atrial fibrillation (AF) for symptom monitoring and health management, but their impact on patient health care use and psychological well‐being is not well understood. 

In this retrospective, propensity‐matched study of patients with AF, survey and electronic health record data were merged to compare AF‐specific health care use (outpatient/inpatient visits, rhythm‐related testing, and procedures) and informal health care use (telephone calls and patient portal messages) over a 9‐month period between wearable users and nonusers. The authors also examined the effects of wearable cardiac monitoring features (eg, heart rate alerts, irregular rhythm notification, and ECG) on patient behavior and well‐being. Of 172 patients with AF in this analysis (age, 72.6±9.0 years; 42 percent women), 83 used wearables. Compared with nonusers, wearable users reported higher rates of symptom monitoring and preoccupation (P=0.03) and more AF treatment concerns (P=0.02). Moreover, 20 percent of wearable users experienced anxiety and always contacted their doctors in response to irregular rhythm notifications. After matching, AF‐specific health care use was significantly greater among wearable users compared with nonusers (P=0.04), including significantly higher rates of ECGs, echocardiograms/transesophageal echocardiogram, and ablation. Wearable users were also significantly more likely to use informal health care resources compared with nonusers (P=0.05). 

Wearables were associated with higher rates of symptom monitoring and preoccupation, AF treatment concerns, AF‐specific health care use, and use of informal health care resources. Prospective, randomized studies are needed to understand the net effects of wearables and their alerts on patients, providers, and the health care system. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Daokun Sun, Hartzell V. Schaff, Kevin L. Greason, Ying Huang, Gabor Bagameri, Alberto Pochettino, Patrick A. DeValeria, Joseph A. Dearani, Richard C. Daly, Kevin P. Landolfo, Robert J. Wiechmann, Sorin V. Pislaru, Juan A. Crestanello

The selection of valve prostheses for patients undergoing surgical aortic valve replacement (SAVR) remains controversial. In this study, the authors compared the long-term outcomes of patients undergoing aortic valve replacement with biological or mechanical aortic valve prostheses. 

The authors evaluated late results among 5,762 patients aged 45-74 years who underwent biological or mechanical aortic valve replacement with or without concomitant coronary artery bypass from 1989 to 2019 at four medical centers. The Cox proportional hazards model was used to compare late survival; the age-dependent effect of prosthesis type on long-term survival was evaluated by an interaction term between age and prosthesis type. Incidences of stroke, major bleeding, and reoperation on the aortic valve following the index procedure were compared between prosthesis groups. 

Overall, 61 percent (n=3,508) of patients received a bioprosthesis. The 30-day mortality rate was 1.7 percent (n=58) in the bioprosthesis group and 1.5 percent (n=34) in the mechanical group (P=0.75). During a mean follow-up of 9.0 years, the adjusted risk of mortality was higher in the bioprosthesis group (HR=1.30, P<0.001). The long-term survival benefit associated with mechanical prosthesis persisted until 70 years of age. Bioprosthesis (vs mechanical prosthesis) was associated with a similar risk of stroke (P=0.20), lower risk of major bleeding (P<0.001), and higher risk of reoperation (P<0.001). 

Compared to bioprostheses, mechanical aortic valves are associated with a lower adjusted risk of long-term mortality in patients aged 70 years or younger. Patients <70 years old undergoing SAVR should be informed of the potential survival benefit of mechanical valve substitutes. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Joel Dunning, Clare Burdett, Anne Child, Carl Davies, Deborah Eastwood, Tim Goodacre, Frank-Martin Haecker, Simon Kendall, Shyam Kolvekar, Lisa MacMahon, Sean Marven, Sarah Murray, Babu Naidu, Bejal Pandya, Karen Redmond, Aman Coonar

Pectus defects are a group of congenital conditions found in approximately 1 in 250 people, where the sternum is depressed back toward the spine (excavatum), protrudes forward (carinatum) or, more rarely, is a mixture of both (arcuatum or mixed defects). For the majority of patients, it is well tolerated, but some patients are affected psychologically, physiologically or both. 

The deformity becomes apparent at a young age due to the growth of the ribs and the cartilage that links them to the sternum. The majority of defects are mild and are well tolerated, i.e. they do not affect activity and do not cause psychological harm. However, some young people develop lower self-esteem and depression, causing them to withdraw from activities, such as swimming and dancing, and from interactions that might “expose” them, such as sleepovers, dating, going to the beach, and wearing fashionable clothing. This psychological harm occurs at a crucial time during their physical and social development. A small number of patients have more extreme depression of their sternum that impedes their physiological reserve, which can occur when engaging in strenuous exercise, such as running, but can also limit moderate activity, such as walking and climbing stairs. The effects can be so extreme that symptoms occur at rest or cause life-threatening compression of the major blood vessels and organs. The group of patients with physiological impairment typically also suffer from low self-esteem and depression. 

This paper summarizes the current evidence for the different treatment strategies for this condition, including supportive care, psychological support and nonsurgical techniques including bracing and vacuum bell therapy. The authors also consider surgical techniques including the Ravitch procedure, the Nuss procedure (minimally invasive repair of pectus excavatum), pectus implants, and other rare procedures such as Pectus Up. 

For the majority of patients, supportive care is sufficient, but for a minority, a combination of the other techniques may be considered. 

This paper also outlines best practice guidance for the delivery of such therapies, including standardized assessment, consent to treatment, audit, quality assurance, and long-term support. 

All the interventions have risks and benefits that the patient, parents, and clinicians need to carefully consider and discuss when deciding on the most appropriate course. The authors hope this evidence review of “Best Practice for Pectus” will make a significant contribution to those considerations and help all involved—from patients to national policy makers—to deliver the best possible care. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Johann Auer, Pavla Krotka, Berthold Reichardt, Denise Traxler, Ralph Wendt, Michael Mildner, Hendrik Jan Ankersmit, Alexandra Graf 

In this large population-based cohort study, long-term mortality and morbidity were investigated in patients undergoing biological surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis. Individual data from the Austrian Insurance Funds from 2010 through 2020 were analyzed. The primary outcome was all-cause mortality, assessed in the overall and propensity score-matched populations. A total of 18,882 patients underwent SAVR (n = 11,749; 62.2 percent) or TAVR (n = 7,133; 37.8 percent); The median follow-up was 5.8 (95 percent CI 5.7-5.9) years (maximum 12.3 years). The risk of all-cause mortality was higher among TAVR patients: HR 1.5, 95 percent CI 1.4-1.6, P < 0.001; propensity score-matched HR 1.5, 95 percent CI 1.4-1.6, P < 0.001. The estimated median survival was 8.8 years (95 percent CI 8.6-9.1) after SAVR versus 5 years (95 percent CI 4.9-5.2) after TAVR. The estimated 5-year survival probability was 0.66 (95 percent CI0.66-0.68) after SAVR versus 0.40 (95 percent CI0.37-0.44) following TAVR, and 0.69 (0.67-0.70) versus 0.56 (0.54-0.58), respectively, in the matched cohort. There was a survival benefit in patients who underwent SAVR among patients aged 65-75 years and >75 years.

Source: NewYork-Presbyterian Hospital
Author(s): NewYork-Presbyterian Hospital Staff

After enduring cardiopulmonary bypass, many patients experience an inflammatory response, which can lead to prolonged ventilation, bleeding, stroke, and renal dysfunction. The NewYork-Presbyterian and Weill Cornell Medicine trial center was chosen to further investigate RBT-1 to see if it can help the production of anti-inflammatory cytokines and reduce the occurrence of common post-surgical complications. Researchers found that patients who received RBT-1 had a 46 percent decrease in blood product transfusions, a lower likelihood of readmission to the hospital within 30 days, and spent less time in the ICU and on a ventilator.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Carolyn Weber, Martin Misfeld, Mahmoud Diab, Shekhar Saha, Ahmed Elderia, Mateo Marin-Cuartas, Maximilian Luehr, Ayla Yagdiran, Peer Eysel, Norma Jung, Christian Hagl, Torsten Doenst, Michael A Borger, Nikolaus Kernich, Thorsten Wahlers

This retrospective multicentric study aimed to analyze the impact of the sequence of surgical treatment of concomitant infective endocarditis and spondylodiscitis on postoperative outcomes. Of a total of 3,991 patients with infective endocarditis, 150 patients (4.4 percent) had concomitant spondylodiscitis. Primary surgery for infective endocarditis was performed in 76.6 percent of patients, and primary surgery for spondylodiscitis in 23.3 percent of patients. The most common microorganisms detected were enterococci and staphylococcus aureus, followed by streptococci and coagulase-negative staphylococci. If spondylodiscitis was operated on first, 30-day mortality was significantly higher than if infective endocarditis was operated on first (25.7 percent versus 11.4 percent; p = 0.037). Primary surgery for spondylodiscitis was an independent predictor of 30-day mortality on multivariable regression analysis.

Source: Journal of the American Heart Association
Author(s): Mateo Marin‐Cuartas, Suzanne de Waha, Manuela de la Cuesta, Salil V. Deo, Alexander Kaminski, Andreas Fach, Anna L. Meyer, Aron‐Frederik Popov, , Christian Hagl, Dominik Joskowiak, Elmar W. Kuhn, Fabio Ius, Florian Leuschner, George Awad, Holger Thiele, Ali Abdalla, Jens Garbade, Joerg Ender, Katharina Wehrmann, Kaveh Eghbalzadeh, Keti Vitanova, Lenard Conradi, Mahmoud Diab, Marcus Franz, Martin Geyer, Massimiliano Meineri, Martin Misfeld, Mohamed Abdel‐Wahab, Oliver D. Bhadra, Rico Osteresch, Rodrigo Sandoval Boburg, Rüdiger Lange, Sergey Leontyev, Shekhar Saha, Steffen Desch, Sven Lehmann, Thilo Noack, Torsten Doenst, Michael A. Borger, and Philipp Kiefer

The number of patients at intermediate and low surgical risk treated by transcatheter aortic valve implantation (TAVI) is rapidly increasing. Current guidelines recommend performing TAVI in heart valve centers with surgical backup. Nonetheless, there is an ongoing discussion about possibly abrogating on‐site surgical backup for TAVI procedures to increase accessibility. However, concerns and uncertainty exist about the safety of performing TAVI in nonsurgical centers.

This collaborative effort, using pooled data from 14 German centers, presents contemporary outcomes of patients undergoing emergency open-heart surgery (E-OHS) due to severe intraprocedural complications during elective transfemoral TAVI. 

The authors conclude that in the setting of a heart team approach with immediate surgical backup, E‐OHS due to potentially lethal TAVI complications is not a futile clinical situation, with acceptable short‐ and long‐term outcomes, especially in low and intermediate-risk patients.

Source: The Annals of Thoracic Surgery
Author(s): Malak Elbatarny, Santi Trimarchi, Amit Korach, Marco Di Eusanio, Davide Pacini, Raffi Bekeredjian, Truls Myrmel, Joseph E. Bavaria, Nimesh D. Desai, Ibrahim Sultan, Derek R. Brinster, Chih-Wen Pai, Kim A. Eagle, Himanshu J. Patel, Mark D. Peterson

A cohort of 2145 patients from the International Registry of Acute Aortic Dissection were compared according to whether they had axillary (1106 [52 percent]) or femoral (1039 [48 percent]) arterial cannulation. Patients with axillary cannulation had more total arch (15 percent versus 11 percent, P < .02) and valve-sparing root replacements (22 percent versus 12 percent, P < .001), but in-hospital mortality (15 percent versus 14 percent, respectively; P = .7) and stroke rates were similar compared with femoral cannulation.

Source: The Annals of Thoracic Surgery
Author(s): Suk Kyung Lim, Chu Hyun Kim, Ki Hong Choi, Joong Hyun Ahn, Young Keun On, Sung Mok Kim, Dong Seop Jeong

In a single-center series of 502 patients who underwent thoracoscopic ablation and left atrial appendage closure, of whom 333 had preoperative and postoperative computed tomographic imaging, complete left atrial appendage closure (defined as residual stump <1 cm on computed tomography one year postoperatively) was lower with the stapled resection (83 percent) compared with a clip (96 percent), and the residual left atrial appendage stump depth was greater (5.3 vs 2.9 mm, respectively). Two patients with a residual stump experienced an ischemic stroke during follow-up. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Sorush Rokui, Byron Gottschalk, Defen Peng, Rosalind Groenewoud, Jian Ye

In this paper, the authors completed a propensity matched retrospective observational study to compare long-term outcomes of isolated mechanical versus bioprosthetic mitral valves in different age groups. After propensity matching, analysis was completed in two age groups: < 65 and 65–75 years. Ten-year survival and freedom from reintervention were superior in those less than 65 years and receiving mechanical valves. In patients aged between 65–75, there was no difference in survival or freedom from reintervention between valve prosthesis.