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
The AATS expert consensus document was recently released and focused on surgical treatment of acute type A aortic dissection. The documents provides evidence-based recommendations, including initial medical therapy, interhospital transfer, surgical triage, cannulation and perfusion strategy, aortic root management, ascending aorta and distal anastomosis, aortic arch management, malperfusion management, and postoperative considerations.
The "Cape Town Declaration On Access to Cardiac Surgery in the Developing World" was published in August 2018, intending to signal a commitment of the global cardiac surgery and cardiology communities to improving care for the 33 million patients affected by rheumatic heart disease. The Cardiac Surgery Intersociety Alliance (CSIA) was subsequently formed as an international consortium of representatives from major cardiothoracic surgical societies and the World Heart Federation. This article describes the history of the CSIA, its formation, ongoing activities and future directions, including the announcement of pilot sites selected in low and middle income countries for CSIA support.
This study assessed the impact of frailty in patients with advanced heart failure on clinical outcomes after heart transplantation (HTx).
The authors included type A aortic dissection patients from the International Registry of Acute Aortic Dissection, who were managed surgically. Their aim was to evaluate the incidence and prognosis of patients with cerebral malperfusion.
The authors provide tips and tricks on ten most important considerations for multi-arterial grafting.
The SVS and STS produced a document that offers a framework of language, including definitions of nomenclature and a description for a new classification system, to allow for more detailed discussions and reporting of type B aortic dissections.
A most comprehensive practice guideline, relevant not only to surgeons involved in VA ECMO, but also all cardiac and thoracic colleagues and perioperative clinicians.
The discussion on the need of modifying the antithrombotic modulation in recipients of post-cardiotomy ECMO (21) and the chapter on vascular complications (12.3) are particularly stimulating in terms of future research.
In the special April issue of JACC Imaging focusing on secondary mitral regurgitation (SMR), a number of articles on outcomes after transcatheter edge-to-edge repair (TEER) are reported. Specifically, the concept of proportionate vs disproportionate SMR was explored. Studies evaluated proportionality of SMR based on effective regurgitant orfice area (EROA) to left ventricular end-diastolic volume (LVEDV) and found a lower ratio (i.e., more proportionate SMR) had reduced benefit after TEER. Similarly, the ratio of regurgitant volume to LVEDV was found to impact survival with only medical therapy among those with high ratio, but benefit was observed after TEER. Yet, in MITRA-FR randomized trial, neither of these 2 parameters were predictive of outcomes after TEER vs optimal guideline-directed medical therapy (GDMT). Another concept looking total leaflet area to annular area ratio showed that a reduced ratio was associated with suboptimal MR reduction after TEER, likely due to inadequate coaptation reserve. In a study evaluating atrial SMR, a relatively new entity suggesting SMR due to left atrial enlargement and type 1 dysfunction, outcomes were poor except when surgery was performed. An important article on echo evaluation of MR was also presented, as well as CT evaluation of neo-LVOT on evaluation of anatomic feasibility of transcatheter mitral valve replacement (TMVR). Overall, this is a must-read issue from JACC Imaging if you want to learn the latest on research into SMR.