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Journal and News Scan

Source: Seminars in Thoracic and Cardiovascular Surgery
Author(s): Lars G. Svensson

In this paper, Dr Svensson covers his technique of leaflet repair during aortic root reimplantation. The core technical points are described as well as the long-term clinical outcomes. The author's experience has shown that for patients having leaflet repair, bracing the root with a reimplantation operation appears to reduce the risk of late regurgitation and reoperation.

Source: News from around the web.
Author(s): Emily Robinson

A multidisciplinary team led by Bob Kiaii at the London Health Sciences Centre in Ontario, Canada, has reportedly completed the world's first robotic performance of a specific aortic valve replacement procedure in a patient with aortic stenosis.

The charity Tiny Tickers is launching a campaign with the goal of ensuring that all maternity wards across the United Kingdom have access to machines for detecting heart defects in newborns.

A woman with cystic fibrosis living in Holbrook, Massachusetts, USA, recently completed her first 5K race after receiving a double-lung transplant.

After reports of several patient injuries, the U.S. Food and Drug Administration has announced a Class I recall for a batch of warfarin test strips used with point-of-care or in-home devices to adjust warfarin dosing.

Research published in The Journal of Nuclear Medicine suggests that a new nuclear medicine tracer could improve the diagnosis and treatment of non-small cell lung cancer.

Source: Circulation Research
Author(s): Yogesh NV Reddy , Masaru Obokata , Katlyn E Koepp , Alexander C Egbe , Brandon Wiley , Barry A Borlaug

Interesting small randomized controlled trial that will definitely be widely discussed.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Samer A M Nashef, Simon Fynn, Yasir Abu-Omar, Tomasz J Spyt, Christine Mills, Colin C Everett, Julia Fox-Rushby, Jeshika Singh, Malcolm Dalrymple-Hay, Catherine Sudarshan, Massimiliano Codispoti, Peter Braidley, Francis C Wells, Linda D Sharples

This is a randomized controlled trial evaluating the impact of adjunct atrial fibrillation surgical treatment in patients undergoing cardiac surgery. Included are 352 patients. Sinus rhythm was restored two times more frequently in those who underwent atrial fibrillation surgery. There was no difference in survival and quality of life up to two years.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Toshitaka Watanabe, Toshiro Ito, Hiroshi Sato, Takuma Mikami, Ryosuke Numaguchi, Naomi Yasuda, Junji Nakazawa, Yosuke Kuroda, Ryo Harada, Nobuyoshi Kawaharada

Watanabe and associates studied the association between false lumen remodeling late after type A dissection repair and the shape of the true lumen in the early postoperative period. They found that the true lumen shape in the early postoperative period predicts false lumen remodeling late after surgery. The methodology of computed tomography angiography measurements used in this work serves as a good example of quantitative image analysis for patients with aortic disease.

Source: Journal of the American College of Cardiology: Cardiovascular Interventions
Author(s): Kundi H, Strom JB, Valsdottir LR, Elmariah S, Popma JJ, Shen C, Yeh RW

Why this study – the rationale/objective

This study compared the volumes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) since the approval of TAVR in the United States. The Medicare Provider Analysis and Review (MEDPAR) database was used to extract volumes for 2011-2014. The volume of SAVR decreased in hospitals with the largest number of TAVR procedures. At the same time, 30-day and 1-year mortality after SAVR declined in the hospitals with the largest TAVR volumes. Patients who underwent SAVR showed a decrease in comorbidities over time. The study provides some interesting insights. First, the large number of excluded centers highlight the large amount of centers in the US that perform very few aortic valve procedures. Second, the lower mortality after SAVR and low risk profile of SAVR patients was likely the result of high risk patients getting TAVR. Third, the current study does not include data from recent years. It will be very interesting to learn whether the increasing TAVR volume leads to a decrease in SAVR volume, especially since results of TAVR vs. SAVR in low risk patients are expected shortly. 

Source: Journal of the American College of Cardiology
Author(s): Durko AP, Reardon MJ, Kleiman NS, Popma JJ, Van Mieghem NM, Gleason TG, Bajwa T, O'Hair D, Brown DL, Ryan WH, Chang Y, De Leon SD, Kappetein AP

The authors of this study analyzed neurological events and quality-of-life in the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial.  A total of 1746 patients with aortic stenosis and intermediate surgical risk were randomized to either TAVI or SAVR. Neurological events and quality of life were analyzed at 30 days, six months, and 12 months. In this group of elderly (approximately 80 years old) patients with an intermediate risk profile (STS-PROM 4.5), the event rates at 30 days were higher for SAVR as compared with TAVI for both stroke and encephalopathy (5.4% vs. 3.3%, p=0.031 and 7.8% vs. 1.6%; p<0.0001, respectively). There were no differences in the incidence of late strokes (TAVI 2.0% vs. SAVR 1.5%). Neurological events were associated with increased mortality at one year. Quality of life after an early stroke in TAVI patients was higher than in SAVR patients who suffered from a stroke.  The thoroughness and consistency in stroke assessment in this trial is a major strength. Whereas the early PARTNER IA trial showed a higher stroke rate with TAVI than with SAVR (4.7% vs. 2.4% respectively), these results show a more favorable outcome for strokes after TAVI.  Interestingly, no embolic protection devices were used in the trial. Application of these devices is now more and more common and might further reduce stroke rate after TAVI. The results of this study provide further evidence supporting TAVI in intermediate risk patients.

Source: The Annals of Thoracic Surgery
Author(s): Raheel Rizwan, Farhan Zafar, Clifford Chin, James Tweddell, Roosevelt Bryant III, David Morales

This study addressed the question of utilization of limited resources, specifically whether ill or low weight infants should be listed for transplant based on survival. Among patients in the United Network for Organ Sharing database, very low weight was associated with worse one year survival, and being on ventilator or extracorporeal membrane oxygenation support carried additional negative effects on survival.

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Friso M. Rijnberg, Vladimir Sojak, Nico A. Blom, Mark G. Hazekamp

Direct relief of subaortic stenosis in single ventricle patients via ventricular septal defect/subaortic chamber enlargement has been mostly replaced by the Damus-Kaye-Stansel/Norwood procedure due to concerns for potential re-obstruction or heart block. However, little is known about long-term outcome. Among 23 single ventricle patients (median age: 7.4 months, range: 10 days to 5.5 years) who underwent direct relief of subaortic stenosis at Leiden University Medical Center (1989-2016), authors observed a high risk of re-obstruction and patch (pseudo)aneurysm formation. However, risk of heart block was low, and the majority of patients underwent Fontan completion successfully. In selected patients, the direct approach can be a relatively simple and safe procedure.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Metesh Nalin Acharya, Pouya Youssefi, Gopal Soppa, Oswaldo Valencia, Justin Nowell, Robin Kanagasabay, Mark Edsell, Robert Morgan, Maite Tome, Marjan Jahangiri

Aortic dissection frequently occurs in patients with normal aortic diameter. The authors indexed aortic area to height and correlated with absolute aortic diameter. Using this new index, they were able to identify a significant proportion of patients with thoracic aortic aneurysms who were at increased risk of aortic complications.