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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Michael E. Bowdish, Robert H. Habib, Tsuyoshi Kaneko, Vinod H. Thourani, Vinay Badhwar

This report presents trends and outcomes of cardiac surgery following initial transcatheter aortic valve replacement (TAVR). The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for all adult patients undergoing cardiac surgery after a previously placed TAVR between January 2012 and March 2023. A total of 5457 patients were identified, of which 2972 (54.5 percent) underwent SAVR (surgical aortic valve replacement), and 2485 (45.5 percent) underwent non-SAVR cardiac surgery. The frequency of cardiac surgery after TAVR increased by 4235.3 percent overall and 144.6 percent per year throughout the study period. The incidence of operative mortality and stroke were 15.5 percent and 4.5 percent, respectively. The observed to expected mortality ratios based on the STS risk score were significantly greater than 1.0, demonstrating a poor performance of the existing STS risk estimation models.

Source: The New England Journal of Medicine
Author(s): Raffaele Marfella, Francesco Prattichizzo, Celestino Sardu, Gianluca Fulgenzi, Laura Graciotti, Tatiana Spadoni, Nunzia D’Onofrio, Lucia Scisciola, Rosalba La Grotta, Chiara Frigé, Valeria Pellegrini, Maurizio Municinò, Mario Siniscalchi, Fabio Spinetti, Gennaro Vigliotti, Carmine Vecchione, Albino Carrizzo, Giulio Accarino, Antonio Squillante, Giuseppe Spaziano, Davida Mirra, Renata Esposito, Simona Altieri, Giovanni Falco, Angelo Fenti, Simona Galoppo, Silvana Canzano, Ferdinando C. Sasso, Giulia Matacchione, Fabiola Olivieri, Franca Ferraraccio, Iacopo Panarese, Pasquale Paolisso, Emanuele Barbato, Carmine Lubritto, Maria L. Balestrieri, Ciro Mauro, Augusto E. Caballero, Sanjay Rajagopalan, Antonio Ceriello, Bruno D’Agostino, Pasquale Iovino, and Giuseppe Paolisso

In preclinical studies, microplastics and nanoplastics have been found to be a potential risk factor for cardiovascular disease. However, there is a lack of clinical evidence that this risk extends to humans. The authors conducted a prospective, multicenter, observational study involving patients undergoing carotid endarterectomy. The excised carotid plaque specimens were analyzed for microplastics and nanoplastics. The primary endpoint of a composite of myocardial infarction, stroke, or death from any cause was compared among patients with evidence of microplastics and nanoplastics in plaque as compared against patients with a plaque that showed no evidence of microplastics and nanoplastics. A total of 304 patients were enrolled in the study, and 257 completed a mean follow up of 34 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4 percent), with a mean level of 21.7 μg per milligram of plaque. A total of 31 patients (12.1 percent) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2 μg per milligram of plaque. Patients in whom microplastics and nanoplastics were detected within the atheroma were at higher risk for a primary endpoint event than those in whom these substances were not detected (hazard ratio, 4.53; 95 percent confidence interval, 2.00 to 10.27; P<0.001).

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Niels Michael Dörr, Marcus Krüger, Miriam Möller, Norman Zinne, Mario Toennies, Olaf Schega, Christoph Ritter, Steffen Decker, Antje Hölsken, Wolfgang Schütte, Christian Biancosino

This study aimed to evaluate the percentage of solitary fibrous pleural tumors presenting unfavorable clinical behavior as to predict negative long-term outcomes. Although historically considered benign neoplasms, this retrospective review identified 25 percent of 74 patients displayed histological evidence of malignancy as per England criteria and the recurrence rate was 21 percent. The authors recommended the pathological differentiation of these tumors into pedunculated, well circumscribed, and sessile growth patterns. They also recommended that all nonpedunculated lesions should be classified as potentially aggressive.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Erik Sachs, Veronica Jackson, Mamdoh Al-Ameri, Ulrik Sartipy

The authors of this paper explored early postoperative outcomes in all patients (n= 833) undergoing uniportal segmentectomy and lobectomy in their unit between 2017 and 2022. During this study period, the utilization of uniportal access operations increased. The authors concluded that early postoperative outcomes were similar between the segmentectomy and lobectomy groups.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Mario Gaudino, Marcus Flather, Davide Capodanno, Milan Milojevic, Deepak L Bhatt, Giuseppe Biondi Zoccai, William E Boden, P J Devereaux, Torsten Doenst, Michael Farkouh, Nicholas Freemantle, Stephen Fremes, John Puskas, Giovanni Landoni, Jennifer Lawton, Patrick O Myers, Björn Redfors, Sigrid Sandner

Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges. A multidisciplinary group evaluated the evidence on mechanisms, diagnosis, and prognosis of PMI. The review found that postoperative troponin thresholds associated with increased mortality risk are markedly higher than those found in current PM definitions. Large increases in other biomarkers are also prognostically relevant, even if supporting evidence of ischemia is lacking. A new algorithm for PMI detection was proposed, and researchers recommended that PMI should be included in the primary composite outcome of trials of coronary interventions.

Source: European Journal of Vascular and Endovascular Surgery
Author(s): Ross Naylor, Barbara Rantner, Stefano Ancetti, Gert J. de Borst, Marco De Carlo, Alison Halliday, Stavros K. Kakkos, Hugh S. Markus, Dominick J.H. McCabe, Henrik Sillesen, Jos C. van den Berg, Melina Vega de Ceniga, Maarit A. Venermo, Frank E.G. Vermassen, George A. Antoniou, Frederico Bastos Goncalves, Martin Bjorck, Nabil Chakfe, Raphael Coscas, Nuno V. Dias, Florian Dick, Robert J. Hinchliffe, Philippe KolhIgor, B. Koncar, Jes S. Lindholt, Barend M.E. Mees, Timothy A. Resch, Santi Trimarchi, Riikka Tulamo, Christopher P. Twine, Anders Wanhainen, Sergi Bellmunt-Montoya, Richard Bulbulia, R Clement Darling III, Hans-Henning Eckstein, Athanasios Giannoukas, Mark J.W. Koelemay, David Lindström, Marc Schermerhorn, David H. Stone

These updated guidelines give a comprehensive guide on the treatment of atheroscleritoc carotid and vertebral artery disease to prevent stroke and TIA.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Justin Ren, Andrea Bowyer, David H Tian, Christopher M Reid, Bridget Hwang, Colin Royse, Doa El-Ansary, Alistair Royse

This article investigates long term survival of total arterial coronary artery bypass grafting comparatively in a male versus female population. The retrospective analysis revealed that, compared to vein dependent procedures, total arterial revascularization was closely associated with a reduced incidence of long-term all-cause mortality for both male (HR, 0.86; 95 percent CI, 0.81–0.91; P < 0.001) and female (HR, 0.82; 95 percent CI, 0.73–0.91; P < 0.001) cohorts.

Source: tctMD
Author(s): Caitlin E. Cox

The device manufacturer Abiomed has issued a recall, issued Class I by the FDA, for its left-sided heart pumps due to cases in which the pump catheter has perforated the left ventricle wall. In its letter, Abiomed advised clinicians to carefully position the pump catheter, use imaging to aid in positioning, and to use caution in high-risk patients. It also specified that the recall is a correction, not a total product removal.

Source: European Journal of Cardiothoracic Surgery
Author(s): Mikolaj Berezowski, Saiesh Kalva, Joseph E Bavaria, Yu Zhao, William L Patrick, John J Kelly, Wilson Y Szeto, Joshua C Grimm, Nimesh D Desai

This study used the German registry of acute aortic dissection type A (GERAADA) score to predict thirty-day mortality in an aortic center in the United States. Six-hundred-eighty-five patients who underwent surgery for acute type A aortic dissection were included. Thirty-day mortality was 12 percent. The GERAADA score had very good discrimination power (area under the receiver operating characteristic 0.762). The observed versus estimated mortality ratio was 0.543, indicating the model overestimated risk. The authors concluded the GERAADA score is a good tool to estimate thirty-day mortality, although it may overestimate the risk in experienced aortic centers.

Source: Interdisciplinary Cardiovascular and Thoracic Surgery
Author(s): Katja Schumacher, Mateo Marin Cuartas, Manuela de la Cuesta, Thilo Noack, Philipp Kiefer, Sergey Leontyev, Michael A Borger, Marcel Vollroth, Martin Misfeld

The frequency of minimally invasive mitral valve (MV) surgery has increased over the last decade. Hence, the number of patients requiring MV reoperations post-minimally invasive MV surgery is increasing. This study analyzed the outcomes of patients undergoing MV reoperation after previous minimally invasive MV surgery during a twenty-year period in a high volume heart valve center. A total of 187 patients were included in the analysis (34 [18.2 percent] patients repeat MV repair; 153 [81.8 percent] MV replacement). Redo MV surgery was performed through median sternotomy in 169 (90.4 percent) patients. The median intensive care unit stay was 1 day (1-5 days). The thirty-day mortality was 6.4 percent, and actuarial survival at 5 and 12 years was 61.8 percent and 38.3 percent, respectively. Endocarditis and preoperative stroke were identified as predictors of late mortality.

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