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Journal and News Scan
This study investigated fluit overload in cardiac and aortic surgery patients.
Goedhart et al. investigated the effect of different heparin/protamine ratios on the amount of blood transfusions following standard cardiac surgery. In the group of patients receiving 0.6/1 protamine/heparin ratio, the fraction of patients without the need of transfusion was higher and the total blood loss was lower compared to patients treated with a 0.8/1 protamine/heparin ratio. In their patient collective, the 0.6/1 protamine/ heparin ratio proved safe and superior.
This manuscript by Hage et al. retrospectively looks into the outcome of more than 2500 patients undergoing aortic arch replacement within the Canadian Thoracic Aortic Collaborative registry. They analyzed risk factors for mortality and stroke. Antegrade perfusion and perfusion at temperatures higher than 24°C were independent predictors of favorable outcomes. This data should encourage aortic surgeons to execute antegrade perfusion strategies and warmer temperature regimes during circulatory arrest for arch surgery.
The authors analyzed dual antiplatelet use after coronary bypass grafting in patients from 2011 to 2017, and they identified an increase driven by patient demographics.
Aneurysmal ascending aortas were collected from elective aortic surgery, and normal aortas from transplant donors, and dissected aortas from surgery for aortic dissection. These aortas underwent delamination testing in simulation of aortic dissection. Biaxial tensile testing was performed to determine modulus of elasticity (aortic stiffness), and energy loss (a measure of efficiency in performing the Windkessel function). Delamination strength (Sd) was lowest in dissected aortas and highest in normal aortas, and aneurysms fell in between, with greater Sd in the BAV group than the TAV group (P<0.001). Bicuspid aortopathy was associated with greater stiffness (P<0.001), while aneurysms with TAV demonstrated greater energy loss (P<0.001). Increased energy loss was associated with decreased Sd, whereas there was no relationship between Sd and aortic stiffness.
Aneurysms with bicuspid aortic valve had higher delamination strength than those with tricuspid aortic valve, suggesting that bicuspid aortic valve was protective. Energy loss was lower in aneurysms with bicuspid aortic valve, and inversely associated with delamination strength, representing a potential novel biomarker.
Meta-analysis of 4 RCTs and 7 observational studies.
Observational studies suggest suggests a benefit of IV iron compared to no iron on mortality [relative risk 0.39, 95% confidence interval (CI) 0.23–0.65; P < 0.001, very low quality], units transfused per patient (mean difference −1.22, 95% CI −1.85 to −0.60; P < 0.001, very low quality), renal injury (relative risk 0.50, 95% CI 0.36–0.69; P < 0.001, very low quality) and hospital length of stay (mean difference −4.24 days, 95% CI −6.86 to −1.63; P = 0.001, very low quality).
RCTs demonstrated a reduction in the number of patients transfused with IV iron compared to oral or no iron (relative risk 0.81, 95% CI 0.70–0.94; P = 0.005, moderate quality). The pooled estimates of effect from RCTs for mortality, hospital length of stay, units transfused per patient and renal injury were consistent in direction with observational studies.
IV iron may improve postoperative morbidity in adult cardiac surgery patients with preoperative anaemia or iron deficiency. A large, rigorous, placebo-controlled, double-blinded, multicentre trial is needed to clarify the role of IV iron in this patient population.
This meta-analysis searched the PubMed, EMBASE, and Cochrane Library databases to investigate both fenestrated and nonfenestrated Fontan procedures, focusing on early outcomes.
This is a retrospective cohort analysis of more than 500 patients undergoing the David I procedure. They specifically looked into the outcome of 50 patients with bicuspid aortic valve undergoing this procedure. While the freedom from reoperation was not different between the two groups, the freedom from reoperation at 10 years was 79% in bicuspid valve patients. Unfortunately, the authors cannot provide markers of success for the David I procedure in patients with bicuspid valves, like geometric findings of the valve prior to reconstruction. However, these results are very encouraging for valve repair success in patients with bicuspid aortic valves.
This study assessed the association between preoperative neurologic dysfunction and postoperative neurologic injury in the diagnosis of acute type A aortic dissection.
This original article retrospectively analyzed the outcome of 671 patients undergoing LVAD implantation within the French multicenter ASSIST-ICD registry. While half of the patients were in cardiogenic shock and more than 20% of patients were on ECLS prior to implantation, the survival at five years is around 50%. This reflects the real world and all-comers nature of this registry and therefore provides a frank picture of LVAD outcomes in France between 2007 and 2017. Looking at their results, the authors recommend earlier referral of heart failure patients to lower the 50% rate of patients being in cardiogenic shock prior to implantation and thereby improving result of LVAD therapy in France.