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Journal and News Scan
The use of bioprostheses for mitral valve replacement is well established and steadily increasing worldwide. However, long-term durability is not well described. Accurate mitral valve bioprosthetic durability reports are necessary to set a standard against which transcatheter mitral valve replacement can be compared. This systematic review aimed to assess the outcomes of bioprosthetic surgical mitral valve replacement based on data from studies published over the last twenty years. Only studies with follow-up beyond a minimum of five years were included in the analysis.
A total of twenty-one studies, including 15.833 patients, were identified and analyzed. Among all implanted bioprostheses, 64 percent were porcine and 36 percent were bovine pericardial. Freedom from structural valve deterioration at ten years ranged from 58.9 percent to 100 percent and at fifteen years from 58.3 percent to 93 percent. Freedom from reoperation ranged from 65 percent to 98.7 percent at ten years and 78.5 percent to 91 percent at fifteen years. There is, however, a lack of information regarding the preoperative baseline mitral valve pathology and insufficient echocardiographic follow-up. Hence, despite the reported results, the authors concluded that there is a considerable variability in reporting long-term outcomes following bioprosthetic mitral valve replacement and therefore an unbiased and generalizable understanding of the long-term outcomes following bioprosthetic mitral valve replacement is difficult across the spectrum of mitral valve pathologies requiring replacement surgery.
This Novo Nordisk funded, multicenter, double blind, randomized, placebo-controlled trial explored whether semaglutide (a glucagon-like peptide-1 receptor agonist) can reduce cardiovascular risk associated with overweight and obesity in the absence of diabetes. The authors recruited 17,604 patients over forty-five years of age with preexisting cardiovascular disease, and a BMI of 27 or greater with no history of diabetes. Patients were randomized in a 1:1 ratio to either 2.4 mg of once-weekly subcutaneous semaglutide or a placebo. The primary end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in a time to first event analysis. Mean duration of follow up was 39.8 (+/-9.4) months. It was found that weekly subcutaneous semaglutide was superior to the placebo at reducing poor outcomes.
The authors of this paper note that the surgical landscape has changed in the last two years. They suggest that the multidisciplinary team should avoid a diagnostic wedge resection if segmentectomy would be the definitive and recommended operation. In that case, advanced navigation techniques should be used for diagnosis. Undertaking a segmentectomy as the primary operation will avoid a second surgery. Established practice may be difficult to overturn, but the authors recommend that a diagnostic wedge resection is avoided so as not to prevent or complicate a segmentectomy.
Although video assisted thoracoscopic surgery (VATS) is associated with less pain than open surgery, there are still several complications that arise due to poor postoperative control with VATS. Epidural analgesia has traditionally been considered the gold standard for pain control, however regional analgesia like paravertebral blocks (PVB) are increasingly being used. The authors explore the use of patient controlled PVB analgesia compared to epidural analgesia as part of a randomized controlled trial. Interestingly, with the PVB, the authors found no additional puncture pain, shorter time duration for catheter placement, and overall reduced failure rate of catheter placement. Hence, PVB is another viable and effective tool that clinicians have at their disposal to optimize pain control after VATS.
Lung cancer screening with low-dose CT is being introduced in several European countries. The management of incidental findings, both pulmonary and extrapulmonary, is an important component of the clinical and cost effectiveness of screening programs. A multi-society European group was convened to discuss the issue. Of twenty-three topics identified, the nine that were considered to be the most important and frequent were reviewed as standalone topics. These included interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities. The remainder were grouped in generic categories. Following the group's recommendations will ensure an evidence-based approach is used and that harms are minimized.
The elderly population is exponentially increasing worldwide, leading to a higher incidence of coronary artery disease. The growing number of elderly patients is closely related to a higher incidence of frailty. Despite frailty being a known predictor of increased mortality and morbidity, there is a lack of evidence regarding the outcomes of coronary artery bypass grafting (CABG) in frail patients.
The FRAGILE trial is a Brazilian multicenter, randomized, controlled clinical trial that analyzed 169 patients aged over sixty years who underwent on-pump and off-pump CABG. In this subanalysis of the FRAGILE trial, patients were divided into two groups for statistical comparisons: off-pump (n= 87) and on-pump CABG (n= 82). Based on the Fried's frailty criteria, patients were classified as frail, pre-frail, and non-frail. Unintentional weight loss, self-reported fatigue, physical activity level, grip strength, and gait speed before and after surgery were compared between the off-pump and on-pump study groups. Patients who were non-frail before surgery were excluded from the analysis.
Patients' frailty was positively impacted by CABG six months following surgery. Overall, more than 50 percent of frail patients became pre-frail after CABG, and only 3 percent of the total patients were classified as frail six months following surgery. Patients reported more total time of physical activity, less fatigue, and an improved gait speed after surgery. Moreover, patients from the off-pump CABG group improved their grip strength and presented with less unintentional weight loss.
Recently, the Tricuspid Valve Academic Research Consortium (TVARC) released its first document, a consensus statement aimed at bridging the current knowledge gaps in the study of tricuspid regurgitation (TR). The current classification of TR is not uniform, and as such it is challenging to stratify and study disease outcomes, especially in a growing field where transcatheter alternates to surgery are also being studied. This first document by the consortium aims to address these knowledge gaps and standardize the terminology and gives general endpoints for trials to allow for better study of the disease and promote research. The authors report that a second paper is underway, which will go into more granular detail to characterize this disease even further.Recently, the Tricuspid Valve Academic Research Consortium (TVARC) released its first document, a consensus statement aimed at bridging the current knowledge gaps in the study of tricuspid regurgitation (TR). The current classification of TR is not uniform, and as such it is challenging to stratify and study disease outcomes, especially in a growing field where transcatheter alternates to surgery are also being studied. This first document by the consortium aims to address these knowledge gaps and standardize the terminology and gives general endpoints for trials to allow for better study of the disease and promote research. The authors report that a second paper is underway, which will go into more granular detail to characterize this disease even further.
The authors of this study conducted a systematic review of clinical outcomes after pediatric aortic valve repair (AVr) and examined life expectancy and risk of reintervention using microsimulation. The study included forty-one publications including 2,636 patients with 17,217 years of follow-up (median follow up was 7.3. years). Pooled early mortality rates after AVr in children (<18 years), infants (<1 year), and neonates (<30 days) were, respectively, 3.5 percent, 7.4 percent, and 10.7 percent. The pooled late reintervention rates in children, infants and neonates were 3.3 percent per year, 6.8 percent per year, and 6.32 percent per year. Microsimulation-based mean life expectancy in the first twenty years was 18.4 years. Despite a high hazard of reintervention for valve dysfunction and slightly impaired survival compared with the general population, AVr has low valve-related event occurrences and should always be considered.
Patients younger than nineteen years old were included in a study developed to gain a better understanding of pediatric patients supported with ventricular assist devices (VADs). The authors found that illness at VAD implantation, diagnosis, and strategy of support affect survival and differ by device type. The study can act as a predictive tool to help providers make informed decisions.
This paper looks to explore the outcomes in obese patients with non-small cell lung cancer following VATS or open lobectomy. The authors utilized data from the European Society of Thoracic Surgeons Database to assess morbidity and postoperative length of stay in 78,018 patients across a fourteen-year period. An intention-to-treat analysis was used, with assessment performed using univariable, multivariable-adjusted, and propensity-score-matched analyses. VATS lobectomy was found to be associated with improved postoperative outcomes.