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Journal and News Scan

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Shiho Naito, Hermann Reichenspurner, Björn Sill

The impact of the surgeon’s experience on outcomes following off-pump coronary artery bypass grafting (OPCAB) is widely known. However, there is a lack of safe and effective strategies for OPCAB training. In this study, a total of 180 patients who underwent an off-pump isolated single coronary bypass of the left anterior descending artery (LAD) using the left internal mammary artery (LIMA) as an in-situ graft via median sternotomy were analyzed. Outcomes were compared in two groups: operations performed by residents in training under supervision (group 1: n = 63) and experienced surgeons (group 2: n = 117). Trainees were already experienced in on-pump coronary artery bypass grafting. There was no significant difference in the rate of major adverse cardiac and cerebrovascular events between the two groups. The authors conclude that a single off-pump LAD bypass might be a reasonable training strategy for OPCAB.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Li J, Wei X

A novel transapical beating-heart septal myectomy (TA-BSM) procedure was performed for patients with latent obstruction and outcomes were compared with those for patients with resting obstruction. The population was comprised of 120 patients with symptomatic hypertrophic obstructive cardiomyopathy, 33 with latent obstruction, and 87 with resting obstruction. There were no important differences in baseline characteristics, but those with latent obstruction had lower basal septal thickness, higher midventricular thickness, smaller left atria, and higher frequency of mitral subvalvular anomalies. After surgery, there was no significant difference in early deaths or midterm survival and the New York Heart Association class was significantly improved. This novel TA-BMS procedure achieved equivalent outcomes regardless of resting left ventricular outflow tract gradients.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Martin Czerny, Martin Grabenwöger, Tim Berger, Victor Aboyans, Alessandro Della Corte, Edward P Chen, Nimesh D Desai, Julia Dumfarth, John A Elefteriades, Christian D Etz, Karen M Kim, Maximilian Kreibich, Mario Lescan, Luca Di Marco, Andreas Martens, Carlos A Mestres, Milan Milojevic, Christoph A Nienaber, Gabriele Piffaretti, Ourania Preventza, Eduard Quintana, Bartosz Rylski, Christopher L Schlett, Florian Schoenhoff, Santi Trimarchi, Konstantinos Tsagakis, EACTS/STS Scientific Document Group

These guidelines, endorsed by the EACTS and STS, represent the organizations’ official viewpoints on aortic syndromes. This comprehensive document details all known aspects of the natural history, diagnosis, and treatment of both acute and chronic aortic pathologies. The guidelines address areas of interest to specialists in aortic diseases and clinicians involved in diagnosis, endovascular, open surgical, or hybrid treatment and surveillance. Furthermore, it provides a transparent basis for informed patients to comprehend the treatment offered by their specialists.

Source: European Heart Journal
Author(s): David Messika-Zeitoun, Bernard Iung, Helmut Baumgartner

This viewpoint article offers a quick overview of 10 articles selected by the authors as the best papers on valvular heart disease published in 2023. The selection was restricted to publications in The New England Journal of Medicine, the Journal of the American Medical Association, Lancet, European Heart Journal, Circulation, the Journal of the American College of Cardiology, and JAMA Cardiology. The 10 papers were chosen based on a consensus between the three authors, who rated quality, the potential impact on clinical practice and future research, and expected interest for the cardiovascular readership. Among others, some selected papers are the Trigistry registry, and the Triluminate, Notion (10 -year results), Partner 3 (five-year results), and PROACT Xa trials.

Source: tctMD
Author(s): Shelley Wood

Dr. Alan Cribier, well known for completing the first TAVI procedure in 2002, has passed away at the age of 79. The French surgeon successfully implanted the first percutaneous aortic valve in a patient who was declared inoperable, resulting in an innovative new procedure that started an important conversation in the CT surgery community. The full article includes tributes from Dr. Cribier’s colleagues. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): François Lacour-Gayet, Joy Zoghbi, Marielle Gouton, Régine Roussin, Olivier Bical, Vincent Lucet, Marion Saint-Pick, Francine Leca

This retrospective multicenter study examined late surgical outcomes for children from low and middle income countries with double outlet right ventricle (DORV). DORV was defined as both great arteries arising entirely or mostly from the right ventricle. A total of 81 consecutive DORV repairs were performed between 1996 and 2022. Six subtypes of DORV were divided into two overall groups: (i) DORV-committed ventricular septal defect (VSD) and (ii) DORV-noncommitted (nc) VSD. Four Fontan patients were excluded, and three patients were lost to follow up. Overall perioperative mortality was 7.4 percent. Overall, 1--year survival was 86 percent. Early mortality was similar in both groups. There was a trend toward satisfactory outcome of biventricular repair for simple DORV with committed VSD compared with complex DORV with ncVSD.

Source: European Journal of Cardiothoracic Surgery
Author(s): Alessandro Brunelli, Herbert Decaluwe, Michel Gonzalez, Dominique Gossot, Rene Horsleben Petersen, Collaborators

This study surveyed 123 thoracic surgeons and posed several questions asking which surgical resection they would prefer if they themselves were diagnosed with several variations of lung cancer size and location. Interestingly, despite two recently published randomized control trials showing the similarities of lobar resections to sublobar resections, for early-stage lung cancer tumors, 19 to 55 percent of surgeons still preferred lobectomy compared to segmentectomy for a variety of reasons including technical expertise as well as oncological concerns. Perhaps this trend may continue to change with time as further research is conducted in this domain.

Source: The Annals of Thoracic Surgery
Author(s): Evaldas Girdauskas, Ümniye Balaban, Eva Herrmann, Timm Bauer, Andreas Beckmann, Raffi Bekeredjian, Stephan Ensminger, Christian Frerker, Helge Möllmann, Johannes Petersen, Thomas Walther, Sabine Bleiziffer

In this study, the authors aimed to analyze the one-year outcome after aortic valve (AV) repair versus surgical AV replacement (SAVR) in patients with aortic regurgitation (AR) using data from the German Aortic Valve Registry (GARY). A total of 8,076 AR patients were included in the analysis. The AV was repaired in 2,327 patients (29 percent) and 5,749 patients (71 percent) underwent SAVR. Patients were matched to correct for baseline differences in both study groups. After adjusting for baseline differences, the one-year survival rate was 97.7 percent (95 percent CI, 97.0 percent to 98.5 percent) in the AV repair cohort versus 96.4 percent (95 percent CI, 95.9 percent to 96.9 percent) SAVR cohort (log-rank P < 0.001). Cox regression analysis showed a significant age independent advantage of AV repair compared with SAVR (hazard ratio, 0.68; 95 percent CI, 0.51-0.90; P < 0.0001) on one-year survival. Furthermore, cardiac event-free survival at one year was 85.7 percent (95 percent CI, 483.8 percent to 87.7 percent) in the AV repair group versus 81.7 percent (95 percent CI, 80.7 percent to 82.9 percent) in the SAVR group (log-rank P < 0.001). There was no difference in the need for AV reintervention when comparing both the AV repair and SAVR cohorts (P = 0.59). The authors concluded that AV repair surgery, if technically feasible, is associated with higher superior one-year survival and one-year cardiac event-free survival than SAVR.

Source: The Annals of Thoracic Surgery
Author(s): Daniel P. Dolan, Maxime Visa, Dan Lee, Kalvin C. Lung, Diego Avella Patino, Chitaru Kurihara, Rafael Garza-Castillon Jr, David D. Odell, Ankit Bharat, Samuel Kim

In this single-center series of 430 patients with stage I or II non-small cell lung cancer who underwent minimally invasive lobectomy (n = 200) or segmentectomy (n = 230), 162 (37 percent) were discharged less than 18 hours postoperatively without a chest tube, and 37 patients were discharged the day of surgery. The authors report that there were no perioperative deaths, no deaths in one year of follow up, and no significant differences in readmission rates.

Source: The Annals of Thoracic Surgery
Author(s): Moritz C. Wyler von Ballmoos, Tsuyoshi Kaneko, Alexander Iribarne, Karen M. Kim, Arman Arghami, Amy Fiedler, Robert Habib, Niharika Parsons, Zouheir Elhalabi, Carole Krohn, Michael E. Bowdish

This annual report from The Society of Thoracic Surgeons Adult Cardiac Surgery Database summarizes key research; trends in patient characteristics; surgeon case volume; surgical techniques including minimally invasive and robotic approaches, repair and replacement, prosthesis, and conduit choice; and concomitant atrial fibrillation surgery in isolated coronary bypass, aortic, mitral, and tricuspid valve surgery between 2015 and 2022.