Journal and News Scan

The Society of Cardiovascular Anesthesiologists created an expert consensus statement intended to help anesthesiologists manage adult patients receiving ECMO who are cared for in the operating room.  This two-part consensus document may serve as a helpful reference for cardiothoracic surgeons, intensivists and all who engaged in the care of ECMO patients. The first part is focused on the technical aspects of ECMO.

Out of 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. Indication for surgery was functional tricuspid valve regurgitation in 64%, lead induced in 18%, and primary leaflet dysfunction in 18%. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (interquartile range [IQR] 5.9-13.5) post-dismissal.

The only procedure which guarantees long-term viability of the aortic valve substitute is the Ross operation. This translates into increased durability, survival, exercise capacity, quality of life, and minimal valve related complications. However, progressive autograft dilatation does provide some is concern. Particularly, when used as a freestanding root. The incidence and degree of dilatation varies considerably in different series and is dependent on the technique used as well as management during the peri-operative period and importantly patient-specific characteristics. Here we present a new method which aims at preventing long-term dilatation, using autologous tissue, while preserving geometry and dynamism of the aortic root.

The Aortic Valve replAcemenT versus conservative treatment in Asymptomatic seveRe aortic stenosis (AVATAR) trial is an investigator-initiated international prospective randomized controlled trial that evaluated surgical aortic valve replacement (SAVR) in asymptomatic patients with severe aortic stenosis and normal left ventricular function.  The study demonstrated that early surgery reduced the primary composite endpoint of all-cause death, acute myocardial infarction, stroke or unplanned hospitalization for heart failure, as compared to conservative therapy.