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Journal and News Scan
Sixteen patients underwent percutaneous placement of a VSD closure device for management of subarterial VSD with puncture through the chest wall and infundibulum of the RV. Fifteen were successful, and 1 patient required conversion to mini-thoracotomy for pericardial effusion and tamponade. Mean LOS was 3.5 days. No deaths, arrhythmias, valve injury, or residual shunting occurred up to 1 year follow-up.
This single institution retrospective study analyzed the effects of single vs multiple complications on acute outcomes to help identify interactions among complications that might predict outcomes. Over a 4 year period 366 pts experienced a complication and 102 of these had 2 or more complications. Multiple complications were associated with mortality in 41% compared to 5% in those with one complication and 0.7% in those without complications. The number of complications was correlated with increased LOS and discharge to other than home. Interactions were evident among all complications, with the combination of renal failure and unplanned reoperation being associated with an OR for increased deaths of 108 (13.5 to 869).
This retrospective study compared Celsior (65% of pts) to all-blood continuous myocardial protection (35%) in 631 patients undergoing elective aortic valve replacement. Troponin T release was lower in Celsior patients, as was the risk of postoperative death (OR 0.33; 0.15 - 0.76). Other outcomes were similar between the groups.
December 17, 2016
Submitted by: Arie Blitz
This study is the 5-year follow-up of a large randomized controlled trial of on-pump CABG vs. OPCAB performed by seasoned surgeons. A total of 4,752 patients were included in this trial. At 5 years of follow-up, there was no difference between the groups in either the composite outcome of death, stroke, MI, or renal failure or between any of the individual components. Question: There appears to be equipoise between either technique for coronary revascularization at 5 years. Are these results determinative? Is there any further information we need? Or, does this settle the issue once and for all?
December 6, 2016
In this article, the authors describe their findings from a direct, propensity score matching and inverse probability-of-treatment weighting analysis of patients with degenerative MR with a flail leaflet, included in a multicenter registry which includes patients from 6 tertiary European and US centers. They compare outcomes between patients undergoing mitral valve repair (n=1709) and mitral valve replacement (213). They conclude that in this cohort of patients, MV repair is associated with lower operative mortality and better long-term survival than MV replacement.
December 5, 2016
Submitted by: Stuart Head
In the largest randomized trial on PCI versus CABG in patients with left main disease (n=1905) and with an inclusion criteria of a SYNTAX score >33, PCI with everolimus-eluting stents was non-inferior to CABG for the composite endpoint of death, stroke, and myocardial infarction at a trial of 3-year follow-up (15.4% versus 14.7%, respectively). However, landmark analysis showed a significant increase in endpoints beyond 30-day follow-up with PCI (HR 1.44, 95% CI 1.06-1.96). Longer follow-up results from the EXCEL trial are required to determine whether PCI is really non-inferior in terms of long-term outcomes.
December 5, 2016
In this manuscript, the authors describe their findings in a propensity score matched analysis of a retrospectively acquire data on 9792 patients undergoing CABG or heart valve surgery over a 6-year period. 461 matched pairs were identified and analysed in order to evaluate the effect of left atrial appendage (LAA) closure on postoperative atrial fibrillation (POAF), stroke and mortality. In this cohort of patients, LAA closure during routine non–AF-related cardiac surgery was independently associated with increased risk of early POAF and did not significantly influence the risk of stroke or long-term mortality.
December 3, 2016
In this manuscript, the authors offer a comprehensive and thorough review of the pathophysiology of aortic stenosis and relate this to the different potential medical treatment options to slow down the progression of the disease.
December 3, 2016
Submitted by: Tom C. Nguyen
Minimally invasive aortic valve replacement represents an increasingly acceptable alternative to standard sternotomy with potential reductions in morbidity. There are technical nuances of the minimally invasive approach in which sutureless valves may offer an advantage. This article by Murzi and colleagues explores the learning curve of minimally invasive aortic valve replacement via a right anterior thoracotomy using a sutureless aortic valve. The authors conclude that right minithoracotomy sutureless valve implantation can be performed safely with a minimal learning curve.
November 28, 2016
Submitted by: Arie Blitz
An extremely important journal article comprised of two case reports involving valve perforation and insufficiency following use of the Cor-Knot Automated Fastener (LSI Solutions, Victor, NY, USA) during valve replacement. Injuries to the leaflets of either a native or prosthetic valve after valve repair or replacement, respectively, consisted of perforations. These perforations corresponded precisely to areas where the valve leaflets would likely abrade against the metallic fasteners of the Cor-Knot. The most likely mechanisms leading to this complication include a non-parallel orientation of the fasteners with respect to the valve annulus and the use of an intra-annular valve replacement technique during AVR. To prevent this complication, the authors suggest that surgeons should be meticulous about orienting the fasteners parallel to the valve annulus and should consider revising their AVR technique to positioning the prosthetic valve in a supra-annular rather than annular position when using the Cor-Knot device. Comment: Of note, this is a rare complication with the Cor-Knot device, but can easily be prevented by following the suggestions of the authors.