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Journal and News Scan
In this meta-analysis, the authors compare surgical aortic valve replacement (SAVR) with transcatheter aortic valve implantation (TAVI) in patients at low surgical risk. They included two randomized controlled trials and four propensity-matched studies for a total of almost 3500 patients. Short term mortality was similar between treatments, but intermediate follow-up (two years) showed higher mortality with TAVI versus SAVR (17.2% versus 12.7%, p=0.006).
Although these results should be taken with caution due to the largely non-randomized nature, it proves that we need to await the results of the currently ongoing low-risk trials (NOTION 2, PARTNER 3, and Medtronic TAVI low-risk trial) before we can recommend TAVI in low-risk patients.
Schweiger and colleagues retrospectively analyzed stroke rate for patients under 19 years old in the European Registry for Patients with Mechanical Circulatory Support database. Analysis of the 51 pediatric patients who were supported with a continuous-flow ventricular assist device revealed an incidence of cerebral stroke of 0.1 per patient-year.
The authors conducted a prospective randomized study of 20 high-risk cardiac surgical patients, split into two groups: pulsatile versus nonpulsatile flow during cardiopulmonary bypass. Using spectral imaging and near-infrared technology, the group found that the the pulsatile perfusion group maintained better perfusion indices in the microcirculation.
In this review article, Duran and colleagues provide an overview of pluripotent stem cell (PSC) technology and its potential for application in heart failure. The authors focus on the derivation and reprogramming of these cells for cardiac regeneration, the potential immunogenicity of cardiomyocytes reprogrammed from PSCs, and current cardiac tissue engineering research.
The Nationwide Inpatient Sample was interrogated for all patients undergoing either CABG, valve replacement, or both from 2008 to 2011, and a total of 1,078,036 patients were included in the analysis. The authors discovered that, overall, 9.8% of patients developed acute kidney injury (AKI) postoperatively. Other important discoveries were:
Outcome non-AKI AKI p
- Death 1.3% 13.9% <0.001
- Mean hospital cost $38,820 $77,178 <0.001
The authors calculate that the net effect of AKI after cardiac surgery at a national level in the United States is over $1 billion annually.
The authors participated in a multi-institutional prospective study to evaluate the frequency, risk factors, and outcomes of patients who suffer mediastinal infection after cardiac surgery. A total of 5,158 patients were enrolled, and there were 43 infections in 41 patients (0.79 cumulative incidence) occurring at a median time of 20 days after surgery. The authors discovered the following risk factors for the development of mediastinitis:
- higher body mass index
- higher creatinine
- peripheral vascular disease
- preoperative steroids
- ventricular assist device or transplant surgery
- postoperative hyperglycemia in nondiabetics
Readmission rates and mortality were five times higher in patients who developed mediastinitis.
This randomized trial compared chemoradiotherapy alone to chemoradiotherapy followed by consolidation therapy with the PDL-1 antibody durvalumab in patients with stage III NSCLC. The treatment group had significantly improved progression-free survival, response rate, and overall survival, with clinically meaningful differences between the groups. The findings suggest that such regimens may be the new standard of care in these patients.
Several charities provided free surgeries to 15 Kashmiri children with congenital heart defects at the Fortis Memorial Research Institute in Gurgaon, India.
A man in his 40s discovered that he had a rare congenital heart defect after doctors were unable to access his left coronary system via angiography.
Newborns around the US are being adorned with red hats to raise heart disease awareness during February, which is considered American Heart Month.
Drugs and Devices
The PureFlex™ line of adult arterial cannulae from LivaNova has received the CE Mark.
Research, Trials, and Funding
The first patient has been enrolled in the BELIEVE trial, a postmarket prospective study sponsored by LivaNova to evaluate leaflet motion in patients who have received a commercially approved LivaNova bioprosthetic aortic valve.
Baylor College of Medicine in Texas and the University of Kentucky recently joined the American Heart Association’s Strategically Focused Vascular Disease Research Network as part of a collaborative effort to better understand the differences in aortic disease between men and women.
This review included 55 publications covering 141 cohort studies. The authors found that the relative risk of stroke associated with smoking just one cigarette a day was 1.25 to 1.31, and for coronary artery disease it was 1.48 to 1.57. There is no safe level of smoking.
An editorial from an influential source discussing the recent robust results of the CASTLE-AF RCT trial. It is likely that interventions for atrial fibrillation will be boosted by these results, in terms of insurance, industry, and clinical guideline support.