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Journal and News Scan
This single-center retrospective cohort analysis looks into the impact of preoperative atrial fibrillation on post-LVAD outcomes. Within their cohort, they did not observe any difference in pump thrombosis and thromboembolic events with regard to this preoperative variable. Thereby, the authors concluded that the MAZE procedure, AF catheter ablation, or LAA exclusion might be of questionable impact within these patients. However, they urge a prospective evaluation of this topic.
Using a German congenital heart defects registry, analyses were performed to identify risk factors for death and reintervention in patients who underwent correction of TGV with VSD and LVOTO. The median follow-up was 15 years. At least five different types of corrective operations were performed.
Five year results of the PARTNER II trial demonstrated no difference in the risk of stroke or death comparing TAVR to surgical aortic valve replacement among intermediate surgical risk patients.
In 2014, Edwards Lifescience launched an ambitious philanthropic initiative called Every Heartbeat Matters (EHM) with the goal of impacting the global burden of heart valve disease through the education, screening and treatment of 1 million underserved people by 2020. By enlisting the help of over 60 patient- and cardiac-focused non-profit partners through grant and product donation support, that goal was exceeded to affect more than 1.7 million underserved people in 46 countries, including 8,700 hearts treated and 164,900 hearts screened by humanitarian care. Additionally, more than 38,000 clinicians have received education to elevate heart valve care for underserved patients.
This month Edwards announced the expansion of that initiative with a new target to affect 2.5 million additional underserved structural heart and critical care patients by the end of 2025. This effort will broaden the initiative's focus from heart valve disease to all structural heart diseases and critical care support with an additional emphasis on recovery strategies, critical care development, and enhanced product donation.
This meta-analysis looks at the impact on concomitant LAA closure during cardiac surgery in patients with AF prior to surgery. The authors analyzed 22 studies with over 250,000 patients. Overall, LAA closure reduced the incidence of postoperative stroke and mortality. Therefore, the authors conclude that LAA closure should be performed in any cardiac surgery in patients with preoperative AF.
This single institution retrospective review assessed outcomes of minimally invasive mitral valve repair (via R minithoracotomy) in 101 consecutive patients. Repair was accomplished by implantation of neochord loops and ring annuloplasty. One-year survival was 100%. Freedom from moderate or worse MR was 100% at three years.
This randomized trial evaluated depth and duration of intraoperative hypotension during noncardiac surgery, comparing a machine learning early warning system to standard care. Hypotension was defined as a MAP <65 mm Hg for one minute or more. The early warning system significantly reduced the degree and duration of hypotension compared to controls. Control patients suffered two adverse events resulting in death (7%), whereas none occured in the intervention group.
This study of Medicare beneficiaries evaluated how often CABG was performed related to narrow intervals around a patient's birthday. Those who were seen just prior to their 80th birthday (thus 79 years old, representing left-digit bias) were abouth 30% more likely to undergo CABG than those who were seen just after their birthday (thus 80 years old). Similar findings were not evident for other ages in the same range (e.g. 77, 78, 79, 81, 82, 83). For comparison, mortality after MI was unrelated to the interval surrounding an individual's 80th birthday. The findings support the presence of left-digit bias in clinical decision-making.
The authors revisit the older, somewhat misinterpreted hypothesis of cocoa and vasodilation. The title may again be misinterpreted by the general media as an encouragement to gorge on HIGH CALORIE, HIGH FAT nutrients
Dr Coselli and associates from Baylor published a comprehensive review of their practice in the perioperative management of patients undergoing thoracoabdominal aortic aneurysm repair.
This is the second part of the review, focusing on fundamentals of postoperative care and management of operative complications.