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Journal and News Scan
The present article is a digital health primer for cardiothoracic surgeons that reviews the role of data integration, processing, modelling, monitoring, and more on the future of cardiothoracic surgery.
The authors created 612 matched pairs of patients with a history of hematologic malignancy and controls. They compared operative details, early postoperative complications, and late survival.
Patients with prior diagnosis of malignancy had lower hemoglobin levels and were at greater risk of receiving postoperative blood transfusions (47.4% vs. 35.6%, P<0.0001).
Reoperations for postoperative bleeding (4.7% vs. 3.3%, P=0.253) and stroke (1.3% vs. 1.3%, P>0.999) were similar. Thirty-day mortality in patients with hematologic malignancy was 3.3%, and 1.5% in matched controls (P=0.061).
Overall survival among patients with cancer was reduced (P<.0001).
The authors concluded that while late survival is reduced in patients with hematologic malignancies, early outcomes are generally similar to matched controls. As such, these patients should be offered surgery.
The authors comducted a comparative analysis of the Trifecta and Perimount Magna Ease bioprosthetic valves, using data from a national Finnish database between 2008 and 2017.
They included 2216 patients, with a mean follow-up 3.8±2.1 years. 851 patients received the Trifecta valve and 1365 received the Perimount Magna Ease bioprosthesis. The rates of late mortality and prosthetic valve endocarditis were comparable in the study cohorts. At 7-year, the Trifecta cohort had significantly higher risk of repeat aortic valve replacement for structural valve failure (3.3% vs. 0%), repeat aortic valve replacement for any cause (3.6% vs. 0.4%) and repeat aortic valve replacement and/or prosthetic valve endocarditis (4.1% vs. 0.9%) compared to the Perimount Magna Ease cohort.
Among 772 propensity score matched pairs, at 7-year, the Trifecta cohort had a higher risk of repeat aortic valve replacement for structural valve failure (5.7% vs. 0%).
The authors report that the Trifecta aortic bioprosthesis is associated with a higher occurrence of repeat aortic valve replacement for structural valve failure compared to the Perimount Magna Ease bioprosthesis.
A review that may affect pharma strategy in the immediate future.
The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.
This single-institution study of 83 patients investigated mitral valve repair for infective endocarditis based on the location of the lesion.
Haunschild et al. investigated the effect of cerebrospinal fluid pressure elevation on spinal cord perfusion in a large animal model. They could measure spinal cord perfusion by NIRS and microsphere injections. The spinal perfusion was significantly diminished during elevated cerebrospinal fluid pressure. Furthermore, rapid withdrawal of cerebrospinal fluid was associated with hyperperfusion, which might lead to aggravated ischemia-reperfusion injury and should therefore be avoided.
David et al. examined the durability of mitral repair using using chordal replacement with expanded polytetrafluoroethylene sutures to correct leaflet prolapse.They evaluated 186 patients who underwent isolated chordal replacement, and 560 patients who underwent both leaflet resection and choral replacement.
David et al. note that chordal replacement with expanded polytetrafluoroethylene sutures provides stable mitral valve function in most patients during the 20 years of follow-up.
The study compared long-term results of loop neochord replacement with leaflet resection techniques in 2134 patients undergoing minimally invasive mitral valve repair.
They demonstrated a significant reduction in early mitral regurgitation with the loop technique (on echocardiographyl; p=0.003) when compared with leaflet resection. Additionally, the long-term outcomes were excellent compared with classical leaflet resection techniques (the 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003).
This study investigated fluit overload in cardiac and aortic surgery patients.