Journal and News Scan

Watanabe and associates studied the association between false lumen remodeling late after type A dissection repair and the shape of the true lumen in the early postoperative period. They found that the true lumen shape in the early postoperative period predicts false lumen remodeling late after surgery. The methodology of computed tomography angiography measurements used in this work serves as a good example of quantitative image analysis for patients with aortic disease.

The authors of this study analyzed neurological events and quality-of-life in the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial.  A total of 1746 patients with aortic stenosis and intermediate surgical risk were randomized to either TAVI or SAVR. Neurological events and quality of life were analyzed at 30 days, six months, and 12 months. In this group of elderly (approximately 80 years old) patients with an intermediate risk profile (STS-PROM 4.5), the event rates at 30 days were higher for SAVR as compared with TAVI for both stroke and encephalopathy (5.4% vs. 3.3%, p=0.031 and 7.8% vs. 1.6%; p<0.0001, respectively). There were no differences in the incidence of late strokes (TAVI 2.0% vs. SAVR 1.5%). Neurological events were associated with increased mortality at one year. Quality of life after an early stroke in TAVI patients was higher than in SAVR patients who suffered from a stroke.  The thoroughness and consistency in stroke assessment in this trial is a major strength. Whereas the early PARTNER IA trial showed a higher stroke rate with TAVI than with SAVR (4.7% vs. 2.4% respectively), these results show a more favorable outcome for strokes after TAVI.  Interestingly, no embolic protection devices were used in the trial. Application of these devices is now more and more common and might further reduce stroke rate after TAVI. The results of this study provide further evidence supporting TAVI in intermediate risk patients.

Direct relief of subaortic stenosis in single ventricle patients via ventricular septal defect/subaortic chamber enlargement has been mostly replaced by the Damus-Kaye-Stansel/Norwood procedure due to concerns for potential re-obstruction or heart block. However, little is known about long-term outcome. Among 23 single ventricle patients (median age: 7.4 months, range: 10 days to 5.5 years) who underwent direct relief of subaortic stenosis at Leiden University Medical Center (1989-2016), authors observed a high risk of re-obstruction and patch (pseudo)aneurysm formation. However, risk of heart block was low, and the majority of patients underwent Fontan completion successfully. In selected patients, the direct approach can be a relatively simple and safe procedure.

Patient Care and General Interest

Earl Bakken, Medtronic co-founder and inventor of the pacemaker, has died at age 94.

A 5-year-old boy in Sacramento, California, USA, who has a congenital heart defect and has undergone four related heart surgeries, has had his wish of becoming a Ghostbuster fulfilled.

A study published in The BMJ suggests that a group of common blood pressure drugs may be linked to lung cancer.

A collection of apps called PulsePoint, which are designed to connect CPR-certified locals to individuals experiencing cardiac arrest nearby, is slated to launch in early 2019.

Drugs and Devices

A study published via the Proceedings of the National Academy of Sciences of the United States of America indicates that wearable technology could potentially monitor the relationship between blood pressure and pulse wave velocity in arteries, possibly helping patients monitor high blood pressure.

According to a study published in the Journal of the American College of Cardiology, an electrocardiogram reading from a specially equipped Apple Watch could potentially prove highly effective in detecting atrial fibrillation.

Research, Trials, and Funding

The Northern New England Biomarker Study suggests that elevated preoperative Galectin-3 is associated with acute kidney injury after cardiac surgery.

Researchers at the University College London’s Great Ormond Street Institute of Child Health in the UK have successfully grown a functional esophagus from stem cells and transplanted it in mice.