This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
Vitanova and colleagues reviewed outcomes of systemic-to-pulmonary artery shunt surgery to identify potential risk factors for negative outcomes in neonates. Between 2000 and 2016, 305 shunts were implanted in 280 newborns, with a median age of 9 days old. Shunt failure occurred in 8% of patients, and shunt-related mortality was 4%. Univariate analysis determined perioperative platelet transfusion, central shunt, shunt size of 3 mm, and postoperative extra corporeal membrane oxygenation to be risk factors for shunt failure.
Hata and colleagues performed a propensity score-matched analysis comparing 85 pairs of patients who underwent either minimally invasive mitral valve repair or chordal-sparing replacement for degenerative mitral valve regurgitation. Freedom from major adverse cardiac and cerebrovascular events after seven years was similar between the groups. There was no difference in mortality and no difference in freedom from valve reintervention.
Garbade and colleagues compared outcomes reported during the European Conformity (CE) Mark clinical trial of the HeartMate 3 left ventricular assist device (LVAD) to outcomes for patients treated since the device came to market. Patients treated after device approval, from the ELEVATE registry, were more severely ill, were older, and underwent more concomitant valve procedures than those treated in the CE Mark trial. After adjusting for baseline differences between the groups, the authors found comparable 30-day survival. Rates of bleeding, infection, and stroke were also similar between the two groups, and no instances of pump thrombosis were recorded.
Malvindi and colleagues assessed the outcomes of aortic clamping strategies, either transthoracic cross-clamp (TTC, n = 165) or endoaortic balloon occlusion (EAO, n = 93) for patients undergoing minimally invasive mitral valve surgery. Endoaortic balloon occlusion was more commonly used for redo surgery (2% of TTC cases versus 12% of EAO cases). Cerebral stroke was more prevalent in EAO cases than TTC cases (0% versus 4.3%, p = 0.03), although after multivariate adjustment this difference was not significant. There was no difference in aortic dissection rates. The authors determined EAO to be a safe method of cross-clamping, and it is their preferred method for redo procedures.
Vergnat and colleagues retrospectively evaluated long-term outcomes for neonates who underwent either balloon valvotomy or open valvoplasty between 1989 and 2015 (51 and 52 patients, respectively). Although both methods offer good survival benefits, open valvoplasty was associated with a higher freedom from operation during the follow-up period.
Stiles and colleagues evaluated outcomes for patients with esophageal cancer undergoing surgical resection after either neoadjuvant chemoradiation or preoperative chemotherapy without radiation. The authors evaluated disease-free and cancer-specific survival from prospective data collected from 338 patients, 112 who underwent neoadjuvant chemoradiation and 226 receiving chemotherapy. Nearly all patients underwent transthoracic esophagectomy for their surgical procedure. Patients with adenocarcinoma showed an increased local tumor response but no difference in survival with neoadjuvant chemoradiation, whereas patient with squamous cell carcinoma had improved cancer-specific survival.
The medical therapies for thoracic aortic aneurysm comprise of β-adrenergic blocking agents and angiotensin II type I receptor. Several large randomized trials of pediatric and adult patients with Marfan syndrome have yielded no evidence that antagonism of angiotensin II type I receptor by losartan slows aortic enlargement more effectively than conventional treatment with β-blockers. Studies in mouse models have begun to resolve the complex molecular pathophysiology underlying onset and progression of aortic disease and have emphasized the need to preserve the transformation growth factor-β signaling to prevent aneurysm formation.
This review describes critical experiments that have influenced the evolution of our understanding of thoracic aortic disease, in addition to discussing old controversies and identifying new therapeutic opportunities.
Patient Care and General Interest
Air pollution tops the World Health Organization’s list of Top 10 threats to global health.
A US woman had an aortic dissection while simultaneously going into premature labor, requiring emergency coordination of two procedures.
An Indian man receives a heart transplant, with the cost of the procedure covered by the Tamil Nadu Chief Minister’s comprehensive Health Insurance Scheme.
Drugs and Devices
Abbott receives US Food and Drug Administration approval for a tiny patent ductus arteriosus occlusion device for premature infants, and it also acquires Cephea Valve Technologies, a company that develops transcatheter mitral valve technologies.
Research, Trials, and Funding
Providing vouchers to reduce the cost of antiplatelet therapy after a heart attack only marginally improved adherence and did not affect outcomes, report researchers from Durham, North Carolina.
Patients reap postoperative benefits from quitting smoking before lung cancer surgery, say researchers from Tokyo, Japan.
Researchers from New Hampshire, US, report on the growth of medical marketing in the US over last two decades.
David and colleagues prospectively examined long-term results of the Ross procedure, following a cohort of 212 patients over a median 18.0 years (interquartile range, 14.6-21.2). They report 10.8% cumulative mortality and 16.8% cumulative probability of Ross-related reoperations at 20 years. Postoperative aortic insufficiency increased with time and was associated with the presence of preoperative aortic insufficiency. The authors conclude that the Ross procedure should be part of the surgical armamentarium for treating aortic stenosis in young adults.
Mariette and colleagues randomly assigned 207 patients with resectable esophageal cancer to undergo either transthoracic open esophagectomy or hybrid minimally invasive esophagectomy. The hybrid procedure resulted in a lower incidence of major intraoperative or postoperative complications (odds ratio, 0.31; 95% confidence interval, 0.18 – 0.55; p<0.001). Both groups had similar survival over three years.