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Journal and News Scan
Although septal myectomy and concomitant mitral valve surgery are typical in the treatment of hypertrophic obstructive cardiomyopathy (HOCM), the combination of these procedures through right anterior mini-thoracotomy has rarely been presented in the literature. This study presents a minimally invasive surgical technique and the clinical results of one institution’s experience with this technique over the past four years.
This specialist review of congenital aortic root anatomy provides a detailed framework for evaluating and treating pediatric and adult patients across the whole spectrum of congenital aortic root pathology.
This outstanding document has been put together by the guidelines committee of the European Association of Cardiothoracic surgery in response to the two major studies that have just been published on segmentectomy versus lobectomy. This document lays out new international guidance for segmentectomy, including management of the lymph node suitability for the procedure and technical advice, and will serve for many years to come in supporting the move towards segmentectomy as the standard of care for tumors less than 2 cm.
While this full report is behind a paywall, a detailed abstract is included through the link above.
Recently, a minimal approach to transcatheter valve replacement using only local anesthesia has been used to promote a faster procedure and recovery time. With this lack of general anesthesia, however, comes more anxiety and the possibility of pain for patients. This single-center study tested the use of virtual reality glasses to provide distraction to patients. The glasses reduced perceived duration and lowered anxiety and pain associated with the procedure. The authors concluded that VR glasses are a safe and effective drug-free option for patients undergoing TAVR with a minimalistic approach.
Transcatheter aortic valve implantation (TAVI) is now a standard procedure for the treatment of symptomatic aortic valve stenosis in many patients. In Germany, according to the annual reports from the German Institute for Quality Assurance and Transparency in Healthcare, the rate of serious intraprocedural complications, such as valve malpositioning or embolization, coronary obstruction, aortic dissection, annular rupture, pericardial tamponade, or severe aortic regurgitation requiring emergency cardiac surgery has decreased markedly in recent years from more than 5.5 percent in 2012 to 2 percent in 2019. However, with increased use, the total number of adverse events remains about 500 per year, about 100 of which require conversion to sternotomy. These sometimes fatal events can occur at any time and are still challenging. Therefore, the interdisciplinary TAVI heart team should be prepared and aware of possible rescue strategies.
This single-center study of 299 patients operated on for type-A aortic dissection between 1992 and 2020 reported lower ten-year mortality (32 percent) after prosthetic or valve-sparing root replacement compared with ascending aorta replacement (52 percent; hazard ratio, 1.38; 95 percent CI, 1.12-1.68) without resecting the coronary sinuses, and lower proximal aorta reoperation rates (14 percent vs 23 percent; hazard ratio, 2.08; 95 percent CI, 1.44-5.56). The authors conclude that aortic root replacement should be considered when the aortic root is partially dissected or pathologically dilated.
The first three cardiac catheterization surgeries at University of Ghana Medical Center were performed recently by a Ghanaian pediatric cardiac specialist. The procedures were performed on three children with three different heart conditions. Ghanaian surgeons and cardiologists emphasize that this minimally invasive surgery could be performed more often with increased medical facilities and logistics resources.
This study analyzed results of aortic valve repair in patients with tricuspid aortic valves and aortic regurgitation caused by prolapse, comparing the results in cases caused by cusp fermentation and myxomatous degeneration. Researchers concluded that repair of cusp prolapse in tricuspid aortic valves with preserved root dimensions can be performed successfully, even when there are fenestrations that must be repaired.
In this analysis of 5,437 patients with clinical stage IA (cT1 N0) non-small cell lung cancer identified from the National Cancer Database, overall survival in patients pathologically upstaged to pN1 disease was greater after lobectomy (2,808 patients) than after wedge resection (128 patients). There was no difference in survival between wedge resection and lobectomy in patients upstaged to N2 disease. The authors conclude that their results highlight the importance of intraoperative detection of lymph node disease in lobectomy candidates.
The authors performed a systematic review to determine whether direct oral anticoagulants (DOACs) are as safe and effective as vitamin K antagonists in the three months after bioprosthetic valve replacement. They found no difference regarding thrombosis, major bleeding, or deaths, although the interpretation was limited by the small number of events and wide confidence intervals. Future studies should focus on DOACs in surgical valves and have long-term follow-up.