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
The effect of blood transfusion (Tx; 1-2 units only) on mortality after isolated CABG was evaluated in nearly 17,000 pts in Michigan. Operative mortality was 0.5% for no Tx and 1.3% for Tx (p<0.0001). Nine other adverse postoperative outcomes were significantly increased in pts receiving Tx. Aggressive attempts at reducing even small Tx amounts may result in substantial outcomes improvement.
The outcomes of failed mitral clipping were evaluated in 19 pts. Surgical risk score increased significantly between the time of clipping and subsequent remedial surgery. Severe valve tissue damage as a result of clip application was evident in most patients. Valve repair was possible in 83% of pts who had a single clip, whereas only 23% of patients with more than one clip could have valve repair. One year survival was 68%.
A multivariable analysis was performed on data from 4 European centers for outcomes comparing trans-apical (TA; 10%) and transfemoral (TF; 90%) AVI. TA-AVI pts had higher predicted risk and more comorbidities. TA-AVI was associated with increased complications, hospital stay, 30 day mortality, and all cause long-term mortality.
The aim of this genetic study conducted on a large lung transplant population is to demonstrate the relationship between some genetic variants of IL-17 and IL-23 and the risk of development of chronic allograft rejection. This association could lead to new ways of prevention and treatment.
This is a multicentre retrospective study of 1556 patients undergoing transcatheter aortic valve implantation (TAVI) with self expandable valves (SEV) and balloon expandable valves (BEV), evaluating the effect of permanent pacemaker implantation (PPI) on outcomes at two years. 15.4% of the patients required PPI. Not surprisingly, the need for PPI was significantly higher in patients receiving a SEV (25,5%) than in patients receiving a BEV (7,1%). There was no difference in the primary outcome of the study, which was defined as a composite of all-cause mortality and hospitalization due to heart failure at last follow-up. Interestingly, there was a lower rate of unexpected death in patients with PPI. Left ventricular ejection fraction improved in patients with no PPI but worsened in those patients with PPI.
This retrospective analysis compares outcomes in patients with aortic intramural hematoma type B (IMHB) to those with type B aortic dissection (ABAD) in patients enrolled in the International Registry of Acute Aortic Dissection (IRAD). There was no difference in in-hospital mortality between the two groups. Patients with IMHB required surgical intervention less frequently than ABAD, with the indications for intervention being the same for the two groups (rupture, malperfusion, refractory pain or hypertension). Periaortic hematoma was observed more often in patients with IMHB and was identified as a risk factor for rupture. Patients with ABAD had significantly more dilation of the descending aorta during follow up and more often had extension into the abdominal aorta than those with IMHB. The authors concluded that IMHB may have a more indolent clinical course than ABAD.
This article by Boyle et al. investigates risk factors that are associated with higher rates of bleeding, stroke and pump thrombosis after LVAD implantation. The authors analyzed 956 patients who underwent Heartmate II implantation as a bridge to transplant (n=405) or as a destination therapy (n=551). They found that gender, age, etiology of heart failure and body mass index were significantly associated with higher risk of bleeding and thrombotic events in LVAD patients.
In this article by Kieser and colleagues in which they analyzed 1000 patients receiving CABG, the authors report that when using arterial grafts, incomplete revascularization (occurrence, 14%) was not associated with increased midterm mortality over a median of 54 months in patients <80 years of age (HR 1.2, 95% CI 0.7-2.1), while it was in patients >80 years old (HR 5.7, 95% CI 1.8-18.0).
This study by Dimitrova et al included 1339 patients who underwent CABG of which 332 patients received a LIMA with a radial artery and 1007 a LIMA with a SVG. In a propensity-matched cohort of 283 pairs, Kaplan-Meier survival in the radial artery versus SVG group at one year (99% vs. 97%), 5 years (93% vs. 87%), 10 years (80% vs. 72%) and 15 years (70% vs. 58%) favoured those receiving a radial artery (P=0.018). In a propensity-score adjusted multivariate analysis of the entire cohort, the use of a radial artery remained an independent predictor of long-term mortality: hazard ratio 0.64, 95% CI 0.44-0.90; P=0.017).
In this paper the authors use data from cohort A of the PARTNER trial to evaluate the effect of preoperative moderate to severe mitral regurgitation on survival at two years in patients treated with surgical aortic valve replacement (SAVR) and TAVI. Mitral regurgitation improved significantly in both groups at 30 days. Preoperative mitral regurgitation had a negative effect on survival in the SAVR group but not in the TAVI group. The authors conclude that TAVI may be a reasonable treatment option in a selected group of patients with aortic stenosis and mitral regurgitation.