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Journal and News Scan
Preserving dynamism and recreating the sinuses in the Dacron graft are recongnized to be important for increasing the results of aortic valve-conserving operations. We describe a novel technique that preserves dynamism and recreates the sinotubular junction.
The only procedure which guarantees long-term viability of the aortic valve substitute is the Ross operation. This translates into increased durability, survival, exercise capacity, quality of life, and minimal valve related complications. However, progressive autograft dilatation does provide some is concern. Particularly, when used as a freestanding root. The incidence and degree of dilatation varies considerably in different series and is dependent on the technique used as well as management during the peri-operative period and importantly patient-specific characteristics. Here we present a new method which aims at preventing long-term dilatation, using autologous tissue, while preserving geometry and dynamism of the aortic root.
Interesting in its candour mini-series of partial arterial revascularisation by left thoracotomy. The perioperative graft failure is delt in some detail.
The Aortic Valve replAcemenT versus conservative treatment in Asymptomatic seveRe aortic stenosis (AVATAR) trial is an investigator-initiated international prospective randomized controlled trial that evaluated surgical aortic valve replacement (SAVR) in asymptomatic patients with severe aortic stenosis and normal left ventricular function. The study demonstrated that early surgery reduced the primary composite endpoint of all-cause death, acute myocardial infarction, stroke or unplanned hospitalization for heart failure, as compared to conservative therapy.
Appropriate conduit selection for right ventricle (RV)-to-pulmonary artery (PA) connection has been studied extensively, with older implantation age, pulmonary (vs aortic) homografts, and true sizing associated with increased longevity. Notably, patients with PA arborization abnormalities (ie, major aortopulmonary collateral arteries [MAPCAs]) are reported to need earlier and more frequent conduit interventions. We aim to understand the behavior of large-diameter aortic homografts in patients with MAPCAs, which are programmatically utilized at our institution.
Treatment guidelines for nonvalvular atrial fibrillation (AF) recommend use of non–vitamin K antagonist oral anticoagulants (NOACs) over warfarin. However, clinical trials did not include individuals with post cardiac surgery AF. We sought to compare outcomes with NOACs vs warfarin for new onset post cardiac surgery AF.
A good-size Terumo-sponsored RCT that is set to impact on decisions to discontinue DAPT early after PCI with absorbable stent, a change that will somehow decrease the surgical risk of bleeding in the event of salvage CABG.
Patients with three-vessel coronary artery disease have been known to have better outcomes with coronary-artery bypass grafting (CABG) than patients with percutaneous coronary intervention (PCI). However, studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking.
In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization.
An extremely useful and free-access update on a major vascular entity. The 'Areas of Uncertainty' is a particularly useful chapter, discussing the available technology and its current supra-renal limitations and the emerging solutions.
In this large series, Dr. Chung and associates performed a study on completeness of guideline-directed imaging surveillance (GDIS) and its association with long-term outcomes. In 888 patients with acute type A dissection who survived surgical repair, 14% received GDIS throughout a median follow-up of 5.2 years, and GDIS was available in 3.4% at 6 years. Intriguingly, greater adherence to GDIS was associated with mortality (hazard ratio: 1.08; 95% confidence interval: 1.05-1.11) and reintervention (hazard ratio: 1.04; 95% confidence interval: 1.01-1.07).