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Journal and News Scan
The use of mechanical circulatory support (MCS) for pediatric patients undergoing heart surgery was analyzed. Of over 96,000 operations, 2.4% were associated with MCS use. MCS use was associated with younger patients, a greater number of preoperative risk factors, and certain operations (Norwood, complex biventricular repair). Mortality associated with MCS was over 50%. MCS rates differed substantially across participating institutions.
37 pairs of matched patients were analyzed for short-term postoperative outcomes. Neurologic complications and pacemaker implant rates were similiar between the groups. Paravalvular leak rate was higher in the TAVI group (13.5% vs 0%). Survival at a mean f/u of 19 mos was better in the sutureless valve group (97% vs 87%). Better survival was associated with the absence of a paravalvular leak.
Outcomes of the Ross procedure in 55 children and adolescents performed over a 20 year period were reviewed. Median f/u was 5.5 years. Hospital mortality was 13%, and long-term survival was 85%. Freedom from reoperation for autograft failure at 10 years was 74%, and was 56% for RV outflow tract replacement.
This meta-analysis included over 5,000 pts in 28 studies and evaluated mortality and neurologic outcomes after aortic arch surgery. Unilateral and bilateral antegrade cerebral perfusion were associated with similar rate of mortality, temporary neurologic deficit, and permanent neurologic dysfunction.
52 patients undergoing thoracotomy were randomized to paravertebral catheter vs epidural catheter for pain management. Use of the paravertebral catheter was associated with better pain control and respiratory effort. Side effects typical of epidural catheters such as nausea, hypotension, and urinary retention were not seen in the paravertebral catheter group.
The authors reviewed their experience with 104 consecutive patients who underwent elective arch treatment with debranching and thoracic endovascular aortic repair between 2005-2013. Major complications at 30 days (death, stroke, and spinal cord ischemia) occurred in 6, 4, and 3 patients, respectively. At 1, 3, and 5 years survival rates were 89.0%, 82.8%, and 70.9%. Extension to ascending aorta (zone 0 landing) was the only multivariate independent predictor for perioperative mortality. Freedom from persistent endoleak was 96.1%, 92.5%, and 88.3% at 1,3, and 5 years. The authors conclude that the endovascular aortic arch repair presents a low rate of aorta-related deaths and reinterventions and acceptable midterm survival. One-third of the aneurysms decreased in diameter over 5 years. Retrograde type A dissection remains a major concern in the perioperative period.
The authors report their results with 50 consecutive patients who underwent TEVAR for management of acute complicated type B dissection between July 2005 and September 2012. In-hospital and 30-day mortality were 0%. The rates of stroke, permanent paraplegia/paraparesis, and new-onset dialysis were 2%, 2%, and 4%, respectively. Survival at 5 and 7 years was 84%. Thirteen (26%) patients required a total of 17 reinterventions; six were performed using open techniques and 11 with endovascular or hybrid methods. The authors report excellent outcomes of TEVAR for acute complicated type B dissection. Aortic reinterventions were required in one-quarter of patients, but no aortic-related deaths were observed, confirming the importance of life-long surveillance by an experienced aortic referral center.
Anomalous Aortic Origin of a Coronary Artery (AAOCA) is a common congenital heart lesion that may rarely be associated with myocardial ischemia and sudden death in the young. Evidence-based criteria for management are lacking. As of June 2012, 198 patients were enrolled in the CHSS Registry of young patients with AAOCA. Analysis of demographic, clinical and morphologic data suggests that management decisions, including surgical referral, are associated with patient symptoms and coronary morphology.
Interesting paper evaluating the usage of IMA for coronary artery bypass graft surgery in the USA from 1988 to 2008 among Medicare users. The study looks into the adoption of IMA grafting over this period of time and the variation in its use among different states which goes from less than 87.5% to over 95%. Differences in outcomes in those patients with and without an IMA graft were also analyzed.
Nice operative video of an anterior approach to resection of a pan coast tumour