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Journal and News Scan

Source: The New England Journal of Medicine
Author(s): Paulus Kirchhof, A. John Camm, Andreas Goette, Axel Brandes, Lars Eckardt, Arif Elvan, Thomas Fetsch, Isabelle C. van Gelder, Doreen Haase, Laurent M. Haegeli, Frank Hamann, Hein Heidbüchel, Gerhard Hindricks, Josef Kautzner, Karl-Heinz Kuck, Lluis Mont, G. Andre Ng, Jerzy Rekosz, Norbert Schoen, Ulrich Schotten, Anna Suling, Jens Taggeselle, Sakis Themistoclakis, Eik Vettorazzi, Panos Vardas, Karl Wegscheider, Stephan Willems, Harry J.G.M. Crijns, Günter Breithardt, for the EAST-AFNET 4 Trial Investigators

Death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome was reduced (P=0.005) by early pharmacogical or inteventional ablation for fast response-atrial fibrillation in a small German RCT. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Tirone E. David, Carolyn M. David, Maral Ouzounian, Christopher M. Feindel, and Myriam Lafreniere-Roula

Dr David and colleagues reported the long-term outcomes of aortic valve reimplantation in 465 patients between 1989 and 2018. Clinical and echocardiographic follow-up was available in 98% for a mean duration of 10 ± 6 years.

Mean age was 47 ± 5.1 years, and 78% were men. Etiology of aortic root aneurysm was Marfan syndrome in 164 patients, Loeys–Dietz syndrome in 13, bicuspid aortic valve (BAV) in 67, and type A aortic dissection in 33. AI was moderate or severe in 298. At 20 years, 69.1% of patients were alive and free from aortic valve reoperation, and the cumulative incidences were 6.0% for aortic valve reoperation with death, and 10.2% for developing moderate or severe AI. Distal aortic dissections occurred in 22 patients, predominantly in those with genetic syndromes. The development of postoperative AI increased by time (in years) (hazard ratio, 1.06; 95% confidence interval, >1.02-1.10; P = 0.006). 

This series show the excellent long-term results of AV reimplantation, which, however, is associated with progressive rate of AI over time.  Patients with genetic syndromes have a risk of distal aortic dissections.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Vincent Chauvette, Ismail Bouhout, Laurence Lefebvre, Mohammed Tarabzoni, Marie-Ève Chamberland, Nancy Poirier, Philippe Demers, Michael W A Chu, Jean Perron, Ismail El-Hamamsy

Chauvette et al. present a multicenter study on the outcome of Ross procedure in adults with infective endocarditis. In their cohort of patients at five centers within Canada and the US, the authors observed an excellent mid-term outcome. The complication rate was low, showing one case of stroke (3%) and 13% cumulative incidence of endocarditis recurrence at eight years. Therefore, the authors conclude the Ross procedure as a safe and reasonable option for selected patients.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Kimberly A. Shemanski, MD, Albert Farias, PhD, Dustin Lieu, BS, Anthony W. Kim, MD, Sean Wightman, MD, Scott M. Atay, MD, Robert J. Canter, MD, MAS, Elizabeth A. David, MD, MAS

In this article, the authors explored cardiothoracic surgeons' perceptions of health services research and practice guidelines through open-ended, semi-structured phone interviews with cardiothoracic surgeons across the United States, highlighting gaps in the translation of guidelines to clinical practice.

Source: The Annals of Thoracic Surgery
Author(s): Kiah M. Williams, BA, Camille E. Hironaka, BS, Hanjay Wang, MD, Simar S. Bajaj, Christian T. O’Donnell, MD, Mark Sanchez, BA, Jack Boyd, MD, Lauren Kane, MD, Leah Backhus, MD, MPH

This article assesses the career paths and interest in cardiothoracic surgery of the Women in Thoracic Surgery scholarship recipients and demonstrates the durability and impact of scholarship programs for women in our specialty. 

Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Author(s): Kunihiko Yoshino, MD, Kohei Abe, MD, Koyu Suzuki, MD, Rihito Tamaki, MD, Atusyuki Mituishi, MD, Manabu Yamasaki, MD, Hiroyasu Misumi, MD

In this article, the authors present a novel no-touch saphenous vein harvesting technique with preservation of the perivascular tissue with use of the harvester (MAQUET Getinge Group, Getinge AB, Göteborg, Sweden).

Source: European Journal of Cardio-Thoracic Surgery
Author(s): An-Hsun Chou, Victor Chien-Chia Wu, Dong-Yi Chen, Kuo-Chun Hung, Shang-Hung Chang, Pao-Hsien Chu, Shao-Wei Chen

Chou et al. analyzed a nationwide ECMO register regarding patients with liver cirrhosis. They identified 233 patients, which represents 3.3% of all 7003 patients. These patients had a very high one-year mortality of more than 95%. Therefore, the authors conclude that ECMO should be used very carefully in patients with known liver cirrhosis.

Source: Circulation
Author(s): Safi U. Khan, Maninder Singh, Shahul Valavoor, Muhammad U. Khan, Ahmad N. Lone, Muhammad Zia Khan, Muhammad Shahzeb Khan, Preethi Mani, Samir R. Kapadia, Erin D. Michos, Gregg W. Stone, Ankur Kalra, and Deepak L. Bhatt

An open-access large metanalysis on the utility and risks of antiplatelets after PCI. Of note, mortality was not a primary endpoint. The message is that long dual antiplatelet use is an exchange between avoidance of myocardial events and serious bleeding.

The novel oral anticoagulants may enter the arena soon..

Source: The Annals of Thoracic Surgery
Author(s): Jatin Anand, MD, Julie Doberne, MD, PhD, Charles M. Wojnarski, MD, MS, Peter K. Smith, MD, Brittany A. Zwischenberger, MD.

The authors implemented a prospective longitudinal, residency-wide coronary anastomosis simulation curriculum providing each participant with a low-fidelity coronary anastomosis simulator, high-quality instruments, and faculty mentor. They demonstrate at 1 year of follow-up improve anastomosis times and technical skills. A great model for programs to adapt to enhance their institution's simulation curriculum. 

Source: The Annals of Thoracic Surgery
Author(s): Ashraf A. Sabe, MD, Edward Percy, MD, Tsuyoshi Kaneko, MD, Ryan P. Plichta, MD, G. Chad Hughes, MD

In this article, the authors review the literature highlighting factors that increase a patient's risk in acute Type A aortic dissection repair and provides suggestions for risk stratification to guide timing of surgery in select patients.