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Journal and News Scan
This paper is an expert consensus on the new definition of relevant myocardial infarction following both PCI and CABG. In patients with normal baseline CK-MB, post-procedural MI is defined as a peak CK-MB rise, measured within 48 hours of the procedure, equal or greater than 10-times the local laboratory upper limit of normal (ULN) or equal or greater than 5-times the local laboratory ULN with new pathologic Q-waves in more than 2 contiguous leads or new persistent LBBB, OR in the absence of CK-MB measurements and a normal baseline cTn, a cTn (I or T) level rise, measured within 48 hours of the procedure, greater than 70-times the local laboratory ULN, or greater than 35-times the ULN with new pathologic Q-waves in more than 2 contiguous leads or new persistent LBBB.
The pulmonary autograft aortic valve replacement (Ross AVR) has clear advantages in growing children below the teenage years. Some recent reports have questioned the durability of the Ross AVR in older children and young adults, particularly those who present with predominant aortic regurgitation and a dilated aortic root. Brown and associates review their experience with the Ross operation in 79 children and young adults between the age of 10 and 20, mean of 16.0 ± 2.7 years. Analysis of outcomes including mortality, early and late complications and the need for reoperation is presented, with comparison to non-Ross AVR patients of the same age group during the same time period. The impact of technical modifications to the Ross operation is also assessed.
This is a very interesting retropsective cohort study that looks at patients that either did or did not have an FFR preoperatively.
FFR for intermediate stenoses reduced the number of grafts required and increased the number of patients suitable for OFF pump surgery with no difference in clinical outcome measures.
This cohort study looks at the Administration of FFP in bleeding patients after cardiac surgery. it finds no difference in mortality in the FFP group and the no FFP group
71-year-old male who underwent successful minimally invasive transapical aortic valve implantation to treat severe aortic stenosis, with simultaneous pulmonary resection for the treatment of lung cancer. At five-year follow-up the patient remains free of symptoms (NYHA I) and recurrence.
This randomized, double-blind study assigned pts with acute VTE who were initially treated with heparin to endoxaban or warfarin. The drugs were equivalent in preventing recurrent VTE, and endoxaban was associated with a lower risk of bleeding (p=0.004). Pts who had RV dysfunction associated with PE had a substantially reduced risk of recurrent VTE with endoxaban.
This randomized trial among 115 centers assigned patients with NYHA class III or IV heart failure, a short QRS duration, and LV dyssynchrony to device implantation with or without CRT. The study was stopped prematurely by the DSMB for futility. CRT was associated with increased deaths (p=0.02) and there was no difference in the primary outcome of death or hospitalization for worsening heart failure.
This issue on “Frozen Elephant Trunk” includes information on hybrid and endovascular surgical management of descending aorta and aortic arch pathologies. The issue includes a systematic review evaluating the current state of evidence on Frozen Elephant Trunks, long-term outcomes from international institutions, perspectives and opinions from leaders in the field, and operative video manuals for different hybrid prostheses.
Outcomes for small children (<10kg) bridged to heart transplant with VADs were compared to those who were not bridged. 2:1 propensity score matching was used to create comparison groups. Survival of 59 bridged pts was similar to that of 108 non-bridged pts, and most major complication rates were similar. Strokes occurred in 8.5% of bridged pts and 0.9% of non-bridged pts.
This randomized study assigned patients with CAD to either PCI or OPCAB and assessed cognition 7.5 years later. The OPCAB group had better cognition at long-term follow-up in univariate analysis, but when adjusted for covariates, there was no significant difference in the cognition outcomes.