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Journal and News Scan
An analysis, from the cardiology viewpoint, of the MI nomenclature issues around the external validity of the EXCEL trial that undermined the EACTS support of the relevant 2018 guidelines
This is an a comprehensive consensus document on post-cardiotomy extracorporeal life support (PC-ECLS) jointly released by the European Association for Cardio-Thoracic Surgery (EACTS), the Extracorporeal Life Support Organization (ELSO), the Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS). This position statement is focused on the most relevant issues to optimize indications and applications, to suggest configurations of PC-ECLS, to avoid or manage complications and to improve outcomes.
An unprecedented position piece signed by all editors of the NEJM condemning US political leadership for their response to the pandemic.
At the first day of its 34th Annual Meeting, the European Association for Cardio-Thoracic Surgery (EACTS) released the "Current Options and Recommendations for the Use of Thoracic Endovascular Aortic Repair in Acute and Chronic Thoracic Aortic Disease. This is an expert consensus document jointly drafted by the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS). It is intended to provide a synopsis of current evidence regarding the use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and reporting standards, and to take a glimpse at the trends of future development.
The authors provide a succint summary of FAQs in pediatric cardiac surgery.
The authors are concerned about the 'deaths at home' having the greatest contribution to the excess of acute cardiovascular deaths in that period of the recent epidemic, AND LOCKDOWN in England and Wales. They advance the position that fear of the virus stopped patients from seeking potentially life-saving hospital treatment for cardiovascular conditions.
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.
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.
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.
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.