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Journal and News Scan

Source: Journal of the American College of Cardiology
Author(s): Howard C. Herrmann, Samuel A. Daneshvar, Gregg C. Fonarow, Amanda Stebbins, Sreekanth Vemulapalli, Nimesh D. Desai, David J. Malenka, Vinod H. Thourani, Jennifer Rymer, Andrzej S. Kosinski

The authors, using the STS/ACC TVT Registry, analyzed the the occurrence of patient-prosthesis mismatch (PPM) in 62,215 patients enrolled between 2014 and 2017. They found that severe and moderate PPM occurred in 12% and 25% of patients, respectively. A greater degree of PPM was associated with a higher risk of mortality and rehospitalization at 1 year.

Source: Circulation
Author(s): Suzanne J. Baron, Kaijun Wang, John A. House, Elizabeth A. Magnuson, Matthew R. Reynolds, Raj Makkar, Howard C. Herrmann, Susheel Kodali, Vinod H. Thourani, Samir Kapadia, Lars Svensson, Michael J. Mack, David L. Brown, Mark J. Russo, Craig R. Smith, John Webb, Craig Miller, Martin B. Leon , David J. Cohen, and on behalf of the PARTNER 2 Investigators

This study analyzed the cost-effectiveness of TAVR versus SAVR in 3110 intermediate-risk aortic stenosis patients from the PARTNER-2 trial. Using a Markov model, the authors found that TAVR is economically dominant from the perspective of lifetime cost-effectiveness in the US healthcare system. TAVR was estimated to save $8,000-$10,000 over the lifetime of the patient and to increase quality-adjusted survival by 0.15-0.27 years.

Source: Heart
Author(s): Stuart W Grant, Graeme L Hickey, Paul Modi, Steven Hunter, Enoch Akowuah, Joseph Zacharias

Grant and colleagues studied short- and midterm outcomes for 639 matched pairs of patients who underwent mitral valve surgery by either sternotomy or a minimally invasive approach at three UK institutions between 2008 and 2016. Patients were included even if they underwent concomitant tricuspid valve surgery or ablation for atrial fibrillation. The median follow-up time was 3.7 years, maximum follow-up was 9.1 years. Reintervention-free survival at eight years was similar in both groups (86.1% and 84.1%), and no differences were found in in-hospital mortality, reoperation during hospital admission, or stroke. Patients undergoing minimally invasive surgery had a reduced need for transfusion and a shorter postoperative hospital stay.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care and General Interest

Truly remote percutaneous coronary intervention was performed in five human patients at Apex Heart Institute in Ahmedabad, India.

Virtual reality comes to continuing medical education, as gastrointestinal surgeries performed at Cedars-Sinai Medical Center in Los Angeles, California, are turned into virtual reality courses.


Drugs and Devices

Meril Life Sciences has launched the MyVal, a transcatheter aortic valve designed and manufactured in India.


Research, Trials, and Funding

Researchers from Boston, Massachusetts, analyzed the alignment of hospital rankings and outcomes in cardiology and cardiac surgery, and their findings question how well readmission rates reflect quality of care.

The first patient has been treated in the Terminate AF study. The study, supported by Medtronic, aims to evaluate the simultaneous use of heat and cold for ablation to treat atrial fibrillation in surgical patients.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Florian S Schoenhoff, David H Tian, Martin Misfeld, Konstantinos G Perreas, David Spielvogel, Friedrich W Mohr, Friedhelm Beyersdorf, Tristan D Yan, Thierry P Carrel

Schoenhoff and colleagues evaluated the impact of reimplantation techniques of the supra-aortic branches, en bloc or separate, on neurological complications following total arch replacement. In a study of 3345 patients enrolled to the ARCH registry, the authors found that separate reimplantation of the supra-aortic branches increased the risk of neurological complications in the full cohort but not in a comparison of 461 matched patient pairs. Implantation technique did not influence early mortality or late survival.

Source: Journal of Cardiac Surgery
Author(s): Hisato Takagi, Yosuke Hari, Shohei Mitta, Norikazu Kawai, Tomo Ando, ALICE (All‐Literature Investigation of Cardiovascular Evidence) Group

Takagi and colleagues performed a meta-analysis of eight randomized controlled trials comparing on-pump and off-pump coronary artery bypass grafting (CABG). They evaluated only trials with follow-up periods of five years or longer, and they pooled hazard ratios rather than odds ratios, where possible. The authors’ analysis found an increased mortality risk with off-pump CABG.

Source: The Annals of Thoracic Surgery
Author(s): Sukhdeep S. Basra, Ambarish Gopal, Katie R. Hebeler, Heike Baumgarten, Audrey Anderson, Srinivasa P. Potluri, William T. Brinkman, Molly Szerlip, Deepika Gopal, Giovanni Filardo, J. Michael DiMaio, David L. Brown, Paul A. Grayburn, Michael J. Mack, Elizabeth M. Holper

Basra and colleagues report that among patients with bioprosthetic aortic valves who had clinical or echocardiographic indications suggestive of leaflet thrombosis, one-third of patients had this diagnosis confirmed by four-dimensional computed tomography (4DCT). The use of 4DCT avoided unnecessary anticoagulation in the remaining two-thirds of patients. The median time from valve replacement to 4DCT was 9.6 months in transcatheter patients and 3.7 years in surgical patients, due to active surveillance in patients who had received a transcatheter valve.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care and General Interest

A patient who had been admitted to the intensive care unit for chronic heart failure coughed up a cast of his right bronchial tree made of coagulated blood.

A Kaiser Health News article discusses the challenges patients can face to cover the cost of organ transplant in the US and the importance for transplant centers to ensure that patients can afford the treatment, which has a much greater need than availability.

The American Medical Association highlights approaches from different institutions around the US that are geared toward creating a healthier work environment for physicians.

Amazon has developed software that it says can pull information from digitized patient records and clinical notes.


Drugs and Devices

The National Institute for Health and Care Excellence recommended that percutaneous repair of the mitral valve with a leaflet clip be more widely available across the National Health System in England.


Research, Trials, and Funding

Researchers from Germany report the transplantation of pig hearts into baboons, with two of the baboons surviving for six months.

Source: The Annals of Thoracic Surgery
Author(s): A. Claire Watkins, Nathan L. Maassel, Mehrdad Ghoreishi, Murtaza Y. Dawood, Si M. Pham, Zachary N. Kon, Bradley S. Taylor, Bartley P. Griffith, James S. Gammie

Watkins and colleagues report their use of preoperative extracorporeal membrane oxygenation (ECMO) to evaluate and stabilize structural heart patients who were at extreme surgical risk. Twelve patients undergoing surgery for severe prosthetic mitral stenosis, ruptured papillary muscle, ischemic ventricular septal defect, or severe aortic stenosis were included. ECMO-associated complications included leg ischemia, wound infection, and major bleeding. Preoperative ECMO support improved the predicted operative mortality risk, and survival was 82% after one year.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Gilles D. Dreyfus, Filip Dulguerov, Cecilia Marcacci, Shelley Rahman Haley, Antonia Gkouma, Carine Dommerc, Adelin Albert

Gilles Dreyfus and colleagues share a decade of mitral reconstruction for degenerative posterior leaflet pathology in Harefield and Monaco (38 per year was the formidable average). The supplementary video is of particular educational value for the mitral surgeon and the cardiologist/TOE (TEE) specialist.