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Journal and News Scan

Source: The Lancet
Author(s): Mäkikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, Trovik T, Eskola M, Romppanen H, Kellerth T, Ravkilde J, Jensen LO, Kalinauskas G, Linder RB, Pentikainen M, Hervold A, Banning A, Zaman A, Cotton J, Eriksen E, Margus S, Sørensen HT, Nielsen PH, Niemelä M, Kervinen K, Lassen JF, Maeng M, Oldroyd K, Berg G, Walsh SJ, Hanratty CG, Kumsars I, Stradins P, Steigen TK, Fröbert O, Graham AN, Endresen PC, Corbascio M, Kajander O, Trivedi U, Hartikainen J, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH; NOBLE study investigators.

This is a prospective, randomised, open-label, non-inferiority trial comparing CABG versus PCI in patients with unprotected left main stenosis. The study was carried out at 36 hospitals in Latvia, Estonia, Lithuania, Germany, Norway, Sweden, Finland, the UK, and Denmark.  In total, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat up to 5 years of follow up. Interestingly, only 8% of the patients in the CABG group had the right internal mammary artery used as a graft (93% had the left ITA used). The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE; death from any cause, non-procedural myocardial infarction,14 repeat revascularisation, or stroke). The key findings of the NOBLE study are that CABG was better than PCI for the composite endpoint of MACCE; all-cause mortality was similar between the two groups; non-procedural myocardial infarction and need for repeat revascularisation were increased after PCI; a higher rate of stroke was observed in the CABG group after 30 days than in the PCI group, but an unexpected, numerically higher rate of stroke was found in PCI-treated patients in 5 year estimates; maximum angina pectoris score was higher after PCI at up to 5 years follow-up.

Source: Circulation Research
Author(s): Beer LA, Kossenkov AV, Liu Q, Luning Prak E, Domchek S, Speicher DW, Ky B .

An interesting case series of cardiotoxicity of modern chemotherapy attempting to elucidate mechanisms of heart failure. This pilot study could well lead to further investigation of finite pathways related to surgical aspects of transplanation, anti-rejection therapy in particular: The authors propose that the immune system is a mediator of cardiac dusfunction.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Fraser D. Rubens, Yen-Yen Gee, Janet M.C. Ngu, Li Chen, Ian G. Burwash

This single institution study evalated the effect of prosthesis choice on regression of LV mass after AVR in patients with AS.  The St. Jude Trifecta performed better than the Edwards Perimount Magna Ease in terms of LV mass regression and intermediate-term clinical outcomes such as valve gradients, freedom from readmission, and all-cause mortality.

Source: Annals of Thoracic Surgery
Author(s): David Jonathan Heineman, Martijn Geert ten Berge, Johannes Marlene Daniels, Michaël Ignatius Versteegh, Perla Jacqueline Marang-van de Mheen, Michael Wilhelmus Wouters, Wilhelmina Hendrika Schreurs

The authors examined the concordance of clinical and pathological staging using prospectively collected data from the Dutch Lung Surgery Audit, examining patients with clinical stage I disease.  Among 1,555 patients, the concordance of cTNM and pTNM was 60%.  22.6% of patients were upstaged after resection, .  The difference was more evident in patients with T2a tumors. 

Source: Annals of Thoracic Surgery
Author(s): Kristen Nelson-McMillan, Christoph P. Hornik, Xia He, Luca A. Vricella, Jeffrey P. Jacobs, Kevin D. Hill, Sara K. Pasquali, Diane E. Alejo, Duke E. Cameron, Marshall L. Jacobs

This database study evaluated outcomes of delayed sternal closure for infants undergoing surgery on cardiopulmonary bypass.  Delayed closure was associated with a 3-fold increase in infectious complications.  Time to closure was associated with an increasing rate of infectious complications.  Location of closure (OR, ICU) was not associated with adverse outcomes.

Source: Annals of Thoracic Surgery
Author(s): Vincent Chan, Elsayed Elmistekawy, Marc Ruel, Mark Hynes, Thierry G. Mesana

This single institution study explored the frequency and time course of failure of mitral valve repair for MR caused by prolapse using longitudinal echocardiography.   Recurrent MR developed in 49 (5.7%) patients at a mean of 3.1 years; 6 had prolapse and 43 did not.   Severe MS occurred in 3.  Reoperation was performed in 21 patients, and was most commonly valve replacement. 

Source: Annals of Thoracic Surgery
Author(s): Julius I. Ejiofor, Maroun Yammine, Morgan T. Harloff, Siobhan McGurk, Jochen D. Muehlschlegel, Prem S. Shekar, Lawrence H. Cohn, Pinak Shah, Tsuyoshi Kaneko

This single institution retrospective study evaluated outcomes of valve replacement for degenerated bioprosthetic aortic valves comparing surgical AVR (SAVR) to transcatheter valve-in-valve procedures (TViV).  Patients were matched into 2 groups of 22 according to STS risk scores.   Operative mortality, stroke rate, and 3-year survival were similar between the groups. 

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Rio Nomoto, Lynn A. Sleeper, Michele J. Borisuk, Lisa Bergerson, Frank A. Pigula, Sitaram Emani, Francis Fynn-Thompson, John E. Mayer, Pedro J. del Nido, Christopher W. Baird

This single center review assessed the need for reintervention after pulmonary valve replacement with bioprostheses for congenital heart disease.  Most patients had TOF, and most were in their teens or twenties.  After correction for age, the Sorin Mitroflow valve required reintervention sooner and more often than the other two valves (Carpentier-Edwards Magna and MagnaEase, Carpentier-Edwards Perimount).  Valve type was the only independent predictor of reintervention. 

See also: Pulmonary valve replacement for congenital heart disease: What valve substitute should we be using?

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Brooks V. Udelsman, Jessica Eaton, Ashok Muniappan, Christopher R. Morse, Cameron D. Wright and Douglas J. Mathisen

This retrospective single institution report examined outcomes of repair of large airway defects with bioprothetic materials.  8 patients underwent repair with aortic homograft or acellular dermal matrix, 5 of whom suffered from airway-enteric fistulae.   Most repairs were buttressed with muscle or omentum.   All airways healed; 2 required debridement of granulation tissue and 1 required dilation.

See also: The search for a long-lasting circumferential tracheal conduit: Belsy's problem and ours



Source: Eur J Cardiothorac Surg
Author(s): Marianna Buonocore, Cristiano Amarelli, Michelangelo Scardone, Angelo Caiazzo, Giuseppe Petrone, Luigi Majello, Pasquale Santé, Gianantonio Nappi, and Alessandro Della Corte

One-hundred eleven patients who underwent surgical repair of acute type A aortic dissection without preoperative malperfusion are analyzed for outcome with regard to arterial cannulation site, route of cerebral perfusion and surgeon’s specific experience. Potential biases are discussed.