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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Sri Harsha Patlolla, MBBS, Hartzell V. Schaff, MD, Kevin L. Greason, MD, Alberto Pochettino, MD, Richard C. Daly, MD, Robert L. Frye, MD, Rick A. Nishimura, MD, Joseph A. Dearani, MD

Out of 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. Indication for surgery was functional tricuspid valve regurgitation in 64%, lead induced in 18%, and primary leaflet dysfunction in 18%. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (interquartile range [IQR] 5.9-13.5) post-dismissal.

Source: The Annals of Thoracic Surgery
Author(s): Magdi H.Yacoub MD, Ahmed Afif iFRCS MD, Hatem Hosny FRCS, Mohamed Nagy MS, Nairouz Shehata MS, Mazen Abou Gamrah MS, AmrEl Sawy MS, Walid Simry MD, Ahmed Mahgoub MD, Nadine Francis MS, Hussam El Nashar BS, Yuan-TsanTseng PhD, Soha Romeih MD PhD, Heba Aguib PhD

Preserving dynamism and recreating the sinuses in the Dacron graft are recongnized to be important for increasing the results of aortic valve-conserving operations. We describe a novel technique that preserves dynamism and recreates the sinotubular junction. 

Source: Annals of Cardiothoracic Surgery
Author(s): Ahmed Afifi, Hatem Hosny, Ahmed Mahgoub, Magdi Yacoub

The only procedure which guarantees long-term viability of the aortic valve substitute is the Ross operation. This translates into increased durability, survival, exercise capacity, quality of life, and minimal valve related complications. However, progressive autograft dilatation does provide some is concern. Particularly, when used as a freestanding root. The incidence and degree of dilatation varies considerably in different series and is dependent on the technique used as well as management during the peri-operative period and importantly patient-specific characteristics. Here we present a new method which aims at preventing long-term dilatation, using autologous tissue, while preserving geometry and dynamism of the aortic root.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Piroze M. Davierwala, Alexander Verevkin, Sophia Sgouropoulou, Elham Hasheminejad, Konstantin von Aspern,Martin Misfeld, Michael A. Borger

Interesting in its candour mini-series of partial arterial revascularisation by left thoracotomy. The perioperative graft failure is delt in some detail.

Source: Circulation
Author(s): Marko Banovic, Svetozar Putnik, Martin Penicka, Gheorghe Doros, Marek A. Deja, Radka Kockova, Martin Kotrc, Sigita Glaveckaite, Hrvoje Gasparovic, Nikola Pavlovic, Lazar Velicki, Stefano Salizzoni, Wojtek Wojakowski, Guy Van Camp, Serge D. Nikolic, Bernard Iung, and Jozef Bartunek

The Aortic Valve replAcemenT versus conservative treatment in Asymptomatic seveRe aortic stenosis (AVATAR) trial is an investigator-initiated international prospective randomized controlled trial that evaluated surgical aortic valve replacement (SAVR) in asymptomatic patients with severe aortic stenosis and normal left ventricular function.  The study demonstrated that early surgery reduced the primary composite endpoint of all-cause death, acute myocardial infarction, stroke or unplanned hospitalization for heart failure, as compared to conservative therapy.

Source: The Annals of Thoracic Surgery
Author(s): Michael Ma, MD, Alisa Arunamata, MD, Lynn F. Peng, MD, Lisa Wise-Faberowski, MD, Frank L. Hanley, MD, Doff B. McElhinney, MD

Appropriate conduit selection for right ventricle (RV)-to-pulmonary artery (PA) connection has been studied extensively, with older implantation age, pulmonary (vs aortic) homografts, and true sizing associated with increased longevity. Notably, patients with PA arborization abnormalities (ie, major aortopulmonary collateral arteries [MAPCAs]) are reported to need earlier and more frequent conduit interventions. We aim to understand the behavior of large-diameter aortic homografts in patients with MAPCAs, which are programmatically utilized at our institution.

Source: The Annals of Thoracic Surgery
Author(s): Victor Nauffal, MD, Ludovic Trinquart, PhD, Asishana Osho, MD, Thoralf M. Sundt, MD, Steven A. Lubitz, MD, MPH, Patrick T. Ellinor, MD, PhD

Treatment guidelines for nonvalvular atrial fibrillation (AF) recommend use of non–vitamin K antagonist oral anticoagulants (NOACs) over warfarin. However, clinical trials did not include individuals with post cardiac surgery AF. We sought to compare outcomes with NOACs vs warfarin for new onset post cardiac surgery AF.

Source: The New England Journal of Medicine
Author(s): MASTER DAPT Investigators

A good-size Terumo-sponsored RCT that is set to impact on decisions to discontinue DAPT early after PCI with absorbable stent, a change that will somehow decrease the surgical risk of bleeding in the event of salvage CABG. 

Source: The New England Journal of Medicine
Author(s): William F. Fearon, M.D., Frederik M. Zimmermann, M.D., Bernard De Bruyne, M.D., Ph.D., Zsolt Piroth, M.D., Ph.D., Albert H.M. van Straten, M.D., Ph.D., Laszlo Szekely, M.D., Giedrius Davidavičius, M.D., Ph.D., Gintaras Kalinauskas, M.D., Ph.D., Samer Mansour, M.D., Rajesh Kharbanda, Ph.D., Nikolaos Östlund-Papadogeorgos, M.D., Adel Aminian, M.D., Keith G. Oldroyd, M.D., Nawwar Al-Attar, M.D., Ph.D., Nikola Jagic, M.D., Ph.D., Jan-Henk E. Dambrink, M.D., Ph.D., Petr Kala, M.D., Ph.D., Oskar Angerås, M.D., Ph.D., Philip MacCarthy, Ph.D., F.R.C.P., Olaf Wendler, M.D., Ph.D., Filip Casselman, M.D., Ph.D., Nils Witt, M.D., Ph.D., Kreton Mavromatis, M.D., Steven E.S. Miner, M.D., Jaydeep Sarma, Ph.D., F.R.C.P., Thomas Engstrøm, Ph.D., D.M.Sci., Evald H. Christiansen, M.D., Ph.D., Pim A.L. Tonino, M.D., Ph.D., Michael J. Reardon, M.D., Di Lu, M.S., Victoria Y. Ding, M.S., Yuhei Kobayashi, M.D., Mark A. Hlatky, M.D., Kenneth W. Mahaffey, M.D., Manisha Desai, Ph.D., Y. Joseph Woo, M.D., Alan C. Yeung, M.D., and Nico H.J. Pijls, M.D., Ph.D. for the FAME 3 Investigators

Patients with three-vessel coronary artery disease have been known to have better outcomes with coronary-artery bypass grafting (CABG) than patients with percutaneous coronary intervention (PCI). However, studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking.

In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization.

Source: The New England Journal of Medicine
Author(s): Andres Schanzer, Gustavo S. Oderich

An extremely useful and free-access update on a major vascular entity. The 'Areas of Uncertainty'  is a particularly useful chapter, discussing the available technology and its current supra-renal limitations and the emerging solutions.