Journal and News Scan

Therapy with b-blockers has shown a beneficial effect in reducing aortic dilation progression and has been proposed as the standard treatment for Marfan´s syndrome (MFS). However, angiotensin II-receptor blockers are emerging as potential alternatives to b-blockers. In this manuscript the authors describe the results of a phase IIIb randomized, parallel, double-blind study of 140 MFS patients comparing the effect of losartan and atenolol. Primary end-points were changes in aortic root and ascending aorta diameter indexed by body surface area (BSA) on MRI after 36 months of treatment. Results showed no differences in the effects of losartan and atenolol on changes in aortic root and ascending aorta diameters in MFS patients.

Guidelines recommend that ICDs should not be implanted until after 90 days following revascularization in patients with an EF<35% and an MI.  Studies have shown that no clinical benefit or detriment was derived by implantation prior to 90 days.  In the PREDICTS study, the results of which are reported in this publication, patients who had sustained an AMI and had an EF<35% around the time of the MI were evaluated for ICD implantation after the 90-day mark.  Of 231 enrolled patients, 84% of patients underwent PCI and 16% underwent medical management.  In the PCI cohort, 94/166 (57%) patients had an EF>35% at follow-up.

Although revascularization in this trial was accomplished by PCI, at least under these circumstances, more than half of patients who initially would have qualified for an ICD by EF criteria alone no longer qualified after 90 days.  

This retrospective study evaluated the relationship between the timing betweenLHC and CABG and its effect on renal function in a cohort of 2371 patients at a single center.  Findings included:

A shorter interval between LHC and CABG was independently associated with postop kidney injury in patients undergoing on-pump CABG, but not in those undergoing OPCAB.

Question:  Should the findings of this study influence whether you perform off-pump vs. on-pump CABG if CABG is performed within a week of LHC, independent of other considerations?

This French group retrospectively compared their experience with tricuspid valve replacements (n=188) using either tissue (82%) or mechanical (18%) valves during a >30-year period.  Findings from the study included:

• Almost half the cases were reoperative surgeries, and concomitant procedures were performed in 71%.
• Overall operative mortality was 28%, but decreased down to 10% in the most recent decade. 
• Freedom from structural valve deterioration trended higher for mechanical valves but did not reach statistical significance.
• Freedom from thromboembolic events and any valve-related adverse events were significantly higher for tissue valves.
• Eleven patients required repeat tricuspid valve replacements for structural valve disease at a mean interval of 16 years (range 4 to 33 years).  None of these valves were mechanical at the original implantation.