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Journal and News Scan
Intermittent lower body perfusion during repair of acute DeBakey type I aortic dissection in moderate hypothermic circulatory arrest (MHCA) seems to be protective against renal failure and increase of liver enzymes compared to MHCA only in a study on 107 patients.
Effect of statin drugs on thoracic aortic aneurysms The American Journal of Cardiology, 10/09/2013 Clinical Article Stein LH et al. - Pharmacologic interventions for thoracic aneurysms remain poorly characterized. The results of a pilot study by the group suggested improved outcomes among patients with thoracic aortic aneurysm who were taking statins. These findings provide a medicinal option for the arsenal of treatment options for patients with aneurysms of the thoracic aorta. Methods The authors undertook a comprehensive analysis of a larger cohort of patients from the Database of the Aortic Institute at Yale-New Haven Hospital. A total of 1,560 patients met the inclusion criteria. The adverse events (i.e., death, dissection, or rupture) and surgery rates for patients with (n = 369, 24%) and without (n = 1,191, 76%) statin therapy were compared. They evaluated 3 anatomic components of the aorta: root, ascending and arch, and descending and thoracoabdominal aortic aneurysms. Results A smaller proportion of the statin group had adverse events: overall, 7% versus 15%; ascending and arch, 6% versus 15%; and descending and thoracoabdominal aortic aneurysms, 8% versus 20%. Also, a smaller proportion of statin patients required surgery: overall, 48% versus 60%; ascending and arch, 51% versus 62%; and descending and thoracoabdominal aortic aneurysms, 36% versus 59% (p <0.001 to 0.01). The protective effect of statins was seen in all segments, except the aortic root. Log-rank evaluation of the interval to an adverse event or surgery was longer among statin-treated patients (p <0.001). The protective effect of statins was seen in all segments, except the aortic root. Log-rank evaluation of the interval to an adverse event or surgery was longer among statin-treated patients (p <0.001). Logistic regression analysis found statin use, angiotensin receptor blocker use, and chronic obstructive pulmonary disease were associated with decreased adverse events, and statin use, angiotensin receptor blocker use, (beta)-blocker therapy, and age were associated with a decreased odds of requiring surgery. Multiple logistic regression analysis found only statins were associated with a decreased odds of an adverse event and that statins, coronary artery disease, and chronic obstructive pulmonary disease were associated with a decreased odds of undergoing surgery.
The efficacy of high dose and low dose Edoxaban, an oral factor Xa inhibitor, was compared to Warfarin in patients with high risk a-fib. The efficacy endpoint was stroke or systemic embolus, the safety endpoint was bleeding. Edoxaban was non-inferior to Warfarin for both doses in terms of efficacy, and was associated with reduced risks of bleeding and cardiovascular death.
The incidence of device thrombosis in HeartMate II VAD devices in 3 centers was investigated. 895 devices were implanted 2004-present. The incidence of device thrombosis increased from 2.2% in the earlier period to 8.4% in the past 2 years. During the same interval the time to thrombosis decreased from 18.6 mos to 2.7 mos. Elevated LDH levels presaged thrombosis. In patients who did not undergo device replacement or transplant after thrombosis, the mortality at 6 mos was 48%.
Short article describing the autopsy findings in the first patient to have a transcatheter valve implantation in the inferior vena cava for tricuspid insufficiency. Three months following implantation, the prosthesis remained in place and with normal appearances. Some interesting autopsy pictures can be found in the manuscript.
Systematic review article comparing surgical versus percutaneous revascularization for ischaemic heart disease in patients with unprotected left main disease (ULMD), diabetes, multivessel CAD or left ventricular dysfunction. The authors reinforce the idea that patients suffering with diabetes appear to do better with surgery. In patients with ULMD, multivessel disease, or left ventricular dysfunction, the type of therapy should be determined by the complexity of the lesions. Patients with SYNTAX score above 22 are better served with coronary artery bypass graft surgery, whereas in patients with a SYTAX score equal or below 22, percutaneous revascularization should be the first choice.
This paper reports on the 1-year follow up of the Timing In Myocardial Infarction Evaluation (TIME) trial, in which patients with moderate to large anterior ST elevation myocardial infarction received treatment with intracoronary delivery of 150 million autologous bone marrow mononuclear cells 3 or 7 days following the event. At 1-year, there continued to be no evidence of improvement in the primary end-points of LVEF and regional (infarct and border zone) LV function in the treatment groups compared with the control group, irrespective of cell delivery at 3 or 7 days.
The goal of this study was to assess the postoperative safety of ketorolac, an intravenously administered nonsteroidal anti–inflammatory drugs (NSAIDs), after cardiac surgery. Ketorolac appears to be well–tolerated for use when administered selectively after cardiac surgery. Although a black box warning exists, the data highlights the need for further research regarding its perioperative administration. Methods A total of 1,309 cardiac surgical patients (78.1% coronary bypass, 28.0% valve) treated between 2006 and 2012. A total of 488 of these patients received ketorolac for postoperative analgesia within 72hours of surgery. Results Ketorolac–treated patients were younger, had better preoperative renal function, and underwent less complex operations compared with non–ketorolac patients. Ketorolac was administered, on average, 8.7hours after surgery (mean doses: 3.1). Postoperative outcomes for ketorolac–treated patients were similar to those expected using Society of Thoracic Surgery database risk–adjusted outcomes. In unadjusted analysis, patients who received ketorolac had similar or better postoperative outcomes compared with patients who did not receive ketorolac, including gastrointestinal bleeding (1.2% v 1.3%; p=1.0), renal failure requiring dialysis (0.4% v 3.0%; p=0.001), perioperative myocardial infarction (1.0% v 0.6%; p=0.51), stroke or transient ischemic attack (1.0% v 1.7%; p=0.47), and death (0.4% v 5.8%; p<0.0001). With adjustment in a multivariate model, treatment with ketorolac was not a predictor for adverse outcome in this cohort (odds ratio: 0.72; p=0.23).
The authors present an analysis of outcome of heart transplantations performed with donors who experienced cardiac arrest during the assessment, comparing them to transplantation with standard donors. No differences were reported in short and long term survivals.
This is an EACTS video debate session held at EACTS 2013 in Vienna.
Drs Maisano, Dr Robert Klautz, Dr Rafaele Rosenhek and Dr Yolanda Kluin
They discuss a range of aspects of minimal access Mitral surgery