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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Michel Pompeu Sá, Xander Jacquemyn, Ahmed K. Awad, James A. Brown, Danny Chu, Derek Serna-Gallegos, Fabian A. Kari, Ibrahim Sultan

Valve sparing aortic root replacement has recently emerged as the preferred procedure, when feasible, for patients undergoing aortic root surgery. Two main options are available to achieve this: the Yacoub procedure (remodeling) and the David procedure (reimplantation). With these techniques differing considerably, the authors completed a meta-analysis of available outcome data to evaluate overall survival and need for reintervention.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Hsiung P-Y, Shih P-Y, Wu Y-L, Chen H-T, Hsu H-H, Lin M-W et al

Postoperative neurocognitive disorder after thoracoscopic surgery with general anesthesia may be linked to reduced intraoperative cerebral oxygenation and perioperative inflammation, both of which might be exacerbated by mechanical ventilation. This study randomized 110 patients into two groups, intubated and nonintubated, and measured cerebral oxygenation during surgery. Neuroinflammatory biomarkers were measured 24 hours before (as a baseline) and after surgery. Neurocognitive test scores were taken at baseline, 24 hours, and six months after surgery. Cerebral oxygenation during surgery was more stable in the nonintubated group. The nonintubated group had significantly higher neurocognitive test scores at 24 hours and six months. Inflammatory markers were higher in the intubated group. Further, the nonintubated patients had a significantly lower comprehensive complication Index. Nonintubated thoracoscopic surgery appears to offer significant benefits for the patient.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Traxler D, Krotka P, Reichardt B, Copic D, Veraar C, Mildner M et al

This population-based cohort study examined midterm outcomes of surgical aortic valve replacement with mechanical or bioprosthetic valves in patients less than 50 years old. A total of 991 patients were included. Multivariable Cox regression showed no significant difference in overall survival, with a median follow up period of 6.2 years. However, reoperation-free survival was significantly decreased and risk of reoperation was increased in those who received bioprosthetic valves. Although a difference in overall survival was not apparent in this study, the lower rate of reoperation with mechanical valves might have an impact on long-term survival.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Shiho Naito, Hermann Reichenspurner, Björn Sill

The impact of the surgeon’s experience on outcomes following off-pump coronary artery bypass grafting (OPCAB) is widely known. However, there is a lack of safe and effective strategies for OPCAB training. In this study, a total of 180 patients who underwent an off-pump isolated single coronary bypass of the left anterior descending artery (LAD) using the left internal mammary artery (LIMA) as an in-situ graft via median sternotomy were analyzed. Outcomes were compared in two groups: operations performed by residents in training under supervision (group 1: n = 63) and experienced surgeons (group 2: n = 117). Trainees were already experienced in on-pump coronary artery bypass grafting. There was no significant difference in the rate of major adverse cardiac and cerebrovascular events between the two groups. The authors conclude that a single off-pump LAD bypass might be a reasonable training strategy for OPCAB.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Li J, Wei X

A novel transapical beating-heart septal myectomy (TA-BSM) procedure was performed for patients with latent obstruction and outcomes were compared with those for patients with resting obstruction. The population was comprised of 120 patients with symptomatic hypertrophic obstructive cardiomyopathy, 33 with latent obstruction, and 87 with resting obstruction. There were no important differences in baseline characteristics, but those with latent obstruction had lower basal septal thickness, higher midventricular thickness, smaller left atria, and higher frequency of mitral subvalvular anomalies. After surgery, there was no significant difference in early deaths or midterm survival and the New York Heart Association class was significantly improved. This novel TA-BMS procedure achieved equivalent outcomes regardless of resting left ventricular outflow tract gradients.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Martin Czerny, Martin Grabenwöger, Tim Berger, Victor Aboyans, Alessandro Della Corte, Edward P Chen, Nimesh D Desai, Julia Dumfarth, John A Elefteriades, Christian D Etz, Karen M Kim, Maximilian Kreibich, Mario Lescan, Luca Di Marco, Andreas Martens, Carlos A Mestres, Milan Milojevic, Christoph A Nienaber, Gabriele Piffaretti, Ourania Preventza, Eduard Quintana, Bartosz Rylski, Christopher L Schlett, Florian Schoenhoff, Santi Trimarchi, Konstantinos Tsagakis, EACTS/STS Scientific Document Group

These guidelines, endorsed by the EACTS and STS, represent the organizations’ official viewpoints on aortic syndromes. This comprehensive document details all known aspects of the natural history, diagnosis, and treatment of both acute and chronic aortic pathologies. The guidelines address areas of interest to specialists in aortic diseases and clinicians involved in diagnosis, endovascular, open surgical, or hybrid treatment and surveillance. Furthermore, it provides a transparent basis for informed patients to comprehend the treatment offered by their specialists.

Source: European Heart Journal
Author(s): David Messika-Zeitoun, Bernard Iung, Helmut Baumgartner

This viewpoint article offers a quick overview of 10 articles selected by the authors as the best papers on valvular heart disease published in 2023. The selection was restricted to publications in The New England Journal of Medicine, the Journal of the American Medical Association, Lancet, European Heart Journal, Circulation, the Journal of the American College of Cardiology, and JAMA Cardiology. The 10 papers were chosen based on a consensus between the three authors, who rated quality, the potential impact on clinical practice and future research, and expected interest for the cardiovascular readership. Among others, some selected papers are the Trigistry registry, and the Triluminate, Notion (10 -year results), Partner 3 (five-year results), and PROACT Xa trials.

Source: tctMD
Author(s): Shelley Wood

Dr. Alan Cribier, well known for completing the first TAVI procedure in 2002, has passed away at the age of 79. The French surgeon successfully implanted the first percutaneous aortic valve in a patient who was declared inoperable, resulting in an innovative new procedure that started an important conversation in the CT surgery community. The full article includes tributes from Dr. Cribier’s colleagues. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): François Lacour-Gayet, Joy Zoghbi, Marielle Gouton, Régine Roussin, Olivier Bical, Vincent Lucet, Marion Saint-Pick, Francine Leca

This retrospective multicenter study examined late surgical outcomes for children from low and middle income countries with double outlet right ventricle (DORV). DORV was defined as both great arteries arising entirely or mostly from the right ventricle. A total of 81 consecutive DORV repairs were performed between 1996 and 2022. Six subtypes of DORV were divided into two overall groups: (i) DORV-committed ventricular septal defect (VSD) and (ii) DORV-noncommitted (nc) VSD. Four Fontan patients were excluded, and three patients were lost to follow up. Overall perioperative mortality was 7.4 percent. Overall, 1--year survival was 86 percent. Early mortality was similar in both groups. There was a trend toward satisfactory outcome of biventricular repair for simple DORV with committed VSD compared with complex DORV with ncVSD.

Source: European Journal of Cardiothoracic Surgery
Author(s): Alessandro Brunelli, Herbert Decaluwe, Michel Gonzalez, Dominique Gossot, Rene Horsleben Petersen, Collaborators

This study surveyed 123 thoracic surgeons and posed several questions asking which surgical resection they would prefer if they themselves were diagnosed with several variations of lung cancer size and location. Interestingly, despite two recently published randomized control trials showing the similarities of lobar resections to sublobar resections, for early-stage lung cancer tumors, 19 to 55 percent of surgeons still preferred lobectomy compared to segmentectomy for a variety of reasons including technical expertise as well as oncological concerns. Perhaps this trend may continue to change with time as further research is conducted in this domain.