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Journal and News Scan

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.

Source: Journal of the American College of Cardiology
Author(s): Kevin R. An, Charlesde Mestral, Derrick Y. Tam, Feng Qiu, Maral Ouzounian, Thomas F. Lindsay, Harindra C. Wijeysundera, and Jennifer C.-Y. Chung

In this large series, Dr. Chung and associates performed a study on  completeness of guideline-directed imaging surveillance (GDIS) and its association with long-term outcomes.  In 888 patients with acute type A dissection who survived surgical repair, 14% received GDIS throughout a median follow-up of 5.2 years, and GDIS was available in 3.4% at 6 years.  Intriguingly, greater adherence to GDIS was associated with mortality (hazard ratio: 1.08; 95% confidence interval: 1.05-1.11) and reintervention (hazard ratio: 1.04; 95% confidence interval: 1.01-1.07).  

Source: The Annals of Thoracic Surgery
Author(s): Thilo P.K. Fleck, MD, Rafael Ayala, MD, Johannes Kroll, MD, Matthias Siepe, MD, David Schibilsky, MD, Christoph Benk, PhD, Sven Maier, MSc, Katja Reineker, MD, René Hoehn, MD, Frank Humburger, MD, Friedhelm Beyersdorf, MD, Brigitte Stiller, MD

Pediatric heart transplant (HTx) recipients with congenital heart defects need complex concomitant surgical procedures with the risk of prolonging the allograft’s ischemic time. Ex vivo allograft perfusion with the Organ Care System (OCS; Transmedics, Andover, MA) may improve survival of these challenging patients.

Source: The Annals of Thoracic Surgery
Author(s): Megan T. Quintana, MD, Michael Mazzeffi, MD, MPH, Samuel M. Galvagno, DO, PhD, Danny Herrera, BS, Gregory P. Boyajian, BS, Nicole M. Hays, BS, David Kaczorowski, MD, Ronson J. Madathil, MD, Raymond P. Rector, CCP, LP, Ali Tabatabai, MD, Daniel Herr, MD, Joseph Rabin, MD

Healthcare-associated infections (HAIs) in critically ill patients are a public health issue. Extracorporeal membrane oxygenation (ECMO) has been increasingly used for patients with severe cardiac or respiratory failure, but it may increase HAI risk. This study's goal was to characterize HAIs in ECMO patients at an ECMO referral center.



Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Peter P. Roeleveld, MD, PhD, Nicolaas A. Blom, MD, PhD, Mark G. Hazekamp, MD, PhD

This is a commentary on the article, "Residual Lesions and ECMO: Seek and You Shall Find Ways to Narrow the ECMO Gap"