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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Anita Nguyen, MBBS MS; Hartzell V. Schaff, MD; Arman Arghami, MD; Gabor Bagameri, MD; M. Sertac Cicek, MD; Juan A. Crestanello, MD; Richard C. Daly, MD; Kevin L. Greason, MD; Alberto Pochettino, MD; Phillip G. Rowse, MD; John M. Stulak, MD; Brian D. Lahr, MS; Joseph A. Dearani, MD

The authors created 612 matched pairs of patients with a history of hematologic malignancy and controls. They compared operative details, early postoperative complications, and late survival.

Patients with prior diagnosis of malignancy had lower hemoglobin levels and were at greater risk of receiving postoperative blood transfusions (47.4% vs. 35.6%, P<0.0001).
Reoperations for postoperative bleeding (4.7% vs. 3.3%, P=0.253) and stroke (1.3% vs. 1.3%, P>0.999) were similar. Thirty-day mortality in patients with hematologic malignancy was 3.3%, and 1.5% in matched controls (P=0.061).
Overall survival among patients with cancer was reduced (P<.0001).

The authors concluded that while late survival is reduced in patients with hematologic malignancies, early outcomes are generally similar to matched controls. As such, these patients should be offered surgery. 

Source: The Annals of Thoracic Surgery
Author(s): Fausto Biancari., MD, PhD; Antti Valtola, MD; Tatu Juvonen, MD, PhD; Annastiina Husso, MD, PhD; Sebastian Dahlbacka, MD, PhD; Teemu Laakso, MD; Maina P. Jalava, MD; Tuomas Tauriainen, MD, PhD; Tuomas Ahvenvaara, MD; Eeva-Maija Kinnunen, MD, PhD; Matti Niemelä, MD, PhD; Timo Mäkikallio, MD, PhD; Markku Eskola, MD, PhD; Marko P.O. Virtanen, MD; Pasi Maaranen, MD; Stefano Rosato, MSc; Vesa Anttila, MD, PhD; Antti Vento, MD, PhD; Juhani Airaksinen, MD, PhD; Peter Raivio, MD, PhD

The authors comducted a comparative analysis of the Trifecta and Perimount Magna Ease bioprosthetic valves, using data from a national Finnish database between 2008 and 2017.

They included 2216 patients, with a mean follow-up 3.8±2.1 years. 851 patients received the Trifecta valve and 1365 received the Perimount Magna Ease bioprosthesis. The rates of late mortality and prosthetic valve endocarditis were comparable in the study cohorts. At 7-year, the Trifecta cohort had significantly higher risk of repeat aortic valve replacement for structural valve failure (3.3% vs. 0%), repeat aortic valve replacement for any cause (3.6% vs. 0.4%) and repeat aortic valve replacement and/or prosthetic valve endocarditis (4.1% vs. 0.9%) compared to the Perimount Magna Ease cohort.
Among 772 propensity score matched pairs, at 7-year, the Trifecta cohort had a higher risk of repeat aortic valve replacement for structural valve failure (5.7% vs. 0%).

The authors report that the Trifecta aortic bioprosthesis is associated with a higher occurrence of repeat aortic valve replacement for structural valve failure compared to the Perimount Magna Ease bioprosthesis.

Source: Circulation Research
Author(s): Laura A Bienvenu, Ana Maluenda, James D McFadyen, Amy Kate Searle, Eefang Yu, Carolyn Haller, Elliot L Chaikof, Karlheinz Peter, Xiaowei Wang

A review that may affect pharma strategy in the immediate future.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Niv Ad, Jessica G Y Luc, Tom C Nguyen, COVID-19 North American Cardiac Surgery Survey Working Group

The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.

Source: The Annals of Thoracic Surgery
Author(s): Takashi Miura, Kikuko Obase, Tsuneo Ariyoshi, Ichiro Matsumaru, Shogo Yokose, Shun Nakaji, Yuichi Tasaki, MD, Takashi Shimada, Junya Miyamoto, Kiyoyuki Eishi

This single-institution study of 83 patients investigated mitral valve repair for infective endocarditis based on the location of the lesion. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Josephina Haunschild, Konstantin von Aspern, Zara Khachatryan, Edoardo Bianchi, Till Friedheim, Sabine Wipper, Constantin J Trepte, Susann Ossmann, Michael A Borger, Christian D Etz

Haunschild et al. investigated the effect of cerebrospinal fluid pressure elevation on spinal cord perfusion in a large animal model. They could measure spinal cord perfusion by NIRS and microsphere injections. The spinal perfusion was significantly diminished during elevated cerebrospinal fluid pressure. Furthermore, rapid withdrawal of cerebrospinal fluid was associated with hyperperfusion, which might lead to aggravated ischemia-reperfusion injury and should therefore be avoided.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Tirone E. David, MD; Carolyn M. David, BN; Myriam Lafreniere-Roula, PhD; Cedric Manlhiot, PhD

David et al. examined the durability of mitral repair using using chordal replacement with expanded polytetrafluoroethylene sutures to correct leaflet prolapse.They evaluated 186 patients who underwent isolated chordal replacement, and 560 patients who underwent both leaflet resection and choral replacement.

The authors demonstrated that re-do cardiac surgery and isolated anterior leaflet prolapse resulted in an increased hazard of mitral valve reoperation. The probability of recurrent moderate or severe mitral regurgitation using repeated measures regression models was 14.1% at 20 years. Variables associated with recurrent MR in multivariable regression analysis were left ventricular ejection <40% and preoperative complete heart block. 
David et al. note that chordal replacement with expanded polytetrafluoroethylene sutures provides stable mitral valve function in most patients during the 20 years of follow-up.


Source: European Journal of Cardio-Thoracic Surgery
Author(s): Bettina Pfannmueller, Martin Misfeld, Alexander Verevkin, Jens Garbade, David M Holzhey, Piroze Davierwala, Joerg Seeburger, Thilo Noack, Michael A Borger

The study compared long-term results of loop neochord replacement with leaflet resection techniques in 2134 patients undergoing minimally invasive mitral valve repair.
They demonstrated a significant reduction in early mitral regurgitation with the loop technique (on echocardiographyl; p=0.003) when compared with leaflet resection. Additionally, the long-term outcomes were excellent compared with classical leaflet resection techniques (the 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003).

Source: The Annals of Thoracic Surgery
Author(s): George Kuo, Shao-Wei Chen, Cheng-Chia Lee, Jia-Jin Chen, Pei-Chun Fan, Shang-Yu Wang, Ya-Chung Tian, Chih-Hsiang Chang

This study investigated fluit overload in cardiac and aortic surgery patients.

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Anne L M Goedhart, Bastiaan M Gerritse, Thijs C D Rettig, Martijn W A van Geldorp, Sander Bramer, Nardo J M van der Meer, Leandra J Boonman-de Winter, Thierry V Scohy

Goedhart et al. investigated the effect of different heparin/protamine ratios on the amount of blood transfusions following standard cardiac surgery. In the group of patients receiving 0.6/1 protamine/heparin ratio, the fraction of patients without the need of transfusion was higher and the total blood loss was lower compared to patients treated with a 0.8/1 protamine/heparin ratio. In their patient collective, the 0.6/1 protamine/ heparin ratio proved safe and superior.