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Journal and News Scan
A retrospective study characterizing "severe intraprocedural complications" during TAVR "requiring immediate surgical or interventional bailout manoeuvres." Analysis of 458 consecutive TAVR patients through transfemoral and transapical approaches. Complications requiring intraoperative bailout manoeuvres were analysed according to the Valve Academic Research Consortium (VARC) criteria. 40 major intraprocedural complications occurred in 35 patients (7.6%), including conversion to surgery for valve embolization/migration (17%), severe aortic regurgitation (12%) and root rupture (5%); need for surgical haemostasis secondary to left ventricular wire perforation and subsequent cardiac tamponade; and percutaneous coronary intervention in 6 patients. All-cause mortality at 30 days was 31.4% in patients with intraprocedural complications and 38.5% in patients requiring surgical conversion. The authors conclude that an interdisciplinary heart-term approach creates "a surgical and interventional safety net" that facilitated bailout strategies in the setting of severe intraprocedural complications.
Single center experience with minimally invasive (right minithoracotomy) fibrillating approach to mitral valve surgery (MVS) and/or atrial fibrillation ablation. Experience (01/2007 - 08/2012) included 292 consecutive patients who underwent MVS (n = 177), surgical ablation (n = 81), or both (n= 34). MV repair rate was 93.4% with 1 operative mortality (0.3%) and no conversions to sternotomy. Other complications included 1 stroke, 1 transient ischemic attack, and 4 reoperations. Survival at 1 and 2-years was 98.5% and 97.8%, respectively. The authors reported results at mean follow-up of 27.3 months compared favorably with data reported by Society of Thoracic Surgeons (STS) in 2011.
240 patients with acute pericarditis randomized to either colchine or placebo in addition to standard NSAIDs. The colchine group had reduced rate of incessant or recurrent pericarditis.
Outcomes for over 12,800 pts operated for lung cancer in England 2004-2008 were analyzed. High volume hospitals operated on patients with more risk factors (advanced age, lower socioeconomic status, more comorbidities), yet achieved better survival, especially in the early postoperative period.
This randomized trial of dabigatran vs warfarin for anticoagulation in patients immediately after or more than 3 mos after MVR or AVR with a mechanical valve was stopped early after enrollment of 252 pts. There were both excess bleeding events and excess thromboembolic events in the dabigatran group, indicating no benefit and increased risk of dabigatran compared to warfarin.
465 pts with acute STEMI who were undergoing urgent PCI were randomized to additional prophylactic PCI of any vessels with significant stenosis or PCI of the target vessel only. The composite outcome was cardiac death + MI + refractory angina. The trial was stopped early because of a incidence of composite outcome of 21 (9 per 100 pts) in the prophylactic PCI group vs 53 (23 per 100 pts) in the control group (HR of 0.35; p<0.001). Similar benefits were seen for each component of the composite outcome.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and its prevalence is ∼1–2% of the general population, but higher with increasing age and in patients with concomitant heart disease. The Cox-maze III procedure was a groundbreaking development and remains the surgical intervention with the highest cure rate, but due to its technical difficulty alternative techniques have been developed to create the lesions sets. The field is fast moving and there are now multiple energy sources, multiple potential lesion sets and even multiple guidelines addressing the issues surrounding the surgical treatment of AF both for patients undergoing this concomitantly with other cardiac surgical procedures and also as stand-alone procedures either via sternotomy or via videothoracoscopic techniques. The aim of this document is to bring together all major guidelines in this area into one resource for clinicians interested in surgery for AF. Where we felt that guidance was lacking, we also reviewed the evidence and provided summaries in those areas. We conclude that AF surgery is an effective intervention for patients with all types of AF undergoing concomitant cardiac surgery to reduce the incidence of AF, as demonstrated in multiple randomized studies. There is some evidence that this translates into reduced stroke risk, reduced heart failure risk and longer survival. In addition, symptomatic patients with AF may be considered for surgery after failed catheter intervention or even as an alternative to catheter intervention where either catheter ablation is contraindicated or by patient choice.
Seventy-five patients with acute type A aortic dissection with coronary artery dissection were analyzed. Preoperative cardiopulmonary arrest and myocardial ischemia were associated with poor survival outcome whereas early revascularization resulted in a lower frequency of low cardiac output syndrome.
Forty-six patients with acute type A aortic dissection underwent valve-sparing root repair with replacement of all pathological sinuses of Valsalva. The actuarial survival rate at 8 years was 85.5 ± 5.6% with no valve-related events and no reoperation on the proximal aorta/aortic valve during the follow-up
About 3% of 458 TAVI patients required emergent conversion to open surgery with a 30-day mortality of 38.5% in a monocenter analysis. The importance of a interdisciplinary surgical and interventional safety net is emphasized.