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Journal and News Scan

Source: New England Journal of Medicine
Author(s): David H. Adams, M.D., Jeffrey J. Popma, M.D., Michael J. Reardon, M.D., Steven J. Yakubov, M.D., Joseph S. Coselli, M.D., G. Michael Deeb, M.D., Thomas G. Gleason, M.D., Maurice Buchbinder, M.D., James Hermiller, Jr., M.D., Neal S. Kleiman, M.D., Stan Chetcuti, M.D., John Heiser, M.D., William Merhi, D.O., George Zorn, M.D., Peter Tadros, M.D., Newell Robinson, M.D., George Petrossian, M.D., G. Chad Hughes, M.D., J. Kevin Harrison, M.D., John Conte, M.D., Brijeshwar Maini, M.D., Mubashir Mumtaz, M.D., Sharla Chenoweth, M.S., and Jae K. Oh, M.D. for the U.S. CoreValve Clinical Investigators

Authors compared transcatheter aortic–valve replacement (TAVR), using a self–expanding transcatheter aortic–valve bioprosthesis, with surgical aortic–valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self–expanding transcatheter aortic–valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic–valve replacement.


  • Authors recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center.
  • Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors.
  • Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self–expanding transcatheter valve (TAVR group) or to surgical aortic–valve replacement (surgical group).
  • The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing.



  • A total of 795 patients underwent randomization at 45 centers in the United States.
  • In the as–treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority).
  • The results were similar in the intention–to–treat analysis.
  • In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life.
  • Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke.
Source: European Heart Journal
Author(s): Stefanini GG, Stortecky S, Cao D, Rat-Wirtzler J, O'Sullivan CJ, Gloekler S, Buellesfeld L, Khattab AA, Nietlispach F, Pilgrim T, Huber C, Carrel T, Meier B, Jüni P, Wenaweser P, Windecker S.

In this study the authors looked at the impact of coronary artery disease (CAD) in a single series of 445 patients undergoing TAVI for aortic valve stenosis.  The pre-established primary endpoint of the study was a composite of cardiovascular death, stroke, or myocardial infarction (MI)—at 1 year. Patients were divided into three groups according to the severity of CAD as determined by the SYNTAX score (SS): no CAD, CAD with SS ≤ 22 and CAD with SS >22. At 1-year, increased CAD severity was associated with higher rates of the primary endpoint. This was mainly driven by a difference in cardiovascular death. The risk of stroke and MI was similar in all three groups.

Source: The Carnegie Mellon Robotics Institute
Author(s): Howie Choset

The Flex System is a flexible endoscopic system that enables surgeons to access and visualize hard-to-reach anatomical locations. The system thus promises to extend the benefits of minimally invasive surgery – shorter hospital stays and recovery times – to a broader population of patients. The company initially has targeted the system for use in head and neck surgery, operating through the mouth.

Source: Itunes
Author(s): Doctor's Guide Publishing Limited

This is a free app that collates thousands of new stories and abstracts from peer reviewed journal and news organisations. It also has a forum area and has cardiology and surgery sections. 

Nothing to do with CTSNet, but it is free so might be worth a look 

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Nguyenvu Nguyen, Jeffrey P. Jacobs, Joseph A. Dearani, Samuel Weinstein, William M. Novick, Marshall L. Jacobs, Jeremy Massey, Sara K. Pasquali, Henry L. Walters III, David Drullinsky, Giovanni Stellin, and Christo I. Tchervenkov

This is an interesting article on the provision of pediatric cardiac surgery in the developing world. 

Source: UWTV on youtube
Author(s): Larry Dean , Gabriel Aldea

Dr. Gabriel Aldea outlines the latest in surgical techniques to repair the irregular rhythms, rapid heart beats, blood clots and ineffective heart muscle contractions associated with atrial fibrillation. He also discusses the restoration of normal cardiac function using catheters, pacemakers and gives insight on the surgical MAZE technique and innovations in ultrasound, laser and cryothermal tools.

Source: The Annals of Thoracic Surgery
Author(s): Richard A. Hopkins, Gary K. Lofland, Jennifer Marshall, Diana Connelly,Gayathri Acharya, Pamela Dennis, Richard Stroup, Chris McFall, James E. O'Brien

In this observational study, the utility of decellularized allogeneic pulmonary artery patches for pulmonary arterioplasty was evaluated in 108 patients. No device failures or adverse events were detected. An historical comparison cohort in whom conventional materials were used experienced a 14% failure rate.

Source: Annals of Thoracic Surgery
Author(s): Fabian A. Kari, Friedhelm Beyersdorf, Elizabeth H. Stephens, Prisca Peter, Bartosz Rylski, Maximilian Russe, Philipp Blanke, Matthias Siepe
This report summarizes outcomes in 40 reoperated patients (mean age 33 years) of an original 122 who underwent initial aortic root surgery for Marfans. Reoperations took place a mean of nearly 10 years later. 5 and 10 year survivals after second operations were 80% and 66%. Open and stent grafts procedures did not appear to have different outcomes. Acute dissection at the time of first operation was the only strong predictor of mortality.
Source: Annals of Thoracic Surgery
Author(s): Terry Shih, Justin B. Dimick
Quality metrics based on administrative databases are sometimes unreliable. This study examined data from nearly 245,000 Medicare patients undergoing CABG to determine the reliability of 30-day readmission rates and whether that metric is an appropriate indicator of hospital quality. The median readmission rate was 17.6%, but less than half lf the rate was attributed to the true signal, the rest being measurement noise. Less than 5% of hospitals had sufficient CABG volume to achieve reliable measurement of readmission rates.
Source: JAMA
Author(s): JM Rohde, DE Dimcheff, N Blumberg, S Saint, KM Langa, L Kuhn, A Hickner, MAM Rogers.

This meta-analysis of 18 randomized trials investigated the risk of infection related to blood transfusions given according to liberal or restrictive criteria. The restrictive strategy (Hgb <7) was associated with an 18% reduction in the risk of serious infection (11.8% vs 16.9%). The effects were most pronounced in patients with sepsis and in those undergoing orthopedic surgery. No difference was evident among patients with heart disease, critical illness, or GI bleeding.