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Journal and News Scan
January 24, 2015
Submitted by: Arie Blitz
This systematic review and meta-analysis explores the literature to determine the relative advantages and disadvantages of using bilateral IMAs over single IMAs on outcomes after CABG in diabetic patients. In their analysis, the group found that patients who underwent bilateral IMA grafting using skeletonized IMAs had no greater incidence of sternal wound infection than those undergoing unilateral IMA harvesting; however, if the mammaries were harvested on a pedicle, an increased incidence of sternal wound infection was noted in the bilateral harvest group. In addition, the meta-analysis demonstrated better long-term survival in the bilateral IMA group, regardless of harvesting method, over the unilateral IMA group. Is it time to reconsider bilateral IMA usage in diabetics? If bilateral IMAs are indeed used, should they be harvested only in skeletonized fashion?
January 24, 2015
Submitted by: Arie Blitz
The Columbia group performed a retrospective analysis of 46 balloon atrial septostomies in 32 patients with severe and medically refractory PAH from 2002-2013. There were no procedural deaths or complications. BAS was safely used as a bridge to lung transplantation or to alleviate right heart failure symptoms and/or syncope.
January 21, 2015
Submitted by: Joseph Basha
In this comprehensive article the author describes the potential harmful effects of peri-operative allogeneic transfusions during cardaic surgery employing the CPB circuit. The author also describes potenital risks of low hematocrits during CPB as would be seen when employing Acute Normovolemic Hemodilution technique for blood conservation. Patient conditions that may provide an early warning of "at risk" patients are outlined. Some insights on potential ways of mitigating the complication of renal failure post cardiac surgery are offered, however, the article left me with a few unanswered questions. Would the use of continuous ultrafiltration during the CPB phase help to remove the neprotoxic PFH? Shoud use of CVVH post operativly in "at risk" patients be a routine standard? Would it help? Should any banked RBC transfusion be first washed in an autotransfusion system before infusion and would this be of potential benefit?
January 20, 2015
Submitted by: Ruben Osnabrugge
The investigators of this project aimed to validate the SYNTAX Score II. This is a risk prediction tool that combines clinical characteristics and the original anatomical SYNTAX score in order to make 4 year mortality predictions with PCI or CABG in patients with unprotected left main disease (ULMCA) and an original SYNTAX score <33). They found that the SYNTAX Score II predicts an equipoise for long-term mortality between CABG and PCI in these patients.
January 18, 2015
Submitted by: J. Rafael Sadaba
This a retrospective study of 175 patients who had survived more than 12 months following TAVI and for whom there were clinical and echocardiographic follow up data. Outcomes were compared between patients with significant (grade II or more) aortic regurgitation (AR) and those without significant aortic regurgitation (less than grade II). Paravalvular, but not intravalvular, AR appeared to improve over time, mainly in the first 6 months. Patients who remained with significant AR grade at 6 month follow-up showed significantly worse survival than patients with less than grade II AR.
January 18, 2015
Submitted by: J. Rafael Sadaba
This is an interesting review of the current status of hybrid coronary revascularization (HCR). The authors discuss the merits and disadvantages of simultaneous versus staged procedures and describe the individual components of HCR. They also analyze the current evidence with regards to results and suggest indications for this type of therapy.
January 18, 2015
Submitted by: Tom C. Nguyen
Anemic off-pump CABG (n=361) versus on-pump CABG (n=578) patients were compared. In anemic patients, off-pump CABG was associated with lower early morbitidy and mortality. 1 to 6 month follow-up mortality, however, was higher in the off-pump CABG cohort.
January 17, 2015
Submitted by: Arie Blitz
The authors perform a meta-analysis of the limited studies available on the utility of tricuspid valve surgery in patients with significant TR at the time of LVAD implantation. No RCTs are available on this issue; however, six observational studies were analyzed by the group. The analysis reveals that, although the addition of TV surgery clearly increases the cardiopulmonary bypass time, no conclusions are warranted regarding the efficacy or safety of TV surgery in these patients. The jury remains out on this controversial issue.
January 17, 2015
Submitted by: Joel Dunning
Guidelines advocate changes in fatty acid consumption to promote cardiovascular health.
This papers summarizes evidence about associations between fatty acids and coronary disease.
They conclude that Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.
January 16, 2015
Submitted by: Joel Dunning
Transcatheter aortic valve implantation has also evolved as a suitable treatment option for degenerative surgical heart valve disease, with considerable experience in the aortic and mitral positions. Success of a valve-in-valve (VIV) procedure depends on four main concepts. These include the following:
- Understanding transcatheter heart valve design.
- A detailed understanding of the design or anatomy, in particular fluoroscopic appearances of the failing SHV.
- Correct sizing of the chosen transcatheter heart valve prosthesis for the existing SHV.
- The ideal implantation position for the transcatheter heart valve.
The aim of this article is to emphasize the impact of the anatomy and design features of surgical heart valve disease (SHV) to provide an understanding of VIV procedures and ensure their success, with focus on VIV in the failing aortic SHV.