Journal and News Scan

Bicuspid aortic valve (BAV) stenosis has been regarded as a relative contraindication for transcatheter aortic valve implantation (TAVI). In this retrospective study of patients from 5 different centres undergoing TAVI for severe aortic stenosis, the authors compare outcomes between a group of 28 patients with BAV and a 1:3 matched group of 84 patients with tricuspid aortic valves (TAV). Uneven expansion of the bioprosthesis was commonly observed in the BAV group. However, this did not influence the overall procedural outcomes. There were no significant differences in 30-day mortality, one-year all-cause mortality, 30-day combined safety end points, and more than mild aortic regurgitation between the two groups. Based on this data, the authors suggest that selected patients with stenotic BAV, can be successfully treated with TAVI.

 – This study aimed to perform a risk–adjusted comparison of mortality, rate of stroke and perioperative morbidity of aortic valve replacement (AVR) conducted through either partial ministernotomy or conventional sternotomy. This study suggests that, AVR can be safely conducted through a partial ministernotomy. This approach is not associated with an increased rate of complications. However, wide CIs reflect the still prevailing statistical uncertainty in estimates, not excluding patient–relevant differences between approaches.

Methods

• Between July 2009 and July 2012, data from 984 consecutive patients undergoing isolated AVR were prospectively recorded.
• In 44.3% (n = 436), the less invasive partial ministernotomy was used.
• Propensity score matching was performed based on 15 preoperative risk factors to correct for selection bias.
• In–hospital mortality, stroke rate as well as other major complications in the minimally invasive group and conventional sternotomy group were compared in 404 matched patient pairs (total 808).

Results

• In–hospital mortality and rate of postoperative intra–aortic balloon pump use were identical for propensity–matched patients, 1.0% (4 in each group).
• The rate of stroke [OR (95% confidence interval (CI)): 0.80 (0.22–2.98)], perioperative myocardial infarction [OR (95% CI): 2.00 (0.18–22.06)], low–output syndrome [OR (95% CI): 0.90 (0.37–2.22)], new onset of dialysis [OR (95% CI): 1.25 (0.49–3.17)] and re–exploration for bleeding [OR (95% CI): 0.88 (0.50–1.56)] were similar.
• Likewise, resource utilization (operation time, duration of stay in the intensive care unit and in–hospital stay) and valve selection (type and size) was not affected by the surgical approach either.

The outcomes of repair of acute type A dissection using aortic valve resuspension and sinus of Valsalva reinforcement were tracked in 489 pts operated 1993-2013.  Hospital mortality was 11%.  5-year survival was 69%, and freedom from proximal reoperation was 96% at 5 years.

Optimal management of superior sulcus tumors remains challenging.  This SWOG protocol was a feasibility study of the utility of consolidation therapy with docetaxel in addition to cisplatin-etoposide, 45Gy, and possible resection.   Of 46 registered pts, 86% completed induction therapy, 66% underwent resection, and 45% completed consolidation therapy.  The R0 resection rate in surgical pts was 97%, and the complete or near-complete pathologic response rate in resected patients was 72%.  Overall 3-year survival was 61%.