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Journal and News Scan

Source: Journal of Vascular Surgery
Author(s): Brandon McGuinness, Michael Troncone, Lyndon P. James, Steve Bisch, Vikram Iyer

Patients with aneurysms 7 cm or greater demonstrated a higher probability of survival when treated immediately, compared to delayed repair, for patients under 80 years of age.

An interesting attempt to construct a decision tool for aortic aneurysms.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Massimiliano M Marrocco-Trischitta, Hector W de Beaufort, Gabriele Piffaretti, Stefano Bonardelli, Mauro Gargiulo, Michele Antonello, Joost A van Herwaarden, Sara Boveri, Raffaello Bellosta, Santi Trimarchi on behalf of the MALAN Collaborators

This original article retrospectively analyzes the outcome of 359 patients after TEVAR at seven centers. All patients were stratified regarding the modified arch landing nomenclatur (MALAN). The rate of proximal endograft failure was significantly lower in patients with favorable landing area (MALAN 2/III and 3/III). Regarding these results, the MALAN classification can be used to guide decisions in pre-TEVAR planning.

Source: Journal of Cardiothoracic and Vascular Anesthesia
Author(s): Harish Ram, Sanjay Dwarakanath, Ashley E. Green, Johannes Steyn, and Eugene A. Hessel

This is a comprehensive review on iatrogenic aortic dissection occurring intraoperatively,and within one month after cardiac surgery, covering the incidence, discovery, pathology, detection modalities, management, risk factors, and prevention of this rare but life-threatening complication.

Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Author(s): Daniel M. Bethencourt, MD

In this article, Dr. Bethencourt outlines eight key strategies for successful robotic heart startups and how to initiate a new robotic program at one's institution. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Jennifer Chung, MD, MSC, Thais Coutinho, MD, Michael W.A. Chu, MD, MEd, Maral Ouzounian, MD, PhD

This succinct article reviews the contemporary literature regarding sex differences in thoracic aortic disease including the epidemiology, biology, natural history, surgical management and outcomes. Furthermore, the authors propose explanations for the observed differences and puts out a call to action to close the gender gap in sex differences in thoracic aortic disease. 

Source: The Annals of Thoracic Surgery
Author(s): Giuseppe Santarpino, MD, Paolo Berretta, MD, Utz Kappert, MD, PhD, Kevin Teoh, MD, Carmelo Mignosa, MD, Bart Meuris, MD, PhD, Emmanuel Villa, MD, PhD, Alberto Albertini, MD, Thierry P. Carrel, MD, PhD, Martin Misfeld, MD, PhD, Gianluca Martinelli, MD, Kevin Phan, MD, Antonio Miceli, MD, PhD, Thierry Folliguet, MD, PhD, Malak Shrestha, MD, Marco Solinas, MD, Martin Andreas, MD, PhD, Carlo Savini, MD, PhD, Tristan Yan, MD, PhD, Theodor Fischlein, MD, Marco Di Eusanio, MD, PhD

The present study reports on the multicenter cohort of patients from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry who underwent minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis. This study demonstrates the safety and feasiblitity of minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis. 

Source: The Annals of Thoracic Surgery
Author(s): Ronald D. Baxter, MD, James I. Fann, MD, J. Michael DiMaio, MD, Kevin Lobdell, MD

The present article is a digital health primer for cardiothoracic surgeons that reviews the role of data integration, processing, modelling, monitoring, and more on the future of cardiothoracic surgery.

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.