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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Jose López-Menéndez, Javier Miguelena, Carlos Morales, Carmen L. Díaz, Francisco Callejo, Juan Carlos Llosa, Jacobo Silva
This retrospective study compared Celsior (65% of pts) to all-blood continuous myocardial protection (35%) in 631 patients undergoing elective aortic valve replacement.  Troponin T release was lower in Celsior patients, as was the risk of postoperative death (OR 0.33; 0.15 - 0.76).  Other outcomes were similar between the groups.
Source: NEJM
Author(s): André Lamy, M.D., P.J. Devereaux, M.D., Ph.D., Dorairaj Prabhakaran, M.D., David P. Taggart, Ph.D., Shengshou Hu, M.D., Zbynek Straka, M.D., Leopoldo S. Piegas, M.D., Alvaro Avezum, M.D., Ahmet R. Akar, M.D., Fernando Lanas Zanetti, M.D., Anil R. Jain, M.D., Nicolas Noiseux, M.D., Chandrasekar Padmanabhan, M.D., Juan-Carlos Bahamondes, M.D., Richard J. Novick, M.D., Liang Tao, M.D., Pablo A. Olavegogeascoechea, M.D., Balram Airan, M.D., Toomas-Andres Sulling, M.D., Richard P. Whitlock, M.D., Yongning Ou, M.Sc., Peggy Gao, M.Sc., Shirley Pettit, R.N., and Salim Yusuf, D.Phil., for the CORONARY Investigators*
This study is the 5-year follow-up of a large randomized controlled trial of on-pump CABG vs. OPCAB performed by seasoned surgeons.  A total of 4,752 patients were included in this trial.  At 5 years of follow-up, there was no difference between the groups in either the composite outcome of death, stroke, MI, or renal failure or between any of the individual components.   Question:  There appears to be equipoise between either technique for coronary revascularization at 5 years.  Are these results determinative?  Is there any further information we need?  Or, does this settle the issue once and for all?
Source: Circulation
Author(s): Lazam S, Vanoverschelde JL, Tribouilloy C, Grigioni F, Suri RM, Avierinos JF, de Meester C, Barbieri A, Rusinaru D, Russo A, Pasquet AA, Michelena HI, Huebner M, Maalouf J, Clavel MA, Szymanski C, Enriquez-Sarano ME, and on behalf of the MIDA investigators
In this article, the authors describe their findings from a direct, propensity score matching and inverse probability-of-treatment weighting analysis of patients with degenerative MR with a flail leaflet, included in a multicenter registry which includes patients from 6 tertiary European and US centers. They compare outcomes between patients undergoing mitral valve repair (n=1709) and mitral valve replacement (213). They conclude that in this cohort of patients, MV repair is associated with lower operative mortality and better long-term survival than MV replacement.
Source: N Engl J Med
Author(s): Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, Kandzari DE, Morice MC, Lembo N, Brown WM 3rd, Taggart DP, Banning A, Merkely B, Horkay F, Boonstra PW, van Boven AJ, Ungi I, Bogáts G, Mansour S, Noiseux N, Sabaté M, Pomar J, Hickey M, Gershlick A, Buszman P, Bochenek A, Schampaert E, Pagé P, Dressler O, Kosmidou I, Mehran R, Pocock SJ, Kappetein AP; EXCEL Trial Investigators.
In the largest randomized trial on PCI versus CABG in patients with left main disease (n=1905) and with an inclusion criteria of a SYNTAX score >33, PCI with everolimus-eluting stents was non-inferior to CABG for the composite endpoint of death, stroke, and myocardial infarction at a trial of 3-year follow-up (15.4% versus 14.7%, respectively). However, landmark analysis showed a significant increase in endpoints beyond 30-day follow-up with PCI (HR 1.44, 95% CI 1.06-1.96). Longer follow-up results from the EXCEL trial are required to determine whether PCI is really non-inferior in terms of long-term outcomes.
Source: Circulation
Author(s): Melduni RM, Schaff HV, Lee HC, Gersh BJ, Noseworthy PA, Bailey KR, Ammash NM, Cha SS, Fatema K, Wysokinski WE, Seward JB, Packer DL, Rihal CS, Asirvatham SJ.
In this manuscript, the authors describe their findings in a propensity score matched analysis of a retrospectively acquire data on 9792 patients undergoing CABG or heart valve surgery over a 6-year period. 461 matched pairs were identified and analysed in order to evaluate the effect of left atrial appendage (LAA) closure on postoperative atrial fibrillation (POAF), stroke and mortality. In this cohort of patients, LAA closure during routine non–AF-related cardiac surgery was independently associated with increased risk of early POAF and did not significantly influence the risk of stroke or long-term mortality.
Source: Circulation
Author(s): Marquis-Gravel G, Redfors B, Leon MB, Généreux P.
In this manuscript, the authors offer a comprehensive and thorough review of the pathophysiology of aortic stenosis and relate this to the different potential medical treatment options to slow down the progression of the disease.
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Michele Murzi, Alfredo Giuseppe Cerillo, Danyar Gilmanov, Giovanni Concistrè, Pierandrea Farneti, Mattia Glauber, Marco Solinas
Minimally invasive aortic valve replacement represents an increasingly acceptable alternative to standard sternotomy with potential reductions in morbidity.  There are technical nuances of the minimally invasive approach in which sutureless valves may offer an advantage.  This article by Murzi and colleagues explores the learning curve of minimally invasive aortic valve replacement via a right anterior thoracotomy using a sutureless aortic valve.  The authors conclude that right minithoracotomy sutureless valve implantation can be performed safely with a minimal learning curve.
Source: Annals of Thoracic Surgery
Author(s): Alexander A. Brescia, Steven F. Bolling, MD, Himanshu J. Patel, MD.
An extremely important journal article comprised of two case reports involving valve perforation and insufficiency following use of the Cor-Knot Automated Fastener (LSI Solutions, Victor, NY, USA) during valve replacement.  Injuries to the leaflets of either a native or prosthetic valve after valve repair or replacement, respectively, consisted of perforations.  These perforations corresponded precisely to areas where the valve leaflets would likely abrade against the metallic fasteners of the Cor-Knot.   The most likely mechanisms leading to this complication include a non-parallel orientation of the fasteners with respect to the valve annulus and the use of an intra-annular valve replacement technique during AVR. To prevent this complication, the authors suggest that surgeons should be meticulous about orienting the fasteners parallel to the valve annulus and should consider revising their AVR technique to positioning the prosthetic valve in a supra-annular rather than annular position when using the Cor-Knot device. Comment:  Of note, this is a rare complication with the Cor-Knot device, but can easily be prevented by following the suggestions of the authors.
Source: JTCVS
Author(s): Hadi Toeg, MD, MSc, MPH, Daniel French, MD, MSc, Sebastien Gilbert, MD, Fraser Rubens, MD, MSc
The authors performed a meta-analysis to evaluate (1)  if the timing of tracheostomy after cardiac surgery and (2) whether the type of tracheostomy (open v. percutaneous) impacted the incidence of sternal wound infection (SWI).   The findings were as follows: The overall incidence of SWI was 7% (operative mortality was 23%). The incidence of SWI did not differ between the early (<14 days) vs. the late (>14 days) tracheostomy groups. The timing after cardiac surgery showed a SWI rate of 3% after percutaneous  v. 9% after open tracheostomy, but this difference did not reach statistical significance.
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Bardia Arabkhani, Jos A. Bekkers, Eleni-Rosalina Andrinopoulou, Jolien W. Roos-Hesselink, Johanna J. M. Takkenberg, and Ad J. J. C. Bogers
A single institution experience is reported for outcomes of aortic allograft use in 353 pts undergoing 92 subcoronary and 261 root replacements.  Hospital mortality was 5.9%.  Mean follow-up was 12 years, during which time 113 pts died.  20-year survival was 41%.  117 pts required valve-related reoperations.  Long-term mortality was related to LV dilatation and severe AR.