ALERT!

This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Evaldas Girdauskas, Ümniye Balaban, Eva Herrmann, Timm Bauer, Andreas Beckmann, Raffi Bekeredjian, Stephan Ensminger, Christian Frerker, Helge Möllmann, Johannes Petersen, Thomas Walther, Sabine Bleiziffer

In this study, the authors aimed to analyze the one-year outcome after aortic valve (AV) repair versus surgical AV replacement (SAVR) in patients with aortic regurgitation (AR) using data from the German Aortic Valve Registry (GARY). A total of 8,076 AR patients were included in the analysis. The AV was repaired in 2,327 patients (29 percent) and 5,749 patients (71 percent) underwent SAVR. Patients were matched to correct for baseline differences in both study groups. After adjusting for baseline differences, the one-year survival rate was 97.7 percent (95 percent CI, 97.0 percent to 98.5 percent) in the AV repair cohort versus 96.4 percent (95 percent CI, 95.9 percent to 96.9 percent) SAVR cohort (log-rank P < 0.001). Cox regression analysis showed a significant age independent advantage of AV repair compared with SAVR (hazard ratio, 0.68; 95 percent CI, 0.51-0.90; P < 0.0001) on one-year survival. Furthermore, cardiac event-free survival at one year was 85.7 percent (95 percent CI, 483.8 percent to 87.7 percent) in the AV repair group versus 81.7 percent (95 percent CI, 80.7 percent to 82.9 percent) in the SAVR group (log-rank P < 0.001). There was no difference in the need for AV reintervention when comparing both the AV repair and SAVR cohorts (P = 0.59). The authors concluded that AV repair surgery, if technically feasible, is associated with higher superior one-year survival and one-year cardiac event-free survival than SAVR.

Source: The Annals of Thoracic Surgery
Author(s): Daniel P. Dolan, Maxime Visa, Dan Lee, Kalvin C. Lung, Diego Avella Patino, Chitaru Kurihara, Rafael Garza-Castillon Jr, David D. Odell, Ankit Bharat, Samuel Kim

In this single-center series of 430 patients with stage I or II non-small cell lung cancer who underwent minimally invasive lobectomy (n = 200) or segmentectomy (n = 230), 162 (37 percent) were discharged less than 18 hours postoperatively without a chest tube, and 37 patients were discharged the day of surgery. The authors report that there were no perioperative deaths, no deaths in one year of follow up, and no significant differences in readmission rates.

Source: The Annals of Thoracic Surgery
Author(s): Moritz C. Wyler von Ballmoos, Tsuyoshi Kaneko, Alexander Iribarne, Karen M. Kim, Arman Arghami, Amy Fiedler, Robert Habib, Niharika Parsons, Zouheir Elhalabi, Carole Krohn, Michael E. Bowdish

This annual report from The Society of Thoracic Surgeons Adult Cardiac Surgery Database summarizes key research; trends in patient characteristics; surgeon case volume; surgical techniques including minimally invasive and robotic approaches, repair and replacement, prosthesis, and conduit choice; and concomitant atrial fibrillation surgery in isolated coronary bypass, aortic, mitral, and tricuspid valve surgery between 2015 and 2022.

Source: tctMD
Author(s): Yael L. Maxwell

A recent study by Jad Malas et al. comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in patients less than 60 years of age was presented during the 2024 STS Annual Meeting in San Antonio, Texas. The analysis included data from 2,306 patients less than 60 years old who underwent TAVI or bioprosthetic SAVR between 2013 and 2021 in California, USA. The data originated from the California State Discharge Administrative Database. Almost half of patients less than 60 years old treated for aortic stenosis in California between 2013 and 2021 received TAVI instead of SAVR, with a steady increase in TAVI use for this population over the study period. The annual increase in TAVI use was about five percent. However, the study also showed a 2.5-fold increased risk of death at five years with TAVI compared to SAVR.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Omar A. Jarral, Christopher W. Jensen, Julie W. Doberne, Peter S. Downey, J. D. Serfas, Andrew M. Vekstein, G. Chad Hughes

This study addressed midterm outcomes with the hemispherical aortic annuloplasty reconstructive technology (HAART) ring used for aortic valve repair (AVr). Seventy-one patients had AVr using the HAART ring—53 had a trileaflet valve and 18 had a bicuspid valve. Their median age was 54 years old and 79 percent were male. Many patients needed concomitant interventions such as arch repair (77 percent) or a root procedure (46 percent). At a mean follow up time of 3.9 ± 1.1 years, freedom from reoperation was 96 percent. Eleven patients had moderate or higher aortic insufficiency (AI) during surveillance, and all of these patients had a trileaflet valve. Three patients suffered ring dehiscence. The authors recommend caution when using the subannular approach for stabilization in patients with trileaflet aortic valves.

Source: tctMD
Author(s): Yael L. Maxwell

New survey data presented at the STS annual meeting showed that female cardiothoracic surgeons have fewer children and are more likely to face infertility than their male colleagues, along with facing more complications when they are pregnant. Leaders in the field suggested systemic changes such as extended parental leave regardless of gender and formal written policies.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Pontailler M, Moiroux-Sahraoui A, Bernheim S, Gaudin R, Houyel L et al

This study addressed the long-term results of the réparation à l’étage ventriculaire (REV) procedure for double outlet right ventricle (DORV) and transposition of the great arteries (TGA) with pulmonary stenosis (PS). From 1980 to 2021, 157 patients underwent an REV procedure. Thirteen patients died (8.3 percent), including four in the first postoperative month and two after heart transplants. Survival at 40 years was 89.3 percent. 37 patients required 68 reinterventions on the right ventricular outflow tract (RVOT) including 49 reoperations with a median delay of nine years (8 months to 27 years). The authors concluded that the REV procedure is a good alternative for patients with TGA and double outlet right ventricle with PS, with only a quarter of patients needing redo RVOT surgery.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Mukharyamov M, Schneider U, Kirov H, Caldonazo T, Doenst T

Conventional cardiac surgery is performed using myocardial protection strategies that were developed decades ago. The context of surgery has changed over this period, with patients now who are older and have more comorbidities. However, the systemic effects of cardioplegia solutions have not been a focus of attention. The authors review the biochemical principles of ischemia, reperfusion and cardioplegic extension of ischemia tolerance. In light of rising patient risk profiles, reduction of surgical trauma and improvement of perioperative morbidity is critical. This means considering the systemic effects of cardioplegia solutions, not just the cardiac effects.

Source: The Annals of Thoracic Surgery
Author(s): Les James, Deane E. Smith, Aubrey C. Galloway, Darien Paone, Michael Allison, Shashwat Shrivastav, et al.

The benefits of early extubation in the operating room (OR) following cardiac surgery remain unproven. In this study, the authors evaluated perioperative outcomes after extubation in the OR versus extubation in the intensive care unit (ICU) in patients who underwent nonemergency isolated coronary artery bypass grafting (CABG). A total of 1,397 patients who underwent nonemergency isolated CABG during a six-year period were analyzed. Among them, 891 (63.8 percent) patients were extubated in the ICU, and 506 (36.2 percent) were extubated in the OR. After propensity score matching, 414 patient pairs were compared. Adjusted comparison did not show differences between the two groups in the incidence of major early postoperative complications such as reintubation, re-exploration for bleeding, stroke, renal failure, or thirty-day mortality. Furthermore, patients extubated in the OR had shorter ICU (P < 0.0001) and hospital stays (P < 0.0001), were more frequently discharged directly home (P < 0.0001), and presented with a lower thirty-day readmission rate (P = 0.04). Based on these results, the authors suggest a wider adoption of routine OR extubation for nonemergency CABG.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Alsoufi B, Kozik D, Lambert AN, Wilkens S, Trivedi J, Deshpande S

Infants awaiting pediatric heart transplantation (PHT) have long waitlist duration and high mortality due to donor shortage. This study examined whether increased donor-recipient weight ratio (DRWR) higher than 2.0, the recommended cutoff, resulted in adverse outcomes. 1,392 infants undergoing PHT between 2007 and 2020 were included. They were divided into three groups: A (DRWR ≤ 1.0, n = 239); B (DRWR 1.0–2.0, n = 947; C (DRWR > 2, n = 206). DRWR ranged from 0.5 to 4.1 and other variables were comparable between groups. Patients in group C were more likely to be ventilated, receive an ABO blood group-incompatible heart, and have longer donor ischemia times. The DRWR group was not associated with operative death in either congenital or cardiomyopathy patients. Infants in group C had shorter waitlist durations and no demonstrable increase in adverse outcomes.

Pages