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Journal and News Scan
Thourani and colleagues used data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry to develop a risk model for in-hospital stroke after transcatheter aortic valve replacement (TAVR), a serious complication. Of the 97,600 TAVR procedures performed between 2014 and 2017 that were included in the analysis, 1,839 patients experienced in-hospital stroke. The authors limited covariate selection to patient demographics and baseline characteristics—with the one exception being access strategy—to increase the usefulness of the model prior to a procedure. Predictors for increased stroke risk included alternative access, prior stroke, procedural acuity, smoking, porcelain aorta, peripheral artery disease, and advanced age.
Additionally, the authors report that patients at 10 of the 521 participating sites were found to have significantly higher odds ratios for stroke than the other sites. They note that the model thus serves as a resource for quality improvement as well as for clinical decision making and patient counseling.
The overarching, free to read under terms, of the TAVR mini-compendium of this week: the most complex question remains "what is a reasonable expectation of a stakeholder on outcomes of aortic stenosis?"
Melfi and colleagues present a keynote lecture outlining the evolution of robotic thoracic surgery. The robotic technique in thoracic surgery has progressively become widespread, particularly for the treatment of mediastinal and pulmonary lesions. The authors discuss the development of technology in the robotic system that has been associated with the improvement of intraoperative and postoperative results.
Aortic endografting leads to aortic stiffening. In this experimental animal study, Yamashita and colleagues evaluated the effect that thoracic endografting had on cardiac afterload, function, and remodeling. The authors report increased aortic input impedance and left ventricular mass after three months, although the effect of experimental descending aorta endografting on left ventricular contractility and efficiency was minimal.
The authors prospectively analyzed right ventricular (RV) function in 109 patients undergoing a broad range of cardiac surgeries. RV function was assessed at several time points by evaluating TAPSE and 2D longitudinal RV strain to evaluate long axis RV function, and fractional area exchange to evaluate global RV function. After CPB and after chest closure, reduced RV function was demonstrated across all cardiac procedures. Thus, there is a significant failure to protect the RV during surgery.
If one accepts these findings, what modes of myocardial protection should be assessed or re-assessed to protect the RV? Why or why not?
The authors of this single-center open-label pilot trial evaluated the intermediate-term outcomes of patients undergoing either heart (n=8) or lung (n=36) transplantation from donors that had evidence of active hepatitis C virus (HCV) infection. All patients underwent treatment of HCV antiviral treatment for 4 weeks after transplantation. The primary outcome measured was a composite of a sustained virologic response at 12 weeks after completion of antiviral therapy for HCV infection and graft survival 6 months after transplantation. Of the initial 35 patients who had completed 6 months of follow-up, all patients met the primary outcome. Thus, at intermediate term follow-up, HCV infection was prevented in 100% of patients.
This single-center study retrospectively analyzed the impact of the implementation of thromboelastography (TEG) on all cardiac procedures performed during 2-year intervals prior to and after TEG implementation. A total of 367 and 310 patients were included in the analysis for the pre-TEG and post-TEG eras, respectively. The authors found that the implementation of TEG was associated with a significant reduction in blood product usage, reoperation, postoperative LOS, and 6-month mortality.
The authors analyzed the STS database for elective aortic root replacement (with several important exclusions) to derive risk factors for mortality and morbidity. A total of 8,807 patients met inclusion criteria. Significant predictors for mortality that were discovered include atrial fibrillation, body surface area, chronic obstructive pulmonary disease, NYHA IV, diabetes, concomitant coronary artery bypass grafting, concomitant mitral valve surgery, and Bentall operation.
Patient Care and General Interest
Uruguay’s fight against tobacco and Phillip Morris was highlighted at the recent Annual Meeting of the American College of Cardiology, and one physician shares her thoughts.
The University of California Los Angeles has opened a new center, the Robert G. Kardashian Center for Esophageal Health, to focus on treatment, research, and education for esophageal disorders.
Drugs and Devices
Boston Scientific’s transcatheter Lotus Edge Aortic Valve System was cleared by the US Food and Drug Administration. The company launched the system recently in Europe and will launch it in the US soon.
Goggles that facilitated a mixed-reality view of 3D echocardiography were used for a percutaneous mitral valve intervention in Poland.
Research, Trials, and Funding
Researchers from St. Louis, Missouri, USA, report on the impact of a 2017 change in US lung transplant policy that expanded the geographic boundaries for determining which patients get first priority for donor lungs.
Simulation training improves a team’s ability to manage operating room fires more than training that is exclusively didactic, say researchers from Illinois, USA.
Park and colleagues sought to identify risk factors that could predict the need for systemic outflow relief operations (SORO) in newborn patients with transposed great arteries and either double-inlet left ventricle or tricuspid atresia. The authors evaluated data from 20 patients with double-inlet left ventricle and 10 patients with tricuspid atresia who underwent single-ventricle palliation between 2000 and 2018. Approximately 67% of patients underwent SORO, and arch obstruction and smaller systemic outflow tract area index at end-systolic phase were both predictive of a subsequent need for an SORO.