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Journal and News Scan

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Bettina Pfannmueller, Martin Misfeld, Alexander Verevkin, Jens Garbade, David M Holzhey, Piroze Davierwala, Joerg Seeburger, Thilo Noack, Michael A Borger

The study compared long-term results of loop neochord replacement with leaflet resection techniques in 2134 patients undergoing minimally invasive mitral valve repair.
They demonstrated a significant reduction in early mitral regurgitation with the loop technique (on echocardiographyl; p=0.003) when compared with leaflet resection. Additionally, the long-term outcomes were excellent compared with classical leaflet resection techniques (the 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003).

Source: The Annals of Thoracic Surgery
Author(s): George Kuo, Shao-Wei Chen, Cheng-Chia Lee, Jia-Jin Chen, Pei-Chun Fan, Shang-Yu Wang, Ya-Chung Tian, Chih-Hsiang Chang

This study investigated fluit overload in cardiac and aortic surgery patients.

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Anne L M Goedhart, Bastiaan M Gerritse, Thijs C D Rettig, Martijn W A van Geldorp, Sander Bramer, Nardo J M van der Meer, Leandra J Boonman-de Winter, Thierry V Scohy

Goedhart et al. investigated the effect of different heparin/protamine ratios on the amount of blood transfusions following standard cardiac surgery. In the group of patients receiving 0.6/1 protamine/heparin ratio, the fraction of patients without the need of transfusion was higher and the total blood loss was lower compared to patients treated with a 0.8/1 protamine/heparin ratio. In their patient collective, the 0.6/1 protamine/ heparin ratio proved safe and superior.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Ali Hage, Louis-Mathieu Stevens, Maral Ouzounian, Jennifer Chung, Ismail El-Hamamsy, Vincent Chauvette, Francois Dagenais, Andreanne Cartier, Mark D Peterson, Munir Boodhwani, Ming Guo, John Bozinovski, Michael C Moon, Abigail White, Kanwal Kumar, Carly Lodewyks, Bindu Bittira, Darrin Payne, Michael W A Chu on behalf of the Canadian Thoracic Aortic Collaborative

This manuscript by Hage et al. retrospectively looks into the outcome of more than 2500 patients undergoing aortic arch replacement within the Canadian Thoracic Aortic Collaborative registry. They analyzed risk factors for mortality and stroke. Antegrade perfusion and perfusion at temperatures higher than 24°C were independent predictors of favorable outcomes. This data should encourage aortic surgeons to execute antegrade perfusion strategies and warmer temperature regimes during circulatory arrest for arch surgery.

Source: The Annals of Thoracic Surgery
Author(s): Alexander P. Nissen, MD, Charles C. Miller III, PhD, Vinod H. Thourani, MD, Y. Joseph Woo, MD, James S. Gammie, MD, Gorav Ailawadi, MD, Tom C. Nguyen, MD

There is controversy in the role of less invasive mitral surgery (LIMS) in treating complex mitral pathology.  This study uses the STS National Database to compare LIMS vs. sternotomy stratified by pathology in 41,082 patients.  The authors found that repair rates were higher with LIMS irrespective of mitral pathology.  Stroke rates, atrial fibrillation, pacemaker, renal failure, and length of stay were also shorter with LIMS.


Source: Journal American College of Cardiology
Author(s): Michael A Borger, Matthias Raschpichler, Raj Makkar

This JANS Note is an editorial in response to a recent publication by Deharo et al comparing TAVR valve-in-valve versus redo-SAVR demonstrating improved short-term outcomes with TAVR ViV.  The detail limitations of this study and provide a persuasive argument for the need of a randomized trial comparing both modalities.  

Source: The Annals of Thoracic Surgery
Author(s): Jared P. Beller, William Z. Chancellor, J. Hunter Mehaffey, Robert B. Hawkins, Matthew R. Byler, Alan M. Speir, Mohammed A. Quader, Andy C. Kiser, MD, Leora T. Yarboro, Gorav Ailawadi, Nicholas R. Teman

The authors analyzed dual antiplatelet use after coronary bypass grafting in patients from 2011 to 2017, and they identified an increase driven by patient demographics.

Source: Journal of the American Heart Association
Author(s): Jennifer C.‐Y. Chung, Edwin Wong, Mingyi Tang, Daniella Eliathamby, Thomas L. Forbes, Jagdish Butany, Craig A. Simmons, and Maral Ouzounian

Aneurysmal ascending aortas were collected from elective aortic surgery, and normal aortas from transplant donors, and dissected aortas from surgery for aortic dissection. These aortas underwent delamination testing in simulation of aortic dissection. Biaxial tensile testing was performed to determine modulus of elasticity (aortic stiffness), and energy loss (a measure of efficiency in performing the Windkessel function). Delamination strength (Sd) was lowest in dissected aortas and highest in normal aortas, and aneurysms fell in between, with greater Sd in the BAV group than the TAV group (P<0.001). Bicuspid aortopathy was associated with greater stiffness (P<0.001), while aneurysms with TAV demonstrated greater energy loss (P<0.001). Increased energy loss was associated with decreased Sd, whereas there was no relationship between Sd and aortic stiffness.

Aneurysms with bicuspid aortic valve had higher delamination strength than those with tricuspid aortic valve, suggesting that bicuspid aortic valve was protective. Energy loss was lower in aneurysms with bicuspid aortic valve, and inversely associated with delamination strength, representing a potential novel biomarker.

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Saurabh Gupta, Puru Panchal, Kevin Gilotra, Ann Mary Wilfred, Winston Hou, Deborah Siegal, Richard P Whitlock, Emilie P Belley-Cote

Meta-analysis of 4 RCTs and 7 observational studies.
Observational studies suggest suggests a benefit of IV iron compared to no iron on mortality [relative risk 0.39, 95% confidence interval (CI) 0.23–0.65; P < 0.001, very low quality], units transfused per patient (mean difference −1.22, 95% CI −1.85 to −0.60; P < 0.001, very low quality), renal injury (relative risk 0.50, 95% CI 0.36–0.69; P < 0.001, very low quality) and hospital length of stay (mean difference −4.24 days, 95% CI −6.86 to −1.63; P = 0.001, very low quality). 
RCTs demonstrated a reduction in the number of patients transfused with IV iron compared to oral or no iron (relative risk 0.81, 95% CI 0.70–0.94; P = 0.005, moderate quality). The pooled estimates of effect from RCTs for mortality, hospital length of stay, units transfused per patient and renal injury were consistent in direction with observational studies.
IV iron may improve postoperative morbidity in adult cardiac surgery patients with preoperative anaemia or iron deficiency. A large, rigorous, placebo-controlled, double-blinded, multicentre trial is needed to clarify the role of IV iron in this patient population.

Source: The Annals of Thoracic Surgery
Author(s): Ismail Bouhout, Walid Ben-Ali, Dori Khalaf, Marie Josée Raboisson, Nancy Poirier

This meta-analysis searched the PubMed, EMBASE, and Cochrane Library databases to investigate both fenestrated and nonfenestrated Fontan procedures, focusing on early outcomes.