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Journal and News Scan

Source: JAMA Network Open
Author(s): Alan Rozanski, Chirag Bavishi, Laura D. Kubzansky, Randy Cohen

The association of cardiovascular events and all-cause mortality with optimism was assessed in this meta-analysis. Optimism was associated with a decreased risk of cardiovascular events (ROR 0.65) and a decrease in all-cause mortality (RR 0.86). Mechansims have yet to be identified.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Andras P. Durko, Stuart J. Head, Philippe Pibarot, Pavan Atluri, Vinayak Bapat, Duke E. Cameron, Filip P.A. Casselman, Edward P. Chen, Gry Dahle, Tjark Ebels, John A. Elefteriades, Patrizio Lancellotti, Richard L. Prager, Raphael Rosenhek, Alan Speir, Marco Stijnen, Giordano Tasca, Ajit Yoganathan, Thomas Walther, Ruggero De Paulis, EACTS–STS–AATS Valve Labelling Task Force

Excellent document from the EACTS, STS, and AATS emphasizing the importance of standardization of prosthetic heart valve labeling.

Source: The British Medical Journal
Author(s): Karla Solo, Shahar Lavi, Conrad Kabali, Glenn N Levine, Alexander Kulik, Ava A John-Baptiste, Stephen E Fremes, Janet Martin, John W Eikelboom, Marc Ruel, Ashlay A Huitema, Tawfiq Choudhury, Deepak L Bhatt, Nikolaos Tzemos, Mamas A Mamas, Rodrigo Bagur

This timely review examines the use of single and mutiple agents to decrease saphenous graft failure after CABG. These are difficult and expensive studies to perform, requiring repeat imaging after surgery, a procedure patients are often reluctant to undergo. In this analysis, the use of aspirin remains the lynchpin, with ticagrelor and clopidigrel as second agents improving outcomes, albeit at an increased in risk of bleeding.

Source: JAMA Internal Medicine
Author(s): Lily Meier, Elizabeth Y. Wang, Madris Tomes, Rita F. Redberg

Reporting of postmarket outcomes for the Sapien 3 and Mitraclip devices frequently misclassified patient deaths as device malfunction or other outcomes. Misclassification for Sapien 3 involved 17.5% of patient deaths, and involved 24.7% of patient deaths for Mitraclip. These outcomes are important for the public and physicians to understand when discussing risks and benefits of such devices. 

Source: TCTMD
Author(s): Michael O'Riordan

David Taggart, MD, PhD (University of Oxford, England), the chairman of the EXCEL surgical committee during the design and recruitment phase of the trial, believes the investigators downplayed the increased risk of all-cause mortality with PCI and oversold the reduced risk of the study’s primary composite endpoint of death, stroke, and MI, particularly since the benefit was largely driven by a higher risk of periprocedural MIs in the CABG arm. 

“I found it worrying that there seemed to be a strong signal here and I don’t think that was accurately reflected in the New England Journal of Medicine paper,” Taggart told TCTMD. “We’re not talking about two tablets for a headache. We’re talking about people dying. The data are the data, and that’s what the data show.

Source: JAMA Surgery
Author(s): Chandima Divithotawela; Marcelo Cypel; Tereza Martinu; Lianne G. Singer; Matthew Binnie; Chung-Wai Chow; Cecilia Chaparro; Thomas K. Waddell; Marc de Perrot; Andrew Pierre; Kazuhiro Yasufuku; Jonathan C. Yeung; Laura Donahoe; Shaf Keshavjee; Jussi M. Tikkanen

Ex vivo lung perfusion was used in 25% of transplanted lungs in the Toronto program since 2008. This resulted in an increase in the number of transplanted patients without any degradation of long-term outcomes, including survival and freedom from chronic dysfunction.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Tatsuhiko Komiya, Takeshi Shimamoto, Michihito Nonaka, Takehiko Matsuo

The authors investigated cusp size in patients undergoing aortic valve repair for valve regurgitation. They found that most patients with small cusps have annulus cusp mismatch. They suggested that small cusp size is not a contraindication in aortic valve repair and recommended to secure annulus by plications to correct annulus cusp mismatch.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Paraskevi Theocharis, Nicola Viola, Nikolaos D Papamichael, Markku Kaarne, Tara Bharucha

In this paper, the objective was to find out the echocardiographic predictors of reoperation for subaortic stenosis. Among 82 patients who initially underwent subaortic stenosis corrective surgery, 30 patients required reoperation. The risk factors were young age, unfavorable left ventricular geometry, interrupted aortic arch, and higher residual left ventricular outflow tract gradient.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Daniel Grinberg, Pierre-Jean Cottinet, Sophie Thivolet, David Audigier, Jean-Fabien Capsal, Minh-Quyen Le, Jean-Francois Obadia

An interesting pilot experiment on attempting to quantify the optimum disposition of neochordae in transapical intervention for severe mitral regurgitation.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Nicola Buzzatti, Mathias Van Hemelrijck, Paolo Denti, Stefania Ruggeri, Davide Schiavi, Iside Stella Scarfò, Diana Reser, Maurizio Taramasso, Alberto Weber, Giovanni La Canna, Michele De Bonis, Francesco Maisano, Ottavio Alfieri

The authors address appropriate use of the transcatheter clip to treat degenerative mitral regurgitation in elderly low to moderate risk patients. Their analysis shows that the transcatheter approach had slightly higher one year survival (97.6% vs 95.3%) than the surgical group but long-term survival was much worse than the surgical group at five years (34.5% vs 82.2%). This is likely related to a much higher incidence of recurrent >3+ mitral regurgitation in the clip group, 36.9% vs 3.9%. The one caveat was that the STS PROM (interquartile range) was higher in the clip group, 2.99 (2.29 to 4.38) vs 1.64(1.3 to 2.41), which has been shown to correlate with long-term survival.

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