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Journal and News Scan
The previous randomized study of minimally invasive esophagectomy vs open esophagectomy (TIME trial) conducted in the Netherlands demonstrated reduced pulmonary complications and LOS with MIE. Compared to the benefits of MIE in those selected high volume centers, national use of MIE was associated with increased overall complications, increased pulmonary complications, and increased reoperation rates.
This original article retrospectively analyzed the outcome of 200 patients after implantation of HeartMate 3 and HeartWare LVAD respectively. The baseline characteristics of both groups, containing 100 patients each, were comparable, despite a higher percentage of INTERMACS I and II patients implanted with the HeartWare device. While the overall survival was not different, patients receiving HeartWare LVAD had more intracranial bleeding, while the total fraction of patients with cerebrovascular accidents was not different. The authors conclude that the devices show a different complication profile, but comparable intermediate survival.
Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time.The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high- versus low-volume centers) and according to the evolution of FET treatment during time (1st period, 2005–2011 versus 2nd period, 2012–2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol.The overall 30-day mortality was 12%. Short- and long-term survival were higher in high- versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2nd time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2nd time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2nd time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%. In conclusion, this study shows that the evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients.
A large retrospective review of almost three decades of extensive thoracoabdominal aortic surgery, with considerable educational value especially on the anatomicoclinical correlations of the spinal vasculature.
The authors analyzed the volumes of thoracic endovascular aneurysm repair (TEVAR) for the treatment of descending thoracic aneurysms for Medicare patients over five years, comparing the proportion of cases to 30-day mortality.
As TAVR is used in progressively lower-risk cohorts, management of device failure will become increasingly important. This study reports the largest series of patients receiving a surgical reoperation after transcatheter aortic valve replacement (TAVR) using the STS Adult Cardiac Surgery Database. A total of 123 patients met inclusion criteria, and cases represent predominantly early TAVR failure (months to a few years from index procedure). Reoperation was associated with an operative mortality of 17.1% and other worse-than-expected outcomes when compared with similar patients initially undergoing surgical aortic valve replacement. Continued experience with this developing technology is needed to reduce the incidence of early TAVR failure and further define optimal treatment of failed TAVR prostheses.
This review provides a concise summary of frequently asked questions related to COVID-19 in children with congenital heart disease.
The authors compared surgically managed signet ring cell adenocarcinoma and esophageal adenocarcinoma patients in the National Cancer Database.
This manuscript by Kusadokoro et al. retrospectively looks into the outcome of patients who underwent either planned or rescue double arterial cannulation in surgery for type A aortic dissection. The propensity match analysis proofed non-inferiority of double arterial cannulation regarding one- and five-year survival. The authors conclude double arterial cannulation to be safe for management and prevention of malperfusion during surgery for type A aortic dissection.
An international, multicenter, cohort study at 235 hospitals in 24 countries including all patients undergoing surgery who had SARS-CoV-2 infection confirmed. Mortality in patients with SARS-CoV-2 was mainly in those who had postoperative pulmonary complications, which was about 50% and at a rate far higher than the pre-pandemic baseline. As hospitals resume routine surgery, it is likely to be in environments that remain exposed to SARS-CoV-2. This study concludes that strategies are urgently required to minimize in-hospital SARS-CoV-2 transmision and mitigate the risk of postoperative pulmonary complications in SARS-CoV-2 infected patients whose surgery cannot be delayed.