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Journal and News Scan
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.
Excellent document from the EACTS, STS, and AATS emphasizing the importance of standardization of prosthetic heart valve labeling.
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.
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.
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.
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.
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.
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.
An interesting pilot experiment on attempting to quantify the optimum disposition of neochordae in transapical intervention for severe mitral regurgitation.
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.