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Journal and News Scan
December 10, 2021
Submitted by: Wei-Guo Ma
On December 9, the American Heart Association (AHA) and American College of Cardiology (ACC) jointly released a clinical practice guideline for coronary artery revascularization in patients with coronary artery disease. The top ten take-home messages are:
1. Treatment decisions regarding coronary revascularization in patients with coronary artery disease should be based on clinical indications, regardless of sex, race, or ethnicity.
2. In patients being considered for coronary revascularization for whom the optimal treatment strategy is unclear, a multidisciplinary Heart Team approach is recommended.
3. For patients with significant left main disease, surgical revascularization is indicated to improve survival relative to that likely to be achieved with medical therapy.
4. Updated evidence from contemporary trials supplement older evidence with regard to mortality benefit of revascularization in patients with stable ischemic heart disease, normal left ventricular ejection fraction, and triple-vessel coronary artery disease. Surgical revascularization may be reasonable to improve survival. A survival benefit with percutaneous revascularization is uncertain.
5. The use of a radial artery as a surgical revascularization conduit is preferred versus the use of a saphenous vein conduit to bypass the second most important target vessel with significant stenosis after the left anterior descending coronary artery.
6. Radial artery access is recommended in patients undergoing percutaneous intervention who have acute coronary syndrome or stable ischemic heart disease, to reduce bleeding and vascular complications compared with a femoral approach.
7. A short duration of dual antiplatelet therapy after percutaneous revascularization in patients with stable ischemic heart disease is reasonable to reduce the risk of bleeding events. After consideration of recurrent ischemia and bleeding risks, select patients may safely transition to P2Y12 inhibitor monotherapy and stop aspirin after 1 to 3 months of dual antiplatelet therapy (Previous recommendations called for 6 or 12 months of DAPT)
8. Staged percutaneous intervention (while in hospital or after discharge) of a significantly stenosed nonculprit artery in patients presenting with an ST-segment–elevation myocardial infarction is recommended in select patients to improve outcomes.
9. Revascularization decisions in patients with diabetes and multivessel coronary artery disease are optimized by the use of a Heart Team approach.
10. Treatment decisions for patients undergoing surgical revascularization of coronary artery disease should include the calculation of a patient’s surgical risk with the Society of Thoracic Surgeons score. The usefulness of the SYNTAX score calculation in treatment decisions is less clear.
December 10, 2021
Submitted by: Christopher Anderson
The most common approach for transcatheter aortic valve replacement (TAVR) is transfemoral access. Yet, a subset of patients require alternative access. This study shows the evolution and outcomes of alternative-access TAVR at Cleveland Clinic.
December 10, 2021
Submitted by: Christopher Anderson
Over one-half of patients treated with esophagectomy for esophageal cancer have recurrence. Oligometastasis, a proposed intermediate state of isolated local or solid organ recurrence that occurs before widespread systemic disease, is a possible target for aggressive local intervention. This study look at presentation and prognosis among solid organ recurrence sites.
December 10, 2021
Submitted by: Christopher Anderson
The wroth of neoadjuvant treatment in conjunction with resection as multimodality therapy (MMT) for stage IIB non-small cell lung cancer is still controversial.
November 30, 2021
Submitted by: Wei-Guo Ma
The Society of Cardiovascular Anesthesiologists created an expert consensus statement intended to help anesthesiologists manage adult patients receiving ECMO who are cared for in the operating room. This two-part consensus document may serve as a helpful reference for cardiothoracic surgeons, intensivists and all who engaged in the care of ECMO patients. The second part discusses intraoperative management and troubleshooting for common ECMO-related problems.
November 30, 2021
Submitted by: Wei-Guo Ma
The Society of Cardiovascular Anesthesiologists created an expert consensus statement intended to help anesthesiologists manage adult patients receiving ECMO who are cared for in the operating room. This two-part consensus document may serve as a helpful reference for cardiothoracic surgeons, intensivists and all who engaged in the care of ECMO patients. The first part is focused on the technical aspects of ECMO.
November 19, 2021
Submitted by: Aristotle Protopapas
Impressive decrease of death (by approximaltely 40% !) in 2 years from a small RCT in elective structural heart surgery for degeneration. The assumption is a benefit by improvement in right ventricular dynamics
November 18, 2021
Submitted by: Christopher Anderson
Out of 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. Indication for surgery was functional tricuspid valve regurgitation in 64%, lead induced in 18%, and primary leaflet dysfunction in 18%. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (interquartile range [IQR] 5.9-13.5) post-dismissal.
November 18, 2021
Submitted by: Malak Elbatarny
Preserving dynamism and recreating the sinuses in the Dacron graft are recongnized to be important for increasing the results of aortic valve-conserving operations. We describe a novel technique that preserves dynamism and recreates the sinotubular junction.
November 18, 2021
Submitted by: Malak Elbatarny
The only procedure which guarantees long-term viability of the aortic valve substitute is the Ross operation. This translates into increased durability, survival, exercise capacity, quality of life, and minimal valve related complications. However, progressive autograft dilatation does provide some is concern. Particularly, when used as a freestanding root. The incidence and degree of dilatation varies considerably in different series and is dependent on the technique used as well as management during the peri-operative period and importantly patient-specific characteristics. Here we present a new method which aims at preventing long-term dilatation, using autologous tissue, while preserving geometry and dynamism of the aortic root.