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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Todd C. Crawford, MD, J. Trent Magruder, MD, Joshua C. Grimm, MD, Alejandro Suarez-Pierre, MD, Christopher M. Sciortino, MD, Kaushik Mandal, MD, Kenton J. Zehr, MD, John V. Conte, MD, Robert S. Higgins, MD, Duke E. Cameron, MD, Glenn J. Whitman, MD
The Johns Hopkins group reviewed their postoperative complications after heart surgery in 2,477 adult patients from 2011 and 2014 to determine the effect of the number of major complications on the primary outcome of death (as well as several secondary outcomes).  The study found the following rates of mortality by the number of complications: 0 Complications:  0.7% mortality 1 Complication:   4.1% mortality >1 Complication:  41% mortality Question:  What impact, if any, might the results of this study have on your practice?  
Source: The New England Journal of Medicine
Author(s): David P. Taggart, Douglas G. Altman, Alastair M. Gray, , Belinda Lees, Stephen Gerry, Umberto Benedetto and Marcus Flather
This editor hastes to submit to JANS this manuscript on the 5 year follow -up of the ART trial. It is guaranteed to be widely cited, probably hotly debated and certainly a disappointment to many of us! We would not like to pre-empt the ctsnet readers' opinions on this important publication, but we are allowed to comment on the positive findings on skeletonisation, a technique I find has been somewhat controversial, and the methodological disappointment of more than 15 in a 100 subjects randomised to BIMA (BITA) not in fact receiving two arterial grafts! I personally remember caring, operating and following-up early ART-enrolled patients in Edinburgh Scotland and look forward to the heated discussions this manuscript will immediately generate.    
Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Gen Shinohara, Kiyozo Morita, Masato Hoshino, Yoshihiro Ko, Takuro Tsukube,Yukihiro Kaneko, Hiroyuki Morishita, Yoshihiro Oshima, Hironori Matsuhisa, Ryuma Iwaki, Masashi Takahashi, Takaaki Matsuyama, Kazuhiro Hashimoto, and Naoto Yagi
The feasibility of synchrotron radiation-based phase-contrast computed tomography (PCCT) for visualization of the atrioventricular (AV) conduction axis in human whole heart specimens was tested using four post-mortem structurally normal newborn hearts obtained at autopsy. In PCCT images of all four of hearts, the AV conduction axis was distinguished as a low-density structure, which was serially traceable from the compact node to the penetrating bundle within the central fibrous body, and to the branching bundle into the left and right bundle branches. This was verified by histological serial sectioning examination. This is the first demonstration that visualization of the AV conduction axis within human whole heart specimens is feasible with PCCT. This is likely to be a powerful tool for study of the conduction system in the setting of congenital cardiac anomalies.
Source: The Lancet
Author(s): Mäkikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, Trovik T, Eskola M, Romppanen H, Kellerth T, Ravkilde J, Jensen LO, Kalinauskas G, Linder RB, Pentikainen M, Hervold A, Banning A, Zaman A, Cotton J, Eriksen E, Margus S, Sørensen HT, Nielsen PH, Niemelä M, Kervinen K, Lassen JF, Maeng M, Oldroyd K, Berg G, Walsh SJ, Hanratty CG, Kumsars I, Stradins P, Steigen TK, Fröbert O, Graham AN, Endresen PC, Corbascio M, Kajander O, Trivedi U, Hartikainen J, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH; NOBLE study investigators.
This is a prospective, randomised, open-label, non-inferiority trial comparing CABG versus PCI in patients with unprotected left main stenosis. The study was carried out at 36 hospitals in Latvia, Estonia, Lithuania, Germany, Norway, Sweden, Finland, the UK, and Denmark.  In total, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat up to 5 years of follow up. Interestingly, only 8% of the patients in the CABG group had the right internal mammary artery used as a graft (93% had the left ITA used). The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE; death from any cause, non-procedural myocardial infarction,14 repeat revascularisation, or stroke). The key findings of the NOBLE study are that CABG was better than PCI for the composite endpoint of MACCE; all-cause mortality was similar between the two groups; non-procedural myocardial infarction and need for repeat revascularisation were increased after PCI; a higher rate of stroke was observed in the CABG group after 30 days than in the PCI group, but an unexpected, numerically higher rate of stroke was found in PCI-treated patients in 5 year estimates; maximum angina pectoris score was higher after PCI at up to 5 years follow-up.
Source: Circulation Research
Author(s): Beer LA, Kossenkov AV, Liu Q, Luning Prak E, Domchek S, Speicher DW, Ky B .
An interesting case series of cardiotoxicity of modern chemotherapy attempting to elucidate mechanisms of heart failure. This pilot study could well lead to further investigation of finite pathways related to surgical aspects of transplanation, anti-rejection therapy in particular: The authors propose that the immune system is a mediator of cardiac dusfunction.
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Fraser D. Rubens, Yen-Yen Gee, Janet M.C. Ngu, Li Chen, Ian G. Burwash
This single institution study evalated the effect of prosthesis choice on regression of LV mass after AVR in patients with AS.  The St. Jude Trifecta performed better than the Edwards Perimount Magna Ease in terms of LV mass regression and intermediate-term clinical outcomes such as valve gradients, freedom from readmission, and all-cause mortality.
Source: Annals of Thoracic Surgery
Author(s): David Jonathan Heineman, Martijn Geert ten Berge, Johannes Marlene Daniels, Michaël Ignatius Versteegh, Perla Jacqueline Marang-van de Mheen, Michael Wilhelmus Wouters, Wilhelmina Hendrika Schreurs
The authors examined the concordance of clinical and pathological staging using prospectively collected data from the Dutch Lung Surgery Audit, examining patients with clinical stage I disease.  Among 1,555 patients, the concordance of cTNM and pTNM was 60%.  22.6% of patients were upstaged after resection, .  The difference was more evident in patients with T2a tumors. 
Source: Annals of Thoracic Surgery
Author(s): Kristen Nelson-McMillan, Christoph P. Hornik, Xia He, Luca A. Vricella, Jeffrey P. Jacobs, Kevin D. Hill, Sara K. Pasquali, Diane E. Alejo, Duke E. Cameron, Marshall L. Jacobs
This database study evaluated outcomes of delayed sternal closure for infants undergoing surgery on cardiopulmonary bypass.  Delayed closure was associated with a 3-fold increase in infectious complications.  Time to closure was associated with an increasing rate of infectious complications.  Location of closure (OR, ICU) was not associated with adverse outcomes.
Source: Annals of Thoracic Surgery
Author(s): Vincent Chan, Elsayed Elmistekawy, Marc Ruel, Mark Hynes, Thierry G. Mesana
This single institution study explored the frequency and time course of failure of mitral valve repair for MR caused by prolapse using longitudinal echocardiography.   Recurrent MR developed in 49 (5.7%) patients at a mean of 3.1 years; 6 had prolapse and 43 did not.   Severe MS occurred in 3.  Reoperation was performed in 21 patients, and was most commonly valve replacement. 
Source: Annals of Thoracic Surgery
Author(s): Julius I. Ejiofor, Maroun Yammine, Morgan T. Harloff, Siobhan McGurk, Jochen D. Muehlschlegel, Prem S. Shekar, Lawrence H. Cohn, Pinak Shah, Tsuyoshi Kaneko
This single institution retrospective study evaluated outcomes of valve replacement for degenerated bioprosthetic aortic valves comparing surgical AVR (SAVR) to transcatheter valve-in-valve procedures (TViV).  Patients were matched into 2 groups of 22 according to STS risk scores.   Operative mortality, stroke rate, and 3-year survival were similar between the groups. 

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