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Journal and News Scan
November 24, 2016
Submitted by: Arie Blitz
The authors performed a meta-analysis to evaluate (1) if the timing of tracheostomy after cardiac surgery and (2) whether the type of tracheostomy (open v. percutaneous) impacted the incidence of sternal wound infection (SWI). The findings were as follows: The overall incidence of SWI was 7% (operative mortality was 23%). The incidence of SWI did not differ between the early (<14 days) vs. the late (>14 days) tracheostomy groups. The timing after cardiac surgery showed a SWI rate of 3% after percutaneous v. 9% after open tracheostomy, but this difference did not reach statistical significance.
A single institution experience is reported for outcomes of aortic allograft use in 353 pts undergoing 92 subcoronary and 261 root replacements. Hospital mortality was 5.9%. Mean follow-up was 12 years, during which time 113 pts died. 20-year survival was 41%. 117 pts required valve-related reoperations. Long-term mortality was related to LV dilatation and severe AR.
Early single institution experience with minimally invasive sutureless aortic valve replacement was reported. Among 300 patients, surgeon-specific and institution-specific learning curves were evaluated for technical success and 30-day complications. A cluster of complications occurred early in the experience and then standardized. No significant learning curve was identified for technical success, although 3 of 6 surgeons exhibited a brief initial learning curve for this metric.
An institutional registry of ECMO patients was surveyed to determine predictors of survival among patients receiving ECMO in the presence of sepsis. Among 151 studied patients, pneumonia was the most common cause of sepsis. Mortality was predicted by advanced age, longer door-to ECMO times, gram-negative sepsis, and sepsis due to infections other than pneumonia.
In this single institution retrospective study, the relationship of PA pressure to long-term mortality was assessed in patients undergoing unifocalization for pulmonary atresia with VSD. A mean PA intraoperative pressure > 25mm Hg was associated with worse survival, and was the sole predictor of medium-term death.
November 23, 2016
Submitted by: Ruben Osnabrugge
Valve in valve transcatheter aortic valve implantation (ViV-TAVI) is an alternative to redo surgical aortic valve replacement (SAVR) in inoperable patients and inpatients at high operative risk. This has become even more important now that approximately 80% of all SAVR are bioprostheses and bioprostheses are implanted at younger age. Several TAVI valves have received CE mark and premarket approval for use in degenerated bioprosthesis. This study analysed the effects of design of four different surgical bioprostheses on the hydrodynamic function of an Edwards Sapien XT valve implanted as a ViV-TAVI. Main findings of this study were: Although there was complete coaptation of the leaflets in all 23-mm label-size ViV combinations, there were considerable differences in regurgitation measurements. This means the differences are attributable to paravalvular leakage. The Sapien XT in the Trifecta and the Perimount had the largest paravalvular leakage compared to the Aspire and Mosaic valves. The paravalvular leakages are most likely the result of different valve material as the porcine leaflets of the Aspire and the Mosaic are less stiff and provide better seal. Surgical valves with externally mounted leaflets (Trifecta) have an increased risk of paravalvular leakage in the ViV combination. On the other hand, mean pressure gradient (MPG) was lower in valves with a higher surgical inner diameter (the Perimount and Trifecta valves). Higher MPG was the result of underexpansion of the Sapien XT in the Trifecta and Mosaic valves, leading to axial overlap of the leaflets. In conclusion: This study showed that surgical valves with a large valve area improved hemodynamics for future ViV-TAVI combinations. Moreover, internally mounted leaflets seem to decrease the risk of paravalvular leakage. Although this is an interesting study, this bench test study was limited to 23mm surgical valves and no calcifications or pannus of the surgical valves were simulated. Use of the valve-in-valve app developed by Dr. Bapat, remains helpful for clinicians making decisions on which TAVI valve is recommended in a specific surgical valve (https://itunes.apple.com/nl/app/valve-in-valve/id655683780?mt=8)
This systematic review of the literature evaluated reported outcomes of myasthenia gravis in patients with and without thymectomy. Among over 10,000 patients evenly divided between thymectomy and medication alone, the likelihood of remission was 31% vs 15%, OR 2.44.
A single institution experience during 22 years for early repair of complete AV canal defects (CAVCD) is reported. Repair was performed in 159 pts between 8 and 12 weeks of age. Operative mortality was 1.9% and later mortality was 7.7%. 13% required reoperation during long-term follow-up, primarily for left AV valve regurgitation. Left AV valve performance at last follow-up was significantly worse in pts older than 3 mons when repaired.
This retrospective single institution study evaluated the relationship between radiation dose to the gastric fundus and the incidence of esophageal anastomotic leak after esophagectomy for cancer. The leak rate was 26%. Pts with a leak had a significantly higher RT dose to the gastric fundus. Using a cut point of 31.4 Gy, leak rates were 43% vs 15% for the high and low dose radiation exposure. Radiation dose was an independent predictor of anastomotic leak in multivariable analysis.
In this retrospective study of propensity-matched patients undergoing CABG, the authors queried whether prior PCI adversely affected outcomes. 9% of over 4500 pts undergoing first time CABG had prior PCI. There was no difference between the groups with regard to hospital mortality or 10-year survival.