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Journal and News Scan

Source: Journal American College of Cardiology
Author(s): Michael A Borger, Matthias Raschpichler, Raj Makkar

This JANS Note is an editorial in response to a recent publication by Deharo et al comparing TAVR valve-in-valve versus redo-SAVR demonstrating improved short-term outcomes with TAVR ViV.  The detail limitations of this study and provide a persuasive argument for the need of a randomized trial comparing both modalities.  

Source: The Annals of Thoracic Surgery
Author(s): Jared P. Beller, William Z. Chancellor, J. Hunter Mehaffey, Robert B. Hawkins, Matthew R. Byler, Alan M. Speir, Mohammed A. Quader, Andy C. Kiser, MD, Leora T. Yarboro, Gorav Ailawadi, Nicholas R. Teman

The authors analyzed dual antiplatelet use after coronary bypass grafting in patients from 2011 to 2017, and they identified an increase driven by patient demographics.

Source: Journal of the American Heart Association
Author(s): Jennifer C.‐Y. Chung, Edwin Wong, Mingyi Tang, Daniella Eliathamby, Thomas L. Forbes, Jagdish Butany, Craig A. Simmons, and Maral Ouzounian

Aneurysmal ascending aortas were collected from elective aortic surgery, and normal aortas from transplant donors, and dissected aortas from surgery for aortic dissection. These aortas underwent delamination testing in simulation of aortic dissection. Biaxial tensile testing was performed to determine modulus of elasticity (aortic stiffness), and energy loss (a measure of efficiency in performing the Windkessel function). Delamination strength (Sd) was lowest in dissected aortas and highest in normal aortas, and aneurysms fell in between, with greater Sd in the BAV group than the TAV group (P<0.001). Bicuspid aortopathy was associated with greater stiffness (P<0.001), while aneurysms with TAV demonstrated greater energy loss (P<0.001). Increased energy loss was associated with decreased Sd, whereas there was no relationship between Sd and aortic stiffness.

Aneurysms with bicuspid aortic valve had higher delamination strength than those with tricuspid aortic valve, suggesting that bicuspid aortic valve was protective. Energy loss was lower in aneurysms with bicuspid aortic valve, and inversely associated with delamination strength, representing a potential novel biomarker.

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Saurabh Gupta, Puru Panchal, Kevin Gilotra, Ann Mary Wilfred, Winston Hou, Deborah Siegal, Richard P Whitlock, Emilie P Belley-Cote

Meta-analysis of 4 RCTs and 7 observational studies.
Observational studies suggest suggests a benefit of IV iron compared to no iron on mortality [relative risk 0.39, 95% confidence interval (CI) 0.23–0.65; P < 0.001, very low quality], units transfused per patient (mean difference −1.22, 95% CI −1.85 to −0.60; P < 0.001, very low quality), renal injury (relative risk 0.50, 95% CI 0.36–0.69; P < 0.001, very low quality) and hospital length of stay (mean difference −4.24 days, 95% CI −6.86 to −1.63; P = 0.001, very low quality). 
RCTs demonstrated a reduction in the number of patients transfused with IV iron compared to oral or no iron (relative risk 0.81, 95% CI 0.70–0.94; P = 0.005, moderate quality). The pooled estimates of effect from RCTs for mortality, hospital length of stay, units transfused per patient and renal injury were consistent in direction with observational studies.
IV iron may improve postoperative morbidity in adult cardiac surgery patients with preoperative anaemia or iron deficiency. A large, rigorous, placebo-controlled, double-blinded, multicentre trial is needed to clarify the role of IV iron in this patient population.

Source: The Annals of Thoracic Surgery
Author(s): Ismail Bouhout, Walid Ben-Ali, Dori Khalaf, Marie Josée Raboisson, Nancy Poirier

This meta-analysis searched the PubMed, EMBASE, and Cochrane Library databases to investigate both fenestrated and nonfenestrated Fontan procedures, focusing on early outcomes. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Erik Beckmann, Andreas Martens, Heike Krüger, Wilhelm Korte, Tim Kaufeld, Alissa Stettinger, Axel Haverich, Malakh Lal Shrestha

This is a retrospective cohort analysis of more than 500 patients undergoing the David I procedure. They specifically looked into the outcome of 50 patients with bicuspid aortic valve undergoing this procedure. While the freedom from reoperation was not different between the two groups, the freedom from reoperation at 10 years was 79% in bicuspid valve patients. Unfortunately, the authors cannot provide markers of success for the David I procedure in patients with bicuspid valves, like geometric findings of the valve prior to reconstruction. However, these results are very encouraging for valve repair success in patients with bicuspid aortic valves.

Source: The Annals of Thoracic Surgery
Author(s): Julia Dumfarth, Markus Kofler, Lukas Stastny, Simone Gasser, Michaela Plaikner, Severin Semsroth, Christoph Krapf, Thomas Schachner, Nikolaos Bonaros, Michael Grimm

This study assessed the association between preoperative neurologic dysfunction and postoperative neurologic injury in the diagnosis of acute type A aortic dissection.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Amedeo Anselmi, Vincent Galand, André Vincentelli, Stéphane Boule, Camille Dambrin, Clément Delmas, Laurent Barandon, Mathieu Pernot, Michel Kindo, Hoang Minh Tam, Philippe Gaudard, Philippe Rouviere, Thomas Senage, Magali Michel, Aude Boignard, Olivier Chavanon, Constance Verdonk, Marylou Para, Vlad Gariboldi, Edeline Pelce, Matteo Pozzi, Jean-François Obadia, Frederic Anselme, Pierre-Yves Litzler, Gerard Babatasi, Annette Belin, Fabien Garnier, Marie Bielefeld, Julien Guihaire, Martin Kloeckner, Costin Radu, Nicolas Lellouche, Thierry Bourguignon, Thibaud Genet, Nicolas D’Ostrevy, Benjamin Duband, Jerome Jouan, Marie Cécile Bories, Fabrice Vanhuyse, Hugues Blangy, Fabrice Colas, Jean-Philippe Verhoye, Raphael Martins, Erwan Flecher On behalf of the Determination of Risk Factors of Ventricular Arrhythmias After Implantation of Continuous Flow Left Ventricular Assist Device (ASSIST-ICD) Investigators

This original article retrospectively analyzed the outcome of 671 patients undergoing LVAD implantation within the French multicenter ASSIST-ICD registry. While half of the patients were in cardiogenic shock and more than 20% of patients were on ECLS prior to implantation, the survival at five years is around 50%. This reflects the real world and all-comers nature of this registry and therefore provides a frank picture of LVAD outcomes in France between 2007 and 2017. Looking at their results, the authors recommend earlier referral of heart failure patients to lower the 50% rate of patients being in cardiogenic shock prior to implantation and thereby improving result of LVAD therapy in France.

Source: The Annals of Thoracic Surgery
Author(s): Ziyad M. Binsalamah, Christopher Ibarra, Zachary Spigel, Rodrigo Zea-Vera, Jessica Zink, Jeffrey S. Heinle, Christopher A. Caldarone

This single-center study analyzed the aortic root replacement strategies for pediatric patients from 1995 to 2018. 

Source: The New England Journal of Medicine
Author(s): Maximilian Ackermann, Stijn E. Verleden, Mark Kuehnel, Axel Haverich, Tobias Welte, Florian Laenger, Arno Vanstapel, Christopher Werlein, Helge Stark, Alexandar Tzankov, , William W. Li, Vincent W. Li, Steven J. Mentzer, Danny Jonigk

A small histopathological study of SARS and influenza autopsies compared to rejected for transplantation lungs. There is some speculation on the popular procoagulopathic nature of the panvirus, based on expression of angiotensin converting enzyme 2.There might be a collateral stimulus for lung preservation in organ retrieval.

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