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Journal and News Scan

Source: Circulation Research
Author(s): Hayat S, Kramann R

This editorial describes the evolving pathway of diagnosing a disease that is predicted to augment the indication for orthotopic cardiac transplantation. Cardiac involvement of sarcoidosis accounts for the majority of deaths in sarcoidosis patients, so it is important to better understand its symptoms. The differential diagnosis with giant cell myocarditis will certainly be of importance in providing nuance to the decisions of the transplant meeting.

Source: The Annals of Cardiothoracic Surgery
Author(s): Gileh-Gol Akhtar-Danesh, MD, Noori Akhtar-Danesh, PhD, and Yaron Shargall, MD
This study aimed to establish risk factors for venous thromboembolism (VTE), a significant cause of mortality in lung cancer surgical patients. Unlike in surgical specialties that have adopted postdischarge VTE prophylaxis, in thoracic surgery the evidence is scarce. The study concluded that patients undergoing more extensive procedures and patients with advance stage lung cancer have an increased VTE risk. Strategies to reduce VTE risk should be considered in these patients.
Source: NPJ Digital Medicine
Author(s): Willian J. Gordon, Naruhiko Ikoma, Heather Lyu, Gretchen Purcell Jackson, Adam Landman
As robotic surgery continues to advance and become a more established method in cardiothoracic and other surgical specialties, concerns have arisen surrounding cybersecurity. Healthcare systems are particularly vulnerable to cybersecurity attacks, and the complex nature of robotic surgery systems creates additional risk. To mitigate that risk, it is important to recognize system complexity, regularly update software, follow cybersecurity best practices, and increase transparency with robotic surgery patients.
Source: Circulation Research
Author(s): Hu J, Yao J, Deng S, Balasubramanian R, Jiménez MC, Li J, Guo X, Cruz DE, Gao Y, Huang T, Zeleznik OA, Ngo D, Liu S, Rosal MC, Nassir R, Paynter NP, Albert CM, Tracy RP, Durda P, Liu Y, Taylor KD, Johnson WC, Sun Q, Rimm EB, Eliassen AH, Rich SS, Rotter JI, Gerszten RE, Clish CB, Rexrode KM.

Plasma metabolomic profiles were examined to determine differences in social determinants of health between Black and white women. This observational study paves the groundwork for further investigation of social disparity in atheromatous disease. The historical hereditary effect of renin aldosterone axis regulation may be proven to reflect such disparities (related to slave trade and water deprivation) concerning people with African heritage. In fact, the study concluded that the significant difference in metabolomic profiles between Black and white women may be associated with coronary heart disease risk and racial disparities in the US.

Source: The Annals of Thoracic Surgery
Author(s): Jennie H. Kwon, MD, Ryan J. Tedford, MD, Bhavadharini Ramu, MD, Lucas J. Witer, MD, Nicolas H. Pope, MD, Brian A. Houston, MD, Zubair A. Hashmi, MD, Marc R. Katz, MD, and Arman Kilic, MD

Over the past three decades, more than 76,000 heart transplantations have been performed. This study evaluated trends and outcomes of patients who underwent the procedure to treat peripartum cardiomyopathy (PPCM)—a disease limited to female patients—the frequency of which increased over the study period. The analysis found that the ten-, fifteen-, and twenty-year survival rates were significantly lower among PPCM heart transplant patients than other female heart transplant patients. Additionally, survival rates were even lower among Black and Hispanic patients. However, the survival rate among PPCM patients did improve over the last decade, particularly for Black transplant patients.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Joseph S. Coselli, Eric E. Roselli, Ourania Preventza, S. Chris Malaisrie, Allan Stewart, Paul Stelzer, Hiroo Takayama, Edward P. Chen, Anthony L. Estrera, Thomas G. Gleason, Michael P. Fischbein, Leonard N. Girardi, Himanshu J. Patel, Joseph E. Bavaria, Scott A. LeMaire

The authors of this study reported the safety and one-year clinical outcomes of the Thoraflex Hybrid frozen elephant trunk prosthesis from the US Investigational Device Exemption trial.  Follow-up was available in 63 of 65 patients from twelve centers at one-year, when the mortality was 11 percent (7/65), and freedom was 81 percent (51/63) from major adverse events, including permanent stroke (n = 3), permanent paraplegia/paraparesis (n = 3), unanticipated aortic-related reoperation, or all-cause mortality (n = 7); planned extension procedures were performed in twenty-six (41%), including twenty-two endovascular procedures by a median of four months. While one-year results are acceptable, long-term data are needed to assess durability of the repairs.

Source: Cardiovascular Business
Author(s): Michael Walter

While transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, a new study in the American Journal of Cardiology showed that there may be a high risk of in-hospital mortality for patients who undergo surgical aortic valve replacement (SAVR) after TAVR. Because of questions surrounding the long-term durability of TAVR, future cardiac surgery often has to be considered. In patients who underwent SAVR after TAVR because of various complications, the mortality rate after one year was 53 percent. This number is higher than past studies and must be monitored as TAVR becomes a more common procedure. Read the full study here.

Source: Duke Today
Author(s): Stephanie Lopez
According to Duke University Health, a team of its surgeons has completed the first partial heart transplant, with living arteries and valves from a donated heart fused onto the heart of the existing newborn patient. This method allows the entire heart to grow as one, which could eliminate the need for multiple heart surgeries in a child’s lifetime and potentially extend the life of the child by decades. The patient has shown remarkable growth since the procedure and will provide insight for future children born with congenital heart diseases.
Source: The Annals of Thoracic Surgery
Author(s): Parth Mukund Patel, MD; Mia Callahan, BS; Andy Dong, BS; Jane Wei, MPH; Jose Binongo, PhD Bradley Leshnower, MD; Edward P. Chen, MD

From 2005 to 2020, 523 patients were treated using a novel method of aortic root replacement that used a self-constructed tissue valve conduit involving a Freestyle subcoronary valve sewn into a Valsalva graft. This study aimed to review the clinical outcomes of the method. Over the fifteen-year period, the five-year survival rate was 83 percent and the ten-year survival rate was 71 percent. Overall, the novel method produced excellent operative and ten-year outcomes, and valve durability was outstanding with low incidence for valve reintervention.

Source: JAMA Cardiololgy
Author(s): Kevin M. Harris, Christoph A. Nienaber, Mark D. Peterson, Elise M. Woznicki, Alan C. Braverman, Santi Trimarchi, Truls Myrmel, Reed Pyeritz, Stuart Hutchison, Craig Strauss, Marek P. Ehrlich, Thomas G. Gleason, Amit Korach, Daniel G. Montgomery, Eric M. Isselbacher, Kim A. Eagle

This is the most recent data on the early mortality of acute type A aortic dissection within the first forty-eight hours from onset. Prior to this study, there was a lack of contemporary data that characterized the positive effects of timely surgery.

Based on 5611 patients enrolled between January 1996 and November 2018, the IRAD investigators have found an overall mortality of 5.8% over the first forty-eight hours. In medically managed patients, mortality was 23.7% at forty-eight hours (0.5% per hour). For patients intended for surgical treatment, forty-eight-hour mortality was 4.4% (0.09% per hour), and 1% died before the operation. Surgical patients were more likely to die of multiorgan failure and bleeding complications, while medically managed patients were more likely to die of aortic rupture and cardiac tamponade.