Journal and News Scan

Aortic stenosis affects more than 9 million people worldwide and is commonly treated with surgical aortic valve replacement (SAVR), which is known for producing excellent long-term outcomes. Recent advancements in transcatheter aortic valve replacement (TAVR) have shown noninferior or improved outcomes compared to SAVR across various risk levels. Despite TAVR's growth, innovations in surgical valves, such as sutureless aortic valves (SURD), are maintaining SAVR's relevance. The Perceval S valve, a sutureless option, has shown promising early and midterm results. It reduces cardiopulmonary bypass and aortic cross-clamp times, which are linked to lower morbidity and mortality. This review highlights the design, deployment, and clinical outcomes of the Perceval S valve. While it offers benefits similar to TAVR, it presents unique advantages for certain patients, including those requiring minimally invasive SAVR (such as robotic, mini thoracotomy, or mini sternotomy approach), those with small aortic annuli, patients undergoing concomitant procedures aimed at shortening cardiopulmonary bypass times, and redo scenarios. However, it presents unique risks as well, including an increased risk of postoperative need for permanent pacemaker implantation. Future research is needed to refine techniques and further evaluate long-term outcomes. 

This study examines trends and long-term survival outcomes for heart transplants involving donation after circulatory death (DCD) versus donation after brain death (DBD). Using data from December 2019 to September 2023, the study identified 792 DCD transplants out of 11,625 total heart transplants, with 249 classified as normothermic regional perfusion (DCD-NRP) and 543 classified as direct procurement and perfusion (DCD-DPP). The proportion of DCD transplants increased from 2 percent in December 2019 to 11 percent in early 2023. Survival rates at 1 and 3 years posttransplant were similar between DBD and both DCD-NRP and DCD-DPP groups. Rates of postoperative complications, including stroke, dialysis, acute graft rejection, and primary graft dysfunction, were also comparable. The study found that survival rates were consistent across different recipient risk levels and transplant center volumes. These results suggest that DCD hearts offer comparable long-term survival to DBD hearts and support the expanding use of DCD donors to increase the available organ pool. 

This study evaluated 139 patients undergoing elective lung resections, focusing on compliance with Enhanced Recovery After Thoracic Surgery (ERATS) protocols and patient outcomes. Key results included a median postoperative hospital stay of seven days and a 19 percent perioperative complication rate, with no 30-day mortality. The study categorized ERATS measures into three compliance groups: patient-dependent measures (49.3 percent compliance), interdisciplinary consensus measures (85.8 percent), and surgical measures (88 percent). Newly implemented strategies included anemia management, carbohydrate loading, and standardized chest drain management. Other existing measures, such as perioperative antibiotics and intraoperative warming, are already well-established. The study emphasized the need for tailored implementation to enhance compliance, particularly in patient-dependent aspects, to improve overall outcomes. These findings suggest that step-by-step integration of ERATS protocols can significantly benefit thoracic surgery practices, offering a framework for better recovery and reduced complications​. 

Ischemic cardiomyopathy (ICM) accounts for more than 60 percent of congestive heart failure cases and is associated with significant morbidity and mortality. Myocardial revascularization in patients with left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF ≤35 percent) is intended to improve survival and quality of life. Most randomized clinical trials, however, have excluded these patients, leaving the evidence base primarily observational. A scoping review, using the Arksey and O’Malley methodology, examined surgical revascularization strategies in adults with ischemic LVD (LVEF ≤35 percent). After screening 385 references, 156 were selected, with 134 deemed suitable for review. The review addressed current knowledge, surgical strategies (off-pump vs on-pump), and graft options for revascularization. Findings suggest that coronary revascularization is beneficial in LVD (LVEF <35 percent) with ONCABG preferred for multivessel disease and OPCAB recommended for older, high-risk patients.