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Journal and News Scan
Changes in end organ function were assessed in 59 pts having a continuous flow LVAD in place for more than 3 years. Renal and hepatic function improved initially, but renal function deteriorated to preoperative levels during the follow-up period.
The authors describe a 10-year experience with extended arteriotomy for endarterectomy of a diffusely diseased LAD, using an internal mammary artery for reconstruction. Perioperative mortality was 1.1% and postoperative MI occurred in 9%. Survival at 5 years was 89% and freedom from acute cardiovascular events was 74%.
This trial randomly assigned 4,752 patients from 19 countries to either on-pump or off-pump CABG with a mean follow-up of 4.8 years. The authors report no difference in death, stroke, myocardial infarction, renal failure or repeat revascularization at 5 years between the two groups.
The webinar will be presented by one of the UK’s most senior general thoracic surgeons, Mr. Pala B. Rajesh, and will entail a one-hour interactive session on “everything you need to know” about the thymus. The session, aimed at trainees and surgeons alike, will be broadcast on March 6 at 2:00 p.m., Central Time (8:00 p.m., GMT), and will be repeated on March 7 at 2:30 a.m., Central Time (8:30 a.m., GMT). Visit https://www.rcsed.ac.uk/professional-support-development-resources/learning-resources/webinars to register.
In this manuscript, the authors describe their findings in an observational prospective study of 52 patients who had tentative diagnoses of bioprosthetic valve thrombosis (BPVT) of surgically implanted valves over a 3-year period. All patients underwent a trial of anticoagulation therapy with warfarin, and follow-up transthoracic or transesophageal echocardiography performed at least 4 weeks after the initiation of anticoagulation therapy. The authors found that an echocardiographic diagnostic score predicted the response to warfarin anticoagulation in BPVT with excellent accuracy, that warfarin significantly reduced prosthetic gradients in 83% of the patients; and that this diagnostic and therapeutic strategy was associated with minimal side effects and no mortality.
Padova and Bologna groups present an interesting cohort of patients treated with cadaveric cryopreserved sternocondral allograft for reconstruction of the anterior chest wall.
Coronary and/or CT angiograms were performed on 585 of 762 (94%) patients at varying intervals after CABG using the PAS-Port System proximal anastomotic device. The authors retrospectively evaluated the SVG patency at a mean follow-up interval (between CABG and the diagnostic procedures) was 319 ± 624 days. The patency rates of the SVG grafts performed with the device were 90% and 81% at 1 and 5 years, respectively, which compare very favorably with established SVG patency rates.
These authors from Spain retrospectively analyzed a group of 805 patients undergoing isolated heart valve surgery in order to correlate levels of high-sensitivity troponin T (hs-cTnT) and CK-MB with whether a patient experienced a postoperative MI, as diagnosed by EKG and/or TTE.
In all, 88 patients (10.9%) met the criteria for MI. In comparing the non-MI to the MI patients, the authors found, by analyzing the Receiver Operating Characteristics (ROC), the following peak cut-off levels to distinguish whether a patient had a postop MI or not:
- hs-cTnT: >1057 pg/mL @ 16 hours
- CK-MB: >55 mg/dl @ 8 hours.
The authors reviewed the retrospective INTERMACS database to assess whether outcomes after continuous-flow (CF) LVAD implantation varied with patient BSA. A total of over 10,000 CF LVAD patients were included. Of these, 231 (2%) had a BSA < 1.5 m².
Outcomes: Survival was similar. Postoepratively, smaller patients had a higher incidence of bleeding and driveline infection, but a lower incidence of RV failure and renal dysfunction.
The authors report on an echocardiographic sub-study of the NOTION trial, a prospective randomized study which compared outcomes between 120 patients undergoing TAVI and 112 patients undergoing aortic valve replacement (AVR). Although at 12 months of follow up, aortic valve area had increased significantly more in patients undergoing TAVI, left ventricular mass regression was more pronounced in those patients undergoing AVR. Also, whereas end diastolic volume (EDV) decreased in the AVR group, EDV increased in the TAVI group. Patients undergoing TAVI had more paravalvular leaks and need for pacemaker implantation. This could explain the differences in left ventricular mass and EDV in favour of AVR.