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Journal and News Scan
Abbott announced that its fourth-generation MitraClip device, MitraClip G4, was approved by the US Food and Drug Administration on July 15, 2019, to treat mitral regurgitation (MR) in a wider population of patients. The MitraClip G4 include new clip sizes and an enhanced leaflet grasping feature
- More flexibility with four unique clip sizes, including clips with a wider grasping area to provide additional treatment options
- Independently controlled grippers that better help with the grasp of one or both mitral leaflets during transcatheter mitral valve interventions
- Upgraded MitraClip catheter can be integrated with a commercially available pressure monitor to continuously track and confirm MR reduction during the implant procedure
Aortic valve repair is complex, and techniques must be tailored to the pathology. With this in mind, the author summarizes his core philosophy on aortic valve repair in 10 points:
- Be prepared!
- Know the geometry of the aortic valve
- Understand the echocardiographic analysis of the aortic valve
- Do not trust looks!
- Identify suitable substrates
- Keep the repair simple and reproducible
- Assess the repair result systematically
- Carefully consider the alternatives
- Follow your patients/Learn from your failures
- Share your results
Each point is discussed in more depth in this editorial.
Investigators reported the distribution of thoracic aortic growth in smokers based on longitudinal data of current and ex-smokers aged 50-70 years from the Danish Lung Cancer Screening Trial. Mean and 95th percentile of annual aortic growth of the ascending aortic and descending aortic diameters were calculated with the first and last noncontrast computed tomography scans during follow-up.
A total of 1,987 participants (56% male, mean age 57.4 ± 4.8 years) were included and followed for a median of 48 months. The ascending and descending aortic growth was approximately 0.1 mm/year and consistent with growth in the general population. The 95th percentile ranged from 0.42 to 0.47 mm/year, depending on sex and location. Larger aortic growth was associated with lower age, increased height, absence of medication for hypertension or hypercholesterolemia, and lower Agatston scores.
An important update on the evolving landscape of surgery for atrial fibrillation.
Later this year, AATS will launch two new open access journals, JTCVS Open and JTCVS Techniques, to provide authors with additional options to publish high-quality information of importance to thoracic and cardiovascular surgeons.
Tirone David's experience on his operation, with interesting data on the durability of the re-implantation.
Hamandi and colleagues reviewed outcomes for 95 patients who underwent isolated tricuspid valve (TV) surgery between 2007 and 2017 at their institution. For 41% of patients, the procedure was reoperative, following either prior coronary artery bypass grafting or prior valve surgery. Valve repair was performed in over 70% of patients. Operative mortality was low, being 3.2% overall and with no mortality in the last 6 years studied (73 patients). The authors conclude that careful patient selection and current periprocedural management have improved morbidity and mortality of isolated TV surgery, and they suggest that these outcomes can serve as a benchmark for catheter-based TV interventions.
Spread through air space (STAS) is a pattern of lung adenocarcinoma invasion, and it is a predictor of recurrence in patients with early-stage lung adenocarcinoma. However, less is known about the role of STAS in advanced lung adenocarcinoma. In this retrospective study including 76 patients with stage III lung adenocarcinoma, the presence of a STAS invasion pattern was a significant risk factor for adenocarcinoma relapse.
Transcatheter aortic valve replacement (TAVR) is expanding to younger patients, but the feasibility of TAVR in failing transcatheter aortic valves (TAV) remains unknown. Dr Tang and colleagues demonstrate in a retrospective review of 551 TAVR procedures by evaluating the postdeployment aortogram using a novel aortic root anatomic classification that TAV-in-TAV after Edwards SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) TAVR may not be feasible in >20% of S3 TAVR procedures and in >50% among patients with type 3 roots.
Unique challenges for TAV-in-TAV compared to surgical aortic valve replacement: (1) the native aortic valve leaflets remain in situ after the initial TAVR, acting as a barrier facing the LM orifice; (2) there is currently no predictable way to align the TAV neocommissures with native commissures; (3) often the only way to engage the left main coronary artery is from the TAV stent frame.
This is particularly important given the potential expansion of TAVR to low-risk and/or younger patients who may need redo TAVR. The ascertainment of aortic root type, STJ and SH relative to TVH is essential to guide valve selection and positioning for TAV-in-TAV feasibility on the basis of left main coronary artery obstruction risk.
The Washington University group compared operator radiation exposure during transcatheter valve implantation when performed via a transfemoral versus an alternative access approach, when performed in a catheterization lab versus a hybrid operating room (OR), and investigated the potential benefit of disposable shielding.
They found that procedures performed in the hybrid OR were associated with higher operator radiation exposure. In comparison to the transfemoral approach, alternative access cases had the highest levels of operator radiation. This is particularly important in cases of transcatheter mitral valve replacement that can only be done via an alternative access approach. The use of disposable radiation shielding in this series did not attenuate operator radiation exposure. The authors conclude that radiation shielding within hybrid ORs should be scrutinized in an effort to remain on par with that found within catheterization labs.