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Journal and News Scan
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.
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.
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.
Recently, there has been an increase in infective endocarditis cases among people who inject drugs. As a result, the American Heart Association has sponsored a writing group of recognized experts to produce a more in-depth article on the management of infective endocarditis among this unique population. The writing group concluded that management of infective endocarditis in people who inject drugs requires a unique and wholistic approach to care, including the involvement of addiction-trained clinicians and measures taken to prevent an infection recurrence. The study also emphasizes that, regardless of current drug use, people with infective endocarditis who inject drugs should be considered for heart valve repair or replacement surgery if needed.
In the past, there has not been an accurate way to calculate mortality risk for patients with atrial fibrillation (AF) who have undergone a successful transcatheter aortic valve implantation (TAVI) and have been discharged home. Now, researchers with the ENVISAGE-TAVI AF trial have developed a risk score to more accurately predict mortality in TAVI patients. George Dangas, of The Zena and Michael A. Wiener Cardiovascular Institute, presented the trial’s findings at the European Society of Cardiology Congress 2022, highlighting that the new risk assessment score focuses on improving outcomes by determining how to categorize patients after a successful TAVI and discharge. Dangas added that the analysis will continue to enhance the understanding of patient risk after TAVI.
In order to best estimate observed-to-expected operative mortality ratios for more than 100 congenital heart centers in North America, The Society of Thoracic Surgeons compared their current approach to approaches that incorporate information on diagnoses as moderators of procedures, other unused risk factors, and additional variation in confidence interval construction. This comparison allowed the authors to characterize center performance using Bayesian additive regression trees and lasso models used to link operative mortality to diagnosis-procedure categories, procedure-specific risk factors, and syndromes/abnormalities. The authors concluded that, after using the new approach, up to 16 percent of hospitals changed performance categories, most improving in performance. Given the significance of this type of quality report for congenital heart centers, they determined that the new method of analysis should be considered.
The decisions that medical students make regarding their career paths have a direct effect on the future medical workforce of a country. Their choice of specialty determines the distribution of their country’s medical workforce among different specialties and its ability to deliver specialized healthcare services.
The location of a medical student’s residency training is one of the most significant decisions they will make. This decision often foreshadows their career prospects, and the majority of students indicate the desire to train abroad. In Nigeria, there is already an alarming rate of brain drain among medical doctors and other healthcare professionals. It is important to begin to understand the factors that influence students’ choice to leave the country so that measures can be taken by policymakers to mitigate the negative impacts of a lean, skewed, and under-specialized workforce.
Although the demand for heart surgeons trained in a year is twenty, Kenya produces only four to five annually. This results in a gap in diagnosis and treatment of heart illnesses. The East African Simulation Centre for Cardiovascular Surgery was recently established at Gertrude's Children's Hospital in Kenya through partnership with the University of Nairobi and the German Heart Institute in Berlin.
Through this collaboration, the University of Nairobi will provide the trainers while the German Heart Institute will donate the equipment to improve training for cardiovascular surgery students and professionals, serving as a hub for the East African region. The center is directed locally by Dr. Mark Awori, head of pediatric cardiac surgery and was made possible from efforts led by Professor Charles Yankah of the German Heart Institute and the Pan-African Society for Cardio-Thoracic Surgery.
Most surgeons practice in high income countries, even though the majority of the world’s population lives in low- or middle-income countries. There is a significant disparity between high-income and low-income countries in the number of both cardiac and pediatric cardiac surgeons. The number of nonsurgical cardiovascular surgeons—including interventional cardiologists, cardiac anesthesiologists, perfusionists, technicians, and other health workers—in low-income countries remains unclear, along with where they are distributed. A clear path exists to foster and uphold heart teams with a high socioeconomic return on investment across countries, but failing to take action means that millions of people will continue to suffer from preventable and treatable cardiac conditions each year.