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Journal and News Scan
Because of the potential risk of early structural valve deterioration, the FDA has sent notice about Abbott’s decision to stop selling and distributing Trifecta aortic surgical heart valves in the United States. The FDA recommends that healthcare providers be aware of the risk of SVD with Trifecta valves, discuss risk with patients, and monitor patients who have undergone implantation with Trifecta valves.Because of the potential risk of early structural valve deterioration, the FDA has sent notice about Abbott’s decision to stop selling and distributing Trifecta aortic surgical heart valves in the United States. The FDA recommends that healthcare providers be aware of the risk of SVD with Trifecta valves, discuss risk with patients, and monitor patients who have undergone implantation with Trifecta valves.
This report describes a new Society of Thoracic Surgeons mortality risk model for adults with congenital heart disease undergoing cardiac operations that are not included in existing risk models. A risk model was developed using forty-seven congenital variables in 192,196 patients operated on between 2011 and 2019. The risk model was more accurate at predicting operative mortality in adult patients undergoing congenital cardiac surgery (C statistic, 0.815) than the existing Society of Thoracic Surgeons adult risk model without congenital variables (C statistic, 0.79). This will support an online risk calculator for adult patients undergoing congenital cardiac surgery.
Authors representing the American Association for Thoracic Surgery and The Society of Thoracic Surgeons published a rebuttal to the Chronic Coronary Disease Guidelines. The authors explain their stance on the revised guidelines, stating their belief that the new recommendations on revascularization are flawed adaptations of the 2021 guidelines. The rebuttal points out contradicting evidence, missing information, selection biases, and more within the revised guidelines.
For more on the societies’ reaction to the new guidelines, read this article from tctMD.
Alberta’s first minimally invasive direct coronary artery bypass (MIDCAB) surgery was performed at one of the few sites in Canada offering the procedure. The procedure is less invasive than traditional bypass surgery and provides patients with a faster recovery time. Since the first procedure, the multidisciplinary team at the center have performed ten more, a big step for Canadian cardiac surgical care.
In forty-eight consecutive patients undergoing explants of transcatheter aortic valve replacement (TAVR) at a single center between 2011 and 2021, at a median of 2.3 years after TAVR, the most common indications for surgery were nonstructural valve dysfunction (patient-prosthesis mismatch or paravalvular leak) in 35 percent, structural valve deterioration in 29 percent, and mitral valve disease in 29 percent. The authors describe that TAVR valves were typically easily removed; however, unplanned aortic root replacement because of aortic root trauma during explantation was required in four patients, and root enlargement was required in four patients. Overall operative mortality was 15 percent.
These new guidelines contain wide-ranging recommendations on the use of beta-blockers, sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1, and other medical therapies to treat chronic coronary disease. They also contain recommendations on how to evaluate, diagnose, and risk stratify patients, as well as the role of coronary revascularization when medical therapy does not work.
Visit this article from tctMD for a summary of the guidelines, including additional observations from the authors.Visit this article from tctMD for a summary of the guidelines, including additional observations from the authors.
To measure the effectiveness of cardiac rehabilitation for CABG patients, researchers used mortality within two years of discharge as the primary outcome. They found that use of cardiac rehabilitation is associated with a lower two-year mortality rate compared with non-CR users. In an article about the study, researchers also stated that “minority and underserved populations face many barriers to cardiac rehab, but improving referral, attendance, and adherence in these populations may be an effective strategy to mitigating longstanding disparities in cardiovascular outcomes.”
This study aimed to determine if socioeconomic status and region had any effect on post-transplant outcomes across different races and ethnicities. After another study found that transplant outcomes varied greatly based on multiple factors, researchers wanted to know if socioeconomic factors played into differences based on race. They found that socioeconomic position did not explain most of the difference in posttransplant outcomes among racial groups. These findings highlight the presence of a complex social reality that warrants further study to increase equity among transplant recipients.
This study aimed to determine whether inferior pulmonary ligament (IPL) division leads to pulmonary dysfunction in 213 upper lobectomy (UL) patients divided into two groups with division or preservation of the IPL. The authors found no difference in complication rate, dead space area, forced vital capacity, or forced expiratory volume in 1 s. However, after left UL, pulmonary function was significantly better in the IPL preservation group. IPL division during left UL caused pulmonary dysfunction and limited airflow due to bronchial kinking.
This expert single-center series analyzes 1,429 ascending aorta and arch replacements performed between 1991 and 2020 with circulatory arrest at nadir temperatures of 14 to 20°C with retrograde cerebral perfusion, including 464 acute type A dissections. The authors report overall operative mortality of 8.9 percent and stroke rate of 8.4 percent. The incidence of stroke was less than 5 percent when retrograde perfusion lasted less than twenty minutes and 11.5 percent at sixty minutes, with a linear relationship. The authors recommend other adjuncts for cerebral protection if circulatory arrest is anticipated to be more than sixty minutes.