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Journal and News Scan

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Hayato Morimura, Minoru Tabata

Morimura et al. report on mechanical circulatory support bridging prior to repair of ventricular septal rupture. In eight patients, the use of intraaortic balloon pump +/- extracorporeal life support led to avoidance of emergency operation. Survival was 7/8 perioperative and 5/8 after one year. Delayed surgery of ventricular septal rupture by mechanical circulatory support bridging constitutes a safe strategy.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Umberto Benedetto, Shubhra Sinha, Matt Lyon, Arnaldo Dimagli, Tom R Gaunt, Gianni Angelini, Jonathan Sterne

Benedetto et al. looked into machine learning as a tool to predict mortality after cardiac surgery. They analyzed single-center data using prediction models, which were developed based on a neural network technique. They demonstrated in their cohort of more than 28.000 surgeries that machine learning methods did not result in improved prediction of mortality following cardiac surgery.

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Mevlüt Çelik, Milan M Milojevic, Andras P Durko, Frans B S Oei, Ad J J C Bogers, Edris A F Mahtab

Celik et al. present a meta-analysis regarding the outcome of TAVI implantation with respect to the survival six years after the implantation and compared it to the outcome of surgical aortic valve replacement. In their reconstructed individual patient data analysis, they found a significant higher 5-year mortality rate in TAVI patients compared to surgical aortic valve replacement.

Source: European Heart Journal Supplements, Volume 22, Issue Supplement_M, November 2020, Pages M19–M25
Author(s): Nikolaos Bonaros, Martin Czerny, Bettina Pfausler, Silvana Müller, Thomas Bartel, Matthias Thielmann, Sharaf-Eldin Shehada, Thierry Folliguet, Jean-Francois Obadia, Johannes Holfeld, Roberto Lorusso, Alessandro Parolari, Ludwig Müller, Michael Grimm, Elfriede Ruttmann-Ulmer

This is brief informative review that aids in decision making and provides criteria for early surgery for infective endocarditis in the setting of a neurologic event.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Raphaelle A Chemtob, Simon Fuglsang, Arnar Geirsson, Anders Ahlsson, Christian Olsson, Jarmo Gunn, Khalil Ahmad, Emma C Hansson, Emily Pan, Linda O Arnadottir, Ari Mennander, Shahab Nozohoor, Anders Wickbom, Igor Zindovic, Aldina Pivodic, Anders Jeppsson, Vibeke Hjortdal, Tomas Gudbjartsson

Chemtob et al. present data from the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD). They database out of eight hospitals the recorded data of 1,128 patients. This analysis focused on perioperative stroke, which occurred in 15.7% of all patients and was higher in patients with preoperative cerebral malperfusion, impaired hemodynamics, and in patients who underwent arch replacement. However, as many patients with prior cerebral malperfusion did not develop stroke, this should never be judged as contra-indication for surgery.

Source: The Annals of Thoracic Surgery
Author(s): Oliver S. Chow, MD, David M. Hoganson, MD, Aditya K. Kaza, MD, Mariana Chavez, MD, Firat H. Altin, MD, Gerald R. Marx, MD, Kevin G. Friedman, MD, Russell W. Jennings, MD, and Christopher W. Baird, MD

This retrospective observational study of patients undergoing surgical repair for TOF-APV between 2006 and 2018 evaluated the safety of pulmonary artery replacement and aggressive direct airway management at initial definitive repair of cardiac TOF-APV.

Source: The New England Journal of Medicine
Author(s): Joakim Nordanstig, M.D., Ph.D., Stefan James, M.D., Ph.D., Manne Andersson, M.D., Ph.D., Mattias Andersson, M.D., Peter Danielsson, M.D., Ph.D., Peter Gillgren, M.D., Ph.D., Martin Delle, M.D., Ph.D., Jan Engström, M.D., Torbjörn Fransson, M.D., Maher Hamoud, M.D., Ph.D., Anna Hilbertson, M.D., Patrik Johansson, M.D., Lars Karlsson, M.D., Ph.D., Björn Kragsterman, M.D., Ph.D., Hans Lindgren, M.D., Ph.D., Karin Ludwigs, M.D., Stefan Mellander, M.D., Ph.D., Niklas Nyman, M.D., Henrik Renlund, Ph.D., Birgitta Sigvant, M.D., Ph.D., Per Skoog, M.D., Ph.D., Joachim Starck, M.D., Gustaf Tegler, M.D., Ph.D., Asko Toivola, M.D., Maria Truedson, M.D., Carl-Magnus Wahlgren, M.D., Ph.D., Jonas Wallinder, M.D., Andreas Öjersjö, M.D., and Mårten Falkenberg, M.D., Ph.D.

An ad hoc interim analysis pursuant to previous publications raising concerns on Paclitaxel DCS in chronic critical and not-critical lower limb ischaemia. The short manuscript requires careful reading to form an individual opinion beyond the relatively simple arithmetics: slightly more deaths in the intervention group. The vasculopathic cohort had a 75% crude overall survival after only 2.5 years.

Source: Journal of Cardiac Surgery
Author(s): Fatima Osman, Noah Caplin, Mohamad Bashir

A brief and readable editorial on the United Kingdom prespective on the global impact of the pandemic to the delivery of cardiovascular care, attempting a semi-quantitative economic appraisal of the problem.

Source: The New England Journal Of Medicine
Author(s): Helio P. Guimarães, Renato D. Lopes, Pedro G.M. de Barros e Silva, Idelzuita L. Liporace, Roney O. Sampaio, Flávio Tarasoutchi, Conrado R. Hoffmann-Filho, Rodrigo de Lemos Soares Patriota, Tiago L.L. Diana Lamprea, Dalton B. ., Fernando A. Atik, Fabio S. Silveira, ., Fabio R. Farias, Diogo O. Barreto, Adail P. Almeida, Alexandre C. Zilli, João D. de Souza Neto, Margaret A. Cavalcante, Fernando A.M.S. Figueira, Flávia C.S. Kojima, Lucas Damiani, Renato H.N. Santos, Nanci Valeis, Viviane B. Campos, Jose F.K. Saraiva, Francisco H. Fonseca, Ibraim M. Pinto, Carlos C. Magalhães, Joao F.M. Ferreira, John H. Alexander, Ricardo Pavanello, Alexandre B. Cavalcanti, Otavio Berwanger, for the RIVER Trial Investigators

A large RCT with results somewhat supportive of considering a NOAC in the place of warfarin for post operative surgical patients. The study will be weighed against healthcare economical aspects. One question will arise:  Why,  if there was a subgroup ( the cohort had an average age below 60 years) eceiving lifelong warfarin or equivalent anticoagulation prior to surgery, they did not have a mechanical prosthesis?  It is of course possible that local financial constrains impede access to such devices, and bioprostheses were more affordable.  

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Hughes GC

A relatively recent, open-access, brief viewpoint on the utility of screening for thoracic aortic pathologies. Although the negative opinion expressed by the author may not be universally accepted, a debate fuelled by data and especially patient-centered cerebrospinal outcomes will certainly be of benefit; evem more so with the spreading of metrics for prediction of acute complications of aortic disease.

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