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Journal and News Scan
The authors analyzed the volumes of thoracic endovascular aneurysm repair (TEVAR) for the treatment of descending thoracic aneurysms for Medicare patients over five years, comparing the proportion of cases to 30-day mortality.
As TAVR is used in progressively lower-risk cohorts, management of device failure will become increasingly important. This study reports the largest series of patients receiving a surgical reoperation after transcatheter aortic valve replacement (TAVR) using the STS Adult Cardiac Surgery Database. A total of 123 patients met inclusion criteria, and cases represent predominantly early TAVR failure (months to a few years from index procedure). Reoperation was associated with an operative mortality of 17.1% and other worse-than-expected outcomes when compared with similar patients initially undergoing surgical aortic valve replacement. Continued experience with this developing technology is needed to reduce the incidence of early TAVR failure and further define optimal treatment of failed TAVR prostheses.
This review provides a concise summary of frequently asked questions related to COVID-19 in children with congenital heart disease.
The authors compared surgically managed signet ring cell adenocarcinoma and esophageal adenocarcinoma patients in the National Cancer Database.
This manuscript by Kusadokoro et al. retrospectively looks into the outcome of patients who underwent either planned or rescue double arterial cannulation in surgery for type A aortic dissection. The propensity match analysis proofed non-inferiority of double arterial cannulation regarding one- and five-year survival. The authors conclude double arterial cannulation to be safe for management and prevention of malperfusion during surgery for type A aortic dissection.
Autopsy examination of lungs from patients who died from SARS-CoV-2 infection, with comparison to the morphologic & molecular features of lungs from patients who died from ARDS secondary to influenza A (H1N1) infection and from uninfected controls. Although a small series, the finding of intussusceptive angiogenesis distinguished the pulmonary pathobiology of Covid-19 from that of equally severe influenza virus infection.
An international, multicenter, cohort study at 235 hospitals in 24 countries including all patients undergoing surgery who had SARS-CoV-2 infection confirmed. Mortality in patients with SARS-CoV-2 was mainly in those who had postoperative pulmonary complications, which was about 50% and at a rate far higher than the pre-pandemic baseline. As hospitals resume routine surgery, it is likely to be in environments that remain exposed to SARS-CoV-2. This study concludes that strategies are urgently required to minimize in-hospital SARS-CoV-2 transmision and mitigate the risk of postoperative pulmonary complications in SARS-CoV-2 infected patients whose surgery cannot be delayed.
This randomized controlled trial conducted by the National Emphysema Treatment Trial (NETT) on the results of lung volume reduction surgery (LVRS) was re-evaluated by the authors for longer-term results. They found long-term benefits to patients randomized to LVRS.
Mohamed and Asimakopoulos published a best evidence topic regarding the optimal INR target for patients with mechanical aortic valves. They analyzed a total of 922 studies and identified seven studies suitable for best evidence analysis. With regards to their results, a target INR below the standard INR target of 2-3 in patients without thrombogenic risk factors seems to be safe and did not increase the risk of thromboembolic events.
Liao et al. investigated the long-term outcome of conventional surgery repair and perventricular device occlusion for doubly committed subarterial (DCSA) VSD. They analyzed single-center results using propensity score matching. There were no differences in adverse events within the two groups. The interventional treatment resulted in shorter mechanical ventilation times and hospital stay. The authors concluded that interventional device therapy might be an alternative for selected patients with DCSA VSD.