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Journal and News Scan
Loger and colleagues implanted transcatheter prostheses in the mitral valve position in 33 pigs. Valve performance and heart function were analyzed for both supra-annular and subvalvular fixation. The supra-annular valve deployment was associated with a low degree of paravalvular leakage and was well-tolerated in the hearts, resulting in excellent three-month outcomes for these animals.
A randomized controlled trial coauthored by the Editor-in-Chief of the host periodical on the risk management of multivessel diabetic coronopathy.
Borracci and colleagues evaluated the incidence of acute kidney injury (AKI) in 418 patients during in-hospital care after cardiac surgery. The authors found AKI in 17.5 % of patients when considering the worst kidney function measurement in the postoperative period compared to 4.5 % of patients when only considering kidney function at discharge. Transient AKI did not affect in-hospital outcomes independently of the patient’s preoperative renal function.
Stanifer and colleagues present a contemporary analysis of tracheal surgery in the US with the goal of identifying predictors of major morbidity and mortality. Tracheal resections reported in The Society of Thoracic Surgeons General Thoracic Surgery Database between 2002 and 2016 were included in this analysis. The cervical approach was the most commonly used, and benign disease was the indication 75% of the time. Centers performing fewer than four resections per year had higher combined morbidity and mortality than centers performing at least four per year.
The authors, using the STS/ACC TVT Registry, analyzed the the occurrence of patient-prosthesis mismatch (PPM) in 62,215 patients enrolled between 2014 and 2017. They found that severe and moderate PPM occurred in 12% and 25% of patients, respectively. A greater degree of PPM was associated with a higher risk of mortality and rehospitalization at 1 year.
This study analyzed the cost-effectiveness of TAVR versus SAVR in 3110 intermediate-risk aortic stenosis patients from the PARTNER-2 trial. Using a Markov model, the authors found that TAVR is economically dominant from the perspective of lifetime cost-effectiveness in the US healthcare system. TAVR was estimated to save $8,000-$10,000 over the lifetime of the patient and to increase quality-adjusted survival by 0.15-0.27 years.
Grant and colleagues studied short- and midterm outcomes for 639 matched pairs of patients who underwent mitral valve surgery by either sternotomy or a minimally invasive approach at three UK institutions between 2008 and 2016. Patients were included even if they underwent concomitant tricuspid valve surgery or ablation for atrial fibrillation. The median follow-up time was 3.7 years, maximum follow-up was 9.1 years. Reintervention-free survival at eight years was similar in both groups (86.1% and 84.1%), and no differences were found in in-hospital mortality, reoperation during hospital admission, or stroke. Patients undergoing minimally invasive surgery had a reduced need for transfusion and a shorter postoperative hospital stay.
Patient Care and General Interest
Truly remote percutaneous coronary intervention was performed in five human patients at Apex Heart Institute in Ahmedabad, India.
Virtual reality comes to continuing medical education, as gastrointestinal surgeries performed at Cedars-Sinai Medical Center in Los Angeles, California, are turned into virtual reality courses.
Drugs and Devices
Meril Life Sciences has launched the MyVal, a transcatheter aortic valve designed and manufactured in India.
Research, Trials, and Funding
Researchers from Boston, Massachusetts, analyzed the alignment of hospital rankings and outcomes in cardiology and cardiac surgery, and their findings question how well readmission rates reflect quality of care.
The first patient has been treated in the Terminate AF study. The study, supported by Medtronic, aims to evaluate the simultaneous use of heat and cold for ablation to treat atrial fibrillation in surgical patients.
Schoenhoff and colleagues evaluated the impact of reimplantation techniques of the supra-aortic branches, en bloc or separate, on neurological complications following total arch replacement. In a study of 3345 patients enrolled to the ARCH registry, the authors found that separate reimplantation of the supra-aortic branches increased the risk of neurological complications in the full cohort but not in a comparison of 461 matched patient pairs. Implantation technique did not influence early mortality or late survival.
Takagi and colleagues performed a meta-analysis of eight randomized controlled trials comparing on-pump and off-pump coronary artery bypass grafting (CABG). They evaluated only trials with follow-up periods of five years or longer, and they pooled hazard ratios rather than odds ratios, where possible. The authors’ analysis found an increased mortality risk with off-pump CABG.