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Commentary: Subclinical valve thrombosis —Are all transcatheter aortic valves created equal?
Transcatheter aortic valve insertion (TAVI) technology presents new opportunities but also new challenges, including subclinical valve thrombosis (SCVT). In this edition of the Journal, Woldendorp and colleagues1 report a meta-analysis investigating SCVT after TAVI focusing on prevalence, predisposing factors, management, and consequences. Twelve studies that screened for SCVT using multidetector computed tomography (MDCT) were included comparing stroke risk between patients with SCVT and those without, as well as the effects of antiplatelet therapy and oral anticoagulation (OAC) on preventing SCVT.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 20, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Sajiram Sarvananthan, Clifford William Barlow Tags: Commentary Source Type: research

Subclinical valve thrombosis in transcatheter aortic valve implantation: A systematic review and meta-analysis.
Recent high-resolution CT studies after transcatheter aortic valve insertion (TAVI) have reported high prevalence of subclinical valve thrombosis (SCVT), potentially contributing to increased risk of late stroke. We aimed to investigate SCVT after TAVI patients with focus on prevalence, predisposing factors, management, and potential sequelae.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 18, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Kei Woldendorp, Mathew P. Doyle, Deborah Black, Martin Ng, Anthony Keech, Stuart Grieve, Paul G. Bannon Source Type: research

Inter- and intrasite variability of mortality and stroke for sites performing both surgical and transcatheter aortic valve replacement for aortic valve stenosis in intermediate-risk patients
Multisite procedure-based randomized trials may be confounded by performance variability and variability among sites. Therefore, we studied variability in mortality and stroke after patients were randomized to surgical (SAVR) or transcatheter aortic valve replacement (TAVR) in the Placement of Aortic Transcatheter Valves-2A (PARTNER-2A) randomized trial.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 14, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Kevin L. Greason, Eugene H. Blackstone, Jeevanantham Rajeswaran, Ashley M. Lowry, Lars G. Svensson, John G. Webb, E. Murat Tuzcu, Craig R. Smith, Raj R. Makkar, Michael J. Mack, Vinod H. Thourani, Susheel K. Kodali, Martin B. Leon, D. Craig Miller Tags: Adult Source Type: research

Inter- and Intra-site Variability of Mortality and Stroke for Sites Performing both Surgical and Transcatheter Aortic Valve Replacement for Aortic Valve Stenosis in Intermediate-risk Patients
Multi-site procedure-based randomized trials may be confounded by performance variability and variability among sites. Therefore, we studied variability in mortality and stroke after patients were randomized to surgical (SAVR) or transcatheter aortic valve replacement (TAVR) in PARTNER-2A.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 14, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Kevin L. Greason, Eugene H. Blackstone, Jeevanantham Rajeswaran, Ashley M. Lowry, Lars G. Svensson, John G. Webb, E.Murat Tuzcu, Craig R. Smith, Raj R. Makkar, Michael J. Mack, Vinod H. Thourani, Susheel K. Kodali, Martin B. Leon, D.Craig Miller Source Type: research

Commentary: Atrial fibrillation after aortic valve replacement: Predict, prevent, protect
When atrial fibrillation (AF) occurs after cardiac surgery, surgeons consider the arrhythmia a nuisance rather than a complication. This reflects natural optimism. Although perioperative AF is most often self-limited, it is associated with increased risk of stroke and death, increased hospital length of stay, and increased health care costs.1 Still, we tend not to worry too much because postoperative AF tends to resolve regardless of treatment strategy.1
Source: The Journal of Thoracic and Cardiovascular Surgery - June 13, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Marc Gillinov, Edward G. Soltesz Tags: Commentary Source Type: research

Balloons are not for angioplasty alone: A novel occlusion technique for stroke prevention
Stroke remains a significant source of morbidity and mortality after thoracic endovascular aortic repair (TEVAR). This is especially true with “hybrid” aortic arch aneurysm repairs, with stroke rates as high as 8% reported previously.1 Many of these patients have significant medical comorbidities, including previous stroke, peripheral vascular, and coronary artery disease, and resultant aortic atheroma and calcifications. It is well kn own that endovascular procedures in the aortic arch result in significant cerebral embolization; in fact, in the SENTINEL trial evaluating transcatheter cerebral embolic protection devic...
Source: The Journal of Thoracic and Cardiovascular Surgery - November 2, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Christopher R. Burke, Pavan Atluri Tags: Editorial Commentary Source Type: research

Commentary: Balloons are not for angioplasty alone: A novel occlusion technique for stroke prevention
Stroke remains a significant source of morbidity and mortality after thoracic endovascular aortic repair (TEVAR). This is especially true with “hybrid” aortic arch aneurysm repairs, with stroke rates as high as 8% reported previously.1 Many of these patients have significant medical comorbidities, including previous stroke, peripheral vascular, and coronary artery disease, and resultant aortic atheroma and calcifications. It is well kn own that endovascular procedures in the aortic arch result in significant cerebral embolization; in fact, in the SENTINEL trial evaluating transcatheter cerebral embolic protection devic...
Source: The Journal of Thoracic and Cardiovascular Surgery - November 1, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Christopher R. Burke, Pavan Atluri Tags: Commentary Source Type: research

Mitral repair in symptom-free patients with normal ventricles: Becoming the new normal?
We have all been there. A young, vigorous woman referred to you with severe asymptomatic mitral regurgitation is in your office to discuss surgical repair. You proceed to describe the incision you are going to make somewhere on her chest; the 1% to 2% risk of bleeding, stroke, infection, heart failure, and death; the fact that she may end up with a prosthetic mitral valve requiring lifelong anticoagulation; and the fact that she is going to have to miss a month or more of her Pilates classes because the American College of Cardiology and American Heart Association Task Force on Practice Guidelines (ACC/AHA) says that it is...
Source: The Journal of Thoracic and Cardiovascular Surgery - September 5, 2018 Category: Cardiovascular & Thoracic Surgery Authors: David D. Yuh Tags: Editorial Commentary Source Type: research

Commentary: Mitral repair in symptom-free patients with normal ventricles: Becoming the new normal?
We have all been there. A young, vigorous woman referred to you with severe asymptomatic mitral regurgitation is in your office to discuss surgical repair. You proceed to describe the incision you are going to make somewhere on her chest; the 1% to 2% risk of bleeding, stroke, infection, heart failure, and death; the fact that she may end up with a prosthetic mitral valve requiring lifelong anticoagulation; and the fact that she is going to have to miss a month or more of her Pilates classes because the American College of Cardiology and American Heart Association Task Force on Practice Guidelines (ACC/AHA) says that it is...
Source: The Journal of Thoracic and Cardiovascular Surgery - September 4, 2018 Category: Cardiovascular & Thoracic Surgery Authors: David D. Yuh Tags: Commentary Source Type: research

Performance of CHA2DS2-VASc Score for Stroke Prediction after Surgical Aortic Valve Replacement
Stroke is a frequent complication occurring early and late after surgical aortic valve replacement (SAVR). There is an unmet clinical need for simple tools to assess postoperative stroke risk. We sought to assess the predictive performance of CHA2DS2-VASc score in patients undergoing SAVR with a bioprosthesis.
Source: The Journal of Thoracic and Cardiovascular Surgery - July 28, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Tuomas Kiviniemi, Joonas Lehto, Maunu Nissinen, Tuomo Nieminen, Juha Hartikainen, Markus Malmberg, Fredrik Yannopoulos, Jyri Savolainen, Pasi Karjalainen, K E Juhani Airaksinen, Stefano Rosato, Fausto Biancari Source Type: research

Reinventing the atrial fibrillation wheel
In this issue of the Journal, Mehta and colleagues1 report their 10-year experience with “De Novo Atrial Fibrillation After Mitral Valve Surgery,” defined as new-onset atrial fibrillation (AF) occurring more than 90 days after discharge. The cause was heterogeneous, with half of the patients having degenerative pathology. The incidence of de novo AF was 14% and 23% at 5 and 10 yea rs, respectively. Multivariable risk factors were tricuspid valve surgery, aortic valve surgery, and older age. Obviously, significantly more patients with AF were anticoagulated, with a strong but not significant trend toward an increased risk of stroke.
Source: The Journal of Thoracic and Cardiovascular Surgery - July 15, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Isidore Dinga Madou, Tsuyoshi Kaneko, Sary F. Aranki Tags: Editorial Commentary Source Type: research

Atheromatous disease of the aorta and perioperative stroke
Despite continued improvements in patient outcomes after cardiac surgery, stroke remains one of the most feared and devastating complications of cardiac surgery and is estimated to occur in 1.2% to 1.6% of patients undergoing coronary artery bypass grafting (CABG).1-3 The incidence of stroke increases for other common cardiac surgical procedures, and contemporary studies from the Society of Thoracic Surgeons database have reported perioperative stroke rates of 1.4% for mitral valve repair,4 1.5% for aortic valve replacement,5 2.1% for mitral valve replacement,4 and 6.6% for proximal aorta replacement.
Source: The Journal of Thoracic and Cardiovascular Surgery - September 13, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Nicholas D. Andersen, Stephen A. Hart, Ganesh P. Devendra, Esther S.H. Kim, Douglas R. Johnston, Jacob N. Schroder, Richard A. Krasuski Tags: Expert review Source Type: research

Cerebral protection for transcatheter aortic valve implantation: A no brainer?
Stroke is one of most devastating and dreaded complications of cardiothoracic procedures, associated with dramatically increased mortality, morbidity, and costs.1,2 Recent years have seen heightened awareness of the prevalence and impact of neurologic complications of surgery. Simultaneously, transcatheter aortic valve implantation (TAVI) has emerged as a major advance in the management of patients with calcific valvular disease, a condition that is becoming increasingly common owing to the aging of the population.
Source: The Journal of Thoracic and Cardiovascular Surgery - May 25, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Steven R. Mess é, Karen L. Furie Tags: Feature expert opinion Source Type: research

Measuring and mitigating stroke in transcatheter aortic valve implantation: Long roads to the easy answers
Transcatheter aortic valve implantation (TAVI) has rapidly displayed its utility in the treatment of aortic valve disease. While presenting a lesser procedural morbidity and mortality risk, as compared with surgical aortic valve replacement (SAVR), early trials reported higher rates of stroke.1,2 To mitigate this complication, cerebral embolic protection (CEP) devices were developed for use in TAVI but there has been limited penetrance into the market. Among the reasons for this are their novelty, relatively low rates of clinically relevant stroke, added complexity of their deployment, cost, and uncertainty of their benefit.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 12, 2017 Category: Cardiovascular & Thoracic Surgery Authors: John Bozinovski Tags: Editorial commentary Source Type: research

Avoiding coronary obstruction after transcatheter aortic valve replacement: Is it the skirt or what's inside that counts?
In this issue of the Journal, Chu and colleagues1 posit that coronary obstruction in patients at high risk undergoing transcatheter aortic valve replacement (TAVR) may be mitigated by the unique engagement mechanism and protective skirt of the ACURATE TA device (Symetis Inc, Ecublens, Switzerland). Initial obstacles with TAVR, including stroke, vascular complications, and paravalvular leak (PVL) have seen marked improvements through case selection and device design; however, the rare and lethal complication of coronary artery obstruction remains vexing, particularly in patients at high risk with small aortic diameters, low...
Source: The Journal of Thoracic and Cardiovascular Surgery - November 20, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Mohamad Alkhouli, Vinay Badhwar Tags: Editorial commentary Source Type: research

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