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Stroke after thoracic endovascular aortic repair: Can you “plug” the problem?
Perioperative stroke has become the main factor determining quality of life in patients undergoing aortic surgery. Complications traditionally associated with aortic surgery, such as myocardial failure or bleeding, now contribute less frequently to mortality in this patient population.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 8, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Florian S. Schoenhoff, Thierry P. Carrel Tags: Editorial Commentary Source Type: research

Commentary: Stroke after thoracic endovascular aortic repair: Can you “plug” the problem?
Perioperative stroke has become the main factor determining quality of life in patients undergoing aortic surgery. Complications traditionally associated with aortic surgery, such as myocardial failure or bleeding, now contribute less frequently to mortality in this patient population.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 7, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Florian S. Schoenhoff, Thierry P. Carrel Tags: Commentary Source Type: research

Comparing apples with oranges: The funfair of statistics
The CHA2DS2-VASc score estimates the risk of stroke in patients with atrial fibrillation.1,2 The CHA2DS2-VASc score accounts for congestive heart failure; hypertension; age of at least 75  years (doubled); diabetes mellitus; previous stroke, transient ischemic attack or thromboembolism (doubled); vascular disease; age 65 to 74 years; and sex category (female). Should the CHA2DS2-VASc score be considered as a categorical or a continuous factor, if the patients have an incremental in crease in risk of death, stroke, or bleeding?
Source: The Journal of Thoracic and Cardiovascular Surgery - August 3, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Ari A. Mennander Tags: Editorial Commentary Source Type: research

Early left ventricular assist device-related strokes: Turn up the flow, turn down the embolism?
Despite technical and surgical advances in continuous-flow left ventricular assist devices (LVADs), stroke remains a major complication. In the eighth annual Interagency Registry for Mechanically Assisted Circulatory Support report,1 stroke dominates as the major cause of death between 6  months and 4 years of device support. Previously identified risk factors for stroke in LVAD patients include pump thrombosis, infection, blood pressure, gastrointestinal bleeding, and excessive antithrombotic treatment.
Source: The Journal of Thoracic and Cardiovascular Surgery - August 3, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Mark Helmers, Pavan Atluri Tags: Editorial Commentary Source Type: research

Impact of concurrent surgical valve procedures in patients receiving continuous-flow devices
Conclusions: Patients frequently require concurrent VPs at the time of LVAD placement; these patients are sicker and have higher early mortality. Furthermore, right ventricular dysfunction is increased in these patients. Further studies to develop selection criteria for concurrent valve interventions are important to further improve clinical outcomes.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 14, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Ranjit John, Yoshifumi Naka, Soon J. Park, Chittoor Sai-Sudhakar, Christopher Salerno, Kartik S. Sundareswaran, David J. Farrar, Carmelo A. Milano Tags: Acquired Cardiovascular Disease Source Type: research

Left Atrial Appendage Exclusion: An Alternative to Anticoagulation in Non-Valvular Atrial Fibrillation
One in every five strokes is due to atrial fibrillation. Anticoagulation has been the evidence-based practice for stroke risk reduction. Anticoagulation is however also associated with a lifelong commitment to a risk of bleeding-related morbidity and mortality. There is a need for alternatives to anticoagulation in atrial fibrillation. In this review, we summarize the evidence behind the technologies that are proposed to reduce the risk of stroke in atrial fibrillation patients who cannot receive or do not want anticoagulation.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 2, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Kareem Bedeir, David R. Holmes, James L. Cox, Basel Ramlawi Source Type: research

Right anterior minithoracotomy versus conventional aortic valve replacement: A propensity score matched study
Conclusions: Right anterior minithoracotomy in patients undergoing isolated aortic valve surgery is associated with a lower incidence of postoperative atrial fibrillation and blood transfusion and shorter ventilation time and hospital length of stay. Prospective randomized trials are needed to confirm our data.
Source: The Journal of Thoracic and Cardiovascular Surgery - April 20, 2012 Category: Cardiovascular & Thoracic Surgery Authors: Mattia Glauber, Antonio Miceli, Daniyar Gilmanov, Matteo Ferrarini, Stefano Bevilacqua, Pier A. Farneti, Marco Solinas Tags: Acquired Cardiovascular Disease Source Type: research

Clinical outcomes of aortic root replacement after previous aortic root replacement
Conclusions: Aortic root replacement after a previous aortic root replacement is associated with a relatively low operative mortality and perioperative morbidity, but long-term survival is suboptimal. Increasing age and prosthetic valve endocarditis adversely affect survival.
Source: The Journal of Thoracic and Cardiovascular Surgery - August 22, 2012 Category: Cardiovascular & Thoracic Surgery Authors: Luis Garrido-Olivares, Manjula Maganti, Susan Armstrong, Tirone E. David Tags: Acquired Cardiovascular Disease Source Type: research

Endovascular versus open elephant trunk completion for extensive aortic disease
Objectives: To compare the outcomes between patients undergoing endovascular (EEC) or open (OEC) approaches to second-stage elephant trunk completion (EC).Methods: From 1993 to 2010, 225 patients underwent second-stage EC (EEC, n = 92; OEC, n = 133). Propensity matching was performed for a fair comparison.Results: The EEC patients were older, more likely to have atrial fibrillation, and had a smaller proximal aorta. The 30-day mortality was 6.2% (6.5% EEC vs 6% OEC, P = .88). No difference was found in bleeding (8.8%), stroke (3%), renal failure (4%), or spinal cord injury (4%); however, the OEC patients required tra...
Source: The Journal of Thoracic and Cardiovascular Surgery - September 26, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Eric E. Roselli, Sreekumar Subramanian, Zhiyuan Sun, Jahanzaib Idrees, Edward Nowicki, Eugene H. Blackstone, Roy K. Greenberg, Lars G. Svensson, Bruce W. Lytle Tags: Acquired Cardiovascular Disease Source Type: research

Outcomes of surgical aortic valve replacement in moderate risk patients: Implications for determination of equipoise in the transcatheter era
Objective: To determine the contemporary outcomes of surgical aortic valve replacement (SAVR) in a moderate surgical risk population.Methods: We studied 502 consecutive adults who had undergone isolated SAVR from January 2002 to June 2011 for severe aortic valve stenosis with a Society of Thoracic Surgery predicted risk of mortality of 4% to 8%. We included concomitant coronary artery bypass and aortic annular enlargement but not other concomitant procedures. The updated Valve Academic Research Consortium definitions were used, as appropriate.Results: The median age was 80 years (range, 49-96), 323 (64.3%) had New York Hea...
Source: The Journal of Thoracic and Cardiovascular Surgery - October 7, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Sebastian A. Iturra, Rakesh M. Suri, Kevin L. Greason, John M. Stulak, Harold M. Burkhart, Joseph A. Dearani, Hartzell V. Schaff Tags: Acquired Cardiovascular Disease Source Type: research

Repair of retrograde ascending dissection after descending stent grafting
Conclusions: Retrograde ascending dissection can present as an early or a late complication after descending stent grafting because of aortic instability or disease progression and has usually been associated with descending dissection or intramural hematoma. It is a life-threatening complication that can be managed safely with early recognition and rapid delivery of open or hybrid repair.
Source: The Journal of Thoracic and Cardiovascular Surgery - October 21, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Jahanzaib Idrees, Amr Arafat, Douglas R. Johnston, Lars G. Svensson, Eric E. Roselli Tags: Acquired Cardiovascular Disease Source Type: research

Reoperative aortic valve replacement in the octogenarians—minimally invasive technique in the era of transcatheter valve replacement
Conclusions: Octogenarians who undergo re-AVR are thought to be high-risk surgical candidates. The present single-center series revealed acceptable in-hospital outcomes and operative mortality. Mre-AVR was associated with better survival compared with Fre-AVR and might benefit this population.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 4, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Tsuyoshi Kaneko, Dan Loberman, Igor Gosev, Fadi Rassam, Siobhan McGurk, Marzia Leacche, Lawrence Cohn Tags: Acquired Cardiovascular Disease Source Type: research

Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery
Objective: Robotic-assisted coronary artery bypass grafting has emerged as an alternative to traditional coronary artery bypass grafting or percutaneous intervention for patients with coronary artery disease. However, the safety and efficacy of this minimally invasive procedure have not been established in large series.Methods: From October 2009 to September 2012, 307 consecutive robotic-assisted coronary artery bypass grafting procedures were performed at a single US institution by 2 surgeons. Isolated, off-pump, left internal thoracic artery to left anterior descending coronary artery grafting was planned via a 3- to 4...
Source: The Journal of Thoracic and Cardiovascular Surgery - October 29, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Michael E. Halkos, Henry A. Liberman, Chandan Devireddy, Patrick Walker, Aloke V. Finn, Wissam Jaber, Robert A. Guyton, John D. Puskas Tags: Acquired Cardiovascular Disease Source Type: research

Minimally invasive tricuspid valve surgery in patients at high risk
Conclusions: The heart-port–based minimally invasive approach seems to be safe, feasible, and reproducible in case of tricuspid valve operations. It ensures low perioperative morbidity, moderate to low rates of tricuspid regurgitation recurrence, and low late mortality. It also seems to have an added value in case of reoperative procedures.
Source: The Journal of Thoracic and Cardiovascular Surgery - April 29, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Davide Ricci, Massimo Boffini, Cristina Barbero, Suad El Qarra, Giovanni Marchetto, Mauro Rinaldi Tags: Acquired Cardiovascular Disease Source Type: research

To cool or not to cool?
To cool or not to cool—that is the question that is raised by the recent study by Greason and colleagues1 appearing in this issue of the Journal. Greason and colleagues1 used the Society of Thoracic Surgeons database to evaluate patients undergoing nonemergency on-pump isolated coronary artery bypass grafting (CABG) with specific attention to the effect of lowest intraoperative recorded core body temperature on the primary end point of operative mortality and secondary end points of stroke, reoperation for bleeding, and a combined infection end point.
Source: The Journal of Thoracic and Cardiovascular Surgery - September 30, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Jennifer S. Lawton Tags: Editorial commentary Source Type: research

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