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Risk Prediction Model for Major Adverse Outcome in Proximal Thoracic Aortic Surgery
ConclusionsThe current study identified risk factors for major adverse outcome after proximal thoracic aortic surgery with HCA for degenerative pathology. The proposed simple, accurate model can quantify risk and facilitate physician-patient counseling prior to possible surgical intervention.
Source: The Annals of Thoracic Surgery - November 9, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Complete sternal-sparing HeartMate 3 implantation: a case series of ten consecutive patients
ConclusionsOur early outcomes suggest that the CSS approach may reduce the incidence of right ventricular failure, bleeding, intubation time and ICU length of stay. Further studies are needed to fully elucidate the advantages of CSS LVAD implantation compared with median sternotomy.
Source: The Annals of Thoracic Surgery - November 14, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Salvage Coronary Artery Bypass Predicts Increased Mortality During Aortic Root Operation
ConclusionsCABG-R results in increased postoperative morbidity or mortality compared with isolated ROOT. Outcomes, however, are influenced by the specific clinical indication. CABG for coronary artery disease was associated with similar outcomes compared with isolated ROOT. Patients undergoing unplanned CABG for acute ventricular failure had the worst outcomes, thus underscoring the importance of technical success during coronary reimplantation.
Source: The Annals of Thoracic Surgery - November 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Clinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic Aortic Valves by Four-Dimensional Computed Tomography
ConclusionsOne-third of patients with clinical or echocardiographic indications suggestive of leaflet thrombosis were found to have evidence of leaflet thrombosis using 4DCT. This allowed tailored anticoagulation therapy with resolution of the thrombus in most patients and avoiding unnecessary anticoagulation in the remaining two-thirds of patients.Visual Abstract
Source: The Annals of Thoracic Surgery - November 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Emergency surgery for acute type A aortic dissection in octogenarians without patient selection
ConclusionsEmergency surgery for type A aortic dissection in octogenarians without patient selection resulted in similar rates of mortality and morbidity to younger patients. Octogenarians should not be refused this life-saving emergent surgery.
Source: The Annals of Thoracic Surgery - November 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Antithrombotic Strategies after Bioprosthetic Aortic Valve Replacement: A Systematic Review
ConclusionsTreatment with warfarin or aspirin both lead to similar outcomes after surgical bAVR. Combining aspirin with warfarin may lead to a small decrease in thromboembolism and mortality but is accompanied by increased bleeding. For TAVR patients, aspirin is equivalent to DAPT for reducing thromboembolism and mortality, with a possible decrease in bleeding.
Source: The Annals of Thoracic Surgery - November 18, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Prothrombin complex concentrate in cardiac surgery: A systematic review and meta-analysis
ConclusionsIn patients with significant bleeding following cardiac surgery, PCC administration seems to be more effective than FFP in reducing perioperative blood transfusions. No additional risks of thromboembolic events or other adverse reactions were observed. Randomized controlled trials are needed to definitively establish the safety of PCC in cardiac surgery.
Source: The Annals of Thoracic Surgery - November 18, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Fatal Neurologic Dysfunction During Continuous-flow Left Ventricular Assist Device Support
ConclusionsOur study elucidates the characteristics and risk factors of patients who died of ND during CF-LVAD support. Further studies are required to find ways to decrease the incidence of fatal ND during CF-LVAD support.
Source: The Annals of Thoracic Surgery - November 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Successful heart transplantation in a patient with Loeys-Dietz Syndrome
Publication date: Available online 1 December 2018Source: The Annals of Thoracic SurgeryAuthor(s): Aliya G. Feroe, Amy G. Fiedler, David A. D’AlessandroAbstractOur patient is a 45-year-old woman with a history of Loeys-Dietz syndrome (LDS), vertebral artery dissection, stroke, prior atrial septal defect (ASD) repair, and spontaneous left main coronary artery dissection re-vascularized with coronary artery bypass grafting who progressed to end-stage heart failure. She was listed for cardiac transplantation and a suitable organ became available. She underwent heart transplantation over one year ago successfully. This is th...
Source: The Annals of Thoracic Surgery - December 2, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Totally Thoracoscopic Closure of the Left Atrial Appendage
This report describes a technique for totally thoracoscopic LAA exclusion with an epicardial clip device. This approach provides a safe and likely more effective alternative to LAA management than other endocardial devices.
Source: The Annals of Thoracic Surgery - December 14, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Neurologic Outcomes in Aortic Arch Repair with Frozen Elephant Trunk versus Two-stage Hybrid Repair
ConclusionsBoth single-stage and two-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined two-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years.
Source: The Annals of Thoracic Surgery - December 20, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

A Novel Toroidal-Flow Left Ventricular Assist Device Minimizes Blood Trauma: Implications of Improved Ventricular Assist Device Hemocompatibility
ConclusionsThe TORVAD design, with markedly lower shear stress and pulsatile flow, caused significantly less blood trauma that the HeartMate II. LVADs with reduced blood trauma are likely to improve clinical outcomes and expand LVAD therapy into patients with less advanced heart failure.
Source: The Annals of Thoracic Surgery - December 24, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Model for End Stage Liver Disease Score Independently Predicts Mortality in Cardiac Surgery
ConclusionsIncreasing MELD score, INR, and bilirubin all independently increase risk of operative mortality. Since high rates of missing data currently limit utilization of MELD, efforts to simplify and improve data collection would help improve future risk models.
Source: The Annals of Thoracic Surgery - January 10, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Valve-Sparing Root Replacement Provides Excellent Midterm Outcomes for Bicuspid Valve Aortopathy
ConclusionsVSRR can be safely and effectively performed in young patients with bicuspid valve anatomy regardless of degree of preoperative AI. Valve function is durable and the incidence of valve-related complications is low. VSRR is an attractive and potentially superior option to conventional root replacement in appropriately selected patients with bicuspid aortopathy.Visual Abstract
Source: The Annals of Thoracic Surgery - January 26, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Early Extubation Without Increased Adverse Events in High-Risk Cardiac Surgical Patients
ConclusionsA prudent and diligent multifaceted early extubation protocol may be successful in high-risk cardiac surgical patients without an increase in adverse outcomes. A larger study is needed in the future to confirm the finding.
Source: The Annals of Thoracic Surgery - January 26, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

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