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Neurologic Deficit Following Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis
ConclusionsAtherothrombotic lesions found by objectively graded computed tomography were predictors of neurologic deficit. Retrograde perfusion in the presence of a distal atherothrombotic lesion should be avoided whenever possible. Strategies based on the full assessment of the whole aortic morphology appear to be mandatory. Anticoagulation therapy should be performed very carefully to avoid intracranial hemorrhagic changes.Graphical abstract
Source: The Annals of Thoracic Surgery - January 31, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Feasibility and Outcomes of Transcatheter Aortic Valve Implantation Using the Left Axillary Artery as Primary Access Site
ConclusionsThis is the first study reporting outcome after transcatheter aortic valve implantation using the LAA as default access. We conclude that it is highly feasible and safe with low rates of major vascular complications, bleeding, and stroke.Visual Abstract
Source: The Annals of Thoracic Surgery - January 26, 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

The Society of Thoracic Surgeons Intermacs Database Annual Report: Evolving Indications, Outcomes, and Scientific Partnerships
ConclusionsWith the evolution of MCS, patient phenotype and outcomes are also changing over time. CF LVAD support is increasingly being used in the less ill patient phenotype and more patients are supported for destination therapy. Mean survival is now approaching 5 years, but adverse events, especially neurologic events, continue to have a detrimental impact on the success of CF LVAD support.
Source: The Annals of Thoracic Surgery - January 26, 2019 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

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

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

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

Impact of Complications on Resource Utilization during 90-day CABG Bundle for Medicare Beneficiaries
ConclusionsMedicare beneficiaries that experience adverse events during their index CABG hospitalization will significantly impact that hospital’s financial risk. The challenge under the voluntary CABG bundled payment program will be to monitor and reduce adverse events and managing the services consumed by Medicare beneficiaries experiencing adverse events delivered at all the venues of care.
Source: The Annals of Thoracic Surgery - December 14, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Association Between Red Blood Cell Transfusion and Clinical Outcomes Among Patients Undergoing Transcatheter Aortic Valve Replacement
ConclusionsPRBC transfusion in patients undergoing TAVR is associated with an increased incidence of adverse outcomes during hospitalization, at 30-day and 1-year follow-up.
Source: The Annals of Thoracic Surgery - December 13, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement – A Report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
ConclusionsA risk model for in-hospital stroke following TAVR was developed from the STS/ACC TVT Registry and used to estimate site-specific stroke performance. This model can serve as a valuable resource for quality improvement, clinical decision-making, and patient counseling.
Source: The Annals of Thoracic Surgery - December 8, 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

Outcomes after thoracic endovascular aortic repair with overstenting of the left subclavian artery
ConclusionsEvery 10th patient with LSA overstenting and no revascularization developed left arm malperfusion. No LSA revascularization, extensive aortic coverage with two or more endografts, and coronary artery disease increased the risk for permanent paraplegia, left-hemispherical stroke, and left arm malperfusion. Patients should undergo LSA revascularization to prevent left vertebral artery-associated central neurologic complications and to maintain upper-left extremity perfusion.
Source: The Annals of Thoracic Surgery - December 1, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Conventional open versus hybrid arch repair of aortic arch disease: early and long-term outcomes
ConclusionsIn the treatment of aortic arch diseases, HAR showed equivalent short-term outcomes compared with TAR but was limited regarding long-term outcomes beyond 5 years post-procedure. Conventional TAR remains the gold standard of therapy, and our findings suggest that the hybrid approach should be reserved for strictly selected patients with significant comorbidities.
Source: The Annals of Thoracic Surgery - December 1, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

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