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Minimally Invasive Approaches to Surgical Aortic Valve Replacement: A Meta-Analysis
ConclusionsMinimally invasive approaches to AVR yield excellent outcomes in high volume centers. They reduce hospital stay and incidence of post-operative atrial fibrillation, and, therefore, should be considered in patients undergoing AVR. However, the operative approach should be selected according to surgeon’s technical expertise and what is best for specific patient profile.
Source: The Annals of Thoracic Surgery - September 6, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Salvage Coronary Artery Bypass Predicts Increased Mortality during Aortic Root Surgery
ConclusionsCABG during ROOT results in increases in postoperative morbidity or mortality compared with isolated ROOT. Outcomes, however, are influenced by the specific clinical indication. CABG for CAD 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 - August 29, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Clinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic Aortic Valves by 4DCT
ConclusionsIn patients with clinical or echocardiographic indications suggestive of leaflet thrombosis, 1/3rd of patients were found to have evidence of leaflet thrombosis using 4DCT. This allowed tailored anticoagulation therapy with resolution of the thrombus in most patients avoiding unnecessary anticoagulation in the remaining 2/3rds of patients.
Source: The Annals of Thoracic Surgery - August 26, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Planned Two-Stage Hybrid Aortic Repair With Dacron-Replaced Proximal Landing Zone
ConclusionsPlanned two-stage HAR with open first-stage proximal aortic replacement, followed by second-stage TEVAR with Dacron-replaced PLZ yields excellent short-term and long-term results, including low rates of reintervention likely due to the long-segment PLZ within the Dacron-replaced aorta. The technique should be considered in patients with even mild (>4.0 cm) ascending aortic dilation in whom HAR is otherwise the preferred treatment option.
Source: The Annals of Thoracic Surgery - August 24, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Valvectomy Versus Replacement for the Surgical Treatment of Tricuspid Endocarditis
ConclusionsTricuspid valve endocarditis patients who undergo tricuspid valve excision, repair, and replacement have similar 30-day operative mortality, as defined by The Society of Thoracic Surgeons. Excision patients have significantly lower unplanned readmission rates at 1 year. Tricuspid valvectomy is an acceptable initial treatment in this high-risk group as part of a surgical strategy to identify patients who are candidates for eventual valve replacement. Further study of long-term outcomes and survival is warranted.
Source: The Annals of Thoracic Surgery - August 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

A Systemic Review and Meta-Analysis of Sutureless Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation
ConclusionsOur meta-analysis of observational studies demonstrates that early mortality is lower after SU-AVR than after TAVI in selected patients. The rates of stroke and pacemaker implant are comparable between procedures; however, the incidence of paravalvular leak is higher after TAVI.
Source: The Annals of Thoracic Surgery - August 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Fate of the Aortic Arch Following Surgery on the Aortic Root and Ascending Aorta in Bicuspid Aortic Valve
ConclusionsProphylactic arch replacement during aortic root and ascending aortic surgery in patients with bicuspid aortic valve is not supported. Our data do not support long-term surveillance of the rest of the aorta in this population.
Source: The Annals of Thoracic Surgery - August 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Hemiarch Reconstruction Versus Clamped Aortic Anastomosis for Concomitant Ascending Aortic Aneurysm
ConclusionsHemiarch replacement using DHCA with RCP does not increase the risk of operative complications compared with a normothermic, clamped-distal aortic anastomosis, and therefore its use should not be limited when planning complex multiprocedural reconstructions during elective ascending thoracic aortic replacement with concomitant cardiac surgery.
Source: The Annals of Thoracic Surgery - August 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Frailty on Outcomes in Acute Type A Aortic Dissection
ConclusionsFrailty, as defined using a 7-component frailty index, can serve as an independent predictor of the risk of late mortality in patients undergoing an ATAAD. Such frailty markers, all of which are easily assessed preoperatively, may provide valuable information for patient counseling and risk stratification before aortic surgery.
Source: The Annals of Thoracic Surgery - August 4, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Programmatic and Surgeon Specialization Improves Mortality in Isolated Coronary Bypass Grafting
ConclusionsSubspecialization in CABG and dedicated coronary surgery programs may lead to faster operations, increased use of bilateral internal mammary arteries, fewer complications, and improved survival after isolated CABG.
Source: The Annals of Thoracic Surgery - July 26, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Aortic Valve Reoperation After Stentless Bioprosthesis: Short- and Long-Term Outcomes
ConclusionsAortic valve reoperation after stentless valve implantation can be performed with low operative mortality and favorable long-term survival.
Source: The Annals of Thoracic Surgery - July 23, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Coronary Revascularization With Single Versus Bilateral Mammary Arteries: Is It Time to Change?
ConclusionsIn a large regional experience, BIMA is associated with no upfront risk of adverse events and improved long-term survival compared with SIMA. Our results indicate that BIMA conduits should be considered more frequently during coronary artery bypass grafting due to their demonstrated survival advantage.
Source: The Annals of Thoracic Surgery - July 23, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Determinants of Reverse Remodeling of the Left Atrium After Transaortic Myectomy
ConclusionsLeft atrial volume decreases significantly after surgical relief of left ventricular outflow tract obstruction. Early changes likely reflect lower LA pressure due to gradient relief and abolishment of mitral regurgitation, and late reduction suggests continued reverse remodeling.
Source: The Annals of Thoracic Surgery - July 23, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Development of a Risk Prediction Model and Clinical Risk Score for Isolated Tricuspid Valve Surgery
ConclusionsMortality and major morbidity after isolated tricuspid valve surgery can be predicted using preoperative patient data from The Society of Thoracic Surgeons National Adult Cardiac Database. A simple clinical risk score predicts mortality and major morbidity after isolated tricuspid valve surgery. This score may facilitate perioperative counseling and identification of suitable patients for tricuspid valve surgery.
Source: The Annals of Thoracic Surgery - July 10, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Long-Term Outcomes for Patients With Stroke After Coronary and Valve Surgery
ConclusionsPostoperative stroke often leads to high mortality and poor long-term outcomes. Patients who experienced a severe stroke and underwent neurosurgical procedures also exhibited poor outcomes. Patients and their families should be informed of relatively high mortality and poor long-term outcomes before neurosurgical operation.
Source: The Annals of Thoracic Surgery - July 10, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

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