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Comparison of Endoaortic and Transthoracic Aortic Clamping in Less-Invasive Mitral Valve Surgery
Conclusions Despite recent concerns arising about EAC, this large multicenter study shows equivalence in terms of safety and effectiveness of this technique compared with TTC. Reduction in postoperative bleeding was observed in the EAC group despite the higher rate of complex redo cases.
Source: The Annals of Thoracic Surgery - February 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Pectus Excavatum on Cardiopulmonary Function
Conclusions The inspiratory HI and CI reflect the effect of pectus excavatum on cardiopulmonary function. The cardiopulmonary system reacts first with an increase in heart rate at anaerobic threshold, followed by a decrease in stroke volume at anaerobic threshold and maximum stroke volume. Increased severity of the deformity then leads to a decrease in cardiac output.
Source: The Annals of Thoracic Surgery - January 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Direct Aortic Access for Transcatheter Aortic Valve Replacement Using a Self-Expanding Device
Conclusions When femoral access is not feasible, DA access allows effective delivery of the valve but incurs an increased risk of death and adverse events, potentially the result of procedural differences.
Source: The Annals of Thoracic Surgery - January 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Retrograde Cerebral Perfusion Is Effective for Prolonged Circulatory Arrest in Arch Aneurysm Repair
Conclusions RCP is an effective adjunctive cerebral protection strategy for complex aortic arch aneurysm repair with prolonged DHCA and is not associated with increased death or neurologic complications.
Source: The Annals of Thoracic Surgery - January 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Safety of Moderate Hypothermia With Antegrade Cerebral Perfusion in Total Aortic Arch Replacement
Conclusions In this series, TOTAL with MHCA and ACP can be safely performed with acceptable operative risk. MHCA and ACP represent an effective strategy for TOTAL and may obviate the need for DHCA.
Source: The Annals of Thoracic Surgery - December 10, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Assessment of Commonly Used Frailty Markers for High- and Extreme-Risk Patients Undergoing Transcatheter Aortic Valve Replacement
Conclusions Among high- and extreme-risk patients undergoing TAVR, our new frailty model was more discriminative of 30-day mortality than The Society of Thoracic Surgeons predicted risk of mortality. New cutoff values for frailty indicators were identified and will require further validation.
Source: The Annals of Thoracic Surgery - November 16, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Stent Is Not to Blame: Lessons Learned With a Simplified US Version of the Frozen Elephant Trunk
Conclusions With the advent of endovascular technology, there is a clinical shift toward increased use of FET to eliminate or facilitate the second surgical stage in treating patients with extensive aortic pathology. The addition of FET to the surgical armamentarium does not seem to pose additional risk (although larger studies are needed), but judicious use is advised nonetheless. A single-piece endoprosthesis for FET instead of a customized one should be considered.
Source: The Annals of Thoracic Surgery - October 18, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Elective Aortic Hemiarch Reconstruction for Aneurysmal Disease in the Elderly
Conclusions Although elderly patients have a more prolonged recovery after elective aortic hemiarch reconstruction for aneurysmal disease, outcomes are acceptable with low operative mortality and with the majority being discharged home. Moderate hypothermic circulatory arrest with antegrade cerebral perfusion is a safe strategy for this cohort. Advanced age alone should not be viewed as a contraindication in these cases.
Source: The Annals of Thoracic Surgery - October 18, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Aortic Atheroma Increases the Risk of Long-Term Mortality in 20,000 Patients
Conclusions Aortic atheromatous disease of any grade in the ascending and descending aorta is a significant long-term risk of long-term, all-cause mortality in cardiac operation patients. This association remains independent of other conventional risk factors and is not related to postoperative cerebrovascular accidents.
Source: The Annals of Thoracic Surgery - September 19, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Hypothermia and Selective Antegrade Cerebral Perfusion Is Safe for Arch Repair in Type A Dissection
Conclusions Unilateral selective antegrade cerebral perfusion with moderate hypothermic circulatory arrest remains a safe strategy for cerebral protection during emergent surgical repair of acute type A dissection and provides equivalent outcomes for both limited and extensive aortic arch reconstruction. Based on these data, unilateral selective antegrade cerebral perfusion and moderate hypothermic circulatory arrest may represent an optimal strategy for cerebral protection in this acute setting.
Source: The Annals of Thoracic Surgery - August 25, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Risk of Intraatrial Thrombi After Thoracoscopic Ablation in Absence of Heparin and Appendage Closure
Conclusions Thoracoscopic ablation of AF can be associated with a risk of left atrial appendage thrombus formation and possibly also stroke. With administration of heparin during the ablation, followed by occlusion of the left atrial appendage as a part of the procedure, this risk can be effectively reduced.
Source: The Annals of Thoracic Surgery - August 25, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke
Conclusions BAA is an independent predictor for the distinctive location of the entry site in the aortic arch and risk factor for stroke.
Source: The Annals of Thoracic Surgery - August 17, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Impact of Thoracic Endovascular Aortic Repair on Long-Term Survival in Type B Aortic  Dissection
Conclusions The treatment of uncomplicated aTBAD with optimal medical therapy results in a high incidence of surgical intervention and poor long-term survival. At the index hospitalization, TEVAR may confer a survival advantage and serve as optimal therapy for complicated and uncomplicated aTBAD patients.
Source: The Annals of Thoracic Surgery - August 16, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Surgical Ablation of Atrial Fibrillation in the United States: Trends and Propensity Matched Outcomes
Conclusions Contemporary utilization of SA is increasing across all operative categories. Performance of SA is accompanied by a 30-day reduction in mortality and stroke. These findings further refine our understanding of the role of SA in the treatment of AF.
Source: The Annals of Thoracic Surgery - July 20, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Long-Term Risk of Ischemic Stroke After the Cox-Maze III Procedure for Atrial Fibrillation
Conclusions This multicenter study showed a low incidence of perioperative and long-term postoperative ischemic stroke/TIA after CM-III. Although general risk of ischemic stroke/TIA was reduced, patients with CHA2DS2-VASc score 2 or greater had a higher risk compared with score 0 or 1. Complete left atrial appendage excision may be an important reason for the low ischemic stroke rate.
Source: The Annals of Thoracic Surgery - July 20, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

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