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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

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

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

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 hypothermic circulatory arrest for degenerative pathology. The proposed simple, accurate model can quantify risk and facilitate physician-patient counseling before possible surgical intervention.
Source: The Annals of Thoracic Surgery - February 20, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

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