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Measuring and Mitigating Stroke in TAVI: Long Roads to the Easy Answers
Designing and successfully conducting the trials to comprehensively evaluate cerebral embolic protection devices might never occur because they would be long-term, costly and labour intensive.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 12, 2017 Category: Cardiovascular & Thoracic Surgery Authors: John Bozinovski Source Type: research

Measuring and mitigating stroke in transcatheter aortic valve implantation: Long roads to the easy answers
Transcatheter aortic valve implantation (TAVI) has rapidly displayed its utility in the treatment of aortic valve disease. While presenting a lesser procedural morbidity and mortality risk, as compared with surgical aortic valve replacement (SAVR), early trials reported higher rates of stroke.1,2 To mitigate this complication, cerebral embolic protection (CEP) devices were developed for use in TAVI but there has been limited penetrance into the market. Among the reasons for this are their novelty, relatively low rates of clinically relevant stroke, added complexity of their deployment, cost, and uncertainty of their benefit.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 12, 2017 Category: Cardiovascular & Thoracic Surgery Authors: John Bozinovski Tags: Editorial commentary Source Type: research

Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation
Patients with atrial fibrillation (AF) are 5 times more likely to have a stroke than individuals in sinus rhythm, and 1 in every 5 strokes is secondary to AF.1-3 Unfortunately, AF-related thrombo-emboli are larger and result in ischemic strokes that are more devastating than those secondary to carotid artery disease or other etiologies.4,5 Lifelong oral anticoagulation with warfarin has been the guideline-based therapy to reduce the risk of AF-related ischemic strokes in patients with a CHA2DS2-VASc (congestive heart failure, hypertension, age>75 and diabetes mellitus, previous history of stroke or transient ischemic attac...
Source: The Journal of Thoracic and Cardiovascular Surgery - February 2, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Kareem Bedeir, David R. Holmes, James L. Cox, Basel Ramlawi Tags: Expert review Source Type: research

Left Atrial Appendage Exclusion: An Alternative to Anticoagulation in Non-Valvular Atrial Fibrillation
One in every five strokes is due to atrial fibrillation. Anticoagulation has been the evidence-based practice for stroke risk reduction. Anticoagulation is however also associated with a lifelong commitment to a risk of bleeding-related morbidity and mortality. There is a need for alternatives to anticoagulation in atrial fibrillation. In this review, we summarize the evidence behind the technologies that are proposed to reduce the risk of stroke in atrial fibrillation patients who cannot receive or do not want anticoagulation.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 2, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Kareem Bedeir, David R. Holmes, James L. Cox, Basel Ramlawi Source Type: research

Building a bioartificial heart: Obstacles and opportunities
The growing numbers of patients with heart failure, both in the United States and around the globe, has led to a pressing need for new therapies. Heart transplantation is a very restricted option due to the limited number of donor hearts available —currently approximately 2800 per year in the United States. Transplant patients also have to take immunosuppressive drugs for the rest of their lives. Ventricular assist devices, used either as bridge to transplant or destination therapy, can prolong patient survival, but present a number of comp lications, including thrombosis, stroke, and infection.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 13, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Martha S. Lundberg, J. Timothy Baldwin, Denis B. Buxton Tags: Feature Expert opinion Source Type: research

The impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery
This study aimed to clarify the impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 10, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Ken-ichi Imasaka, Eiki Tayama, Yukihiro Tomita Tags: Acquired: Aortic symposium: Aortic arch Source Type: research

The impact of carotid and/or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery
This study aimed to clarify the impact of carotid and/or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 9, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Ken-ichi Imasaka, Eiki Tayama, Yukihiro Tomita Source Type: research

Avoiding coronary obstruction after transcatheter aortic valve replacement: Is it the skirt or what's inside that counts?
In this issue of the Journal, Chu and colleagues1 posit that coronary obstruction in patients at high risk undergoing transcatheter aortic valve replacement (TAVR) may be mitigated by the unique engagement mechanism and protective skirt of the ACURATE TA device (Symetis Inc, Ecublens, Switzerland). Initial obstacles with TAVR, including stroke, vascular complications, and paravalvular leak (PVL) have seen marked improvements through case selection and device design; however, the rare and lethal complication of coronary artery obstruction remains vexing, particularly in patients at high risk with small aortic diameters, low...
Source: The Journal of Thoracic and Cardiovascular Surgery - November 20, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Mohamad Alkhouli, Vinay Badhwar Tags: Editorial commentary Source Type: research

Outcomes of Early Surgery for Infective Endocarditis With Moderate Cerebral Complications
We sought to clarify the effect of stroke severity on clinical outcomes in infective endocarditis (IE) patients with cerebral complications, and evaluate the impact of early surgery in the active phase on long-term prognosis in patients with non-severe neurological deficits.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 15, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Ryosuke Murai, Shunsuke Funakoshi, Shuichiro Kaji, Takeshi Kitai, Kitae Kim, Tadaaki Koyama, Yutaka Furukawa Source Type: research

On-pump versus off-pump: It's all about the grafts!
Originally proposed as a less-invasive form of revascularization, off-pump coronary artery bypass (OPCAB) surgery promised to reduce morbidity, decrease resource use, and provide a better surgical option for high-risk patients. Early enthusiasm has yielded to a more balanced approach. Meta-analyses of prospective randomized control trials suggest a benefit in reducing perioperative stroke and potentially renal impairment,1,2 whereas longer-term studies suggest decreased graft patency and increased need for revascularization.
Source: The Journal of Thoracic and Cardiovascular Surgery - October 23, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Paul Kurlansky Tags: Editorial commentary Source Type: research

Scallops, fenestrations, CHIMPS, and other monkey business
The coverage of branch vessels during thoracic endovascular aortic repair (TEVAR) with resultant end-organ ischemia is a limitation of endograft technology. Although coverage of the left subclavian artery (LSA) initially was thought to be safe (zone 2 TEVAR), experience has shown that LSA ischemia comes at the cost of permanent stroke and spinal cord injury and reversible complications of arm claudication and vertebrobasilar ischemia. Preserving flow to the LSA in the acute setting remains a clinical dilemma because the emergency nature of the procedure often precludes time-consuming efforts to preserve LSA flow.
Source: The Journal of Thoracic and Cardiovascular Surgery - July 28, 2016 Category: Cardiovascular & Thoracic Surgery Authors: S. Chris Malaisrie Tags: Editorial commentary Source Type: research

Residual aortic regurgitation after transcatheter aortic valve replacement under the echocardiographic microscope
Transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis has expanded dramatically in patients deemed suboptimal for surgical aortic valve replacement (SAVR). The explosive growth of TAVR has been supported by unparalleled clinical trial data in specifically defined patient subsets, with equal or superior survival and stroke rates,1-3 improved early quality of life,4 lower major adverse clinical events,1 and improved systolic flow parameters,1 including lower rates of patient prosthetic mismatch5 when compared with SAVR.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 27, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Michael J. Reardon, Jeffrey J. Popma Tags: Editorial commentary Source Type: research

A randomized, prospective pilot comparison of 3 atrial appendage elimination techniques: Internal ligation, stapled excision, and surgical excision
Elimination of the left atrial appendage (LAA) attempts to reduce stroke in patients with atrial fibrillation (AF). A retrospective review suggests that various surgical techniques are often unsuccessful and may leave a stump or gap. In a pilot study, we prospectively evaluated 3 surgical techniques with long-term follow up to define effectiveness.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 21, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Richard Lee, Patricia Vassallo, Jane Kruse, S.Chris Malaisrie, Vera Rigolin, Adin-Cristian Andrei, Patrick McCarthy Tags: Acquired Source Type: research

A randomized, prospective pilot comparison of three atrial appendage elimination techniques: Internal Ligation, Stapled Excision and Surgical Excision
Left Atrial Appendage (LAA) elimination attempts to reduce stroke in patients with atrial fibrillation (AF). Retrospective review suggests that various surgical techniques are often unsuccessful and may leave a stump or gap. In a pilot study, we prospectively evaluated 3 surgical techniques with long-term follow up to define effectiveness.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 21, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Richard Lee, Patricia Vassallo, Jane Kruse, S.Chris Malaisrie, Vera Rigolin, Adin-Cristian Andrei, Patrick McCarthy Source Type: research

A randomized, prospective pilot comparison of 3 atrial appendage elimination techniques: Internal ligation, stapled excision, and surgical excision
Elimination of the left atrial appendage (LAA) attempts to reduce stroke in patients with atrial fibrillation (AF). A retrospective review suggests that various surgical techniques are often unsuccessful and may leave a stump or gap. In a pilot study, we prospectively evaluated 3 surgical techniques with long-term follow up to define effectiveness.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 21, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Richard Lee, Patricia Vassallo, Jane Kruse, S.Chris Malaisrie, Vera Rigolin, Adin-Cristian Andrei, Patrick McCarthy Tags: Acquired Source Type: research

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