Open access

NEWS - Cardiac Surgery

Perspective by Dr. Eugene Braunwald: Aortic Stenosis: Then and Now – Circulation (free for a limited period)


Effect of Ticagrelor Plus Aspirin, Ticagrelor Alone, or Aspirin Alone on Saphenous Vein Graft Patency 1 Year After Coronary Artery Bypass Grafting: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentary: Ticagrelor + Aspirin, Ticagrelor Alone, or Aspirin Alone on SVG Patency – American College of Cardiology, Latest in Cardiology (free)

““The major limitation of the DACAB trial is the selection of vein graft patency as the primary outcome”. Agree:we’re starting to understand CAD is a bit more complicated than an open duct (also for this reason, medical practice requires clinical outcomes)” (via @camialderighi see Tweet)


Meta-analysis: Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentary: Long-Term Outcomes of On- vs. Off-Pump CABG – American College of Cardiology, Latest in Cardiology (free)

“Off pump CABG. probably best used in a limited set of patients…” (via @keaglemd see Tweet)


Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data – The Lancet (free)

This meta-analysis of randomized trials showed CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. There was no mortality benefit in patients with left main disease.


Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients: A Meta-Analysis of Individual Participant Data From 6 Randomized Trials – JACC: Cardiovascular Interventions (link to abstract – $ for full-text)

Commentary: Dual Antiplatelet Therapy Duration in Elderly Patients – American College of Cardiology, Latest in Cardiology (free)

Short-term Dual Antiplatelet Therapy was not associated with increased risk of ischemic events in elderly patients and was associated with a significant reduction in major bleeding.


Transcatheter versus surgical aortic valve replacement in patients at low surgical risk: A meta-analysis of randomized trials and propensity score matched observational studies – Catheterization Cardiovascular Interventions (link to abstract – $ for full-text)

Commentary: Meta-Analysis Raises ‘Red Flag’ on TAVR in Low-Risk Patients – TCTMD (free)

“Data from six studies show that while short-term mortality is similar between TAVR and SAVR, more low-risk TAVR patients die by 2 years” (from TCTMD)


All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: a meta-analysis of short-term and long-term randomised trials – OpenHeart (free)

“PCI is associated with a reduction in the risk of major cardiovascular outcomes at short-term follow-up in patients with LMCA stenosis; but at long term, MACCE rate is increased for PCI”


European Society of Cardiology: Cardiovascular Disease Statistics 2017 – European Journal of Cardiology (free)

“The European Atlas of Cardiology brings together data from 56 countries to demonstrate the prevalence and cost of cardiovascular disease, and the need to utilise resources more effectively” (RT @OUPMedicine see Tweet)


Long-term Outcomes of Multiple Arterial Coronary Artery Bypass Grafting: A Population-Based Study of Patients in British Columbia, Canada – JAMA Cardiology (free)

Commentaries: Study: Triple-Vessel CABG Strategy Matters in the Long Run – MedPage Today (free registration required)

In patients with multivessel disease who are undergoing coronary artery bypass grafting, multiple arterial grafting (MAG) is associated with reduced mortality, repeated revascularization, myocardial infarction, and heart failure when compared with left internal thoracic artery (LITA) supplemented by saphenous vein grafts (LITA+SVG).


Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis – JAMA Internal Medicine (free)

Invited commentary: Coronary Computed Tomographic Angiography—The First Test for Evaluating Patients With Chest Pain? (free)

Commentary: Coronary CT Angiography vs. Stress Testing: Meta-Analysis Offers Mixed Results – Physician’s First Watch (free)

Coronary Computed Tomografic Angiography (CCTA) was associated with a very small reduction in the incidence of myocardial infarction (0.7% vs 1.1% = 0.4% absolute risk reduction), but without differences in death or cardiac hospitalization. Patients undergoing CCTA were significantly more likely to undergo invasive coronary angiography (11.7% vs 9.1%), revascularization (7.2% vs 4.5%) and were also more likely to receive a diagnosis of new CAD and to have initiated aspirin or statin therapy.


Interventions for treating tuberculous pericarditis – Cochrane Library (free)

News release: Treatment for tuberculosis infection of the membrane around the heart (free)

“For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant”.


The 10-Year Prognostic Value of Zero and Minimal CAC – Journal of The American College of Cardiology (no abstract – $ for full text)

Commentary: Calcium in Arteries Influences Heart Attack Risk –  UT Southwestern Medical Center, via NewsWise (free) AND Study: Calcium in arteries influences heart attack risk – UPI (free)

“Half of the participants had no calcium deposits in their arteries or a zero coronary artery calcium, or CAC, score, and had less than a 3 percent chance of a cardiovascular event over a 10-year period despite having other risk factors for heart disease and stroke such as type 2 diabetes, high blood pressure and high bad cholesterol levels” (from UPI)


Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials – The Lancet (link to abstract – $ for full-text)

Commentary: Optimal Timing of an Invasive Strategy in NSTE-ACS Patients – American College of Cardiology, Latest in Cardiology (free)

An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in most patients with NSTE-ACS, but seems to reduce mortality in high-risk patients.


A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients – World Journal of Emergency Surgery (free)

This meta-analysis, mainly from observational studies and including 1276 patients, suggests a positive effect of REBOA on mortality among non-compressible torso hemorrhage patients.


Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement – Circulation (free)

Commentary: Fewer infections in mechanical heart valves – Karolinska Institutet (free)

In this large cohort with follow-up time of up to 18 years, the risk of endocarditis was about 50 per cent higher with a biological prosthesis than with a mechanical prosthesis.



Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)

Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)

This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.


Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain – Circulation (link to abstract – $ for full-text)

Commentary: CT angiography appears better at predicting future risk for patients with chest pain – Massachusetts General Hospital, via ScienceDaily (free)

Source: EvidenceAlerts (free resource to find articles of interest)

“The most important result indicated that the ability of coronary CTA to identify nonobstructive coronary artery disease – a less-than-70-percent narrowing of a coronary artery – identifies an at-risk group of patients not found by functional testing” (from ScienceDaily)


Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non–ST-Elevation Acute Coronary Syndrome – The American Journal of Cardiology (link to abstract – $ for full-text)

Source: EvidenceAlerts

In patients with Non–ST-Elevation Acute Coronary Syndrome and left main or multivessel CAD, CABG significantly reduced the risk of death from any causes, myocardial infarction, or stroke compared with PCI with drug-eluting stents


A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery – Annals of Surgery (link to abstract – $ for full-text)

Source: EvidenceAlerts (free resource to find articles of interest)

“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”


Trends and Outcomes of Off-Label Use of Transcatheter Aortic Valve Replacement: Insights From the NCDR STS/ACC TVT Registry – JAMA Cardiology (free)

The JAMA Network – For the Media: Study Examines Use, Outcomes of Valve Replacement Procedure Performed for Off-Label Indications

Commentary: Outcomes of Off-Label Use of TAVR – American College of Cardiology, Latest in Cardiology (free)

“A randomized controlled trial directly comparing TAVR with surgery among specific subsets of off-label populations is needed to provide convincing evidence, and significant ‘off-label’ use captured in registries such as this should motivate such prospective randomized studies” (from Latest in Cardiology).


Thirty-Year Mortality After Coronary Artery Bypass Graft Surgery: A Danish Nationwide Population-Based Cohort Study – Circulation: Cardiovascular Quality and Outcomes (link to abstract – $ for full-text)

Commentary: Many good years after heart bypass surgery, but something happens after ten years – Aarhus University, via Science Daily (free)

“For patients who make it through the first month after the operation is close to that of the population in general. But 8-10 years after a heart bypass operation, mortality increases by 60-80 per cent” (from Science Daily)


Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease – Cochrane Library (link to abstract – $ for full-text) (RT @Gas_Craic see Tweet)

“Compared with culprit-only intervention, the complete revascularisation strategy may be superior due to lower proportions of long-term cardiovascular mortality, long-term revascularisation, and long-term non-fatal myocardial infarction, but these findings are based on evidence of very low quality”


Finally, Success Reducing Recurrent Stroke With PFO Closure – Medscape (free registration required)

Two randomized trials presented at the 3rd European Stroke Organization Conference (ESOC) 2017 showed that in carefully selected stroke patients in whom Patent Foramen Oval (PFO) was suspected to be a cause of their strokes, a reduction in recurrent stroke was observed with PFO closure.


Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017 – Radiology (free)

Source: Management of Pulmonary Nodules Found Incidentally on Computed Tomography Scans – Journal Watch (free)

Incidental pulmonary nodules discovered outside the context of screening or cancer follow-up are increasingly common in clinical practice. The purpose of these updated recommendations is to reduce the number of unnecessary follow-up examinations while providing practical guidance on follow-up intervals for selected larger nodules.


Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients – New England Journal of Medicine (link to abstract – $ required for full text)

Quick Take Video Summary: SURTAVI Study: TAVR versus Open Surgery (free)

See this and other highlights from the American College of Cardiology’s 66th Annual Scientific Session (some articles are no longer free)

This innovative technology seems to be useful for patients with aortic stenosis at high risk for surgery. In this new study, it was noninferior to surgery at 2 years of follow-up in old patients (averaged nearly 80 years) at intermediate risk. Longer follow up data will be important to see if it is a suitable alternative for younger patients.


ACR Appropriateness Criteria Adds Topics, Covers More Clinical Variants Than Ever Before (free)

Browse Appropriateness Criteria Topics (free)

Source: Newswise

This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.


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