Cardiac Surgery

Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentaries: Meta-Analysis of TAVR vs. SAVR in Low-Risk Patients – American College of Cardiology (free) AND TAVR Survival Surpasses SAVR in Low-Risk Patients: Meta-analysis – Medscape (free registration required)

“The one clear unknown that everyone points to is valve durability” (form Medscape)

“longer follow-up regarding valve degeneration will be needed to confirm TAVR as the preferred treatment for low-risk patients with severe AS.” (from American College of Cardiology)

 


Surgery Does Not Improve Survival in Patients With Isolated Severe Tricuspid Regurgitation – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentary: Surgery for Severe Tricuspid Regurgitation – American College of Cardiology (free)

 

Related Commentary on Twitter

 


Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentaries: Off- vs. On-Pump Surgery for Left Main Disease – American College of Cardiology (free) Higher Mortality With Off-Pump CABG: EXCEL Analysis – TCTMD (free)

Related Study: Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass (link to abstract and commentaries)

 

Related Commentary on Twitter

 


Management of Congenital Heart Disease: State of the Art – Children (free articles)

Part I—ACYANOTIC Heart Defects

Part II—Cyanotic Heart Defects

 


Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis – Drugs in R&D (free)

“The efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are similar to those of warfarin.”

 


Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations – JAMA Surgery (free for a limited period)

Invited Commentary: The Enhanced Recovery After Surgery in Cardiac Surgery Revolution – JAMA Surgery (free)

Related: Enhanced Recovery After Surgery (ERAS) Society Guidelines (free articles)

 

Related Commentary on Twitter

 


Effect of an Incentive Spirometer Patient Reminder After Coronary Artery Bypass Grafting: A Randomized Clinical Trial – JAMA Surgery (free for a limited period)

Invited Commentary: Benefits of Incentive Spirometry: Still More Work to Do – JAMA Surgery (free)

Simple intervention leading to improved outcomes, but confirmatory studies are required (see invited commentary).

 


Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass – Cochrane Library (free)

Summary: Epidural analgesia for heart surgery with or without the heart lung machine in adults – Cochrane Library (free)

“Compared with systemic analgesia, epidural analgesia may reduce the risk of myocardial infarction, respiratory depression, and atrial fibrillation / atrial flutter, as well as the duration of tracheal intubation and pain, in adults undergoing cardiac surgery.”

 


Supplement: Atrial Septal Defects

16 Oct, 2018 | 23:38h | UTC

Atrial septal defects – Journal of Thoracic Disease (comprehensive review – free articles)

 


Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery – New England Journal of Medicine (free for a limited period)

“In moderate-to-high-risk patients undergoing cardiac surgery, six-month outcomes show that a restrictive red-cell transfusion strategy is noninferior to a liberal strategy” (via @NEJM see Tweet with Visual Abstract)

 


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)

 


Review: Isolated Tricuspid Regurgitation

13 Jan, 2018 | 19:03h | UTC

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”

 


Review: Ischemic mitral regurgitation

3 Dec, 2017 | 17:21h | UTC

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”.

 


RCT: Palliative Care in Heart Failure

10 Sep, 2017 | 02:00h | UTC

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.