The following is a collection of featured adult cardiac articles in press from the Journal of Thoracic and Cardiovascular Surgery (JTCVS). To read the latest issue, or browse the feature video library and other journal highlights, please visit www.jtcvs.org.
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AORTA
Is previous cardiac surgery a risk factor for open repair of acute type A aortic dissection?
Elizabeth L. Norton, MS, Carlo Maria Rosati, MD, Karen M. Kim, MD, Xiaoting Wu, PhD, Himanshu J. Patel, MD, G. Michael Deeb, MD, Bo Yang, MD, PhD
ATAAD in patients with PCS can be and should be treated surgically for favorable short- and long-term outcomes.
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Commentary: An equal opportunity to survive—Previous cardiac surgery is not a contraindication to type A dissection repair
Christopher Lau, MD, Leonard N. Girardi, MD
Patients with acute type A dissection after previous cardiac surgery should be offered surgery. Outcomes are like no PCS in experienced centers and better than medical management in all settings.
AORTA FEATURED VIDEO
Discussion of surgical treatment of ATAAD in patients with PCS: short- and long-term outcomes.
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Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients
Ourania Preventza, MD, Jane L. Liao, MD, Jacqueline K. Olive, BA, Katherine Simpson, MS, Andre C. Critsinelis, MD, Matt D. Price, MS, Marianne Galati, MSW, MLS, Lorraine D. Cornwell, MD, Vicente Orozco-Sevilla, MD, Shuab Omer, MD, Ernesto Jimenez, MD, Scott A. LeMaire, MD, Joseph S. Coselli, MD
In FET, 10-cm stent length is advisable; length 15 cm or greater or coverage to or beyond T8 should be avoided to prevent SCI. FET should be used cautiously for acute type A aortic dissection.
Commentary: The elephant in the room: Walking the walk and talking the talk after a frozen elephant trunk procedure
Xiaoying Lou, MD, Edward P. Chen, MD
FET may increase risk of spinal cord ischemia with extended stent coverage and should be used cautiously in acute type A dissection. RCTs are needed to guide best practice as FET gains widespread use.
Commentary: Is it time to thaw the frozen elephant trunk procedure?
Nicholas T. Kouchoukos, MD
Extensive analysis continues to indicate that spinal cord ischemic injury is an important complication of the frozen elephant trunk technique for repair of extensive thoracic aortic disease.
Summary of meta-analysis study of more than 3000 patients in whom the FET technique was used and a discussion of this technique's importance.
AORTIC VALVE
Two different geometric orientations for aortic neoroot creation in bicuspid aortic valve repair with root reimplantation
Mary A. Siki, BS, Andreas Habertheuer, MD, PhD, Joseph E. Bavaria, MD, Caroline Komlo, BS, Maxwell Hunt, BS, Melanie A. Freas, CRNP, Rita K. Milewski, MD, PhD, Nimesh D. Desai, MD, PhD, Wilson Y. Szeto, MD, Prashanth Vallabhajosyula, MD, MS
Respecting the BAV geometry for VSRR neoroot creation yields excellent midterm outcomes. This may minimize leaflet billowing and stress from “forcing” a 150°/210° type I BAV into a 180°/180° neoroot.
Commentary: Should we attempt to refine an already imperfect nature?
Ruggero De Paulis, MD
Symmetric bicuspid valves appear to function better and probably longer. The reestablishment of a good symmetry at the time of valve repair appears promising, but it is still matter of controversy.
Commentary: Bicuspid aortic valve geometry—A tale of two valves
J. Hunter Mehaffey, MD, MSc, Robert B. Hawkins, MD, MSc
Valve-sparing root reimplantation is feasible in bicuspid aortic valve, and respecting the geometry may provide the optimal outcomes in the higher-risk Sievers type 1 valves.
Thrombocytopenia after implantation of the Perceval S aortic bioprosthesis
Philipp Stegmeier, MD, Markus Schlömicher, MD, Hugo Stiegler, MD, Justus T. Strauch, MD, J.F. Matthias Bechtel, MD
Platelet counts after aortic valve replacement with the Perceval S (LivaNova PLC, London, United Kingdom) bioprosthesis decrease significantly more compared with other biological valves, but without apparent clinical consequences.
Commentary: Perceval S bioprosthesis valve and platelets: The thrombocytopenia is behind the corner and the mystery continues
Francesco Formica, MD, Fabio Guarracino, MD
The Perceval S valve implant is still linked to thrombocytopenia, a relevant and unsolved event early after surgery. No severe complications are directly correlated with this reversible phenomenon.
Commentary: Thrombocytopenia yes…thrombocytopenia no…that is the question
Antonio Miceli, MD, PhD
Thrombocytopenia is a transient and multifactorial phenomenon in the absence of clinical complications. Mechanical stress induced by oversizing may be a potential cause of thrombocytopenia.
CORONARY
Development of a risk score for early saphenous vein graft failure: An individual patient data meta-analysis
Alexios S. Antonopoulos, MD, PhD, Ayodele Odutayo, MD, PhD, Evangelos K. Oikonomou, MD, PhD, Marialena Trivella, BSc, MSc, DPhil, Mario Petrou, PhD, FRCS (CTh), Gary S. Collins, BSc, PhD, Charalambos Antoniades, MD, PhD, the SAFINOUS-CABG (Saphenous Vein Graft Failure—An Outcomes Study in Coronary Artery Bypass Grafting) group
A novel risk score (SAFINOUS score) estimates the individualized risk for early vein graft failure based on clinical, anatomical, and operative factors.
Commentary: Saphenous vein graft risk score: But where is the vein?
Bobby Yanagawa, MD, PhD, Mario F.L. Gaudino, MD
It is unlikely that a risk score could be used to guide grafting strategy.
Commentary: Better prediction, better execution, better management
Daniel J.P. Burns, MD, MPhil
With a summary published risk of 11%, early saphenous vein graft failure remains an important issue. A novel scoring system for early failure may help surgeons predict this event.
MECHANICAL CIRCULATORY SUPPORT
Early outcomes with durable left ventricular assist device replacement using the HeartMate 3
Yaron D. Barac, MD, PhD, Charles M. Wojnarski, MD, MS, Parichart Junpaparp, MD, Oliver K. Jawitz, MD, Han Billard, MD, Mani A. Daneshmand, MD, Richa Agrawal, MD, Adam Devore, MD, Chetan B. Patel, MD, Jacob N. Schroder, MD, Carmelo A. Milano, MD
LVAD replacement with HM3 can be performed safely and may be considered as the pump of choice in patients requiring LVAD replacement.
Commentary: For the pumps they are a-changin’
Bryan A. Whitson, MD, PhD
As we are firmly into a new era of centrifugal, continuous-flow left ventricular assist devices, our management of the complications of previous-generation pumps and these pumps evolves.
Commentary: Left ventricular assist devices, they are a-changin'…
Daniel J. Goldstein, MD
For patients in need of LVAD pump exchange, replacement with a HM3 device provides survival and freedom from recurrent pump thrombosis benefits.
Commentary: Left ventricular assist device exchange: Have we found the golden ticket?
Kareem Bedeir, MD, Tsuyoshi Kaneko, MD, and Sary Aranki, MD, Boston, MA
The tool box of nonfemoral access for TAVI has evolved, with the optimal alternative approach yet to be determined.