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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acute type B aortic dissection with malperfusion via
Elizabeth L. Norton, MS, David M.
Williams, MD, Karen M. Kim, MD, Minhaj S. Khaja, MD,
MBA, Xiaoting Wu, PhD, Himanshu J. Patel, MD, G.
Michael Deeb, MD, Bo Yang, MD, PhD
fenestration/stenting can effectively resolve dynamic
and static malperfusion in ATBAD with favorable short-
and long-term outcomes (survival and reoperation).
Fenestration in static malperfusion for acute type B
aortic dissection: Teamwork can be the Holy Grail, but
Teamwork produced excellent results
in patients with malperfusion from acute type B
aortic dissection. Reproducibility remains a real
concern that should be addressed.
Fenestration and stenting technique and malperfusion
syndrome—To give to Caesar what is Caesar's
Formica, MD, Stefano D'Alessandro, MD, FECTS
Malperfusion syndrome in patients
with acute type B aortic dissection needs a correct
diagnosis to evaluate static or dynamic
obstruction. Fenestration and stenting technique
remains a safe procedure.
Webcast of AATS presentation
the aortic arch in patients with Loeys–Dietz syndrome
Florian S. Schoenhoff, MD, Diane
E. Alejo, BA, James H. Black, MD, Todd C. Crawford, MD,
Harry C. Dietz, MD, Joshua C. Grimm, MD, Jonathan T.
Magruder, MD, Nishant D. Patel, MD, Luca A. Vricella,
MD, Allen Young, MD, Thierry P. Carrel, MD, Duke E.
absence of dissection, patients with LDS have a greater
rate of arch intervention after root surgery than
patients with MFS. After dissection, arch
reintervention rates are similar in the 2 groups.
Bridging the arch in Loey-Dietz syndrome
DeAnda Jr, MD
Interventions of the proximal aorta
in Loey-Dietz syndrome may result in the need for
secondary interventions on the arch, with a
mortality risk. A tear-directed approach may lower
Aortic surgery in patients with Loeys–Dietz syndrome:
When, why, and how?
Iesu, MD, Pierpaolo Chivasso, MD, Vito Domenico
Bruno, MD, PhD
Loeys–Dietz syndrome is rare but can
lead to severe complications of the aorta. Knowing
what to do in the presence of a patient with this
disease is important for any aortic surgeon.
Management of the aortic arch in Loeys–Dietz and Marfan
B. Balsam, MD
A new study shows that after
elective surgery for root aneurysms, patients with
Loeys–Dietz syndrome require more aortic arch
reinterventions compared with patients with Marfan
crossclamp to perfect degenerative mitral valve repair:
Decision-making algorithm, safety, and outcomes
Ahmed El-Eshmawi, MD, Anelechi
Anyanwu, MD, Percy Boateng, MD, Amit Pawale, MD,
Dimosthenis Pandis, MD, MSc, Himani Bhatt, DO, MPA,
FASE, Erick Sun, BA, David H. Adams, MD
bypass run to perfect mitral repair within a clinical
algorithm is a critical procedure to perfect mitral
repair with minimal incremental risk and potential for
In the pursuit of perfect mitral valve repair: A stitch
in time saves nine
De Martino, MD, Uberto Bortolotti, MD
Adequate repair is crucial in
patients with degenerative mitral valve
regurgitation. When the result is suboptimal, a
second pump run, guided by an ad hoc algorithm, may
provide a perfect result.
Mitral valve re-repair: Rejection of imperfection
D. Yuh, MD, FACS, FACC
Striving for structurally sound
mitral repairs, including re-repair, should be
standard practice to maintain the “gold standard”
of surgical therapy against which new devices must
Residual mitral regurgitation: The fork in the road
Pawale, MD, Patrick M. McCarthy, MD
Data-driven strategies for residual
intraoperative mitral regurgitation are essential
to determine when to employ a second crossclamp and
can result in excellent and durable repair results.
multidose cardioplegia in adult cardiac surgery patients:
Ivancarmine Gambardella, MD, FRCS,
Mario F.L. Gaudino, MD, FEBCTS, George A. Antoniou, MD,
FEBVS, Mohamad Rahouma, MD, Berhane Worku, MD, Robert
F. Tranbaugh, MD, Francesco Nappi, MD, Leonard N.
cardioplegia, only in the form of del Nido but not of
HTK solution, reduced operative times, reperfusion
fibrillation, and surge of cardiac enzymes compared
with multidose cardioplegia.
One and done: The case for single-dose del Nido
Helmers, MD, Pavan Atluri, MD
In a meta-analysis of over more than
patients, single administration of del Nido
cardioplegia reduced operative times, reperfusion
ventricular fibrillation, and postoperative cardiac
Single- versus multidose cardioplegia: Could 15 minutes
save your patient?
The current meta-analysis
reconfirmed that single-dose cardioplegia is safe
when dealing with straightforward cases.
MECHANICAL CIRCULATORY SUPPORT
versus central extracorporeal membrane oxygenation for
postcardiotomy shock: Multicenter registry, systematic
review, and meta-analysis
Giovanni Mariscalco, MD, PhD,
Antonio Salsano, MD, PhD, Antonio Fiore, MD, Magnus
Dalén, MD, PhD, Vito G. Ruggieri, MD, PhD, Diyar Saeed,
MD, Kristján Jónsson, MD, PhD, Giuseppe Gatti, MD,
Svante Zipfel, MD, Angelo M. Dell'Aquila, MD, Andrea
Perrotti, MD, PhD, Antonio Loforte, MD, PhD, Ugolino
Livi, MD, Marek Pol, MD, Cristiano Spadaccio, MD,
Matteo Pettinari, MD, Sigurdur Ragnarsson, MD, PhD, Khalid
Alkhamees, MD, Zein El-Dean, MRCS, LLM, Karl Bounader,
MD, Fausto Biancari, MD, PhD, the PC-ECMO group
postcardiotomy shock, peripheral cannulation for
venoarterial extracorporeal membrane oxygenation may be
associated with lower hospital mortality and
complications than central cannulation.
Postcardiotomy shock: Are stones still unturned?
Etchill, MD, MPH, Glenn J.R. Whitman, MD
Peripheral as opposed to central
extracorporeal membrane oxygenation for
postcardiotomy shock appears to improve survival
with fewer complications, but the overall mortality
rate of 60% still represents a significant
Greater loss with central extracorporeal membrane
Kim, MD, Joon Bum Kim, MD, PhD
The question of central or
peripheral venoarterial extracorporeal membrane
oxygenation (VA-ECMO) for postcardiotomy shock
requires an individualized approach. However,
peripheral VA-ECMO may be associated with more
favorable outcomes when feasible.
Extracorporeal membrane oxygenation cannulation for
postcardiotomy shock—Is location really everything?
Mohammadi, MD, FRCSC, Dimitri Kalavrouziotis, MD,
Peripheral versus central
cannulation for VA-ECMO influences outcomes in
postcardiotomy shock greatly. It remains unclear
whether this is a true cause or a simply a
surrogate of patient-level risk.
oral anticoagulant use after cardiac surgery is rapidly
Jared P. Beller, MD, Elizabeth D.
Krebs, MD, MSc, Robert B. Hawkins, MD, MSc, J. Hunter
Mehaffey, MD, MSc, Mohammed A. Quader, MD, Alan M. Speir,
MD, Andy C. Kiser, MD, Mark Joseph, MD, Leora T.
Yarboro, MD, Nicholas R. Teman, MD, Gorav Ailawadi, MD
is rapidly increasing for an array of indications in
the postoperative cardiac surgery setting.
Smoke on the clotter
Bozinovski, MD, MSc
Changing practice patterns in
anticoagulation post-cardiac surgery is occurring
in the absence of quality evidence—is it
insufficient interest, resources, or both?
NOAC? No problem
Y. Sako, MD, PhD
The use of NOACs as the preferred
method of anticoagulation is increasing in part due
to their relative ease of use. This should not
preclude the requisite studies of efficacy and
biomarkers to reduce acute kidney injury following
Daniel T. Engelman, MD, Cheryl
Crisafi, MS, RN, Michael Germain, MD, Barbara Greco,
MD, Brian H. Nathanson, PhD, Richard M. Engelman, MD,
Thomas A. Schwann, MD, MBA
multidisciplinary acute kidney response team triggered
by urinary biomarkers for kidney stress reduced acute
kidney injury following cardiac surgery.
Biomarkers and magical thinking
Chikwe, MD, FRCS, Dominic Emerson, MD
Novel biomarkers are set to
transform science and health care, but rigorous
research methodology, including validation, is
Is it time for a rapid kidney response team?
Dhawan, MD, MPH, Mark A. Chaney, MD
Identification of postoperative
kidney stress through urinary biomarkers, followed
by initiation of therapeutic interventions, may
decrease incidence of stage 2 to 3 acute kidney