Cardiovascular Surgery
COAPT Trial: Transcatheter Mitral Valve Repair Leads to Early and Sustained Health Improvements in Patients with Secondary Mitral Regurgitation
A study led by Dr. Suzanne Arnold published in the Journal of American College of Cardiology showed that in patients with heart failure secondary to mitral regurgitation, transcatheter mitral valve repair resulted in early and sustained health status improvement compared with medical therapy alone.
PARTNER 3 Trial: Lower Risk of Death, Stroke and Rehospitalization in Patients with Severe Aortic Stenosis and Low Surgical Risk Treated with TAVR
A randomized controlled trial led by Dr. M.J. Mack, published in the New England Journal of Medicine, showed that in patients with severe aortic stenosis and a low surgical risk, treatment with transcatheter aortic valve replacement (TAVR) with a balloon expandable valve was associated with a lower risk of stroke, death or rehospitalization by 1 year when compared to surgery.
Recently Released Joint Statement Proposes New Model of Care for Patients with Valvular Heart Disease
A joint report that proposes an integrated model of care for patients with valvular heart disease (VHD) was recently released by the American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions (SCAI) and Society of Thoracic Surgeons (STS). This collaboration was published with the aim of optimizing the care received by patients with VHD.
Randomized Trial Shows That Transcatheter Aortic-valve Replacement is Non-inferior to Surgery in Low Risk Patients
A study by Dr. Jeffrey Popma and colleagues published in the New England Journal of Medicine showed that transcatheter aortic-valve replacement (TAVR) was non-inferior to surgery with respect to death or the occurrence of a disabling stroke by 24 months in the low-risk group of patients with aortic stenosis. Previous studies showed that in patients with severe aortic stenosis who were at high risk of complications or death from surgery, TAVR with a self-expanding supra-annular bioprosthesis had better outcomes than medical therapy or surgery. However, there was not enough evidence to advocate the use of TAVR instead of surgery in a younger, healthier population. The authors aimed to address this knowledge gap through this study.
TAVR Using Balloon Expandable Valve Superior To Surgical Aortic Valve Replacement In Low Risk Patients With Severe Aortic Valve Stenosis 1-year trial results presented at the ACC 2019 annual scientific session, New Orleans
A randomized multi-center trial which enrolled 1000 patients from 71 centers around the world has shown that in patients with severe aortic stenosis who are at low surgical risk, the rate of the composite of death, stroke, or rehospitalization at 1 year is significantly lower with transcatheter aortic valve replacement (TAVR) than with surgery. Continue reading
Randomized Trial Comparing Bilateral with Single Internal-Thoracic-Artery Grafting for CABG Shows No Significant Difference in All-Cause Mortality Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years
A recent study published in the New England Journal of Medicine showed that among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. Coronary-artery bypass grafting (CABG) surgery with the use of left internal- thoracic-artery grafts plus vein grafts had been deemed superior to percutaneous coronary intervention in patients with severe coronary artery disease and in those with diabetes. The benefit of using left internal thoracic artery grafts has been attributed to their superior long-term patency as compared with vein grafts. However, it is hypothesized that multiple arterial grafts may result in longer survival than single arterial grafts after coronary-artery bypass grafting (CABG) surgery. In the light of this, the study aimed to evaluate the use of bilateral internal-thoracic-artery grafts for CABG. Continue reading
Long-Term Consequences Post Device Closure of Patent Foramen Ovale in Patients With Cryptogenic Embolism
Recently, Jérôme Wintzer-Wehekind M.D. and his team at Quebec Heart & Lung Institute, Laval University, Quebec, Canada conducted a vast cohort study published in the Journal of American College of Cardiology to look into the long-term outcomes (> 10 years) following PFO closure. Previous randomized trials conducted by various investigators had shown a marvelous reduction in ischemic stroke events for around 2-6 years post PFO closure but not many had gone beyond 10 years. The current study validated that device closure of PFO decreased recurrence of ischemic neurological events and continued to show similar results with the passage of time. Continue reading
Survival Over the First Few Decades Following Tetralogy of Fallot Repair A Study From the Pediatric Cardiac Care Consortium
A study published in JAMA cardiology has shown that long-term survival after simple Tetralogy of Fallot (TOF) repair is excellent. Staged repair and non–valve-sparing operations were negatively associated with survival in the early post repair phase but not the late post repair phase. The study, led by Dr. Clayton A. Smith, Emory University School of Medicine is important for patients with repaired TOF and their caretakers and may guide surgical strategies for optimizing the long-term outcomes of this population. Continue reading
2018: Cardiology News at A Glance Most important trials published in 2018
COAPT trial
This prospective, multicenter, open-label, randomized trial aimed to assess the use of transcatheter mitral valve repair in heart failure (HF) patients with mitral regurgitation due to left ventricular dysfunction. A total of 614 patients were randomized to either receiving guideline-directed medical therapy (GDMT) alone or GDMT in addition to transcatheter mitral-valve repair. The primary efficacy endpoint was all hospitalizations due to heart failure at 24 months of follow-up, while the primary safety endpoint was freedom from device-related complications at 12 months of follow-up. The study showed that the device group had a lower risk of hospitalization for HF (HR 0.53, 95% CI 0.4-0.7) and all-cause mortality (HR 0.62, 95% CI 0.46-0.82) at 24 months. Moreover, the rate of freedom from device complications at 12 months was 96.6% which exceeded the prespecified safety threshold. Continue reading
Saphenous Vein Graft Harvesting for CABG: Endoscopic Vs Open Technique Results from the REGROUP trial
A new study published in the New England Journal of Medicine showed no significant difference in the risk of major adverse cardiac events (MACE) between patients undergoing endoscopic and open harvest of the saphenous vein grafts for coronary artery bypass grafting (CABG). Continue reading
Low Dose Rivaroxaban Plus Aspirin Reduces Major Adverse Limb Events in COMPASS A COMPASS subgroup analysis
According to a new subgroup analysis of the COMPASS trial published in the Journal of the American College of Cardiology, the prevention of Major Adverse Limb Events (MALE) is of utmost importance in patients with lower extremity Peripheral Arterial Disease (PAD) due to its poor prognosis. Additionally, it has been found that the aspirin and rivaroxaban 2.5mg twice daily combination leads to a significant reduction of Major Adverse Limb Events (MALE) in these patients.
Assessment of Long-term Outcomes in Patients Undergoing SAVR
A contemporary cohort study recently published in Journal of the American College of Cardiology highlighted the clinical significance of age and other associated comorbidities in determining the clinical outcome in patients undergoing surgical aortic valve replacement (SAVR). The 10-year mortality rate was found to be considerably high in elderly SAVR recipients of a bioprosthetic valve and almost one-third of the population exhibited subclinical structural valve degeneration (SVD). Continue reading
CABG Versus PCI in Multivessel Disease
In a recent study published in The Lancet, it was found that there is a mortality benefit for patients with multivessel disease undergoing CABG compared to PCI. However, the reduction in mortality was not statistically significant in patients with only left main artery disease. With recent advancements in stenting techniques, the benefit of using CABG over PCI has been debatable. Prior to this , no study was powered to compare the mortality benefits between these interventions.
S-LAAO Reduces Thromboembolism in AFib Patients After Heart Surgery
In a recent retrospective cohort study published in the Journal of American Medical Association conducted on patients with atrial fibrillation (AF) undergoing cardiac surgery, surgical left atrial appendage occlusion (S-LAAO) as compared with no surgical left atrial appendage occlusion (no S-LAAO) was significantly associated with lower risk of readmission for thromboembolism. Continue reading
Continued versus Interrupted NOAC at the time of Device Surgery
Dr. David Birnie and Dr. C. Michael Gibson Discuss
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LAAO Among AFib Patients Undergoing Cardiac Surgery
Dr. Daniel J. Friedman and Dr. C. Michael Gibson Discuss
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