Cardiac Surgery 2019 Reviewed

Abstract

For the year 2019, almost 25,000 published references can be found in PubMed when entering the search term “cardiac surgery.” We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for article selection and reviewed the main fields of adult cardiac surgery (i.e., coronary, valve, aortic, and heart failure surgery). The past decade has experienced an enormous development of interventional techniques that compete more and more with classic surgery. This contest was broadly visible in 2019. It peaked over the interpretation of the EXCEL trial data, where percutaneous coronary intervention and coronary artery bypass grafting (CABG) for left main disease were compared. A novel pathomechanism for CABG was proposed, potentially answering open questions in the field. In aortic valve surgery, two low-risk trials comparing transcatheter aortic valve implantation (TAVI) to classic aortic valve replacement (surgical aortic valve replacement) received attention for showing equal or superior short-term outcomes for TAVI. Longer follow-up information from recent trials became available presenting results emphasizing the need for joint decision making. While publications addressing surgery on the aorta and the mitral and tricuspid valves were less abundant, there was substantial activity regarding left ventricular assist device support and heart transplantation. This article attempts to summarize the most pertinent publications. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide a condensed summary of 2019s publications with a stimulus for in-depth reading and a basis supporting patient information.

Surgical collateralization: The hidden mechanism for improving prognosis in chronic coronary syndromes

“…It also receives support from a plethora of recent reports that we recently reviewed. 16 We suggested that a patent graft to a distal coronary artery creates a surgical collateral that may prevent the occurrence of a new infarction in case the vessel occludes proximal to bypass insertion (eg, by a ruptured plaque). 1 The mechanism of action is then similar to a collateral stemming from angiogenesis E1).…”

Cardiac Surgery 2021 Reviewed

“…5C, D ). 34 47 48 Thus, individual decision-making, taking local expertise, and prognosis for the individual patient into account seem to be the most promising way for optimal patient care.…”

“…Second, the echocardiographic data from the COAPT trial are highly implausible and therefore prevent recommendations for patient selection based on echocardiography. 34,47 The trial published a regurgitant volume of 60 mL in patients that have a 60 mL total stroke volume (ejection fraction of 31% at 194 mL end-diastolic volume). A theoretical concept of proportionate and disproportionate MR was published by the COAPT-protagonists to explain this discrepancy.…”

“…While tricuspid valve surgery has generally been considered high risk, more and more evidence comes to light demonstrating that not the surgical procedure per se but the existing comorbidities at the time of treatment reflect that risk. 34,47 The pathophysiology of TR has moved the liver into the focus of attention. A retrospective study on 85 patients having undergone isolated tricuspid valve surgery between 2005 and 2019 showed significantly increased mortality in patients with a MELD XI score above 12.…”

Decellularized Pulmonary Xenograft Matrix PplusN versus Cryopreserved Homograft for RVOT Reconstruction during Ross Procedure in Adults

“…In the constantly evolving landscape for valve replacement therapy recommendations, the Ross procedure still represents a very suitable option for a selected group of patients. [1][2][3][4] Middle-aged adults can benefit the most from the superior hemodynamics, better survival without the need for anticoagulation, and lower thromboembolic events following the Ross procedure, compared with mechanical valve replacement. 1,2 Yet, observations that a single-valve disease could become a double-valve disease are still on the table.…”