Cardiac Surgery 2021 Reviewed

Abstract

PubMed displayed more than 35,000 hits for the search term “cardiac surgery AND 2021.” We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term “myocardial revascularization” is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

Cardiac Surgery 2022 Reviewed

“…The current status here can be summarized as follows: SAVR patients have slightly higher postprocedural gradients and more postprocedural atrial fibrillation (AF), while TAVI patients require more pacemakers, have more thrombus formation on the valve (hypoattenuating leaflet thickening [HALT]), more paravalvular leaks, and possibly worse survival at longer follow-up. 32 The latter finding is supported also in 2022 from a Polish registry analysis (►Fig. 3A) 33 that repeats registry outcomes from Germany, Italy, and France, demonstrating better survival with SAVR after 5 years, while short-term outcomes are either the same or better with TAVI.…”

Cardiac Surgery 2023 Reviewed

“…PCI did not meet the noninferiority criteria in the primary outcome analysis, despite its huge noninferiority margin of 1.65. 2 16 For the 3-year results, the authors now present a new combined endpoint of death, stroke, and MI (excluding the need for re-revascularization). For this endpoint, the authors describe no difference and report an incidence of 9.2% for CABG versus 12% for PCI.…”

“…Since the selection will always be biased and affected by individual perception (despite this standardized process), we have again focused on applying a mechanistic perspective wherever possible and also on information most relevant for a proper risk-benefit assessment. We hope the reader appreciates our efforts, which are (as in recent years [1][2][3][4][5][6] ) strictly adherent to the common principle that everyone is entitled to his or her own opinion, but not to his or her own facts. In other words, readers may not agree with our interpretation of the data, but they can rest assure that the quoted data and associations are accurate.We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach for a systematic literature review.…”

To Repair a Broken Heart: Stem Cells in Ischemic Heart Disease

“…In any case, the limited regenerative capability displayed by endogenous cardiomyocytes is not adequate to fully address the incurred cardiomyocyte loss [ 57 , 80 , 81 , 82 ]. Though revascularization may restore the flow of oxygen and nutrients to an injured area [ 13 ], local cardiomyocyte populations are indeed not completely restored, with infarcted areas often replaced by collagen-rich fibrous scars [ 83 , 84 ]. To tackle this problem, various studies have examined the effect of stem cells or stem cell-related products on infarcted myocardial tissue, both in a preclinical as well as a clinical setting [ 85 ].…”

“…Nevertheless, these procedures might be associated with complications [ 9 , 10 , 11 ]. Furthermore, the problem at hand might not be fully addressed with the first intervention, often requiring repeat procedures [ 12 , 13 ]; with re-operative cardiac surgery in particular, there might be increased morbidity and mortality [ 14 ]. An additional therapeutic measure could thus present an appealing solution to facilitate tissue healing and regeneration after myocardial infarction (MI).…”