Cardio Trial Files: TAVR vs. SAVR in Severe Aortic Stenosis and SAA, Cryoablation vs. Radiofrequency Ablation in AFib, and Aortic Arch Surgery HCA Temperature Strategies
Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Small Aortic Annulus
Rodés-Cabau J et al. Circulation (October 2023)
Bottom Line: This is a prospective multicenter international randomized trial comparing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in 151 patients with severe aortic stenosis and small aortic annulus (SAA). The primary outcome was impaired valve hemodynamics at 60 days, and secondary outcomes included clinical events (mortality, stroke, and cardiac hospitalization). After a median follow-up of 2 years, here were no differences between groups in the rate of severe prosthesis patient mismatch (TAVR, 4 [5.6%]; SAVR, 7 [10.3%]; P=0.30) and moderate-severe aortic regurgitation (none in both groups). There were also no differences between groups in mortality, stroke, and cardiac hospitalization. The study suggests that both TAVR and SAVR are valid treatment options for patients with severe aortic stenosis and SAA, and treatment should be individualized based on patient characteristics and preferences. However, the study was underpowered and larger studies are needed to confirm these findings.
Atrial fibrillation progression after cryoablation vs. radiofrequency ablation (CIRCA-DOSE)
Andrade JG et al. European Heart Journal (August 2023)
Bottom Line: This was a randomized study with a duration of 944.0 days (median). The study population consisted of 346 patients with drug-refractory paroxysmal AF. The intervention group received contact-force-guided RF ablation (n=115), while the comparator groups received either 4 min cryoballoon ablation (n=115) or 2 min cryoballoon ablation (n=116). The primary outcome was the first episode of persistent atrial tachyarrhythmia, with significantly lower rates in the intervention group (0.0%) compared to the comparator groups (7.0% and 4.3%, respectively). Secondary outcomes included atrial tachyarrhythmia recurrence and arrhythmia burden, which were also lower in the intervention group. The conclusion was that catheter ablation using radiofrequency energy was associated with a lower risk of persistent AF in patients with paroxysmal AF.
Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest Trial (GOT ICE)
Hughes GC et al. Circulation (February 2024)
Bottom Line: This randomized, single-blind, multicenter study compared the effects of low-moderate hypothermia (20.1-24.0 °C) with deep (≤20.0 °C) and high-moderate (24.1-28.0 °C) hypothermia during hypothermic circulatory arrest for aortic arch surgery. The study included 282 patients from 4 US referral aortic centers and followed them for 4 weeks postoperatively. The primary outcome was global cognitive change score, and secondary outcomes included domain-specific cognitive change scores, neuroimaging findings, quality of life, and adverse events. The results showed that low-moderate hypothermia was noninferior to deep hypothermia in terms of global cognitive change score, but deep hypothermia showed better preservation of structured verbal memory. There were no significant differences in safety outcomes between the three temperature groups. This study suggests that low-moderate hypothermia may be a suitable alternative to deep hypothermia during hypothermic circulatory arrest for aortic arch surgery, with potential benefits in preserving cognitive function.
Cardio Trial Files Issue #CRD-2024-07
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