30-Second Takeaway
- Fenestrated/branched EVAR achieves good 5‑year survival but carries meaningful SCI risk and very frequent reinterventions.
- For multivessel disease, CABG trades higher in‑hospital mortality for better 5‑year survival and lower downstream resource use than PCI.
- Post‑CABG troponin I and T are not interchangeable for perioperative MI definitions or quality benchmarks.
- ECPR and LVAD programs should refine selection and perioperative care using neurologic, hemodynamic, and device-specific risk data.
- Marfan type B dissection and distal anastomotic dissection require lifelong distal aortic surveillance and timely thoracoabdominal intervention.
Week ending April 25, 2026
Key updates for complex aortic repair, coronary revascularization, LVAD care, and ECPR
Long-term outcomes after 916 fenestrated/branched EVARs in a high-volume center
This 14‑year single-center series reports outcomes of 916 fenestrated/branched EVARs for juxtarenal and thoracoabdominal aneurysms, mostly using custom-made devices. Thirty-day mortality was 7.4% overall and lower in elective cases, with aortic rupture independently increasing early death risk. Spinal cord ischemia occurred in 16%, with 2.9% nonrecovery Grade 3 SCI; rupture and off-the-shelf devices were independent SCI predictors. Five-year survival exceeded 80%, with low aorta-related mortality, but freedom from any aortic reintervention was only 40% at 5 years.
National data show CABG improves 5-year survival vs PCI despite higher in-hospital mortality
This English population-based cohort included 173,771 patients undergoing multivessel PCI or CABG with complete 5‑year follow-up. Instrumental variable analysis using regional CABG-to-PCI ratios estimated the causal impact of revascularization strategy on mortality. CABG was associated with higher in-hospital all-cause mortality than PCI by about 1 absolute percentage point. However, CABG reduced 5‑year all-cause mortality by roughly 5 absolute percentage points compared with PCI.
Troponin I vs T substantially alter perioperative MI rates after CABG
This study measured cTnT and cTnI simultaneously after isolated CABG in 258 patients with uneventful postoperative courses. Median peak values on postoperative day 1 were markedly higher for cTnI than cTnT, reflecting different scaling of the assays. Standard perioperative MI definitions were exceeded more often by cTnI than cTnT, especially for Academic Research Consortium-2 criteria. Even when ECG and echocardiography criteria were added, cTnI still yielded higher apparent perioperative MI rates than cTnT.
Long-term neurological outcomes and selection factors in ECPR for refractory arrest
This 14‑year single-center cohort included 295 adults receiving venoarterial ECMO ECPR for in- and out-of-hospital refractory cardiac arrest. At six months, 17.3% achieved good neurological outcome (CPC 1–2), more often after in-hospital than out-of-hospital arrest. Younger age, initial shockable rhythm, and shorter low-flow duration independently predicted favorable neurological recovery. Stepwise tightening of selection using these factors increased the proportion of good outcomes but excluded some potential survivors.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.