Michael J. Mack M.D.

Kron, I. L., D. J. LaPar, M. A. Acker, D. H. Adams, G. Ailawadi, S. F. Bolling, J. W. Hung, D. S. Lim, M. J. Mack, P. T. O’Gara, M. K. Parides and J. D. Puskas (2017). “2016 update to the american association for thoracic surgery (aats) consensus guidelines: Ischemic mitral valve regurgitation.” J Thorac Cardiovasc Surg 153(5): e97-e114.

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The objective of this project was to provide an update to the previously published consensus 2015 The American Association for Thoracic Surgery (AATS) evidence-based guidelines for the management of ischemic mitral regurgitation (IMR).

Kron, I. L., D. J. LaPar, M. A. Acker, D. H. Adams, G. Ailawadi, S. F. Bolling, J. W. Hung, D. S. Lim, M. J. Mack, P. T. O’Gara, M. K. Parides and J. D. Puskas (2017). “2016 update to the american association for thoracic surgery consensus guidelines: Ischemic mitral valve regurgitation.” J Thorac Cardiovasc Surg 153(5): 1076-1079.

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We are very pleased to update The American Association for Thoracic Surgery (AATS) Consensus Guidelines on ischemic mitral valve regurgitation (IMR) (Figure 1). These Guidelines were developed based on the results of published randomized clinical trials, large observational studies, and the expert opinion of the authors. Subsequent to the publication of the 2015 AATS IMR Guidelines,1 the 2-year follow-up results of the Cardiothoracic Surgical Trials Network (CTSN) severe and moderate ischemic mitral regurgitation (MR) trials were published.2,3

Blanke, P., P. Pibarot, R. Hahn, N. Weissman, S. Kodali, V. Thourani, R. Parvataneni, D. Dvir, C. Naoum, B. L. Norgaard, P. Douglas, W. Jaber, O. K. Khalique, H. Jilaihawi, M. Mack, C. Smith, M. Leon, J. Webb and J. Leipsic (2017). “Computed tomography-based oversizing degrees and incidence of paravalvular regurgitation of a new generation transcatheter heart valve.” JACC Cardiovasc Interv 10(8): 810-820.

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OBJECTIVES: The aim of the study was to investigate the influence of the extent of computed tomography (CT)-based area and perimeter oversizing on the incidence and severity of paravalvular aortic regurgitation (PAR) for the Edwards SAPIEN 3 (Edwards Lifesciences, Irvine, California) device, using CT data and echocardiographic outcome data of the PARTNER II (Placement of AoRTic TraNscathetER Valves Trial II) SAPIEN 3 intermediate-risk cohort. BACKGROUND: Transcatheter heart valve (THV) sizing algorithms are device specific, requiring refinements for new valve designs. METHODS: A total of 835 intermediate-risk patients with severe, symptomatic aortic stenosis enrolled in a multicenter, nonrandomized registry at 57 sites in the United States and Canada with available systolic CT data and echocardiographic follow-up were included in this analysis. THV size selection was primarily CT guided based on annular area. Area-based and perimeter-based oversizing was calculated using systolic annular CT dimensions and nominal dimensions of the implanted THV size. PAR was assessed at 30 days according to a 5-class scheme. RESULTS: Mean oversizing by area was 7.7 +/- 9.4% and mean oversizing by perimeter was 1.7 +/- 4.4%. An inverse proportional relationship between degree of oversizing and frequency and severity of PAR was observed for both area and perimeter oversizing. Perimeter and area oversizing confer similar predictive capacity in regard to the occurrence of PAR after THV implantation (area under the curve: 0.78 [95% confidence interval: 0.70 to 0.85] vs. area under the curve: 0.78 [95% confidence interval: 0.72 to 0.85]; p < 0.0001). No aortic root ruptures were observed. CONCLUSIONS: For the SAPIEN 3 THV, the frequency and extent of PAR is inversely related to the degree of oversizing with acceptable rates of PAR being achieved at lower degrees of oversizing. Perimeter and area oversizing confer similar predictive capacity in regard to the occurrence of PAR after implantation of the SAPIEN 3 THV. Therefore, the SAPIEN 3 THV may offer the opportunity to reduce the risk of annular rupture associated with more significant degrees of oversizing in borderline annular anatomy.

Mack, M. (2017). “The transatlantic relationship: Hands across the ocean from borst to mohr.” Thorac Cardiovasc Surg 65(S 03): S164-s166.

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The metaphor of “hands across the ocean” was first embraced by Hans Borst in 1985 to define the close, collaborative relationship between German and American thoracic surgeons ([Fig. 1]).[1] In the postwar era, numerous American surgeons helped put German thoracic surgery back on its feet. This led to a bidirectional transatlantic alliance in which patients in both countries benefited from the cross-fertilization and coeducation among surgeons. Prof. Friedrich Mohr crossed the ocean in the late 1980s to build a lifelong collaboration with, among others, Jack Matloff and Frank Litvak at the Cedars-Sinai Medical Center in Los Angeles, United States.

Mumtaz, M., H. Gada, M. J. Mack and M. J. Reardon (2017). “Who’s afraid of the big bad wolf?” J Thorac Cardiovasc Surg: 2017 Mar [Epub ahead of print].

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Cardiac surgeons traditionally have been leaders in the development of innovative therapy for the treatment of cardiovascular diseases. We hold deep convictions and strong opinions on discovering and delivering the best treatment for our patients. We have led the way in all of medicine in data collection and rigorous outcomes analysis to improve the care of our patients. Our passion for rigorous self-examination is unparalleled. Simply put, we are staunch patient advocates who do not run from the challenges of finding and delivering the best care to our patients. Surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis is arguably one of the most successful cardiac procedures ever developed. Since the introduction of SAVR in 1960, millions of lives have been saved and improved. Although never tested against the previous standard of care, medical therapy, we as surgeons knew it was the right choice because without SAVR these patients were resigned to heart failure and death. We did track our outcomes both individually and nationally by the creation of the Society of Thoracic Surgery Adult Cardiac Surgery database, which now encompasses more than 6.1 million patients contributed by more than 95% of cardiac surgeons in the United States.