The Beat With Joel Dunning Ep. 150: Concerning Trends Seen in Aortic Stenosis Related-Mortality
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In this episode of the CTSNet Podcast, Joel Dunning explores a concerning trend in aortic stenosis-related mortality in the United States, drawing on a groundbreaking analysis by Samir Hirji using the CDC WONDER database. The data reveals a long-term decline in AS-related deaths until the widespread adoption of TAVR, after which mortality began to rise—particularly among patients under 75. This counterintuitive finding challenges the assumption that new technologies always improve outcomes and raises urgent questions about patient selection, underdiagnosis, and systemic disparities in care access. Hirji’s research underscores the need for population-level scrutiny beyond trial and registry data, highlighting potential gaps in how we identify and treat asymptomatic or low-risk patients. The episode also covers several high-impact papers: a large Medicare study favoring bioprosthetic valves over mechanical ones in patients over 65; a randomized trial finding no significant difference between fissure-first and fissure-last lobectomy techniques; and a compelling study on the durability of the Ozaki procedure in dialysis patients. The segment concludes with three exceptional global surgical videos, including a minimally invasive left atrial myxoma resection from Ukraine, a conduction-sparing aortic valve technique from Lebanon, and a complex coronary aneurysm repair from Cleveland Clinic.
Aortic stenosis-related mortality in the U.S. has increased since the liberalization of TAVR guidelines, suggesting potential issues with patient selection or underdiagnosis.
Bioprosthetic valves outperform mechanical valves in patients over 65 across all major outcomes, including mortality, stroke, and re-intervention.
The Ozaki procedure demonstrates excellent durability and low regurgitation rates even in chronic dialysis patients, making it a promising alternative to bioprosthetics.
Fissure-first vs. fissure-last lobectomy shows no significant difference in air leak rates in modern enhanced recovery settings, challenging long-standing surgical dogma.
Conduction-sparing aortic valve replacement techniques can dramatically reduce pacemaker dependency, with only 1 in 179 patients needing one in a large series.
…and 3 more takeaways available in PodZeus
Introduction to the Episode and Key Papers
Joel Dunning introduces the episode, highlighting a major new analysis by Samir Hirji on rising aortic stenosis mortality in the U.S. following TAVR expansion. He previews four key papers: a study on bioprosthetic vs. mechanical valves in patients over 65, a randomized trial on lobectomy techniques, the Ozaki procedure in dialysis patients, and a landmark video from Cleveland Clinic on complex coronary aneurysm repair.
Gender Disparities in Thoracic Surgery
Dunning discusses a New York Times article exposing systemic inequities in female thoracic surgeons, including lower pay, higher miscarriage rates, and slower promotions. He emphasizes that the U.S. faces worse gender disparities than Europe or Australia, calling for collective action to address these issues.
Bioprosthetic vs. Mechanical Valves in Patients Over 65
Dunning presents a large-scale study of 69,423 Medicare patients showing bioprosthetic valves significantly outperform mechanical ones in all outcomes—mortality, stroke, re-intervention, and readmissions—despite lower reintervention rates expected for mechanical valves.
Fissure-First vs. Fissure-Last Lobectomy: A Randomized Trial
A trial from the University of Turin finds no meaningful difference in air leak rates between fissure-first and fissure-last lobectomy techniques, challenging established dogma and suggesting that surgical precision and sealing techniques matter more than the order of dissection.
The Ozaki Procedure in Dialysis Patients
“The Ozaki procedure is brilliant in dialysis patients, in not dialysis patients. And Cambry relied on at five years to do a great result.”
“If you are seeing an increase in mortality despite widespread approval, what are we missing in the equation?”
“They open it all up... then identify every single side branch... and do a side-to-side anastomosis. I think they do eight.”
“The Ozaki procedure is brilliant in dialysis patients, in not dialysis patients. And Cambry relied on at five years to do a great result.”
Host
Guest
Joel Dunning
person
TAVR
other
CDC WONDER database
organization
Samir Hirji
person
SAVR
other
Ozaki procedure
other
New York Times
organization
Cleveland Clinic
organization
STS
organization
Bassam Abu Khalil
person
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