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Journal and News Scan
The authors report on a randomized, multicenter, open-label, clinical trial involving 500 patients with 1460 SVGs who were assigned to 3 groups: (1) Ticagrelor + ASA; (2) Ticagrelor alone; (3) ASA alone. Neither patients nor physicians were blinded to the allocation. The primary outcome was SVG patency at 1 year, assessed by either coronary angiography or CT angiography.
Results: The SVG patency rates for groups 1,2, and 3 were 88.7%, 82.8%, and 76.5%. The differences between group 1 and group 3 were significant at p<0.001. The differences between the remaining groups were not significant.
Conclusion: Among patients undergoing elective CABG, the combination of ASA + Ticagrelor resulted in higher SVG patency at one year over ASA alone. Five major bleeding episdoes occurred during 1 year of follow-up, all in either group 1 or 2.
Stiles and colleagues retrospectively analyzed prospectively-collected data on approximately 3,200 surgical lung cancer patients, finding that more than one fifth of these patients are never-smokers. Compared to patients with a history of smoking, never-smokers were more likely to be younger, female, and to suffer from adenocarcinoma. Despite these demographic and disease differences, these patients had similar survival and risk for recurrence as smokers.
The Chinese Red Cross has announced that 25 Afghan children with congenital heart disease will receive free medical treatment in China.
The National Health System England has chosen HeartFlow™ FFRct Analysis to be funded through the Innovation and Technology Payment program, which may allow more patients with coronary artery disease to avoid angioplasty.
The Children’s Heart Foundation and the Adult Congenital Heart Association will host a number of Congenital Heart Walks around the US in 2018 to promote disease awareness and to raise funding for research and educational programs.
Drugs and Devices
In the latest development in a patent spat over transcatheter heart valve technologies, the European Patent Office has revoked a patent owned by Edwards Lifesciences in favor of Boston Scientific. In March, however, the US Patent and Trademark Office ruled in favor of Edwards Lifesciences that claims made by Boston Scientific were invalid.
Research, Trials, and Funding
Researchers report that 45% of patients with non-small cell lung cancer who received nivolumab prior to surgery showed a major pathologic response in the resected tumor, presenting their findings at the recent annual meeting of the American Association for Cancer Research.
Cardiome Pharma has completed enrollment for the Phase 4 SPECTRUM study in the EU evaluating vernakalant hydrochloride for recent onset atrial fibrillation.
A recent study of Swedish adults found that nut consumption was inversely associated with one’s risk for atrial fibrillation and for heart failure.
The authors present the 5-year follow-up results of the HYBRID trial, wherein 200 patients with multivessel disease requiring revascularization were randomized to either conventional coronary artery bypass grafting (CABG) or hybrid coronary revascularization (HCR). Notably, the patients undergoing HCR had a LIMA to LAD via a minimally invasive approach combined with percutaneous coronary intervention (PCI) of the remaining vessels.
The following table summarizes the results from this trial:
Outcome CABG HCR p-value
All-cause mortality 9.2% 6.4% 0.69
Myocardial infarction 7.2% 3.4% 0.30
Repeat revascularization 45.4% 37.2% 0.38
Stroke 4.1% 2.1% 0.35
MACCE 53.4% 45.2% 0.39
The authors conclude that there were no differences in outcomes between the two types of revascularization.
Comment: Although none of the differences achieved statistical significance, there does appear to be a trend for better outcomes with HCR. The lack of significance may be related to inadequate power of the study to detect a difference.
Question: Is it not time to rethink our approach to HCR? Most centers are approaching the procedure with a minimally invasive approach using a single mammary artery. If our main concern is outcomes—as it should be—is it not time to reassess HCR as a conventional or minimally invasive procedure utilizing both LIMA and RIMA for appropriate targets, and PCI for the rest? This would seem to be the optimal approach, so that the patient gets the true benefit of both worlds: the superiority of bilateral mammary revascularization over any alternative conduits, and the superiority of PCI over SVG. What do you think?
Coronary artery bypass grafting (CABG), the second most common cardiac procedure in the US, was added to the US Hospital Readmissions Reduction Program in 2015. Given the relatively high rate of readmission after CABG, Zywot and colleagues sought to develop a scale for predicting readmission risk. Using the State Inpatient Database discharge records of 126,519 patients from New York and California, the authors found that comorbidities such as renal failure (OR, 1.56) and congestive heart failure (OR, 2.82) were strongly predictive of readmission. Older age, female gender, African American ethnicity, and not having private insurance also predicted a higher readmission rate. Factors that were predictive of and associated with readmission were used to develop a scale of readmission risk, which was shown to be a good predictor of readmission in a validation cohort.
In this systematic review, Drury and colleagues evaluated 333 randomized trials in pediatric cardiac surgery that comprised approximately 24,000 children. Most of the trials were early phase trials and recruited relatively few patients. The authors found that less than one third of the trials met basic quality requirements. They emphasize the need for high-quality multicenter clinical trials to achieve reliable evidence for contemporary pediatric heart surgery.
The authors present their experience in treating 39 patients with thoracic aortic endovascular repair of the ascending aorta who were determined to be very high risk for open surgical repair from 2006 to 2016. Treated pathologies included acute type A dissection in 31%, intramural hematoma in 5%, pseudoaneurysm in 56%, and chronic dissection suture line entry tear in 8%. Ascending TEVAR was performed in 36 pateints, and occluder devices were deployed in three patients with pseudoaneurysm. Operative mortality was 13% in this high risk group of patients, with complications including stroke in 10% and myocardial infarction in 5%. The authors propose a zone zero classification system for describing the location of pathology by segmental proximity to the aortic annulus and for assessing prognosis.
The authors demonstrate that mediastinoscopy at the time of either open or VATS lobectomy is independently associated with an increased risk of postoperative pulmonary complications (OR 1.46 and 1.53, respectively).
This retrospective analysis of salvage esophagectomy after definitive chemoradiotherapy in 308 patients identified increased mortality and morbidity associated with squamous histology and radiation dose >55 Gy. Survival at three years was 34%.
Michael Mack and Alec Vahanian discuss the state and future of transcatheter mitral valve replacement.
A new guideline on the use of endoscopic eradication therapy in Barrett’s esophagus published by the American Society for Gastrointestinal Endoscopy recommends against surgery for patients with high-grade dysplasia and intramucosal esophageal adenocarcinoma.
Drugs and Devices
Researchers found that a smartphone app evaluates blood flow in radial and ulnar arteries prior to coronary angiography with higher accuracy than the traditional Allen test.
Research, Trials, and Funding
A man in Texas, USA, became one of the first recipients of lungs transplanted using ex vivo lung perfusion, as part of the EXPAND II OCS trial.
Chronic thromboembolic hypertension was one of the topics at the ongoing Annual Meeting of the International Society for Heart and Lung Transplantation in Nice, France. Another session focused on DCD heart transplantation and ex vivo heart perfusion.
Researchers in Michigan, USA, found that patients undergoing coronary revascularization after the 2014 Medicaid insurance expansion in the USA had outcomes comparable to those for patients who underwent revascularization before the expansion.