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Journal and News Scan
August 3, 2018
Submitted by: Claire Vernon
Ongoing questions in the surgery for type A aortic dissection include arterial cannulation site and the type of distal anastomosis for ascending or hemiarch replacement. Shimamura and colleagues report on the outcomes of 300 patients who underwent aortic repair using transapical arterial cannulation and the adventitial inversion technique at a distal anastomosis. The in-hospital mortality rate was 8%. During a mean follow-up of 31.7 ± 25.2 months, distal reintervention was performed in 11% of patients, with 3% in-hospital mortality for elective reintervention. The authors conclude that transapical cannulation and the adventitial inversion technique for repair of acute type A aortic dissection provide good early and midterm results.
August 3, 2018
Submitted by: Claire Vernon
Engelhardt and colleagues reviewed cases of mediastinal sarcoma in the US National Cancer Database from 2004 to 2012. Overall survival at five years was poor, at only 14.8%, and just under half of patients underwent surgical resection. For patients receiving surgery, an R0 resection was associated with better survival (30.1% versus 18.9%), and surgery combined with radiation therapy was associated with the best survival (40.1%).
August 3, 2018
Submitted by: Arie Blitz
The authors debate how much information should be included in the informed consent, and they use the case of resistant Mycobacterium chimaera found in the LivaNova PLC Stockert 3T heater-cooler system as a case-in-point. The issue raised specifically by this case is whether institutions that use this specific heater-cooler system are obligated to inform the patient of the specific risks of infection with resistant M chimaera. The publication is very informative, and the scope of the debate focuses on the purpose of informed consent, the legal obligation, and how narrow or broad the consent need be. It should not be surprising to anyone that there are no straightforward answers.
July 31, 2018
Submitted by: Claire Vernon
Head and colleagues used a patient-data pooled analysis of 11 randomized clinical trials to compare stroke rates between surgical and percutaneous coronary revascularization. They found that in the first 30 postoperative days, the stroke rate was higher after coronary artery bypass grafting (CABG, 1.1%) than after percutaneous coronary intervention (PCI, 0.4%), and this early difference accounted for the difference in the stroke rate seen at 5 years. Between 31 days and 5 years, stroke rates were not different between CABG and PCI (2.1% versus 2.2%). Regardless of the revascularization approach, patients experiencing a stroke in the first 30 days had significantly higher 5-year mortality than those not experiencing early stroke.
July 28, 2018
Submitted by: Tom C. Nguyen
The US Centers for Medicare and medicaid Services (CMS) convened a panel on 07/25/2018 to discuss recommendations for hospitals to maintain and begin TAVR programs. The focus of the discussion was the procedural volume requirements for TAVR, SAVR, and PCI (https://www.cms.gov/medicare-coverage-database/details/medcac-meeting-de...). The dialogue was balanced. Further recommendations from CMS will be forthcoming.
July 27, 2018
Submitted by: Claire Vernon
Patient Care and General Interest
A woman developed a combination planner, record-keeping notebook, and journal to help her husband through his treatment for esophageal cancer, and other patients now use it to manage their own journeys through complex illness.
August 1 is World Lung Cancer Day.
A surgeon’s experience with related procedures may correlate with reduced hospital mortality for patients undergoing complicated procedures such as esophagectomies.
Drugs and Devices
HeartStitch® presented an initial series of percutaneous suture-based tricuspid repairs with its Heart-Rose™ technology at the recent CSI Frankfurt Conference in Germany.
Australian company Ademus will sell its bioscaffold product CardioCel® through Medical Instruments in Italy and Cardiva in Spain and Portugal.
Research, Trials, and Funding
Research from the Multicenter Italian Lung Detection trial suggests that subsolid lung nodules are an indication of increased cancer risk but that they can be safely managed with surveillance.
July 27, 2018
Submitted by: Aristotle Protopapas
A useful editorial debating current issues on the classification of mesothelioma.
July 26, 2018
Submitted by: Claire Vernon
Barili and colleagues discuss the importance of identifying heterogeneity in meta-analyses and the use of a random-effects or fixed-effects model to account for differences between or within studies. The authors review the assumptions and components of these models, discussing appropriate applications for each of them. Finally, they use an example analysis of surgical and transcatheter valve replacement outcomes to demonstrate the differences between random-effects and fixed-effects models.
July 25, 2018
Submitted by: Aristotle Protopapas
Interesting to read that percutaneous coronary intervention did not confer any survival benefit (nor protection from myocardial infarction) in an international randomized controlled trial of 888 patients when compared to medical therapy!
July 24, 2018
Submitted by: Claire Vernon
This video and article from Desai and colleagues demonstrates double transposition and single branched endovascular repair for total arch replacement in a 59-year-old man who presented with a 7 cm chronically dissected arch and distal aorta. The patient had previously undergone a DeBakey I dissection repair.