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Journal and News Scan
This report provides long-term outcome data on the Perimount valve implanted in the mitral position in patients 65 years of age or less. The expected valve durability was 14.2 years, which compares favourably with other prosthetic valves. Long term mortality was considered valve-related in 1.3% per valve-years, with an overall mortality of 4% per valve-years. The authors provide useful predictions of valve degeneration rates and need for reoperative surgery.
This represent a large series of patients with HOCM who were treated surgically. The study provides prognostic data based on the morphology of the HOCM, which was divided into basal septum, whole of septum, and diffuse left ventricular hypertrophy. Each group had differing survival.
Wang and colleagues present a systematic review of outcomes reported in 26 articles for 67 patients who underwent endovascular treatment for diseases of the ascending aorta, excluding type A dissection. The authors expect a gain in popularity of this intervention in select high-risk patients, but they consider further analysis necessary.
Interesting article commenting on the perception that some remedies in medicine are so obviously beneficial that testing their effectiveness is a waste of time. As it turns out, many of what physicians think are "slam dunk" remedies have mixed or negative results.
Doctors in Abu Dhabi, UAE, say that a surprisingly high number of young Emirati adults have atrial fibrillation.
Two lung cancer survivors attended last Sunday’s Super Bowl 52 in Minnesota, USA, as winners of Team Draft’s Super Bowl Challenge, a part of the Team Draft Foundation’s initiative to increase lung cancer awareness and funding for research.
Drugs and Devices
The Revivent TC™ TransCatheter Ventricular Enhancement System from BioVentrix has received NUB Status 1, an award that designates innovative medical devices to receive reimbursement support in Germany.
Research, Trials, and Funding
Researchers from The Netherlands found robotic surgery to have a lower complication rate than open surgery for esophagectomy, and they presented their findings at the recent Gastrointestinal Cancers Symposium.
Acesion Pharma has received approval to begin a phase 1 study on a new compound for treating atrial fibrillation, which they expect to start in March 2018. This news comes shortly after results of the CASTLE-AF trial were published in the New England Journal of Medicine suggesting that catheter ablation techniques are superior to medical therapy for atrial fibrillation.
In this meta-analysis, the authors compare surgical aortic valve replacement (SAVR) with transcatheter aortic valve implantation (TAVI) in patients at low surgical risk. They included two randomized controlled trials and four propensity-matched studies for a total of almost 3500 patients. Short term mortality was similar between treatments, but intermediate follow-up (two years) showed higher mortality with TAVI versus SAVR (17.2% versus 12.7%, p=0.006).
Although these results should be taken with caution due to the largely non-randomized nature, it proves that we need to await the results of the currently ongoing low-risk trials (NOTION 2, PARTNER 3, and Medtronic TAVI low-risk trial) before we can recommend TAVI in low-risk patients.
Schweiger and colleagues retrospectively analyzed stroke rate for patients under 19 years old in the European Registry for Patients with Mechanical Circulatory Support database. Analysis of the 51 pediatric patients who were supported with a continuous-flow ventricular assist device revealed an incidence of cerebral stroke of 0.1 per patient-year.
The authors conducted a prospective randomized study of 20 high-risk cardiac surgical patients, split into two groups: pulsatile versus nonpulsatile flow during cardiopulmonary bypass. Using spectral imaging and near-infrared technology, the group found that the the pulsatile perfusion group maintained better perfusion indices in the microcirculation.
In this review article, Duran and colleagues provide an overview of pluripotent stem cell (PSC) technology and its potential for application in heart failure. The authors focus on the derivation and reprogramming of these cells for cardiac regeneration, the potential immunogenicity of cardiomyocytes reprogrammed from PSCs, and current cardiac tissue engineering research.
The Nationwide Inpatient Sample was interrogated for all patients undergoing either CABG, valve replacement, or both from 2008 to 2011, and a total of 1,078,036 patients were included in the analysis. The authors discovered that, overall, 9.8% of patients developed acute kidney injury (AKI) postoperatively. Other important discoveries were:
Outcome non-AKI AKI p
- Death 1.3% 13.9% <0.001
- Mean hospital cost $38,820 $77,178 <0.001
The authors calculate that the net effect of AKI after cardiac surgery at a national level in the United States is over $1 billion annually.