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Journal and News Scan
A retrospective Mount Sinai small series on selective emergent implantation of long-term ventricular assist devices in cardiogenic shock. It challenges the traditional concept of short-term stabilisation with ECMO or short-term support, and is likely to generate criticism and discussions.
The Mayo Clinic team retrospectively reviewed their experience with isolated CABG for multivessel coronary artery disease over a 15-year period to assess usage of bilateral internal mammary arteries (BIMA) and selected outcomes. The population included a total of 6468 isolated CABG procedures.
Some of the salient findings from their study are:
- The use of BIMA doubled over the most recent 4-year period (13% to 27%).
- Propensity-matched patients exhibited a survival advantage for BIMA patients, with a hazard ratio of 0.81.
- Sternal infection was not significantly higher in the BIMA group.
The authors conclude that BIMA use should be encouraged and expanded.
The authors retrospectively examined the mid-term outcomes in 34 patients who required stabilization of the sternum with the Synthes Titanium Sternal Fixation System for either established sternal dehiscence or high risk for sternal dehiscence. Reported outcomes (at a median follow-up period of 1.4 years) were as follows:
- All patients had stable sternums on physical exam.
- Bone consolidation assessment by CT scans on follow-up showed: complete consolidation of bone in 26% of patients, near-complete in 39%, partial in 10%, and missing in 26%.
- 13 patients (38%) required plate removal for either pain or infection.
While thoracic stabilization was thus achievable, the authors caution that the non-negligible complication rate should reserve plating for patients at high risk for dehiscence and who are unsuitable for standard closure.
Weder and colleagues present a debate addressing surgery versus stereotactic body radiotherapy as the primary treatment of early-stage lung cancer. Arguments relating to outcome and the impact on further therapy are given by both surgeons and radiation oncologists.
A succinct, readable, and well-referenced editorial on extending criteria for surgery on bicuspid aortopathy below the threshold of 4.5 cm diameter. It is even more interesting in the era of increasing industry pressure for transcatheter aortic valve replacement.
An alarming list of some crazy things our colleagues have done in the recent past.
A woman in the northwest US who was thought to have drowned makes a surprising recovery, aided by a local hospital’s use of extracorporeal membrane oxygenation for traumatic heart and lung injuries.
An Indian man now has two hearts, as his surgical team performed a heterotopic heart transplant upon realizing that the donor heart could be too small for the patient.
Drugs and Devices
The SherpaPak™ and SherpaPerfusion™ Cardiac Transport Systems, heart and kidney transportation devices from Paragonix Technologies, have received the CE mark.
The US Food and Drug Administration has approved tezacaftor/ivacaftor and ivacaftor from Vertex Pharmaceuticals to treat cystic fibrosis in patients with particular CFTR mutations.
Research, Trials, and Funding
Researchers in Philadelphia, Pennsylvania, found that over 20% of children who underwent cardiac surgery as infants had hearing loss, a rate 20 times higher than in the general population.
Research from the Penn Atrial Fibrillation Free Study, based at the University of Pennsylvania, suggests that despite having a lower risk of developing atrial fibrillation, African Americans with atrial fibrillation have a higher risk of stroke when compared to Caucasian Americans.
In this patient level meta-analysis of 11 randomised trials, the authors compare PCI using stents with CABG. In total, almost 12,000 randomised patients were included.
They found that at a mean of 3.8 years of follow-up, mortality was higher after PCI versus CABG (11.2% versus 9.2%, hazard ratio 1.20, 95% confidence interval 1.06 - 1.37, p = 0.0038). The vast amount of data allowed meaningful analysis of subgroups. The mortality benefit was particularly clear in patients with multivessel disease and diabetes, whereas there was no difference between the two treatments in patients with left main disease or without diabetes.
A comprehensive review of pleural diseases from the internists' viewpoint. Relevant to surgeons in the sense of referrals for empyema, pleural effusions, and other traditional surgical problems that are now often dealt with revitalised internist-led options such as office pleuroscopy/pleurodesis.
A well-written, brief, pessimistic editorial on the loss of surgeon autonomy in innovation.