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Journal and News Scan
The incoming issue of the Journal comes with an interesting group of papers revolving around a provocative topic: work from Seattle on the absence of predictive value of standard pulmonary function tests in LVAD surgery. Vivek Rao takes the opportunity to present his thoughts in this brief editorial, the important central message of which cannot be ignored.
This brief article compares costs and morbidities for TAVR and SAVR in the current era. TAVR costs are higher than for SAVR and have increased despite no apparent change in comorbidity index. In contrast, SAVR costs remained stable during the same period.
An enthusiastic yet balanced and succinct editorial on the occasion of a small series with short follow-up and absolute survival of ECMO-supported recipients of pulmonary transplantation (mostly with interstitial fibrosis) with short waiting time after ECMO (less than 16 days). The key word is 'selection.' It is also worth contemplating whether placing a lung transplant candidate on ECMO expedites the donation and implantation, and the ramifications of that in terms of manipulating the waiting lists.
This interesting article outlines language-related aspects of gender bias and provides some suggestions for mitigation.
With the impressive average of 150 mitral repairs annually for the last 16 years (possibly a world record, even more impressive given the population of Portugal), the Coimbra team led by Antunes reflects on six cases of circumflex artery injury, mostly in non-right dominant anatomy as expected.
Mery and colleagues retrospectively reviewed outcomes of 383 neonates and infants undergoing repair of congenital heart defects to determine if the presence of congenital gastrointestinal (GI) malformations affected cardiac surgery outcomes. Although long-term survival after discharge was similar between groups, patients with thoracic GI malformations had worse perioperative outcomes than controls. The authors conclude that GI malformations do not contraindicate cardiac repair, however they suggest that families receive appropriate counseling on the risk.
The Hospital Readmissions Reduction Program (HRRP) was established as part of the Affordable Care Act in the US with the goal of adding an incentive for quality care that reduced hospital readmission rates. HRRP reduces Medicare reimbursement for hospitals with excess readmissions.
Gupta and colleagues sought to understand how this program affected outcomes for heart failure patients. The authors evaluated readmission for Medicare beneficiaries with heart failure from 2006 to 2014 using the American Heart Association’s Get With The Guidelines-Heart Failure registry and associated Medicare claims files. The authors found that the one-year risk-adjusted readmission rate decreased (HR 0.92) and the one-year risk-adjusted mortality rate increased (HR 1.10) following HRRP implementation. Secondary analysis that excluded patients who were discharged to hospice care found similar though attenuated changes.
The authors conclude that public health policies should be studied, as are drugs and devices, to ensure they confer the intended benefits.
The Wall Street Journal published an article highlighting this paper.
This randomized trial evaluated restricted (threshold of Hgb <7.5 at induction of anesthesia ) versus liberal (Hgb <9.5 at induction of anesthesia or <8.5 on arrival in ICU) for patients undergoing cardiac surgery who had a EuroSCORE of 6 or more. The composite outcome was death, MI, stroke, or new onset renal failure. Transfusion occurred in 52% of the restricted group and 73% of the liberal group. Outcomes were similar between these moderate-to-high risk groups.
To commemorate its 15th anniversary, the Asian Heart Institute in Mumbai, India, has pledged to subsidize the costs of 15 heart transplants for patients who cannot afford them.
Doctors at the Cleveland Clinic Abu Dhabi in UAE have noted a relatively high number of patients treated for achalasia with peroral endoscopic myotomy.
Drugs and Devices
Abbott’s MitraClip is the first transcatheter treatment for mitral regurgitation to be approved by Japan’s Ministry of Health, Labor, and Welfare.
An app developed by a startup in Haifa, Israel, can monitor a COPD patient’s phone calls and alert them to changes in their voice that might be associated with worsening lung function.
Research, Trials, and Funding
Neovasc has received US Food and Drug Administration approval to begin a North America clinical trial of its Reducer, a catheter-based technology for refractory angina that is already approved in Europe.
An editorial from Nature discusses the road of translational research that lead to the genetically-modified skin transplant that now allows a young boy to play outside without blistered skin.