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Journal and News Scan
A stimulating discussion of the Vienna paper that advances elective ECMO support for bilateral pulmonary transplantation.
The latest on portable venovenous ECMO in a cohort in which half of the subjects died after a resource-intensive treatment. The results of the relevant EOLIA trial are keenly awaited.
A somewhat delayed publication of a 2016 paper that discusses important trends in cardiac transplanation in the light of increasing use of ECMO.
Using the Premier healthcare database, the authors analyzed the data of over 100,000 adult patients admitted to an ICU in the U.S. with a primary diagnosis of heart failure from 2010-2014. Hierarchical logistic regression models revealed that the likelihood of care by a cardiologist was 42% higher for white as opposed to black patients with heart failure. Cox regression showed that care by a cardiologist was associated with a 20% higher likelihood of survival.
Question: Is this healthcare disparity a true disparity based on race, or are other confounding and unaccounted for variables responsible?
The authors performed a patient-level meta-analysis of six randomized trials comparing left internal mammary artery (LIMA) + saphenous vein graft (SVG) versus LIMA + radial artery graft. In a total of more than 1000 patients and at a follow-up of 60 months, the incidence of adverse cardiac events (death, myocardial infarction, or repeat revascularization) was significantly lower in patients with a radial artery graft as compared with those in the SVG group (hazard ratio, 0.67; 95% confidence interval, 0.49 - 0.90; p = 0.01). Moreover, the patency rate at 50 months of angiographic follow-up was higher in the LIMA + radial artery group. These results emphasize the importance of using more arterial grafts.
The Jos University Teaching Hospital in Nigeria has received a donation of surgical equipment for cardiothoracic surgery from Project CURE, which will allow the hospital to offer more surgical services to patients.
Italy’s former president, Giorgio Napolitano, underwent emergency surgery for a ruptured aorta.
A former goalkeeper for the national Pakistani field hockey team is in need of a heart transplant and has appealed to the Indian government for a medical visa.
Drugs and Devices
The CoAp Pro device from HeartStitch, designed to provide a percutaneous suture-based approach for mitral valve remodeling and repair, has received CE Mark approval in the European Union.
The US Food and Drug Administration has expanded approved use of osimertinib from AstraZeneca to include first-line treatment for metastatic non-small cell lung cancer with epidermal growth factor receptor mutations.
A planned firmware upgrade for certain implantable cardiac devices from Abbott includes a cybersecurity update.
Research, Trials, and Funding
The VEST US trial has enrolled the first 20 patients. The trial will evaluate the safety and effectiveness of a device for treating saphenous vein graft disease after coronary artery bypass grafting.
The authors retrospectively evaluated the long-term fate of the aortic arch in 168 patients with bicuspid aortic valves who had undergone either ascending aortic (24%) or aortic root (76%) replacement. At a median follow-up of 5.9 years, the mean aortic arch diameter went from 2.9 cm preoperatively to 3.0 cm at follow-up (p=ns). The authors conclude that prophylactic arch replacement in this population is not indicated, and perhaps neither is long-term aortic surveillance.
Rizwan and colleagues retrospectively reviewed data from the United Network for Organ Sharing database for pediatric donor hearts and transplants from 2000 to 2015. The authors focused on two cohorts: recipients who accepted a heart with three or fewer prior refusals due to donor quality (RDQ), and recipient accepting hearts with more than three RDQs. Recipients who were adolescents, on extracorporeal support, or in need of a retransplant were more likely to accept a donor heart with a high number of RDQs. Despite this, the rates of posttransplant stroke, dialysis, acute rejection, and rejection within one year were not different between the two groups. Additionally, accepting a heart with more than three prior RDQs did not predict one-year or overall mortality (p = 0.427 and p = 0.626, respectively).
The authors report on a randomized, multicenter, open-label, clinical trial involving 500 patients with 1460 saphenous vein grafts (SVG) who were assigned to three groups: (1) ticagrelor + asprin (ASA), (2) ticagrelor alone, or (3) ASA alone. Neither patients nor physicians were blinded to the allocation. The primary outcome was SVG patency at one 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 coronary artery bypass grafting, the combination of ASA and ticagrelor resulted in higher SVG patency at one year over ASA alone. Five major bleeding episdoes occurred during one 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.