ALERT!

This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Journal and News Scan

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Nick Freemantle, Marc Ruel, Mario F.L. Gaudino, Domenico Pagano
Freemantle and colleagues discuss evidence evaluating myocardial revascularization strategies, focusing in particular on conclusions that can and cannot be drawn from subgroup analyses. The authors detail the benefits and limitations inherent to meta-analyses, and they comment on dividing left main coronary artery stenosis and multivessel coronary artery disease into subgroups when comparing outcomes between surgical and percutaneous interventions.
Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Frank A. Baciewicz Jr

A brief readable editorial on a retrospective analysis of the costs of coronary artery bypass grafting in Virginia, USA, which suggests the value of enhanced recovery in coronopathy.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Marc de Perrot

A succinct balanced editorial advancing, amongst other things, the position for initial nonintervention for submassive pulmonary embolism.

Source: The Annals of Thoracic Surgery
Author(s): Kambiz Hassan, Nikolai Bayer, Friederike Schlingloff, Martin Oberhoffer, Peter Wohlmuth, Michael Schmoeckel, Stephan Geidel

Hassan and colleagues performed a retrospective analysis of 81 patients who presented for open cardiac surgery while receiving novel oral anticoagulant (NOAC) therapy. Patients were off NOACs for a median of 4 days (IQR, 3 - 6 days) prior to surgery. The authors found the length of the NOAC withdrawal period was significantly related to the postoperative 24-hour drainage volume, which was 480 ml (IQR, 350 - 600 ml). Additionally, 6.2% of patients required rethoracotomy to investigate bleeding. The authors suggest that 10 days of NOAC withdrawal might be preferable prior to elective cardiac surgery.

Source: JAMA Surgery
Author(s): Erika L. Rangel, Douglas S. Smink, Manuel Castillo-Angeles, Gifty Kwakye, Marguerite Changala, Adil H. Haider, Gerard M. Doherty

This survey of general surgeons in the US who had a pregnancy during surgical training identified a number of challenges that may influence career satisfaction.  These included inadequate scheduling support, lactation facilities, and mentoring.  30% of participants would advise a female medical student not to pursue a surgical career.

Source: Innovations
Author(s): Olivia K. Ginty, John M. Moore, Yuanwei Xu, Wenyao Xia, Satoru Fujii, Daniel Bainbridge, Terry M. Peters, Bob B. Kiaii, Michael W.A. Chu

This article examines an interesting concept for preparing for mitral repair. This may have useful assistance in complex valve repairs and in the early stages of training of young surgeons.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

A teen in Chicago, Illinois, USA, awaiting a heart transplant received the news that a heart was available from his pediatric cardiologist, who dressed up as Chewbacca from Star Wars just for the occasion.

Surgeons in the UAE replaced all four heart valves in a man with infective endocarditis.

A hospital system based in Delaware, USA, plans to launch an app to help monitor infants born with a single ventricle when they are discharged from the hospital after surgery.

 

Drugs and Devices

Japan’s Ministry of Health, Labor, and Welfare has granted national reimbursement for the MitraClip™ from Abbott, a move that will make the technology more accessible through the country’s health insurance system.

 

Research, Trials, and Funding

Researchers from the Netherlands presented a proof-of-concept study at the recent European Heart Rhythm Association meeting, showing that putting light-sensitive ion channels into the heart allows it to terminate arrhythmias itself in response to a pulse of light.

Reports of severe myocarditis after cancer treatment with immune checkpoint inhibitors are increasing, say researchers from the US and France, and they speculate that this is due both to increased use of these drugs and heightened awareness of this complication.

Source: Science Translational Medicine
Author(s): Chun Gwon Park, Christina A. Hartl, Daniela Schmid, Ellese M. Carmona, Hye-Jung Kim, Michael S. Goldberg

Surgery for cancer is known to suppress immune response and facilitate the development of metastases.  In this study in mice, a scaffold designed to release agonists of innate immunity over time was placed in the bed of resected tumors.  The treatment reduced local recurrence and improved survival. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Maximilian Luehr, Sven Peterss, Andreas Zierer, Davide Pacini, Christian D Etz, Malakh Lal Shrestha, Konstantinos Tsagakis, Bartosz Rylski, Giampiero Esposito, Klaus Kallenbach, Ruggero De Paulis, Paul P Urbanski

Of 1,232 patients who underwent elective arch repairs at 11 European aortic centers, 155 were selected and their surgical outcomes were analyzed retrospectively. Approximately 13% of patients suffered an aortic event, and 85% of them needed reoperation. Multivariate analysis found older age at reoperation to be the only independent risk factor for in-hospital mortality.

Source: Annals of Surgery
Author(s): Luca Gianotti, Roberto Biffi, Marta Sandini, Daniele Marrelli, Andrea Vignali, Riccardo Caccialanza, Jacopo Viganò, Annarita Sabbatini, Giulio Di Mare, Mario Alessiani, Francesco Antomarchi, Maria Grazia Valsecchi, Davide P Bernasconi

One of the more contentious issues in Enhanced Recovery After Surgery (ERAS) programs is the role of preoperative carbohydrate loading.  This randomized trial demonstrated less need for insulin for treating serum glucose >180 mg/dl in the carbohydrate-loading group compared to the placebo group (2.4% versus 16.0%; RR 0.15; p<0.001) with no change in the frequency of postoperative infection.

Pages