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Journal and News Scan
A brief, informative, and helpful article. It highlights alarming reports that 80% to 90% of "negative" randomized controlled trials in surgery are not adequately powered to reliably declare a negative outcome.
Kepez and colleagues retrospectively evaluated the incidence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Of 83 patients with CTEPH who underwent coronary angiography prior to pulmonary endarterectomy, collaterals were found definitively in 15 patients (18.1%) and were probable in an additional 4 patients (4.8 %). The presence of coronary artery-pulmonary artery collaterals was associated with higher pulmonary artery pressure, higher pulmonary vascular resistance, and a greater reduction in pulmonary vascular resistance following surgery.
A medium-size RCT comparing full sternotomy to limited sternotomy for conventional aortic valve replacement, presented at the SCTS Annual Meeting in Glasgow. The 7-10% one year attrition rate seems quite disappointing, and will most probably be discussed. We will await the full paper to see what was the learning curve for the innovative approach.
Please scroll to page 14 in the link provided to read the presentation summary.
A hijacked journal is a legitimate scientific journal that offers print-only version, for which a bogus website has been created by a malicious third party fake publisher for the purpose of fraudulently offering research scientists the chance to rapidly publish their paper online with publication fee. Journal hijackers are dominant in analyzing the behaviors of researchers and journalism worldwide. They find the email addresses of authors from the websites of commercial and non-peer-reviewed journals. During last few years, more than one hundred of hijacked journals have been observed. They charge a fee, but your article does not get published and you will not get a medline indexed citation.
The authors studied 852 adults with bicuspid aortic valves. The prevelance of three morphotypes was tallied. Relative fusion rates were: RL 72.9%, RN 24.1% and LN 3%. Additionally, 18.3% had no raphe. Aortic regurgitation was unrelated to morphotype. Aortic stenosis was more common in the RN fusion group and in the presence of a raphe. Seventy-six percent had ascending aortic dilation unrelated to morphotype but associated with valve dysfunction. Aortic root dilation was present in 34% and was more commonly associated with male sex and aortic regurgitation.
Read the amazing story of the 44-year-old nurse who got acute chest pain in a remote area of Australia. He was the only clinican in the area, so he took his own ECG, diagnosed his acute MI, and cannulated and thrombolysed himself!
They make them tough in Australia.
Some Syrian refugee children have received surgery for congenital heart defects in Jordan, however many refugees in need of complex medical care are unable to receive such care.
A hospital in Philadelphia, Pennsylvania, is working to increase the rate of patient referral for cardiac rehab after surgery.
Several Rwandan heart patients will receive surgical treatment as part of a free surgery camp at King Faisal Hospital in Kigali, Rwanda, an initiative sponsored by the Rwandan Ministry of Health, King Faisal Hospital, and the non-profit organization Team Heart.
Drugs and Devices
The US Food and Drug Administration took the first formal step toward a major policy change that would reduce the amount of nicotine allowed in cigarettes.
The UK Medicines and Healthcare Products Regulatory Agency announced plans to review anticoagulant usage after a study published in the BMJ suggested increased risk for atrial fibrillation patients with chronic kidney disease.
Research, Trials, and Funding
Japanese researchers have received approval from Osaka University to test the ability of iPS cell-derived sheets of cardiac muscle to treat ischemic cardiomyopathy. The team must now gain approval from the Japanese Health, Labor, and Welfare Ministry.
Researchers from the US and Canada find that COPD patients selected for lung transplant have better survival than one would expect based on their BODE score, potentially because the transplant qualification process reduces comorbid conditions that are unrelated to lung function in this group of patients.
Early studies on wearable devices for atrial fibrillation screening were presented at the recent meeting of the American College of Cardiology, but the findings don’t yet address whether the increased screening results in improved patient outcomes.
Mainwaring and colleagues retrospectively reviewed the outcomes for 51 patients with transposition of the great arteries (TGA) who were enrolled in a left ventricle (LV) retraining program in preparation for an arterial switch procedure. Retraining was successful in 52% of patients with D-TGA and 92% of patients with L-TGA. Of patients who had successful retraining and underwent an arterial switch operation, the procedure was successful for 77% of patients with D-TGA and 100% with L-TGA. To quantify the LV response to training, the authors calculated an “LV retraining ratio” based on the change in the LV/RV pressure ratio in response to the first pulmonary artery banding. This ratio correlated with the presence or absence of heart failure and accurately predicted the ultimate success of retraining in 95% of patients.
The EJCTS and ICVTS are publishing a series of Statistical Primers to help clinicians perform and interpret research. Although Kaplan-Meier analyses are standard in the cardiothoracic surgical literature, there are several pitfalls that should be kept in mind. In this primer, Thuijs and coauthors describe the fundamental concepts of analyzing survival data.
Reddy and colleagues evaluated oral, esophageal, and gastric microbial flora in 55 patients who underwent successful esophagectomy for adenocarcinoma, squamous cell carcinoma, or benign disease. The authors did not observe significant patterns between microbiome diversity and tumor stage or histology. Patients who had anastomotic leak, however, showed a greater variance in the composition of preoperative oral flora versus intraoperative gastric flora than patients who did not (p = 0.015). The authors suggest that better understanding of the relationship between the microbiome and esophagectomy recovery could lead to new predictive or therapeutic approaches for esophageal anastomotic leak.