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Journal and News Scan
September 25, 2017
Submitted by: Arie Blitz
The authors conducted a double-blinded prospective, randomized clinical trial in 249 patients >60 years of age who underwent cardiac surgery with cardiopulmonary bypass to assess whether interventions based on cerebral oximetry would decrease the incidence of postoperative delirium. Two groups were compared: The control group, in which the results of cerebral oximetry were blinded, and the intervention group, in which an algorithm was instituted for oximetry values below 75% of baseline.
Results: Postop delirium occurred in 24.4% and 24.6% of the intervention and control groups, respectively (p=0.97). Thus, interventions based on cerebral oximetry data do not appear to alter the incidence of postop delirium. Incidentally, a higher baseline cerebral oximetry value was associated with a lower incidence of postoperative delirium.
September 22, 2017
Submitted by: Claire Vernon
Patient Care
Updated guidelines on dual antiplatelet therapy in coronary artery disease have been published by the European Association for Cardio-Thoracic Surgery and the European Society of Cardiology.
Heart patients at Mongkutwattana General Hospital in Bangkok, Thailand, will continue receiving percutaneous coronary interventions under the universal healthcare scheme, despite the hospital having a part-time rather than a full-time cardiothoracic surgeon.
Children’s Health in Dallas, Texas, joins hospitals in Washington, DC, and London, UK, in conducting radiation-free cardiac catheterization procedures.
Drugs and Devices
Medtronic has launched a post-market clinical study of its CoreValve Evolut Pro implant across 35 European centers.
Research, Trials, and Funding
Engineers and clinicians in Rochester, New York, were awarded a grant to develop a noninvasive medical technology for mobile devices that would detect atrial fibrillation.
A report finds that, between 2006 and 2014, lung cancer cases in Northern Ireland increased by more than 30%.
September 21, 2017
Submitted by: Claire Vernon
Duerr and colleagues describe the experimental development of a mitral anuloplasty ring, which should facilitate later transcatheter valve-in-ring implantation. Two accompanying videos demonstrate valve expansion and implantation within the ring. The article illustrates the potential importance these new technologies are expected to gain in the near future.
September 20, 2017
Submitted by: Claire Vernon
Vida and colleagues retrospectively reviewed 111 left-sided reoperations after an arterial switch operation (ASO) across 17 ECHSA centers between 1975 and 2010. The authors found a low reoperation frequency of 1.4% after ASO. Initial diagnosis of D-transposition of the great arteries (D-TGA) was more common among patients who required reoperation than was diagnosis of double-outlet right ventricle TGA-type, however a greater percentage of the latter group encountered postoperative complications (5 of 12, versus 16 of 99). The majority of survivors were asymptomatic at last follow-up, with only 13% in New York Heart Association class II and only 3% in class III.
CME related to this article is available through The Annals' website.
September 20, 2017
Submitted by: Marco Nardini
We urgently need more answers for the patients affected by mesothelioma, a devastating diasese whose prognosis is 6-9 months from the diagnosis. We are now living the era of plateau of the epidemiology due to industrial use of amiantus of the last century. Furthermore, there are other etiology than asbestos in endemic areas, like for example the natural exposure to fluoro-edenite of certain regions of Japan and Sicily. We do need more informatinos to direct the difficult management of all these individuals and there are many ongoing studies where surgery is considered a valid option. This trial will compare the outcome of 2 groups: the first group will have a debulking surgery and hyperthermic intraoperative intrathoracic chemotherapy (HITHOC) with cisplatinum while the second group will receive talc pleurodesis alone. The primary outcomes measured will be length of hospital stay, quality of life, and long-term survival.
September 19, 2017
Submitted by: Joel Dunning
This single institution observational study compares clinical outcomes and resource utilization associated with two surgical approaches for single-stage repair of coarctation of the aorta and ventricular septal defect. Authors found that single-stage two-incision repair of both defects in appropriately selected patients may be associated with higher value of care compared to single-stage one incision repair.
September 19, 2017
Submitted by: Arie Blitz
The authors queried the UNOS heart transplantation database to determine if LVAD device-related complications (DRCs) were associated with worse postoperative graft survival. The 5 categories of DRCs were as follows: device thrombosis, infection, device malfunction, life-threatening arrhythmias, and others.
Results: None of the 5 categories of DRCs was associated with worse graft survival on multivariate analysis.
September 17, 2017
Submitted by: Arie Blitz
In this study the authors randomized 142 patients within two separate treatment arms: (1) Patients undergoing on-pump CABG were randomized to either a single- vs. double-clamp technique for proximals; (2) patients undergiong OPCAB were randomized to either a Heartstring device or single clamp for proximals. For all 4 treatment groups, the number of embolic HITS was assessed with transcranial doppler of the middle cerebral artery.
Results:
(1) On-pump CABG: The mean number of HITS in the single-clamp group was 10.0, while that for the double-clamp group was 16.0 (p=.10). (Although the difference was not significant, the treatment groups were rather small.)
(2) OPCAB: The mean number of HITS in the Heartstring group was 30.0, whereas that for the partial clamp group was 7.0 (p<.0001). Thus, the Heartstring group had more than 4 times the embolic load by TCD.
Notably, neurocognitive outcomes were not different among the groups.
September 15, 2017
Submitted by: Claire Vernon
Patient Care
Three more UK surgical centers will introduce heart transplants from non-heart beating donors. In the UK, this procedure is currently only performed at three hospitals, where it benefits patients such as this sports enthusiast.
The Montreal Heart Institute in Canada has a new surgical robot dedicated to CABG and mitral valve surgery.
Drugs and Devices
Neovasc Inc. released an update on the performance of its self-expanding mitral bioprosthesis, the TiaraTM valve, which is being implanted in several European and US centers as part of three parallel investigational programs.
The European Medicines Agency and the European Center for Disease Control and Prevention will host a meeting to discuss the threat of antimicrobial resistance and how they can support efforts to combat this threat.
Research, Trials, and Funding
Researchers from France analyzed data from the US Nurses’ Health Study II, finding a correlation between exposure to disinfectants and development of COPD.
Chinese researchers have published a case study on closing aortic anastomosis leaks with a transcatheter approach.
A study of a Swedish national database matched sibling pairs to further investigate the relationship between height and likelihood of venous thromboembolism.
September 14, 2017
Submitted by: Joel Dunning
Minimally Invasive Lobectomy for Lung Cancer is the latest installment in the Society’s webinar series on quality initiatives. The webinar features Drs Bill R. Burfeind Jr (moderator), Thomas A. D’Amico, Todd L. Demmy, Mark W. Onaitis, and Shari L. Meyerson.
Watch 47 minutes of the world's experts talking about this technique