Journal and News Scan

Pts undergoing cardiac surgery requiring CPB were randomized to remote ischemic preconditioning of the upper extremity or sham intervention.  The end point was combined death, MI, stroke, and acute renal failure during hospitalization, and secondary endpoints were the occurrence of any such event within 90 days.  Outcomes were similar between the groups, with no treatment effects evident on multiple sub-analyses.

Patients entered into a clinical trial of TAVR and patients in two registries were evaluated for possible subclinical leaflet thrombosis in their bioprosthetic valves.  40% of the patients in the TAVR trial and 13% of registry patients were found to have such thrombosis.  The risk was lower in patients anticoagulated with warfarin.  Therpeutic anticoagulation for thrombosis resulted in a high rate of resolution.The risk of TIA and stroke was somewhat increased in patients with thrombosis.

Ischemic mitral regurgitation (IMR) is a subset of functional mitral regurgitation (MR) that has the potential to impact an increasing number of patients in the future. This is in the context of a worldwide population, which continues to live longer with improved survival after myocardial infarction. Substantial data have accumulated over the past few decades demonstrating the negative effects of IMR. Further, significant research has been done to define the optimal surgical approach and several studies have compared mitral repair versus replacement for patients with severe mitral regurgitation (SMR). Studies supporting performance of mitral repair cite superior operative morbidity and mortality rates, while proponents of mitral replacement cite improved long-term durability and correction of MR. Lack of clinically robust Level I randomized controlled trial data have curtailed attempts to better define appropriate surgical treatment allocation over the past few decades. Recently, however, the Cardiothoracic Surgical Trials Network (CTSN) conducted the first randomized controlled trial, funded by the National Heart, Lung, and Blood Institute, the National Institute for Neurological Diseases and Stroke and the Canadian Institute for Health Research, to compare the performance of mitral repair versus replacement for SMR. Herein, the present review describes the design, results and implications of the CTSN SMR trial and its efforts to identify the most efficacious surgical approach to SMR. This review also describes CTSN investigation to predict the recurrence of MR after mitral repair.

A Spanish cancer patient has received a 3D printed titanium sternum and rib cage designed and manufactured right here in Australia, at our Melbourne-based 3D printing facility in Melbourne.

Suffering from a chest wall sarcoma (a type of cancerous tumour that grows, in this instance, around the rib cage), the 54 year old man needed his sternum and a portion of his rib cage replaced. This part of the chest is notoriously tricky to recreate with prosthetics, due to the complex geometry and design required for each patient. So the patient’s surgical team determined that a fully customisable 3D printed sternum and rib cage was the best option.