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Journal and News Scan
March 13, 2019
Submitted by: Claire Vernon
Anderson and colleagues present the rationale and design for a peer-evaluation protocol of congenital heart surgeon technical skill using direct video observation. All attending surgeons who contribute data to The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) are invited to submit their own surgical videos, to rate peers, or both. Videos are rated anonymously using the Objective Structured Assessment of Technical Skills score. Ratings are linked to the STS-CHSD and surgeon questionnaires. Over a quarter of US congenital heart surgeons have agreed to participate, and recruitment is ongoing.
March 12, 2019
Submitted by: Tom C. Nguyen
With the disruptive advancement of catheter-based technologies and minimally invasive techniques in structural heart disease, surgeons must obtain the necessary skills to continue to serve this large patient population. An emergency overhaul of current structural training must occur to ensure standardized training in structural heart disease. This is vital as surgeons are uniquely positioned to offer the full spectrum of valve therapy but risk erosion of the heart team concept without urgent action. The train has left the station and this manuscript is a call to action.
March 11, 2019
Submitted by: Mark Ferguson
This article describes an unfortunate encounter between a physician and a patient via video conference, during which the physician discussed end of life options.
March 8, 2019
Submitted by: Claire Vernon
Patient Care and General Interest
The American Heart Association has released a scientific statement summarizing emerging knowledge about sensitization after heart transplant.
The National Health Service England in the UK will place mobile scanning trucks in supermarket parking lots to expand lung cancer screening of people who are at high risk of developing the disease.
Engineers from Rochester, New York, USA, have embedded sensors in a toilet seat, an innovation that they hope could improve daily cardiovascular monitoring for patients with heart failure.
Drugs and Devices
Kaiser Health News has released a report detailing a US Food and Drug Administration program that allowed device-related injuries and malfunctions to be reported in a repository that was not publicly available.
Innovative Cardiovascular Solutions, LLC, announced the beginning of the European feasibility study of the next-generation of its Emblok™ Embolic Protection System for transcatheter aortic valve replacement.
Research, Trials, and Funding
Overlapping surgery is safe in most cases but it may increase poor outcomes for high-risk patients and patients undergoing coronary artery bypass grafting, report researchers from Harvard Medical School in Boston, Massachusetts, USA.
A study from researchers at Vanderbilt University in Tennessee, USA, suggests the nonsteroidal anti-inflammatory drug celecoxib might worsen valve disease pathology, conflicting with previous findings that found the drug safe for heart patients.
March 7, 2019
Submitted by: Claire Vernon
Chen and colleagues retrospectively compared outcomes for children who underwent intraoperative device closure of a perimembranous ventricular septal defect (VSD) via two different approaches. VSD closure was performed through a minimal incision in the lower sternum in 52 patients and through a right transthoracic minimal incision in 46 patients. Patients were included if they had small to moderate sized VSDs with at least a 2 mm subaortic rim, mild pulmonary hypertension, and were over one year old, among other criteria. Postoperative complications were comparable between the groups, except for higher incidences of poor surgical wound healing and thoracic deformity in the patients with a lower sternal incision. Short-term follow-up revealed similar outcomes in both groups, and the authors conclude that the right thoracic ventricle approach is an acceptably safe alternative to a lower midline sternotomy for device closure of a perimembranous VSD in children.
March 6, 2019
Submitted by: Claire Vernon
Takayuki and colleagues reviewed the outcome of mitral valve replacement after failed mitral valve repair with MitraClip in 25 patients. Perioperative mortality was 28%, and overall one-year survival was 53%. Risk factors for perioperative mortality included preoperative cardiogenic shock, septic shock, and liver failure. Mitral valve regurgitation after MitraClip implantation was usually caused by valve leaflet damage, degeneration, or infection.
March 4, 2019
Submitted by: Aristotle Protopapas
An important review in a mainstream periodical read by cardiologist colleagues.
March 4, 2019
Submitted by: Marco Nardini
The complete pathologic response rate in this study is revealed to be low, lower than expected after stereotactic ablative radiotherapy (SABR) for early stage non-small cell lung cancer: only 60%. The authors suggest a combined approach (SABR plus surgery), adopted in this experimental phase 2 trial, as a possible management scheme. This is questionable and further research will be needed.
March 1, 2019
Submitted by: Claire Vernon
Patient Care and General Interest
One of the professional golfers who qualified for this weekend’s PGA Tour event is also a two-time heart transplant recipient.
Drugs and Devices
LivaNova announced that its Perceval sutureless aortic valve will be reimbursed for patients through Japan’s Ministry of Health, Labor, and Welfare.
Research, Trials, and Funding
A program designed specifically to address racial disparity in lung cancer treatment rates in North Carolina, USA, eliminated this disparity and increased treatment rates for all participants.
Researchers from Ontario, Canada, report a 60% pathologic complete response rate for stereotactic ablative radiotherapy in patients with resectable lung cancer, much lower than they had hypothesized.
A study using data from the UK Biobank found that adults with mild congenital heart defects had increased incidences of heart failure, atrial fibrillation, stroke, and heart attack, even after accounting for cardiovascular risk factors.
The Thoracic Surgery Foundation (TSF) has awarded 24 grants that will support research and educational endeavors in 2019. Visit their website to learn more about TSF and future funding opportunities.
Women have worse outcomes after aortic surgery than men do, report researchers from Ontario, Canada.
March 1, 2019
Submitted by: Wei-Guo Ma
Though medical care has become ever more dependent on teamwork, the profession has devoted relatively little attention to what makes for a good team. In this roundtable discussion moderated by Lisa Rosenbaum, panelists Amy Edmondson, Neel Shah, and Thoralf Sundt discuss empirical and cultural approaches to the pursuit of better collaboration.
This audio roundtable is the companion to a three-part series on teamwork, written by Lisa Rosenbaum and published in the New England Journal of Medicine. In this series, Dr Rosenbaum made important reflections on and explorations into the professional, psychological, cultural, and social approaches to fostering high-quality communication and collaboration in the medical community. These articles and links are as follows:
Teamwork — Part 1: Divided We Fall
https://www.nejm.org/doi/full/10.1056/NEJMms1813427
Teamwork — Part 2: Cursed by Knowledge — Building a Culture of Psychological Safety
https://www.nejm.org/doi/full/10.1056/NEJMms1813429
Teamwork — Part 3: The Not-My-Problem Problem