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Journal and News Scan
December 7, 2018
Submitted by: Claire Vernon
Watkins and colleagues report their use of preoperative extracorporeal membrane oxygenation (ECMO) to evaluate and stabilize structural heart patients who were at extreme surgical risk. Twelve patients undergoing surgery for severe prosthetic mitral stenosis, ruptured papillary muscle, ischemic ventricular septal defect, or severe aortic stenosis were included. ECMO-associated complications included leg ischemia, wound infection, and major bleeding. Preoperative ECMO support improved the predicted operative mortality risk, and survival was 82% after one year.
December 6, 2018
Submitted by: Aristotle Protopapas
Gilles Dreyfus and colleagues share a decade of mitral reconstruction for degenerative posterior leaflet pathology in Harefield and Monaco (38 per year was the formidable average). The supplementary video is of particular educational value for the mitral surgeon and the cardiologist/TOE (TEE) specialist.
December 5, 2018
Submitted by: Claire Vernon
Coyan and colleagues report outcomes following double valve surgery in a cohort of patients who underwent operation between 2011 and 2017. Mitral repair was associated with better perioperative outcomes than mitral replacement when performed concomitantly with aortic valve replacement, though the authors note that differences in underlying comorbidities between the groups could have contributed to this result. Longer term outcomes were comparable between mitral repair and replacement.
December 4, 2018
Submitted by: Aristotle Protopapas
Essential reading, paying particular attention to the table in Section 7: the European experts recommend, again, that in Marfan and other systematic connective tissue diseases conventional techniques are still advantageous because the landing zones will eventually degenerate.
Jointly published in the European Journal of Vascular and Endovascular Surgery at: https://doi.org/10.1016/j.ejvs.2018.09.016
December 3, 2018
Submitted by: Claire Vernon
Park and colleagues genotyped cancer tissue for epidermal growth factor receptor (EGFR) mutations in patients with complete resection for lung adenocarcinoma who had a recurrence. Lung adenocarcinoma with EGFR gene mutations was associated with a longer disease-free interval than was the wild-type EGFR gene. Additionally, EGFR gene mutation was a prognostic factor for disease-free interval.
November 30, 2018
Submitted by: Benjamin Bidstrup
The EXCEL is one of several prospective studies that examine the use of single versus bilateral internal thoracic artery (ITA) grafts for myocardial revascularization (in this case, compared with percutaneous coronary intervention) for left main disease. This did not show differences in the surgical population (905 patients) between one and two ITA grafts with regard to mortality and DSWI. There are significant limitations in the patient allocation process that make the value of these outcomes less than helpful.
November 30, 2018
Submitted by: Benjamin Bidstrup
Once again, analyses of studies that are ostensibly well-designed randomized controlled trials have limitations that do not answer the question at hand: are two-arterial CABGs better than one? This editorial comments on a publication regarding the EXCEL Study, which showed no differences at 3 years.
November 30, 2018
Submitted by: Claire Vernon
Patient Care and General Interest
Surgeons at the Cleveland Clinic Abu Dhabi in the UAE used a metal stent for an emergency repair of a patient’s windpipe, which had been completely severed in a traffic accident.
A report from the UK Lung Cancer Coalition says that geographic variation persists despite improvements in 5-year survival rates for lung cancer in the UK.
Drugs and Devices
Medtronic has received the CE Mark for its Valiant Navion™ thoracic stent graft system, a low-profile thoracic stent for patients with small iliac arteries and other anatomic variations.
Research, Trials, and Funding
Physicians in Ontario, Canada, evaluate in-hospital counseling and surgery for injection drug users with endocarditis, finding that both reduce mortality in these patients.
Researchers at Stanford University in California are matching donor and pediatric recipient heart volumes using CT scans, rather than relying on height and weight to determine if a child could accept a particular donor heart.
At the recent meeting of the American Heart Association, researchers from Germany reported similar rates of major adverse cardiovascular events and major bleeding for patients taking either ticagrelor or aspirin after coronary artery bypass.
November 30, 2018
Submitted by: Claire Vernon
Netuka provides several important technical nuances to consider when implanting the HeartMate 3 left heart assist device. He focuses on apical cuff attachment, optimal positioning of the pump in the pericardial cavity, and positioning of the outflow graft. Furthermore, he describes alternative surgical implantation strategies for minimizing invasiveness.
November 29, 2018
Submitted by: Claire Vernon
Patent descending aortic false lumen in type A dissection is associated with limited long-term outcomes. Inoue and colleagues aimed to evaluate the efficacy of their group’s strategy for these patients. Among 290 patients with type A aortic dissection and patent false lumen at the descending aorta, 124 underwent ascending aortic replacement and 166 additional total aortic arch replacement. Total aortic arch replacement was associated with better freedom from descending aortic aneurysm. There was no difference in in-hospital mortality between the groups.