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Journal and News Scan
August 9, 2018
Submitted by: Claire Vernon
Transcatheter aortic valve replacement (TAVR) periprocedural complications rate are low; however, those patients requiring conversion to surgery are under an increased mortality risk. Arsalan and colleagues evaluated 32 patients, 2.1% of 1775 total TAVR procedures at their center, who needed immediate conversion to sternotomy during the TAVR procedure. The most common reasons for conversion were annular rupture, device embolization, and pericardial tamponade. The only predictor for conversion was the usage of a self-expandable valve (OR 0.38, 95% CI 0.16 - 0.90, p = 0.03). Survival at 30 days was 56%, emphasizing the importance of an experienced heart team and access to emergency surgical procedures for these uncommon but unpredictable situations.
August 6, 2018
Submitted by: Claire Vernon
Endoleak is a potential complication of total endovascular aortic repair (TEVAR). This video and article from Fukuhara and Roselli illustrate a modified reverse frozen elephant trunk to repair a type IA endoleak from a prior TEVAR for an acute type B dissection. The authors also discuss the advantages and caveats associated with the technique shown.
August 6, 2018
Submitted by: Claire Vernon
This story from the BBC reveals a report on a London, UK, hospital’s cardiac surgery department. The hospital commissioned the external review after a higher than expected mortality rate was brought to its attention. The report underscores the importance of positive professional relationships for successful surgical teamwork and quality patient outcomes.
August 3, 2018
Submitted by: Claire Vernon
Patient Care and General Interest
Renowned former Formula 1 racing champion Niki Lauda recently underwent a lung transplant.
The president of the West African College of Surgeons (WACS) urged the streamlining of cardiothoracic surgery training in Nigeria in remarks during the commissioning of the WACS permanent secretariat.
The Amrita Institute of Medical Sciences in Kochi, India, is setting up a homograft bank, the second such bank in the state.
The National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand have published updated recommendations for the diagnosis and management of atrial fibrillation to confront the growing incidence of arrhythmia.
Research, Trials, and Funding
Researchers from Canada, Spain, and Germany found that optical coherence tomography was better than angiography at identifying coronary vascular changes in pediatric heart transplant recipients.
Adding racial considerations to the lung cancer screening recommendations in the US might improve screening efficacy and help reduce disparities in lung cancer mortality, say researchers from Chicago, Illinois.
Researchers from around the US have transplanted bioengineered lungs into pigs.
August 3, 2018
Submitted by: Claire Vernon
Ongoing questions in the surgery for type A aortic dissection include arterial cannulation site and the type of distal anastomosis for ascending or hemiarch replacement. Shimamura and colleagues report on the outcomes of 300 patients who underwent aortic repair using transapical arterial cannulation and the adventitial inversion technique at a distal anastomosis. The in-hospital mortality rate was 8%. During a mean follow-up of 31.7 ± 25.2 months, distal reintervention was performed in 11% of patients, with 3% in-hospital mortality for elective reintervention. The authors conclude that transapical cannulation and the adventitial inversion technique for repair of acute type A aortic dissection provide good early and midterm results.
August 3, 2018
Submitted by: Claire Vernon
Engelhardt and colleagues reviewed cases of mediastinal sarcoma in the US National Cancer Database from 2004 to 2012. Overall survival at five years was poor, at only 14.8%, and just under half of patients underwent surgical resection. For patients receiving surgery, an R0 resection was associated with better survival (30.1% versus 18.9%), and surgery combined with radiation therapy was associated with the best survival (40.1%).
August 3, 2018
Submitted by: Arie Blitz
The authors debate how much information should be included in the informed consent, and they use the case of resistant Mycobacterium chimaera found in the LivaNova PLC Stockert 3T heater-cooler system as a case-in-point. The issue raised specifically by this case is whether institutions that use this specific heater-cooler system are obligated to inform the patient of the specific risks of infection with resistant M chimaera. The publication is very informative, and the scope of the debate focuses on the purpose of informed consent, the legal obligation, and how narrow or broad the consent need be. It should not be surprising to anyone that there are no straightforward answers.
July 31, 2018
Submitted by: Claire Vernon
Head and colleagues used a patient-data pooled analysis of 11 randomized clinical trials to compare stroke rates between surgical and percutaneous coronary revascularization. They found that in the first 30 postoperative days, the stroke rate was higher after coronary artery bypass grafting (CABG, 1.1%) than after percutaneous coronary intervention (PCI, 0.4%), and this early difference accounted for the difference in the stroke rate seen at 5 years. Between 31 days and 5 years, stroke rates were not different between CABG and PCI (2.1% versus 2.2%). Regardless of the revascularization approach, patients experiencing a stroke in the first 30 days had significantly higher 5-year mortality than those not experiencing early stroke.
July 28, 2018
Submitted by: Tom C. Nguyen
The US Centers for Medicare and medicaid Services (CMS) convened a panel on 07/25/2018 to discuss recommendations for hospitals to maintain and begin TAVR programs. The focus of the discussion was the procedural volume requirements for TAVR, SAVR, and PCI (https://www.cms.gov/medicare-coverage-database/details/medcac-meeting-de...). The dialogue was balanced. Further recommendations from CMS will be forthcoming.
July 27, 2018
Submitted by: Claire Vernon
Patient Care and General Interest
A woman developed a combination planner, record-keeping notebook, and journal to help her husband through his treatment for esophageal cancer, and other patients now use it to manage their own journeys through complex illness.
August 1 is World Lung Cancer Day.
A surgeon’s experience with related procedures may correlate with reduced hospital mortality for patients undergoing complicated procedures such as esophagectomies.
Drugs and Devices
HeartStitch® presented an initial series of percutaneous suture-based tricuspid repairs with its Heart-Rose™ technology at the recent CSI Frankfurt Conference in Germany.
Australian company Ademus will sell its bioscaffold product CardioCel® through Medical Instruments in Italy and Cardiva in Spain and Portugal.
Research, Trials, and Funding
Research from the Multicenter Italian Lung Detection trial suggests that subsolid lung nodules are an indication of increased cancer risk but that they can be safely managed with surveillance.