Journal and News Scan

Direct relief of subaortic stenosis in single ventricle patients via ventricular septal defect/subaortic chamber enlargement has been mostly replaced by the Damus-Kaye-Stansel/Norwood procedure due to concerns for potential re-obstruction or heart block. However, little is known about long-term outcome. Among 23 single ventricle patients (median age: 7.4 months, range: 10 days to 5.5 years) who underwent direct relief of subaortic stenosis at Leiden University Medical Center (1989-2016), authors observed a high risk of re-obstruction and patch (pseudo)aneurysm formation. However, risk of heart block was low, and the majority of patients underwent Fontan completion successfully. In selected patients, the direct approach can be a relatively simple and safe procedure.

Patient Care and General Interest

Earl Bakken, Medtronic co-founder and inventor of the pacemaker, has died at age 94.

A 5-year-old boy in Sacramento, California, USA, who has a congenital heart defect and has undergone four related heart surgeries, has had his wish of becoming a Ghostbuster fulfilled.

A study published in The BMJ suggests that a group of common blood pressure drugs may be linked to lung cancer.

A collection of apps called PulsePoint, which are designed to connect CPR-certified locals to individuals experiencing cardiac arrest nearby, is slated to launch in early 2019.

Drugs and Devices

A study published via the Proceedings of the National Academy of Sciences of the United States of America indicates that wearable technology could potentially monitor the relationship between blood pressure and pulse wave velocity in arteries, possibly helping patients monitor high blood pressure.

According to a study published in the Journal of the American College of Cardiology, an electrocardiogram reading from a specially equipped Apple Watch could potentially prove highly effective in detecting atrial fibrillation.

Research, Trials, and Funding

The Northern New England Biomarker Study suggests that elevated preoperative Galectin-3 is associated with acute kidney injury after cardiac surgery.

Researchers at the University College London’s Great Ormond Street Institute of Child Health in the UK have successfully grown a functional esophagus from stem cells and transplanted it in mice.

A post-market study (ELEVATE registry) of the fully magnetically levitated continuous flow HeartMate III left ventricular assist device (LVAD) found no pump thrombosis in 463 patients in Europe and Kazakhstan.

Mean age was 55.6 ± 11.7 years, 89% were male, 48% had ischaemic aetiology, and 70% were on inotropes. Indication was bridge-to-transplantation in 66% and destination therapy in 26%. Mean left ventricular ejection fraction was 18.3% and INTERMACS profile was 1–2 in 32%.

In 463 patients, there was no incidence of pump thrombosis; major bleeding was 25%, major infection 35%, and any stroke type 5%. Functional capacity improved significantly (Δ6MWD 230 ± 191 m), as did quality of life (ΔVAS 31 ± 23). Survival at six months was 82 ± 2%. Freedom from unplanned rehospitalizations at six months was 68 ± 2%.

This potential to reduce haemocompatibility-related events is one of the main improvements of HeartMate III over other LVADs. 

Kim and colleagues sought to determine if a supra-annular aortic valve prosthesis implantation is superior to an intra-annular implantation. The authors retrospectively reviewed outcomes and echocardiographic data for 587 patients who received either supra-annular or intra-annular aortic valve prostheses from St Jude Medical. The implantation technique did not significantly affect the risk of overall mortality or major adverse events, however there were superior hemodynamics with lower peak velocity, lower mean pressure gradient, and improved ventricular mass index in patients with supra-annular implantation.