Journal and News Scan

Fallon and colleagues evaluated patient-prosthesis mismatch (PPM) following isolated aortic valve replacement reported in the STS Adult Cardiac Surgery Database. They found that both moderate and severe PPM were associated with worse outcomes compared to no PPM over the 10-year study period. Readmission for congestive heart failure and aortic valve rereplacement were both more likely in patients with moderate or severe PPM, and overall survival was lower. The incidences of moderate and severe PPM were reduced over the study period, from 60.1% to 46.8% and from 13.8% to 6.2%, respectively. Because of the worse outcomes with even moderate PPM, the authors emphasize that continued efforts to avoid implantation of too small a prosthesis remain necessary.

Patient Care and General Interest

A guideline for the number of opioid pills that should be prescribed after different surgeries, from cochlear implantation to coronary artery bypass grafting, is self-published by an expert group of health professionals as part of the effort to reduce overprescribing these drugs in the US.

A webcam in the operating room allows cardiothoracic surgeons in Pennsylvania, US, to update a patient’s family on a successful procedure earlier than usual.

After a baby’s heart transplant, her parents—a pediatrician and a school district trustee—are writing a children’s book for the kids and families who face this type of procedure.

The first double-lung transplant in the UAE is performed at the Cleveland Clinic Abu Dhabi using a minimally invasive approach.

Drugs and Devices

The Incraft Stent Graft System for endovascular abdominal aortic aneurysm repair, from Cardinal Health/Cordis, has received a vote of approval from a US Food and Drug Administration advisory panel.

Research, Trials, and Funding

A trial has begun to evaluate the first biological heart valve made in India. If shown to be a good therapeutic option, it is hoped that this locally-manufactured bioprosthesis will help bring down the cost of valve implantation for patients.

A VATS approach to early-stage lung cancer resection leads to survival outcomes similar to thoracotomy, say researchers from Yale University in Connecticut, US.

A brief, readable, sensibly balanced, and well-referenced editorial on the occasion of the retrospective Austrian paper on venoarterial extracorporeal membrane oxygenation (ECMO). Taken in the context of the recent New England Journal of Medicine paper on venovenous ECMO for acute respiratory distress syndrome and the relevant ATS presentations on the EOLIA trial, the editorial raises questions on the utility of the expensive innovation of ECMO.

This written and video case review from Osho and colleagues centers on a 54-year-old woman who suffered smoke inhalation injury as a result of a house fire. Following prolonged intubation, mechanical ventilation, open tracheostomy tube placement, and recurrent pneumonia, the patient was diagnosed with a tracheoesophageal fistula (TEF). The authors prefer to manage TEF via an anterior cervical approach with division of the trachea, though a right thoracotomy may be used in the setting of highly distal TEFs. They emphasize that careful operative technique and the interposition of a robust muscle flap are the most important safeguards in surgical management of TEF.