Journal and News Scan

Patient Care

Michael Mack and Alec Vahanian discuss the state and future of transcatheter mitral valve replacement.

A new guideline on the use of endoscopic eradication therapy in Barrett’s esophagus published by the American Society for Gastrointestinal Endoscopy recommends against surgery for patients with high-grade dysplasia and intramucosal esophageal adenocarcinoma.

Drugs and Devices

Researchers found that a smartphone app evaluates blood flow in radial and ulnar arteries prior to coronary angiography with higher accuracy than the traditional Allen test.

Research, Trials, and Funding

A man in Texas, USA, became one of the first recipients of lungs transplanted using ex vivo lung perfusion, as part of the EXPAND II OCS trial.

Chronic thromboembolic hypertension was one of the topics at the ongoing Annual Meeting of the International Society for Heart and Lung Transplantation in Nice, France. Another session focused on DCD heart transplantation and ex vivo heart perfusion.

Researchers in Michigan, USA, found that patients undergoing coronary revascularization after the 2014 Medicaid insurance expansion in the USA had outcomes comparable to those for patients who underwent revascularization before the expansion.

How to manage solitary pulmonary nodules appearing after treatment of a prior malignancy remains a clinical challenge.  The authors found that such patients most often had intrapulmonary metastases and less often had new lung cancers.  Factors associated with new lung cancers included spiculated nodules, absence of nodal involvement with prior cancers, and prior cancers from other than head/neck and genitourinary sources.

Madariaga and colleagues retrospectively evaluated operative characteristics and outcomes in 86 patients who underwent resection of a posterior mediastinal tumor, with or without preoperative angiography. The nine patients who were selected for angiography had larger tumors that more often involved the neuroforamen than patients who were not selected. Blood loss, complication rate, and deaths related to tumor resection were comparable between patients who did and did not undergo angiography, and the authors did not find angiography itself to be associated with increased complications. They suggest that for properly selected patients, the ability to limit resection blood loss with embolization and to define spinal and tumor blood supply could outweigh the risk of angiography.

This is a retrospective review of 143 patients requiring reoperation after an initial AVR with a Freestyle® stentless bioprosthesis. Valve survival was 10.4 years for those with structural valve deterioration, but it was much less (4.1 years) if the initial procedure was for infective endocarditis. Operative mortality was <2%. This suggests a favourable result for reoperation.