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Journal and News Scan
July 11, 2017
Submitted by: Joel Dunning
Video assisted thoracoscopic surgery (VATS) lobectomies have been instrumental in the evolution of thoracic surgical oncology since its introduction in the early 90s. Although there is no robust data to confirm or refute its superiority over open conventional lobectomy, there have been a number of meta-analyses which have shown that VATS is safe and feasible for those undergoing radical resection for cancer. Over the years, VATS lobectomy has continued to evolve with newer techniques, less ports and better instruments. There is now an interest in performing uniportal VATS lobectomy and this is now moving to one without a need for incision in the intercostal space. Microlobectomy, originally envisaged by a group of surgeons from 6 different centres and involves using subcentimeter incisions alongside a subxiphoid utility port. Some of the technical disadvantages of VATS are that the images are 2-dimensional (2D), there is limited depth perception; and manoeuvring rigid instruments within the limited confines of the chest can make dissection difficult. The advent of robotic lobectomy has addressed some of these problems. The 3D vision is unparalleled, the endowrist seamLessly mimic human hand movements and the instrument movement within the chest is fluid. However, the high capital costs may deter smaller centres from introducing this service, especially when working within a limited budget in the public hospital. This can be circumvented by ensuring that the robot is used in a multi-specialty setting and concentrated in a few high volume tertiary centres.
July 10, 2017
Submitted by: Joel Dunning
Minimally invasive mitral valve surgery provides outcomes that match those of conventional sternotomy without increasing use of resources, and lower costs after surgery offset potentially higher operation costs, according to a single-center, propensity-matched analysis of almost 500 patients presented at the meeting sponsored by the American Association for Thoracic Surgery.
July 10, 2017
Submitted by: Joel Dunning
In a risky and delicate procedure performed for the first time in Israel this week, an interdisciplinary team of Hadassah Medical Center physicians fixed a severe heart defect in a 28-week-old fetus in the womb.
July 10, 2017
Submitted by: Joel Dunning
A mother has published the hospital bill for her child's heart operation on Twitter to make a highly personal plea to the US Senate not to scrap one of the key provisions of Obamacare.
With the fate of the replacement for Obamacare hanging in the balance, Ali Ranger, used social media to illustrate what would happen if the new measure allowed insurers to impose a lifetime cap on benefits.
July 10, 2017
Submitted by: Claire Vernon
Kalfa and colleagues retrospectively evaluated restenosis, pulmonary vein (PV) reoperation, and mortality in patients undergoing operations for primary pulmonary vein stenosis (PPVS). Pulmonary hypertension one month after surgery and the severity of PV stenosis were risk factors for negative outcomes. Additionally, the authors found that outcomes were not different between patients receiving a sutureless repair compared to endovenectomy or patch venoplasty, underscoring the poor prognosis for patients with PPVS regardless of surgical technique.
July 7, 2017
Submitted by: Claire Vernon
Patient Care
A boy’s growth had fallen well behind that of his twin brother, leading doctors in Abu Dhabi, UAE, to discover and surgically treat a congenital heart condition.
A woman in the UK fell ill with a tear in her aorta late during her pregnancy, requiring a diverse team of health professionals to deliver a healthy baby and a replacement aorta.
A nurse practitioner discusses the benefits of perioperative multimodal analgesia over opioid monotherapy following her own experience as a surgical patient.
A US News & World Report analysis of publicly reported outcomes data from the STS highlights the safety of congenital heart surgery at high-volume centers.
Drugs and Devices
The US Food and Drug Administration approved the INSPIRIS RESILIA aortic valve from Edwards Lifesciences Corp., supported by data from the COMMENCE trial and the European RESILIA feasibility study.
Implanted cardiac devices might help determine time and cause of death when autopsy results are unclear.
The CardioMEMS HF System for monitoring cardiovascular status in heart failure was implanted for the first time in Canada at the Peter Munk Cardiac Centre in Toronto, Canada.
Research, Trials, and Funding
Researchers in Toronto, Canada, find that new opioid use among older COPD patients is associated with an increased risk of cardiac-related death.
Researchers at the University of Virginia School of Medicine received funding to study ex vivo lung perfusion among other approaches for improving lung transplantation and evaluating donor lungs.
An observational study of the SWEDEHEART database shows an increased incidence of myocardial infarction on Mondays and during the winter holidays, and lower incidence during the July summer holiday.
July 6, 2017
Submitted by: Claire Vernon
In a prospective study, the authors analyzed blood samples from 102 patients with stage I–IIIA non-small-cell lung cancers for the presence of circulating tumour cells (CTCs). Samples were taken prior to and one month after radical resection of the primary tumour, and CTCs were detected using immunomagnetic techniques. Presence of postoperative CTCs correlated to the 18F-fluorodeoxyglucose uptake of the primary tumour measured on preoperative PET scans and was associated with shorter recurrence-free survival, independent of disease staging.
July 6, 2017
Submitted by: Arie Blitz
The authors conducted a meta-analysis of 35 RCTs analyzing the use of IV Mg for the prevention or treatment of arrhythmias following cardiac surgery. The studies included had significant methodological heterogeneity.
Findings: Mg use was associated with a reduction in Afib as well as ventricular arrhythmias postop, with a RR of 0.69 (p=0.002) and 0.46 (p=.004), respectively.
July 5, 2017
Submitted by: Ruben Osnabrugge
In this excellent review article, the authors review the practice and evidence for fractional flow reserve (FFR) in patients undergoing CABG.
July 5, 2017
Submitted by: Claire Vernon
Talwar and colleagues randomized 100 pediatric patients receiving bidirectional superior cavopulmonary anastomosis to on-cardiopulmonary bypass (CPB) and off-CPB groups. Significantly lower anastomosis time, postoperative inotropic support, and ICU and hospital stay duration were observed in the off-CPB group. Although the study only addressed early outcomes, no short-term difference in neurocognitive measures was observed between groups.