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Journal and News Scan
January 25, 2015
Submitted by: Joel Dunning
Dear Colleagues,
I am heartbroken to inform you that Dr. Michael J. Davidson, director of Endovascular Cardiac Surgery at Brigham and Women’s Hospital, has tragically died this evening after sustaining gunshot wounds this morning during the shooting event at the Shapiro Cardiovascular Center.
Dr. Davidson was a wonderful and inspiring bright light and an outstanding cardiac surgeon who devoted his career to saving lives and improving the quality of life of every patient he cared for. It is truly devastating that his own life was taken in this horrible manner.
Dr. Davidson was kind, compassionate and beloved by his colleagues and his patients. He was deeply dedicated to the Brigham. In 2010, he ran the Boston Marathon with Team Brigham to celebrate his 40th birthday. He stated at the time, “There is no better way to commemorate a birthday, run the marathon to achieve a personal goal and, in the process, support Team Brigham and its mission to help so many people.”
He was part of the remarkable team that performed the hospital’s first tricuspid “valve-in-valve” procedure and was involved in establishing the hybrid OR at BWH, once of the most advanced operating rooms in the country. Dr. Davidson graduated from Yale University School of Medicine and then trained at Duke University and Brigham and Women’s Hospital, joining our Brigham family in 2006.
The world is a better place because of Dr. Davidson. Let us honor our dear colleague’s memory and legacy by treating each other with kindness and providing the best possible care to those who come to us in need. If you need support, the Employee Assistance Program staff are available for any employees who wish to contact them. The telephone number is 617-732-6017.
Our thoughts and prayers are with his family at this time. More information on a memorial service will be forthcoming.
January 25, 2015
Submitted by: Arie Blitz
This study from the University of Texas Southwestern sought to analyze the effects of mechanical unloading during prolonged LVAD support on mitochondrial mass, DNA damage response (DDR), and cardiomyocyte proliferation. Ten matched human samples of LV myocardium were analyzed before and after mechanical circulatory support. Among its interesting findings, the study found that prolonged mechanical unloading induces adult human cardiomyocyte proliferation, hypothesized to occur through prevention of mitochondria-mediated activation of DDR. How do we optimize LVAD myocardial recovery regimens to leverage this important finding?
January 24, 2015
Submitted by: Arie Blitz
This systematic review and meta-analysis explores the literature to determine the relative advantages and disadvantages of using bilateral IMAs over single IMAs on outcomes after CABG in diabetic patients. In their analysis, the group found that patients who underwent bilateral IMA grafting using skeletonized IMAs had no greater incidence of sternal wound infection than those undergoing unilateral IMA harvesting; however, if the mammaries were harvested on a pedicle, an increased incidence of sternal wound infection was noted in the bilateral harvest group. In addition, the meta-analysis demonstrated better long-term survival in the bilateral IMA group, regardless of harvesting method, over the unilateral IMA group. Is it time to reconsider bilateral IMA usage in diabetics? If bilateral IMAs are indeed used, should they be harvested only in skeletonized fashion?
January 24, 2015
Submitted by: Arie Blitz
The Columbia group performed a retrospective analysis of 46 balloon atrial septostomies in 32 patients with severe and medically refractory PAH from 2002-2013. There were no procedural deaths or complications. BAS was safely used as a bridge to lung transplantation or to alleviate right heart failure symptoms and/or syncope.
January 21, 2015
Submitted by: Joseph Basha
In this comprehensive article the author describes the potential harmful effects of peri-operative allogeneic transfusions during cardaic surgery employing the CPB circuit. The author also describes potenital risks of low hematocrits during CPB as would be seen when employing Acute Normovolemic Hemodilution technique for blood conservation. Patient conditions that may provide an early warning of "at risk" patients are outlined. Some insights on potential ways of mitigating the complication of renal failure post cardiac surgery are offered, however, the article left me with a few unanswered questions. Would the use of continuous ultrafiltration during the CPB phase help to remove the neprotoxic PFH? Shoud use of CVVH post operativly in "at risk" patients be a routine standard? Would it help? Should any banked RBC transfusion be first washed in an autotransfusion system before infusion and would this be of potential benefit?
January 20, 2015
Submitted by: Ruben Osnabrugge
The investigators of this project aimed to validate the SYNTAX Score II. This is a risk prediction tool that combines clinical characteristics and the original anatomical SYNTAX score in order to make 4 year mortality predictions with PCI or CABG in patients with unprotected left main disease (ULMCA) and an original SYNTAX score <33). They found that the SYNTAX Score II predicts an equipoise for long-term mortality between CABG and PCI in these patients.
January 18, 2015
Submitted by: J. Rafael Sadaba
This a retrospective study of 175 patients who had survived more than 12 months following TAVI and for whom there were clinical and echocardiographic follow up data. Outcomes were compared between patients with significant (grade II or more) aortic regurgitation (AR) and those without significant aortic regurgitation (less than grade II). Paravalvular, but not intravalvular, AR appeared to improve over time, mainly in the first 6 months. Patients who remained with significant AR grade at 6 month follow-up showed significantly worse survival than patients with less than grade II AR.
January 18, 2015
Submitted by: J. Rafael Sadaba
This is an interesting review of the current status of hybrid coronary revascularization (HCR). The authors discuss the merits and disadvantages of simultaneous versus staged procedures and describe the individual components of HCR. They also analyze the current evidence with regards to results and suggest indications for this type of therapy.
January 18, 2015
Submitted by: Tom C. Nguyen
Anemic off-pump CABG (n=361) versus on-pump CABG (n=578) patients were compared. In anemic patients, off-pump CABG was associated with lower early morbitidy and mortality. 1 to 6 month follow-up mortality, however, was higher in the off-pump CABG cohort.
January 17, 2015
Submitted by: Arie Blitz
The authors perform a meta-analysis of the limited studies available on the utility of tricuspid valve surgery in patients with significant TR at the time of LVAD implantation. No RCTs are available on this issue; however, six observational studies were analyzed by the group. The analysis reveals that, although the addition of TV surgery clearly increases the cardiopulmonary bypass time, no conclusions are warranted regarding the efficacy or safety of TV surgery in these patients. The jury remains out on this controversial issue.