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Journal and News Scan
September 2, 2022
Submitted by: Cameron Lind
In the past, there has not been an accurate way to calculate mortality risk for patients with atrial fibrillation (AF) who have undergone a successful transcatheter aortic valve implantation (TAVI) and have been discharged home. Now, researchers with the ENVISAGE-TAVI AF trial have developed a risk score to more accurately predict mortality in TAVI patients. George Dangas, of The Zena and Michael A. Wiener Cardiovascular Institute, presented the trial’s findings at the European Society of Cardiology Congress 2022, highlighting that the new risk assessment score focuses on improving outcomes by determining how to categorize patients after a successful TAVI and discharge. Dangas added that the analysis will continue to enhance the understanding of patient risk after TAVI.
September 2, 2022
Submitted by: Cameron Lind
In order to best estimate observed-to-expected operative mortality ratios for more than 100 congenital heart centers in North America, The Society of Thoracic Surgeons compared their current approach to approaches that incorporate information on diagnoses as moderators of procedures, other unused risk factors, and additional variation in confidence interval construction. This comparison allowed the authors to characterize center performance using Bayesian additive regression trees and lasso models used to link operative mortality to diagnosis-procedure categories, procedure-specific risk factors, and syndromes/abnormalities. The authors concluded that, after using the new approach, up to 16 percent of hospitals changed performance categories, most improving in performance. Given the significance of this type of quality report for congenital heart centers, they determined that the new method of analysis should be considered.
August 27, 2022
Submitted by: Emily Farkas
The decisions that medical students make regarding their career paths have a direct effect on the future medical workforce of a country. Their choice of specialty determines the distribution of their country’s medical workforce among different specialties and its ability to deliver specialized healthcare services.
The location of a medical student’s residency training is one of the most significant decisions they will make. This decision often foreshadows their career prospects, and the majority of students indicate the desire to train abroad. In Nigeria, there is already an alarming rate of brain drain among medical doctors and other healthcare professionals. It is important to begin to understand the factors that influence students’ choice to leave the country so that measures can be taken by policymakers to mitigate the negative impacts of a lean, skewed, and under-specialized workforce.
August 27, 2022
Submitted by: Emily Farkas
Although the demand for heart surgeons trained in a year is twenty, Kenya produces only four to five annually. This results in a gap in diagnosis and treatment of heart illnesses. The East African Simulation Centre for Cardiovascular Surgery was recently established at Gertrude's Children's Hospital in Kenya through partnership with the University of Nairobi and the German Heart Institute in Berlin.
Through this collaboration, the University of Nairobi will provide the trainers while the German Heart Institute will donate the equipment to improve training for cardiovascular surgery students and professionals, serving as a hub for the East African region. The center is directed locally by Dr. Mark Awori, head of pediatric cardiac surgery and was made possible from efforts led by Professor Charles Yankah of the German Heart Institute and the Pan-African Society for Cardio-Thoracic Surgery.
August 27, 2022
Submitted by: Emily Farkas
Most surgeons practice in high income countries, even though the majority of the world’s population lives in low- or middle-income countries. There is a significant disparity between high-income and low-income countries in the number of both cardiac and pediatric cardiac surgeons. The number of nonsurgical cardiovascular surgeons—including interventional cardiologists, cardiac anesthesiologists, perfusionists, technicians, and other health workers—in low-income countries remains unclear, along with where they are distributed. A clear path exists to foster and uphold heart teams with a high socioeconomic return on investment across countries, but failing to take action means that millions of people will continue to suffer from preventable and treatable cardiac conditions each year.
August 26, 2022
Submitted by: Cameron Lind
In a recent study comparing modes of cardiac rehabilitation, the authors found that home-based cardiac rehabilitation results in fewer hospitalizations among patients. Because of accessibility issues, many patients who could benefit from cardiac rehabilitation to improve health after cardiac issues do not take advantage of these resources. To remedy this problem, home-based rehabilitation was developed in facilities such as Kaiser Permanente Southern California (KPSC), where this study was conducted. Although previous studies have concluded that home-based and center-based rehabilitation result in similar outcomes, this study encompasses previously unstudied diverse and medically complex populations, allowing for a more inclusive result.
August 26, 2022
Submitted by: Cameron Lind
Historically, investment in surgical care has been limited in low-income countries, where children are fourteen times more likely to die before age five than in high-income countries. The authors argue that with simple and affordable surgical care, children with treatable illnesses such as congenital anomalies, injuries, and infections could be saved. Networks of physicians funded by charitable donation and driven by commitments from the United Nations are integral to providing necessary surgical care, and the authors emphasize that the global health philanthropy community needs to pivot a larger portion of its focus to surgical programs in underserved countries.
August 26, 2022
Submitted by: Cameron Lind
As one of the most challenging medical emergencies, acute Type A aortic dissection (ATAAD) is associated with increased mortality even when recognized and treated early. This article from Zara Khachatryan, et. al—recently opened to nonsubscribers—describes the benefits of using valve-sparing aortic root replacement, or the David procedure, in patients with ATAAD. The authors found that, especially in younger patients and those with connective tissue disorders, the David procedure is associated with good preoperative safety and long-term efficacy. When performed effectively by experienced surgeons, valve-sparing aortic root replacement has become a desirable option in treating ATAAD in properly selected patients.
August 19, 2022
Submitted by: Mary Hammon
A new analysis by a team led by Dr. Mario Gaudino of Weill Cornell Medicine and NewYork-Presbyterian shows that a combination of two antiplatelets drugs can benefit patients after coronary artery bypass graft surgery but also increases the risk of potentially dangerous bleeding. Reported on August 9 in JAMA, the finding suggests physicians should carefully weigh the use of these medications after this procedure.
August 19, 2022
Submitted by: Mary Hammon
Surgical management for potentially resectable stage IIIA-N2 non-small cell lung cancer (NSCLC) is controversial. In this study, researchers examined outcomes of a well-selected surgical cohort of postinduction IIIA-N2 NSCLC patients with persistent N2 disease and found that overall survival for patients with non-R(un) or persistent N2 (true R0) was similar to those with mediastinal downstaging.
Authors say this study underscores the importance of classifying the extent of mediastinal involvement for persistent N2 patients, supporting the proposed International Association for the Study of Lung Cancer R(un) classification.