Journal and News Scan

There is limited data about the impact of timing of pulmonary valve replacement (PVR) on right heart reverse remodeling in patients with pulmonary regurgitation following intervention for isolated pulmonary valve stenosis (PS). This study compared differences in postprocedural right heart reverse remodeling after early versus late PVR (defined as PVR before versus after attainment of the conservative consensus criteria proposed by Bokma et al, 2018) in patients with prior intervention for PS, using patients with tetralogy of Fallot as the reference group. 

Right atrial reservoir strain and right ventricular free wall strain were measured at baseline, one and three years after PVR. There were 114 patients with PS (early PVR, 87 [76 percent]; late PVR, 27 [24 percent]) and 291 patients with tetralogy of Fallot (early PVR, 197 [67 percent]; late PVR, 96 [33 percent]). The PS group had greater improvement in right atrial reservoir strain at one year (12 percent ±4 percent versus 8 percent±4 percent; P<0.001) and three years (15 percent±6 percent  versus 9 percent ±6 percent ; P<0.001), and a greater improvement in right ventricular free wall strain at one year (12 percent ±4 percent  versus 7 percent ±3 percent , P=0.008) and three years (16 percent ±6 percent  versus 12 percent ±5 percent ; P=0.01) after PVR compared with the tetralogy of Fallot group. There was no difference in right heart reverse remodeling between patients who underwent early versus later PVR within the PS group. In contrast, late PVR was associated with less right heart reverse remodeling within the tetralogy of Fallot group. 

These data suggest that patients with palliated PS presenting pulmonary regurgitation have a more benign clinical course, hence, delaying PVR in this population may be appropriate. 

Wearables are increasingly used by patients with atrial fibrillation (AF) for symptom monitoring and health management, but their impact on patient health care use and psychological well‐being is not well understood. 

In this retrospective, propensity‐matched study of patients with AF, survey and electronic health record data were merged to compare AF‐specific health care use (outpatient/inpatient visits, rhythm‐related testing, and procedures) and informal health care use (telephone calls and patient portal messages) over a 9‐month period between wearable users and nonusers. The authors also examined the effects of wearable cardiac monitoring features (eg, heart rate alerts, irregular rhythm notification, and ECG) on patient behavior and well‐being. Of 172 patients with AF in this analysis (age, 72.6±9.0 years; 42 percent women), 83 used wearables. Compared with nonusers, wearable users reported higher rates of symptom monitoring and preoccupation (P=0.03) and more AF treatment concerns (P=0.02). Moreover, 20 percent of wearable users experienced anxiety and always contacted their doctors in response to irregular rhythm notifications. After matching, AF‐specific health care use was significantly greater among wearable users compared with nonusers (P=0.04), including significantly higher rates of ECGs, echocardiograms/transesophageal echocardiogram, and ablation. Wearable users were also significantly more likely to use informal health care resources compared with nonusers (P=0.05). 

Wearables were associated with higher rates of symptom monitoring and preoccupation, AF treatment concerns, AF‐specific health care use, and use of informal health care resources. Prospective, randomized studies are needed to understand the net effects of wearables and their alerts on patients, providers, and the health care system. 
 

Pectus defects are a group of congenital conditions found in approximately 1 in 250 people, where the sternum is depressed back toward the spine (excavatum), protrudes forward (carinatum) or, more rarely, is a mixture of both (arcuatum or mixed defects). For the majority of patients, it is well tolerated, but some patients are affected psychologically, physiologically or both. 

The deformity becomes apparent at a young age due to the growth of the ribs and the cartilage that links them to the sternum. The majority of defects are mild and are well tolerated, i.e. they do not affect activity and do not cause psychological harm. However, some young people develop lower self-esteem and depression, causing them to withdraw from activities, such as swimming and dancing, and from interactions that might “expose” them, such as sleepovers, dating, going to the beach, and wearing fashionable clothing. This psychological harm occurs at a crucial time during their physical and social development. A small number of patients have more extreme depression of their sternum that impedes their physiological reserve, which can occur when engaging in strenuous exercise, such as running, but can also limit moderate activity, such as walking and climbing stairs. The effects can be so extreme that symptoms occur at rest or cause life-threatening compression of the major blood vessels and organs. The group of patients with physiological impairment typically also suffer from low self-esteem and depression. 

This paper summarizes the current evidence for the different treatment strategies for this condition, including supportive care, psychological support and nonsurgical techniques including bracing and vacuum bell therapy. The authors also consider surgical techniques including the Ravitch procedure, the Nuss procedure (minimally invasive repair of pectus excavatum), pectus implants, and other rare procedures such as Pectus Up. 

For the majority of patients, supportive care is sufficient, but for a minority, a combination of the other techniques may be considered. 

This paper also outlines best practice guidance for the delivery of such therapies, including standardized assessment, consent to treatment, audit, quality assurance, and long-term support. 

All the interventions have risks and benefits that the patient, parents, and clinicians need to carefully consider and discuss when deciding on the most appropriate course. The authors hope this evidence review of “Best Practice for Pectus” will make a significant contribution to those considerations and help all involved—from patients to national policy makers—to deliver the best possible care. 

After enduring cardiopulmonary bypass, many patients experience an inflammatory response, which can lead to prolonged ventilation, bleeding, stroke, and renal dysfunction. The NewYork-Presbyterian and Weill Cornell Medicine trial center was chosen to further investigate RBT-1 to see if it can help the production of anti-inflammatory cytokines and reduce the occurrence of common post-surgical complications. Researchers found that patients who received RBT-1 had a 46 percent decrease in blood product transfusions, a lower likelihood of readmission to the hospital within 30 days, and spent less time in the ICU and on a ventilator.