Journal and News Scan

Modolo et al. present a substudy from the EXCEL trail. They looked into the impact of the SYNTAX score II treatment recommendation for patients with left main disease. Patients who were randomized to PCI treatment against the SYNTAX II CABG recommendation had a four-fold higher mortality compared to patients who underwent CABG in conclusion with the syntax II recommendation.

The UNOS donor heart allocation system was revised in 2018, giving priority to patients on inpatient mechanical circulatory support (MCS).  Patients admitted with heart failure-associated cardiogenic shock were tracked for the frequency of use of mechanical circulatory support before and after implementation of this change.   In non-transplant centers, there was no change in the frequency of MCS.  In transplant centers, use of MCS increased from 25% to 43%.

See also:  https://jamanetwork.com/journals/jamacardiology/article-abstract/2764755?resultClick=1

Guidance document to assist in decision making and triage of congenital cardiac surgical patients during the COVID-19 pandemic. The article also includes guidance principles on the need and methods to preserve the workforce and emphasizes the need for regional collaboration, use of telecommunication technologies, and the evolving role of the congenital cardiac surgeon in the pandemic.  

Topical review on the epidemic in Britain, with a number of observations that relate to the cardiothoracic surgeons and all healthcare professionals:

-The assertion that the National Health Service in Britain was overrun PRIOR to the pandemic.

-The assertion that acute angina is now being undertreated.

-Perhaps most worryingly, the assumed increase in non-COVID positive deaths in Scotland.

In the light of the government poised to review the lockdown in an attempt to balance the prevention of another viral infestation versus the conceivable grave financial implications here in the UK and worldwide, it is interesting to see their take on the financial toll on patients.