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Journal and News Scan
The European Association for Cardio-Thoracic Surgery and the European Society of Cardiology have, for the third time, brought together cardiac surgeons and cardiologists to draft a document on the treatment of coronary heart disease. These guidelines provide new information and recommendations on calculation of the Syntax score, radial access as standard approach for coronary angiography, drug-eluting stents for any percutaneous coronary intervention, preferred surgical myocardial revascularisation if left ventricular ejection fraction is less than 35%, among other updates.
Ibezim and colleagues examined outcomes for patients undergoing their first mechanical mitral valve replacement (M-MVR) before 21 years of age. Using information from the Pediatric Cardiac Care Consortium database, the authors performed a retrospective analysis of 441 children from 36 centers in the United States. Nearly 60% of patients were less than 6 years old when they underwent their first M-MVR, and the most common diagnoses were complete and partial atrioventricular canal defects. Mortality within 90 days was 11.1%, and 76% of patients who survived more than 90 days were still alive and transplant-free after 20 years. Early risk factors were age younger than 2 years and concurrent mechanical valve replacement of another valve.
Schroeter and colleagues sought to determine the influence of Parkinson’s disease (PD) on perioperative outcomes after cardiac surgery, given the increasing incidence of cardiac surgery in patients with PD. They performed a retrospective analysis of 130 matched patient pairs who underwent surgery from 2001 to 2013. The authors found similar outcomes for patients with and without PD, including similar 30-day and overall all-cause mortality.
Patient Care and General Interest
Ireland’s Cabinet is expected to consider opt-out organ donation legislation this spring.
A veterinarian in Colorado, USA, discusses the potential for learning about novel interventional cardiology devices by studying their use in veterinary medicine.
The US Congenital Heart Futures Reauthorization Act, which increases the federal funding available for studying congenital heart disease, was signed into law at the end of 2018.
Drugs and Devices
Pembrolizumab, an anti-PD-1 therapy from Merck, received three new approvals for use in advanced non-small cell lung cancer from the Japan Pharmaceuticals and Medical Devices Agency.
Boston Scientific has acquired the company Millipede, adding the investigational IRIS Transcatheter Annuloplasty Ring System for mitral regurgitation to its line of products.
Research, Trials, and Funding
Researchers from California, USA, found that cardiac surgery and cardiac catheterization are associated with similar levels of cognitive decline.
Researchers from Switzerland reported encouraging midterm outcomes from the TriValve Registry of transcatheter interventions for tricuspid regurgitation.
An inhalable formulation of messenger RNA was developed by researchers from the Massachusetts Institute of Technology in the USA, who postulate that it could contribute to new therapies for diseases like cystic fibrosis.
Loghin and Loghin detail the intricacies of imaging modalities available for the assessment of patients in the era of novel mitral technologies. They include a description of functional mitral valve anatomy and discuss the multimodel approach to evaluation of patients undergoing implantation of transcatheter devices.
Diwan and colleagues retrospectively compared daytime to nighttime extubation for patients after cardiac surgery, considering outcomes for patients who were extubated early and patients who had longer intubation times. While there was no time-dependent difference in mortality for patients undergoing extubation within the first 24 hours after arrival in the intensive care unit, patients who were intubated for longer times showed a greater mortality risk with nighttime extubation than with daytime extubation (odds ratio 2.46, 95% confidence interval 1.45 - 4.16, p = 0.001).
Cao and colleagues compared outcomes with stereotactic body radiation therapy (SBRT) to surgery for patients with non–small cell lung cancer using a meta-analysis of 23 studies. Although periprocedural risk was lower for SBRT, surgery provided improved overall survival at later times in both unmatched (16 studies) and matched cohorts (14 studies), with odds ratios of 2.49 and 1.71, respectively. Subgroup analysis demonstrated superior overall survival for lobectomy and sublobar resection when compared with SBRT. The authors also evaluated cancer-specific survival, disease-free survival, and freedom from recurrence for the subsets of studies that reported them.
Patients who were nonadherent to participating in cancer screening tests experienced increased mortality from noncancer causes. It is hypothesized that such patients are also noncompliant with general medical care recommendations, and that such noncompliance represents a behavioral phenotype.
Within a year after a diagnosis of lung cancer the suicide rate for such patients is 6 times higher than in the general population. This is among the greatest increases in the risk of suicide among all cancer diagnoses.
Malignant pleural effusions (MPE) affect up to 15% of all patients with cancer, and in the last few years several well-designed randomized clinical trials have been published. In this position paper, members from both the European Respiratory Society and the European Association for Cardio-Thoracic Surgery summarize the available evidence, focusing on six topics: (1) symptomatic MPE, (2) MPE with trapped lung, (3) loculated MPE, (4) factors predicting prognosis, (5) timing of oncological therapy and definitive fluid management, and (6) histological diagnosis versus cytology.