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Journal and News Scan
December 13, 2018
Submitted by: Claire Vernon
Schoenhoff and colleagues evaluated the impact of reimplantation techniques of the supra-aortic branches, en bloc or separate, on neurological complications following total arch replacement. In a study of 3345 patients enrolled to the ARCH registry, the authors found that separate reimplantation of the supra-aortic branches increased the risk of neurological complications in the full cohort but not in a comparison of 461 matched patient pairs. Implantation technique did not influence early mortality or late survival.
December 11, 2018
Submitted by: Claire Vernon
Takagi and colleagues performed a meta-analysis of eight randomized controlled trials comparing on-pump and off-pump coronary artery bypass grafting (CABG). They evaluated only trials with follow-up periods of five years or longer, and they pooled hazard ratios rather than odds ratios, where possible. The authors’ analysis found an increased mortality risk with off-pump CABG.
December 10, 2018
Submitted by: Claire Vernon
Basra and colleagues report that among patients with bioprosthetic aortic valves who had clinical or echocardiographic indications suggestive of leaflet thrombosis, one-third of patients had this diagnosis confirmed by four-dimensional computed tomography (4DCT). The use of 4DCT avoided unnecessary anticoagulation in the remaining two-thirds of patients. The median time from valve replacement to 4DCT was 9.6 months in transcatheter patients and 3.7 years in surgical patients, due to active surveillance in patients who had received a transcatheter valve.
December 7, 2018
Submitted by: Claire Vernon
Patient Care and General Interest
A patient who had been admitted to the intensive care unit for chronic heart failure coughed up a cast of his right bronchial tree made of coagulated blood.
A Kaiser Health News article discusses the challenges patients can face to cover the cost of organ transplant in the US and the importance for transplant centers to ensure that patients can afford the treatment, which has a much greater need than availability.
The American Medical Association highlights approaches from different institutions around the US that are geared toward creating a healthier work environment for physicians.
Amazon has developed software that it says can pull information from digitized patient records and clinical notes.
Drugs and Devices
The National Institute for Health and Care Excellence recommended that percutaneous repair of the mitral valve with a leaflet clip be more widely available across the National Health System in England.
Research, Trials, and Funding
Researchers from Germany report the transplantation of pig hearts into baboons, with two of the baboons surviving for six months.
December 7, 2018
Submitted by: Claire Vernon
Watkins and colleagues report their use of preoperative extracorporeal membrane oxygenation (ECMO) to evaluate and stabilize structural heart patients who were at extreme surgical risk. Twelve patients undergoing surgery for severe prosthetic mitral stenosis, ruptured papillary muscle, ischemic ventricular septal defect, or severe aortic stenosis were included. ECMO-associated complications included leg ischemia, wound infection, and major bleeding. Preoperative ECMO support improved the predicted operative mortality risk, and survival was 82% after one year.
December 6, 2018
Submitted by: Aristotle Protopapas
Gilles Dreyfus and colleagues share a decade of mitral reconstruction for degenerative posterior leaflet pathology in Harefield and Monaco (38 per year was the formidable average). The supplementary video is of particular educational value for the mitral surgeon and the cardiologist/TOE (TEE) specialist.
December 5, 2018
Submitted by: Claire Vernon
Coyan and colleagues report outcomes following double valve surgery in a cohort of patients who underwent operation between 2011 and 2017. Mitral repair was associated with better perioperative outcomes than mitral replacement when performed concomitantly with aortic valve replacement, though the authors note that differences in underlying comorbidities between the groups could have contributed to this result. Longer term outcomes were comparable between mitral repair and replacement.
December 4, 2018
Submitted by: Aristotle Protopapas
Essential reading, paying particular attention to the table in Section 7: the European experts recommend, again, that in Marfan and other systematic connective tissue diseases conventional techniques are still advantageous because the landing zones will eventually degenerate.
Jointly published in the European Journal of Vascular and Endovascular Surgery at: https://doi.org/10.1016/j.ejvs.2018.09.016
December 3, 2018
Submitted by: Claire Vernon
Park and colleagues genotyped cancer tissue for epidermal growth factor receptor (EGFR) mutations in patients with complete resection for lung adenocarcinoma who had a recurrence. Lung adenocarcinoma with EGFR gene mutations was associated with a longer disease-free interval than was the wild-type EGFR gene. Additionally, EGFR gene mutation was a prognostic factor for disease-free interval.
November 30, 2018
Submitted by: Benjamin Bidstrup
The EXCEL is one of several prospective studies that examine the use of single versus bilateral internal thoracic artery (ITA) grafts for myocardial revascularization (in this case, compared with percutaneous coronary intervention) for left main disease. This did not show differences in the surgical population (905 patients) between one and two ITA grafts with regard to mortality and DSWI. There are significant limitations in the patient allocation process that make the value of these outcomes less than helpful.