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Journal and News Scan

Source: MedPage Today
Author(s): Kenneth Lin

Interesting article commenting on the perception that some remedies in medicine are so obviously beneficial that testing their effectiveness is a waste of time.  As it turns out, many of what physicians think are "slam dunk" remedies have mixed or negative results.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

Doctors in Abu Dhabi, UAE, say that a surprisingly high number of young Emirati adults have atrial fibrillation.

Two lung cancer survivors attended last Sunday’s Super Bowl 52 in Minnesota, USA, as winners of Team Draft’s Super Bowl Challenge, a part of the Team Draft Foundation’s initiative to increase lung cancer awareness and funding for research.


Drugs and Devices

The Revivent TC™ TransCatheter Ventricular Enhancement System from BioVentrix has received NUB Status 1, an award that designates innovative medical devices to receive reimbursement support in Germany.


Research, Trials, and Funding

Researchers from The Netherlands found robotic surgery to have a lower complication rate than open surgery for esophagectomy, and they presented their findings at the recent Gastrointestinal Cancers Symposium.

Acesion Pharma has received approval to begin a phase 1 study on a new compound for treating atrial fibrillation, which they expect to start in March 2018. This news comes shortly after results of the CASTLE-AF trial were published in the New England Journal of Medicine suggesting that catheter ablation techniques are superior to medical therapy for atrial fibrillation. 

Researchers in Sweden and Germany find that montelukast, an asthma drug that targets leukotrienes, protects mice against models of aortic aneurysm. Their findings were published in PNAS.

Source: Catheterization Cardiovascular Interventions
Author(s): Guy Witberg, Adi Lador, Dafna Yahav, Ran Kornowski

In this meta-analysis, the authors compare surgical aortic valve replacement (SAVR) with transcatheter aortic valve implantation (TAVI) in patients at low surgical risk. They included two randomized controlled trials and four propensity-matched studies for a total of almost 3500 patients. Short term mortality was similar between treatments, but intermediate follow-up (two years) showed higher mortality with TAVI versus SAVR (17.2% versus 12.7%, p=0.006).

Although these results should be taken with caution due to the largely non-randomized nature, it proves that we need to await the results of the currently ongoing low-risk trials (NOTION 2, PARTNER 3, and Medtronic TAVI low-risk trial) before we can recommend TAVI in low-risk patients.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Martin Schweiger, Oliver Miera, Theo M.M.H. de By, Michael Hübler, Felix Berger, Mustafa Özbaran, Antonio Loforte, Burkhardt Seifert, Gaetano Gargiulo, Jan Gummert, Paul Mohacsi, the EUROMACS members

Schweiger and colleagues retrospectively analyzed stroke rate for patients under 19 years old in the European Registry for Patients with Mechanical Circulatory Support database. Analysis of the 51 pediatric patients who were supported with a continuous-flow ventricular assist device revealed an incidence of cerebral stroke of 0.1 per patient-year.

Source: The Annals of Thoracic Surgery
Author(s): Michael P. O’Neil, Rene Alie, Linrui Ray Guo, Mary-Lee Myers, John Murkin, Chris Ellis

The authors conducted a prospective randomized study of 20 high-risk cardiac surgical patients, split into two groups:  pulsatile versus nonpulsatile flow during cardiopulmonary bypass.  Using spectral imaging and near-infrared technology, the group found that the the pulsatile perfusion group maintained better perfusion indices in the microcirculation.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Ana G. Duran, Olivia Reidell, Harald Stachelscheid, Kristin Klose, Manfred Gossen, Volkmar Falk, Wilhelm Röll, Christof Stamm

In this review article, Duran and colleagues provide an overview of pluripotent stem cell (PSC) technology and its potential for application in heart failure. The authors focus on the derivation and reprogramming of these cells for cardiac regeneration, the potential immunogenicity of cardiomyocytes reprogrammed from PSCs, and current cardiac tissue engineering research.

Source: The Annals of Thoracic Surgery
Author(s): Husain N. Alshaikh, Nevin M. Katz, Faiz Gani, Neeraja Nagarajan, Joseph K. Canner, Seema Kacker, Peter A. Najjar, Robert S. Higgins, Eric B. Schneider

The Nationwide Inpatient Sample was interrogated for all patients undergoing either CABG, valve replacement, or both from 2008 to 2011, and a total of 1,078,036 patients were included in the analysis.   The authors discovered that, overall, 9.8% of patients developed acute kidney injury (AKI) postoperatively. Other important discoveries were:

Outcome                                        non-AKI          AKI                         p  

  • Death                                     1.3%              13.9%            <0.001
  • Mean hospital cost        $38,820       $77,178        <0.001

The authors calculate that the net effect of AKI after cardiac surgery at a national level in the United States is over $1 billion annually.

Source: The Annals of Thoracic Surgery
Author(s): Louis P. Perrault, Katherine A. Kirkwood, Helena L. Chang, John C. Mullen, Brian C. Gulack, Michael Argenziano, Annetine C. Gelijns, Ravi K. Ghanta, Bryan A. Whitson, Deborah L. Williams, Nancy M. Sledz-Joyce, Brian Lima, Giampaolo Greco, Nishit Fumakia, Eric A. Rose, John D. Puskas, Eugene H. Blackstone, Richard D. Weisel, Michael E. Bowdish

The authors participated in a multi-institutional prospective study to evaluate the frequency, risk factors, and outcomes of patients who suffer mediastinal infection after cardiac surgery.  A total of 5,158 patients were enrolled, and there were 43 infections in 41 patients (0.79 cumulative incidence) occurring at a median time of 20 days after surgery.  The authors discovered the following risk factors for the development of mediastinitis: 

  • higher body mass index
  • higher creatinine
  • peripheral vascular disease
  • preoperative steroids
  • ventricular assist device or transplant surgery
  • postoperative hyperglycemia in nondiabetics

Readmission rates and mortality were five times higher in patients who developed mediastinitis.

Source: New England Journal of Medicine
Author(s): Scott J. Antonia, Augusto Villegas, Davey Daniel, David Vicente, Shuji Murakami, Rina Hui, Takashi Yokoi, Alberto Chiappori, Ki H. Lee, Maike de Wit, Byoung C. Cho, Maryam Bourhaba, Xavier Quantin, Takaaki Tokito, Tarek Mekhail, David Planchard, Young-Chul Kim, Christos S. Karapetis, Sandrine Hiret, Gyula Ostoros, Kaoru Kubota, Jhanelle E. Gray, Luis Paz-Ares, Javier de Castro Carpeño, Catherine Wadsworth, Giovanni Melillo, Haiyi Jiang, Yifan Huang, Phillip A. Dennis, and Mustafa Özgüroğlu, for the PACIFIC Investigators

This randomized trial compared chemoradiotherapy alone to chemoradiotherapy followed by consolidation therapy with the PDL-1 antibody durvalumab in patients with stage III NSCLC.  The treatment group had significantly improved progression-free survival, response rate, and overall survival, with clinically meaningful differences between the groups.  The findings suggest that such regimens may be the new standard of care in these patients.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

Several charities provided free surgeries to 15 Kashmiri children with congenital heart defects at the Fortis Memorial Research Institute in Gurgaon, India.

A man in his 40s discovered that he had a rare congenital heart defect after doctors were unable to access his left coronary system via angiography.

Newborns around the US are being adorned with red hats to raise heart disease awareness during February, which is considered American Heart Month.


Drugs and Devices

The PureFlex™ line of adult arterial cannulae from LivaNova has received the CE Mark.


Research, Trials, and Funding

The first patient has been enrolled in the BELIEVE trial, a postmarket prospective study sponsored by LivaNova to evaluate leaflet motion in patients who have received a commercially approved LivaNova bioprosthetic aortic valve.

Baylor College of Medicine in Texas and the University of Kentucky recently joined the American Heart Association’s Strategically Focused Vascular Disease Research Network as part of a collaborative effort to better understand the differences in aortic disease between men and women.