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Journal and News Scan
June 7, 2018
Submitted by: Claire Vernon
Johnston and colleagues evaluated morbidity and mortality following different cardiac operations at 18 institutions to determine if outcomes of coronary artery bypass grafting (CABG), aortic valve replacement, and mitral valve replacement were correlated within each institution. The large volume of CABG makes this procedure an obvious choice for large-scale measurement and reporting of outcomes, and the authors sought to determine if CABG outcomes correlated with, and could therefore be considered representative of, valve replacement outcomes. While the institutional observed-to-expected (OE) ratios for mortality were not correlated across the three procedures, the OE ratios for morbidity were. The authors suggest this could reflect greater dependence of morbidity on postoperative care and resources that are more broadly shared within an institution and greater dependence of early mortality on procedure-specific skills.
June 6, 2018
Submitted by: Claire Vernon
Dobrovie and colleagues performed a retrospective analysis of mitral regurgitation (MR) in 128 patients who had a left ventricular assist device (LVAD) implanted. The authors found that even severe MR improved following LVAD implantation without intraoperative repair of the valve. Survival after one and three years for patients with severe preoperative MR was comparable to LVAD patients with none to moderate preoperative MR.
June 5, 2018
Submitted by: Claire Vernon
Timman and colleagues assessed the functional outcomes of patients who underwent laryngotracheal resection (LTR) and reconstruction for benign laryngotracheal stenosis. Between 1996 and 2017, 119 consecutive patients underwent LTR (n = 47) or end-to-end segmented tracheal resection (n = 56). There was consistent functional improvement during follow-up, particularly with respect to the sensation of dyspnea during exercise and the reduction of inspiratory stridor, although early voice alterations without recurrent nerve palsy were reported more often after LTR (34% versus 16%). All airway-related scores and quality of life measures improved significantly following both therapeutic modalities. While these results are promising, the low questionnaire response rate (63%) prompts caution.
June 4, 2018
Submitted by: Claire Vernon
Risk-prediction models are well-known in cardiac surgery—the EuroSCORE and STS models being some of the most recognized. They are used for risk stratification, decision-making, and benchmarking. However, development of these models can be complex and once a model is developed, it is important to validate it. This article by Grant and colleagues discusses various issues in developing and validating risk-prediction models to aid clinicians in gaining a basic understanding of the advantages and limitations of such models.
June 1, 2018
Submitted by: Claire Vernon
Patient Care and General Interest
World No Tobacco Day was observed on May 31st, and it focused on cardiovascular disease with the 2018 theme of “Tobacco breaks hearts. Choose health, not tobacco.”
The US Food and Drug Administration recently released a safety communication focusing on surgical fires and practices that can prevent them.
Experts in India campaign for mandatory screening of newborns for critical congenital heart disease.
Research, Trials, and Funding
A surgeon in California shared his experience with awake video-assisted thoracic surgery at the recent Annual Meeting of the American Thoracic Society.
Early results suggest good 30-day outcomes with the Tendyne Transcatheter Mitral Valve Replacement system from Abbott, say researchers from Sydney, Australia, who presented the results at the recent EuroPCR meeting in Paris, France.
June 1, 2018
Submitted by: Claire Vernon
Kim and colleagues retrospectively analyzed long-term patency of reimplanted branch vessels following thoracoabdominal aortic aneurysm repair in 168 patients. Patency rates were high for visceral branches. For segmental arteries, patency rates depended on reimplantation technique and were worst for graft interpositions.
May 31, 2018
Submitted by: Mark Ferguson
This randomized trial evaluating the relative efficacy of immunotherapy and chemotherapy in patients with recurrent or metastatic disease, immunotherapy was associated with significantly better progression-free survival. Tumor mutational burden was a marker for patient selection for immunotherapy.
May 31, 2018
Submitted by: Claire Vernon
Liufu and colleagues evaluated outcomes for repair of supracardiac total anomalous pulmonary venous connection via the superior approach in 198 pediatric patients, with a median age of 95 days at the time of surgery. Repair via the superior approach avoids dispensable incisions to the atrial septum, extra force being placed on the heart, and potential anastomotic distortion. The authors found that rates of both survival (97%) and freedom from postoperative pulmonary venous obstruction (85%) were acceptable using this approach.
May 30, 2018
Submitted by: Mark Ferguson
The addition of pembrolizumab (targeting PD-1) to standard chemotherapy substantially improved time to progression and overall survival compared to chemotherapy alone in patients with metastatic lung cancer.
May 29, 2018
Submitted by: Claire Vernon
Umari and colleagues appraise approaches to optimize postoperative pain management after pulmonary resection by video-assisted thoracoscopic surgery. The authors recommend an opioid-sparing multimodal approach, and they discuss loco-regional analgesic techniques, nonopioid analgesics, and perioperative gabapentinoids.