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Journal and News Scan

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

Patient Care

The American Heart Association and the American College of Cardiology released an updated definition of high blood pressure this week.

Heart patients in Malaysia seem to be successfully reducing their cholesterol levels, though cholesterol levels are still on the rise in the general population.

A lung surgeon discusses the immediate and long-term effects of air pollution in Delhi, India.

 

Drugs and Devices

Medtronic presented 30-day outcomes from the pilot study for its Intrepid™ transcatheter mitral valve replacement system, which indicate successful implantation in nearly all patients and reduced regurgitation.

Four cardiac health monitoring apps and devices received recent approval from the US Food and Drug Administration (FDA).

The US FDA will now permit an electric stimulation device to be marketed for opioid withdrawal, though the device is contraindicated in patients with cardiac pacemakers.

 

Research, Trials, and Funding

Lungs from donors over 60 years old might be suitable for patients who need double lung transplants.

Researchers from the University of the Witwatersrand in Johannesburg, South Africa, highlight the importance of psychosocial factors in health as they report high financial stress is associated with 13-fold higher odds of having a heart attack.

Source: CNN.com
Author(s): Susan Scutti

Dr. John Warner, President of the AHA, suffered a minor heart attack during the AHA congress in California.  The day prior he had delivered an address describing the impact that coronary artery disease has had on his extended family. He was treated with stent placement and is recovering well.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Vivek Rao

The incoming issue of the Journal comes with an interesting group of papers revolving around a provocative topic: work from Seattle on the absence of predictive value of standard pulmonary function tests in LVAD surgery.  Vivek Rao takes the opportunity to present his thoughts in this brief editorial, the important central message of which cannot be ignored.

 

Source: JAMA Surgery
Author(s): Aditya Mantha, Yen-Yi Juo, Ravi Morchi, Ramin Ebrahimi, Boback Ziaeian, Richard J. Shemin, Peyman Benharash

This brief article compares costs and morbidities for TAVR and SAVR in the current era.  TAVR costs are higher than for SAVR and have increased despite no apparent change in comorbidity index.  In contrast, SAVR costs remained stable during the same period.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Jules Lin

An enthusiastic yet balanced and succinct editorial on the occasion of a small series with short follow-up and absolute survival of ECMO-supported recipients of pulmonary transplantation (mostly with interstitial fibrosis) with short waiting time after ECMO (less than 16 days). The key word is 'selection.'  It is also worth contemplating whether placing a lung transplant candidate on ECMO expedites the donation and implantation, and the ramifications of that in terms of manipulating the waiting lists.

Source: Annals of Surgery
Author(s): Chelsea A. Harris, Natalie Blencowe, Dana A. Telem

This interesting article outlines language-related aspects of gender bias and provides some suggestions for mitigation.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Gonçalo F. Coutinho, Filipe Leite, Manuel J. Antunes

With the impressive average of 150 mitral repairs annually for the last 16 years (possibly a world record, even more impressive given the population of Portugal), the Coimbra team led by Antunes reflects on six cases of circumflex artery injury, mostly in non-right dominant anatomy as expected.

Source: The Annals of Thoracic Surgery
Author(s): Carlos M. Mery, Luis E. De León, J. Rubén Rodriguez, R. Michael Nieto, Wei Zhang, Iki Adachi, Jeffrey S. Heinle, Lauren C. Kane, E. Dean McKenzie, Charles D. Fraser Jr

Mery and colleagues retrospectively reviewed outcomes of 383 neonates and infants undergoing repair of congenital heart defects to determine if the presence of congenital gastrointestinal (GI) malformations affected cardiac surgery outcomes. Although long-term survival after discharge was similar between groups, patients with thoracic GI malformations had worse perioperative outcomes than controls. The authors conclude that GI malformations do not contraindicate cardiac repair, however they suggest that families receive appropriate counseling on the risk.

Source: JAMA Cardiology
Author(s): Ankur Gupta, Larry A. Allen, Deepak L. Bhatt, Margueritte Cox, Adam D. DeVore, Paul A. Heidenreich, Adrian F. Hernandez, Eric D. Peterson, Roland A. Matsouaka, Clyde W. Yancy, Gregg C. Fonarow

The Hospital Readmissions Reduction Program (HRRP) was established as part of the Affordable Care Act in the US with the goal of adding an incentive for quality care that reduced hospital readmission rates. HRRP reduces Medicare reimbursement for hospitals with excess readmissions.

Gupta and colleagues sought to understand how this program affected outcomes for heart failure patients. The authors evaluated readmission for Medicare beneficiaries with heart failure from 2006 to 2014 using the American Heart Association’s Get With The Guidelines-Heart Failure registry and associated Medicare claims files. The authors found that the one-year risk-adjusted readmission rate decreased (HR 0.92) and the one-year risk-adjusted mortality rate increased (HR 1.10) following HRRP implementation. Secondary analysis that excluded patients who were discharged to hospice care found similar though attenuated changes.

The authors conclude that public health policies should be studied, as are drugs and devices, to ensure they confer the intended benefits.

The Wall Street Journal published an article highlighting this paper.

Source: New England Journal of Medicine
Author(s): C. David Mazer, Richard P. Whitlock, Dean A. Fergusson, Judith Hall, Emilie Belley-Cote, Katherine Connolly, Boris Khanykin, Alexander J. Gregory, Étienne de Médicis, Shay McGuinness, Alistair Royse, François M. Carrier, Paul J. Young, Juan C. Villar, Hilary P. Grocott, Manfred D. Seeberger, Stephen Fremes, François Lellouche, Summer Syed, Kelly Byrne, Sean M. Bagshaw, Nian C. Hwang, Chirag Mehta, Thomas W. Painter, Colin Royse, Subodh Verma, Gregory M.T. Hare, Ashley Cohen, Kevin E. Thorpe, Peter Jüni, and Nadine Shehata, for the TRICS Investigators and Perioperative Anesthesia Clinical Trials Group

This randomized trial evaluated restricted (threshold of Hgb <7.5  at induction of anesthesia ) versus liberal (Hgb <9.5 at induction of anesthesia or <8.5 on arrival in ICU) for patients undergoing cardiac surgery who had a EuroSCORE of 6 or more.  The composite outcome was death, MI, stroke, or new onset renal failure.  Transfusion occurred in 52% of the restricted group and 73% of the liberal group.  Outcomes were similar between these moderate-to-high risk groups.

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