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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Kambiz Hassan, Nikolai Bayer, Friederike Schlingloff, Martin Oberhoffer, Peter Wohlmuth, Michael Schmoeckel, Stephan Geidel

Hassan and colleagues performed a retrospective analysis of 81 patients who presented for open cardiac surgery while receiving novel oral anticoagulant (NOAC) therapy. Patients were off NOACs for a median of 4 days (IQR, 3 - 6 days) prior to surgery. The authors found the length of the NOAC withdrawal period was significantly related to the postoperative 24-hour drainage volume, which was 480 ml (IQR, 350 - 600 ml). Additionally, 6.2% of patients required rethoracotomy to investigate bleeding. The authors suggest that 10 days of NOAC withdrawal might be preferable prior to elective cardiac surgery.

Source: JAMA Surgery
Author(s): Erika L. Rangel, Douglas S. Smink, Manuel Castillo-Angeles, Gifty Kwakye, Marguerite Changala, Adil H. Haider, Gerard M. Doherty

This survey of general surgeons in the US who had a pregnancy during surgical training identified a number of challenges that may influence career satisfaction.  These included inadequate scheduling support, lactation facilities, and mentoring.  30% of participants would advise a female medical student not to pursue a surgical career.

Source: Innovations
Author(s): Olivia K. Ginty, John M. Moore, Yuanwei Xu, Wenyao Xia, Satoru Fujii, Daniel Bainbridge, Terry M. Peters, Bob B. Kiaii, Michael W.A. Chu

This article examines an interesting concept for preparing for mitral repair. This may have useful assistance in complex valve repairs and in the early stages of training of young surgeons.

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

Patient Care

A teen in Chicago, Illinois, USA, awaiting a heart transplant received the news that a heart was available from his pediatric cardiologist, who dressed up as Chewbacca from Star Wars just for the occasion.

Surgeons in the UAE replaced all four heart valves in a man with infective endocarditis.

A hospital system based in Delaware, USA, plans to launch an app to help monitor infants born with a single ventricle when they are discharged from the hospital after surgery.

 

Drugs and Devices

Japan’s Ministry of Health, Labor, and Welfare has granted national reimbursement for the MitraClip™ from Abbott, a move that will make the technology more accessible through the country’s health insurance system.

 

Research, Trials, and Funding

Researchers from the Netherlands presented a proof-of-concept study at the recent European Heart Rhythm Association meeting, showing that putting light-sensitive ion channels into the heart allows it to terminate arrhythmias itself in response to a pulse of light.

Reports of severe myocarditis after cancer treatment with immune checkpoint inhibitors are increasing, say researchers from the US and France, and they speculate that this is due both to increased use of these drugs and heightened awareness of this complication.

Source: Science Translational Medicine
Author(s): Chun Gwon Park, Christina A. Hartl, Daniela Schmid, Ellese M. Carmona, Hye-Jung Kim, Michael S. Goldberg

Surgery for cancer is known to suppress immune response and facilitate the development of metastases.  In this study in mice, a scaffold designed to release agonists of innate immunity over time was placed in the bed of resected tumors.  The treatment reduced local recurrence and improved survival. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Maximilian Luehr, Sven Peterss, Andreas Zierer, Davide Pacini, Christian D Etz, Malakh Lal Shrestha, Konstantinos Tsagakis, Bartosz Rylski, Giampiero Esposito, Klaus Kallenbach, Ruggero De Paulis, Paul P Urbanski

Of 1,232 patients who underwent elective arch repairs at 11 European aortic centers, 155 were selected and their surgical outcomes were analyzed retrospectively. Approximately 13% of patients suffered an aortic event, and 85% of them needed reoperation. Multivariate analysis found older age at reoperation to be the only independent risk factor for in-hospital mortality.

Source: Annals of Surgery
Author(s): Luca Gianotti, Roberto Biffi, Marta Sandini, Daniele Marrelli, Andrea Vignali, Riccardo Caccialanza, Jacopo Viganò, Annarita Sabbatini, Giulio Di Mare, Mario Alessiani, Francesco Antomarchi, Maria Grazia Valsecchi, Davide P Bernasconi

One of the more contentious issues in Enhanced Recovery After Surgery (ERAS) programs is the role of preoperative carbohydrate loading.  This randomized trial demonstrated less need for insulin for treating serum glucose >180 mg/dl in the carbohydrate-loading group compared to the placebo group (2.4% versus 16.0%; RR 0.15; p<0.001) with no change in the frequency of postoperative infection.

Source: Annals of Surgery
Author(s): Yanik J. Bababekov, Sahael M. Stapleton, Jessica L. Mueller, Zhi Ven Fong, David C. Chang

A brief, informative, and helpful article.  It highlights alarming reports that 80% to 90% of "negative" randomized controlled trials in surgery are not adequately powered to reliably declare a negative outcome.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Alper Kepez, Bulent Mutlu, Ashok Paudel, Cigdem Ileri, Halil Atas, Bedrettin Yildizeli

Kepez and colleagues retrospectively evaluated the incidence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Of 83 patients with CTEPH who underwent coronary angiography prior to pulmonary endarterectomy, collaterals were found definitively in 15 patients (18.1%) and were probable in an additional 4 patients (4.8 %). The presence of coronary artery-pulmonary artery collaterals was associated with higher pulmonary artery pressure, higher pulmonary vascular resistance, and a greater reduction in pulmonary vascular resistance following surgery.

Source: Society for Cardiothoracic Surgery in Great Britain and Ireland
Author(s): Sukumaran Nai on behalf of the MiniStern Trial Investigators.

A medium-size RCT comparing full sternotomy to limited sternotomy for conventional aortic valve replacement, presented at the SCTS Annual Meeting in Glasgow. The 7-10% one year attrition rate seems quite disappointing, and will most probably be discussed. We will await the full paper to see what was the learning curve for the innovative approach.

Please scroll to page 14 in the link provided to read the presentation summary.

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