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Journal and News Scan

Source: The New England Journal of Medicine
Author(s): Michael Y. Mi, Peter C. Block, Joseph P. Broderick

The authors present a case vignette. Particularly interesting is the statement on reliability of sonography to assess the oval fossa, especially for placing confidence in echocardiographic screening of cardiac donors.

Source: Circulation Research
Author(s): Sonia R. Singh, Jeffrey Robbins

A sober editorial on a murine model of induced cardiac failure, which highlights the challenges of translating animal omics to humans

Source: The Annals of Thoracic Surgery
Author(s): Daniel C. Thomas, Brian N. Arnold, Jessica R. Hoag, Michelle C. Salazar, Frank C. Detterbeck, Daniel J. Boffa, Anthony W. Kim, Justin D. Blasberg

Thomas and colleagues performed a retrospective analysis of patient information from the National Surgical Quality Improvement Program database to identify risk factors for postdischarge venous thromboembolism (VTE) following lung resection. Although VTE events occurred in only 1.6% of patients (234 of 14,308), the authors found that 44% of all VTE events occurred after discharge, and older age, obesity, pneumonectomy, and prolonged operative time were all independent predictors of postdischarge VTE. They conclude that prophylactic management of postdischarge VTE, particularly for patients with high risk, should be included in guidelines for postoperative VTE management.

Source: People
Author(s): Julie Mazziotta

When she was four months old, doctors determined that Bryce would need heart surgery as soon as possible. Though she was in the 50th percentile for weight when she was born, Bryce had sunk to below zero.

Her cardiologist brought in Khanh H. Nguyen of Maria Fareri Children’s Hospital who performs a unique form of open-heart surgery, where the incision is made under the armpit, rather than the traditional method of sternotomy. Dr Nguyen started using this different approach 14 years ago.

Source: YouTube
Author(s): Tristan Yan

This is a fabulous video of a miniAVR with a right thoracotomy that is only 3 cm in size and hardly could fit the valve through it!

Professor Yan used a series of specialised instruments, a corknot, and an endoscope to achieve this fantastic result.

Well done.

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

Patient Care

The Doodle Factory, an Egyptian brand that combines art and charity, has launched a new collection to fund heart surgeries for two children.

Premium cigar makers in the US are launching a second bid to convince the US Food and Drug Administration (FDA) to exempt their products from a previous expansion of tobacco regulations.

The cardiac surgery program at the University of Arkansas for Medical Sciences has been suspended while the program recruits a replacement for its lead surgeon, who retired.


Drugs and Devices

The US FDA has approved Andexxa from Portola, an antidote for factor Xa inhibiting blood thinners, and the company expects to launch the drug in June.

The US FDA is seeking permanent injunctions against two stem cell clinics for deviations from good manufacturing practices and for marketing stem cell products to patients without FDA approval. The clinics were said to have been administering stem cells for the experimental treatment of cancers, heart disease, and chronic obstructive pulmonary disease, among other conditions.


Research, Trials, and Funding

Researchers in the US find that women are proportionately represented in clinical trials for hypertension and atrial fibrillation but underrepresented in trials for coronary artery disease and acute coronary syndrome.

Researchers in Sweden published research suggesting that lung cancer surgery outcomes are not affected by the day of the week that the surgery is performed.

An international group of researchers from Italy, the US, and the UK described disparities in lung cancer care between England and the US, finding that fewer patients in England present with early stage lung cancer and fewer English patients with stage I disease undergo surgery.

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Mark Nelson Awori, Nikita P. Mehta, Frederick O. Mitema, Naomi Kebba

Awori and colleagues reviewed 19 published studies on repair of tetralogy of Fallot (TOF), representing 2,500 patients of which 54.8% had a transannular patch (TAP) inserted to relieve right ventricular outflow tract obstruction. The measured pulmonary annulus size, expressed as a z-score, is often used to determine when to insert a TAP, however similar z-scores derived via different methods can represent different annulus sizes and flow rates. Multiple suggested z-score “cut-offs” are quoted in the literature, and the authors wanted to know whether differences in z-score calculation methods were related to these different cut-off values. Surprisingly few studies (26.3%) mention what pulmonary annulus size “cut-off” was used, but the authors conclude that derivation of z-scores from different data sets may contribute to different cut-off values.

Source: Critical Care
Author(s): Jian-Jhong Wang, Nai-Hsin Chi, Tao-Min Huang, Rory Connolly, Liang Wen Chen, Shih-Chieh Jeff Chueh, Wei-Chih Kan, Chih-Cheng Lai, Vin-Cent Wu, Ji-Tseng Fang, Tzong Shinn Chu, Kwan-Dun Wu

The authors have used a number of novel kidney related biomarkers to improve the identification of patients with acute kidney injury (AKI) and its likely progression. This is an important issue in cardiac surgery, as the outcomes after significant kidney injury can be quite devastating. If we can improve on watching creatinine changes, we can then look at interventions which may reduce the incidence or severity of AKI.

Source: The Annals of Thoracic Surgery
Author(s): A. Laurie W. Shroyer, William E. Gioia, Muath Bishawi, Amelia S. Wallace, Brian C. Gulack, Ying Xian, Sean M. O’Brien, Vinod H. Thourani, Thomas V. Bilfinger

Shroyer and colleagues evaluated observed-to-expected outcome ratios for 30-day operative mortality and major morbidity across over 540,000 nonemergent first-time coronary artery bypass graft (CABG) procedures in The Society for Thoracic Surgeons Adult Cardiac Surgery Database. Given the increasing number of US health care system mergers and the decreasing proportion of cardiothoracic surgeons in private practice, the authors sought to determine whether risk-adjusted CABG outcomes varied based on the number of centers at which a surgeon operates. They found that observed-to-expected mortality ratios were better for single-center than for multicenter surgeons (0.97, 95% CI 0.94-1.00, versus 1.06, 95% CI 1.01-1.12), and that ratios for multicenter surgeons were better at their primary hospital (1.01, 95% CI 0.96-1.07) than at their satellite facilities (1.17, 95% CI 1.09-1.27).

Source: Annals of Cardiothoracic Surgery
Author(s): Brooks Udelsman, Douglas J. Mathisen, Harald C. Ott

This systematic review by Udelsman and colleagues assesses the clinical successes and setbacks of the current methods of airway replacement. Twenty-one studies, focusing primarily on the clinical translation of circumferential or near circumferential tracheal substitutes, were included in the final assessment. A total of 41 patients were identified as having received allotransplantation, autologous tissue reconstruction, bioprosthetic reconstruction, or tissue engineered reconstruction between January 2000 and October 2017. The authors conclude that each modality has its unique advantages and disadvantages; however, no clear ideal prosthetic or graft material stands out at present. Further laboratory work is required before tracheal substitutes, particularly tissue engineered conduits, are more widely utilized.