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Journal and News Scan
Pulmonary hypertension is considered a contraindication for lung volume reduction surgery. Caviezel and colleagues evaluated outcomes of lung volume reduction performed in 30 patients with emphysema, 10 of whom had mild-to-moderate pulmonary hypertension. At the authors’ center, pulmonary hypertension was a contraindication for patients with homogeneous, but not heterogeneous, emphysema. There was no 90-day mortality, and the postoperative course did not differ between patients with and without pulmonary hypertension. The authors conclude that mild-to-moderate pulmonary hypertension might not be a contraindication for lung volume reduction surgery and encourage further confirmation in other studies.
Despite the benefit for most patients, some patients have poor outcome after transcatheter aortic valve implantation (TAVI). Currently it is hard to predict which patient is predisposed to poor outcome at one year. This paper investigates the performance of a previously developed prediction model of poor outcome after TAVI.
Arnold and colleagues previously built a prediction model of poor outcome using data from high-risk TAVI trials. The model included the preoperative Kansas City Cardiomyopathy Questionnaire (KCCQ), mean aortic valve gradient, usage of home oxygen, creatinine level, atrium fibrillation, and atrial fibrillation. Poor outcome was defined as death, poor quality of life (KCCQ-OS <60), or moderate worsening in quality of life (decrease of >10 points in KCCQ-OS) at one year. In the current paper they set out to validate the model in lower-risk real-world dataset of >13000 TAVI patients from the TVT registry. The model was validated based on discrimination and calibration, and was recalibrated for this real-world population.
Poor outcome decreased from 42.0% in 2012 to 37.8% in 2015. Initially, the model performed poorly with moderate discrimination but poor calibration. After recalibration, the model performed well with a C index of 0.65, but excellent calibration.
The recalibrated model can be used to identify patients who are less likely to benefit from TAVI and to help patients prepare for the recovery phase after the procedure.
Unfortunately, risk models are inherently imperfect, as was shown by the only moderate discrimination. This means it cannot be used to accurately predict who will or will not have a poor outcome. Rather, it helps to estimate the chances of good recovery. This information will be useful for patients in order to prepare for the recovery and have realistic expectations.
The authors of this paper investigated the efficacy and safety of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in 15 patients with hypertophic cardiomyopathy (HOCM). At six months, they found significant reductions in peak left ventricular outflow tract gradients and intraventricular septal thickness. This also led to functional improvement, measured in NYHA class and total exercise time. These results show that PIMSRA could potentially offer a less invasive alternative for surgical myectomy.
Patient Care and General Interest
A family in Atlanta, Georgia, USA, whose 13-month-old daughter was born with pulmonic stenosis, has adopted a dog with the same congenital heart defect.
Drugs and Devices
A team of researchers from the University of California, San Diego has developed a non-invasive wearable ultrasound patch that could potentially monitor patients with heart or lung diseases, and help detect cardiovascular problems at an earlier stage.
Research, Trials, and Funding
The GALILEO trial has been halted due to concerns over rivaroxaban causing higher rates of death or thromboembolic events following transcatheter aortic valve replacement.
The Magee-Womens Research Institute in Pittsburgh, Pennsylvania, USA, has awarded the $1 million Magee Prize to an international team of scientists studying the potential connection between defects in the placenta during gestation and congenital heart defects.
A study conducted at the Karolinska Institute in Sweden suggests that atrial fibrillation may speed up dementia in older adults.
A long-term follow-up study in Australia of patients who underwent CABG surgery with radial artery grafts instead of saphenous vein grafts indicates that they did not experience impaired forearm blood flow.
This analysis of the National Cancer Database included over 2000 eligible patients resected with N2 disease who did not receive induction therapy. The addition of radiotherapy to postoperative chemotherapy did not affect survival in either the unmatched or the matched groups.
This institutional series from Leipzig Heart Centre presents results from 15 years of bilateral internal thoracic artery usage in off-pump CABG (OPCABG). Survival analysis as well as detailed postoperative outcomes are presented to demonstrate that OPCABG with bilateral internal thoracic artery grafting is a safe operation with low mortality and morbidity.
A brief viewpoint article (by the savior of baby Esperanza) from a widely read non-surgical journal on the debate on ECMO/EOLIA. I assume 'thoracotomy' implies 'sternotomy' as the standard surgical approach for ECMO cannulation in adults and larger children.
The surgical reader will of course realize that this paper is focusing on non-arterial ECMO ( V-V), although the distinction between VV and V-A is not discussed explicitly by Dr. Bartlett on this occasion.
This is a damning article about profiteering in academic publishing at the expense of researchers, institutions, and other interested parties.
Patients undergoing tracheobronchoplasty for diffuse tracheobronchial malacia were retrospectively stratified as severely frail or other based on a cumulative deficits model score. Severe frailty was associated with an increased risk of respiratory failure (OR 13.1), pneumonia (OR 20.1), and overall respiratory complications (OR 17.4).
There are several different strategies for arterial cannulation in patients with acute aortic dissection type A. Kitamura and colleagues compared results of direct true-lumen cannulation (Samurai cannulation) with other cannulation options. The retrospective review includes 100 patients undergoing surgery for acute type A aortic dissection, 61 of whom underwent Samurai cannulation. Samurai and other cannulation site patients had in-hospital mortality rates of 5% and 7%, respectively. Seven percent of Samurai cannulation patients and 10% of other cannulation site patients experienced disabling stroke. There was no difference between the groups regarding survival and freedom from aorta-related death at follow-up. The authors conclude that Samurai cannulation is a safe and reasonable option in patients with type A dissection.