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Journal and News Scan
Three-time Formula 1 world champion Niki Lauda has died at the age of 70. Lauda, who underwent a lung transplant in August and had previously had 2 renal transplants, "passed away peacefully" on Monday, his family said. He was only days away from death 9 months ago when he underwent life saving lung transplant surgery.9 months ago Marco Idzko, head of AHK Vienna hospital's division of pulmonology, explained: "Mr Lauda suffered from a so-called haemorrhagic alveolitis. This is an inflammation of the alveoli [air sacs inside the lungs], which has been accompanied by bleeding into the pulmonary tissue and respiratory tract."
After he was taken ill, Lauda received immunosuppressive therapy, which led to "a significant improvement in the respiratory situation", but the 69-year-old was then affected by acute lung disease.
"This ultimately leads to the destruction and loss of functional lung tissue - and the patient is no longer able to absorb enough oxygen through his lungs," said Idzko, who added such a scenario carries a high mortality rate.
With further drug therapy options limited, Lauda had to be given mechanical ventilation in the intensive care unit.
"Unfortunately, after 10 days in intensive care, because of a critical oxygen supply, therapy escalated," says cardiologist Gottfried Heinz.
"We had to perform a mechanical lung replacement, an ECMO - an extracorporeal membrane oxygenation."
At this point, they said Lauda had a life expectancy of only a few days, which resulted in him being listed for a transplant and assigned a high LAS (Lung Allocation Score) that measures the urgency rating according to objective criteria.
"We could assume that he would be assigned a suitable organ within the next few days," said thoracic surgeon Konrad Hotzenecker, who performed the transplant last Thursday with Walter Klepetko and his team.
"The average waiting time in this case is five days."
Lauda was fitted with a new donor lung that his physicians say has settled well into his body.
"The lung has an excellent primary function, so that we were able to remove the circulatory support, the ECMO, in the operating theatre," explained Hotzenecker.
"The graft lung has taken over its function well."
Cardiology director Christian Hengstenberg added:"We can state that the patient survived it excellently and could already be extubated after 24 hours. That means, the tube in the lung could be removed and the patient could breathe spontaneously.
"This is extremely important for us and for the entire healing process as well. We can see that he is fully conscious and that all the institutions are functioning properly.
The authors utilized a retrospective review of the UNOS database from 2007-2014 to evaluate the impact of donor sequence number (DSN) on outcomes. Specifically, they interestingly identified that survival is the same across various DSNs, indicating a potential ability to increase transplant numbers based on similar survival when utilizing donors of higher DSN.
Rates of unforeseen N2 disease were similar between nodal staging by EBUS and mediastinoscopy, but mediastinoscopy had a complication rate of 6%.
Excellent review of recent advances that will shape therapy in the next 5 years.
Discussion and critique editorials accompany this report on extensive emergency surgical treatment of aortic dissection, fueling an important debate.
Vaughn A. Starnes, MD, became the 100th President of the American Association for Thoracic Surgery (AATS). He officially succeeded David H. Adams, MD, in a ceremony at the AATS 99th Annual Meeting in Toronto. Joining him in new positions on the Executive Committee are Marc R. Moon, MD, who is now President-Elect after serving as Vice President for the past year and Secretary for five years, Shaf Keshavjee, MD, who was elected as the new AATS Vice President and who served as Treasurer for five years, and Emile A. Bacha, MD, who became Treasurer following three years as Director. David R. Jones, MD, was reappointed to serve as Secretary.
In this surgical video, Durand presents a four-arm robotic sleeve right upper lobectomy and node harvest. The patient was a 60-year old man who had been diagnosed with a proximal right upper lobe squamous cell carcinoma after exploration for hemoptysis. Additionally, the author highlights the differences between the technique shown in this video and other recently published techniques.
Patient Care and General Interest
The British Heart Foundation reports that the number of premature deaths related to cardiovascular disease has risen in the UK for the first time in 50 years.
A federal judge in the US ruled against the Food and Drug Administration’s (FDA) 2017 decision to allow e-cigarettes to remain on the commercial market prior to obtaining FDA approval, a move that was applauded by the associations that brought the suit.
Drugs and Devices
The US FDA has expanded the approved duration of support for 2 Impella heart pumps from 6 to 14 days.
Xvivo Perfusion, Inc, was granted premarket approval by the US FDA for its ex vivo lung perfusion system, a move that expands the device’s previous humanitarian device exemption authorization.
The US FDA has approved dalteparin sodium for treating venous thromboembolism in children as young as 1 month old.
Research, Trials, and Funding
The antiplatelet agent ticagrelor showed antibacterial activity against Staphylococcus and Enterococcus strains that was not seen with other antiplatelet agents, say researchers from Liege, Belgium.
Researchers in China compared the levels of circulating tumor cells after either a vein-first or artery-first approach to lobectomy for lung cancer.
An iron boost on the day before cardiac surgery reduced the need for blood transfusion in patients with anemia or iron deficiency, say researchers from Zurich, Switzerland.
Researchers in Durham, North Carolina, USA, grew human acellular vessels that were implanted in dialysis patients, and they speculate about potential future applications for these vessels, such as use during heart surgery.
Zhang and colleagues retrospectively compared outcomes for 27 patients who underwent lung transplantation either with or without ex vivo lung perfusion at their center. The ex vivo lung perfusion group consisted of recipients who received initially-discarded donor lungs that were reconditioned using ex vivo perfusion. Similar outcomes were observed between the two groups, including primary graft dysfunction, pulmonary function, chronic lung allograft dysfunction, and survival.
I believe that this is the world's first randomized controlled trial of mini aortic valve replacement (AVR) versus full sternotomy AVR.
It is a very well-conducted study where the surgeon was randomly assigned to perform an AVR by sterntomy or by manubrium-only. The same consultant surgeon performed either operation after randomization. No trainee performed any operations as operating surgeon. The protocol was very tightly adhered to.
The primary outcome was red cell transfusion at 7 days, and there were many secondary outcomes including length of stay, complications, etc, as might be expected.
The mean age was 69 and the mean EuroSCORE was 5.2 and the groups were perfectly matched.
The bypass time was 82 minutes in the ministernotomy group and 59 minutes in the sternotomy group.
The major outcome results might surprise you! Click on the link to find out!