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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Sajjad Raza, MD, Eugene H. Blackstone, MD, Penny L. Houghtaling, MS, Marijan Koprivanac, MD, Kirthi Ravichandren, MD, Hoda Javadikasgari, MD, Faisal G. Bakaeen, MD, Lars G. Svensson, MD, PhD, Joseph F. Sabik III, MD

This CCF retrospective study compared outcomes for diabetic patients undergoing CABG who received either (1) bilateral internal thoracic artery (BITA) grafts or (2) single internal thoracic artery  (SITA) plus radial artery (RA) grafts during CABG.  A total of 1,325 patients over a 17-year period were included in the analysis, with a median follow-up of 7.4 years.  Results:  For propensity-matched patients, in-hospital outcomes and long-term survival were similar in the two groups.

Question:  For diabetic patients, should the choice of BITA vs. SITA + RA be considered equivalent?  Why or why not?

Source: JTCVS
Author(s): Joshua R. Sonett, Mitchell J. Magee,and Lyall Gorenstein,

This is an expert summary of the evidence for thymectomy in nonthymomatous myasthenia gravis, titled Thymectomy and myasthenia gravis: A history of surgical passion and scientific excellence.

It really suggests that this operation is the standard of care for these patients if they are ACh-positive and young and MGFA II or above.

Source: Seminars in Thoracic and Cardiovascular Surgery
Author(s): Brian Mitzman, Waseem Lutfi, Chi-Hsiung Wang, Seth Krantz, John A. Howington, Ki-Wan Kim

The authors compare outcomes of open versus minimally invasive esophagectomy (OE, MIE) from the National Cancer Databased (NCDB) 2010-2012 and use propensity scoring to match patients (977 pairs).  Short term outcomes were equivalent for LOS and mortality, and median survival was similar.  Nodal removal was higher for MIE (16.3 vs 14.5). 

Source: Circulation Research
Author(s): Roberto Bolli

An editorial on what will be soon required from papers sent to the Circulation group ofperiodicals, and probably soon to all reputable biomedical journals. Bolli advances that the internal and external validity of manuscripts has space for improvement!

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

Patient Care

Several private hospitals in Kolkata, India, have applied for licenses to perform heart and lung transplants in a region underserved for transplant of these organs.

A personal trainer from England shared a picture of herself to spread the message that you don’t have to be a smoker to get lung cancer.

Surgeons at Fortis Vasant Kunj in New Delhi, India, removed a pleural tumor weighing over 3 kg from a man’s chest.

 

Drugs and Devices

The US Food and Drug Administration has cleared the Haart 200 aortic annuloplasty device from BioStable Science & Engineering for bicuspid aortic valve repairs.

The Minneapolis Heart Institute Foundation in Minnesota, USA, announced that the first patient has been enrolled in a study to evaluate a clip-based repair for tricuspid regurgitation.

 

Research, Trials, and Funding

Researchers in the United Kingdom show that greater birth weight predicts better outcomes for infants with congenital heart disease.

A biopharmaceutical company, PolyPid Ltd, announced that it has completed enrollment in an early stage trial for an antibiotic drug reservoir product meant to prevent sternal infection after cardiac surgery.

Robotic-assisted transhiatal esophagectomy is found to be safe and effective for select patients with esophageal cancer, in a retrospective study by Allina Health researchers.

Medtronic announced a global randomized clinical trial to compare dual antiplatelet therapy outcomes with two drug-eluting stents following PCI procedures.

Source: www.change.org
Author(s): Caroline Fleming , supported by the Society for Cardiothoracic Surgery in UK and Ireland (The SCTS)

At the  Annual Meeting of the SCTS in Belfast,  Catherine Fowler gave a moving talk about how her father died of a missed aortic dissection.

Catherine’s sister, Caroline has started a petition that will call on the UK parliament to implement a policy to improve diagnosis and raise awareness of aortic dissection in the NHS. If successful, this may help other countries to implement such polices internationally. It is open for anyone worldwide to put their name to this petition if you agree that the diagnosis of aortic dissection in our Hospitals needs improving. 

Click on the link above if you want to give your support to this. 

 

Here is their story : 

In 2015, our father Tim Fleming suddenly became very unwell, presenting all of the classic symptoms of Aortic Dissection; severe and sudden onset of pain in his back, chest and abdomen. Sadly, it appears to us that all of the markers and indicators were missed. The correct diagnosis of an Aortic Dissection was not made when Dad initially presented to A&E. Dad paid the ultimate price with his life.

This petition is an urgent call to parliament for the implementation of a robust policy, diagnostics and awareness for Aortic Dissection within the NHS.

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"Think Aorta" is a campaign to lower the unacceptable high rate of misdiagnosed Aortic Dissections in Accident and Emergency Departments and GP Surgeries across the UK and Ireland.

Aortic dissection is the most common life-threatening disorder affecting the aorta. It occurs when a tear inside of the aorta causes blood to flow between the layers of the wall of the aorta. Early diagnosis and treatment is critical for survival.Aortic Dissection can quickly lead to a painful and frightening death as a result of reduced blood flow to the heart or rupture of the aorta.

A&E medical staff must immediately rule out Aortic Dissection. It is a known fast killer where the death rate increases 1% for each hour that diagnosis and surgical repair are delayed, therefore advanced medical care is needed immediately.

Aortic Dissection IS one of the top deadly three chest pain entities and very often mimics a heart attack. ECG and chest x-rays are routinely used to diagnose heart attack but cannot rule out Aortic Dissection, as both can appear normal in a patient with a life-threatening Aortic Dissection.

A&E health care professionals and medical staff MUST remain suspicious at all times - until aortic dissection is ruled out.

The condition, "Aortic Dissection" is well documented since the early 18th Century.  But AORTIC DISSECTION continues to be misdiagnosed by our A&E medical professionals and GP’s despite well established treatment guidelines but where no medical policy exists.

The rate of misdiagnosed Aortic Dissection is unacceptably high.

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TIME FOR CHANGE

This is an urgent call for the government to implement the following actions across the NHS in the UK and Ireland:

1. POLICY - The introduction of policy and guidelines for timely identification and treatment of Aortic Dissection for emergency services and A&E departments across the NHS.

2. DIAGNOSTICS - The implementation across the NHS of consistent, routine emergency diagnostics for Aortic Dissection – once a heart attack is ruled-out, doctors should routinely check for Aortic Dissection.

3. EDUCATION - Training, awareness and education for our medical professionals to ensure rapid, consistent adoption of the identified best practice.

4. PROCESS - Organisation of emergency cardiac surgical services so that patients with aortic dissection are always treated by surgeons with the appropriate experience.

PLEASE SIGN THIS PETITION TO STOP THE MISDIAGNOSIS OF THIS KILLER

“Think Aorta” Timely detection and treatment of Aortic Dissection will save lives. 

This petition will be delivered to:

  • UK Secretary of State for Health
    Rt Hon. Jeremy Hunt MP
  • Irish Minister for Health
    Mr Simon Harris

 

Source: YouTube
Author(s): Jimmy Kimmel

Jimmy Kimmel's son was born with Tetralogy of Fallot with pulmonary atresia. He had emergency surgery at the Children’s Hospital Los Angeles in the first week of his life, and this video describes the operation and he goes on to thank all the medical staff who helped in the baby's care.  This video has had 11 million hits. Well done, everyone involved in this case.

Source: JAMA Surgery
Author(s): Mitchell G. Goldenberg, James Jung, Teodor P. Grantcharov

Many of the adverse events that occur in hospitals are a result of human error.  The authors describe a system for use in the OR that collects and collates intraoperative data feeds, including patient and OR team physiological parameters, audiovisual content, and environmental factors.  The data are analyzed to assist in proactive assessment of risks, support root cause analyses, facilitate team training, assess efficiency, and help in evaluation of surgical technology.  This technologica approach may reflect our work environment in the future.

Source: JAMA Surgery
Author(s): Jialin Mao, Philip Goodney, Jack Cronenwett, Art Sedrakyan

In this study of low volume surgeons (defined as performing fewer than 1 index operation annually) the authors studied outcomes in New York state for open AAA repair (OAR) and carotid endarterectomy (CEA).   About 50% of surgeons performing these operations were low volume surgeons.  Low volume surgeons had higher rates of operative mortality for OAR (OR 2.09; 95% CI 1.41 - 3.08) and of postoperative MI (OR 1.83; 1.03 - 3.26) and stroke (OR 1.78; 1.21 - 2.62) for CEA.  Health care resource utilization was higher for low volume surgeons for OAR and CEA.

Source: JAMA Surgery
Author(s): Jason C. Pradarelli, Joseph P. Thornton, Justin B. Dimick

This editorial outlines the changing legal landscape for device manufacturers.  The authors discuss a recent legal judgment against Intuitive (da Vinci robot) that found the company failed to notify a hospital regarding a new robot user, indicating that Intuitive held responsibility for ensuring safe implementation of their systems in clinical settings.

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