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Journal and News Scan
A well-written, brief, pessimistic editorial on the loss of surgeon autonomy in innovation.
This great video documents the beginning of the first successful robotic mitral surgery program in the UK, by Paul Modi and proctored by Doug Murphy.
They use the LEAR technique–Lateral Endoscopic Approach for Robotics–which is a totally port-based approach to intracardiac robotic surgery. I am sure we will see many more videos from this group in the near future.
An interesting article describing the interface between medical 3D printing and art. It briefly outlines current and future applications, and it also describes constraints to the use of this technology.
An FDA advisory committee voted 6-4 against expanding approved indications for liposomal bupivicaine for regional pain control after surgery. This drug is a central element in many institutions' Enhanced Recovery After Surgery programs. They cited inconsistent results, failure to provide comparative results, and increased deaths associated with the drug. The official FDA will use this assessment as part of their deliberations.
A balanced comment on the occasion of the latest retrospective nonrandomised Coselli report on redo thoracoabdominal aortic aneurysms (TAAAs).
Raanani mentions the inappropriateness of endovascular techniques for Marfan syndrome patients, on account of high rate of endoleak probably related to the diffuse aortopathy. He also picks up the schism of early and late morbidity, and analyzes the confounders well.
It might be important that such as strong and vocal advocate of open aortic surgery as Joseph Coselli reports inferior nonrandomized long-term mortality of his favored traditional approach. This may impact positively on insurance and reimbursement for hybrid TAAA repairs.
A professional US football player who had a congenital coronary artery anomaly corrected as a teenager meets with kids currently undergoing treatment for congenital heart disease, seeking to provide them with hope and inspiration.
Drugs and Devices
The self-expanding CENTERA transcatheter aortic valve from Edwards Lifesciences has received the CE Mark.
The Lotus heart valve will not relaunch in the US or European markets until 2019, says Boston Scientific.
The US Food and Drug Administration expanded premarket approval for several Abiomed Impella heart pumps to include heart failure associated with cardiomyopathy leading to cardiogenic shock.
Research, Trials, and Funding
Researchers in Australia recently published a meta-analysis suggesting that regular exercise ahead of lung cancer surgery can reduce complication rates.
Children’s Hospital Los Angeles has joined the HLHS Consortium, a Phase I study of innovative therapies for hypoplastic left heart syndrome that was launched at the Mayo Clinic in Minnesota during 2017.
Researchers in the UK published a retrospective analysis in the BMJ that questions whether older adults with both atrial fibrillation and chronic kidney disease should be given anticoagulation medication.
This report provides long-term outcome data on the Perimount valve implanted in the mitral position in patients 65 years of age or less. The expected valve durability was 14.2 years, which compares favourably with other prosthetic valves. Long term mortality was considered valve-related in 1.3% per valve-years, with an overall mortality of 4% per valve-years. The authors provide useful predictions of valve degeneration rates and need for reoperative surgery.
This represent a large series of patients with HOCM who were treated surgically. The study provides prognostic data based on the morphology of the HOCM, which was divided into basal septum, whole of septum, and diffuse left ventricular hypertrophy. Each group had differing survival.
Wang and colleagues present a systematic review of outcomes reported in 26 articles for 67 patients who underwent endovascular treatment for diseases of the ascending aorta, excluding type A dissection. The authors expect a gain in popularity of this intervention in select high-risk patients, but they consider further analysis necessary.
Interesting article commenting on the perception that some remedies in medicine are so obviously beneficial that testing their effectiveness is a waste of time. As it turns out, many of what physicians think are "slam dunk" remedies have mixed or negative results.