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Journal and News Scan
Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) was recently approved by the FDA for intermediate risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR). However, many answers need to be addressed before adoption in lower risk patients. This paper highlights the pros and cons of TAVI based mostly on randomized clinical trials involving the two device platforms approved in the United States. We focused our analysis on metrics that will play a key role in expanding TAVR indication in healthier individuals. We review the significance and gave a perspective on paravalvular leak (PVL), valve performance, valve durability, leaflet thrombosis, stroke and pacemaker requirement.
Helminen and colleagues employ near-infrared imaging as a novel technique for lymphatic mapping in minimally invasive esophagectomy of distal esophageal cancer. Indocyanine green dye was injected endoscopically and used to identify nodal stations outside of the en bloc resection area.
The “I Love Life” campaign to raise awareness of heart failure in Egypt launched this week.
Pollution was determined to contribute to over 9 million deaths worldwide in 2015, with over 70% of these being heart-related and lung-related deaths linked to air pollution.
Surgical teams from Komfo Anokye Teaching Hospital in Kumasi, Ghana, and Boston Children’s Hospital in the US collaborated to provide congenital heart surgery free of charge for 140 Ghanaian children.
Drugs and Devices
Alectinib (Alecensatm, Roche) was recommended by the European Medicine Agency CHMP as a first-line treatment for ALK-positive non-small cell lung cancer.
The Phase 3 JUNIPER trial evaluating abemaciclib (Verzeniotm, Eli Lilly) as monotherapy for KRAS-mutated non-small cell lung cancer did not meet the primary endpoint of overall survival, but secondary endpoints suggested efficacy.
Research, Trials, and Funding
A review published in JAMA: Internal Medicine highlights what the authors determined to be the 10 most notable studies examining medical overuse published in 2016.
Heart surgery might provide useful benefits to patients with trisomy 13 and trisomy 18.
Physicians are sometimes at risk related to services they provide for patients. This study describes the effects of low dose radiation in the cath lab on the brains of interventional cardiologists. This is something for CT surgeons to be aware of as they become more involved in catheter-based techniques.
The authors review cybersecurity issues related to newer generations of pacemakers. Telemetric capabilities providing patient data to health care workers can be co-opted, enabling malicious software to endanger patients. Risks include intentional battery depletion and malicious reprogramming.
This study evaluates 1028 octogenarians who underwent isolated aortic valve replacement (AVR, 306 TAVR and 722 SAVR) between 2002 and 2015 at Brigham and Women’s Hospital in the US. The mean age of patients was 84.4 ± 3.4 years old, with overall STS-PROM score of 5.96 ± 3.87. After adjusting for confounders, both of these elderly cohorts had similar operative mortality and short-term outcomes. No difference in mid-term survival was seen when comparing transfemoral TAVR, transsubclavian or transaortic TAVR, minimally invasive AVR, and sternotomy AVR. The authors suggest that these results indicate a continued role for SAVR in treating aortic stenosis in this patient population.
The authors report the non-intuitive finding that blood from female donors who had ever been pregnant was associated with increased mortality among male recipients (HR 1.13). If validated by other studies, might this substantially complicate matching donated blood with appropriate recipients? Clearly the underlying mechanism will be interesting to sort out.
The author decries what he sees as the corporatization of airline pilots, with their accompanying loss of autonomy and prestige. He speculates on whether a similar future is ahead for physicians, but does not provide specific suggestions on how to avoid this from occurring.
In this JAMA Forum article, Harvard's Ashish Jha discusses the pros and cons of public reporting of individual surgeon's outcomes. He uses the New York state cardiac surgery registry as an example and argues why, despite its problems, it is still the way forward. What are your thoughts!?
Hobbes and colleagues retrospectively evaluated systemic-to-pulmonary shunt procedures for 173 patients over a 10-year period at a single institution. Despite their importance for many patients with single ventricle or complex biventricular lesions, shunt procedures carry a high risk of morbidity and mortality. The authors found the main predictors of morbid events in their cohort were patient characteristics such as extracardiac or genetic anomalies and needing preoperative ventilation, but not age, weight, or shunt size to weight ratio. Additionally, oxygen saturation on ICU admission and amount of platelets transfused each predicted early shunt thrombosis.