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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Sukhdeep S. Basra, Ambarish Gopal, Katie R. Hebeler, Heike Baumgarten, Audrey Anderson, Srinivasa P. Potluri, William T. Brinkman, Molly Szerlip, Deepika Gopal, Giovanni Filardo, J. Michael DiMaio, David L. Brown, Paul A. Grayburn, Michael J. Mack, Elizabeth M. Holper

Basra and colleagues report that among patients with bioprosthetic aortic valves who had clinical or echocardiographic indications suggestive of leaflet thrombosis, one-third of patients had this diagnosis confirmed by four-dimensional computed tomography (4DCT). The use of 4DCT avoided unnecessary anticoagulation in the remaining two-thirds of patients. The median time from valve replacement to 4DCT was 9.6 months in transcatheter patients and 3.7 years in surgical patients, due to active surveillance in patients who had received a transcatheter valve.

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

Patient Care and General Interest

A patient who had been admitted to the intensive care unit for chronic heart failure coughed up a cast of his right bronchial tree made of coagulated blood.

A Kaiser Health News article discusses the challenges patients can face to cover the cost of organ transplant in the US and the importance for transplant centers to ensure that patients can afford the treatment, which has a much greater need than availability.

The American Medical Association highlights approaches from different institutions around the US that are geared toward creating a healthier work environment for physicians.

Amazon has developed software that it says can pull information from digitized patient records and clinical notes.

 

Drugs and Devices

The National Institute for Health and Care Excellence recommended that percutaneous repair of the mitral valve with a leaflet clip be more widely available across the National Health System in England.

 

Research, Trials, and Funding

Researchers from Germany report the transplantation of pig hearts into baboons, with two of the baboons surviving for six months.

Source: The Annals of Thoracic Surgery
Author(s): A. Claire Watkins, Nathan L. Maassel, Mehrdad Ghoreishi, Murtaza Y. Dawood, Si M. Pham, Zachary N. Kon, Bradley S. Taylor, Bartley P. Griffith, James S. Gammie

Watkins and colleagues report their use of preoperative extracorporeal membrane oxygenation (ECMO) to evaluate and stabilize structural heart patients who were at extreme surgical risk. Twelve patients undergoing surgery for severe prosthetic mitral stenosis, ruptured papillary muscle, ischemic ventricular septal defect, or severe aortic stenosis were included. ECMO-associated complications included leg ischemia, wound infection, and major bleeding. Preoperative ECMO support improved the predicted operative mortality risk, and survival was 82% after one year.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Gilles D. Dreyfus, Filip Dulguerov, Cecilia Marcacci, Shelley Rahman Haley, Antonia Gkouma, Carine Dommerc, Adelin Albert

Gilles Dreyfus and colleagues share a decade of mitral reconstruction for degenerative posterior leaflet pathology in Harefield and Monaco (38 per year was the formidable average). The supplementary video is of particular educational value for the mitral surgeon and the cardiologist/TOE (TEE) specialist.

Source: Journal of Cardiac Surgery
Author(s): Garrett N. Coyan, Edgar Aranda‐Michel, Ibrahim Sultan, Thomas G. Gleason, Forozan Navid, Danny Chu, Michael S. Sharbaugh, Arman Kilic

Coyan and colleagues report outcomes following double valve surgery in a cohort of patients who underwent operation between 2011 and 2017. Mitral repair was associated with better perioperative outcomes than mitral replacement when performed concomitantly with aortic valve replacement, though the authors note that differences in underlying comorbidities between the groups could have contributed to this result. Longer term outcomes were comparable between mitral repair and replacement.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Martin Czerny, Jürg Schmidli, Sabine Adler, Jos C van den Berg, Luca Bertoglio, Thierry Carrel, Roberto Chiesa, Rachel E Clough, Balthasar Eberle, Christian Etz, Martin Grabenwöger, Stephan Haulon, Heinz Jakob, Fabian A Kari, Carlos A Mestres, Davide Pacini, Timothy Resch, Bartosz Rylski, Florian Schoenhoff, Malakh Shrestha, Hendrik von Tengg-Kobligk, Konstantinos Tsagakis, Thomas R Wyss, EACTS/ESVS scientific document group

Essential reading, paying particular attention to the table in Section 7: the European experts recommend, again, that in Marfan and other systematic connective tissue diseases conventional techniques are still advantageous because the landing zones will eventually degenerate.

Jointly published in the European Journal of Vascular and Endovascular Surgery at: https://doi.org/10.1016/j.ejvs.2018.09.016

Source: European Journal of Cardio-Thoracic Surgery
Author(s): In Kyu Park, Kwanyong Hyun, Eung Re Kim, Samina Park, Chang Hyun Kang, Young Tae Kim

Park and colleagues genotyped cancer tissue for epidermal growth factor receptor (EGFR) mutations in patients with complete resection for lung adenocarcinoma who had a recurrence. Lung adenocarcinoma with EGFR gene mutations was associated with a longer disease-free interval than was the wild-type EGFR gene. Additionally, EGFR gene mutation was a prognostic factor for disease-free interval.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Daniel JFM Thuijs, Stuart J Head, Gregg W Stone, John D Puskas, David P Taggart, Patrick W Serruys, Ovidiu Dressler, Aaron Crowley, W Morris Brown III, Ferenc Horkay, Piet W Boonstra, Gabor Bogáts, Nicolas Noiseux, Joseph F Sabik III, A Pieter Kappetein

The EXCEL is one of several prospective studies that examine the use of single versus bilateral internal thoracic artery (ITA) grafts for myocardial revascularization (in this case, compared with percutaneous coronary intervention) for left main disease. This did not show differences in the surgical population (905 patients) between one and two ITA grafts with regard to mortality and DSWI. There are significant limitations in the patient allocation process that make the value of these outcomes less than helpful.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Mario Gaudino, Stephen Fremes, Philippe Kohl

Once again, analyses of studies that are ostensibly well-designed randomized controlled trials have limitations that do not answer the question at hand: are two-arterial CABGs better than one? This editorial comments on a publication regarding the EXCEL Study, which showed no differences at 3 years.

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

Patient Care and General Interest

Surgeons at the Cleveland Clinic Abu Dhabi in the UAE used a metal stent for an emergency repair of a patient’s windpipe, which had been completely severed in a traffic accident.

A report from the UK Lung Cancer Coalition says that geographic variation persists despite improvements in 5-year survival rates for lung cancer in the UK.

 

Drugs and Devices

Medtronic has received the CE Mark for its Valiant Navion™ thoracic stent graft system, a low-profile thoracic stent for patients with small iliac arteries and other anatomic variations.

 

Research, Trials, and Funding

Physicians in Ontario, Canada, evaluate in-hospital counseling and surgery for injection drug users with endocarditis, finding that both reduce mortality in these patients.

Researchers at Stanford University in California are matching donor and pediatric recipient heart volumes using CT scans, rather than relying on height and weight to determine if a child could accept a particular donor heart.

At the recent meeting of the American Heart Association, researchers from Germany reported similar rates of major adverse cardiovascular events and major bleeding for patients taking either ticagrelor or aspirin after coronary artery bypass.

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