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Journal and News Scan
Failing Fontan circulation poses risk factors for cardiac transplantation that are distinct from patients needing transplantation for other congenital heart diseases. In this review, Kirklin and colleagues discuss the circulatory, lymphatic, and hepatic vulnerabilities associated with Fontan circulation that make early referral for heart transplant important for these patients. The authors also review the surgical challenges of transplantation after a Fontan operation, and they present approaches that are key to improved patient outcomes.
I particularly enjoyed Table 1 of this succinct mini manual on ' robotic' assisted oncologic pulmonary resections (‘robotic’ is a catchy cross-speciality misnomer particularly adored by popular media; probably too late to ostracise the term, yet it leaves the computer-assisted surgeons open to malpractice claims!).
I admit I would be uncomfortable NOT to re-insufflate the ipsilateral lung after clamping and before dividing a submain bronchus, although I have come across colleagues who eschew this step.
In this large propensity-matched study, outcomes after Transcatheter versus Surgical Aortic Valve Replacement (TAVR vs. SAVR) were assessed in a real world intermediate- and high-risk cohort of 9500 patients in the United States. There was no difference in 1-year mortality (17.3% vs. 17.9%; HR 0.93, 95% confidence interval [CI] 0.83-1.04) and stroke (4.2% vs.3.3% HR 1.18; 95% CI 0.95-1.47). Results were consistent among subgroups of patients. Importantly, there were no differences in effect across the male/female subgroups. This shows that not gender in itself, but rather gender-related comorbidities play a role in a better outcome of TAVR in female patients. This important study shows data from daily practice and further confirms the results of randomized controlled trials.
In this study, the Dabigatran reversal-drug Idarucizumab was tested. 503 patients were enrolled, of whom 202 had to undergo an urgent procedure. Of the patients requiring an urgent procedure, the median time of initiation of the procedure was 1.6 hours, and at that time periprocedural hemostasis was assessed as normal in 93.4% of the patients. At 90 days, thrombotic events had occurred in 7.4% of the patients requiring an urgent procedure and the mortality rate was 18.9%. The results of this study show that Idarucizumab is a rapid and effective reversal drug for the effects of Dabigatran in case of the need for urgent surgery. As Dabigatran is increasingly being used in patients with atrial fibrillation, the availability of Idarucizumab is important.
In this editorial, the authors review the current risks associated with aortic valve replacement in younger patients, with an emphasis on anticoagulation options and future perspectives.
A father administered CPR to his infant son in the car ride to the hospital in Mumbai, India, for complications related to a tumor in the child’s heart. He had learned CPR several months earlier in a training course at work.
Kaiser Health News discusses the practice of a surgeon “running two rooms,” focusing on patient thoughts and questioning whether such multitasking is efficient.
Families at St Louis Children’s Hospital in Missouri, USA, can receive Snapchat-like updates from the teams performing their child’s surgery.
According to the UK’s National Health Service, more than 50,000 people in the UK are alive today because of an organ transplant.
Mount St John’s Medical Centre in Antigua & Barbuda performs its first pacemaker implantation.
Drugs and Devices
Data from the SURTAVI trial has lead the US Food and Drug Administration to approve a Medtronic TAVR/TAVI platform for use in intermediate-risk patients.
Research, Trials, and Funding
Researchers at Loyola Medicine in Chicago, USA, are enrolling patients in a major study of Hermansky-Pudlak syndrome, a rare, hereditary lung disease that affects a disproportionately large number of Puerto Ricans.
Accra, Ghana, hosted the 20thAfrica Union Conference on Lung Health this week, which focused on tuberculosis, tobacco use, and non-communicable diseases.
Running might be good for your heart, but perhaps running a marathon isn’t ideal.
Preoperative Inspiratory Muscle Training (IMT) with the Powerbreathe device was assessed with regard to whether A-a gradients and inspiratory muscle power would be improved after CABG. A group of 40 male patients were randomized to receiving (20) or not receiving (20) preop IMT. Postoperatively, the group receiving IMT had significantly better lung function (inspiratory muscle power, A-a gradient, oxygen saturation) .
Video assisted thoracoscopic surgery (VATS) lobectomies have been instrumental in the evolution of thoracic surgical oncology since its introduction in the early 90s. Although there is no robust data to confirm or refute its superiority over open conventional lobectomy, there have been a number of meta-analyses which have shown that VATS is safe and feasible for those undergoing radical resection for cancer. Over the years, VATS lobectomy has continued to evolve with newer techniques, less ports and better instruments. There is now an interest in performing uniportal VATS lobectomy and this is now moving to one without a need for incision in the intercostal space. Microlobectomy, originally envisaged by a group of surgeons from 6 different centres and involves using subcentimeter incisions alongside a subxiphoid utility port. Some of the technical disadvantages of VATS are that the images are 2-dimensional (2D), there is limited depth perception; and manoeuvring rigid instruments within the limited confines of the chest can make dissection difficult. The advent of robotic lobectomy has addressed some of these problems. The 3D vision is unparalleled, the endowrist seamLessly mimic human hand movements and the instrument movement within the chest is fluid. However, the high capital costs may deter smaller centres from introducing this service, especially when working within a limited budget in the public hospital. This can be circumvented by ensuring that the robot is used in a multi-specialty setting and concentrated in a few high volume tertiary centres.
Minimally invasive mitral valve surgery provides outcomes that match those of conventional sternotomy without increasing use of resources, and lower costs after surgery offset potentially higher operation costs, according to a single-center, propensity-matched analysis of almost 500 patients presented at the meeting sponsored by the American Association for Thoracic Surgery.
In a risky and delicate procedure performed for the first time in Israel this week, an interdisciplinary team of Hadassah Medical Center physicians fixed a severe heart defect in a 28-week-old fetus in the womb.