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Journal and News Scan

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Valerie Lacroix, Zahra Mosala Nezhad, David Kahn, Arnaud Steyaert, Alain Poncelet, Thierry Pieters, Philippe Noirhomme

Lacroix and colleagues evaluated pulmonary function, pain, and quality of life in patients who underwent robotic thoracic surgery, predominantly for non-small cell lung cancer. The authors observed no difference between preoperative and 7-month postoperative pulmonary function. Although the majority of patients reported some level of pain at the surgical site, pain was not neuropathic-like and only weakly interfered with daily activities.

Source: European Heart Journal
Author(s): Matthias Thielmann, Vikram Sharma, Nawwar Al-Attar, Heerajnarain Bulluck, Gianluigi Bisleri, Jeroen JH Bunge, Martin Czerny, Péter Ferdinandy, Ulrich H. Frey, Gerd Heusch, Johannes Holfeld, Petra Kleinbongard, Gudrun Kunst, Irene Lang, Salvatore Lentini, Rosalinda Madonna, Patrick Meybohm, Claudio Muneretto, Jean-Francois Obadia, Cinzia Perrino, Fabrice Prunier, Joost P.G. Sluijter, Linda W. Van Laake, Miguel Sousa-Uva, Derek J. Hausenloy

This collaborative position paper recommendations are provided on the management of peri-operative myocardial infarction in patients undergoing CABG. 

These recommendations are based on thorough literature review and are illustrated in a practical flowchart.

Source: European Heart Journal
Author(s): John B. Chambers, Bernard Prendergast, Bernard Lung, Raphael Rosenhek, Jose Luis Zamorano, Luc A. Piérard, Thomas Modine, Volkmar Falk, Arie Pieter Kappetein, Phillipe Pibarot, Thoralf Sundt, Helmut Baumgartner, Jeroen. J Bax, Patrizio Lancellotti

This review paper, written by the ESC working group on valvular heart disease, defines what consitutes a good Heart Valve Centre. All relevant topics including multidisciplenary heart teams, data collection and review, training and future directions are discussed from an organizational point of view. 

Source: Lung Cancer
Author(s): Kapetanakis EI, Sidiropoulou T, Machairas A, Tomos P

A Letter to the Editor of Lung Cancer that was kindly brought to our attention while still 'in press.' Our readership may find in it 'food  for thought' on all matters of healthcare policies and economics, especially on maintaining morale ('reshaping prevailing nihilistic attitudes') and efficient resupply and recycling of semi-disposable surgical devices in time of austerity. Economizing  always sets a desirable paradigm for cardiothoracic surgeons and their managers worldwide!

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

Patient Care

Public outcomes reporting on individual cardiac surgeons in California, USA, sparks debate on what such statistics mean and how they might influence the willingness of a surgeon to help the sickest patients.

Can around-the-clock care from an experienced intensivist reduce complication risk in the cardiac ICU?

Visualizing the surgery with 3D technology helps surgeons separate conjoined sisters who shared a heart.

An ophthalmology surgeon talks about responding to intraoperative complications on the JAMA Network Blog.

A US woman with Marfan syndrome suffered an aortic dissection late in her pregnancy, and four medical teams worked together to deliver a healthy mom and baby.

An external minister of affairs in India helps a Pakistani infant receive heart surgery at Jaypee Hospital in Noida, India.


Drugs and Devices

Philips Electronics is expanding its profile in cardiac ultrasound by acquiring TomTec Imaging Systems, which is headquartered in Germany.

The availability of ClearFlow’s “shorter effective drainage length” PleuraFlow for pediatric patients will expand to all cardiac surgery centers, after a limited release in Germany, Switzerland, the UK, and the US was successful.


Research Trials and Funding

Researchers at Mount Sinai in New York have been studying gene therapy for pulmonary hypertension, and Mount Sinai is partnering with Theragene Pharmaceuticals to work toward clinical trials.

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): James K. Kirklin, F. Bennett Pearce, Robert J. Dabal, Waldemar F. Carlo Jr, and David C. Mauchley

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.

Source: The Journal of Visualized Surgery
Author(s): Omar I. Ramadan, Robert J. Cerfolio, Benjamin Wei

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.

Source: Journal of the American College of Cardiology
Author(s): J. Matthew Brennan, Laine Thomas, David J. Cohen, David Shahian, Alice Wang, Michael J. Mack, David R. Holmes, Fred H. Edwards, Naftali Z. Frankel, Suzanne J. Baron, John Carroll, Vinod Thourani, E. Murat Tuzcu, Suzanne V. Arnold, Roberta Cohn, Todd Maser, Brenda Schawe, Susan Strong, Allen Stickfort, Elizabeth Patrick-Lake, Felicia L. Graham, Dadi Dai, Fan Li, Roland A. Matsouaka, Sean O’Brien, Fan Li, Michael J. Pencina, Eric D. Peterson

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. 

Source: New England Journal of Medicine
Author(s): Charles V. Pollack, Jr., Paul A. Reilly, Joanne van Ryn, John W. Eikelboom, Stephan Glund, Richard A. Bernstein, Robert Dubiel, Menno V. Huisman, Elaine M. Hylek, Chak-Wah Kam, Pieter W. Kamphuisen, Jörg Kreuzer, Jerrold H. Levy, Gordon Royle, Frank W. Sellke, Joachim Stangier, Thorsten Steiner, Peter Verhamme, Bushi Wang, Laura Young, and Jeffrey I. Weitz

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. 

Source: European Heart Journal
Author(s): Richard P. Whitlock Graham R. McClure John W. Eikelboom

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.