This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
Six billion people lack access to safe, timely, and affordable cardiac surgical care due to limited access, capacity, and financial support. Noncommunicable diseases and surgical care receive a small fraction of global health funding, compared with infectious diseases, despite evidence supporting the effectiveness and socioeconomic benefits of expanding global access. This article reviews the ethical arguments for resource allocation for cardiac surgical care worldwide, with a particular focus on rural and remote settings in low- and middle-income countries, supported by country-level case studies from Ghana and India.
In this study, the authors evaluated survival after heart transplantation in adults with single and biventricular congenital heart disease against those receiving a transplant without congenital heart disease. It is a retrospective analysis over a fifteen-year period. The study found that among CHD transplant recipients, single-ventricle diseases correlated with higher short-term mortality.
The authors interrogated a Norwegian national database for patients with tracheal cancer, a rare but treatable disease. Seventy-sevent patients were identified, giving a crude incidence rate of 0.075 per 100,000 per year. The overall five-year survival was 31.7 percent, and in those treated with surgical resection or curative radiotherapy it was 53.7 percent. Age, histological type, and treatment mode were found to be independent prognostic factors. Although survival has improved, the prognosis is generally still poor. Increased awareness among physicians and early diagnosis are crucial.
This excellent review summarizes the existing evidence for use of balloon pulmonary angioplasty (BPA) based on the 2022 European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines and discusses the safety, efficacy, and its current role in relation to the more established pulmonary endarterectomy (PEA) and existing best medical therapies.
ESC/ERS updated their guidelines for BPA from IIb-C in 2015 to I-B in 2022 and recognized the role of BPA, not as a replacement for PEA/medical therapy, but as both an adjunct and as standalone therapy in cases where PEA may not be applicable because of prohibitive surgical risk. Given the relatively recent introduction of BPA and ongoing improvements in technique, guidelines and standards of care with regards to BPA continue to evolve.
Should we consider mesothelioma patients surgical candidates for resection? Are we actually doing more harm than good?
During the presidential plenary of the IASLC World Conference 2023 on Lung Cancer, Dr. Eric Lim presented the results from the first randomized control trial directly comparing extended pleurectomy decortication versus platinum and pemetrexed chemotherapy alone for the treatment of patients with mesothelioma.
The MARS 2 (Mesothelioma and Radical Surgery) trial was conducted at a single center in the United Kingdom. A total of 169 patients were randomized to surgery plus chemotherapy and 166 to chemotherapy alone. The patients were followed for a median of 22.4 months.
One of the hallmark findings of this study was that surgery increased the risk of death in the first 42 months by 28 percent (p=0.03.) Furthermore, there were more adverse events, increased treatment costs, and decreased median survival in the cohort undergoing surgery and chemotherapy.
This raises the question of why thoracic surgeons should intervene in the treatment of these patients if the outcomes are indeed as above. It may be time for outdated guidelines to be updated as per the evidence base.
Despite the findings alluding to the retirement of surgical therapy for mesothelioma, the study did not find any difference in the long-term survival between both cohorts.
However, surgery did lead to a 3.36 times increased risk for adverse events (p<0.001) and reduced EORTC quality of life scores in global health, particularly in global health, physical, social, and role functioning. Patients who underwent surgery also reported worse symptom scores for pain, insomnia, dyspnea, loss of appetite, and financial difficulties. With the median survival of mesothelioma being 12.1 months according to these results, chemotherapy alone may be a more cost-effective and clinically beneficial treatment.
Dr. Lim stated that changing attitudes so that the disease is considered unresectable would increase access to more effective systemic treatment to improve survival. He did face some scrutiny as the primary outcome of MARS2 was overall survival and with no difference currently reported it may be premature to be rethinking the treatment for such an aggressive thoracic malignancy.
A new device developed by researchers at University of Central Florida and Orlando Health monitors blood in real time to provide surgeons with analysis and track for deadly blood coagulation. Monitoring for this complication is especially important in cardiac surgery on infants, who cannot consistently have their blood drawn for testing. The device is set for its second clinical trial this year. Read the full article for input from researchers who worked on the project.A new device developed by researchers at University of Central Florida and Orlando Health monitors blood in real time to provide surgeons with analysis and track for deadly blood coagulation. Monitoring for this complication is especially important in cardiac surgery on infants, who cannot consistently have their blood drawn for testing. The device is set for its second clinical trial this year. Read the full article for input from researchers who worked on the project.
This large-scale analysis of the National Cancer Database (NCDB) highlights some interesting trends in the current use of systemic therapy in patients with NSCLC who undergo pneumonectomy. Current practice patterns show only 12 percent of patients undergoing pneumonectomy for pathologic stage IB to IIIA received neoadjuvant therapy, 43 percent received adjuvant therapy, and 45 percent underwent surgery alone. Although this retrospective study is subject to limitations of large database analysis, including selection bias reporting only patients who received a particular therapy without reasons identified, this large difference in treatment patterns is certainly an area of potential research. In an era of rapid oncological advances with targeted therapy and immunotherapy, there seems to be a role for further systemic therapy in patients who require pneumonectomy, as the authors highlight survival benefits and downstaging of tumors to perhaps allow a lesser resection to be performed.
This free-access report raises a number of research questions in light of a relatively unsatisfactory response of 55 percent that may reflect unrecorded deaths and should be addressed in future research.
A further analysis of the subgroup of connective tissue aortopathies, possibly differentiating between Marfan and less common pathology, may generate further information in order to understand the patients’ journey in acute aortic syndrome. This would help to guide allocation of resources, counseling, and most importantly, manage the expectations of the public from the aortic service.
The apparent equipoise of conservative treatment and intervention is alarming, to an extent. The key to understand that is, perhaps, the 45 percent of nonresponders.
This paper explores the application of a novel aortic valve visualization and pressurization device to inspect the valve under physiological conditions following aortic repair. The authors report their results in a cohort of twenty-four patients.This paper explores the application of a novel aortic valve visualization and pressurization device to inspect the valve under physiological conditions following aortic repair. The authors report their results in a cohort of twenty-four patients.
This is the newly published latest version of Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection developed by the Japanese Circulation Society, Japanese Society for Cardiovascular Surgery, Japanese Association for Thoracic Surgery, and Japanese Society for Vascular Surgery. Compared to the 2022 ACC/AHA Guidelines on Aortic Disease, the Japanese document discusses the following topics in more detail, along with 86 figures and 1,943 references, which may warrant careful study. Topics included definition, pathogenesis, and epidemiology; pathology; symptoms, examinations, and diagnosis; selection of treatment; treatment for aortic aneurysm; treatment for aortic dissection, issues associated with aortic surgery, other aortic diseases; rehabilitation; and various issues of medical treatment for aortic diseases.