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Journal and News Scan

Source: Journal of Experimental Medicine
Author(s): Moises Freitas-Andrade, Nan Wang, John F. Bechberger, Marijke De Bock, Paul D. Lampe, Luc Leybaert, Christian C. Naus

Researchers from the University of British Columbia, Seattle and Belgium successfully used a new approach that significantly minimized brain damage caused by ischemic stroke in mouse models. The new approach works by blocking hemichannels—pathways allowing for the flow of chemical ions and small molecules—that are expressed by astrocytes, ie, cells playing a protective role for neurons in the brain.

The hypothesis is that when stroke occurs, these hemichannels open and leak toxic molecules into the space outside the astrocytes, causing inflammation and damage to neurons; therefore, blockade of these channels may minimize damage to the brain during stroke.

In this study, a genetic approach that mutated the channel proteins, called Connexin-43 (Cx43), was used to block the formation of hemichannels. This allows the astrocytes to protect the neurons, significantly reducing the size of the stroke injury in the brain. Pharmacological blockade of Cx43 hemichannels with a molecule called TAT-Gap19 in the same ischemic stroke model, also resulted in smaller stroke damage.

These two approaches demonstrate that Connexin hemichannel blockers could be used as a neuroprotective agent in stroke. Thus, a new treatment of ischemic stroke may soon be possible. 

Connexin hemichannel blockers also have a potential role in treating other neurodegenerative conditions such as traumatic brain injury and Alzheimer's disease.

Source: Circulation Research
Author(s): Sebastian Brandhorst, Valter D. Longo

Very useful open access review, especially the simple figure on page 959.

Source: The American College of Cardiology Press Releases
Author(s): The American College of Cardiology

On Wednesday March 13, the ACC Quality Summit announced in New Orleans that beginning in mid-2019, hospitals performing transcatheter valve repair and replacement will be able to apply for the American College of Cardiology's new Transcatheter Valve Certification.

The ACC's Transcatheter Valve Certification is an external review and certification process that will hold hospitals to specific standards for multidisciplinary teams, formalized training and shared decision-making. Participation in a national clinical registries such as the Trancathether Valve Therapy (TVT) registry is required for certification. The TVT registry tracks patient characteristics, procedural indications, and outcomes for patients undergoing transcatheter aortic valve replacement and transcatheter mitral valve repair.

According to the release, the certification will link process improvements to patient outcomes and will be “responsive to the resourcing at hospitals focused and committed to performance improvement in patient care delivery and coordination post-procedure.” Participation in the program will also connect hospitals to data which can track performance metrics and inform best practices.

Source: The New York Times
Author(s): Anahad O’Connor

Dr Eric Topol, a cardiologist and founder and director of the Scripps Research Translational Institute, has long heralded the use of artificial intelligence in medicine and healthcare. Now, in his new book “Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again,” Dr Topol explores how artificial intelligence is likely to transform almost everything that doctors do.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Sabrina Siregar, Daan Nieboer, Michel I. M. Versteegh, Ewout W Steyerberg, Johanna J. M. Takkenberg

Siregar and colleagues review the methods for updating existing risk prediction models, an approach that allows models that have lost their predictive power to be adjusted to new clinical situations. When appropriate, this approach can be more efficient than creating an entirely new model. They consider five methods: intercept recalibration, logistic recalibration, model revision, closed test procedure, and Bayesian modeling. The authors then illustrate the application of these methods, using data from the Netherlands Heart Registry to update the EuroSCORE II model.

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Brett R. Anderson, S. Ram Kumar, Danielle Gottlieb-Sen, Matthew H. Liava’a, Kevin D. Hill, Jeffrey P. Jacobs, Francis X. Moga, David M. Overman, Jane W. Newburger, Sherry A. Glied, Emile A. Bacha, on behalf of the Congenital Heart Technical Skill Study

Anderson and colleagues present the rationale and design for a peer-evaluation protocol of congenital heart surgeon technical skill using direct video observation. All attending surgeons who contribute data to The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) are invited to submit their own surgical videos, to rate peers, or both. Videos are rated anonymously using the Objective Structured Assessment of Technical Skills score. Ratings are linked to the STS-CHSD and surgeon questionnaires. Over a quarter of US congenital heart surgeons have agreed to participate, and recruitment is ongoing.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Tom C. Nguyen, Gilbert H.L. Tang, Stephanie Nguyen, Jessica Forcillo, Isaac George, Tsuyoshi Kaneko, Vinod H. Thourani, Joseph E. Bavaria, Anson W. Cheung, Michael J. Reardon, Michael J. Mack

With the disruptive advancement of catheter-based technologies and minimally invasive techniques in structural heart disease, surgeons must obtain the necessary skills to continue to serve this large patient population. An emergency overhaul of current structural training must occur to ensure standardized training in structural heart disease. This is vital as surgeons are uniquely positioned to offer the full spectrum of valve therapy but risk erosion of the heart team concept without urgent action. The train has left the station and this manuscript is a call to action.

Source: The New York Times
Author(s): Julia Jacobs

This article describes an unfortunate encounter between a physician and a patient via video conference, during which the physician discussed end of life options.

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

Patient Care and General Interest

The American Heart Association has released a scientific statement summarizing emerging knowledge about sensitization after heart transplant.

The National Health Service England in the UK will place mobile scanning trucks in supermarket parking lots to expand lung cancer screening of people who are at high risk of developing the disease.

Engineers from Rochester, New York, USA, have embedded sensors in a toilet seat, an innovation that they hope could improve daily cardiovascular monitoring for patients with heart failure.


Drugs and Devices

Kaiser Health News has released a report detailing a US Food and Drug Administration program that allowed device-related injuries and malfunctions to be reported in a repository that was not publicly available.

Innovative Cardiovascular Solutions, LLC, announced the beginning of the European feasibility study of the next-generation of its Emblok™ Embolic Protection System for transcatheter aortic valve replacement.


Research, Trials, and Funding

Overlapping surgery is safe in most cases but it may increase poor outcomes for high-risk patients and patients undergoing coronary artery bypass grafting, report researchers from Harvard Medical School in Boston, Massachusetts, USA.

A study from researchers at Vanderbilt University in Tennessee, USA, suggests the nonsteroidal anti-inflammatory drug celecoxib might worsen valve disease pathology, conflicting with previous findings that found the drug safe for heart patients.

Source: The Annals of Thoracic Surgery
Author(s): Qiang Chen, Han-Fan Qiu, Gui-Can Zhang, Liang-Wan Chen

Chen and colleagues retrospectively compared outcomes for children who underwent intraoperative device closure of a perimembranous ventricular septal defect (VSD) via two different approaches. VSD closure was performed through a minimal incision in the lower sternum in 52 patients and through a right transthoracic minimal incision in 46 patients. Patients were included if they had small to moderate sized VSDs with at least a 2 mm subaortic rim, mild pulmonary hypertension, and were over one year old, among other criteria. Postoperative complications were comparable between the groups, except for higher incidences of poor surgical wound healing and thoracic deformity in the patients with a lower sternal incision. Short-term follow-up revealed similar outcomes in both groups, and the authors conclude that the right thoracic ventricle approach is an acceptably safe alternative to a lower midline sternotomy for device closure of a perimembranous VSD in children.