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

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.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Ivan Netuka

Netuka provides several important technical nuances to consider when implanting the HeartMate 3 left heart assist device. He focuses on apical cuff attachment, optimal positioning of the pump in the pericardial cavity, and positioning of the outflow graft. Furthermore, he describes alternative surgical implantation strategies for minimizing invasiveness.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Yosuke Inoue, Hitoshi Matsuda, Atsushi Omura, Yoshimasa Seike, Kyokun Uehara, Hiroaki Sasaki, Junjiro Kobayashi

Patent descending aortic false lumen in type A dissection is associated with limited long-term outcomes. Inoue and colleagues aimed to evaluate the efficacy of their group’s strategy for these patients. Among 290 patients with type A aortic dissection and patent false lumen at the descending aorta, 124 underwent ascending aortic replacement and 166 additional total aortic arch replacement. Total aortic arch replacement was associated with better freedom from descending aortic aneurysm. There was no difference in in-hospital mortality between the groups.

Source: The Annals of Thoracic Surgery
Author(s): Katherine R. Hebeler, Heike Baumgarten, John J. Squiers, Jordan Wooley, Benjamin D. Pollock, Cecile Mahoney, Giovanni Filardo, Brian Lima, J. Michael DiMaio

Hebeler and colleagues hypothesized that the inclusion of measures of frailty might improve the prediction of mortality one-year after transcatheter aortic valve replacement (TAVR). In 470 patients undergoing TAVR, sarcopenia was measured and frailty was assessed preoperatively by gait speed, hand grip strength, serum albumin, and Katz activities of daily living. The addition of both sarcopenia and frailty measures to the STS Predicted Risk of Mortality improved the predictive capacity of the model (area under the curve of 0.61 versus 0.52), and albumin was the only marker that was significantly associated with an increased one-year mortality risk.

Source: US Food & Drug Administration
Author(s): US Food & Drug Administration

On November 26, 2018, FDA Commissioner Scott Gottlieb, MD, and Director of the Center for Devices and Radiological Health Jeff Shuren, MD,  announced proposed changes intended to modernize the 510(k) clearance pathway to keep pace with the increasing complexity of rapidly evolving technology. The FDA is planning to rename this new approach the “Safety and Performance Based Pathway” to reflect its focus on advancing improved safety and performance of new low-risk to moderate-risk products. It is an alternative pathway to substantial equivalence that will provide more direct evidence of the safety and performance of a device and better information for patients and providers to make well-informed health care decisions. This new approach may also drive greater market competition to develop safer devices. 

Source: Journal of Vascular Surgery
Author(s): James C. Iannuzzi, Sahael M. Stapleton, Yanik J. Bababekov, David Chang, Robert T. Lancaster, Mark F. Conrad, Richard P. Cambria, Virendra I. Patel

The authors compared the early and long-term survival in 9165 patients undergoing medical therapy (95%), open repair (2%), and thoracic endovascular aortic repair (TEVAR, 2.9%) for uncomplicated acute type B dissection. One- and 5-year survivals were 84% and 60% for medical therapy, 76% and 67% for open repair, and 85% and 76% for TEVAR (log-rank, P < .01). On risk-adjusted multivariable analysis, TEVAR had a significant survival benefit compared to medical therapy (hazard ratio, 0.68; 95% confidence interval, 0.6-0.8; P < .01).  This study on survival after acute uncomplicated type B aortic dissection shows a survival advantage for TEVAR over medical therapy. These data add further evidence for a paradigm shift in the management of acute type B dissection in favor of early TEVAR.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Aya Saito, Hiraku Kumamaru, Minoru Ono, Hiroaki Miyata, Noboru Motomura

Saito and colleagues evaluated the idea that anastomosis assist devices reduced complications for patients undergoing off-pump coronary artery bypass grafting. Their study is a one-to-one propensity scores matched analysis including 7,348 pairs of patients comparing the outcomes of anastomosis assist devices with a side-biting clamp. The authors found no difference in 30-day mortality or stroke. However, transient ischemic attack occurred more frequently in the side-clamp group.

Source: JAMA Surgery
Author(s): Patrick G. Chan, Ernest G. Chan, Laura Seese, Ibrahim Sultan, Arman Kilic, Thomas G. Gleason, Danny Chu

This single institution retrospective study examined the utility of using nonpledgeted sutures for aortic valve replacement. In short-term follow-up, 3.6% of patients had insignificant perivalvular leak and 0.9% had significant perivalvular leak requiring reoperation. This technique has the potential benefits of reduced cross-clamp time, reduced risk of decreasing the effective orifice area, reduced cost, and reduced indwelling foreign body.

Source: The Annals of Thoracic Surgery
Author(s): Jeremiah R. Brown, Jeffrey P. Jacobs, Shama S. Alam, Heather Thiessen-Philbrook, Allen Everett, Donald S. Likosky, Kevin Lobdell, Moritz C. Wyler von Ballmoos, Devin M. Parker, Amit X. Garg, Todd Mackenzie, Marshall L. Jacobs, Chirag R. Parikh

Brown and colleagues evaluated levels of six biomarkers to determine if they improved the prediction of readmission after cardiac surgery: ST2, galectin-3, N-terminal pro-brain natriuretic peptide, cystatin C, interleukin-6, and interleukin-10. The addition of these biomarkers to a model based on only clinical risk factors improved the predictive ability of the model in the derivation cohort (area under the receiver-operating characteristics curve (AUROC) of 0.74 versus 0.66), but it did not improve prediction in an external validation cohort (AUROC of 0.52 versus 0.48).