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Journal and News Scan
An alarming list of some crazy things our colleagues have done in the recent past.
A woman in the northwest US who was thought to have drowned makes a surprising recovery, aided by a local hospital’s use of extracorporeal membrane oxygenation for traumatic heart and lung injuries.
An Indian man now has two hearts, as his surgical team performed a heterotopic heart transplant upon realizing that the donor heart could be too small for the patient.
Drugs and Devices
The SherpaPak™ and SherpaPerfusion™ Cardiac Transport Systems, heart and kidney transportation devices from Paragonix Technologies, have received the CE mark.
The US Food and Drug Administration has approved tezacaftor/ivacaftor and ivacaftor from Vertex Pharmaceuticals to treat cystic fibrosis in patients with particular CFTR mutations.
Research, Trials, and Funding
Researchers in Philadelphia, Pennsylvania, found that over 20% of children who underwent cardiac surgery as infants had hearing loss, a rate 20 times higher than in the general population.
Research from the Penn Atrial Fibrillation Free Study, based at the University of Pennsylvania, suggests that despite having a lower risk of developing atrial fibrillation, African Americans with atrial fibrillation have a higher risk of stroke when compared to Caucasian Americans.
In this patient level meta-analysis of 11 randomised trials, the authors compare PCI using stents with CABG. In total, almost 12,000 randomised patients were included.
They found that at a mean of 3.8 years of follow-up, mortality was higher after PCI versus CABG (11.2% versus 9.2%, hazard ratio 1.20, 95% confidence interval 1.06 - 1.37, p = 0.0038). The vast amount of data allowed meaningful analysis of subgroups. The mortality benefit was particularly clear in patients with multivessel disease and diabetes, whereas there was no difference between the two treatments in patients with left main disease or without diabetes.
A comprehensive review of pleural diseases from the internists' viewpoint. Relevant to surgeons in the sense of referrals for empyema, pleural effusions, and other traditional surgical problems that are now often dealt with revitalised internist-led options such as office pleuroscopy/pleurodesis.
A well-written, brief, pessimistic editorial on the loss of surgeon autonomy in innovation.
This great video documents the beginning of the first successful robotic mitral surgery program in the UK, by Paul Modi and proctored by Doug Murphy.
They use the LEAR technique–Lateral Endoscopic Approach for Robotics–which is a totally port-based approach to intracardiac robotic surgery. I am sure we will see many more videos from this group in the near future.
An interesting article describing the interface between medical 3D printing and art. It briefly outlines current and future applications, and it also describes constraints to the use of this technology.
An FDA advisory committee voted 6-4 against expanding approved indications for liposomal bupivicaine for regional pain control after surgery. This drug is a central element in many institutions' Enhanced Recovery After Surgery programs. They cited inconsistent results, failure to provide comparative results, and increased deaths associated with the drug. The official FDA will use this assessment as part of their deliberations.
A balanced comment on the occasion of the latest retrospective nonrandomised Coselli report on redo thoracoabdominal aortic aneurysms (TAAAs).
Raanani mentions the inappropriateness of endovascular techniques for Marfan syndrome patients, on account of high rate of endoleak probably related to the diffuse aortopathy. He also picks up the schism of early and late morbidity, and analyzes the confounders well.
It might be important that such as strong and vocal advocate of open aortic surgery as Joseph Coselli reports inferior nonrandomized long-term mortality of his favored traditional approach. This may impact positively on insurance and reimbursement for hybrid TAAA repairs.
A professional US football player who had a congenital coronary artery anomaly corrected as a teenager meets with kids currently undergoing treatment for congenital heart disease, seeking to provide them with hope and inspiration.
Drugs and Devices
The self-expanding CENTERA transcatheter aortic valve from Edwards Lifesciences has received the CE Mark.
The Lotus heart valve will not relaunch in the US or European markets until 2019, says Boston Scientific.
The US Food and Drug Administration expanded premarket approval for several Abiomed Impella heart pumps to include heart failure associated with cardiomyopathy leading to cardiogenic shock.
Research, Trials, and Funding
Researchers in Australia recently published a meta-analysis suggesting that regular exercise ahead of lung cancer surgery can reduce complication rates.
Children’s Hospital Los Angeles has joined the HLHS Consortium, a Phase I study of innovative therapies for hypoplastic left heart syndrome that was launched at the Mayo Clinic in Minnesota during 2017.
Researchers in the UK published a retrospective analysis in the BMJ that questions whether older adults with both atrial fibrillation and chronic kidney disease should be given anticoagulation medication.