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Journal and News Scan

Source: The American Journal of Cardiology
Author(s): Maria Comanici, Sunil K. Bhudia, Nandor Marczin, Shahzad G. Raja

Use of antiplatelet medication following coronary artery bypass grafting is common practice to reduce thrombotic events. However, antiplatelet resistance is of growing concern. The authors of this review conducted a systematic review and meta-analysis of eleven studies involving 3122 patients. The primary outcome measures were major adverse cardiovascular events and mortality. The authors report a 39 percent prevalence of antiplatelet resistance from the studies included.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Abeln KB, Matsushima S, Ehrlich T, Giebels C, Schäfers H-J

Unicuspid aortic valve requires intervention in early life and the ideal treatment is unknown. This study examined 345 patients divided into two groups: 167 undergoing valve repair and 91 undergoing a Ross procedure. Survival at ten years was 95 percent in the Ross group and 97 percent after valve repair, and freedom from reintervention at ten years was better with Ross (98 percent) as compared to repair (80.5 percent). ROC analysis indicated a trend toward better durability in patients aged less than twenty-six years. It seems that repair of a unicuspid valve can be used as a bridge to pulmonary autograft replacement in younger patients.

Source: The Annals of Thoracic Surgery
Author(s): Dominique Vervoort, Kathleen N. Fenton

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.

Source: Journal of the American College of Cardiology
Author(s): Syed Shahyan Bakhtiyar, Sara Sakowitz, Konmal Ali, Nikhil L. Chervu, Arjun Verma, Ming-Sing Si, David D’Alessandro, and Peyman Benharash

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.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Nilssen Y, Solberg S, Brustugun O, Møller B, Sundset A, Wahl SGF et al.

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.

Source: Journal of Clinical Medicine
Author(s): Banaszkiewicz et. Al.

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.

Source: IASLC Lung Cancer News
Author(s): Fred Gebhart

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.

Source: UCF Today
Author(s): Robert Wells

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.

Source: JTO Clinical and Research Reports
Author(s): Rodriguez-Quintero et. Al.

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.

Source: European Journal of Vascular and Endovascular Surgery
Author(s): Frederike Meccanici, Carlijn G.E. Thijssen, Arjen L. Gökalp, Annemijn W. Bom, Jorg L. de Bruin, Jos A. Bekkers, Roland R.J. van Kimmenad, Guillaume S.C. Geuzebroek, Paul Poyck, Joost J. ter Woorst, Kathinka Peels, Jelena Sjatskig, Robin H. Heijmen, Marco C. Post, Mostafa M. Mokhles, Hence J.M. Verhagen, Johanna J.M. Takkenberg, Jolien W. Roos-Hesselink

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.
 

 

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