Journal and News Scan

The culture of health care creates important challenges for health care professionals. In particular, this culture is 1) hierarchical, 2) competitive, and 3) perfectionistic. Unfortunately, the tendency of acquiescing to those demands is contrary to promoting resonant teamwork. It is important for leaders of multidisciplinary teams to understand how to create environments that flatten the hierarchy (by encouraging all team members to contribute and to genuinely seek the wisdom and knowledge of their colleagues), that encourage collaboration and cooperation (emphasizing collective “wins” and “losses” both for the immediate team as well as for all of us, as a profession), and that invites excellence (which is a process) rather than an expectation of perfection (which is an unrealistic outcome).

In this article, the authors outline the concepts that promote development of this kind of leadership thinking, which covers topics like emotional intelligence, professionalism, interpersonal and communication skills, and efficient, timely, equitable, unprejudiced and patient-centered care.

This a must-read for cardiothoracic surgeons, who are always leading their surgical team.

Although both bicuspid aortic valve (BAV) and Marfan syndrome have been associated with aortic dissection risk, it is unknown if the presence of BAV is associated with an increased aortic risk in patients with an FBN1 gene mutation. Milleron and associates evaluated aortic diameters, aortic valve function, aortic shape and aortic events during follow-up in 1437 patients with an FBN1 gene mutation, 26 of whom (1.8%) had a BAV.

Patients with BAV had a larger aortic root maximal diameter and normalized Z score at all ages compared with patients with tricuspid aortic valve. Patients with BAV were more likely to have prophylactic aortic root surgery at a younger age, although the aortic diameter threshold was similar in the two groups. No aortic dissection was seen in patients with BAV.

In patients with a FBN1 mutation, BAV is associated with larger aortic root diameter, with no difference in evolution of Z score with age. A trend was found towards prophylactic aortic root surgery at younger ages but similar aortic diameter thresholds without occurrence of aortic dissection. This study found no evidence for lowering aortic diameter thresholds for prophylactic root surgery in the presence of BAV in patients with FBN1 mutations.

Boersma and associates reported the outcomes of left atrial appendage (LAA) closure with the Watchman device in international registry (EWOLUTION), which recruited 1,020 patients from 47 different centers. Mean age was 73.4 years and 49% had a CHA2DS2-VASc score of 5 or higher—indicating a high risk of stroke.

After a median follow-up of two years, the following outcomes were observed:

1. Twenty-two strokes, or 1.3 per every 100 patient-years, which correlates to an 83% reduction in strokes compared to historic data of the population’s risk profile.
2. Forty-seven nonprocedural bleeding events, translating to 2.7 per 100 patient-years—a 46% reduction versus historic data.
3. Stroke and bleeding rates were 76% and 41% lower, respectively, compared to historic data among the 311 study participants with prior ischemic stroke. For the 153 participants with prior hemorrhagic stroke, stroke and bleeding rates were 81% and 67% lower, respectively.
4. Device thrombus occurred in 34 patients (4.1%).

The authors conclude that LAA closure with the Watchman device was associated with low rates of stroke and bleeding events in high-risk atrial fibrillation patients over a two-year follow-up period.

Patient Care and General Interest

In this brief video, an oncologist shares some thoughts on the value of tumor board discussions and the importance of having them early in a patient’s care.

Drugs and Devices

The US Food and Drug Administration has given Investigational Device Exemption approval to the RejuvenAir System from CSA Medical, a bronchoscopic system that uses liquid nitrogen for targeted treatment in chronic obstructive pulmonary disease with chronic bronchitis.

Research, Trials, and Funding

Research presented at the recent Annual Meeting of the International Society for Heart and Lung Transplantation reports on the success of an approach to organ recovery and evaluation for transplant that is based on military-style Special Ops teams.

An association between coffee intake and lung cancer risk, as reported by researchers at the recent Annual Meeting of the American Association for Cancer Research, is noted as interesting but not a finding that should distract from the contribution of smoking to lung cancer.

Biomedical engineering researchers from the University of Arkansas in the USA applied vector flow imaging to improve ultrasound assessment of the heart in two children, demonstrating the feasibility of the technology.