Journal and News Scan

Patient Care and General Interest

The US Centers for Medicare and Medicaid Services have released their proposed update to the national coverage policy for transcatheter aortic valve replacement, in which they did not increase volume requirements.

An updated guideline for lung cancer diagnosis and management from the UK National Institute for Health and Care Excellence was published in the British Medical Journal.

Research, Trials, and Funding

A randomized trial conducted in 18 countries and published in the Canadian Medical Association Journal suggests that steroid administration during coronary artery bypass grafting (CABG) does not reduce the risk of acute kidney injury.

Researchers in Pennsylvania, USA, have applied a machine learning algorithm to low-dose computed tomography scans try to reduce false positives in lung cancer screening.

Motion-correcting software combined with fetal magnetic resonance imaging was used to generate improved 3D images for diagnosing congenital heart disease, report researchers from London, UK, in the Lancet.

Researchers in Milan, Italy, report results from the randomized MYRIAD trial, finding that patients undergoing CABG have equivalent survival whether they receive intravenous or inhaled anesthesia.

A population-based prospective study of more than 50,000 individuals in northeastern Iran found an association between the preference for drinking one’s tea “very hot” and esophageal cancer risk, say researchers in the International Journal of Cancer.

Professor Yacoub and his team reported their experience with the use of the Mustard operation, in its original form and in a new modification designed to enhance the atrial functions and filling of the left ventricle.

In 5 years, 101 patients with transposition of the great arteries (TGA) underwent the Mustard operation, 86 with the new modification. The median age at operation was 16 months (6 months - 27 years), 75 patients were male (74.3%), and median preoperative oxygen saturation was 71%. There were no early deaths. Three patients died during a median follow-up of 24.2 months, all with large VSD and established pulmonary vascular disease. At latest follow up, all patients were in stable sinus rhythm. There were no baffle leaks. Seven patients had asymptomatic narrowing of the superior baffle, and one required balloon dilation. The authors report that follow-up is 100% complete and includes CT and MRI at regular intervals (75 patients to date). Analysis of representative subsets showed enhanced rate and pattern of left ventricle filling in the modified operation compared to the classic Mustard operation.

The authors conclude that the Mustard operation, particularly the modified technique, should play an important role in treating late-presenting patients with TGA. Improving the pattern of filling of the left ventricle could enhance the long-term results of the Mustard operation.

The investigators published the final analysis of the MOMENTUM 3 trial comparing the fully magnetically levitated centrifugal continuous-flow HeartMate 3 pump to the mechanical-bearing axial continuous-flow HeartMate II pump. The composite primary end point was survival at two years free of disabling stroke or reoperation to replace or remove a malfunctioning device. The principal secondary end point was pump replacement at two years.

HeartMate 3 and HeartMate II were implanted in 516 and 512 patients, respectively. In the analysis of the primary end point, 397 patients (76.9%) with HeartMate 3, as compared with 332 (64.8%) with HeartMate II, remained alive and free of disabling stroke or reoperation to replace or remove a malfunctioning device at two years (relative risk, 0.84; 95% confidence interval [CI], 0.78 to 0.91; P<0.001 for superiority). Pump replacement was less common in the HeartMate 3 group than in the HeartMate II group (12 patients [2.3%] versus 57 patients [11.3%]; relative risk, 0.21; 95% CI, 0.11 to 0.38; P<0.001). The number of events per patient-year for stroke of any severity, major bleeding, and gastrointestinal hemorrhage were lower in patients with HeatMate 3 comparted to patients with HeartMate II.

These data show that among patients with advanced heart failure, the fully magnetically levitated centrifugal-flow HeartMate 3 was associated with less frequent need for pump replacement and superior survival free of disabling stroke or reoperation to replace or remove a malfunctioning device.

Andreas and colleagues report their experience of aortic valve replacement with rapid-deployment surgical aortic valves prostheses in 500 patients over seven years. The authors found a 0.8% 30-day mortality, and the valves showed excellent hemodynamic performance, durability, and safety with a median follow-up time of 12 months. Minimally invasive access was achieved in 47% of patients.