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Journal and News Scan
March 4, 2019
Submitted by: Marco Nardini
The complete pathologic response rate in this study is revealed to be low, lower than expected after stereotactic ablative radiotherapy (SABR) for early stage non-small cell lung cancer: only 60%. The authors suggest a combined approach (SABR plus surgery), adopted in this experimental phase 2 trial, as a possible management scheme. This is questionable and further research will be needed.
March 1, 2019
Submitted by: Claire Vernon
Patient Care and General Interest
One of the professional golfers who qualified for this weekend’s PGA Tour event is also a two-time heart transplant recipient.
Drugs and Devices
LivaNova announced that its Perceval sutureless aortic valve will be reimbursed for patients through Japan’s Ministry of Health, Labor, and Welfare.
Research, Trials, and Funding
A program designed specifically to address racial disparity in lung cancer treatment rates in North Carolina, USA, eliminated this disparity and increased treatment rates for all participants.
Researchers from Ontario, Canada, report a 60% pathologic complete response rate for stereotactic ablative radiotherapy in patients with resectable lung cancer, much lower than they had hypothesized.
A study using data from the UK Biobank found that adults with mild congenital heart defects had increased incidences of heart failure, atrial fibrillation, stroke, and heart attack, even after accounting for cardiovascular risk factors.
The Thoracic Surgery Foundation (TSF) has awarded 24 grants that will support research and educational endeavors in 2019. Visit their website to learn more about TSF and future funding opportunities.
Women have worse outcomes after aortic surgery than men do, report researchers from Ontario, Canada.
March 1, 2019
Submitted by: Wei-Guo Ma
Though medical care has become ever more dependent on teamwork, the profession has devoted relatively little attention to what makes for a good team. In this roundtable discussion moderated by Lisa Rosenbaum, panelists Amy Edmondson, Neel Shah, and Thoralf Sundt discuss empirical and cultural approaches to the pursuit of better collaboration.
This audio roundtable is the companion to a three-part series on teamwork, written by Lisa Rosenbaum and published in the New England Journal of Medicine. In this series, Dr Rosenbaum made important reflections on and explorations into the professional, psychological, cultural, and social approaches to fostering high-quality communication and collaboration in the medical community. These articles and links are as follows:
Teamwork — Part 1: Divided We Fall
https://www.nejm.org/doi/full/10.1056/NEJMms1813427
Teamwork — Part 2: Cursed by Knowledge — Building a Culture of Psychological Safety
https://www.nejm.org/doi/full/10.1056/NEJMms1813429
Teamwork — Part 3: The Not-My-Problem Problem
February 27, 2019
Submitted by: Claire Vernon
Kofler and colleagues evaluated prospectively-measured psoas muscle area in more than 1,000 patients who underwent transcatheter aortic valve replacement at two centers. Indexed psoas area was independently associated with 30-day and follow-up mortality. The authors suggest adding indexed psoas area to The Society of Thoracic Surgeons (STS) score to improve the STS score prognostic value.
February 27, 2019
Submitted by: Aristotle Protopapas
A very useful synopsis of treatment strategies for a vexing lethal condition.
February 26, 2019
Submitted by: Wei-Guo Ma
Today, The Society of Thoracic Surgeons published the third annual Pediatric Interagency Registry for Mechanical Circulatory Support (PEDIMACS) report. Between Sep 19, 2012 and Dec 31, 2017, 423 patients (less than 19 years of age) in 30 hospitals were supported with 508 devices. The etiology was cardiomyopathy in 261 patients (62%), myocarditis in 48 (11%), congenital heart disease (CHD) in 86 (20%, with 52 of these having single ventricle physiology), and other in 28 (7%). The two most common support strategies included left ventricular assist device in 342 patients (81%) and biventricular assist device (BiVAD) in 64 (15%).
At 6 months, 80% of patients were alive on a device or bridged to transplantation/recovery. Patient characteristics and survival were different among three groups of patients supported with three types of pumps:
- 197 implantable continuous flow pumps: implant age 13.4 ± 3.8 years, 19% INTERMACS profile 1, 21% intubated at implant, 12% with CHD; 92% alive at 6 months
- 79 paracorporeal continuous flow (PC) pumps: implant age 3.9 ± 5.2 years, 49% INTERMACS profile 1, 86% intubated at implant, 38% with CHD; 66% alive at 6 months
- 121 paracorporeal pulsatile pumps: implant age 3.3 ± 3.9 years, 41% INTERMACS profile 1, 77% intubated at implant, 21% with CHD; 77% alive at 6 months
Risk factors for early death were INTERMACS profile 1 (hazard ratio, HR 12.6), BiVAD (HR 3.6), percutaneous devices (HR 13.5), PC pumps (HR 4.1), small volume center (HR 3.3), low age (HR 1.01 for age squared), and low weight (HR 0.9). Intubation (functional capacity, HR 4.3) and liver dysfunction (bilirubin in mg/dL, HR 1.1) at the time of implant were constant hazards.
The investigators conclude that implantable continuous flow pumps are the most common type in children, with greater than 90% survival at 6 months, which may represent the maturation in both patient selection and timing of implantation. Currently paracorporeal continuous flow or pulsatile pumps are limited to supporting most challenging patients, those weighing less than 20 kg, and those with congenital heart defects.
February 25, 2019
Submitted by: Claire Vernon
Schubert and colleagues developed a novel trileaflet mechanical heart valve prosthesis. They compared this device with a conventional mechanical bileaflet heart valve in vitro, evaluating hemodynamic parameters and thrombogenicity. The trileaflet valve had a larger effective orifice area and smaller pressure gradient than the bileaflet one. There were fewer clotting deposits on the trileaflet valve, and the authors pointed to the off-wall systolic position of the hinges in the new valve as a major advantage.
February 25, 2019
Submitted by: Claire Vernon
In this statistical primer, Grant and colleagues focus on the use of multivariable regression analyses. The authors review the three most common types of multivariable regression models encountered in the cardiothoracic surgical literature, and they highlight less common models, underscoring the importance of using the correct model for a particular study. They also discuss appropriate approaches for selecting variables and the need to report the model completely so others can reproduce it.
February 22, 2019
Submitted by: Claire Vernon
Patient Care and General Interest
The Cardiac Surgery Advanced Life Support (CALS) protocol is expanding to India from the UK, as a cardiac surgical team at Sri Ramachandra Institute of Higher Education and Research in Chennai will become certified CALS trainers.
Drugs and Devices
Edwards Lifesciences has received CE Mark approval for its Pascal transcatheter mitral repair system.
Moves are afoot in the world of robotic bronchoscopy, as Intuitive Surgical receives US Food and Drug Administration approval for its Ion system and Johnson & Johnson acquires Auris Health and its Monarch platform.
Admedus reports interim data from the feasibility study of its single-piece 3D stentless aortic valve in sheep.
CareDx, Inc, announced that the company’s donor derived cell-free DNA test for lung transplant rejection, AlloSure Lung, will be available under a compassionate use program.
Research, Trials, and Funding
Adding acetaminophen to administration of a sedative reduced the incidence and duration of delirium after cardiac surgery, say researchers from Boston, Massachusetts, in JAMA.
Embyronic heart-derived immune cells keep valves slim and in shape, say developmental biologists from the University of California Los Angeles.
Researchers from around the US are advancing computational modeling to predict the postoperative outcome of mitral repairs with presurgical imaging data.
February 20, 2019
Submitted by: Claire Vernon
Flynn and colleagues evaluated their center’s implementation of a protocol for extubation within six hours after cardiac surgery, focusing on the rate of adverse events before and after protocol implementation particularly for those patients at highest surgical risk. The authors analyzed prospectively-collected data for patients undergoing cardiac operations within six months of the initiation of the early extubation protocol, 181 patients before and 152 after. They found no differences in the total number of adverse events (renal failure, reintubation, 30-day mortality, or postoperative stroke) before and after the protocol was initiated (16% versus 19%, p = 0.557). In a subset analysis focusing specifically on patients with STS predicted morbidity or mortality score over 40% (8 patients before, 6 patients after the protocol began), the number of adverse events were not different and the median ventilation time was reduced to less than six hours.
The authors conclude that these results are encouraging but merit further investigation, considering the small sample size.