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Journal and News Scan
A brief readable commentary on the Robiscek technique on the occasion of a meta-analysis of an expensive alternative.
The latest instalment in the gender discordance saga, this one proferred by business/management school academics. I am not convinced that the coarse gender comparison takes into account the size discrepancy in coronary arteries and other, well-known to medical practitioners, anatomico-physiological differences of human genders. I do not see any discussion of age groups in the abstract. The article is already attracting considerable attention in the electronic media and, unless further scrutiny contests its titular conclusion, may affect insurance policies. I doubt that the esteemed authors are familiar with the EuroSCORE...
Patient Care and General Interest
A New Zealand woman with cystic fibrosis who is a lung transplant recipient prepares to compete in swimming, biking, and running events in the Australian Transplant Games, held at the end of September.
China’s National Health Commission has launched a congenital heart disease screening project in 24 provincial-level regions, as part of the goal to reduce the country’s neonatal mortality rate.
A Canadian man received a new heart in the 500th heart transplant performed in British Columbia.
Research, Trials, and Funding
Researchers from the University of Maryland in the US find that the development of a subspecialized coronary surgery program resulted in improved mortality rates at their center.
If recent trends continue, researchers from Spain report that global lung cancer mortality among women could increase by over 40% by 2030.
Mitral valve procedures in the US increased by more than double the rate of cardiac procedures as a whole between 2011 and 2016, say researchers.
Researchers in Seattle, Washington, US, find that many smokers have misconceptions about lung cancer and lung cancer screening.
O’Connor and colleagues hypothesized that higher risk of posttransplant mortality in children receiving heart transplants could be predicted using patient-specific factors not currently accounted for in commonly used risk models. The authors retrospectively reviewed outcomes for 74 patients who underwent heart transplant over a six-year period in their center. They identified six risk factors: single-ventricle congenital heart disease, biventricular assist device, a history of four or more sternotomies, panel reactive antibody exceeding 10%, any previous operation at another institution, and pulmonary vein disease. After assigning a single point to each of these risk factors, a score of 4 points or more predicted posttransplant mortality with 57% sensitivity and 90% specificity.
This study shows the use of inhaled nitric oxide (NO) via noninvasive means (nasal prongs or high flow nasal cannulae) is an effective method for reduction of PV resistance. With right ventricular dysfunction becoming an increasingly recognised event after cardiac surgery, this allows for application of NO without the need for intubation.
This is a further report from the extensive dataset of the STICH Trial. This examines the impact of immediate postoperative events (length of time of intubation) on short- and long-term outcomes. If the time was >36 hours, there was significant correlation with increased mortality, both 30-day and one-year. Those included patients with mitral valve disease, renal dysfunction, advanced age, and redo coronary surgery.
This is a look at the costs related to surgical site infections (SSI), as defined by CDC. They show the impact on the monetary costs as well as length of stay with a variety of treatment methods. The costs of a deep SSI add significanty to the overall procedure costs, mainly due to the additional length of stay. The results are not surprising but provide a basis for investment in methods to reduce infections.
Transcatheter aortic valve replacement (TAVR) periprocedural complications rate are low; however, those patients requiring conversion to surgery are under an increased mortality risk. Arsalan and colleagues evaluated 32 patients, 2.1% of 1775 total TAVR procedures at their center, who needed immediate conversion to sternotomy during the TAVR procedure. The most common reasons for conversion were annular rupture, device embolization, and pericardial tamponade. The only predictor for conversion was the usage of a self-expandable valve (OR 0.38, 95% CI 0.16 - 0.90, p = 0.03). Survival at 30 days was 56%, emphasizing the importance of an experienced heart team and access to emergency surgical procedures for these uncommon but unpredictable situations.
Endoleak is a potential complication of total endovascular aortic repair (TEVAR). This video and article from Fukuhara and Roselli illustrate a modified reverse frozen elephant trunk to repair a type IA endoleak from a prior TEVAR for an acute type B dissection. The authors also discuss the advantages and caveats associated with the technique shown.
This story from the BBC reveals a report on a London, UK, hospital’s cardiac surgery department. The hospital commissioned the external review after a higher than expected mortality rate was brought to its attention. The report underscores the importance of positive professional relationships for successful surgical teamwork and quality patient outcomes.