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Journal and News Scan

Source: The New England Journal of Medicine
Author(s): Frank A. Lederle, Tassos C. Kyriakides, Kevin T. Stroupe, Julie A. Freischlag, Frank T. Padberg Jr, Jon S. Matsumura, Zhiping Huo, Gary R. Johnson, for the OVER Veterans Affairs Cooperative Study Group

The NEJM published the long-term results of the OVER study of open repair (OR) versus endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) on May 30.

The OVER study demonstrated similar long-term overall survival between patients undergoing EVAR and OR. These results were not consistent with the findings of worse performance of EVAR with respect to long-term survival that were seen in two studies conducted in Europe.

In OVER, patients with asymptomatic AAA were randomly assigned to either EVAR or OR for aneurysm treatment and were followed for up to 14 years. This study enrolled 881 patients who were candidates for either procedure, with 444 assigned to EVAR and 437 to OR. The primary outcome was all-cause mortality. Although elective EVAR of AAA has shown lower perioperative mortality than OR, this survival advantage was not seen after 4 years.

Imporant trends include, although none were signficant:

  • 302 patients (68%) in the EVAR group and 306 patients (70%) in the OR group died (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.82–1.13).
  • In the first 4 years of follow-up, overall survival appeared to be higher with EVAR versus OR.
  • In year 4 through year 8, overall survival was higher in the OR group.
  • After 8 years, overall survival was higher in the EVAR group (HR for death, 0.94; 95% CI, 0.74–1.18).

Additional findings:

  • There were 12 aneurysm-related deaths (2.7%) in the EVAR group and 16 (3.7%) in the OR group (between-group difference, -1.0 percentage point; 95% CI, -3.3–1.4) with most deaths occurring in the perioperative period.
  • Aneurysm rupture occurred in seven patients (1.6%) with EVAR, and rupture of a thoracic aneurysm occurred in one patient (0.2%) with OR (between-group difference, 1.3 percentage points; 95% CI, 0.1–2.6).
  • Death from chronic obstructive lung disease was approximately 50% more common in OR patients than EVAR patients (8.2% vs 5.4%) with a between-group difference of -2.8 percentage points (95% CI, -6.2–0.5).
  • More patients in the EVAR group underwent secondary procedures.
Source: The Annals of Thoracic Surgery
Author(s): Yuliya Tipograf, Michael Salna, Elizaveta Minko, Eric L. Grogan, Cara Agerstrand, Joshua Sonett, Daniel Brodie, Matthew Bacchetta

Tipograf and colleagues analyzed outcomes for 121 patients with end-stage lung disease who were placed on extracorporeal membrane oxygenation (ECMO), 70 of whom (59%) were successfully bridged to lung transplantation. Independent predictors of unsuccessful bridging included unplanned endotracheal intubation, renal replacement therapy, and cerebrovascular accident. Lung transplant recipients who received pretransplant ECMO support had similar outcomes to transplant recipients not receiving support, and the authors conclude that ECMO can be used successfully to bridge patients to lung transplantation when it is implemented by an experienced team with adherence to stringent protocols and patient selection.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Jawad H Butt, Peter Skov Olsen, Christian Torp-Pedersen, Gunnar H Gislason, Lars Køber, Emil L Fosbøl

Butt and colleagues examined the incidence and reasons for hospitalizations following coronary artery bypass grafting  (CABG). This study was performed using a Danish nationwide registry including more than 30,000 patients. Within 1 year after CABG, 40% of patients were readmitted at least once, most of them due to a cardiovascular cause. Risk factors for readmission included lower socioeconomic status, preoperative comorbidities, postoperative complications during the index admission, and a longer length of stay in the hospital.

Source: Annals of Cardiothoracic Surgery
Author(s): Giye Choe, Bernard Park

In this narrated video, Choe and Park present the case of a 56-year old woman with T3N0M0 lung cancer, who underwent robotic lobectomy with concomitant chest wall resection.

Source: Nature Communications
Author(s): Brandon A. Guenthart, John D. O’Neill, Jinho Kim, Dawn Queen, Scott Chicotka, Kenmond Fung, Michael Simpson, Rachel Donocoff, Michael Salna, Charles C. Marboe, Katherine Cunningham, Susan P. Halligan, Holly M. Wobma, Ahmed E. Hozain, Alexander Romanov, Gordana Vunjak-Novakovic, Matthew Bacchetta

A common cause of donor lung unsuitability is aspiration pneumonitis. Pig lungs experimentally damaged by aspiration of gastric contents were supported using cross-circulation with a living swine donor, resulting in cellular regeneration and substantial recovery.

Source: Science Translational Medicine
Author(s): Hsin-Jung Yang, Ilkay Oksuz, Damini Dey, Jane Sykes, Michael Klein, John Butler, Michael S. Kovacs, Olivia Sobczyk, Ivan Cokic, Piotr J. Slomka, Xiaoming Bi, Debiao Li, Mourad Tighiouart, Sotirios A. Tsaftaris, Frank S. Prato, Joseph A. Fisher, Rohan Dharmakumar

Using period hypercapnea as a surrogate "contrast" agent, myocardial oxygenation was assessed using cardiac MR and accurately mapped areas of relative ischemia.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care and General Interest

Despite being the leading cause of death in the US, heart disease was the most-Googled disease in only one state: Maine.

A study that sought to understand the importance of successful teamwork for general surgery used cardiothoracic surgical teams as their comparison group because of the stability and experience that these teams typically have.

Experts call attention to what they say is a public health crisis facing countries that continue to produce and use asbestos, including Brazil, Russia, India, and China.

A 50-year-old mitral valve prosthesis is rediscovered when a woman in Italy undergoes an operation.

 

Drugs and Devices

In an update to a letter sent in February 2019, the US Food and Drug Administration has warned healthcare providers against off-indication use of the Impella RP system from Abiomed, emphasizing that the benefits of the device outweigh the risks in appropriately selected patients.

Health Canada has approved the Apple Watch’s electrocardiogram app and irregular rhythm notifications.

 

Research, Trials, and Funding

Researchers from Pakistan and across the US report finding positive “spin” of results in approximately two-thirds of articles publishing cardiovascular-focused randomized clinical trials.

Metformin reduced left ventricular hypertrophy in patients with coronary artery disease who did not have diabetes, say researchers from the UK.

At the recent EuroPCR meeting in Paris, France, researchers present the usage of Abbott’s transcatheter tricuspid valve repair system to treat tricuspid regurgitation in 85 patients.

Canadian and Brazilian researchers report their use of radar to remotely monitor heart and respiratory rates, with 80% and 94% correlation with a wearable sensor, respectively.

Source: BBC
Author(s): Andrew Benson

Three-time Formula 1 world champion Niki Lauda has died at the age of 70. Lauda, who underwent a lung transplant in August 2018 and had previously had 2 renal transplants, "passed away peacefully" on Monday, his family said. He was only days away from death 9 months ago when he underwent life-saving lung transplant surgery.

For more information about Mr Lauda's lung transplant, please see the following resources:

https://www.autosport.com/f1/news/137926/lauda-was-days-away-from-death-...

https://www.sport24.co.za/Motorsport/lung-transplant-worse-than-nurburgr...

0:35How Niki Lauda Is Doing After Lung Transplant Surgery - https://www.youtube.com/watch?v=t1OmFpjFRiU

https://www.foxsports.com.au/motorsport/formula-one/f1-niki-lauda-was-gi...

Source: Circulation: Heart Failure
Author(s): David Baran, Hannah Copeland, Jack Copeland

The authors utilized a retrospective review of the UNOS database from 2007-2014 to evaluate the impact of donor sequence number (DSN) on outcomes. Specifically, they interestingly identified that survival is the same across various DSNs, indicating a potential ability to increase transplant numbers based on similar survival when utilizing donors of higher DSN.

Source: Journal of Thoracic Oncology
Author(s): Jelle E. Bousema, Martijn van Dorp, Valentin J.J.M. Noyez, Marcel G.W. Dijkgraaf, Jouke T. Annema, Frank J.C. van den Broek

Rates of unforeseen N2 disease were similar between nodal staging by EBUS and mediastinoscopy, but mediastinoscopy had a complication rate of 6%.

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