ALERT!

This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Journal and News Scan

Source: TCT MD
Author(s): David Taggart

In the ongoing debate about the results of the EXCEL trial in which Professor Taggart withdrew his authorship and EACTS withdrew their support for the recommendations regarding PCI versus CABG, we previously posted the response from the EXCEL remaining coauthors : 

https://www.tctmd.com/slide/official-response-excel-leadership

This posting is Professor Taggart's response to this document.

Also see here for EACTS response: 

https://www.eacts.org/changing-evidence-changing-practice/

A full list of all the documents relevant to this discussion provided by the SCTS will also be available on the SCTS website. As more information becomes available, SCTS will endeavour to post it online and communicate with members directly, as appropriate. Please use the following link for items that are included as separate PDFs. Thank you. (https://www.dropbox.com/sh/9bq984evzqzkky5/AAAGTLyNYcUCiagA4dYkJ8Npa?dl=0)

  1. EXCEL trial (8th December 2016)


    https://www.nejm.org/doi/full/10.1056/NEJMoa1610227

  2. EXCEL trial 5-year outcomes (28th September 2019)  
    https://www.nejm.org/doi/full/10.1056/NEJMoa1909406
    https://solaci.org/_files/tct-2019/excel-5yearpdf.pdf

  3. TCTMD commentary (7th October 2019)


    https://www.tctmd.com/news/former-excel-investigator-alleges-trial-manipulation-prompting-vehement-denials

  4. BBC news story (9th December 2019)
    https://www.bbc.co.uk/news/health-50715156

  5. EACTS initial response to Newsnight article (9th December 2019)


    https://www.eacts.org/eacts-responds-to-bbc-newsnights-investigation-on-the-excel-trial/

  6. Cardiovascular news commentary (9th December 2019)


    https://cardiovascularnews.com/eacts-issues-response-to-bbc-newsnight-investigation-of-excel-trial/

  7. TCTMD commentary (10th December 2019)


    https://www.tctmd.com/news/eacts-pulls-out-left-main-guidelines-after-bbc-bombshell-alleging-excel-trial-cover

  8. British Cardiovascular Intervention Society (BCIS) statement (11th December 2019)


    https://www.bcis.org.uk/wp-content/uploads/2019/12/The-Excel-controversy-finalab.pdf

  9. Society for Cardiothoracic Surgery in Great Britain & Ireland (SCTS) joint statement with BCS & BCIS  (12th December 2019)

  10. Official response of EXCEL Leadership (12th December 2019)


    https://www.tctmd.com/slide/official-response-excel-leadership

  11. Medscape commentary & podcast (13th December 2019)


    https://www.medscape.com/viewarticle/922528

  12. SCTS second statement (18th December 2019)

  13. Taggart response to EXCEL rebuttal (19th December 2019)


    https://www.tctmd.com/slide/response-david-taggart-md-phd-excel-statement

  14. EACTS subsequent statement (19th December 2019)


    https://www.eacts.org/changing-evidence-changing-practice/

  15. ATTS statement (21st December 2019)


    https://www.aats.org/aatsimis/AATSWeb/Association/About/Statement%20ESC-EACTS.aspx

Source: Aorta
Author(s): Thais Faggion Vinholo, Adam J. Brownstein, Bulat A. Ziganshin, Mohammad A. Zafar, Helena Kuivaniemi, Simon C. Body, Allen E. Bale and John A. Elefteriades

This is an updated list of genes associated with thoracic aortic aneurysm and dissection. Dr Elefteriades and associates published the first version in 2017 and made an update in 2018. During the last year, six new genes were reported to be associated with thoracic aortic aneurysm and dissection.

Source: Fox News
Author(s): Hollie McKay

As a new political crisis for the United States evolves in Iraq, this is a timely glimpse at the impact of medical diplomacy. "In conflict zones, I enter each operation knowing that each surgery - mostly open-heart - is saving a life while all around us people are dying for mere thought differences. This frequently is my first thought in the morning and last at night." - Dr. William Novick 

Source: JAMA Oncology
Author(s): Yihan He, Xinfeng Guo, Brian H. May, Anthony Lin Zhang, Yihong Liu, Chuanjian Lu, Jun J. Mao, Charlie Changli Xue, Haibo Zhang

In this analysis of randomized controlled studies, accupuncture and/or accupressure significantly reduced cancer-associated pain compared to sham procedures.  

Source: The Annals of Thoracic Surgery
Author(s): Nicholas J. Goel, Amit Iyengar, John J. Kelly, Chase R. Brown, Fabliha Kurshan, Pavan Atluri, Michael A. Acker, Zehang Chen, Nimesh D. Desai

The readmission rate after mitral valve surgery was 17% among over 75,000 patients in the National Readmissions Database. Predictors included extended initial LOS, chronic lung or renal disease, and low hospital procedural volume for mitral surgery. The mean cost of readmission was over $15,000.

Source: TCTMD
Author(s): Anthony Gershlick, Roxana Mehran, Stuart Pocock, Patrick Serruys, Joseph Sabik III, and Gregg Stone

Following the withdrawal of the support of EACTS for the left main stem chapter of the EACTS/ESC Chapter of the revascularisation guidelines following the BBC Newsnight documentary of this, and the withdrawal of Professor David Taggart as an author of the EXCEL trial published in the NEJM, the EXCEL trial authors have published a very robust defence of their trial that was ten years in the creation and conduct. 

Find the EACTS statement here:

https://www.eacts.org/eacts-responds-to-bbc-newsnights-investigation-on-the-excel-trial/

Go straight to the response document from the EXCEL trial here: 

https://s3.amazonaws.com/prod.tctmd.com/public/2019-12/Response%20final.pdf

Source: JAMA Surgery
Author(s): Chandima Divithotawela, Marcelo Cypel, Tereza Martinu, Lianne G. Singer, Matthew Binnie, Chung-Wai Chow, Cecilia Chaparro, Thomas K. Waddell, Marc de Perrot, Andrew Pierre, Kazuhiro Yasufuku, Jonathan C. Yeung, Laura Donahoe, Shaf Keshavjee, Jussi M. Tikkanen

Donor lungs undergoing EVLP were more injured, but long-term outcomes of transplant were similar between EVLP and non-EVLP lungs, including the incidence of graft dysfunction and survival.

Source: The New England Journal of Medicine
Author(s): Yuki B. Werner, Bengt Hakanson, Jan Martinek, Alessandro Repici, Burkhard H.A. von Rahden, Albert J. Bredenoord, Raf Bisschops, Helmut Messmann, Marius C. Vollberg, Tania Noder, Jan F. Kersten, Oliver Mann, Jakob Izbicki, Alexander Pazdro, Uberto Fumagalli, Riccardo Rosati, Christoph-Thomas Germer, Marlies P. Schijven, Alice Emmermann, Daniel von Renteln, Paul Fockens, Guy Boeckxstaens, Thomas Rösch

A medium-size RCT on the growing research question of efficacy of peroral myotomy for achalasia, with a 17% failure to improve symptoms in the peroral endoscopic myotomy (POEM) arm, is discussed in this article. It recognizes a quite sobering incidence of endoscopically-evidenced reflux esophagitis in both arms, bafflingly improving between 3 and 24 months in the POEM group and increasing in the controls (Dor), while the incidence in the POEM arm was double!

Source: Trials volume 20, Article number: 718 (2019)
Author(s): Tom Treasure, Vern Farewell, Fergus Macbeth, Kathryn Monson, Norman R Williams, Chris Brew-Graves, Belinda Lees, Olivia Grigg, Lesley Fallowfield & PulMiCC Trial Group

The PulMiCC is a randomized clinical trial that tried to build more evidence for performing pulmonary metastasectomy in patients affected by advanced colorectal cancer and previously treated with curative intent. Unfortunately, the trial was stopped earlier becasue of poor recruitment and high drop out rate. The resuts are now published, and the authors question the relevance of performing pulmonary metastasectomy in order to prolong survival.  

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Gui-Qiang Gao, Shang-Dong Xu, Chang-Wei Ren, Sheng Yang, Chao-Liang Liu, Jun Zhen, Yong-Min Liu, Jun-Ming Zhu, Lian-Jun Huang, Li-Zhong Sun

This is a report on outcomes after thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissection in 751 patients. Ten-year survival was 83% and the 10-year reintervention rate was 10%. The authors concluded that TEVAR may be considered a first choice for patients with uncomplicated type B dissection. 

Pages