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Journal and News Scan
Modolo et al. present a substudy from the EXCEL trail. They looked into the impact of the SYNTAX score II treatment recommendation for patients with left main disease. Patients who were randomized to PCI treatment against the SYNTAX II CABG recommendation had a four-fold higher mortality compared to patients who underwent CABG in conclusion with the syntax II recommendation.
A prepublication manuscript describing a balanced system for multidimensional decision making about timing of surgery in the COVID era.
The UNOS donor heart allocation system was revised in 2018, giving priority to patients on inpatient mechanical circulatory support (MCS). Patients admitted with heart failure-associated cardiogenic shock were tracked for the frequency of use of mechanical circulatory support before and after implementation of this change. In non-transplant centers, there was no change in the frequency of MCS. In transplant centers, use of MCS increased from 25% to 43%.
Guidance document for the triage of operations for thoracic malignancies produced by the Thoracic Outcomes Research Network. Their recommendations emphasize the importance of shared decision making, transparency and adherence to ethical principals.
Guidance document to assist in decision making and triage of congenital cardiac surgical patients during the COVID-19 pandemic. The article also includes guidance principles on the need and methods to preserve the workforce and emphasizes the need for regional collaboration, use of telecommunication technologies, and the evolving role of the congenital cardiac surgeon in the pandemic.
Guidance Statement from the Canadian Society of Cardiac Surgeons (CSCS) and its Board of Directors on patient assessment and triage, risk reduction, and real-time sharing of expertise and experiences during the COVID-19 pandemic.
Topical review on the epidemic in Britain, with a number of observations that relate to the cardiothoracic surgeons and all healthcare professionals:
-The assertion that the National Health Service in Britain was overrun PRIOR to the pandemic.
-The assertion that acute angina is now being undertreated.
-Perhaps most worryingly, the assumed increase in non-COVID positive deaths in Scotland.
In the light of the government poised to review the lockdown in an attempt to balance the prevention of another viral infestation versus the conceivable grave financial implications here in the UK and worldwide, it is interesting to see their take on the financial toll on patients.
Prediction of postoperative ventricular dysfunction is performed using preop LVEF prior to mitral valve surgery for degenerative mitral regurgitation. In this study the utility of LV strain as a predictor of ventricular dysfunction after mitral surgery was assessed. Preoperative RV, LV, and LA strain were strongly associated with postoperative LV dysfunction, and may prove useful in timing of surgery for degenerative mitral regurgitation.
The authors present a meta-analysis of randomized controlled trials regarding the outcome of ticagrelor-based antiplatelet therapies in patients after coronary artery bypass graft (CABG) surgery. They found a reduced rate of major adverse cardiac events and a reduced mortality in these patients receiving aspirin and/or clopidogrel. This finding should be investigated in randomized trials, as it could potentially change the standard of care of CABG patients.
The NCDB was queried to assess the optimal timing for resection after induction therapy for IIIA NSCLC. Survival was better in patients who underwent surgery in a short delay interval (<77 days) compared to a long delay (>114 days); short and medium delay intervals had similar outcomes.