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Journal and News Scan
David Taggart, MD, PhD (University of Oxford, England), the chairman of the EXCEL surgical committee during the design and recruitment phase of the trial, believes the investigators downplayed the increased risk of all-cause mortality with PCI and oversold the reduced risk of the study’s primary composite endpoint of death, stroke, and MI, particularly since the benefit was largely driven by a higher risk of periprocedural MIs in the CABG arm.
“I found it worrying that there seemed to be a strong signal here and I don’t think that was accurately reflected in the New England Journal of Medicine paper,” Taggart told TCTMD. “We’re not talking about two tablets for a headache. We’re talking about people dying. The data are the data, and that’s what the data show.
Ex vivo lung perfusion was used in 25% of transplanted lungs in the Toronto program since 2008. This resulted in an increase in the number of transplanted patients without any degradation of long-term outcomes, including survival and freedom from chronic dysfunction.
The authors investigated cusp size in patients undergoing aortic valve repair for valve regurgitation. They found that most patients with small cusps have annulus cusp mismatch. They suggested that small cusp size is not a contraindication in aortic valve repair and recommended to secure annulus by plications to correct annulus cusp mismatch.
In this paper, the objective was to find out the echocardiographic predictors of reoperation for subaortic stenosis. Among 82 patients who initially underwent subaortic stenosis corrective surgery, 30 patients required reoperation. The risk factors were young age, unfavorable left ventricular geometry, interrupted aortic arch, and higher residual left ventricular outflow tract gradient.
An interesting pilot experiment on attempting to quantify the optimum disposition of neochordae in transapical intervention for severe mitral regurgitation.
The authors address appropriate use of the transcatheter clip to treat degenerative mitral regurgitation in elderly low to moderate risk patients. Their analysis shows that the transcatheter approach had slightly higher one year survival (97.6% vs 95.3%) than the surgical group but long-term survival was much worse than the surgical group at five years (34.5% vs 82.2%). This is likely related to a much higher incidence of recurrent >3+ mitral regurgitation in the clip group, 36.9% vs 3.9%. The one caveat was that the STS PROM (interquartile range) was higher in the clip group, 2.99 (2.29 to 4.38) vs 1.64(1.3 to 2.41), which has been shown to correlate with long-term survival.
An important and recent consensus update.
In this systemic review and meta-analysis, the authors compared outcomes of valve-sparing root replacement vs. the Bentall procedure in patients with acute aortic dissection type A. Valve-sparing root replacement was associated with lower risk of early and late mortality compared with the Bentall procedure. However, there was an increased risk of reintervention after valve-sparing root replacement. The authors concluded that valve-sparing root replacement can be performed safely in experienced centers and should be performed especially in young active patients.
Abnormal pulmonary artery bending in the setting of the Lecompte maneuver may affect right ventricular afterload in the absence of stenosis. The authors identified novel measurements related to the curvature of the pulmonary artery branches, and found that they correlated with right ventricular systolic pressures, as measured by contributions of curvature in the pulmonary arteries.
The Hugo system includes a tower, surgeon console, surgical end effectors, and robotic arm carts.
Key aspects of the Hugo system include:
- Modularity — The arms and other parts of the system are modular — and they’re on wheels — allowing for flexibility when it comes to placement and swapping around parts of the system. A surgeon could complete a procedure with an arm, push it out of the way, and start a laparoscopic procedure still using the tower, for example. After the surgery, hospital staff could undrape the system and roll it into a second sterilized and prepped OR so that the surgeon could quickly start a new surgery after a break. Because the arms are modular, a hospital could split up the arms for use in different procedures at the same time.
- Universal use — The tower and its visualization system, generator, processors and endoscope are meant to support both robot-assisted surgery and laparoscopic applications, and even open surgery. The endoscope, for example, is a standard length. The FT10 generator powering the robotic system is the same type of generator powering laparoscopic and open surgery devices.
- Upgradeable — Medtronic designed the system so that health providers can swap in new systems, generators, etc. as they become available, without having to buy an entirely new system. The company also has a pipeline of software applications and features that it will continually roll out.
- An open console — The surgical console design boasts an open architecture with foot pedals so that surgeons can still interact with the patient and OR staff during procedures. At the same time, three-dimensional, high-definition glasses provide an immersive situation.
- Drawing on existing surgical tool expertise — Medtronic is taking advantage of the expertise, know-how, and IP from its existing surgical instrumentation portfolio, which makes sense because the system’s instruments could be a big revenue source for the company. Doctors consulting for the company said today that they also like that the surgical tools are familiar.